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Lazzarini P.A.,Allied Health Research Collaborative | Lazzarini P.A.,Metro North Health Service District | Lazzarini P.A.,Queensland University of Technology | Geraghty J.,Queensland University of Technology | And 2 more authors.
Journal of Foot and Ankle Research | Year: 2013

Background: Research is a major driver of health care improvement and evidence-based practice is becoming the foundation of health care delivery. For health professions to develop within emerging models of health care delivery, it would seem imperative to develop and monitor the research capacity and evidence-based literacy of the health care workforce. This observational paper aims to report the research capacity levels of statewide populations of public-sector podiatrists at two different time points twelve-months apart.Methods: The Research Capacity & Culture (RCC) survey was electronically distributed to all Queensland Health (Australia) employed podiatrists in January 2011 (n = 58) and January 2012 (n = 60). The RCC is a validated tool designed to measure indicators of research skill in health professionals. Participants rate skill levels against each individual, team and organisation statement on a 10-point scale (one = lowest, ten = highest). Chi-squared and Mann Whitney U tests were used to determine any differences between the results of the two survey samples. A minimum significance of p < 0.05 was used throughout.Results: Thirty-seven (64%) podiatrists responded to the 2011 survey and 33 (55%) the 2012 survey. The 2011 survey respondents reported low skill levels (Median < 4) on most aspects of individual research aspects, except for their ability to locate and critically review research literature (Median > 6). Whereas, most reported their organisation's skills to perform and support research at much higher levels (Median > 6). The 2012 survey respondents reported significantly higher skill ratings compared to the 2011 survey in individuals' ability to secure research funding, submit ethics applications, and provide research advice, plus, in their organisation's skills to support, fund, monitor, mentor and engage universities to partner their research (p < 0.05).Conclusions: This study appears to report the research capacity levels of the largest populations of podiatrists published. The 2011 survey findings indicate podiatrists have similarly low research capacity skill levels to those reported in the allied health literature. The 2012 survey, compared to the 2011 survey, suggests podiatrists perceived higher skills and support to initiate research in 2012. This improvement coincided with the implementation of research capacity building strategies. © 2013 Lazzarini et al.; licensee BioMed Central Ltd.


Lazzarini P.A.,Allied Health Research Collaborative | Lazzarini P.A.,Metro North Health Service District | Lazzarini P.A.,Queensland University of Technology | Mackenroth E.L.,Metro North Health Service District | And 9 more authors.
Journal of Foot and Ankle Research | Year: 2011

Background: Foot ulcers are a frequent reason for diabetes-related hospitalisation. Clinical training is known to have a beneficial impact on foot ulcer outcomes. Clinical training using simulation techniques has rarely been used in the management of diabetes-related foot complications or chronic wounds. Simulation can be defined as a device or environment that attempts to replicate the real world. The few non-web-based foot-related simulation courses have focused solely on training for a single skill or "part task" (for example, practicing ingrown toenail procedures on models). This pilot study aimed to primarily investigate the effect of a training program using multiple methods of simulation on participants' clinical confidence in the management of foot ulcers.Methods: Sixteen podiatrists participated in a two-day Foot Ulcer Simulation Training (FUST) course. The course included pre-requisite web-based learning modules, practicing individual foot ulcer management part tasks (for example, debriding a model foot ulcer), and participating in replicated clinical consultation scenarios (for example, treating a standardised patient (actor) with a model foot ulcer). The primary outcome measure of the course was participants' pre- and post completion of confidence surveys, using a five-point Likert scale (1 = Unacceptable-5 = Proficient). Participants' knowledge, satisfaction and their perception of the relevance and fidelity (realism) of a range of course elements were also investigated. Parametric statistics were used to analyse the data. Pearson's r was used for correlation, ANOVA for testing the differences between groups, and a paired-sample t-test to determine the significance between pre- and post-workshop scores. A minimum significance level of p < 0.05 was used.Results: An overall 42% improvement in clinical confidence was observed following completion of FUST (mean scores 3.10 compared to 4.40, p < 0.05). The lack of an overall significant change in knowledge scores reflected the participant populations' high baseline knowledge and pre-requisite completion of web-based modules. Satisfaction, relevance and fidelity of all course elements were rated highly.Conclusions: This pilot study suggests simulation training programs can improve participants' clinical confidence in the management of foot ulcers. The approach has the potential to enhance clinical training in diabetes-related foot complications and chronic wounds in general. © 2011 Lazzarini et al; licensee BioMed Central Ltd.


