Publications by authors named "Kelly-Ann Bowles"

59 Publications

A comparison of young children's spatiotemporal gait measures in three common types of footwear with different sole hardness.

Gait Posture 2021 Sep 6;90:276-282. Epub 2021 Sep 6.

Department of Physiotherapy, Monash University, Melbourne, Australia; Peninsula Health, Melbourne, Victoria, Australia.

Background: It is unknown what the impact of sole hardness is on young children's gait. Yet, this feature is commonly marketed as having differing benefits for young children's walking and development.

Research Question: What are the differences in spatiotemporal measures of gait during walking and running in three common types of young children's footwear with a soft sole, compared to a hard sole?

Methods: The study used a quasi-experimental design, with the condition order randomised using a Latin square sequence. Forty-seven children were recruited (aged 2-4 years). Participants walked or ran the length of a GAITRite mat in a randomized order in a soft (Shore 48-53) or hard soled (Shore 60-65) sneaker, boot and sandal condition. Linear regression analyses were used to investigate the difference between footwear for the different gait parameters including velocity, cadence, step time, swing percentage, stance percentage, double support time and the toe in/out angle.

Results: Children walked with a shorter stride length in the hard-soled sandals compared to the soft- soled sandals (p < 0.05). There were no other differences in spatiotemporal variables in the soft versus hard soled sandals during walking or running (p > 0.05). There were no differences in any spatiotemporal gait variables during walking or running in soft versus hard- soled runners and no differences in walking or running in soft versus hard-soled boots (p > 0.05).

Significance: There were few differences in spatiotemporal parameters between soft and hard-soled footwear in both walking and running in three different types of footwear. This may be a positive finding for footwear designers and manufacturers, as a harder sole appeared to have limited impact on spatiotemporal gait parameters.
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http://dx.doi.org/10.1016/j.gaitpost.2021.09.165DOI Listing
September 2021

Investigating first-year graduate paramedics' reason for current work location: A cross-sectional, data linkage study.

Aust J Rural Health 2021 Sep 7. Epub 2021 Sep 7.

Faculty of Medicine, Nursing and Health Sciences, School of Primary Allied Health Care, Monash University, Melbourne, Victoria, Australia.

Objective: This study aims to describe the demographic and employment characteristics of first-year graduates from a Victorian-based paramedicine course and investigate factors that influenced their choice in place of practice.

Design: Cross-sectional study using data from the Nursing and Allied Health Graduate Outcomes Tracking study.

Setting: Victoria, Australia.

Participants: First-year graduates (2019) from the Monash University range of paramedicine programs.

Main Outcome Measures: Variables of interest included principal place of practice and the reasons for working in the current location.

Results: Over half of the 2018 paramedicine course graduates responded to the 2019 Graduate Outcomes Survey. Nearly all were registered as paramedics (including double registrants as nurses), and over a fifth were from a rural background; however, less than that were working in a rural area. Of those with complete data, the most cited reasons for current work location were 'spouse/partner's employment or career', 'opportunity for career advancement' and 'scope of practice within the role'.

Conclusion: This study provides important insight into the factors associated with rural practice location amongst paramedicine graduates, specifically rural origin or personal, lifestyle and professional influences. The study adds to the sparse literature about paramedic practice location decision-making and highlights the need for further systematic longitudinal research examining the 'where' and 'why'.
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http://dx.doi.org/10.1111/ajr.12786DOI Listing
September 2021

Cardiometabolic, Dietary and Physical Health in Graduate Paramedics during the First 12-Months of Practice - A Longitudinal Study.

Prehosp Emerg Care 2021 Jul 27:1-13. Epub 2021 Jul 27.

Received April 1, 2021 from Paramedic Health and Wellbeing Research Unit, Monash University, Frankston, Australia (BM, APW, KS, LP, KAB, MPB); Department of Paramedicine, Monash University, Frankston, Australia (BM, KS, KAB); Ambulance Victoria, Doncaster, Australia (BM, KS); Turner Institute for Brain and Mental Health, Monash University, Clayton, Australia (APW); Department of Physiotherapy, Monash University, Frankston, Australia (LP); Department of Nutrition, Dietetics and Food, Monash University, Clayton, Australia (MPB). Revision received June 21, 2021; accepted for publication June 23, 2021.

Shift work is an established risk factor for poor health yet is necessary for paramedics to provide continuous care to the public. It is unknown how early into a career shift work may begin to impact health. This study sought to identify changes in cardiometabolic health, diet, aerobic capacity, physical activity and health-related quality of life (HRQoL) in graduate paramedics during the first 12-months of their career. Fifty-six paramedics with no history of regular shift work (28 female, 28 male; median age 24.5, IQR 23-26 years) were recruited for this study. Dietary patterns (food frequency questionnaires) and HRQoL (36-Item Short Form Questionnaire) were assessed at baseline, 6- and 12-months. Body weight, body mass index (BMI) and blood samples (fasting lipids, glucose, insulin and C-reactive protein) were measured at baseline and 12-months to ascertain cardiometabolic health risk. A subset of participants (n = 19; 10 female, 9 male) wore a physical activity monitor for 12 months and completed baseline and 12-month maximal aerobic capacity assessments (V̇O). Body weight and BMI decreased in males and increased in females (-0.7% versus 1.7%, p = 0.02). HRQoL and dietary intake did not change over 12-months, except for a small decrease in fat intake (-1%). Consumption of core/healthy foods was lower than recommended at all timepoints. Biomarkers of cardiometabolic health were within normal range and did not change over 12-months, excepting insulin where a small non-significant increase was seen (+0.5 mIU/L, p = 0.61). Baseline V̇O was 41.4 (37.1-49.1) ml.kg.min, with no change noted at 12-months. Comparison of quarterly physical activity data showed no difference in steps per day (p = 0.47) or moderate to vigorous physical activity (MVPA, p = 0.92) across the 12-months. Paramedics completed less MVPA on day shifts compared to rostered days off (-14.68 minutes, p = 0.04). Dietary patterns, HRQoL, cardiometabolic health, aerobic capacity and physical activity levels did not change meaningfully in the first year of practice. Some dietary behaviors and physical activity levels could be improved and may mitigate health effects of exposure to shift work. Long-term follow-up of this group may aid in developing programs to enhance health for paramedics and other health workers.
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http://dx.doi.org/10.1080/10903127.2021.1949081DOI Listing
July 2021

Changing nursing practice in response to musculoskeletal l pain and injury in the emergency nursing profession: What are we missing?

