搜索结果：The Australian journal of physiotherapy

What is the effect of the addition of arthroscopy to physiotherapy and medication in patients with osteoarthritis (OA) of the knee? Randomised, controlled trial with blinded outcome assessment and intention-to-treat analysis. A university sports medicine clinic in Ontario, Canada. Adults with idiopathic or secondary moderate-to-severe oa of the knee (Grade 2, 3, or 4 radiographic severity on the modified Kellgren-Lawrence classification). Key exclusion criteria were large meniscal tears, inflammatory arthritis, previous arthroscopic treatment for knee OA and more than 5 degrees of lateral deformity. Randomisation of 188 participants allotted 94 to an intervention group and 94 to a control group. The intervention group underwent arthroscopy within 6 weeks after randomisation and a standard physiotherapy and medication regimen was initiated within 7 days after surgery. the control group initiated the same physiotherapy and medication regimen at an equivalent time. Physiotherapy was provided for 1 hour once a week for 12 weeks. It included range-of-motion and strengthening exercises to be performed at home twice daily, information about activities of daily living, instruction in the use of heat and cold, and an educational video. Exercises were individualised according to the severity of oa and age. After the 12-week period, participants were advised to continue the exercise program. medications (potentially including paracetamol, non-steroidal anti-inflammatory drugs, hyaluronic acid, and glucosamine) were prescribed according to standard guidelines. The primary outcome was the WOMAC score at 2 years follow up. The WOMAC is scored from 0 (worst) to 2400, with subscales for pain, stiffness, and physical function. Secondary outcomes included the Physical Component Summary Score of the Short Form-36 (0 to 100); the McMaster Toronto Arthritis patient preference (MACTAR) questionnaire (0 to 500); and the Arthritis Self-Efficacy Scale (ASES) (10 to 100). 168 participants completed the study. After 2 years, the mean (SD) WOMAC scores were 874 (624) in the intervention group and 897 (583) in the control group, mean difference 23 (95% CI -208 to 161). The groups differed on the SF-36 by only 0.2 (95% CI -3.2 to 3.6), on the MACTAR questionnaire by only 6 (95% CI -37 to 49), and on each of the ASES subscales by less than 6 (all non-significant). The addition of arthroscopy to a regimen of physiotherapy and medication does not improve physical function, pain, or health-related quality of life in patients with moderate-to-severe OA of the knee.

Does assessment by a multidisciplinary team, or assessment by a community nurse with the ability to refer to other professionals, reduce further falls in recurrent fallers? Cluster-randomised, controlled trial. 18 general practices in the UK. Adults aged at least 65 years, living in the community, who had experienced 2 or more falls in the past year, and who did not present to an emergency department for their most recent fall. Inability to participate for one year, abbreviated mental test score less than 7, and nursing home placement were exclusion criteria. Randomisation of 516 participants allotted 213 to care by the multidisciplinary team (secondary care), 141 to care by the community nurse (primary care), and 162 to usual care. Participants allocated to secondary care attended a multidisciplinary clinic (comprising a doctor, nurse, physiotherapist, and occupational therapist) with referral for investigations, interventions, (including Homecheck), and follow-up if necessary. Participants allocated to primary care were assessed by a community nurse who identified risk factors for falls and could refer to other professionals. Participants in the usual care group were assessed by their usual primary care physicians, who provided management at their own discretion. the primary outcome was the proportion of participants in each group who had at least one fall during the follow-up period of 12 months. Other outcomes were death, move to institutional care, change in Barthel score, change in the timed Get Up and Go score, fall-related fractures, and hospitalisations. Participants lost to follow-up were assumed to have had an adverse outcome. 466 participants contributed data to the primary outcome, with an adverse outcome assumed for a further 39 participants on falls and other dichotomous outcomes. At 12 months, 75% of the secondary care group, 87% of the primary care group, and 84% of the usual care group had fallen. Secondary care prevented significantly more falls than usual care (adjusted odds ratio 0.52, 95% Ci 0.35 to 0.79). the secondary care group also had a significantly more positive Barthel index than the usual care group. the groups did not significantly differ on the other outcomes. The data were also analysed without imputing adverse outcomes for participants who were lost to follow-up. Compared to the usual care group, the secondary care group had significantly fewer falls, fractures, hospitalisations, and deaths. Multidisciplinary assessment of elderly, recurrent fallers reduces the risk of further falls compared to usual care. Assessment of risk factors for falls by a community nurse with the potential to refer to other professionals did not have the same benefit.

