School of Allied Health

Permanent link for this collectionhttps://hdl.handle.net/10292/10495

The School of Allied Health encompasses Physiotherapy, Podiatry, Occupational Therapy, and Rehabilitation.

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'It's more than just kale (cough)'. New Zealand Sāmoan Attitudes to Living With Chronic Cough and Healthcare Access
(CSIRO Publishing, 2025-11-27) Mooney, Sarah; Fia'ali'i, Jessee; Televave, Eti; Upsdell, Angela
INTRODUCTION: Chronic cough is burdensome for individuals and healthcare providers and is a symptom common to a number of health conditions, including bronchiectasis. The prevalence of respiratory conditions particularly bronchiectasis is disproportionately high amongst Pacific people residing in Counties Manukau. Barriers to healthcare access and engagement both practical and cultural, contribute to delayed presentation and advanced illness. AIM: To explore attitudes to cough and healthcare access by Sāmoan adults living in Counties Manukau. METHODS: Semi-structured interviews guided by Talanoa, a Pacific-specific method, were conducted focused on cough duration and characteristics, treatment-seeking behaviours, and healthcare experiences. Data were analysed thematically and framed using the Fonofale Model of Health. RESULTS: Two overarching themes were constructed from seven Talanoa: 'Understanding my cough' and 'healing, curing and coping with cough'. Chronic kale/cough was found to impact on all pou (posts) of the Fonofale health model. Kale/cough management strategies were drawn from Sāmoan and Western health paradigms, perceived as complimentary. Access to specialist services was valued and extended participants' coping repertoire further. Respect and trust shaped relationships with healthcare providers and influenced engagement. DISCUSSION: Models such as the Fonofale health model provide a framework for healthcare providers to better understand the multi-dimensional impact of cough. Recognising the cultural perspectives of populations underrepresented in the health workforce provides valuable insights to re-frame healthcare practice and service to optimise engagement with on-going symptoms such as cough and in supporting chronic conditions.
Changing the Osteoarthritis Narrative in Aotearoa New Zealand
(CSIRO Publishing, 2026-01-30) O'Brien, Daniel; Holt, Elizabeth; McLeod, Dell; Molyneux, Prue; Meiring, Rebecca; Tombs, Kore
Osteoarthritis (OA) affects one in ten adults in Aotearoa New Zealand, yet care remains fragmented and under-prioritised. The 2025 Aotearoa Osteoarthritis Summit explored re-framing OA through a lifespan, equity-focused lens. Summit attendees contribution to a collaborative workshop at the event highlighted misconceptions, harmful “wear and tear” narratives, and inconsistent information. Attendees called for empowering, strengths-based messaging, culturally responsive care, and early, lifelong joint-health strategies. Recommendations included myth-busting, accessible education, community support, and integrated non-surgical management. Equity for Māori, Pasifika, rural, and low-income communities was emphasised. Changing the OA narrative requires collaboration, consistent messaging, and scalable frameworks to improve outcomes nationwide.
The Effect of Chiropractic Spinal Manipulation on the H-reflex and Muscle Strength in Children With Cerebral Palsy: A Feasibility Study
(F1000 Research Ltd, 2024-09-25) Duehr, Jenna; Niazi, Imran Khan; Nedergaard, Rasmus Bach; Taylor, Denise; Haavik, Heidi
Background: Children with cerebral palsy (CP) have deficits in various aspects of motor control, including motor neuron excitability, which can affect muscle strength, gait, and ability to perform activities of daily living. Previous research on chiropractic spinal manipulation in healthy adults, athletes, and a brain-injured population has indicated improvements in motor neuron excitability, muscle strength, and various aspects of motor control. Thus, chiropractic spinal manipulation may improve motor control in children with CP. Methods: Children with spastic diplegic CP, aged 8-13 years, were recruited for a randomized, controlled feasibility study. Feasibility was assessed in terms of recruitment strategy and rate, data collection procedures, equipment, intervention, and compliance. Results: Three children completed the data collection comprising pre- and post-measurements of the H reflex, V-wave, and muscle strength. The recruitment strategy and rate were not feasible. The data collection procedures were appropriate and complied with, except for the V-wave measurements. The H-reflex threshold decreased and s50 and slope increased in the participants who received chiropractic spinal manipulation; the opposite was seen in the control group. The changes in MVC force were inconsistent between subjects. Conclusion: This study answered some important feasibility questions regarding conducting a large-scale randomized controlled study with the same design. Some aspects proved feasible, such as H-reflex recordings, and some aspects, such as recruitment methods and V-wave recordings, need to be altered for future research in this area.
