School of Clinical Sciences

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https://hdl.handle.net/10292/1241

The School of Clinical Sciences plays an important role in specialist teaching and research conducted by its academic staff and postgraduate students. This places AUT students at the forefront of much of the ground-breaking research undertaken in New Zealand, especially in the fields of Midwifery, Nursing, Occupational Therapy, Oral Health, Paramedicine, Physiotherapy, Podiatry.

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30-year trends in stroke rates and outcome in Auckland, New Zealand (1981-2012): a multi-ethnic population-based series of studies
(PLoS One, 2015) Feigin, VL; Krishnamurthi, RV; Barker-Collo, S; McPherson, KM; Barber, PA; Parag, V; Arroll, B; Bennett, DA; Tobias, M; Jones, A; Witt, E; Brown, P; Abbott, M; Bhattacharjee, R; Rush, E; Suh, FM; Theadom, A; Rathnasabapathy, Y; Te Ao, B; Parmar, PG; Anderson, C; Bonita, R; ARCOS IV Group
Insufficient data exist on population-based trends in morbidity and mortality to determine the success of prevention strategies and improvements in health care delivery in stroke. The aim of this study was to determine trends in incidence and outcome (1-year mortality, 28-day case-fatality) in relation to management and risk factors for stroke in the multi-ethnic population of Auckland, New Zealand (NZ) over 30-years.
A description of the methodology used in an overview of reviews to evaluate evidence on the treatment, harms, diagnosis/ classification, prognosis and outcomes used in the management of neck pain
(Bentham Open, 2013) Santaguida, L; Keshavarz, H; Carlesso, L; Lomoton, M; Gross, A; MacDermid, J; Walton, D; Reid, Duncan Arthur
Background: Neck Pain (NP) is a common musculoskeletal disorder and the literature provides conflicting evidence about its management. Objective: To describe the methodology used to conduct an overview of reviews (OvR) and to characterize the distribution and risk of bias profiles across the evidence for all areas of NP management. Methods: Standard systematic review (SR) methodology was employed. MEDLINE, CINAHL, EMBASE, ILC, Cochrane CENTRAL, and LILACS were searched from 2000 to March 2012; Narrative and SR and clinical practice guidelines (CPG) evaluating the efficacy of treatment (benefits and harms), diagnosis/classification, prognosis, and outcomes were eligible. For treatment, articles were limited to SRs from 2005 forward. Risk of bias of SR was assessed with the AMSTAR; the AGREE II was used to critically appraise the CPGs. Results: From 2476 articles, 508 were eligible for full text screening. A total of 341 articles were included. Treatment (n=117) had the greatest yield. Other clinical areas had less literature (diagnosis=54, prognosis=16, outcomes=27, harms=16). There were no SR for classification and narrative reviews were problematic for this topic. There was great overlap across different databases within each clinical area except for those for outcome measures. Risk of bias assessment using the AMSTAR of eligible SRs showed a similar trend across different clinical areas. Conclusion: A summary of methods used to review the literature in five clinical areas of NP management have been described. The challenges of selecting and synthesizing eligible articles in an OvR required customized solutions across different areas of clinical focus.
A Heideggerian Analysis of Good Care in an Acute Hospital Setting: Insights from Healthcare Workers, Patients and Families.
(Wiley, 2023-05-17) Dewar, Jan; Cook, Catherine; Smythe, Elizabeth; Spence, Deborah
This study articulates the relational constituents of good care beyond techno-rational competence. Neoliberal healthcare means that notions of care are readily commodified and reduced to quantifiable assessments and checklists. This novel research investigated accounts of good care provided by nursing, medical, allied and auxiliary staff. The Heideggerian phenomenological study was undertaken in acute medical-surgical wards, investigating the contextual, communicative nature of care. The study involved interviews with 17 participants: 3 previous patients, 3 family members and 11 staff. Data were analysed iteratively, dwelling with stories and writing and rewriting to surface the phenomenality of good care. The data set highlighted the following essential constituents: authentic care: caring encompassing solicitude (fürsorge); impromptu care: caring beyond role category; sustained care: caring beyond specialist parameters; attuned care: caring encompassing family and culture; and insightful care: caring beyond assessment and diagnosis. The findings are clinically significant because they indicate the importance of nurse leaders and educators harnessing the potential capacity of all healthcare workers to participate in good care. Healthcare workers reported that participating in or witnessing good care was uplifting and added meaning to their work, contributing to a sense of shared humanity.
