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Professor Karen Grimmer recently returned from a six month period in South Africa where she worked on the South African Guidelines Excellence Project (Project SAGE). SAGE aims to enhance the quality of primary healthcare by engaging in a stakeholder-driven process to improve the standards of local guideline development, adaptation, contextualisation and, ultimately, implementation. Here are some updates of her work while she was there:
A workshop was run in Cape Town, South Africa on the 24th July by Dr Janine Dizon (UniSA alumni, former President’s Scholar), Shingai Machingaidze (Project SAGE project manager) and Professor Karen Grimmer. This workshop discussed guideline contextualisation. This workshop was an output of Project SAGE (South African Guideline Excellence) (go to iCAHE's project SAGE webpage for more details). Karen, Janine and Shingai shared a small part of the work coming out of the Project SAGE team. The workshop was attended by guideline developers and users from around South Africa, from National and Provincial Government, academia, private practice and Non-Government Organisations. It presented the notion that developing a completely new guideline to suit the local needs weren’t necessary if you could contextualise the recommendations in a relevant international guideline to make them work in the local setting. The attendees learnt about the mechanics of guideline construction and the steps to contextualisation. The process of contextualisation was first developed in the Philippines by Janine, Dr Consuelo Gonzalez-Suarez and Karen Grimmer, as part of the work started in 2010 by the Philippines Academy of Rehabilitation Medicine (go to iCAHE's PARM project page for more details). It was great to see this efficient approach to guideline implementation happening in another lower to middle income country, where there are scarce resources for de novo development activities.
Images from the July SAGE Implementation workshop.
Three posters from Project SAGE will be presented at the 12th Guidelines Intercollegiate Network (GIN) Conference, Amsterdam, October 7-10 2015 by Shingai Machingaidze. Poster 1.3 is about the use of the iCAHE guideline quality checklist to evaluate the quality of 16 South African primary care guidelines. The iCAHE team in Australia is excited that the iCAHE checklist is on the world stage now at such a prestigious conference! This checklist has also been recently cited in a systematic review of efficient tools to evaluate the quality of clinical guidelines for busy clinicians and policy-makers (Semlitsch T, Blank WA, Kopp IB, Siering U, Siebenhofer A. Evaluating Guidelines: A Review of Key Quality Criteria. Deutsches Ärzteblatt International 2015. 112(27-28);471-478).
The Stroke and Rehabilitation group
Susan Hillier (one of the leaders of the iCAHE Stroke and Rehabilitation Research Group) and colleagues were fortunate to secure funding for a repetitive Transcranial Magnetic Stimulation unit. This unit has three research functions:
1. to offer neurophysiological measurement of brain function (corticospinal tracts in particular)
2. to create temporary “virtual lesions” in the brain to simulate brain pathology and allow studies of mechanisms of effect/s and proof of concept in health humans prior to clinical trials
3. offers an intervention for people with brain-based pathology from diverse patient populations – depression through to stroke and chronic pain.
The Stroke group were able to secure the following grants for this unit:
NHMRC Equipment Grant 2014 – repetitive Transcranial Magnetic Stimulator (rTMS) - Susan Hillier on behalf of a group of researchers including Michelle McDonnell (Stroke and Rehabilitation Research Group); Lorimer Moseley (Body in Mind), Ashleigh Smith (ARENA) and Gaby Todd (Pharmacy). Contributions from the Schools of Health Science and Pharmacy and the Sansom Institute.
UniSA Strategic Research Infrastructure Round 2015 – Amplifiers to support rTMS - Susan Hillier on behalf of a group of researchers including Michelle McDonnell (Stroke and Rehabilitation Research Group); Lorimer Moseley (Body in Mind), Ashleigh Smith (ARENA) and Gaby Todd (Pharmacy).
The work of ICAHE’s Stroke and Rehabilitation group was well represented at the Stroke 2015 Conference held in Melbourne Sept 2-4th.
iCAHE members including Susan Hillier, Elizabeth Lynch, Lindy Williams, Julie Luker and Michelle McDonnell shared oral and poster presentations of their research. Elizabeth (Liz) Lynch rpovided the following report:
The two national stroke conferences (Stroke Society of Australasia Annual Scientific Meeting and Smartstrokes Allied Health and Nursing conference) were combined into one super-conference in Melbourne, from 2nd to 4th of September this year. More than 800 clinicians, researchers, sponsors and consumers attended. University of South Australia was well represented with Marcie Packer (honours student), Lindy Williams, Julie Luker, Susan Hillier, Coralie English and myself all presenting oral papers. I was pleased to be able to present 3 separate talks about different results from my PhD study regarding how people with stroke are assessed for rehabilitation in Australian hospitals. The paper that I received the most feedback about was one where we asked clinicians what prevented them from assessing the rehabilitation needs of patients with stroke, and I provided a quote from clinicians who were unwilling to assess patients' rehabilitation requirements for fear of being sued if rehabilitation could then not be sourced due to limited rehabilitation service availability.