Physiotherapist-Led Triage Within Orthopaedic Spine Consultation: Evaluation of a Novel Secondary Care Model of Care
(New Zealand Medical Association, 2026-04-17) Chauhan, Rohil; Kheterpal, Aanirudh; Segar, Anand
Aim: Timely access for orthopaedic spine consultation remains a challenge due to increasing demand and workforce constraints. Integrating advanced physiotherapy consultation models within orthopaedic services is an emerging strategy to streamline care. While common in New Zealand’s tertiary care sector, comparable models in secondary care are lacking. This study evaluated the outcomes of a novel physiotherapist-integrated orthopaedic consultation model in secondary care. Methods: A retrospective review of patients seen from March to July 2023 was conducted using a five-step physiotherapist-integrated orthopaedic consultation model to assess management decisions, patient satisfaction, impact on consultation wait times and service capacity, and diagnostic concordance. Results: Among 233 patients (mean age 46.8 years; 53.6% male), 73.4% presented with lower back and associated lower limb symptoms. Most (74.7%) were managed non-operatively, 25.3% underwent surgical workup and 10.7% proceeded to surgery. Patient satisfaction was high (overall mean 91.3%), with highest scores for quality of care (92.3%) and explanation of treatment/expected outcomes (91.7%). While mean consultation wait times were longer than the 2021 pre-model cohort (63 vs 47.4 days), service capacity increased by 32%. Across three magnetic resonance imaging variables, diagnostic concordance was substantial (overall agreement: 78.1%; mean kappa: 0.65 [0.63–0.68]). Conclusion: A physiotherapist-integrated orthopaedic consultation model in secondary care is highly accepted by patients, increases service capacity and broadens multidisciplinary decision-making capacity. While a model as such is theoretically positioned to reduce consultation wait times, this was not observed in the present analysis—reflecting a growing unmet need for orthopaedic consultation in secondary care.
Physiotherapy Management of Adults With Breathing Pattern Disorders: A Scoping Review
(Informa UK Limited, 2026-05-09) Stewart, Abby; Ellis, Richard; Mooney, Sarah
Introduction: Breathing pattern disorders (BrPD) are recognised as prevalent and debilitating, often occurring secondary to conditions such as asthma and anxiety. Physiotherapy, particularly breathing retraining, is a core treatment for BrPD, however, physiotherapy management remains poorly defined. This scoping review aimed to map and summarise literature on physiotherapy management in adults with BrPD. Methods: The Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews and Joanna Briggs Institute methodology framed this review. Sources published in English from 1975 onwards including adults with BrPD and physiotherapy management approaches were eligible, without restriction on source of evidence. Comprehensive searches were conducted across eight databases and grey literature. Results: A total of 137 sources were included. Physiotherapy BrPD management commonly involved breathing retraining (99%), with frequent inclusion of relaxation (49%) and education (47%). Delivery was predominantly face-to-face and one-on-one, with growing use of self-directed delivery formats. Discussion: Physiotherapy management of BrPD is multifaceted and anchored by breathing retraining, supported by adjunctive education, relaxation, and self-management. Considerable variability was found in treatment components and delivery models. Physiotherapists are well placed to lead BrPD management. Future research should focus on robust intervention and outcome reporting for this challenging and costly condition.