Australas Emerg Care 2021 May 28. Epub 2021 May 28.

Monash University Nursing and Midwifery, Wellington Road, Clayton, Victoria, 3800, Australia. Electronic address:

Background: Musculoskeletal disorders in emergency nurses result in physical, psychological and financial strain. Contributing factors include: environmental, organisational, patient-related, medical emergencies, nurse's knowledge and health status. Stress and moral distress impact on nurses changing manual handling practices.

Methods: Part of a cross-sectional survey of Australian emergency nurses, this study used content analysis to identify occurrence of change to practice and enablers to reporting injury. Secondary interpretive analysis using moral distress theory informed an alternative understanding of why nurses may not change their practice in response to injury.

Results: Most respondents made practice changes and reported pain/injury; 23% did not change, and 45.7% did not report. Respondents considered change impossible due to high demands and lack of resources; a position where nurses may have felt pressured to carry out unsafe manual handling practices. When conflicted between reporting a perceived insignificant injury, with feelings of guilt, nurses can feel devalued. Moral distress can occur when nurses and managers are conflicted between providing care and caring for self.

Conclusions: A culture of trust, respect and open communication decreases stress/moral distress, enables safer manual handling and reporting of pain/injury. Moral distress is an invisible workplace challenge that needs to be met for staff wellbeing.
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http://dx.doi.org/10.1016/j.auec.2021.05.001DOI Listing
May 2021

Describing Frequencies of Lower-Limb Apophyseal Injuries in Children and Adolescents: A Systematic Review.

Clin J Sport Med 2021 Apr 7. Epub 2021 Apr 7.

Department of Medicine, Faculty of Medicine, Nursing and Health Science Central Clinical School, Monash University, Frankston, VIC, Australia; Department of Physiotherapy, School of Primary and Allied Health Care, Monash University, Frankston, VIC, Australia; and Department of Paramedicine, School of Primary and Allied Health Care, Monash University, Frankston, VIC, Australia.

Objective: To describe the frequency with which children are affected by lower-limb apophyseal injuries, and subgroups at greater risk.

Design: Systematic review.

Setting: N/A.

Participants: N/A.

Interventions: N/A.

Main Outcome Measures: Systematic review of Medline OVID, PsycINFO, Cinahl, and PubMed from inception until February 21st, 2020. Articles reporting prevalence and/or incidence of an apophyseal injury (eg, calcaneal apophysitis) or its eponym (Severs or Sever disease). Per person data relating to the incidence or prevalence. Subgroup comparisons were made between sex groups and between activity participant groups.

Results: There was wide variation in measurement approaches and follow-up timeframes with the majority of studies reporting on traction apophysitis of the tibial tubercle (Osgood-Schlatter disease). This condition had a point prevalence of 10% in the general population of children between the ages of 12 and 15 years, whereas the lifetime incidence has been reported as 13%. Point prevalence was higher among those who participated in sport compared with those who did not {relative risk [95% confidence interval (CI): 1.98 (1.31-2.99)]}, whereas lifetime incidence was higher among those who participated in sport at the age of 13 years compared with those who did not [relative risk (95% CI): 4.63 (2.31-9.26)]. Other apophyseal injuries did not report enough data to permit comparisons.

Conclusion: Sports participation is likely to substantially increase the frequency of traction apophysitis of the tibial tubercle. Further research is required with standardized approaches to compare frequencies between different apophyseal injuries and subgroups of interest.
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http://dx.doi.org/10.1097/JSM.0000000000000925DOI Listing
April 2021

Review article: Paramedic pain management of femur fractures in the prehospital setting: A systematic review.

Emerg Med Australas 2021 Aug 12;33(4):601-609. Epub 2021 May 12.

Department of Paramedicine, Monash University, Melbourne, Victoria, Australia.

Femur shaft and neck of femur (NOF) fractures are often undertreated in the prehospital setting. These injuries can present unique clinical and logistical concerns in the prehospital setting. This systematic review aimed to investigate paramedic prehospital pain management of patients who had suffered NOF or femur fractures, and to investigate which interventions are effective. A systematic review was conducted in line with Preferred Reporting Item for Systematic Reviews and Meta-Analyses guidelines. Four databases were searched from inception date 23 March 2020. Articles were independently reviewed by two authors and conflicts resolved by a third author, followed by a hand search of the included reference lists. References were included if they addressed paramedic interventions for NOF or femur shaft fractures. Outcomes of interest were the effectiveness and complications of different modalities administered by paramedics. The search yielded 6868 articles, of which 19 met the final inclusion criteria. Studies investigated a variety of interventions including traction splints, intravenous (IV) analgesia and alternative analgesic options. Traction splinting and IV analgesia were consistently reported as underutilised. Alternative analgesics such as auricular acupressure, transcutaneous electrical nerve stimulation (TENS) and fascia iliaca compartment block were found to be effective techniques that could be safely and competently employed by paramedics, reducing pain for patients with limited adverse events. NOF and femur shaft fractures are an undertreated injury in the prehospital setting. Traction splinting and IV analgesia remain the traditional methodologies of treatment for these injuries; however, there are alternatives such as TENS, auricular acupressure and fascia iliaca compartment block that appear to be emerging as safe and effective options for the prehospital setting.
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http://dx.doi.org/10.1111/1742-6723.13793DOI Listing
August 2021

Quantifying Lumbar Movement Patterns of Allied Health Professionals in an Australian Health Care Facility.

J Appl Biomech 2021 Apr 27:1-7. Epub 2021 Apr 27.

Monash University.