Hip or knee replacement is a major surgical procedure that can be physically and psychologically stressful for patients. It is hypothesised that education before surgery reduces anxiety and enhances clinically important postoperative outcomes. To determine whether preoperative education in people undergoing total hip replacement or total knee replacement improves postoperative outcomes with respect to pain, function, health-related quality of life, anxiety, length of hospital stay and the incidence of adverse events (e.g. deep vein thrombosis). We searched the Cochrane Central Register of Controlled Trials (2013, Issue 5), MEDLINE (1966 to May 2013), EMBASE (1980 to May 2013), CINAHL (1982 to May 2013), PsycINFO (1872 to May 2013) and PEDro to July 2010. We handsearched the Australian Journal of Physiotherapy (1954 to 2009) and reviewed the reference lists of included trials and other relevant reviews. Randomised or quasi-randomised trials of preoperative education (verbal, written or audiovisual) delivered by a health professional within six weeks of surgery to people undergoing hip or knee replacement compared with usual care. Two review authors independently assessed trial quality and extracted data. We analysed dichotomous outcomes using risk ratios. We combined continuous outcomes using mean differences (MD) or standardised mean differences (SMD) with 95% confidence intervals (CI). Where possible, we pooled data using a random-effects meta-analysis. We included 18 trials (1463 participants) in the review. Thirteen trials involved people undergoing hip replacement, three involved people undergoing knee replacement and two included both people with hip and knee replacements. Only six trials reported using an adequate method of allocation concealment, and only two trials blinded participants. Few trials reported sufficient data to analyse the major outcomes of the review (pain, function, health-related quality of life, global assessment, postoperative anxiety, total adverse events and re-operation rate). There did not appear to be an effect of time on any outcome, so we chose to include only the latest time point available per outcome in the review.In people undergoing hip replacement, preoperative education may not offer additional benefits over usual care. The mean postoperative anxiety score at six weeks with usual care was 32.16 on a 60-point scale (lower score represents less anxiety) and was 2.28 points lower with preoperative education (95% confidence interval (CI) -5.68 to 1.12; 3 RCTs, 264 participants, low-quality evidence), an absolute risk difference of -4% (95% CI -10% to 2%). The mean pain score up to three months postoperatively with usual care was 3.1 on a 10-point scale (lower score represents less pain) and was 0.34 points lower with preoperative education (95% CI -0.94 to 0.26; 3 RCTs, 227 participants; low-quality evidence), an absolute risk difference of -3% (95% CI -9% to 3%). The mean function score at 3 to 24 months postoperatively with usual care was 18.4 on a 68-point scale (lower score represents better function) and was 4.84 points lower with preoperative education (95% CI -10.23 to 0.66; 4 RCTs, 177 participants; low-quality evidence), an absolute risk difference of -7% (95% CI -15% to 1%). The number of people reporting adverse events, such as infection and deep vein thrombosis, did not differ between groups, but the effect estimates are uncertain due to very low quality evidence (23% (17/75) reported events with usual care versus 18% (14/75) with preoperative education; risk ratio (RR) 0.79; 95% CI 0.19 to 3.21; 2 RCTs, 150 participants). Health-related quality of life, global assessment of treatment success and re-operation rates were not reported.In people undergoing knee replacement, preoperative education may not offer additional benefits over usual care. The mean pain score at 12 months postoperatively with usual care was 80 on a 100-point scale (lower score represents less pain) and was 2 points lower with preoperative education (95% CI -3.45 to 7.45; 1 RCT, 109 participants), an absolute risk difference of -2% (95% CI -4% to 8%). The mean function score at 12 months postoperatively with usual care was 77 on a 100-point scale (lower score represents better function) and was no different with preoperative education (0; 95% CI -5.63 to 5.63; 1 RCT, 109 participants), an absolute risk difference of 0% (95% CI -6% to 6%). The mean health-related quality of life score at 12 months postoperatively with usual care was 41 on a 100-point scale (lower score represents worse quality of life) and was 3 points lower with preoperative education (95% CI -6.38 to 0.38; 1 RCT, 109 participants), an absolute risk difference of -3% (95% CI -6% to 1%). The number of people reporting adverse events, such as infection and deep vein thrombosis, did not differ between groups (18% (11/60) reported events with usual care versus 13% (7/55) with preoperative education; RR 0.69; 95% CI 0.29 to 1.66; 1 RCT, 115 participants), an absolute risk difference of -6% (-19% to 8%). Global assessment of treatment success, postoperative anxiety and re-operation rates were not reported. Although preoperative education is embedded in the consent process, we are unsure if it offers benefits over usual care in terms of reducing anxiety, or in surgical outcomes, such as pain, function and adverse events. Preoperative education may represent a useful adjunct, with low risk of undesirable effects, particularly in certain patients, for example people with depression, anxiety or unrealistic expectations, who may respond well to preoperative education that is stratified according to their physical, psychological and social need.