Extended Reality in Rehabilitation: Innovative or Just an Illusion? A Scoping Review of Interventions for Complex Regional Pain Syndrome
(Springer, 2026-05-04) Weiss, Claire; Lewis, Gwyn; Shaikh, Nusratnaaz; Bean, Debbie
Purpose Extended reality (XR) technologies, incorporating virtual and augmented reality, are increasingly being explored as potential adjuncts in the management of complex regional pain syndrome (CRPS). However, the appropriateness of these interventions in terms of their alignment with CRPS symptomatology, patient experiences, and rehabilitation principles remains unclear. This scoping review aimed to critically examine the current approaches used in XR-based rehabilitation for CRPS and assess their suitability for managing this condition. Methods A systematic search was conducted in several health databases for articles describing the use of XR for management of people with CRPS. Data were extracted on study characteristics and intervention details, and the intervention was critiqued using a custom framework designed to evaluate the incorporation of rehabilitation principles. Results Sixteen studies met the inclusion criteria. There was considerable diversity in study methodologies, participant characteristics, and technological approaches. All studies provided appropriate theoretical justifications of their intervention and were suitable for clinical use, while most showed potential for CRPS symptom reduction. However, there were significant gaps in the interventions related to fostering independence, feasibility of home use, potential for progression, and cultural considerations. Conclusions XR interventions show promise in certain aspects of CRPS management but opportunities exist for more comprehensive intervention delivery formats that address key rehabilitation principles. Future development and evaluation studies should place greater emphasis on fostering independent use, integration of user feedback, and overtly incorporate cultural considerations.
Prehabilitation in Thoracic Surgery: Strong Signal or Surgical Confounding?
(AME Publishing Company, 2026-04-30) Lai, Victoria; Reeve, Julie; Boden, Ianthe
[From Editorial] Preventing postoperative pulmonary complications (PPCs) following lung resection surgery is a key objective of perioperative care. PPCs are a leading cause of morbidity, with reported incidence of 15% to over 40%, depending on patient risk factors, surgical characteristics, and PPC definition (1,2). Despite advances in surgical techniques, anaesthetic management, and enhanced recovery after surgery pathways, PPCs continue to be associated with longer hospital stays, higher healthcare costs, and reduced quality of life (2,3).
A Return to Normality: A Descriptive Qualitative Interview Study Exploring the Patient Experience of Gout Flare Resolution
(Wiley, 2026-05-18) Stewart, Sarah; Horne, Anne; Gaffo, Angelo; Stamp, Lisa K; Edwards, N Lawrence; Dalbeth, Nicola
OBJECTIVES: While the definition of a gout flare is well established, the state of gout flare resolution has not yet been defined. This study aimed to explore patients' experiences and perceptions of gout flare resolution. METHODS: Semi-structured interviews were conducted with 24 people with gout, guided by open-ended questions exploring their experiences of gout flare resolution. To facilitate discussion, participants were shown graphs depicting changes in pain intensity during a hypothetical flare. Prompts relating to key flare features, including pain, swelling, warmth, and medication use, were used as appropriate. Data were analysed using a descriptive approach to thematic analysis to prioritise participants' voices and experiences. RESULTS: Four themes, closely tied to an overarching concept of a return to normality, were generated: (1) return to personal baseline pain - where most participants required a pain score of 0/10, while the remaining considered resolution to occur at low-to-moderate pain levels; (2) return of function; (3) restoration of emotional wellbeing; and (4) disappearance of joint swelling, warmth and redness. CONCLUSIONS: Flare resolution is experienced as a return to normality, encompassing relief from pain, return of mobility, restored wellbeing and the disappearance of other inflammatory features, such as swelling, warmth and redness. Incorporating these insights into the development of a patient-centred definition for flare resolution may support more meaningful, patient-centred approaches to measuring and managing gout flares.