Health professionals responsible for return to work plans have little data about allied health movement to guide recommendations following lower back injury. This study aimed to quantify the lumbar movement patterns of allied health professionals within a health care facility throughout a normal workday. An observational case study was undertaken at a public health care facility with 122 allied health professionals. The lumbar movements were recorded with the ViMove together with pain scale measurement. The mean (SD) recording time for allied health was 7.7 (0.7) hours. A mean (SD) 3 (1.4) hours total were spent in standing, 3.8 (1.7) hours in sitting, and 0.8 (0.4) hours in locomotion. Forty-nine flexions were recorded on average per session, most identified as short term (<30 s) within low range (0°-20°). Lumbar movement patterns differed among professions. Thirty-seven (31%) participants reported a history of lower back injury, and 57 (47%) reported low back pain at the end of their workday. This study provides an insight into allied health professionals' back movement in a hospital or community-based health care setting. These data may inform those who make return to work recommendations or provide rehabilitation services for allied health professionals working with a lower back injury.
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http://dx.doi.org/10.1123/jab.2020-0268DOI Listing
April 2021

Australian emergency nurses' lumbar movement during a shift: An observational study.

Australas Emerg Care 2021 Apr 7. Epub 2021 Apr 7.

Monash University Nursing and Midwifery, Wellington Road, Clayton, Victoria, 3800, Australia; Monash Emergency Research Collaborative, Monash Health, Clayton, Victoria, 3800, Australia. Electronic address:

Background: Emergency nurses are at higher risk than the average worker of experiencing lumbar pain. This is the first study to undertake real time monitoring to quantify lumbar movements of nurses working in the emergency department (ED).

Methods: Emergency nurses at a single Australian ED were recruited for a prospective observational case study. Participants worked in four discrete clinical areas of the ED; In-charge, triage, resuscitation, and cubicles. Data collected included participant demographics, lumbar pain pre- and post-shift, and real-time recording of lumbar movements.

Results: Sixty-two nurses participated. There were statistically significant differences in time spent standing (p = 0.005), sitting (p ≤ 0.001) and in locomotion (moving) (p ≤ 0.001) when compared by clinical role. Triage nurses spent over half their shift sitting, had the most sustained (> 30 s) flexions (60+ degrees) and had a median of 4 periods of uninterrupted sitting (10-30 mins) per shift.

Conclusions: Differences in movement demands were identified based on various clinical roles in the ED. Triage was associated with greater periods of uninterrupted sitting and with greater degrees of sustained flexion, both of which are predictors for back pain. This study provides foundation evidence that triage may not be the most appropriate location for staff returning from back injury.
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http://dx.doi.org/10.1016/j.auec.2021.03.007DOI Listing
April 2021

Comparison of swimming versus running maximal aerobic capacity in helicopter rescue paramedics.

Ergonomics 2021 Apr 13:1-12. Epub 2021 Apr 13.

Paramedic Health and Wellbeing Research Unit, Monash University, Frankston, Australia.

Swimming is a critical task for helicopter rescue paramedics and aerobic capacity is assessed in this occupation to determine job suitability. We evaluated one treadmill-based and one pool-based assessment of maximal aerobic capacity (V̇O) in 14 helicopter rescue paramedics. There was a small absolute difference ( = 0.11,  = 0.46) between V̇O in the swim (45.5 ± 7.8 ml.kg.min) compared to the run (48.5 ± 5.5 ml.kg.min), with a moderate relationship noted ( = 0.74, 95% CI [0.35-, 0.91],  = 0.0023). Whilst not interchangeable, run V̇O was a predictor of swim V̇O. Maximal blood lactate was similar ( = 0.93) in swim (13.4 ± 3.8 mmol.L) and run (12.2 ± 3.0 mmol.L), and maximal heart rate 13% lower ( < 0.0001) in the swim (162 ± 11 bpm) versus the run (186 ± 10 bpm). To estimate swimming V̇O in paramedics a treadmill test is sufficient but does not replace assessment of swimming proficiency. : We developed a swim protocol to assess maximal aerobic capacity in helicopter rescue paramedics. Compared to a treadmill-based test, our swim protocol generated 20% lower submaximal V̇O and 6% lower V̇O. Although not interchangeable, a treadmill V̇O test is indicative of maximal aerobic capacity in rescue paramedics whilst swimming. HEMS: helicopter emergency medical service; PES: physical employment standards; ICFP: intensive care flight paramedic; RPE: rating of perceived exertion.
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http://dx.doi.org/10.1080/00140139.2021.1910350DOI Listing
April 2021

Assessment of Cardiometabolic Health, Diet and Physical Activity in Helicopter Rescue Paramedics.

Prehosp Emerg Care 2021 Apr 13:1-16. Epub 2021 Apr 13.

Shift work is an established risk factor for weight gain, cardiovascular disease, Type II diabetes mellitus, and impaired health-related quality of life (HRQoL). Prolonged exposure to shift work is common in paramedics and other emergency medical service (EMS) providers. Sub-populations of EMS workers may have varying health outcomes when exposed to shift work, but the reasons for this have not been investigated. We sought to describe cardiometabolic health, dietary patterns, physical activity, and health-related quality of life (HRQoL) in a sample of experienced intensive care flight paramedics (ICFPs) working for a Helicopter Emergency Medical Service (HEMS). Fifteen paramedics (median age 45, IQR 42-48 years) were recruited to undertake a range of health assessments. These included a food frequency questionnaire to assess dietary patterns, sampling of biomarkers to determine cardiometabolic health risk, maximal aerobic capacity assessment via treadmill running and assessment of HRQoL via the SF-36 survey. In an extension of the study protocol, ten of the fifteen participants wore a physical activity monitor for one year. Median (IQR) weight was 79.9 (72.3-89.3) kg, body fat percentage 23.3 (21.9-26.5) %, body mass index (BMI) 25.1 (21.9-27.4) kg.m, and waist to height ratio 0.48 (0.45-0.54). Dietary analyses showed high discretionary food intake. Biomarkers of cardiometabolic health risk were all within normal range. HRQoL was 86.2/100 for physical health and 85.1/100 for mental health. V̇O was 47.0 (43.0-54.6) mL.kg.min. The ten participants that wore activity monitors completed 11,235 (8334-15,380) steps per day and undertook 50 (12-98) minutes per day/350 (84-686) minutes per week of moderate to vigorous physical activity. The least amount of physical activity was conducted on day shifts. For ICFPs included in this study, HRQoL, cardiometabolic and physical activity outcomes are representative of good health. Although shift work influences the amount of physical activity, ICFPs exceeded minimum recommendations even when rostered to duty. Despite lengthy careers in EMS, ICFPs demonstrate an excellent health profile that is likely due to high physical activity levels and healthy BMI. This information may be useful in guiding health interventions in the wider EMS workforce.
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http://dx.doi.org/10.1080/10903127.2021.1907492DOI Listing
April 2021

The impact of shift work schedules on PVT performance in naturalistic settings: a systematic review.