Peel N.M.,University of Queensland | Kuys S.S.,Allied Health Research Collaborative | Kuys S.S.,Griffith University | Klein K.,University of Queensland
Journals of Gerontology - Series A Biological Sciences and Medical Sciences | Year: 2013

Background.Gait speed is a quick, inexpensive, reliable measure of functional capacity with well-documented predictive value for major health-related outcomes. Numerous epidemiological studies have documented gait speed in healthy, community-dwelling older people. The purpose of this study is to undertake a systematic review and meta-analysis of gait speed in a specific group with mobility limitations-geriatric patients in clinical settings.Methods.Relevant databases were searched systematically for original research articles published in February 2011 measuring gait speed in persons aged 70 or older in hospital inpatient or outpatients settings. Meta-analysis determined gait speed data for each setting adjusting for covariates.Results.The review included 48 studies providing data from 7,000 participants. Across the hospital settings, the gait speed estimate for usual pace was 0.58 m/s (95% confidence interval [CI]: 0.49-0.67) and for maximal pace was 0.89 m/s (95% CI: 0.75-1.02). These estimates were based on most recent year of publication (2011) and median percentage of female participants (63%). Gait speed at usual pace in acute care settings was 0.46 m/s (95% CI: 0.34-0.57), which was significantly slower than the gait speed of 0.74 m/s (95% CI: 0.65-0.83) recorded in outpatient settings.Conclusions.Gait speed is an important measure in comprehensive geriatric assessment. The consolidation of data from multiple studies reported in this meta-analysis highlights the mobility limitations experienced by older people in clinical settings and the need for ongoing rehabilitation to attain levels sufficient for reintegration in the community.Decision Editor: Stephen Kritchevsky, PhD © 2012 The Author.


Kuys S.S.,Allied Health Research Collaborative | Kuys S.S.,Griffith University | Peel N.M.,University of Queensland | Klein K.,University of Queensland | And 2 more authors.
Journal of the American Medical Directors Association | Year: 2014

Background: Gait speed, recently proposed as the sixth vital sign of geriatric assessment, is a strong predictor of adverse outcomes. Walking faster than 1.0 m/s is associated with better survival in community-dwelling older adults, and a recent meta-analysis of older adults in clinical settings estimated usual gait speed to be 0.58 m/s. Here, we aimed to review gait speed values for long term care residents. Methods: Relevant databases were systematically searched for original research studies published prior to December 2012. Inclusion criteria were participants living in long term care, mean age >70 years, and gait speed measured over a short distance. Meta-analysis determined gait speed data adjusting for covariates including age, sex, and cognition. Results: Final data included 2888 participants from 34 studies. The percentage of residents ineligible because of inability to mobilize was stated in only 1 study. Of the 34 studies, 22 reported cognitive status using the Mini-Mental State Examination. Usual pace and maximal pace gait speeds were determined separately using a random effects model. No association between gait speed and covariates was found. Usual pace gait speed was 0.475 m/s (95% confidence interval 0.396-0.554) and maximal pace was 0.672 m/s (95% confidence interval 0.532-0.811). Conclusions: In ambulant older people in long term care, gait speed is slow but remains functional. However, since many residents are likely to have been ineligible to participate in assessments, these results cannot be generalized to the long term care population as a whole. © 2014.


Kuys S.S.,Allied Health Research Collaborative | Kuys S.S.,Griffith University | Dolecka U.E.,Princess Alexandra Hospital | Guard A.,Princess Alexandra Hospital
Archives of Gerontology and Geriatrics | Year: 2012

Objectives: To determine the activity level of people admitted for an acute hospital medical admission and to describe the location of and people present at the activity. Design: Prospective observational behavioral mapping study. Participants: 102 patients admitted to general medical wards. Intervention: Participants were observed 1. min every 10. min during a working day from 8.30. am to 4.30. pm. Outcome measures: Highest level of activity was recorded; location, activity and person/s attending the participant. Results: Data from 76 participants were analyzed; mean age 67 (SD 19) years, 38 (50%) male. Participants were observed for 450. min. They spent 394 (88%) min in their rooms, 18 (4%) min in the bathroom and 27 (6%) min off the ward. Of the time in their rooms, participants spent a median 315 (IQR 205-398) min lying in bed, 10 (IQR 0-38) min sitting on or out of bed and 1 (IQR 0-20) min standing or walking. Participants spent a median 115 (IQR 70-158) min doing nothing, 80 (IQR 43-160) min resting or sleeping and 75 (IQR 40-168) min talking, reading or watching television. Participants were alone 280 (IQR 230-340) min and with one person 90 (IQR 50-130) min. Participants were with staff a median 120 (IQR 73-180) min; nurses 35 (IQR 20-60) min, medical staff 10 (IQR 0-18) min and allied health staff 10 (IQR 0-20) min. Conclusion: People admitted to general medical wards are inactive during hospital stay; spending the majority of the working day in their rooms, in bed and alone. © 2012 Elsevier Ireland Ltd.


