School of Clinical Sciences - Te Kura Mātai Haumanu
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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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Recent Submissions
- ItemTargeting Exercise Intensity and Aerobic Training to Improve Outcomes in Parkinson’s Disease(Springer Science and Business Media LLC, 2024-02-07) Panassollo, TRB; Mawston, G; Taylor, D; Lord, SAerobic training is popular for people with Parkinson’s disease (PD) given its potential to improve aerobic capacity, relieve symptoms, and to stabilise disease progression. Although current evidence supports some of the assertions surrounding this view, the effect of exercise intensity on PD is currently unclear. Reasons for this include inconsistent reporting of exercise intensity, training regimes based on general guidelines rather than individualised physiological markers, poor correspondence between intended exercise intensities and training zones, and lack of awareness of autonomic disturbance in PD and its impact on training regimes and outcome. We also consider the selective effect of exercise intensity on motor symptoms, function and disease progression. We review aerobic training protocols and recent guidelines for people with PD, highlighting their limitations. Considering this, we make suggestions for a more selective and discerning approach to aerobic training programming.
- ItemA Supported Primary Health Pathway for Mild Traumatic Brain Injury: Quality Improvement Report(CSIRO Publishing, 2024-03-04) Theadom, A; Chua, J; Sintmaartensdyk, A; Kara, S; Barnes, R; Macharg, R; Leckey, E; Mirza, AIntroduction: Best-practice guidelines recommend that patients are followed-up to check if they have recovered following a mild traumatic brain injury (mTBI) and to refer to concussion services, if needed. However, in New Zealand, rates of follow-up are low and access to concussion services can be delayed. Aim: We aimed to improve rates of follow-up and access to concussion services for mTBI patients aged ≥8 years by the implementation of a supported health pathway and test its success. Methods: The pathway included a decision support tool, funded follow-up appointments, clinician training and a patient education resource. Sociodemographics, injury details and proportions of patients receiving a follow-up by type and time were extracted from the Accident Compensation Corporation (ACC) database between 18 May 22 and 30 June 23 and compared to national ACC data prior to implementation. Results: Data were extracted for 220 patients, with a mean age of 31.5 years, 51.4% female and 21.4% Māori and Pacific. There was an increase in the proportion of patients receiving a follow-up from 36% pre-implementation to 56.8% post-implementation. Sixty-three patients (28.6%) accessed a concussion service post-implementation compared to 10% pre-implementation. Time to concussion service reduced from an average of 55 (s.d. = 65.4) to 37 days (29.5). Discussion: Risk factor criteria within the decision support tool need to be weighted to improve specificity of referrals. Timing from injury to medical review in primary care needs to be considered. This quality improvement project provides preliminary evidence for implementation of a supported health care pathway for mTBI.
- ItemPreoperative Physiotherapy Prevents Postoperative Pulmonary Complications After Major Abdominal Surgery: A Meta-Analysis of Individual Patient Data(Elsevier, 2024-03-11) Boden, Ianthe; Reeve, Julie; Jernås, Anna; Denehy, Linda; Fagevik Olsén, MonikaQUESTIONS: Among patients having elective abdominal surgery, how much does preoperative physiotherapy education with breathing exercise training reduce the incidence of postoperative pulmonary complications (PPCs), hospital length of stay and 12-month mortality? How stable are the treatment effects across different PPC definitions, including pneumonia? How much do the treatment effects on PPC, hospital length of stay and mortality vary within clinically relevant subgroups? DESIGN: Individual participant-level meta-analysis (n = 800) from two randomised controlled trials analysed with multivariable regression. PARTICIPANTS: Adults undergoing major elective abdominal surgery. INTERVENTIONS: Experimental participants received a single preoperative session with a physiotherapist within 4 weeks of surgery and educated on PPC prevention with breathing exercises and early mobilisation. They were taught breathing exercises and instructed to start them immediately on waking from surgery. The control group received no preoperative or postoperative physiotherapy, or early ambulation alone. OUTCOME MEASURES: PPC, hospital length of stay and 12-month mortality. RESULTS: Participants who received preoperative physiotherapy had 47% lower odds of developing a PPC (adjusted OR 0.53, 95% CI 0.34 to 0.85). This effect was stable regardless of PPC definition. Effects were greatest in participants who smoked, were aged ≤ 45 years, had abnormal body weight, had multiple comorbidities, or were undergoing bariatric or upper gastrointestinal surgery. Participants having operations ≤ 3 hours in duration were least responsive to preoperative physiotherapy. Participants with multiple comorbidities were more likely to have a shorter hospital stay if provided with preoperative physiotherapy (adjusted MD -3.2 days, 95% CI -6.2 to -0.3). Effects on mortality were uncertain. CONCLUSION: There is strong evidence to support preoperative physiotherapy in preventing PPCs after elective abdominal surgery.
