Ambulance Tasmania attendances to falls related incidents: Commencement of a Tasmanian dataset

Mr John Cannell1, Mr Alex Wilson2

1Tasmanian Health Service North, Launceston, Australia, 2Ambulance Tasmania, Hobart, Australia

Whilst falls occur across the age spectrum, allied health staff are particularly involved in the minimization of harm and prevention of falls in the older population. Published literature reports that in the western world an average of 25% of over 60 year olds and 30% of over 65 year olds fall each year. One tenth of these falls result in people seeking assistance from a health professional.

Understanding the incidence of falls in older community dwelling Tasmanians is difficult. There are no published studies or reports. Whilst there are systems within healthcare settings to record and monitor the incidence there is no equivalent option for the community. As Ambulance Tasmania attends a proportion of community falls which require medical assistance and review, their clinical data provides insight into the incidence of injurious falls.

Tasmanian Paramedics record their assessment and client management in an electronic module called the Victorian Ambulance Clinical Information System (VACIS). This system is used in multiple states of Australia. Through application to Ambulance Tasmania, Tasmanian Health Services North has been able to access and analyse one year of de-identified case information. 10329 of the 72096 case notes for the 2016-17 financial year contained the words “fall” or “fell”.

Providing analysis and breakdown of these cases across the Tasmania will provide insight and assist service development to allied health professions. Rates by locality, region, age, transportation to hospital, are able to be accessed from the data. Using keyword searches, falls which involved sporting activities or modes of transport are able to be separated from mechanical or syncopal falls.

The incidence and consequences of falls in our ageing population is creating further pressure on our health system. Utilising the Ambulance Tasmania’s VACIS dataset will assist us to understand and plan for the health needs of our Tasmanian population.


Biography:

John is the clinical lead physiotherapist for rehabilitation at the LGH. He has a been an active member of hospital and regional falls committees for over 10 years. John, like many allied health professions, is trying to move to a more proactive model of falls prevention. This presentation showcases a new initiative to share information which is able to guide our future health care service development.

Ambulance Tasmania attendances to falls related incidents: Commencement of a Tasmanian dataset

Mr John Cannell1, Mr Alex Wilson2

1Tasmanian Health Service North, Launceston, Australia, 2Ambulance Tasmania, Hobart, Australia

Whilst falls occur across the age spectrum, allied health staff are particularly involved in the minimization of harm and prevention of falls in the older population. Published literature reports that in the western world an average of 25% of over 60 year olds and 30% of over 65 year olds fall each year. One tenth of these falls result in people seeking assistance from a health professional.

Understanding the incidence of falls in older community dwelling Tasmanians is difficult. There are no published studies or reports. Whilst there are systems within healthcare settings to record and monitor the incidence there is no equivalent option for the community. As Ambulance Tasmania attends a proportion of community falls which require medical assistance and review, their clinical data provides insight into the incidence of injurious falls.

Tasmanian Paramedics record their assessment and client management in an electronic module called the Victorian Ambulance Clinical Information System (VACIS). This system is used in multiple states of Australia. Through application to Ambulance Tasmania, Tasmanian Health Services North has been able to access and analyse one year of de-identified case information. 10329 of the 72096 case notes for the 2016-17 financial year contained the words “fall” or “fell”.

Providing analysis and breakdown of these cases across the Tasmania will provide insight and assist service development to allied health professions. Rates by locality, region, age, transportation to hospital, are able to be accessed from the data. Using keyword searches, falls which involved sporting activities or modes of transport are able to be separated from mechanical or syncopal falls.

The incidence and consequences of falls in our ageing population is creating further pressure on our health system. Utilising the Ambulance Tasmania’s VACIS dataset will assist us to understand and plan for the health needs of our Tasmanian population.


Biography:

John is the clinical lead physiotherapist for rehabilitation at the LGH. He has a been an active member of hospital and regional falls committees for over 10 years. John, like many allied health professions, is trying to move to a more proactive model of falls prevention. This presentation showcases a new initiative to share information which is able to guide our future health care service development.