Int Arch Occup Environ Health 2021 10 11;94(7):1475-1494. Epub 2021 Mar 11.

Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia.

Objective: The Psychomotor Vigilance Test (PVT) is considered the gold standard for detecting sleep loss and circadian misalignment related changes in performance in laboratory and field settings. This short 3-, 5- or 10-min test appraises an individual's sustained vigilant attention on a visual stimulus through reaction time, false starts and performance lapses. The PVT has been widely used as a measure to assess vigilant attention among shift workers, but information evaluating the application and performance of this test in different naturalistic shift work settings is limited. The purpose of this review is to synthesise and evaluate existing literature which has used the PVT to assess and monitor psychomotor performance in response to shift work schedules and rosters performed in real-world settings.

Methods: A systematic search of studies examining PVT performance in response to 24/7 shift work schedules (e.g., day, afternoon, evening and night shifts) performed under naturalistic conditions was conducted. Articles were identified by searching Medline, Embase, CINHAL and PsycINFO databases in April 2020.

Results: The search yielded 135 results, of which 16 publications were suitable to be included in this review. Articles were grouped according to when the PVT was applied to a research cohort, which included (a) multiple instances per shift, (b) commencement and cessation of shift and (c) other varying times.

Conclusions: This review suggests PVT performance is typically congruent across studies when the test is applied at generally consistent time intervals. The lack of research concerning the use of the PVT during extended duty shifts (e.g., shifts and on call work > 30 h) is an area for future research.
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http://dx.doi.org/10.1007/s00420-021-01668-0DOI Listing
October 2021

Defining the characteristics of physically demanding winch rescue in helicopter search and rescue operations.

Appl Ergon 2021 May 1;93:103375. Epub 2021 Feb 1.

Monash University, Paramedic Health and Wellbeing Research Unit, McMahons Rd, Frankston, 3199, Australia; Monash University, Department of Physiology, Wellington Rd, Clayton, VIC, 3800, Australia.

Helicopter emergency medical service search and rescue (HEMS SAR) paramedics perform physically demanding winch rescues. Rescue organisations require valid physical employment standards (PES) to ensure personnel can adequately perform duties. There are no studies describing validated PES for HEMS SAR. We convened a subject matter expert (SME) focus group to review historical case data and generate task descriptions for land and water winch rescue as the basis for development of task simulations to assess physiological workload. Sixteen helicopter rescue paramedics with a mean age of 47 (range, 36-52) years and 8 (2-20) years' experience in helicopter rescue participated in a SME focus group. When provided with data from historical cases, SMEs achieved consensus (≥80%) when generating descriptions of winch rescue. This method may be useful to develop simulations for assessment of physiological demands of winch rescue and similar tasks, and to enhance validity and reliability of PES for rescue organisations.
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http://dx.doi.org/10.1016/j.apergo.2021.103375DOI Listing
May 2021

"Why have you done it that way?" Educator perceptions of student-initiated conversations about perceived deviations from evidence-based clinical practice.

Nurse Educ Today 2021 Mar 14;98:104768. Epub 2021 Jan 14.

School of Primary and Allied Health Care, Monash University, Wellington Road, Clayton, Victoria, Australia.

Students on clinical placement may encounter practice that deviates from what they perceive to be evidence-based. However, queries by students about the evidence-base of their clinical educators decision-making and practice can be a challenging conversation to initiate. It is unclear how these conversations occur, and what impact engaging in these challenging conversations may have on practice, the learning experience, and the relationship with the educator. This study sought to explore clinical educators' experiences of student-initiated discussions that question the evidence-base of their clinical practice. And to identify their preferred approaches for students to initiate these conversations. Individual interviews were conducted with 23 clinical educators from five professions at three different hospitals in Victoria, Australia. Semi-structured interviewing techniques were employed to identify participants' context and experiences. Participants described student-initiated conversations about deviations from evidence-based practice as challenging encounters with potential for positive or negative impact on clinical educators, students and patients. They noted that the perceived appropriateness of the discussion could be influenced by the method utilised by students to initiate the conversation. Elements identified by clinical educators as barriers or enablers to support students to appropriately initiate conversations about clinical practice may be utilised by education and health providers to enhance opportunities for learning conversations to occur.
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http://dx.doi.org/10.1016/j.nedt.2021.104768DOI Listing
March 2021

Reply.

Occup Med (Lond) 2020 12;70(8):610

Paramedic Health and Well-being Research Unit, Monash University, Frankston, Victoria, Australia.

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http://dx.doi.org/10.1093/occmed/kqaa135DOI Listing
December 2020

A comparison of young children's spatiotemporal measures of walking and running in three common types of footwear compared to bare feet.

Gait Posture 2020 09 7;81:218-224. Epub 2020 Aug 7.

Department of Physiotherapy, Monash University, Melbourne, Australia; Peninsula Health, Melbourne, Victoria, Australia.

Background: Clinicians and footwear manufacturers often advise young children to wear soft-soled footwear when they are first learning to walk. There is limited evidence as to why this advice is given, and if soft-soled shoes are as close to barefoot as thought.

Research Question: What are the differences in spatiotemporal measures of gait during walking and running in three common types of children's footwear with a soft-soled compared to barefoot in young children?

Methods: The study used a quasi-experimental design, with the condition order randomised using a Latin square sequence. Forty-seven children were recruited (2 - 4 years). Participants walked or ran the length of a GAITrite mat in a randomized order for barefoot and soft-soled sneaker, boot and sandal conditions. Linear regression analyses were used to investigate the main effect of each soft-soled footwear compared to bare feet in the different gait parameters.

Results: For walking and running trials, cadence decreased whereas step time and stride length increased in all footwear types compared to the barefoot condition. While wearing sneakers and sandals increased the stance percentage for walking and running trials, compared to barefoot, this difference was only apparent during the running trial for the boots. Likewise, although double support time increased for both the boots and sneakers in walking and running, compared to barefoot, this difference was only observed in the sandals during walking.