Does the instillation of normal saline before suctioning reduce the incidence of ventilator-associated pneumonia in intubated and ventilated adults? Randomised, controlled trial with blinded outcome assessment. The medical/surgical intensive care unit of a tertiary oncology hospital in Brazil. Adults expected to require at least 72 hours of mechanical ventilation via an endotracheal or tracheostomy tube. Previous ventilation within the past month and contraindications to bronchoscopy were exclusion criteria. Randomisation of 262 participants allotted 130 to the intervention group and 132 to a control group. Closed tracheal suction systems with heat and moisture exchangers were used with both groups and were changed regularly. All patients were nursed with backrest elevation to 45 degrees. medical or nursing staff, who were blinded to group allocations, requested suctioning when any of the following occurred: visible or audible secretions, ventilator-patient asynchrony, and increased peak inspiratory pressures or decreased tidal volumes attributed to secretions. Respiratory therapists performed the suctioning according to a standardised procedure that included preoxygenation. The therapists instilled 8 mL of normal saline prior to suctioning in the intervention group only. The primary outcome was the incidence of ventilator-associated pneumonia (VAP). If VAP was suspected because of radiographic evidence plus either fever, leukocytosis, or purulent secretions, a bronchoscopy with standardised lavage was performed. VAP was considered confirmed if the bacterial density of the lavage fluid exceeded 1000 colony-forming units/mL. Secondary outcome measures included time to VAP, duration of mechanical ventilation, length of stay and mortality in the intensive care unit, unscheduled ventilation circuitry changes due to secretions, and number of suctions per day. all participants completed the study. Significantly fewer participants in the saline group developed VAP (14/130) than in the control group (31/132), relative risk reduction 0.54 (95% CI 0.18 to 0.74). This indicates that one patient will avoid developing VAP for every 8 patients in which saline instillation is used. Significant benefits of saline instillation were also seen in the incidence of VAP (9 vs 21 per 1000 days of mechanical ventilation, p = 0.01) and in the time to first VAP (p = 0.02). The groups did not differ significantly on the remaining secondary outcomes. Instillation of normal saline before tracheal suctioning decreases the incidence of VAP in mechanically ventilated adults.