DIGnity Supported Community Gardening: Cultivating a balance between risk and support

Jessie Bynon1, Dr Pauline Marsh2

1 Grow Occupational Therapy, Carlton TAS; 2 Centre for Rural Health, University of Tasmania, Hobart TAS

DIGnity is a wellbeing project that aims to build the therapeutic capacity of three established community gardens. DIGnity enables health workers, artists and researchers to work alongside community members, garden coordinators and volunteers in the shared public gardening space. We aim to provide an environment for people to feel safe, welcome and able to participate with other members of the community, particularly for people who have lost the confidence or their physical or cognitive capacity to garden. The team includes an Occupational Therapist, fibre artist, mental health counsellor and social researcher who liaise closely with local service providers, GPs, carer organisations and community groups. Having health staff on site can reassure carers that participants will be well looked after – while at the same time the outdoor setting affords people a certain dignity of risk, which benefits physical and mental health as well as self-esteem. This presentation reports on some of our learnings over the first six months of the DIGnity project.


Biography:

Jessie has over 10 years experience in working as an occupational therapist in a variety of inpatient, outpatient and community settings throughout Tasmania. She currently runs her own private occupational therapy practice in the Hobart region and feels strongly about healthy aging, occupational participation and maintaining meaningful community roles into older age.

Pauline is social researcher with the Centre for Rural Health, University of Tasmania. Her research takes place mainly in community gardens, where she uses videography to explore the therapeutic capacity of these shared garden spaces.

Lung infection prevention post-surgery major abdominal with pre-operative physiotherapy (lippsmack-pop) trial: 12-month mortality and sub-group effects

Ms Ianthe Boden1,2, Dr Elizabeth Skinner2,3, Dr Laura  Browning2,3, Professor David Story4, Professor Linda Denehy2

1Launceston General Hospital, Launceston, Australia, 2University of Melbourne, Melbourne, Australia, 3Division of Allied Health, Western Health, Footscray, Australia, 4Department of Aneasthesia, University of Melbourne, Melbourne, Australia

Introduction: A postoperative pulmonary complication (PPC) is the most common serious complication following upper abdominal surgery. Preparing patients preoperatively so that breathing exercises are initiated immediately upon awakening may prevent PPCs.

Methods: LIPPSMAck POP was a pragmatic, bi-national, multi-centre, double blinded, parallel group, randomised controlled superiority trial. 441 adults scheduled for elective open upper abdominal surgery at three Australian and New Zealand hospitals were randomised using concealed allocation to receive either i) an information booklet or ii) an information booklet and a single preoperative physiotherapy education and training session. Postoperative early mobilisation was standardised and no additional respiratory physiotherapy was provided. Primary outcome was PPC using standardised diagnostic criteria. Secondary outcomes include hospital length of stay (LOS), pneumonia, ICU readmission, 30 day patient reported complications, and all-cause mortality to 12 months. Data was adjusted for covariates and analysed intention-to-treat and per-protocol.

Results: 434 participants completed the trial (98%). Preoperative physiotherapy halved PPC (HR 0.48, 95%CI 0.31 to 0.76: p<.001) and pneumonia (HR 0.48, 95%CI 0.27 to 0.84) with a NNT of 6 (95%CI 4 to 11). Patients in the intervention group were ready for discharge a day earlier (8.6 v 7.5 days, p=.02) and, if seen by an experienced physiotherapist prior to surgery, there was a stronger prophylactic effect size and patients were consequently more likely to be alive at 3 and 12 months (HR 0.31, 95%CI 0.11 to 0.88, p=.03). Per-protocol analysis strengthened the effect across all outcomes including lower LOS; 3 days (13.7 v 10.6 days, p=.03) and less 6-week respiratory complications (IRR 0.62, 95%CI 0.38 to 1.0, p=.05). Conclusion: LIPPSMAck POP is the most rigorous trial investigating physiotherapy to prevent PPC following surgery to date providing conclusive evidence that a single preoperative physiotherapy education session prevents PPC and mortality following major upper abdominal surgery.


Biography:

Ianthe Boden is the Cardiorespiratory Team Leader at the Launceston General Hospital. Ianthe is currently completing a PhD at The University of Melbourne investigating the prevention of pulmonary complications following abdominal surgery. Ianthe’s first randomised controlled trial, LIPPSMACK-POP, has won major research prizes at Physiotherapy, Anaesthetics, and Surgery conferences. Ianthe is currently Chief Investigator of two active randomised controlled trials (ICEAGE and NIPPER PLUS) and leading CHESTY (Chest infection prevalence after surgery). CHESTY will be one of the largest international collaborative trials in Cardiorespiratory Physiotherapy and will involve over 40 hospitals world-wide.