Significance: This research found that various types of soft-soled footwear impacted gait compared to the barefoot condition, with some differences seen between walking and running trials. These findings challenge the assumption that soft-soled footwear facilitate a similar gait to barefoot walking and running, although the clinical significance of these differences is unknown.
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http://dx.doi.org/10.1016/j.gaitpost.2020.07.147DOI Listing
September 2020

The effect of transferring weekend physical therapy services from the acute to sub-acute setting in patients following hip and knee arthroplasty: a quasi-experimental study.

Physiother Theory Pract 2020 Jun 22:1-13. Epub 2020 Jun 22.

School of Primary and Allied Health Care, Monash University and Monash Health Allied, Health Research Unit, Frankston, Australia.

Background: Weekend physical therapy services in the acute and/or sub-acute setting may optimize postoperative recovery following hip and knee arthroplasty, though evidence supporting these services is limited.

Purpose: To explore the change in patient and service outcomes of transferring a weekend physical therapy service from the acute to the sub-acute setting following hip and knee arthroplasty.

Methods: This was a quasi-experimental research design nested within two stepped-wedge cluster randomized controlled trials. Acute weekend physical therapy services were sequentially discontinued and reallocated to the sub-acute setting in a random order from one ward at a time within the broader trial. Patient and service outcomes for participants 6 weeks following hip and knee arthroplasty (N = 247) were compared during 6 months of acute weekend physical therapy services (Phase 1, n = 117) followed by 6 months of sub-acute services (Phase 2, n = 130). Intention-to-treat statistical analyses were conducted.

Results: The intervention had a negligible effect on medium-term outcomes. The only statistically significant difference observed was slightly higher ratings of "worst pain experienced over the past week" [coefficient 0.865 (0.123 to 1.606), = .022] during Phase 2. No interaction effects were observed despite a 2.4-day reduction in length of stay amongst complex patients during Phase 2 (18.28 and 15.86 days in Phase 1 and 2, respectively).

Conclusions: No comparative advantage or disadvantage was observed by reallocating a weekend physical therapy budget from the acute to sub-acute setting following hip and knee arthroplasty. Further research investigating the cost-effectiveness of these services in the sub-acute setting may be warranted for complex patients.
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http://dx.doi.org/10.1080/09593985.2020.1777604DOI Listing
June 2020

What is the prevalence of frequent attendance to emergency departments and what is the impact on emergency department utilisation? A systematic review and meta-analysis.

Intern Emerg Med 2020 10 15;15(7):1303-1316. Epub 2020 Jun 15.

Department of Paramedicine, Monash University, Peninsula Campus, McMahons Road, PO Box 527, Frankston, Melbourne, VIC, 3199, Australia.

Patients who frequently attend to emergency departments are a varying group and have complex health care needs. This systematic review and meta-analysis aimed to determine the prevalence of patients who have frequent attendance to emergency departments. A systematic review was performed in line with PRISMA guidelines. A database search was conducted, and studies were included in the final review if they analysed a population of frequent attendance. Meta-analysis was performed only on population-based studies to estimate prevalence. The search yielded 2922 nonduplicate publications, of which 27 were included in the meta-analysis. The most common definition used for frequent attendance was greater than three presentations a year. The proportion of people who frequently attended as a percentage of the total study population ranged from 0.01 to 20.9%, with emergency department presentations from frequent attenders ranging from 0.2 to 34%. When limiting the definition of frequent attendance to greater than three visits in a 12-month period, people who frequently attended contributed between 3 and 10% [pooled estimate 6%; CI 4-7%] of emergency department presentations and between 12 and 34% [pooled estimate 21%; CI 15-27%] of total emergency department presentations. Meta-analysis found substantial heterogeneity between estimates [I > 50%]. The prevalence of frequent attendance compared to the total population of patients seeking emergency care was small, but the impact on emergency department utilisation is significant. Early identification of people attending for frequent care at an emergency department provides the opportunity to implement alternative models of care.
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http://dx.doi.org/10.1007/s11739-020-02403-2DOI Listing
October 2020

The health and well-being of paramedics - a professional priority.

Occup Med (Lond) 2020 May;70(3):149-151

Paramedic Health and Well-being Research Unit, Monash University, Frankston, Victoria, Australia.

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http://dx.doi.org/10.1093/occmed/kqaa039DOI Listing
May 2020

What is the effect of electronic clinical handovers on patient outcomes? A systematic review.

Health Informatics J 2020 12 29;26(4):2422-2434. Epub 2020 Feb 29.

Monash University, Australia.

Handover between physicians is a high-risk event for communication errors. Using electronic handover platforms has potential to improve the quality of informational transfer and therefore minimise this risk. This systematic review sought to compare the effectiveness of electronic handover methods on patient outcomes. Articles were identified by searching MEDLINE, EMbase, Scopus and CINAHL databases. Studies involving electronic handover between two healthcare personnel or teams, and which described patientspecific outcomes, were included. This search yielded 390 articles, with a total of nine publications included in the analysis. Outcomes reported in studies included length of stay, adverse event rates, time to procedure and handover completeness. This review suggests that e-handover may improve the handover completeness; however, it is unclear at this time if that translates to an improvement in patient care. The lack of reliable evidence highlights the need for further research exploring the effect of e-handovers on patient care.
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http://dx.doi.org/10.1177/1460458220905162DOI Listing
December 2020

Correction to: The impact of shoe flexibility on gait, pressure and muscle activity of young children. A systematic review.

J Foot Ankle Res 2020;13. Epub 2020 Jan 20.

1Department of Physiotherapy, Monash University, Melbourne, Australia.

[This corrects the article DOI: 10.1186/s13047-019-0365-7.].
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http://dx.doi.org/10.1186/s13047-019-0368-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6970291PMC
January 2020

Students as patients: A systematic review of peer simulation in health care professional education.

Med Educ 2020 05 23;54(5):387-399. Epub 2020 Feb 23.

Department of Physiotherapy, School of Science and Health, Western Sydney University, Campbelltown, NSW, Australia.

Context: Evidence supports the substitution of both clinical placement time and traditional educational activities with simulation-based education (SBE). However, lack of resources can be a barrier to SBE implementation. Peer simulation provides an alternative to simulated patient (SP)-based SBE by educating students to portray patient roles. This diversifies learning experiences for students using SBE and may decrease costs.