The use of technology could potentially improve the quality of in-home aged care and reduce staff workload. However, there is a lack of research into the digital readiness of the in-home aged care workforce. This study aimed to identify the distinct digital readiness profiles of Australian in-home aged care staff and the demographic characteristics associated with each profile. A cross-sectional study was conducted at an Australian national in-home aged care provider between May and August 2023, recruiting aged care staff from services in South Australia, Victoria and Western Australia. Data regarding participants' demographic characteristics, personal technology use, digital literacy and attitude towards using technology in in-home aged care were collected. Latent profile analysis and Fisher's exact test were conducted for data analysis. In total, 267 participants completed this study. Three digital readiness profiles (higher, medium and lower) were identified. The largest subgroup was participants with medium digital readiness (64%), followed by participants with higher digital readiness (24%) and lower digital readiness (12%), respectively. Age group (p = .003), education level (p = .03) and role (p = .009) were found to be associated with the digital readiness profile. Three distinct profiles of digital readiness were identified in the Australian in-home aged care workforce. A small but substantial proportion of the workforce had lower digital readiness and may require targeted support to improve their preparedness to use technology in delivering in-home aged care services.

Do patients with a severe ankle injury (baseline ankle function score < or = 40) do worse in the short-term than patients with a mild injury (score > 40)? Does physiotherapy intervention have more effect on patients with a severe injury compared with a mild injury in the short- or long-term? Is self-reported recovery related to ankle function score over time? Subgroup analysis of a randomised trial. 102 adults with an acute lateral ankle sprain. The experimental group received physiotherapist-supervised exercises in addition to conventional intervention. Outcomes were self-reported recovery, pain, and instability all measured on a 10-point visual analogue scale, and incidence of re-sprain. Measurements were collected at baseline, 4 and 8 weeks, 3 and 12 months. Participants with a severe injury did worse in 3 out of 7 outcomes than those with a mild injury at 4 weeks but not at 8 weeks. There was no difference in effect of physiotherapy intervention in those with a severe injury compared with a mild injury, at 8 weeks or 12 months. However, there was an effect of physiotherapy intervention in those with a severe injury in 3 out of 7 outcomes at 8 weeks. Self-reported recovery was related to ankle function score at all points in time (r = 0.48 to 0.79). The results of this study only partially support the recommendations regarding the use of the ankle function score in the 'Acute Ankle Injury' guideline of the Royal Dutch Society of Physiotherapists.

There is no consensus if a relationship exists between idiopathic congenital talipes equinovarus (CTEV) and developmental dysplasia of the hip (DDH). Our research aim was to provide a contemporary Australian population statistical relationship between DDH and idiopathic CTEV, compared to published data. We conducted a retrospective data analysis of a continuous sample of infants with idiopathic CTEV, who attended a Ponseti Clinic at Sydney Children's Hospital, born between 2010 and 2019. The prevalence of DDH requiring treatment was diagnosed utilising screening ultrasonography and compared to the most valid population data from Australia. The relative risk compared to this data was also determined. There were 250 subjects who met the inclusion criteria and had complete datasets for analysis. The prevalence of DDH in our idiopathic CTEV study population was 52.9 (95% CI 27.6-90.5) per 1000. This represents a higher prevalence rate than Western Australian and South Australian datasets, with 9.5 (95% CI 8.9-10.1) and 5.0 (95% CI 4.6-5.5) per 1000, respectively. The relative risk of DDH in our idiopathic CTEV study population was 5.59 (95% CI 3.21-9.73, p&#x2009;<&#x2009;0.0001) and 10.50 (95% CI 6.01-18.34, p&#x2009;<&#x2009;0.0001), compared to Western Australian and South Australian population datasets, respectively. Our study findings support a positive correlation between idiopathic CTEV and DDH. The relative risk of DDH in the idiopathic CTEV population is 5-10 times higher than the general Australian population. When selective hip ultrasound screening is used, we believe idiopathic CTEV should be considered a risk factor for DDH.