A Historical Narrative of the Development of Midwifery Education in Indonesia
(Elsevier, 2022-06-20) Adnani, Qorinah Estiningtyas Sakilah; Gilkison, Andrea; McAra-Couper, Judith
AIM: To describe the history of midwifery education, present the current education programmes and explore the ways that have been undertaken to advance the midwifery profession in Indonesia. METHODS: Historical and contemporary government documents were reviewed. FINDINGS: The history of midwifery education in Indonesia shows a complex picture during and since colonisation with government, education institutes and association proposing different ways in which midwives were to be educated. Advocacy from the midwifery profession in Indonesia meant increasingly it is midwives who are determining how midwifery education is provided. Recent initiatives have resulted in a diploma, advanced diploma, bachelor's degree, and a master's degree in midwifery. The work of the midwifery profession advocating for midwifery education culminated in the Midwifery Act 2019. These changes in this Act will ensure that midwifery education meets the needs of women and their families but also lead to competent midwives who have the knowledge and skills to provide midwifery services at all levels of health provision. The history of midwifery in Indonesia illustrates the importance of the ICM pillars of association, regulation, and education. CONCLUSION: The history of midwifery education in Indonesia shows that for too long midwifery education was decided, determined and even regulated by authorities and disciplines other than midwifery. However, when the midwifery association and regulation inform and regulate midwifery education then there is an opportunity to provide care that will make a difference in outcomes for women and their families. The historical analysis of the story of Indonesia midwifery gives insight into what is required for quality education.
A new paradigm for primary prevention strategy in people with elevated risk of stroke
(International Journal of Stroke published by John Wiley & Sons Ltd on behalf of World Stroke Organization, 2014-07) Feigin, VL; Norrving, B
Existing methods of primary stroke prevention are not sufficiently effective. Based on the recently developed Stroke Riskometer app, a new 'mass-elevated risk stroke/cardiovascular disease prevention' approach as an addition to the currently adopted absolute risk stroke/cardiovascular disease prevention approach is being advocated. We believe this approach is far more appealing to the individuals concerned and could be as efficient as the conventional population-based approach because it allows identification and engagement in prevention of all individuals who are at an increased (even slightly increased) risk of stroke and cardiovascular disease. The key novelty of this approach is twofold. First, it utilizes modern far-reaching mobile technologies, allowing individuals to calculate their absolute risk of stroke within the next 5 to 10 years and to compare their risk with those of the same age and gender without risk factors. Second, it employs self-management strategies to engage the person concerned in stroke/cardiovascular disease prevention, which is tailored to the person's individual risk profile. Preventative strategies similar to the Stroke Riskometer could be developed for other non-communicable disorders for which reliable predictive models and preventative recommendations exist. This would help reduce the burden of non-communicable disorders worldwide.
A phenomenological study of occupational engagement in recovery from mental illness
(SAGE, 2012) Sutton, D; Hocking, C; Smythe, L
This study aimed to uncover the meaning of occupation for 13 people who self identified as being in recovery from mental illness. Recovery narratives were collected from the participants in a series of open ended conversational interviews that were recorded and transcribed. The interview transcripts were analysed using phenomenological and hermeneutic approaches, with a focus on participants’ descriptions of engagement in everyday occupations. A range of experiences were evident, from complete disengagement to complete absorption in occupations. Participants described significant shifts in their experience of time, space, body and other people while in different modes of occupation and these were captured under the themes of ‘non-doing’, ‘half-doing’, ‘engaged doing’ and ‘absorbed doing’. Each mode had the potential to support recovery by creating opportunities for participants to reconnect with aspects of their being-in-the-world. The findings highlight the dynamics at play in different modes of occupation and suggest that all forms of engagement, including disengagement, can be significant in the recovery process. A greater understanding of the dynamics of occupation for people experiencing mental illness will enable carers and mental health services to more effectively support people in their recovery.
