Evaluation Of Exercise Rehabilitation For Survivors Of Intensive Care
Funder
National Health and Medical Research Council
Funding Amount
$359,282.00
Summary
Intensive care medicine has improved survival in critically ill patients. However, international literature reports poor quality of life and physical outcomes in ICU survivors compared to people of the same age. In addition, patients who require a prolonged ICU stay consume a large amount of resources. This project is testing whether an early ICU physiotherapist-directed exercise rehabilitation program continuing until after hospital discharge will improve patient's quality of life, physical fun ....Intensive care medicine has improved survival in critically ill patients. However, international literature reports poor quality of life and physical outcomes in ICU survivors compared to people of the same age. In addition, patients who require a prolonged ICU stay consume a large amount of resources. This project is testing whether an early ICU physiotherapist-directed exercise rehabilitation program continuing until after hospital discharge will improve patient's quality of life, physical function and decrease the use of health resources compared with patients' receiving standard care. Patients in the rehabilitation group will take part in a physiotherapy exercise rehabilitation program including returning to out patient classes after discharge. The physiotherapist will treat patients daily during hospital stay then twice weekly for 8 weeks after discharge. All patients will complete 2 quality of life questionnaires and physical function will be assessed using a new test developed for the acute ICU stay the 6 minute walk test, which measures how far patients can walk quickly in 6 minutes. The timed up and go test will also be used and it measures how quickly patients can get up from a chair and walk. An activity monitor, worn on the wrist, for some of the time after discharge will measure how much exercise and moving about patients are doing at home. Measurements will performed by a physiotherapist, blinded to the group to which patients were randomly allocated, on admission to the ICU (quality of life only by proxy), on discharge from the ICU, discharge from hospital and at 3, 6, 12 months after discharge. Economic evaluation will be performed to examine overall use of resources using information from the questionnaires.Read moreRead less
Efficacy Of A Physiotherapy Treatment For Knee Joint Osteoarthritis: A Randomised, Double-blind, Controlled Trial
Funder
National Health and Medical Research Council
Funding Amount
$156,743.00
Summary
Osteoarthritis of the knee is a disabling condition affecting the lining of the joints giving rise to pain and stiffness. It is common in older individuals and is a major cause of disability. Physiotherapy is often used to decrease pain and improve muscle strength and functional ability. However, there are few well controlled scientific studies which prove the efficacy of physiotherapy as a form of treatment in this condition. This project aims to establish whether a 12 week course of physiother ....Osteoarthritis of the knee is a disabling condition affecting the lining of the joints giving rise to pain and stiffness. It is common in older individuals and is a major cause of disability. Physiotherapy is often used to decrease pain and improve muscle strength and functional ability. However, there are few well controlled scientific studies which prove the efficacy of physiotherapy as a form of treatment in this condition. This project aims to establish whether a 12 week course of physiotherapy treatment is effective in reducing pain and improving function in 50-80 year old individuals diagnosed with osteoarthritis of the knee joint. It will also assess whether any improvements seen after treatment can be maintained with a home program. This will provide scientific evidence to justify the role of physiotherapy management in this condition.Read moreRead less
Many older people who fracture their hip do not recover to their previous level of function. This study will test whether it is possible to help recovery of function, particularly walking, after hip fracture by using different and more intensive physiotherapy treatment. The treatment will concentrate on exercise when standing, will be provided twice daily and will continue after the person with hip fracture has returned home. Four months after the hip fracture it is expected that walking ability ....Many older people who fracture their hip do not recover to their previous level of function. This study will test whether it is possible to help recovery of function, particularly walking, after hip fracture by using different and more intensive physiotherapy treatment. The treatment will concentrate on exercise when standing, will be provided twice daily and will continue after the person with hip fracture has returned home. Four months after the hip fracture it is expected that walking ability, strength and balance will be improved by the new treatment methods.Read moreRead less
Patellofemoral Arthritis: Efficacy Of Physiotherapy And Understanding The Role Of Joint Stress
Funder
National Health and Medical Research Council
Funding Amount
$616,430.00
Summary
Arthritis of the kneecap leads to considerable pain and difficulty with daily activities. This project is testing whether a physiotherapy treatment (8 sessions over 12 weeks) designed specifically for people with kneecap arthritis is effective. In order to understand more about kneecap arthritis, this project will calculate the force on the kneecap and its relationship to pain and other factors, including thigh and hip muscle strength, knee alignments and knee movements.