Does the PEDro scale measure only one construct ie, the methodological quality of clinical trials? What is the hierarchy of items of the PEDro scale from least to most adhered to? Is there any effect of year of publication of trials on item adherence? Are PEDro scale ordinal scores equivalent to interval data? Rasch analysis of two independent samples of 100 clinical trials from the PEDro database scored using the PEDro scale. Both samples of PEDro data showed fit to the Rasch model with no item misfit. The PEDro scale item hierarchy was the same in both samples, ranging from the most adhered to item random allocation, to the least adhered to item therapist blinding. There was no differential item functioning by year of publication. Original PEDro ordinal scores were highly correlated with transformed PEDro interval scores (r = 0.99). The PEDro scale is a valid measure of the methodological quality of clinical trials. It is valid to sum PEDro scale item scores to obtain a total score that can be treated as interval level measurement and subjected to parametric statistical analysis.

What predicts short - and medium term activity limitation in people after ankle fracture? Inception cohort observational study. Adults with ankle fracture recruited within days following cast removal from physiotherapy departments of teaching hospital in Sydney, Australia. The predictive value of variables that were injury-related (fracture management, fracture severity, angle of the ankle during cast immobilisation, and time from cast removal to baseline) and performance-related (activity limitation, pain, mobility and dorsiflexion range of motion measured soon after cast removal) were examined in one dataset (n = 150) using univariate linear regression. Significant variables (p <or = 0.20) were further examined with a multivariate linear model. A clinical prediction rule was derived then validated using data from an independent dataset (n = 94). Fracture management, fracture severity, baseline activity limitation, pain, mobility and dorsiflexion had significant but weak univariate associations with activity limitation. Only pain and dorsiflexion range of motion contributed independently to the clinical prediction rule. When applied to the validation data, the rule explained 12% of the short-term and 9% of the medium-term variance in activity limitation. Performance-related variables were stronger predictors than injury-related variables. A clinical prediction rule consisting of pain and dorsiflexion range of motion explained a small amount of variance in short- and medium-term activity limitation, suggesting that it may be appropriate to identify people with high levels of pain and restricted dorsiflexion after ankle fracture and target intervention accordingly.

Allied health professionals in residential aged care facilities (RACFs) make important contributions to the physical and mental wellbeing of residents. Yet to date, health services research in RACFs has focused almost exclusively on nursing disciplines. This review aims to synthesise the current evidence on allied health services in RACF; specifically, how therapy-based allied health is delivered, what factors impact the quantity delivered, and the impact of services on resident outcomes and care quality. Empirical peer-reviewed and grey literature focusing on allied health service delivery in RACFs from the past decade was identified through systematic searches of four databases and over 200 targeted website searches. Information on how allied health delivered, factors impacting service delivery, and impact on resident outcomes were extracted. The quality of included studies was appraised using the Mixed Methods Appraisal Tool (MMAT) and the AACODS (Authority, Accuracy, Coverage, Objectivity, Date, Significance) checklist. Twenty-eight unique studies were included in this review; 26 peer-reviewed and two grey literature studies. Sixteen studies discussed occupational therapy and 15 discussed physiotherapy, less commonly studied professional groups included dieticians (n&#x2009;=&#x2009;9), allied health assistants (n&#x2009;=&#x2009;9), and social workers (n&#x2009;=&#x2009;6). Thirteen studies were assigned a 100% quality rating. Levels of allied health service provision were generally low and varied. Five studies examined the association between system level factors and allied health service provision, and seven studies examined facility level factors and service provision. Higher levels of allied health provision or access to allied health services, specifically physiotherapy, occupational therapy, and nutrition, were associated with reduced falls with injury, improved care quality, activities of daily living scores, nutritional status, and meal satisfaction in five studies. Evidence on how allied health is delivered in RACFs, and its impact on resident health outcomes, is lacking globally. While there are some indications of positive associations between allied health staffing and resident outcomes and experiences, health systems and researchers will need commitment to consistent allied health data collection and health services research funding in the future to accurately determine how allied health is delivered in RACFs and its impact on resident wellbeing.