One of the highlights of the conference for me was a speech by Emma Gee, a stroke survivor. Emma was a recently graduated occupational therapist who ran half marathons and did volunteer work overseas before she experienced a devastating stroke in her early 20's. Emma's talk about her experiences, and her advice to clinicians to consider the person inside the stroke-affected body, was both very sad, but also powerful, uplifting and inspiring.
On a personal note, I was very honoured to be presented a one-off award for research excellence, which was presented in memory of Renee Sheedy. I didn't know Renee, but had heard her story - she was a physiotherapist working with patients with stroke in Geelong and was enrolled in a PhD investigating the effect of early mobilisation after stroke. She was diagnosed in 2012 with an aggressive brain tumour, and died in December 2014. I was able to meet her husband and parents who came to the conference to present the award, which they had asked be awarded to a researcher from allied health or nursing professions. I feel like this prize is a really special one, probably because it feels so personal, and I feel very grateful and honoured to be the award recipient.
All in all, it was a great conference.
Congratulations to the first participants to complete the Professional Certificate in Consumer Engagement
The International Centre for Allied Health Evidence (iCAHE, UniSA), in partnership with Health Consumers Alliance, co-designed and delivered a Professional Certificate in Consumer Engagement in 2015. Health professionals, consumers representatives and researchers worked together to inform the objectives, content, delivery and assessment of the two courses that make up this Professional Certificate. The participants developed competence and confidence to apply evidence-informed consumer engagement practice in the areas of health research, governance, policy, services and care. The Professional Certificate was led by Ms Debra Kay, and Dr Michelle Guerin, iCAHE, UniSA
iCAHE would like to congratulate the participants on their achievement and also thank Hon Jack Snelling, Minister of Health, and Prof Roger Eston, Head, School of Health Science, UniSA for presenting the Statements of Participation, Appreciation and Competence on 10 September 2015 at Parliament House, Adelaide. For further information about the Professional Certificate in Consumer Engagement visit the iCAHE website (www.unisa.edu.au/cahe).
Check out our new iCAHE web resources
The iCAHE learning hub is the starting point for a range of self-directed, open access learning resources aimed to introduce you to, or expand your knowledge of, evidence-based practice (EBP). This section of the iCAHE website provides you with tutorials, podcasts, examples and booklets that you can work through at your own pace and in a manner best suited to your learning style.
Current learning hub courses:
EBP e-learning resource: provides an innovative and flexible means for self-directed training at a pace appropriate to your own style of learning. It offers resources and tutorial modules.
MS Excel short course in data handling & statistical function with an example dataset: provides you with a structured, enjoyable and practical approach to learn to use MS Excel. These skills will enable you to undertake research and data handling activities within your clinical practice.This booklet is designed for all skill levels, from absolute beginner to more advanced knowledge.
A short course in searching the literature: An introduction to developing a search strategy and executing a search. Also has some useful database hints.
Podcast presentations: a menu of short (5-15 minute) presentations on a variety of health research topics and tools.
Feature guideline- See this month’s featured guideline on the Appropriate use criteria for the treatment of distal radius fractures
Outcomes Calculator- See the feature outcomes measure, The Nottingham Sensory Assessment
The National Primary Health Care Conference 2015 will be held on 2-4 November 2015 at the National Convention Centre Canberra. This event will bring together leading international and national speakers providing a platform to engage, challenge and exchange ideas, where pivotal issues for the future of primary health care in Australia will be discussed and where delegates will learn from the experience, opinions and perspectives of sector leaders and their peers. Go to the conference webpage for more details.
The 25th Annual Conference of the Australasian Rehabilitation Nurses’ Association (ARNA) will be held on the 22-23 October at the Brisbane Convention & Exhibition Centre. Got to the Conference webpage for more details.