PubMed | Allied Health Research Collaborative
Type: Editorial | Journal: Journal of foot and ankle research | Year: 2012

Diabetes is one of the greatest public health challenges to face Australia. It is already Australias leading cause of kidney failure, blindness (in those under 60years) and lower limb amputation, and causes significant cardiovascular disease. Australias diabetes amputation rate is one of the worst in the developed world, and appears to have significantly increased in the last decade, whereas some other diabetes complication rates appear to have decreased. This paper aims to compare the national burden of disease for the four major diabetes-related complications and the availability of government funding to combat these complications, in order to determine where diabetes foot disease ranks in Australia. Our review of relevant national literature indicates foot disease ranks second overall in burden of disease and last in evidenced-based government funding to combat these diabetes complications. This suggests public funding to address foot disease in Australia is disproportionately low when compared to funding dedicated to other diabetes complications. There is ample evidence that appropriate government funding of evidence-based care improves all diabetes complication outcomes and reduces overall costs. Numerous diverse Australian peak bodies have now recommended similar diabetes foot evidence-based strategies that have reduced diabetes amputation rates and associated costs in other developed nations. It would seem intuitive that its time to fund these evidence-based strategies for diabetes foot disease in Australia as well.


PubMed | Allied Health Research Collaborative
Type: Journal Article | Journal: Journal of physiotherapy | Year: 2011

Does exercise using a gaming console result in similar cardiovascular demand and energy expenditure as formally prescribed exercise in adults with cystic fibrosis? How do these patients perceive gaming console exercise?Randomised cross-over trial with concealed allocation and intention-to-treat analysis.19 adults with cystic fibrosis admitted to hospital for treatment of a pulmonary exacerbation.Participants underwent two 15-minute exercise interventions on separate days; one involving a gaming console and one a treadmill or cycle ergometer.Cardiovascular demand was measured using heart rate and rating of perceived exertion (RPE). Energy expenditure was estimated using a portable activity monitor. Perception (enjoyment, fatigue, workload, effectiveness, feasibility) was rated using a horizontal 10-cm visual analogue scale.There was no significant difference in average heart rate (mean difference 3 beats/min, 95% CI -3 to 9) or energy expenditure (0.1 MET, 95% CI -0.3 to 0.5) between the two interventions. Both interventions provided a hard workout (RPE 15). Gaming console exercise was rated as more enjoyable (mean difference 2.6 cm, 95% CI 1.6 to 3.6) than formal exercise but they didnt differ significantly in fatigue (-1.0 cm, 95% CI -2.4 to 0.3), perceived effectiveness (-0.4 cm, 95% CI -1.2 to 0.3), or perceived feasibility for inclusion in routine management (0.2 cm, 95% CI -0.7 to 1.1).Gaming console exercise provides a similar cardiovascular demand as traditional exercise modalities. It is feasible that adults with cystic fibrosis could include gaming console exercise in their exercise program.ACTRN12610000861055.


PubMed | Allied Health Research Collaborative
Type: Journal Article | Journal: Archives of gerontology and geriatrics | Year: 2012

To determine the activity level of people admitted for an acute hospital medical admission and to describe the location of and people present at the activity.Prospective observational behavioral mapping study.102 patients admitted to general medical wards.Participants were observed 1min every 10min during a working day from 8.30am to 4.30pm.Highest level of activity was recorded; location, activity and person/s attending the participant.Data from 76 participants were analyzed; mean age 67 (SD 19) years, 38 (50%) male. Participants were observed for 450min. They spent 394 (88%) min in their rooms, 18 (4%) min in the bathroom and 27 (6%) min off the ward. Of the time in their rooms, participants spent a median 315 (IQR 205-398) min lying in bed, 10 (IQR 0-38) min sitting on or out of bed and 1 (IQR 0-20) min standing or walking. Participants spent a median 115 (IQR 70-158) min doing nothing, 80 (IQR 43-160) min resting or sleeping and 75 (IQR 40-168) min talking, reading or watching television. Participants were alone 280 (IQR 230-340) min and with one person 90 (IQR 50-130) min. Participants were with staff a median 120 (IQR 73-180) min; nurses 35 (IQR 20-60) min, medical staff 10 (IQR 0-18) min and allied health staff 10 (IQR 0-20) min.People admitted to general medical wards are inactive during hospital stay; spending the majority of the working day in their rooms, in bed and alone.

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