Active Virtual Reality for Chronic Primary Pain: Mixed Methods Randomized Pilot Study
(JMIR Publications, 2022-07-13) Tuck, Natalie; Pollard, Catherine; Good, Clinton; Williams, Caitlin; Lewis, Gwyn; Hames, Murray; Aamir, Tipu; Bean, Debbie
Background: The modern management of chronic pain is largely focused on improving functional capacity (often despite ongoing pain) by using graded activation and exposure paradigms. However, many people with chronic pain find functional activation programs aversive, and dropout rates are high. Modern technologies such as virtual reality (VR) could provide a more enjoyable and less threatening way for people with chronic pain to engage in physical activity. Although VR has been successfully used for pain relief in acute and chronic pain settings, as well as to facilitate rehabilitation in conditions such as stroke and cerebral palsy, it is not known whether VR can also be used to improve functional outcomes in people with chronic pain. Objective: This study aimed to assess the feasibility of conducting an adequately powered randomized controlled trial (RCT) to test the efficacy of VR in a chronic pain treatment center and assess the acceptability of an active VR treatment program for patients in this setting. Methods: For this mixed methods pilot study, which was designed to test the feasibility and acceptability of the proposed study methods, 29 people seeking treatment for chronic pain were randomized to an active VR intervention or physiotherapy treatment as usual (TAU). The TAU group completed a 6-week waitlist before receiving standard treatment to act as a no-treatment control group. The VR intervention comprised twice-weekly immersive and embodied VR sessions using commercially available gaming software, which was selected to encourage movement. A total of 7 VR participants completed semistructured interviews to assess their perception of the intervention. Results: Of the 99 patients referred to physiotherapy, 53 (54%) were eligible, 29 (29%) enrolled, and 17 (17%) completed the trial, indicating that running an adequately powered RCT in this setting would not be feasible. Despite this, those in the VR group showed greater improvements in activity levels, pain intensity, and pain interference and reported greater treatment satisfaction and perceived improvement than both the waitlist and TAU groups. Relative effect sizes were larger when VR was compared with the waitlist (range small to very large) and smaller when VR was compared with TAU (range none to medium). The qualitative analysis produced the following three themes: VR is an enjoyable alternative to traditional physiotherapy, VR has functional and psychological benefits despite continued pain, and a well-designed VR setup is important. Conclusions: The active VR intervention in this study was highly acceptable to participants, produced favorable effects when compared with the waitlist, and showed similar outcomes as those of TAU. These findings suggest that a confirmatory RCT is warranted; however, substantial barriers to recruitment indicate that incentivizing participation and using a different treatment setting or running a multicenter trial are needed.
No Effect of a Single Session of Anodal Transcranial Direct Current Stimulation on Exercise-induced Hypoalgesia in Knee Osteoarthritis: A Randomized Cross-over Trial
(Wiley, 2026-03-03) Toomey, David; Lewis, Gwyn; Rashid, Usman; Tuck, Natalie; Rice, David
BACKGROUND: Exercise induces short-term pain relief (exercise-induced hypoalgesia, EIH), but this response is often blunted in people with knee osteoarthritis (OA). Transcranial direct current stimulation (tDCS) has been proposed as a potential enhancer of EIH. OBJECTIVE: This study aimed to determine whether a single session of 2-mA anodal tDCS applied for 20 minutes over the contralateral primary motor cortex augments the exercise-induced hypoalgesic response to isometric quadriceps exercise in individuals with knee OA. MATERIALS AND METHODS: In this double-blind randomized cross-over trial, 27 participants with knee OA completed two experimental sessions (active anodal tDCS + exercise; sham tDCS + exercise) in counterbalanced order. Pressure pain thresholds (PPTs at the knee and forearm), resting knee pain, and evoked knee pain during stepping were assessed pre- and post intervention. Linear mixed models compared pre- and postexercise changes between active and sham conditions. Blinding success was evaluated using Bang's blinding index. RESULTS: Both sessions produced EIH (knee PPT increased pre-to-post; all p ≤ 0.001). Between active and sham conditions, there were no significant differences for knee PPT (mean difference 0 kPa [95% CI -50 to 40], p = 0.82), forearm PPT (-20 kPa [-60 to 30], p = 0.45), resting knee pain (1/100 [-13 to 15], p = 0.89), or evoked knee pain (1/100 [-7 to 8], p = 0.14). Blinding was successful, and no adverse events were reported. CONCLUSIONS: These findings indicate that a single session of anodal tDCS does not augment the immediate EIH response to isometric quadriceps exercise in people with knee OA. PERSPECTIVE: This randomized cross-over trial found that anodal tDCS did not enhance EIH in people with knee OA. These findings suggest that a single session of anodal tDCS does not meaningfully augment the immediate exercise-induced hypoalgesic response in individuals with knee OA. CLINICAL TRIAL REGISTRATION: The Australian New Zealand Clinical Trials Registry number for the study is ACTRN12621000787886, registered July 1, 2021, prospectively.