Does an eight-week exercise program reduce the intensity and prevalence of low back pain in 12-13 year old children? Does it decrease the childhood physical risk factors for low back pain and promote a sense of well-being? Randomised trial with concealed allocation and assessor blinding. Seventy-two 12-13 year old children, who had complained of low back pain in the past three months. The experimental group completed eight exercise classes of 40-45 minutes duration over eight weeks conducted by a physiotherapist, whilst the control group received no intervention. The primary outcome was pain intensity measured on a 10-cm visual analogue scale. Secondary outcomes included 3-month prevalence of pain, childhood physical risk factors for low back pain, and sense of well-being. Measures were taken at baseline (Month 0), post-intervention (Month 3), and three months later (Month 6). Pain intensity over the past month had decreased by 2.2 cm (95% CI 1.0 to 3.5) more for the experimental group than the control group at Month 3 and was still 2.0 cm (95% CI 0.5 to 3.5) less than the control group at Month 6. The absolute risk reduction for 3-month prevalence in low back pain in the experimental group was 24% (95% CI 4 to 41) compared with the control group at Month 3, and 40% (95% CI 18 to 57) at Month 6. There were also statistically-significant between-group differences in neural mobility. Exercise is effective in reducing the intensity and prevalence of low back pain in children. Clinical trials NCT00786864.

Are volunteered and endorsed descriptors of recalled breathlessness consistent with descriptors of exercise-induced breathlessness? Are volunteered and endorsed descriptors of exercise-induced breathlessness consistent? Within-participant, repeated measures, experimental study. 57 people with symptomatic chronic respiratory disease aged 71 years. There were three conditions. The first was recalled breathlessness. Two conditions of exercise-induced breathlessness were created by getting the participants to undertake the 6-min Walk Test twice (breathlessness 1 and 2). Descriptors of breathlessness were volunteered (where participants' used their own words) or endorsed (from a pre-existing list of 15 breathlessness statements). Emotive descriptors made up 65% of recalled descriptors compared with 11% of exercise-induced descriptors, whereas physical descriptors made up 35% of recalled descriptors compared with 89% of exercise-induced descriptors. Of the 237 potential language pairs volunteered to describe recalled and exercise-induced breathlessness 1, only 27 (11%) were identical whereas of the 171 potential language pairs endorsed as describing recalled and exercise-induced breathlessness 1, 66 (39%) were identical. Of the 175 potential language pairs of descriptors volunteered to describe exercise-induced breathlessness 1 and 2, 72 (41%) were identical whereas of the 153 potential language pairs endorsed as describing exercise-induced breathlessness 1 and 2, 71 (46%) were identical. The language used to describe exercise-induced breathlessness immediately after two walking challenges was similar. However, descriptions of recalled breathlessness did not consistently match descriptions of exercise-induced breathlessness, which may reflect the different contexts under which breathlessness was recalled and induced.

Does health locus of control predict the smallest worthwhile effect of motor control exercise or spinal manipulative therapy when adjusted for severity of pain? Cross-sectional observational study. 86 people with non-specific low back pain who had not yet commenced physiotherapy intervention. Predictors were severity of pain measured over the last 7 days using an 11-point scale from 0 to 10, and external and internal health loci of control measured using Form C of the Multidimensional Health Locus of Control scale. The outcome of interest was smallest worthwhile effect which was measured in terms of the percentage perceived change necessary to make two evidence-based physiotherapy interventions for non-specific low back pain (motor control exercise and spinal manipulative therapy) worthwhile. Data were collected before intervention commenced. Multivariate analysis showed that when adjusted for pain and internal locus of control, external locus of control predicted the smallest worthwhile effect for motor control exercise (B 0.79; CI 0.10 to 1.48), explaining 0.07 of the variance. None of the predictors significantly predicted the smallest worthwhile effect for spinal manipulative therapy. Patients with low back pain who have externalised beliefs and agree more strongly with the notion that others are responsible for their condition report higher estimates of smallest worthwhile effect of an active intervention such as motor control exercise than patients who do not have externalised beliefs.