A postoperative shoulder exercise program improves function and decreases pain following open thoracotomy: a randomised trial
(Australian Physiotherapy Association, 2010) Reeve, J; Stiller, K; Nicol, K; McPherson, KM; Birch, P; Gordon, IR; Denehy, L
QUESTION: Does a postoperative physiotherapy exercise program incorporating shoulder exercises improve shoulder function, pain, range of motion, muscle strength, and health-related quality of life in patients undergoing elective pulmonary resection via open thoracotomy? DESIGN: Randomised trial with concealed allocation, assessor blinding, and intention-to-treat analysis. PARTICIPANTS: 76 patients who underwent pulmonary resection via open thoracotomy. INTERVENTION: All participants received standard medical and nursing care involving a clinical pathway. The experimental group also received physiotherapy interventions that included daily supervised, progressive exercises until discharge and a postoperative exercise booklet on discharge. OUTCOME MEASURES: Preoperatively and up to 3 months postoperatively pain was measured with a numerical rating scale, shoulder function with the Shoulder Pain and Disability Index, and quality of life with the Short Form-36. Shoulder range of motion and muscle strength were measured in a subgroup. RESULTS: The experimental group had 1.3 units (95% CI 0.3 to 2.2) less shoulder pain (scored /10) and 2.2 units (95% CI 0.2 to 4.3) less total pain (scored /30) at discharge, and 7.6% (95% CI 1.7 to 13.6) better function at 3 months. The Short Form-36 physical component score was 4.8 points (95% CI -0.3 to 10.0) better for the experimental group than the control group at 3 months. Differences between groups in all range of motion and strength measures were small and statistically non-significant. CONCLUSION: A physiotherapist-directed postoperative exercise program resulted in significant benefits in pain and shoulder function over usual care for patients following open thoracotomy.
A Process for Assessing the Reliability and Validity of Questions for Use in Online Surveys: Exploring How Communication Technology Is Used Between Lead Maternity Carer Midwives and Pregnant People in Aotearoa New Zealand
(SAGE Publishing, 2023-01-22) Wakelin, KJ; McAra-Couper, J; Fleming, T; Erlam, GD
There is growing use of communication technology in Aotearoa New Zealand. How it is used between midwives and pregnant people is unknown. Surveys are ideal for gathering information when there is little known of a phenomenon. Aligning questions to a midwifery informed framework provides an innovate approach to explore this issue. To assess reliability and validity of questions for two online surveys using a tool created for an expert advisory group of midwives with experience in survey design and midwifery practice. An innovative approach is taken to validate questions for two online surveys using an expert advisory group of seven midwifery academic researchers with experience in both quantitative and qualitative research designs, and midwifery practice. The group were asked to rate items using a 4-point rating scale ranging from strongly agree to strongly disagree. Analysis of the scoring was undertaken using Content Validity Index, Cronbach’s alpha coefficient and review of comments by the group. Quantitative scoring of both survey instruments were valid and reliable. The overall Content Validity Index score was 0.92 (midwives) and 0.93 (pregnant people). The overall Cronbach’s alpha coefficient score was.78 (midwives) and.83 (pregnant people). Qualitative comments reinforced the validity and reliability of survey questions. An innovative approach was taken in assessing the reliability and validity of two online surveys using a midwifery expert advisory group and a midwifery framework to situate the surveys within a midwifery body of expertise and knowledge. The comments made by midwifery experts provided an extra layer in the validation of survey instruments using Content Validity Index and Cronbach’s alpha coefficient scoring. Creating a tool for validating questions developed by midwives for an expert group of midwives recognises the potential patriarchal roots of knowledge production and dissemination and enables marginalised voices to be heard.