Objectives: This study aimed to determine the impact of students portraying the roles of patients in a simulation-based learning environment (peer simulation) on learning outcomes in entry-level health care professional students.

Methods: Seven databases were searched (from inception to 8 May 2019) using terms including 'peer simulation,' 'role-play' and 'simulated/standardised patient.' The studies included described a health care professional student SBE interaction involving peer simulation. Data were extracted by two independent investigators. Study quality was assessed using the Medical Education Research Study Quality Instrument (MERSQI) and Critical Appraisal Skills Programme (CASP). A descriptive analysis was completed and meta-analysis conducted in instances in which outcomes could be pooled.

Results: A total of 12 studies met the inclusion criteria. Constructs measured by the studies included communication, empathy, self-efficacy and confidence. Five randomised controlled trials compared peer simulation with the use of SPs and demonstrated greater or equivalent patient empathy gains in peer simulation. Meta-analysis determined no difference in communication capabilities between the two groups. Students perceived peer simulation as comparably valuable and frequently superior to other forms of learning. This review was unable to determine effective design features of peer simulation initiatives.

Conclusions: Students were positive about peer simulation, but there has been limited evaluation of learning outcome attainment. Significant heterogeneity was observed; studies were diverse in design, outcome measures and the training provided for peer patients. Peer simulation positively influences student communication and development of patient empathy and offers an alternative to learning with SPs. Further rigorous research is required to understand the impact of peer simulation for a broader range of learning outcomes and to confirm the impact of this developing educational approach.
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http://dx.doi.org/10.1111/medu.14058DOI Listing
May 2020

The impact of shoe flexibility on gait, pressure and muscle activity of young children. A systematic review.

J Foot Ankle Res 2019 29;12:55. Epub 2019 Nov 29.

1Department of Physiotherapy, Monash University, Melbourne, Australia.

Background: There is limited evidence of shoe impact in younger children, particularly in the context of immature gait patterns. It is unclear if the impact from shoes in younger children is similar to what has been seen in older children. This systematic review aims to identify any impact of shoe features on younger children's gait, and if there are any differences between shoe sole flexibility compared to barefoot.

Methods: Study inclusion criteria included: typically developing children aged ≤6 years; comparison of barefoot and shod conditions (walking and/or running) with shoe features or style of shoe described; sample size > 1. Novelty types of footwear were excluded, as was any mention of in shoe support or modifications. Studies were located from six databases. Study methodology was assessed using the McMasters critical review form. Sample size weighted standardized mean differences (SMD) and 95% confidence intervals (CI) were calculated.

Results: Four studies were included. Participant age ranged from 15.2 to 78.7 months, with 262 participants across all studies. All studies had limited methodological bias based on their design type. Compared to barefoot walking, shoes increased velocity, step time and step length. Shod walking decreased cadence. Peak plantar pressure was generally lower in the stiff shoe design and there was a higher peak plantar pressure in the Ultraflex shoes. No studies were found investigating muscle activation.

Conclusions: Shoes affect younger children's gait in spatiotemporal gait aspects, similar to those seen in older children. There is limited evidence on effects of particular shoe features such as sole hardness, on gait, and no evidence of any changes in muscle activation patterns. Further research is required to evaluate the impact of different types of shoe and shoe features in this population to provide clinical advice on the type of shoe that is appropriate in this age group.
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http://dx.doi.org/10.1186/s13047-019-0365-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6884820PMC
April 2020

Barriers to Engagement in Chronic Heart Failure Rehabilitation: An Australian Survey.

Heart Lung Circ 2020 Aug 13;29(8):e177-e184. Epub 2019 Aug 13.

School of Nursing and Midwifery, Monash University, Melbourne, Vic, Australia.

Background: While exercise has been shown to improve quality of life and physical function and reduce hospital admission rates in people with chronic heart failure (CHF), engagement is poor in condition specific rehabilitation programs. This project aims to identify barriers to engagement in rehabilitation, strategies to address these, and comprehensively detail CHF rehabilitation practise in Australia.

Methods: An online survey was emailed to all cardiac and chronic heart failure rehabilitation programs in Australia utilising a publicly available database.

Results: The survey was completed by 165 respondents: Australian Capital Territory (ACT) = 4, New South Wales (NSW) = 49, Northern Territory (NT) = 2, Queensland (Qld) = 23, South Australia (SA) = 12, Tasmania (Tas) = 2, Victoria (Vic) = 37, Western Australia (WA) = 12, including metropolitan (37%), regional (47%) and remote (9%) locations. Common barriers were themed into four areas: poor condition-specific health literacy, lack of medical professional support, interrupted health care systems, and personal and external deterrents. Strategies to improve engagement and attendance focussed mostly on the patient, with few strategies aimed at improving patient and health professional knowledge and referral processes. Programs generally appeared to follow current Australian Heart Foundation recommendations for CHF rehabilitation.

Conclusions: This survey identifies common barriers that need to be addressed to improve engagement and attendance levels in CHF rehabilitation programs. While patient barriers are already being addressed, strategic planning needs to occur to address poor health literacy including for medical and health professionals, improved flow through the health care system and improving the flexibility of program delivery. Adaptation of home-based and tele-rehabilitation can help with this, while education and advertisement to patients and potential referrers needs to start early in the disease journey.
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http://dx.doi.org/10.1016/j.hlc.2019.07.012DOI Listing
August 2020

Sitting Posture During Occupational Driving Causes Low Back Pain; Evidence-Based Position or Dogma? A Systematic Review.

Hum Factors 2021 Feb 12;63(1):111-123. Epub 2019 Sep 12.

Monash University, Melbourne, Victoria, Australia.

Objective: In this review, we determine if there is evidence to demonstrate a relationship between occupational driving posture and low back pain.

Background: The burden of low back pain is increasing. An understanding of this relationship is required to enable the development of recommendations for clinicians and policy-makers for the driving industry.

Method: Five databases were searched up to March 12, 2018. Study quality was assessed using the National Heart, Lung, and Blood Institute's Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies, followed by a GRADE analysis to consider the evidence as a whole. A narrative, critical synthesis was completed that considered the methods by which driving posture and low back pain were measured and analyzed.

