I’m tired. I’m weak. I’m in an ICE age. Where to from here?

Steve Cadell

BPhysio, Masters of Rehabilitation (Physiotherapy) Student

Background: ICE/methamphetamine abuse in rural populations is becoming an increasingly serious phenomenon resulting in end stage renal failure (ESRF). Intradialytic therapies are fast becoming necessary to promote functional capacity and maximise quality of life in a younger patient population.

Aim: This systematic review seeks to ascertain whether the prescription of intradialyitic strengthening exercises in adults, (under the age of 65yrs with ESRF) may promote increased functional capacity and strength. Outcome measures include functional capacity assessments, muscle mass on cellular, molecular and tissue levels.

Method: Databases used for this review included SCIENCE DIRECT, PEDro & MEDLINE retrieving 4 appropriate articles based on exclusion criteria.  Exclusion criteria included: not a randomised control trial, abstract only, participants over the age of 65years, required payment, non-English or written before the year 2006.  Articles were rated as 1b evidence (NHMRC) and critically appraised using the PEDro tool.

Discussion/Recommendations: Evidence suggests intradialytic strength/resistance training in patients with ESRF under the age of 65years of age is effective in promoting muscle growth, strength and increased functional capacity. No research is specific to methamphetamine induced ESRF and associated deconditioning therefore further research is required. A qualitative approach understanding the behaviours and emotions associated with methamphetamine related renal failure is necessary to provide a holistic rehabilitation model of care. The ICE/methamphetamine epidemic will require us to manage an aging population concurrently with a prematurely aged demographic. How will we maximise future therapies and resource expenditure in order to preserve life and save “our village?”

Where is the voice of community in rural and remote allied health service and workforce design?

Debra Jones

Background

Rural and remote Australian communities can experience multiple and simultaneous allied heath disadvantages and service inequities. Engaging communities in the identification of their allied health needs and solutions to address these needs, and associated workforce shortages, is critical in enhancing service accessibility and acceptability.  New approaches that centrally locate communities in allied health service and workforce design are required however these voices can be marginalised in their own health care agendas.

Methods

Findings from a qualitative study that explored the impact and outcomes of participation in a rural community-campus partnership and associated allied health service-learning program that sought to address allied health service inequities in far west NSW have been drawn on in the identification of nine key features for enhanced community engagement in service and workforce design.

Results

The nine features of engagement are: 1) responding to community need, 2) acquiring a sense of rural place, 3) provision of services of value, 4) community innovation, 5) community leadership, 6) reputation and trust, 7) continuity and continuums, 8) multi-directional knowledge transference, translation and generation, 9) and adaptability.

Discussion

A failure by health and higher education systems to address these features contributes to mal-aligned services to community needs, practice to contexts, and lack of service accessibility and acceptability. These engagement features need to be addressed if we are to enhance systems’ capacity to engage with rural and remote communities, support the active collaboration of communities in allied health service and workforce design, and ultimately improve rural and remote health outcomes.

Biography

Debra Jones is a registered nurse by background with extensive experience in rural and remote Australian health care. Debra has held senior management positions in both state health organisations and higher education institutions.   Debra has been involved in a number of rural and remote health service and workforce innovations that have sought to align health service to community identified needs and develop health professionals to provide services in these contexts. Debra holds a Master of Indigenous Health (with Distinction) and is currently undertaking a PhD.

Stroke rehabilitation in country: Are we getting it right?

Alanna Grover1

1Whyalla Hospital & Health Service, PO box 267 Whyalla, SA 5600, alanna.grover@sa.gov.au

Background

Stroke is a major health care concern in Australia. Therefore there are best practice standards, informed by current best research evidence, on the management of stroke. Despite these standards, translating these into practice face numerous challenges, especially in rural and remote areas where access to health care is already compromised, resulting in poor health outcomes. A clinical audit project was undertaken to determine if the current physiotherapy practice adhered to current best practice for stroke patients in Country Health SA Local Health Network (CHSALHN) inpatient rehabilitation services.