Investigating tools for pre-operative prediction of inpatient rehabilitation for patients undergoing elective hip or knee arthroplasty in Tasmania

Ms Rebecca Cannell1

1THS-N, Launceston, Australia

Challenges for timely elective hip or knee arthroplasty (HKA) within Tasmania can be summarised into the following areas: length of time to be reviewed by an Orthopaedic Surgeon; time between being listed for, and having surgery; and average length of stay (LOS) in hospital.

Assessing patients pre-operatively through a suite of tools can provide clinicians with critical information for predicting LOS and discharge destination including the need for inpatient rehabilitation.  There is currently no accepted tool within the Launceston General Hospital to indicate this need.

Occupational Therapy and Physiotherapy are trialling a number of assessment tools (Risk Predictor Assessment Tool, Timed Up and Go, Post-operative Delirium Screen, health outcome measure EQ-5L-5D, and The Oxford Hip/Knee Scale) to predict LOS and potential need for inpatient rehabilitation.  Data is being collected pre and post-operatively to establish reliability and sensitivity of the chosen tools administered in pre-admission assessment unit (POAU).

From January 2017 and to August 2017, 296 patients have attended POAU, with 208 of those receiving surgery.  Using complete data sets, a unique way of communicating summaries of these tools was developed, with patients classified into one of three categories; green, orange or red. Of 53 patients predicted “green”, 50 met that prediction (94.3% accuracy). For “orange” of 125 patients, 98 met that prediction (78.4% accuracy).  Within “red”, of 37 patients, 14 patients met that criteria (37.8% accuracy).  Low numbers of patients predicted for rehabilitation show the need for a larger sample size to further establish which of the tool/s can enhance our understanding of this population.

Strong communication of predictions has resulted in a unique way of prediction data dissemination, a common language between clinicians and a shift in HKA patients’ care. These changes have been positively received by the LGH and there is wide interest in allied health’s ongoing work.


Biography:

Rebecca is a senior occupational therapist working in THS-N, with a strong background in inpatient rehabilitation and stroke care.  Rebecca has more recently been involved in the multi-disciplinary teams working in the pre-operative assessment unit and acute surgical wards.

Using Apps, internet and sensors to connect patients and therapists remotely: A feasibility study

Ms Dawn Simpson1, Dr Matthew Schmidt2, Dr Marie-Louise Bird3, Professor Stuart Smith4, Dr  Michele Callisaya1

1Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia, 2School of Health Science, University of Tasmania, Hobart, Australia, 3Department of Medicine, University of British Columbia, Vancouver, Canada, 4Southern Cross University, Coffs Harbour, Australia

Background: In stroke rehabilitation intensity of exercise practice is important in to improve function. Patient access to services and specialised clinicians can be limited in rural and remote populations, and innovative approaches are required to improve exercise adherence and motivation at home. We aimed to determine whether use of an activity monitor combined with an app/SMART device could increase exercise in the home. Additionally, we assessed if a therapist could remotely monitor, progress exercises and provide the patient with feedback remotely.

 Methods: We formed a novel partnership between industry and therapists to develop sensor and app technology. Ten community dwelling people with stroke were recruited to a 4 week exercise intervention. An activity monitor was set up in the participant’s home and participants were taught how to use the app and device. A therapist remotely monitored the daily program, updated exercise targets, and sent weekly personalised feedback. Outcome measures included adherence to the prescribed exercise program (%), patient satisfaction about the system (physical activity enjoyment scale, system usability scale and perceived benefit of activity), and physical function (short performance physical battery, 2 minute sit-to-stand test).

 Results: Participants (mean age 71.5 years [range 55-88 years], 55% male) performed exercise on 96% of the days set. There was a mean adherence with the exercise repetitions prescribed of 104% [range 86% to 123%]. Participants rated the system usability as high (mean score 69/100), enjoyment moderate to high (mean score 86/126) and rated perceived benefit of the system positively.

 Conclusions: We found that delivering an exercise program via an internet app and sensor-based system feasible to use for both the therapist and the patient. The technology assisted delivery and progression of therapy remotely. The connection of patients and therapists with this system facilitated motivation in exercise and was efficient to deliver.