- ItemWhat Influences Patient Decision Making After Anterior Cruciate Ligament Injury in Australia: An Internet Survey(Informa UK Limited, 2024-06-08) Nasser, AM; McCambridge, AB; Verhagen, APObjectives: We aimed to understand what influences patient decision-making after ACL rupture. Methods: A survey was carried out online, targeting individuals who had experienced an ACL rupture injury. Outcomes included person(s) who influenced patient decision-making, sources of information used to assist the decision-making process and the main reasons that informed their decision to undergo ACL reconstruction surgery or rehabilitation only. Results: 174 participants (mean age 29.8 years, 53% male) met inclusion criteria, of which 144 (80%) underwent ACL reconstructive surgery and 20 (11%) completed rehabilitation alone. The most common people who influenced decisions were the orthopaedic surgeon for those who had surgery (n = 103, 84%) and the physiotherapist for those who underwent rehabilitation alone (n = 12, 75%). The most common reason for choosing ACL reconstructive surgery was to be able to return to sport (n = 100, 82%), and for rehabilitation alone, it was because they believed it would give the same result as surgical management (n = 12, 75%). Of those who had surgery, 56% (n = 67) received limited to no information on non-surgical management options. Conclusions: Many people in Australia undergo surgical reconstruction for their ACL, with limited awareness of trialling rehabilitation alone. The most influential people in a patient’s treatment decision after ACL rupture in Australia are the orthopaedic surgeon and physiotherapist.
- ItemThe Effect of Chronotropic Incompetence on Physiologic Responses During Progressive Exercise in People with Parkinson’s Disease(Springer, 2024-04-29) Benevides Panassollo, Tone Ricardo; Lord, Sue; Rashid, Usman; Taylor, Denise; Mawston, GrantPURPOSE: Heart rate (HR) response is likely to vary in people with Parkinson's disease (PD), particularly for those with chronotropic incompetence (CI). This study explores the impact of CI on HR and metabolic responses during cardiopulmonary exercise test (CPET) in people with PD, and its implications for exercise intensity prescription. METHODS: Twenty-eight participants with mild PD and seventeen healthy controls underwent CPET to identify the presence or absence of CI. HR and metabolic responses were measured at submaximal (first (VT1) and second (VT2) ventilatory thresholds), and at peak exercise. Main outcome measures were HR, oxygen consumption (VO2), and changes in HR responses (HR/WR slope) to an increase in exercise demand. RESULTS: CI was present in 13 (46%) PD participants (PDCI), who during CPET, exhibited blunted HR responses compared to controls and PD non-CI beyond 60% of maximal workload (p ≤ 0.05). PDCI presented a significantly lower HR at VT2, and peak exercise compared to PD non-CI and controls (p ≤ 0.001). VO2 was significantly lower in PDCI than PD non-CI and controls at VT2 (p = 0.003 and p = 0.036, respectively) and at peak exercise (p = 0.001 and p = 0.023, respectively). CONCLUSION: Although poorly understood, the presence of CI in PD and its effect on HR and metabolic responses during incremental exercise is significant and important to consider when programming aerobic exercises.