Methods

Medical records documentation and client contact data from the three CHSALHN inpatient rehabilitation services for all patients admitted for inpatient stroke rehabilitation in the financial year 14/15 was audited. Compliance was measured against national clinical practice guidelines using a customised clinical audit tool.

Results

Findings from the data indicate that physiotherapy services are compliant for task specific training, retraining of sitting balance, transfers/gait, standing balance, progressive resisted strengthening and cardiovascular training. However, areas for improvement were identified including initial assessment, client/family-centred goals setting and decision making, intensity of therapy, prevention of shoulder subluxation, and intervention for somatosensory impairments.

Discussion

These findings highlight the ongoing challenges confronting rural and remote allied health clinicians in providing best practice care for stroke. While the challenges are evident, the solution to these issues remains difficult. This is because of the complexity of the health system, competing clinical priorities etc. If these issues are to be addressed, a system wide approach to change is required.

Biography

Alanna is the Clinical Senior Physiotherapist for Rehabilitation services in Country Health SA Local Health Network, and is based at the Whyalla Hospital.  She has worked in country South Australia since 2006 and is passionate about ensuring people from country South Australia have access to specialist rehabilitation services closer to home.

It takes a village: A partnership to provide speech pathology placements and clinical services

Michelle Smith-Tamaray1, Ruth Mulligan2, Chelsea Hillennaar3

1 School of Community Health, Charles Sturt University, PO Box 789, Albury, 2640. mchsmith@csu.edu.au
2 Alpine Health, 30 O’Donnell Avenue, Myrtleford, 3736. Ruth.mulligan@alpinehealth.org.au
3 Alpine Health, 30 O’Donnell Avenue, Myrtleford, 3736. Chelsea.hillennaar@alpinehealth.org.au

Background

Provision of allied health services within the residential care sector is an ongoing challenge due to a number of factors, including costs and access. This is particularly evident in rural settings, where availability of services is exacerbated by distance. A collaborative approach between a rural, multi-site health service and a university program has been developed to address an identified need for speech pathology services. This paper will present data from an ongoing evaluation of this student speech pathology service, and the challenges and benefits experienced by the stakeholders involved.

Method

A mixed method approach is being utilised, including audits, surveys, and interviews. The program is being evaluated from 3 perspectives: benefits to the service, benefits to the residents and benefits to the students. Descriptive statistics, content and thematic analysis are being undertaken.

Results

Preliminary data suggest positive outcomes for all stakeholders involved. The service has received an increased number of speech pathology consults, and has also assisted in identifying areas of focus for quality assurance initiatives. Students have reported positively on the program, both from the perspective of skill development as well as their attitudes to working within the aged care setting. Current data collection is focused on residents’ and nurses’ reports, as well as some of the challenges encountered, with ongoing evaluation being undertaken.

Discussion

This partnership has resulted in development of a model for increased opportunities for clinical placements, as well as provision of difficult to access speech pathology services for residential care in a rural area.

Biography

Michelle is a lecturer within the Speech Pathology program at Charles Sturt University. She has experience working in both generalist and adult-specific positions across a range of clinical settings, as well asundertaking management roles and student supervision. She has also served as a member on local health and education organisation boards, as well as Department of Health working parties. Michellehas an interest in rural health and equity issues, particularly in the provision of services to adults.

Falls risk screening and assessment: Barriers and enablers for rural physiotherapists

Robyn Gill1, Meredith Stewart 2, Paul O’Callaghan3, Nicholas Petch4

1 Senior Clinical Educator, Physiotherapy, Country Health SALHN/ Flinders University of SA, PO Box 2100 Adelaide SA 5001 robyn.gill@sa.gov.au
2 Falls Prevention Project Manager, Country Health SALHN, PO Box 270 Angaston SA 5353 meredith.stewart@sa.gov.au
3 Paul O’Callaghan, Master of Physiotherapy student, Flinders University of SA
4 Nicholas Petch, Master of Physiotherapy student, Flinders University of SA

Background

This study explored perceived barriers and enablers of the use of the Falls Risk for Older People in the Community (FROP-Com) screening and assessment tools among physiotherapists in the Country Health South Australia Local Health Network (CHSALHN).

