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.

Joe Brooks Keynote Abstract

Joe Brooks

Joe Brooks is a young podiatrist working in Hobart. In his talk he will discuss his mental health journey from the lows of his first panic attack at primary school and almost breaking down in front of a patient to the highs of walking the Kokoda track to raise money for beyond blue. He will also touch on the great services that Beyond Blue provide to make sure that you are healthy so you can provide health advice for patients. Joe thinks mental health awareness is important and hopes that sharing his story will help people seek the help they deserve and break down stigma surrounding mental health.


Biography:

Joe Brooks is a young podiatrist working in private practice where he enjoys helping people. He is a Hobart boy but moved away and since returned to be closer to his young nieces and nephews.

Joe is a volunteer speaker for beyondblue, a national organisation that works to raise awareness about anxiety and depression, reduce the associated stigma and encourage people to get help.

Joe became a beyondblue speaker because he wants to work towards reducing the stigma associated

with mental health, especially in young men. Sharing his own story helps break down misconceptions about mental health and also helps himself and others to accept their condition and get the help they need.

Joe’s interests include eating good food with good people and having a laugh. He is sports mad and lives his life by the motto ‘life is too short for bad coffee’.

Research views and research creation

Facilitators:  Dr Rosie Nash & Dr Pieter Van Dam

This is an informative and fun workshop exploring health research methods using your own context.   We will tailor the workshop to 30 participants and their needs and we will begin by dispelling any myths or concerns you may have about ethics committees. We will then invite you to focus on an issue dear to your heart, using a template to guide your thinking.  You will then have the opportunity to frame a research question and consider how to establish whether a sound answer to your question already exists in the scientific literature.  We will explore how to proceed when you need to undertake your own investigation, considering multiple designs that could be used to answer your question.

Once you have identified the best method (you can only choose 1) we will split you into teams. We will finish with a debate led by each teams arguing in the affirmative for one’s research method. At the completion of this workshop you will be inspired to undertake research in your work environment.

What to bring?

  • A research idea or problem you have identified in your work setting that you would like to explore further.
  • Ability to be open-minded and to see things from multiple viewpoints.

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.

The clinical care of patients with hip and knee osteoarthritis in Northern Tasmania: A challenge and an opportunity

Mr David Jovic1

1.THS-north West Launceston Tasmania

Background
Osteoarthritis is highly prevalent in Tasmania. The primary objective is to assess the reliability of Physiotherapy assessment of chronic knee and hip pain, when compared to an Orthopaedic Surgeon. The secondary outcomes focus on the quality of care currently being delivered to patients with hip and knee OA in Northern Tasmania.

Methods
The study assessed all patients with hip or knee osteoarthritis, greater than 50 years old, referred to 2 Orthopaedic Consultants at Launceston General Hospital Orthopaedic Department. Patients were assessed by both Orthopaedic Consultant and an experienced post-graduate trained Physiotherapist. Assessment of this patient group included key demographics, patient reported outcome measures related to OA, assessment of conservative care and routine Physiotherapy/Orthopaedic assessment. The clinical diagnosis and treatment plan were compared.

Results
36 patients have been through the assessment process to this point. Main results will be available by November. Physiotherapy assessment agreed with Orthopaedic Consultant assessment in 86% of cases. The cases of disagreement were all deemed to be low risk by an independent Orthopaedic Consultant. Potential surgical conversion rate has increased from 61% to 92%. Assessment of conservative care indicates that care delivered prior to Orthopaedic referral generally focuses on analgesia, despite high levels of inactivity, physical impairments and obesity being present in this cohort. Patient satisfaction with this process was very high.

Conclusions
The clinical pathway for patients in Northern Tasmania seems to be analgesia followed by referral to Orthopaedic surgeon. Many patients referred to the Orthopaedic Clinic have minimal access to other conservative care, despite the fact that 80% of this cohort were physically inactive, 70% were overweight or obese and 60% feel they are not confident to manage there OA by themselves.


Biography 

Dave is a Physiotherapist in Launceston.
He splits his work between private practice and the Launceston General Hospital, where he is the Clinical Lead for Musculoskeletal Physiotherapy.

Follow-up of patients after hip and knee replacement at the LGH in 2017

Mr David Jovic,1 Mrs Margot Lowther,1 Mr Thomas Senyard1

1.THS-north West Launceston Tasmania

Introduction

In financial year 2014-15, the LGH Orthopaedic Department completed a total of 186 hip and knee replacements. Between February and August 2017, 172 hip and knee replacements have been completed at the LGH. Prior to 2017, patients were seen in 1:1 clinical environment, dependant on their discharge location. The primary aim of this study was to ascertain whether Arthroplasty Group Rehabilitation (AGR) provided timely, goal orientated rehabilitation that met patients needs and satisfaction

Methods

Data has been collected for all patients who undertook hip or knee replacement for osteoarthritis from February 2017. Preoperative data was collected including Oxford Hip/Knee Score (OHKS), TUGT and RAPT. Data was collected around discharge destination and subacute rehabilitation requirements. AGR collected pre and post exercise/education group data, including patient specific functional scale, OHKS and EQ5D, as well as a post group satisfaction survey.

Results

45/172 patients were discharged to AGR (27%). On average they were followed up at 10 days postop. Forty patients were discharged back to the districts. 20 patients were discharged to subacute rehab (13%).  83% of patients achieved their goals, defined as PSFS >8/10, after attending 6 weeks of group practice. OHKS score improved by 35% on average over the 6 weeks. Patients satisfaction with AGR was very high. However, satisfaction with education of patients at discharge from the acute hospital was seen as poor.

Conclusion

AGR is a feasible option for the follow up of patients post hip or knee arthroplasty. AGR appears to provide a timely, patient centred and evidence based option for this population. The process has also provided important feedback for Physiotherapists on the Orthopaedic Ward in relation to planning follow-up care.

 

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.

 

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