Can the risk of developing postoperative pulmonary complications be predicted after upper abdominal surgery? Prospective observational study. 268 consecutive patients undergoing elective upper abdominal surgery who received standardised pre- and postoperative prophylactic respiratory physiotherapy. Predictors were 17 preoperative and intraoperative risk factors. A postoperative pulmonary complication was diagnosed when four or more of the following criteria were present: radiological evidence of collapse/consolidation, temperature > 38 degrees C, oxyhaemoglobin saturation < 90%, abnormal sputum production, sputum culture indicating infection, raised white cell count, abnormal auscultation findings, or physician's diagnosis of pulmonary complication. 35 participants (13%) developed postoperative pulmonary complications. Five risk factors predicted postoperative pulmonary complications: duration of anaesthesia (OR 4.3, 95% CI 1.7 to 10.8); surgical category (OR 2.3, 95% CI 1.1 to 4.7); current smoking (OR 2.1, 95% CI 1.0 to 4.5); respiratory co-morbidity (OR 2.1, 95% CI 1.0 to 4.4); and predicted maximal oxygen uptake (OR 2.0, 95% CI 1.0 to 4.3). A clinical rule for predicting the development of postoperative pulmonary complications predicted 82% of participants who developed complications. The odds of high risk participants developing pulmonary complications were 8.4 (95% CI 3.3 to 21.3) times that of low risk participants. This clinical rule for predicting the risk of developing postoperative pulmonary complications from five risk factors may prove useful in prioritising postoperative respiratory physiotherapy. Further research is needed to validate the rule.

To identify factors that health and allied health practitioners consider central to excellence in residential aged care facilities (RACFs) with the objective of supporting improvements in monitoring, accountability and service delivery within the sector. In a qualitative, exploratory designed study, interviews were undertaken with seventeen participants from 10 health and allied health disciplines (general practice, dentistry, pharmacy, psychiatry, psychology, neuropsychology, physiotherapy, speech pathology, occupational therapy and palliative care) with experience of working in Victorian RACFs. The interviews focused on how practitioners perceived excellence within RACFs. Data were analysed thematically. Thematic analysis yielded five themes, which correspond with different dimensions or ways of understanding excellence, including resident well-being, residences as a true home, good practice models, effective management and skilled staff, and unmet needs. Under each of these themes, participants referred to issues closely related to the concerns of their particular professions as well as those more general in nature. The diversity in issues to which participants drew attention highlights the importance of obtaining the perspectives of a broad range of practitioners providing services to RACF residents to achieving excellence in the sector. Commonalities in their responses indicate the potential for a greater level of collaboration among the health and allied health professions.

How much of an effect do five common physiotherapy interventions need to have for patients with low back pain to perceive they are worth their cost, discomfort, risk, and incovenience? Are there any differences between the interventions? Do specific characteristics of people with low back pain predict the smallest important difference? Cross-sectional, observational study. 77 patients with non-specific low back pain who had not yet commenced physiotherapy intervention. The smallest worthwhile effect was measured in terms of global perceived change (0 to 4) and percentage perceived change. Participants perceived that intervention would have to make them 'much better', which corresponded to 1.7 (SD 0.7) on the 4-point scale, or improve their symptoms by 42% (SD 23), to make it worthwhile. There was little distinction made between interventions, regardless of whether smallest worthwhile effects were quantified as global perceived change (p = 0.09) or percentage perceived change (p = 1.00). Severity of symptoms independently (p = 0.01) predicted percentage perceived change explaining 9% of the variance, so that for each increase in severity of symptoms of 1 point out of 10 there was an increase of 4% in the percentage perceived change that participants considered would make intervention worthwhile. Typically people with low back pain feel that physiotherapy intervention must reduce their symptoms by 42%, or make them feel 'much better' for intervention to be worthwhile.