Biography:

Dawn is a PhD candidate at the Menzies Institute for Medical research in Hobart, Tasmania. Her PhD project focuses on sedentary behaviour and physical activity after stroke, and what factors may influence these behaviours. She is a physiotherapist, with 19 years clinical experience, predominantly working in rehabilitation, with a particular interest in stroke rehabilitation.

Parkinson’s Disease Wellbeing Program: Translating information into action

Mr Jeremey Horne1, Miss Megan  Campbell1, Mrs Susan Harkness1

1Calvary Health Care Kogarah, Kogarah, Australia

Background: There is growing evidence that exercise provides a benefit in treating the motor and non-motor symptoms in Parkinson’s disease (PD). Interventions promoting client engagement and establishing strategies for symptom management can prevent inactivity related decline and improve quality of life. Yet, as the incidence rises, PD remains inadequately serviced by the Australian health system.

 Objective: The aims of this study were to determine 1) whether a 5-week PD-specific program resulted in sustained physical and psycho-social benefits, 2) the relationship between patient characteristics, exercise, falls and physical and psycho-social parameters.

 Method: PD clients (Hoehn–Yahr stage 1-3, MMSE >24) were invited to attend a Parkinson’s disease Wellbeing program (PWbP). The 5 week multidisciplinary program conducted in a Day Rehabilitation Unit consisted of 2 x 2.5 hour weekly sessions including group education and exercise for 6-8 clients per session. Assessment was conducted at the commencement and completion of the 5 week PWbP and at 12 months.

 Results: Results from 135 patients (M:97; F:38); (Age: mean 70; range 30-91) revealed significant improvements (P-value <0.01) in walking endurance, gait speed, sit to stand, timed up and go, balance and grip strength. These benefits were being sustained at 12 months post discharge. In addition, a 50% reduction in falls and a 2 fold increase in exercise participation was reported. Psychosocial measures including quality of life (PDQ-39); fatigue (PSF-16) and mood (DASS-21) all improved significantly (P-value <0.01) at 6 weeks but not at 12 months. Clients also improved their knowledge of PD (P-value <0.01).

 Conclusion: Patients recruited into a 5-week PD education and exercise program achieved significant 12-month benefits in physical but not psycho-social measures. Patients with >1 fall post-treatment were less likely to be exercising at 12-month follow-up. Regular contact is needed to address psycho-social factors associated with this chronic, progressive, neurological disease.


Biography:

Jeremey Horne – Senior physiotherapist, manager of the Day Rehabilitation Unit for the past 11 years. Specialist interest in Parkinson’s disease and has developed an education and exercise program for people newly diagnosed with PD which has helped over 400 clients in almost 4 years since inception.

Developing tools to support independent practise of balance, reactive stepping & dual tasking exercises

Miss Meg Lowry1

1Next Step Physio, Brisbane, Australia

A Brisbane community rehab physio set about developing fit-for-purpose tools to maximise the effectiveness and enjoyment of home exercise programs for people of all ages who at risk of falls.

‘Clock Yourself’ is a low-tech exergame that is accessible as either an app or a CD & workbook. It leverages the familiarity of a clockface, visualised on the floor beneath the feet. The app prompts steps to those 12 intuitive co-ordinates. Dual tasking, abstract reasoning, language learning and memory games are embedded into higher levels of the app.

The pace is adjustable and measurable, the cognitive complexity is varied and there are modifications for people who need to hold onto a bench for support.

‘Balance Yourself’ is a guidebook with evidence based fall prevention education and step-by-step balance & dual tasking exercise progressions.

Meg Lowry will present her innovation journey; discussing the evidence that inspired its inception, the contribution of her patients in the development, and the opportunities for research collaboration that have arisen from this initiative.

 


Biography:

Meg Lowry BPhty MHSM APAM

Meg is a clinician on a mission to develop tools to empower our clients to shape their course of ageing.

Before establishing her private practice (Next Step Physio – Brisbane) and beginning her innovation journey with Clock Yourself and Balance Yourself, Meg worked as a senior physiotherapist in the hospital outpatient rehab setting.

She is the current chair of the QLD APA gerontology committee.

Meg promotes active engagement and knowledge sharing between health professionals using  Twitter (@MegLowryPT), Linked In and the APA gerontology Facebook page.