Results: There were 653 articles identified, with seven eligible for review. Four articles identified an association between occupational driving posture and low back pain, yet this was based on the use of measurement tools lacking validity. Although a relationship may exist, the specific driving postures associated with low back pain and the strength of this relationship have not been confirmed.

Conclusion: Future research needs to employ validated and reliable, real-time qualitative methods for measuring occupational driving posture to advance our understanding of this relationship.

Application: Clinical and policy recommendations regarding driving posture and low back pain should be used with caution, as they are guided by evidence incorporating bias. Future studies are required to confirm the specific postures assumed while occupational driving and their relationship with low back pain, before recommendations can be made.
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http://dx.doi.org/10.1177/0018720819871730DOI Listing
February 2021

Design, delivery and evaluation of a simulation-based workshop for health professional students on falls prevention in acute care settings.

Nurs Open 2019 Jul 23;6(3):1150-1162. Epub 2019 Jul 23.

School of Primary and Allied Health Care Monash University Melbourne Victoria Australia.

Aims And Objectives: To describe the design, delivery and evaluation outcomes of a simulation-based educational workshop to teach a patient-centred falls prevention strategy to health professional students tasked with implementing the strategy during clinical placement.

Background: Falls are among the most common and costly threat to patient safety. The Safe Recovery Programme (SRP) is an evidence-based, one-to-one communication approach with demonstrated efficacy at preventing falls in the postgraduate context. Simulation-based education (SBE) is commonly used to address issues of patient safety but has not been widely incorporated into falls prevention.

Methods: This study was a Pre-Post-test intervention design. Health professional students were taught how to deliver the SRP in an SBE workshop. The workshop incorporated content delivery, role-play simulations and interactions with a simulated patient. Students completed surveys immediately before and after the workshop and after clinical placement. Linear and logistic regression analysis was undertaken to identify differences within each pairwise comparison at the three time points. Qualitative free text responses underwent content analysis.

Results: There were 178 students trained. The educational design of the programme described in this paper was highly valued by students. Following the workshop, students' falls knowledge increased and they correctly identified evidence-based strategies except bedrail use and patient sitters. Following clinical placement, fewer SBE students correctly identified evidence surrounding bed alarm use. Students became more confident about falls communication post-SBE; however, this confidence decreased postclinical placement. Motivation to implement the SRP decreased between postworkshop and postclinical placement time points.

Conclusions: Falls research often includes educational components but previous studies have failed to adequately describe educational methods. Students learnt about best evidence falls prevention strategies using interactive educational methodologies with a workshop viewed by students as being well-designed and assisting their learning from theory to practice.While students valued the delivery of the SRP using SBE, confidence and motivation to implement falls strategies were not sustained following clinical placement. A programme of education including SBE can be used to support the delivery of falls-based education, but further research is needed to identify what factors may influence student's motivation and confidence to implement falls prevention strategies during clinical placement.
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http://dx.doi.org/10.1002/nop2.318DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6650696PMC
July 2019

The Balance Intensity Scales for Therapists and Exercisers Measure Balance Exercise Intensity in Older Adults: Initial Validation Using Rasch Analysis.

Phys Ther 2019 10;99(10):1394-1404

Faculty of Medicine, Nursing, and Health Sciences, Monash University.

Background: The Balance Intensity Scales (BIS) have been developed to measure the intensity of balance exercise in older adults.

Objective: The objective was to determine whether the BIS for therapists (BIS-T) and for exercisers (BIS-E) are unidimensional measures of balance exercise intensity, able to be refined using the Rasch model into a hierarchical item order, and appropriately targeted for the older adult population with a variety of diagnoses in a range of exercise testing settings.

Design: This was a scale development study using a pragmatic mixed-methods approach.

Methods: Older adult exercisers (n = 108) and their therapists (n = 33) were recruited from a large metropolitan health service and rated balance exercise tasks on the BIS-T and BIS-E in a single session.

Results: Scores on both the BIS items and global effort ratings for therapists and exercisers had good correlation and demonstrated unidimensionality. The BIS-T and BIS-E demonstrated a hierarchical distribution of items that fit the Rasch model. The Person Separation Index was moderate (0.62) for the BIS-T but poor (0.33) for the BIS-E.

Limitations: The limitations were that therapists in this study underprescribed high-intensity balance tasks.

Conclusions: Initial validation of the BIS-T and the BIS-E demonstrated that these scales can be used for the measurement of balance exercise intensity in older adult populations. The BIS-T items and global effort ratings are recommended for use by therapists, and the global effort ratings are recommended for use by exercisers. Ongoing validation of both scales using high-intensity balance task ratings and different populations of older adults is recommended.
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http://dx.doi.org/10.1093/ptj/pzz092DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6821236PMC
October 2019

Understanding the impact of age, gender, height and body mass index on children's balance.

Acta Paediatr 2020 01 30;109(1):175-182. Epub 2019 Jul 30.

Department of Physiotherapy, School of Primary and Allied Health Care, Monash University, Frankston, Vic., Australia.

Aim: This research aimed to understand the influence of age, gender, height and body mass index (BMI) on balance ability in children aged 4-12 years. The secondary aim was to develop normative values for three balance tests on the Balance Master system.

Methods: Children were recruited in 2017 through community advertising. Balance testing occurred at three recreational centres in Frankston, Victoria, Australia. Data were collected by the Rhythmic Weight Shift, modified Clinical Test of Sensory Integration and Limits of Stability balance tests of the Balance Master equipment. Multiple regression analysis determined associations between variables including age, gender, height and BMI.

Results: There were 91 children recruited and consented. Children were aged between 4 and 12 years old. Balance ability was shown to improve with age (P < .05), with girls demonstrating more mature balance strategies at earlier ages. Decreased BMI was associated with greater balance ability and postural control (P < .05).

Conclusion: The normative values established may be used to support clinical paediatric assessment with this equipment. Findings of this study suggest that increased BMI may be associated with poorer balance ability in children. However, further research studies are needed to explore this assertion.
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http://dx.doi.org/10.1111/apa.14933DOI Listing
January 2020

A novel counterbalanced implementation study design: methodological description and application to implementation research.

Implement Sci 2019 05 2;14(1):45. Epub 2019 May 2.