Methods

In 2015, a survey was sent to all CHSALHN physiotherapists to determine perceived barriers and enablers of the FROP-Com screening and assessment tools.

Results

Fifty one physiotherapists completed the survey (52%). Overall there was a positive attitude toward the FROP-Com tools. The majority of respondents reported that referral pathways for falls risk screening and assessment had been developed for their region (90%). However, results suggested a breakdown in referral pathways and an increased reliance on physiotherapists to complete the FROP-Com tools. The greatest enabler for screening was staff interest in falls management (70%). Superior falls education (71%) was the greatest enabler for assessment with barriers identified as time (89%) and prioritisation (73%).

Discussion and recommendations

Understanding physiotherapists’ perceptions concerning the FROP-Com tools is an important platform in contributing to an effective falls management system. This research presents a number of recommendations to improve the adherence and process of performing FROP-Com screening and assessments, most pertinent being further education of staff around use of the tools and recording practice. Other recommendations include a review of referral pathways and amendments to the FROP-Com tools. Further research around falls intervention uptake in other health networks and across disciplines may guide increased adherence to falls screening and assessment and improve delivery of rural patient care.

Biography

Robyn joined Country Health SA in 2014 as Senior Clinical Educator in Physiotherapy for CHSALHN/ Flinders University.Her role is to support Flinders Uni Physiotherapy CHSALHN clinical placements.Robyn has been an educator of Physiotherapy students for over 25 years at both Flinders University and Uni SA.Robyn holds a Master of Applied Science in Physio (Manipulative Physio) from the Uni of SA.Areas of interest are Rural/ Remote Health; Musculoskeletal Physiotherapy; education in the discipline of Physiotherapy especially Clinical Simulation, blended learning and giving feedback.

Accessibility of speech pathology services in non-metropolitan New South Wales and Victoria

Linda Wilson1, Michelle Smith-Tamaray2

1School of Community Health, Charles Sturt University, P.O. Box 789, Albury, 2640, liwilson@csu.edu.au
2School of Community Health, Charles Sturt University, P.O. Box 789, Albury, 2640, mchsmith@csu.edu.au

Background

Some years ago, we presented a paper at a SARRAH conference outlining a methodology for investigating the geographic accessibility of speech pathology services in non-metropolitan New South Wales (NSW) and Victoria. This presentation will consist of a summary of data obtained via this methodology, and a demonstration of how the different types of data can be used to document a range of accessibility issues.

Method

A custom-designed telephone survey was conducted with representatives of speech pathology departments within public health facilities across rural NSW and Victoria. Representatives were asked questions about the area serviced by their department, locations and frequency of services, client eligibility criteria, staffing numbers (etc.). Data were analysed for different client groups, such as preschool children and adult outpatients, via mapping processes, simple statistics, and thematic analysis of qualitative data.

Results

While clients living in some areas of non-metropolitan NSW and Victoria were provided with geographically accessible speech pathology services, clients in other areas were not. In addition, some areas that were provided with services received those services less frequently than would be required to properly manage common speech pathology conditions. Maps and other data will be used to illustrate these and other results.

Discussion

This research was the first attempt to document the accessibility of speech pathology services in Australia. The data obtained are very powerful, and can be used for advocacy and for planning for improved accessibility of existing services. A similar methodology could be used to document the accessibility of other allied health services in rural areas.

Biography

Linda Wilson is a lecturer in speech pathology at Charles Sturt University, who has conducted research into telehealth delivery of speech pathology services. She has also worked with colleagues and research higher degree students to research the accessibility of speech pathology services in rural areas. Most recently, she has developed a Masters-level subject in which students engage with concepts related to geographic, institutional and cultural accessibility, in order to better understand how practice decisions can affect clients’ abilities to access services.

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