The National Allied Health Organising Committee is delighted to present the 11th National Allied Health Conference, Melbourne, Australia for all allied health disciplines. This premiere conference will be held at the Crown Convention Centre, Melbourne, from 9 - 11 November 2015, with pre-conference workshops held on Monday, 9 November 2015. Go to the conference webpage for more details.
Puntumetakul R, Suvarnnato T, Werasirirat P, Uthaikhup S, Yamauchi J, Boucaut R. Acute effects of a single multiple level thoracic manipulations on chronic mechanical neck pain: a randomized controlled trial. Neuropsychiatric Disease and Treatment. 2015:11 137-144
Karukunchit U, Puntumetakul R, Swangnetr M, Boucaut R. Prevalence and risk factor analysis of lower extremity abnormal alignment characteristics among rice farmers. Patient Preference and Adherence. 2015:9 785-795
McDonnell M, Hillier S, Opie G, Nowosilskyj M, Haberfield M, Todd G. 2015. Continuous passive movement does not influence motor maps in healthy adults. Frontiers in Human Neuroscience.
April 2015. Volume 9 Article 230
Howard V, McDonnell M. 2015. Physical Activity in Primary Stroke Prevention. Just Do It!
Stroke. 2015; 46:1735-1739
MacDonnell M, Hillier S. 2015. Vestibular rehabilitation for unilateral peripheral vestibular dysfunction (Review). The Cochrane Library 2015, Issue 1.
Bradnam L, Graetz J, McDonnell M, Ridding M. 2015. Anodal transcranial direct current simulation to the cerebellum improves handwriting and cyclic drawing kinematics in focal hand dystonia. Frontiers in Human Neuroscience. May 2015 Volume 9 Article 286
Weeks S, Atlas A. 2015. Clinical audit for occupational therapy intervention for children with autism spectrum disorder: sampling steps and sample size calculation. BMC Research Notes. 2015, 8:282
Beaton K, McEvoy C, Grimmer K. 2015. Identifying indicators of early functional decline in community-dwelling older people. A review. Geriatrics Gerontology. 2015 15: 133-140
Reznik J, Milanese S, Gordon S, Lamont A, Galea M. 2015. Prevalence of Neurogenic Heterotopic Ossification in Traumatic Head – and Spinal-Injured Patients Admitted to a Tertiary Referral Hospital in Australia. Health Care Manager. January/March 2015 Volume 34 Issue 1 p54-61
Gibbs D, Boshoff K, Stanley M. 2015 Becoming the parent of a preterm infant: A meta-ethnographic synthesis. British Journal of Occupational Therapy.1-13
Murray C, Turpin M, Edwards I, Jones M. 2015. A qualitative meta-synthesis about challenges experienced in occupational therapy practice. British Journal of Occupational Therapy.
September 2015 vol. 78 no. 9 534-546
Morris J, Vine K, Grimmer K. 2015. Evaluation of performance quality of an advanced scope physiotherapy role in a hospital emergency department. Patient Related Outcome Measures. 2015:6 191-203
Lizarondo K, Turnbull C, Kroon T, Grimmer K, Bell A, Kumar S, McEvoy M, Milanese S, Russell M, Sheppard L, Walters J, Wiles L. 2015. Allied Health: Integral to transforming health. CSIRO Publishing. Australian Health Review.
Odunaiya N, Grimmer K, Louw Q. 2015. High prevalence and clustering of modifiable CVD risk factors among rural adolescents in southwest Nigeria: implication for grass root prevention. BMC Public Health. 15:661
Singla M, Jones, M, Edwards I, Kumar S. 2015. Physiotherapists’ assessment of patients’ psychosocial status: Are we standing on thin ice? A qualitative descriptive study. Manual Therapy (2015) 328-334
Luker J, Bernhardsson S, Lynch E, Murray C, Hill O, Bernhardt J. 2015. Carers’ experiences, needs and preferences during inpatient stroke rehabilitation: a protocol for a systematic review of qualitative studies. 2015 4:108
McEvoy C, Wiles L, Bernhardsson S, Grimmer K. 2015. Triage for patients with Spinal Complaints: A systematic review of the literature. Physiotherapy Research International.
Abstract (Epub ahead of print)
Machingaidze S, Kredo T, Louw Q, Young T, Grimmer K. South African Guidelines Excellence (SAGE): Clinical Practice Guidelines – quality and credibility. SAMJ.