A service delivery model of Constraint-Induced Movement Therapy utilising clinical education
(World Confederation for Physical Therapy, 2011) Binns, E; Taylor, D
Purpose: To use a unique method of service delivery for Constraint-Induced Movement Therapy Relevance: Despite strong evidence of effectiveness Constraint-Induced Movement Therapy is not a readily available treatment option in New Zealand post-stroke. There is no hard evidence to provide a rationale for the lack of this treatment option however, anecdotally the amount of therapist time required and therefore the amount of human resource consumed deems this treatment financially prohibitive. Participants: A self-selected group of chronic stroke patients (n=6, time since stroke ranged from 22 to 84 months). Methods: A Constraint-Induced Movement Therapy programme was delivered five hours a day for five days a week for 2 two weeks. as per the original protocol described by Wolf and colleagues
A Six-Month Telerehabilitation Programme Delivered via Readily Accessible Technology Is Acceptable to People Following Stroke: A Qualitative Study
(Elsevier BV, 2023-05-19) Saywell, Nicola L; Mudge, Suzie; Kayes, Nicola M; Stavric, Verna; Taylor, Denise
Objective To explore the experiences of participants during a six-month, post-stroke telerehabilitation programme. Design A qualitative descriptive study to investigate participant experiences of ACTIV (Augmented Community Telerehabilitation Intervention), a six-month tailored exercise programme delivered by physiotherapists primarily using readily accessible telecommunication technology. Semi-structured, in-depth interviews were used to collect data, which were analysed using thematic analysis. Setting Interviews conducted in participants’ homes or a community facility. Participants Participants were eligible if they had a stroke in the previous 18 months and had participated in ACTIV. Results Twenty-one participants were interviewed. Four key themes were constructed from the data: 1. ‘ACTIV was not what I call physio’ (it differed from participants’ expectations of physiotherapy, but they reported many positive aspects to the programme). 2. ‘There’s somebody there’ (ongoing support from the physiotherapists helped participants find strategies to continue improving). 3. ‘Making progress’ (in the face of barriers, small improvements were valued). 4. ‘What I really want’ (participant goals were frequently more general than therapy goals and involved progress towards getting back to ‘normal’). Conclusions Although ACTIV was not what participants expected from physiotherapy, the majority found contact from a physiotherapist reduced the feeling of being left to struggle alone. Most participants found a programme with minimal face-to-face contact augmented by phone calls and encouraging text messages to be helpful and acceptable.
A Snapshot of the Counselling and Psychotherapy Workforce in Australia in 2020: Underutilised and Poorly Remunerated, yet Highly Qualified and Desperately Needed
(Psychotherapy and Counselling Federation of Australia, 2021-11-01) Bloch-Atefi, Alexandra; Day, Elizabeth; Snell, Tristan; O'Neill, Gina
The aim of the 2020 workforce survey was to profile professionals affiliated with the Psychotherapy and Counselling Federation of Australia (PACFA) to inform future policy and service planning. PACFA is a national peak body for Australian counsellors and psychotherapists, representing 3,500 members across all states and territories. This study builds on previous workforce studies, the first of which was conducted in 2004. An online questionnaire was circulated to PACFA members covering participants’ demographics, qualifications, employment, sources of client referrals, client groups and presentations, along with the impact of the COVID-19 pandemic. Reflecting previous findings, participants predominantly identified as female, as coming from Australian or English backgrounds, and as being located in or around major cities. Notably, a higher proportion of counsellors and psychotherapists than psychologists and psychiatrists (who also have qualifications as counsellors or psychotherapists) were found in regional and rural Australia. The shortage of mental health services in Australia, especially in remote areas, and the desire for more working hours among over one quarter of registered practitioners, mean this workforce needs to be far better utilised to meet public demand and reduce health inequities for people in regional, rural, and remote Australia. Government recognition of registered counsellors and practitioners through Medicare’s Better Access subsidised sessions would significantly remedy the shortage of mental health services.
A Study Protocol for a Cluster-Randomised Controlled Trial of Smartphone-Activated First Responders with Ultraportable Defibrillators in Out-of-Hospital Cardiac Arrest: The First Responder Shock Trial (FIRST)
(Elsevier BV, 2023-09-01) Todd, Verity; Dicker, Bridget; Okyere, Daniel; Smith, Karen; Smith, Tony; Howie, Graham; Stub, Dion; Ray, Michael; Stewart, Ralph; Scott, Tony; Swain, Andy; Heriot, Natalie; Brett, Aroha; Mahony, Emily; Nehme, Ziad
Objective To describe the First Responder Shock Trial (FIRST), which aims to determine whether equipping frequently responding, smartphone-activated (GoodSAM) first responders with an ultraportable AED can increase 30-day survival rates in OHCA. Methods The FIRST trial is an investigator-initiated, bi-national (Victoria, Australia and New Zealand), registry-nested cluster-randomised controlled trial where the unit of randomisation is the smartphone-activated (GoodSAM) first responder. High-frequency GoodSAM responders are randomised 1:1 to receive an ultraportable, single-use AED or standard alert procedures using the GoodSAM app. The primary outcome is survival to 30 days. The secondary outcome measures (shockable rhythm, return of spontaneous circulation, event survival, and time to first shock delivery) are routinely collected by OHCA registries in both regions. The trial was registered with the Australian New Zealand Clinical Trials Registry (ANZCTR) (Registration: ACTRN12622000448741) on 22 March 2022. Results The trial started in November 2022 and the last patient is expected to be enrolled in November 2024. We aim to detect a 7% increase in the proportion of 30-day survivors, from 9% in patients attended by control responders to 16% in patients attended by responders randomised to the ultraportable AED intervention arm. With 80% power, an alpha of 0.05, a cluster size of 1.5 and a coefficient of variation for cluster sizes of 1, the sample size required to detect this difference is 714 (357 per arm). Conclusion The FIRST study will increase our understanding of the potential role of portable AED use by smartphone-activated community responders and their impact on survival outcomes.