The Efficacy Of Manipulation For Recent Onset Neck Pain
Funder
National Health and Medical Research Council
Funding Amount
$393,974.00
Summary
Neck pain is extremely common, with a point prevalence of 46% in the general community. Neck pain can cause significant disability, and is the second most common injury causing people to take time off work. Neck pain and its associated disability clearly poses a substantial social and economic burden. Neck manipulation (high velocity thrust of the joints, often associated with a click) is widely used by physiotherapists for the management of recent onset neck pain, but there is no clear evidence ....Neck pain is extremely common, with a point prevalence of 46% in the general community. Neck pain can cause significant disability, and is the second most common injury causing people to take time off work. Neck pain and its associated disability clearly poses a substantial social and economic burden. Neck manipulation (high velocity thrust of the joints, often associated with a click) is widely used by physiotherapists for the management of recent onset neck pain, but there is no clear evidence for its efficacy. In addition, the use of manipulation is associated with serious, although rare, adverse events such as stroke or even death. The risk-benefit analysis, therefore, does not clearly favour manipulation because efficacy has not been established, while the risks are serious, but infrequent. The findings of the proposed study will clearly and precisely determine the efficacy of manipulation compared with the safer treatment technique of mobilisation (gentle oscillatory pressure applied to the joints), information that is currently unavailable. This information is of vital importance to many different disciplines, including health professionals, insurance companies, and to administrators for development of health policy. Our findings will thus provide evidence-based guidelines for the use of manipulation, and will ultimately lead to safer practice of physiotherapy for neck pain.Read moreRead less
Effectiveness Of Training Somatosensation In The Hand After Stroke: A Randomized Controlled Trial.
Funder
National Health and Medical Research Council
Funding Amount
$180,660.00
Summary
Stroke is a leading cause of death and disability, requiring provision of rehabilitation services to help minimize impairment and its impact on the ability to resume daily activities. The ability to feel textures and objects through touch and to know where one s limbs are in space are impaired in up to 85% of people who have suffered a stroke. People with this loss are handicapped by difficulties in exploring objects through touch and in performing everyday tasks that require grasp and manipulat ....Stroke is a leading cause of death and disability, requiring provision of rehabilitation services to help minimize impairment and its impact on the ability to resume daily activities. The ability to feel textures and objects through touch and to know where one s limbs are in space are impaired in up to 85% of people who have suffered a stroke. People with this loss are handicapped by difficulties in exploring objects through touch and in performing everyday tasks that require grasp and manipulation of objects. Yet clinicians are either not treating the problem or are using methods without a sound theoretical basis and controlled evidence to support their application. We have systematically investigated optimal methods of sensory training across different sensory abilities using a series of single-subject experiments. Marked improvement in the ability to discriminate trained and related untrained texture stimuli and limb positions was achieved and maintained in most participants. These findings have provided the foundation for development a scientifically based and clinically focused sensory retraining program that has apparently excellent therapeutic potential. The purpose of the proposed study is to test the effectiveness of this scientifically based, clinical sensory retraining program in a broad group of stroke clients using the internationally recommended randomized controlled group design. The program will train a range of functionally important sensory discrimination tasks, i.e. texture discrimination, limb position sense and tactual object recognition, in clinical and home environments. Demonstration of clinically important and statistically significant training effects will provide the evidence necessary to recommend the introduction of the program into routine health service delivery. Investigation of patient characteristics that may impact on the ability to benefit from training will assist in the targeting of services to appropriate individuals.Read moreRead less
Improving The Care For People With Acute Low Back Pain By Allied Health Professionals: Cluster RCT.
Funder
National Health and Medical Research Council
Funding Amount
$682,134.00
Summary
The project focuses on the NHMRC Clinical Practice Guidelines (CPG) for the management of acute low back pain, and more specifically the key messages of non-referral to x-ray and advising patients to stay active. A mixed design approach will be used in line with the framework for evaluating complex interventions (MRC 2000). A qualitative approach using semi-structured interviews with physiotherapists, chiropractors and the patients of both will be conducted to identify the barriers and enablers ....The project focuses on the NHMRC Clinical Practice Guidelines (CPG) for the management of acute low back pain, and more specifically the key messages of non-referral to x-ray and advising patients to stay active. A mixed design approach will be used in line with the framework for evaluating complex interventions (MRC 2000). A qualitative approach using semi-structured interviews with physiotherapists, chiropractors and the patients of both will be conducted to identify the barriers and enablers to implementation of the evidence-based clinical practice guideline. The interviews will be underpinned by a theoretical framework grounded in behavioural theory. Information from the interviews will be used to develop a survey to canvas views of a larger population of chiropractors and physiotherapists. The results of the interviews and survey will inform the development of a targeted implementation strategy suitable for use in private physiotherapy and chiropractic clinics. Potential interventions include educational strategies, patient and practitioner information via various media, reminder systems and peer leadership. A cluster randomised controlled trial (C-RCT) will then be conducted to determine the effects of the strategy. Practices will be randomised to receive either the developed implementation strategy, including strategies targeted at clinicians and patients, or to a control group receiving access to the guideline alone. The outcomes of the implementation strategy will be assessed at the level of the practitioner (did the strategy result in a change of practice?), and the patient (did the practice change result in improved patient outcomes?). Subgroup analyses will investigate effects specific to chiropractors and physiotherapists.Read moreRead less
Neuromuscular Exercise : A Novel Treatment To Reduce Symptoms And Joint Load In Medial Knee Osteoarthritis
Funder
National Health and Medical Research Council
Funding Amount
$719,199.00
Summary
There is currently no cure for knee osteoarthritis (OA). Thus treatments are needed that not only reduce symptoms but also slow disease progression. Exercise is recommended for knee OA but traditional thigh muscle strengthening exercises do not appear to be effective in all cases and may not slow the disease. This project will compare novel 'neuromuscular exercise' and compare it to traditional strengthening exercise. The results have the potential to alter current exercise prescription