EDITORIAL. September 2015, Vol. 105, No.9
Ducat W, Kumar s. 2015. A systematic review of professional supervision experiences and effects for allied health practitioners working in non-metropolitan health care settings. Journal of Multidisciplinary Healthcare. 2015:8 397-407
Martin P, Kumar S, Lizarondo L, VanErp A. 2015. Enablers of and barriers to high quality clinical supervision among occupational therapists across Queensland in Australia: findings from a qualitative study. BMC Health Services Research. 2015 15:413
Ducat W, Martin P, Kumar S, Burge V, Abernathy L. 2015. Oceans apart yet connected: Findings from a qualitative study on professional supervision in rural and remote allied health services. The Australian Journal of Rural Health.
Kumar S, Lehmann T. 2015. Clinical supervision of allied health professionals in country South Australia: A mixed methods pilot study. The Australian Journal of Rural Health.
Osborne B, Parange N, Thoirs K. 2015. The effectiveness of the use of high fidelity simulators in obstetric ultrasound training: A systematic review. Australasian Journal of Ultrasound in Medicine. August 2015 18 (3) pp.101-105
Childs J, Thoirs K, Esterman A. 2015. Computed tomography volume measurements of the liver using a liver segmentation and analysis package: an intra- and inter-rater reliability study. Journal of Biomedical Graphics and Computing. Vol. 5. No 2 pp 17-22
Butcher R, Gaggini R, Thoirs K. 2015. Does Wearing a Real-Time Visual Dosimeter Reduce the Personal Radiation Dose for Interventional Radiology Nurses? An Observational Comparative Study. Journal of Radiology Nursing. Vol. 34 Issue 3. Pp 137-142
Sellar B. “Interrogating power and reason: Critical theory and philosophy” in Nayar S & Stnaley M (eds) Qualitative Research Methodologies for Occupational Science and Therapy. Routledge Oxon, pp 208-224.
Rothmore R, Boucaut R. Chapter 9. Occupational Health and Safety. In Management and Leadership – A Guide to Clinical Professionals. Patole S. Editor.
Murray C, Stanley M. 2015. Meta-synthesis de-mystified: connecting islands of knowledge. Chapter in book: Qualitative research methodologies for occupational science and therapy. Taylor & Francis, Melbourne. Victoria. P174-189
Magarey M, Jones M, Baida S. 2015. Motor control of the shoulder region. In: Fernandez de Las Penas, c, Cleland J, Dommerholt J. (eds) Manual Therapy for Musculoskeletal Pain Syndromes of the Upper and Loweer Quadrants: An Evidence and Clinical-informed Approach. Chapter 32, 358-372.
Koya Mine, from Nagasaki, Japan, completed the Masters of Musculoskeletal and Sports Physiotherapy in 2014 at UniSA. He has been working as a research assistant in iCAHE since December 2014. Koya’s brief has been to undertake systematic reviews of Japanese-language literature of physiotherapy treatment questions, and write English-language systematic reviews of the findings. He has been working with Dr Steve Milanese and Prof Karen Grimmer (UniSA) and Prof Takashi Nakayama (UniSA Alumni, adjunct lecturer to UniSA School of Health Science, and Professor, Department of Physiotherapy, Tokyo University of Technology, Tokyo). Koya has recently had his first systematic review accepted for publication in Physical Therapy Reviews, and he has four more reviews underway. To find the Japanese language literature, Koya and Prof Nakayama have developed comprehensive search strategies of Japanese research databases, and they have shared the critical appraisal, and data extraction processes. Lack of Japanese language has been a barrier to his only-English-speaking collaborators at UniSA. Koya has also been invited to publish three educational pieces in Japanese Journal of Manual Physical Therapy (in Japanese) on evidence-based practice, which is a relatively new concept in Japanese physiotherapy. We believe that Koya’s recently accepted systematic review is the first ever, of non-English language literature. Koya’s work has highlighted the volume of literature which is not published in English, which could be ‘unlocked’ using the dual translation process that he and Prof Nakayama have developed.
Health Services Research – Implementation Science
Members - Carolyn Murray, Ian Edwards, Julie Luker, Kate Kennedy, Kerry Thoirs, Louise Wiles, Mandy Stanley, Mark Jones, Michelle Guerin, Olivia Hill, Shylie Mackintosh, Susan Hillier, Zuzana Machotka and Saravana Kumar.