A survey of physiotherapy on-call and emergency duty services in New Zealand
(New Zealand Society of Physiotherapists, 2003) Reeve, JC
Physiotherapists working in hospitals are commonly required to undertake emergency on-call duties. Concerns from within the profession about the quality of on-call services have been expressed. The aims of this study were to audit oncall practice in New Zealand, identify variations in service provision and ascertain physiotherapists’ concerns in providing these services. A postal questionnaire was distributed to senior physiotherapists in all New Zealand hospitals expected to provide physiotherapy emergency on-call duties (n = 38). A response rate of 97.4% (n=37) was obtained of which 33 respondents provided on-call physiotherapy. Assessment of competency to undertake on-call duties, agreed standards of practice, the use of protocols, training and support provided were ascertained. Respondents were asked to highlight their most important concerns in the provision of their on-call service. These were found to be maintenance of competency, service provision, training and resource issues. This study demonstrates wide variations in the practice and provision of on-call duties by physiotherapists and highlights common concerns in the provision of these services. Strategies to diminish these concerns require further consideration at both national and local levels.
A Systematic Review of Fear of Falling and Related Constructs After Hip Fracture: Prevalence, Measurement, Associations with Physical Function, and Interventions
(Springer Science and Business Media LLC, 2023-06-23) Gadhvi, Chandini; Bean, Debbie; Rice, David
Background Hip fracture is a common and debilitating injury amongst older adults. Fear of falling (FoF) and related constructs (balance confidence and falls efficacy) may impede rehabilitation after hip fracture. An updated systematic review to synthesize existing literature on FoF after hip fracture is needed. This review focussed on four research questions: In the hip fracture population: (1) What is the prevalence of FoF?; (2) What FoF assessment tools are validated? (3) What is the relationship between FoF and physical function?; (4) What interventions are effective for reducing FoF? Methods A systematic search was undertaken in EBSCO Health, Scopus and PsychINFO in January 2021 (and updated December 2022) for articles on FoF after hip fracture. Data in relation to each research question was extracted and analysed. The quality of the studies was appraised using the ‘Risk of Bias Tool for Prevalence Studies’, ‘COSMIN Risk of Bias checklist for Patient-reported outcome measures’, modified version of the ‘Appraisal Tool for Cross-sectional studies’, and the ‘Cochrane Risk of Bias 2’ tools for each research question, respectively. Results 36 studies (37 articles) with 5099 participants were included (mean age 80.2 years and average 78% female). Prevalence rates for FoF after hip fracture ranged between 22.5% and 100%, and prevalence tended to decrease as time progressed post hip fracture. The ‘Falls Efficacy Scale – International’ (FES-I) and ‘Fear of Falling Questionnaire – Revised’ (FFQ-R) were found to be reliable, internally consistent, and valid tools in hip fracture patients. FoF after hip fracture was consistently associated with measures of physical function including balance, gait speed, composite physical performance measures and self-reported function. Ten of 14 intervention studies were considered high risk of bias. Exercise-based interventions with or without a psychological component were not effective in reducing FoF after hip fracture compared to a control condition. Conclusion FoF is prevalent after hip fracture and is consistently associated with poorer physical function. Only two instruments (FES-I and FFQ-R) have been validated for measuring FoF in the hip fracture population. However, there remains a need for larger, higher quality randomised controlled trials targeting FoF after hip fracture in order to guide clinical practice.