School of Primary and Allied Health Care, Monash University, Building G Peninsula Campus, McMahons Road, Frankston, Victoria, 3199, Australia.

Background: Implementation research is increasingly being recognised for optimising the outcomes of clinical practice. Frequently, the benefits of new evidence are not implemented due to the difficulties applying traditional research methodologies to implementation settings. Randomised controlled trials are not always practical for the implementation phase of knowledge transfer, as differences between individual and organisational readiness for change combined with small sample sizes can lead to imbalances in factors that impede or facilitate change between intervention and control groups. Within-cluster repeated measure designs could control for variance between intervention and control groups by allowing the same clusters to receive a sequence of conditions. Although in implementation settings, they can contaminate the intervention and control groups after the initial exposure to interventions. We propose the novel application of counterbalanced design to implementation research where repeated measures are employed through crossover, but contamination is averted by counterbalancing different health contexts in which to test the implementation strategy.

Methods: In a counterbalanced implementation study, the implementation strategy (independent variable) has two or more levels evaluated across an equivalent number of health contexts (e.g. community-acquired pneumonia and nutrition for critically ill patients) using the same outcome (dependent variable). This design limits each cluster to one distinct strategy related to one specific context, and therefore does not overburden any cluster to more than one focussed implementation strategy for a particular outcome, and provides a ready-made control comparison, holding fixed. The different levels of the independent variable can be delivered concurrently because each level uses a different health context within each cluster to avoid the effect of treatment contamination from exposure to the intervention or control condition.

Results: An example application of the counterbalanced implementation design is presented in a hypothetical study to demonstrate the comparison of 'video-based' and 'written-based' evidence summary research implementation strategies for changing clinical practice in community-acquired pneumonia and nutrition in critically ill patient health contexts.

Conclusion: A counterbalanced implementation study design provides a promising model for concurrently investigating the success of research implementation strategies across multiple health context areas such as community-acquired pneumonia and nutrition for critically ill patients.
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http://dx.doi.org/10.1186/s13012-019-0896-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6498461PMC
May 2019

Health care staff responses to disinvestment-A systematic search and qualitative thematic synthesis.

Health Care Manage Rev 2021 Jan/Mar;46(1):44-54

Deb Mitchell, BAS, is Advisor, Allied Health Workforce, Innovation, Strategy, Education and Research Unit, Monash Health, Dandenong, Victoria, Australia. E-mail: Kelly-Ann Bowles, PhD, BSc, is Director of Research, Department of Community Emergency Health and Paramedic Practice, School of Primary and Allied Health Care, Monash University, Dandenong, Victoria, Australia. Lisa O'Brien, PhD, is Director of Research, School of Primary and Allied Health Care, Monash University, Dandenong, Victoria, Australia. Anne Bardoel, PhD, MBA, is Professor of Management, Department of Management and Marketing, Swinburne University of Technology, Hawthorn, Victoria, Australia. Terry Haines, PhD, is Head of School of Primary and Allied Health Care, Monash University, Dandenong, Victoria, Australia.

Background: Health care services must deliver high-quality, evidence-based care that represents sound value. Disinvestment is the process of withdrawing resources from any existing health care practices that deliver low gain for their cost and reallocating these toward practices that are more effective, efficient, and cost-effective, thus benefiting patients and the community.

Purpose: This is the first review to examine the responses of health care staff to disinvestment and investigate the factors that increase the likelihood of these staff accepting disinvestment or reallocation of resources from the health services they provide.

Methods: We conducted a systematic search of five electronic databases using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) framework. A critical appraisal process of the quality of the included studies was performed by two authors. We undertook a thematic synthesis of the qualitative data to develop an overarching narrative.

Results: Twelve studies were identified for synthesis and all found that the disinvestment process was challenging and controversial for those health care staff involved. Negative staff reactions to disinvestment identified were anxiety, disempowerment, distrust, and feelings of being dismissed and disrespected. Engagement with disinvestment was observed when staff were invited to participate in a process they considered transparent and in the best interests of the community.

Practice Recommendations: Health care staff have a strong professional identity associated with autonomy in their decision making in the provision of health care services. Disinvestment from a service that health care staff can usually choose to provide threatens this identity. Engaging clinical champions to lead change, using rigorous patient outcome data, and transparent decision-making processes may assist health care staff to embrace a new identity as innovators and accept disinvestment in low-value health care.
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http://dx.doi.org/10.1097/HMR.0000000000000239DOI Listing
February 2019

Quantifying the lumbar spine movements of surgeons during surgical lists in a teaching hospital.

ANZ J Surg 2019 03 17;89(3):153-158. Epub 2018 Sep 17.

Department of Community Emergency Health and Paramedic Practice, Monash University, Melbourne, Victoria, Australia.

Background: Low back pain (LBP) is a common occupational musculoskeletal complaint among health professionals. No research has quantified lumbar movement patterns in the surgical workplace, identifying 'at risk' behaviours with objective measures. This project aimed to identify lumbar movement patterns and change in LBP of surgeons and surgical trainees during a surgical list.

Methods: Surgeons or surgical trainees were recruited in a tertiary metropolitan hospital. Low back movements were quantified in real time via a monitoring system. This measured three-dimensional movement, velocity, acceleration and orientation to gravity during a typical theatre session. Pre- and post-surgery LBP, or low back injury measures of functional disability were quantified using the Oswestry disability index. Mean (standard deviation) and median (interquartile range) low back movement patterns were described. A Wilcoxon signed-rank test determined differences in LBP recorded from beginning to end of recording periods.

Results: Participants (n = 28) recorded data for a mean (standard deviation) of 6.1 (2.2) h. On average, 27.7 lumbar flexion events were recorded per monitoring session, with flexion movements held for >30 s an average of 5.6 times. Many of the flexion events were considered low range (between 20° and 40°) with an average of 19.1 events per session. Orthopaedic trainees recorded the highest average of lumbar and sustained lumbar flexions per hour (4.13 times). LBP significantly increased over the work day (z = -2.53, P = 0.012).

Conclusion: This study provides a base for the understanding of low back movement patterns during surgery. This data may be useful in helping surgeons to identify their 'high risk' movements and prevent low back symptoms.
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http://dx.doi.org/10.1111/ans.14812DOI Listing
March 2019
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