Educational initiatives can improve care delivery and the experience of living in residential aged care for people with dementia. This review aimed to determine the impact of nurse and care staff education on measures of functional ability and quality of life for older people with dementia living in care homes. Systematic review. Search of on-line databases in English between January 2000 and January 2017. Three reviewers used data extraction and critical appraisal tools of the Joanna Briggs Institute to determine methodological quality of research. Thirty-two studies met the initial inclusion criteria and 13 were retrieved for full appraisal. There was limited impact of nurse and care staff education on residents' agitation, anxiety, mood and quality of life. The most consistent improvement in functional ability due to education may be in the execution of activities of daily living. More successful programs included multi-faceted components (e.g. hands on support, clinical auditing) in conjunction with didactic teaching. There is a need for more rigorous and well-designed studies to test interventions.

Does a graded exercise program emphasising lumbar stabilising exercises reduce pain and disability at 12 months, compared with a walking program, for patients with recurrent low back pain? Randomised controlled trial. A single private physiotherapy clinic in Sweden. 71 patients with recurrent mechanical low back pain (>8 weeks duration, with at least 1 pain-free period during the past year) and without leg pain were allocated to one of two groups, using a concealed allocation process. The groups were comparable at baseline with respect to age, sex, proportion of participants who had sought care for back pain, and pain duration (approximately 10 years). The graded exercise program and the walking program were both 8 weeks' duration. The exercise program was individually supervised by a physiotherapist weekly for 45 minutes. In the walking program, patients met with a physiotherapist for 45 minutes in week 1 and again in week 8. The exercise program consisted primarily of stabilising exercises for the lumbar spine, commencing with re-learning activation of the transversus abdominis and multifidus muscles, with assistance of a pressure biofeedback cuff. Exercises were progressed according to clinical judgement, pain levels, and movement control and quality. Progression entailed incorporation of muscle activation in upright positions and during functional activities. Continued implementation of the exercises in daily life was encouraged. The reference group were instructed to walk for 30 minutes daily at the fastest pace that did not aggravate pain. Walking compliance was monitored with a self-completed daily diary. The primary outcomes were perceived pain and disability at 12 months, measured by self-completed questionnaires returned by post. Disability was measured with the Oswestry Disability Questionnaire (scale 0-100, where 100 = maximum disability). Pain was measured with 100-mm visual analogue scale (where 100 = worst pain imaginable). At 12 months 86% of patients were followed up. At this time there was no clinically-important difference between the groups with respect to median (IQR) change in pain: exercise group -12 (-34 to -3); walking group -12 (-22 to 0). For disability at 12 months, the between-group difference in median scores was 8 on the Oswestry score: exercise group -10 (-20 to -2); walking group -2 (-12 to 2). Lumbar stabilising exercises appear to have a similar effect on pain and disability for patients with recurrent low back pain as a daily walking program.

What baseline characteristics predict good or poor quality of life among community-dwelling seniors undertaking a three-month progressive resistance exercise program? A prospective cohort observational study. 63 Japanese men and women over 65 years with mild disability. Health-related quality of life was measured using the Short Form 36. Predictors included age, sex, body mass index, presence of chronic diseases, frequency of exercise, number of falls, and activity limitations measured before undertaking the exercise program. The presence of diabetes negatively predicted a good outcome (OR 0.20, 95% CI 0.05 to 0.88) and positively predicted a poor outcome (OR 4.40, 95% CI 1.21 to 18.86) when adjusted for age, sex and body mass index. The accuracy of the prediction of a good outcome was 1.25 (LR+) and 0.44 (LR-). The accuracy of the prediction of a poor outcome was 7.15 (LR+) and 0.87 (LR-). The quality of life improved in a community-dwelling elderly population with mild disability who undertook a three-month group-based progressive resistance exercise program. However, those with diabetes mellitus were more likely to experience decreased quality of life. Therefore, health care providers need to monitor carefully participants with this disease who are undertaking progressive resistance exercise.