What is the purpose of this group? – Recent times have witnessed transformative changes in health care in response to the growing challenges that confront the Australian society. It is abundantly clear that the way we used to conceptualise and deliver health care historically may not be ideally suited to meet the emerging needs and requirements of contemporary health care. An important driver for this change has been the increasing role of evidence-based practice in health care, which can contribute to the quality and safety of health care. There is now consistent evidence that not all health care is good quality with numerous instances of misuse, overuse and underuse of health care interventions reported. Health care quality and safety is now everyone’s business with increasing focus on poor quality care and opportunities for improvement. For example, in the past fortnight, the Four Corners program of the Australian Broadcasting Corporation featured a story titled “Wasted” which highlighted numerous inefficiencies and wastages within the Australian health system contributing to poor quality and unsafe health care practices (partly due to lack of using evidence-based decision making). The crux of the story featured on the Four Corners program is nothing new as there has been ongoing research in Australia which has showcased the inappropriateness and the low value of many health care interventions. These findings have influenced the development of initiatives such as “Choosing Wisely Australia”. With such overt focus on quality and safety of heath care, it is imperative that health care stakeholders collaborate to address poor quality and unsafe health care practices. The Health Services Research-Implementation Science group aims to contribute to addressing poor quality and unsafe health care practices through transforming and redesigning health systems, implementing best practice and achieving practice and behaviour change.
Who are we? – We are team of academics and researchers in the fields of health services research and implementation science. Health services research is a multidisciplinary field of science which investigates health services, its structures and processes and the patient journey through the healthcare system. This is a unique field of science as it brings together health, social, environmental, personal and organisational philosophies. Simply put this multidisciplinary field of research examines how people get access to health care, how much health care costs, and what happens to people as a result of this care.
The health services research group has provided research evidence on best practice for the delivery of safe and quality health care through cutting edge research on patient safety, clinical governance, models of care, evaluation and workforce redesign and innovation. We also use evidence-based practice as a vehicle to improve the quality and safety of healthcare by accessing, synthesising and implementing best available evidence. In particular, members of this group, underpinned by the science of evidence implementation, shape, devise and implement behaviour and practice change strategies within health care settings. Members of this group work closely with health professionals, consumers, administrators and policymakers to ensure access to and delivery of quality and safe health care to all Australians.
What do we do? – Broadly speaking, what we do as a group can be classified into 5 Es.
- Evidence synthesis – We undertake secondary research through reviews of the literature (such systematic review, clinical practice guidelines), which can then be used to inform health care policy and practice.
- Evidence generation - We undertake primary research (quantitative, qualitative and mixed methods) which generates new body of evidence across a range of topics.
- Evidence implementation - As implementing evidence into clinical practice is complex and often difficult, we work with health care stakeholders to assist in the implementation of best practice and change in health care. For example, currently, members of this group are actively involved in shaping the future of healthcare service delivery for South Australians through the Transforming Health initiative, led by SA Health. As means of providing access to evidence implementation resources, we also have a dedicated website called Implementation Central, which acts as a one-stop shop for everything related to implementing evidence and change in health care.
- Evaluation – We recognise that in order to improve the quality and safety of health care, ongoing evaluation is a must. Therefore, members of the group work in close collaboration with health care stakeholders to evaluate and review existing practices and identify ongoing opportunities for improvement.
- Education – Achieving change in health care will only be possible if all health care stakeholders collaborate and work together. An important and vital stakeholder in this are the clinicians who are at the coalface of health care service delivery. Partnering with clinicians, supporting and mentoring them will be crucial during these transformative times. Therefore, we provide educational opportunities (in the form of workshops, seminars, mentorships) to clinicians, which will enable them to successfully implement and sustain best practice in their clinical contexts. As passionate educators at University of South Australia, members of the group recognise the importance of ongoing education and continuing professional development opportunities for clinicians. An example such an initiative was showcased in a past iCAHE newsletter.
What’s new? – Over the past few months, members of this group have published a series of publications (one, two, three and four) about the opportunities and challenges that confront health professionals in regional, rural and remote regions of Australia. There is now consistent evidence to indicate that Australian in rural and remote regions of Australia have poorer health outcomes compared to their metropolitan peers. While there are a number of reasons for this, one reason is the recruitment and retention difficulties of health professionals to rural and remote regions of Australia which impacts access to health care. Our research sheds new light on how to support our health professionals in rural and remote regions so that they can continue to provide high quality health care to people living in these areas.