A Trojan Horse for Positivism? A Critique of Mixed Methods Research
(AUT University; Lippincott Williams & Wilkins, 2007) Giddings, L; Grant, B
Mixed methods research is captured by a pragmatically inflected form of postpositivism. Although it passes for an alternative methodological movement that purports to breach the divide between qualitative and quantitative research, most mixed methods studies favor the forms of analysis and truth finding associated with positivism. We anticipate a move away from exploring more philosophical questions or undertaking modes of enquiry that challenge the status quo. At the same time, we recognize that mixed methods research offers particular strengths and that, although it serves as a Trojan Horse for positivism, it may productively carry other paradigmatic passengers.
Accessing Rural Health Services: Results From a Qualitative Narrative Gerontological Study
(Australian Council on the Ageing, 2020) Neville, S; Napier, S; Adams, J; Shannon, K
OBJECTIVE: Explore how older adults' talk about accessing rural community health services. METHODS: A qualitative narrative gerontological approach explored issues related to accessing health services in their community. Semi-structured digitally recorded individual interviews were undertaken with 32 community-dwelling older people aged between 75 and 93 years. A narrative data analytic process was undertaken. The COnsolidated criteria for REporting Qualitative research guidelines were followed to ensure rigour in this study. RESULTS: Three collective narratives resulted from the data analytic process: (a) "accessing local health services"; (b) "accessing specialist services"; and (c) "accessing emergency services." CONCLUSIONS: Narrators identified a number of issues related to accessing rural health services. These included long waiting times, lack of continuity in care provision by doctors and difficulties accessing specialist and emergency services. Nurses were frequently cited as a reliable point of contact for these older people. Expansion of nursing roles would enhance the provision of rural health-care services.
The Accuracy and Reliability of Plantar Pressure Measurements for the Early Diagnosis of Foot Deformities in Patients Suffering from Rheumatoid Arthritis
(Insight Medical Publishing Group (imedPub), 2017-08-03)
Aim: Pedobarographic analysis may be employed to quantify foot function, however, the value of pedobarographic analysis as a diagnostic tool for the screening of recently diagnosed Rheumatoid Arthritis (RA) patients remains uncertain. The aim of this systematic review was to: a) assess the different instruments used to analyse plantar pressure; b) to report on the technical considerations associated with manual and automatic masking and c) to assess the validity together with the inter- and intraobserver reliability of pedobarographic analyses for identification of pathological profiles in patients suffering with RA. Method: Following the PRISMA guidelines, a literature search was undertaken using a variety of computerised bibliographic databases. The Quality Appraisal of Diagnostic Reliability was employed to assist in the analysis of reliability. Results: A review and analysis of the literature found only 20 papers with relevant reliability and accuracy. Conclusion: The literature concerning the validity and reliability of pedobarography in the screening for early onset foot deformities in RA patients has not been proven. Although the forefoot has been identified as a common area of the plantar surface where deformities occur in RA, there are very few studies that demonstrate any subtle changes that could forecast forefoot deformities in asymptomatic RA patients. Keywords: Accuracy; Reliability; Plantar pressure; Inflammatory arthritis; Progressive foot impairment; QAREL
Across the ditch: the collective diabetic foot assessment
(BioMed Central Ltd, 2011) Rome, K; Ihaka, B
Acting on Stroke and Noncommunicable Diseases: Preventing and Responding to Stroke to Work Towards Universal Health Coverage 2022
(NCD Alliance, Geneva, Switzerland, 2022) Feigin, VL
This policy brief, authored by NCD Alliance, World Stroke Organization and American Stroke Association, focuses on stroke as a major contributor to the increasing burden of NCDs in society and the urgent need to implement effective, affordable and widely applicable strategies to prevent and treat stroke before, during and after its occurrence. It also provides key recommendations for healthcare providers, policymakers and civil society on advocacy and implementation to improve the response to stroke and NCDs. These recommendations are based on a comprehensive approach across the stroke continuum of care as part of working towards Universal Health Coverage (UHC).
Advancing Leaders and Leadership: New Zealand Women in Respiratory Medicine
(John Wiley & sons, 2022-03-01) Yap, E; Mooney, S

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