 

Rural pharmacies and oral health in Tasmania

Ms Stephanie Dunbar1, Dr Ha Hoang1, Dr Tony  Barnett2, Mr Mark Kirschbaum2

1Centre for Rural Health, University Of Tasmania, Launceston, Australia, 2School of Health Sciences, University of Tasmania, Launceston , Australia

Introduction

People living in rural and remote areas of Australia have poorer oral health and less access to oral health services than those in metropolitan areas. In the absence of a resident dentist, rural dwellers often present to non-dental primary care providers (e.g. pharmacists) with oral health problems. This study aimed to investigate the views and experiences of rural pharmacists in providing oral health advice/treatment.

Methods

Semi-structured interviews were conducted 20 pharmacists and 1 assistant in rural Tasmania. Data was analysed in Nvivo 10 using thematic analysis.

Results

Pharmacists reported that they had 9 to 10 visits per week, for oral health problems. The oral health presentations to the pharmacists included toothache, abscesses, oral thrush, mouth ulcers and dry mouth.  Some respondents reported no confidence around providing oral health care while others were very confident. Barriers for patients to access dental services included cost of care, financial capacity, long waitlists, and distances to services, value of good dental health and fear of dentists.  Most pharmacies identified that they had a close relationship with at least one doctor in the area, but not with local dental services. The participants described their roles in oral health care in terms of health promotion, referring, and advice. Participants also commented on the key role of pharmacy assistants in oral health. Overall, responses suggested low coverage of oral health in pharmacy training.

Conclusions

There is a need to build collaborations between rural pharmacists and dentists in order to provide better oral health services for rural communities. Oral health training for rural pharmacists would be best if it were offered online and counted towards continuous professional development (CPD). Suggested strategies for overcoming patients’ barriers in oral health are: education to rural residents, free dental care, having a local dentist and increased access to public dental health.


Biography:

Stephanie Dunbar is an Allied Health Research Practitioner working with the Centre for Rural Health at the University of Tasmania. She is a registered psychologist, who also works in private practice. With a background in mixed methods research, Stephanie worked for the Queensland University of Technology for 6 years in research roles, before moving to Tasmania. She is passionate about improving mental and physical health through research.

Education in the digital age – first results from online nutrition training

Ms Caitlin Saunders1, Ms Juliet Bociulis2, Ms Caryn Batchelor2, Ms Kacey Rubie2

1Public Health Services DHHS, Hobart, Australia, 2Public Health Services DHHS, Launceston, Australia

The Commonwealth Home Support Programme (CHSP) is a federal government initiative which helps older people to stay living independently and in their homes for as long as possible. CHSP staff and volunteers have close, regular contact with older people. They are in a unique position to identify potential health issues as they arise, ensuring that older Tasmanians get support to maintain and improve their wellbeing sooner.

Many CHSP services (such as day respite centres, and in-home care services) find it hard to offer face-to-face professional development for their staff and volunteers. Part-time roles, shift-work, and client needs can make it hard to get everyone together for training, and an innovative approach is needed.

Dietitians at Public Health Services, DHHS developed a ‘nutrition for older people’ online training package, to make it easier for CHSP service staff and volunteers to undertake professional development in a flexible and convenient way.

The ‘nutrition for older people’ online training was launched in April 2017, and since then 83 participants have fully completed the training, with a further 86 in progress. Evaluation results indicate a high level of satisfaction with the online training (average 4.3/5), with most participants (89%) stating they would like to undertake further nutrition professional development online.

Online training also led to an intention to change practice, with 51/83 respondents (61%) describing things they will do differently as a result of training. Examples of intended practice changes included ‘being more proactive with malnutrition’, ‘keeping an eye out for nutrition changes in clients’, and ‘pushing for a nutrition review of every client we see’.

These results indicate that online professional development can be a useful adjunct to face-to-face training, and is an innovative way to upskill staff and volunteers to identify and help manage nutrition issues in older people who live at home.


Biography:

Caitlin has worked as a community dietitian for 7 years, with a focus on older adult nutrition since 2014. She is passionate about the role of nutrition in preventive health; and works with respite centres, day centres and delivered meal programs to support older adults to remain living independently at home. When she isn’t talking about food at work, she loves growing fruit and veggies in her back yard, and cooking for friends.

Important Dates

Abstract Submission - Monday 14 August 2017
Early Bird - Friday 27 October 2017
Symposium - Friday 10 November 2017

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