Imaging With Ultrasound in Physical Therapy: What is the PT's Scope of Practice? A Competency-based Educational Model and Training Recommendations
(BMJ Publishing Group, 2019-04-25) Whittaker, Jackie L; Ellis, Richard; Hodges, Paul William; OSullivan, Cliona; Hides, Julie; Fernandez-Carnero, Samuel; Arias-Buria, Jose Luis; Teyhen, Deydre S; Stokes, Maria J
Physical therapists employ ultrasound (US) imaging technology for a broad range of clinical and research purposes. Despite this, few physical therapy regulatory bodies guide the use of US imaging, and there are limited continuing education opportunities for physical therapists to become proficient in using US within their professional scope of practice. Here, we (i) outline the current status of US use by physical therapists; (ii) define and describe four broad categories of physical therapy US applications (ie, rehabilitation, diagnostic, intervention and research US); (iii) discuss how US use relates to the scope of high value physical therapy practice and (iv) propose a broad framework for a competency-based education model for training physical therapists in US. This paper only discusses US imaging-not 'therapeutic' US. Thus, 'imaging' is implicit anywhere the term 'ultrasound' is used.
The Sacred Connection of the Feet (Te Tuhono Tapu o ngā Waewae): The Cultural and Spiritual Impact of Diabetes‐Related Lower Limb Amputation Among Māori
(Wiley, 2026-05-20) Otene, Cynthia; Ihaka, Belinda; Carroll, Matthew R
Diabetes prevalence in Aotearoa New Zealand is rising rapidly, disproportionately affecting Māori communities and contributing to significantly higher rates of diabetes‐related lower limb amputations. These inequities reflect systemic issues such as colonisation, racism, and limited access to culturally safe care rather than clinical factors alone. Embedding tikanga (Māori customs) within podiatry foot screening offers a pathway to culturally responsive practice that honours Māori spiritual, physical, and cultural well‐being. Integrating Rongoā Māori (traditional healing) and whānau‐centred approaches alongside biomedical care can improve engagement and outcomes, whereas marae‐based and community‐led models enhance accessibility and trust. Workforce development in cultural safety is essential to uphold Te Tiriti o Waitangi obligations of equity, partnership, and protection. Culturally grounded podiatry services not only reduce the risk of amputation but also restore connections to tūrangawaewae (place of belonging) and whakapapa (genealogy), ensuring that care is meaningful and effective for Māori communities.
Evicted From Paradise: Methodological Challenges of Posthuman Healthcare Research
(SAGE Publications, 2026-04-21) Nicholls, David A; Hebron, Clair; Chubb, Shirley
Interest in posthuman concepts and ideas, philosophies and theories has grown enormously over the last 25 years, and posthumanism is now one of the most vibrant and innovative frontiers in healthcare thinking. At its most basic, posthumanism is a philosophical approach that decentres the human and considers other non-human or more-than-human objects as equally important. But this description belies the many challenges posthumanism presents to the researcher. There are many competing approaches to consider, there is often opaque language to navigate, and there are many structural problems to overcome. In this paper we tackle three major methodological challenges: vitalism, or the question of what gives life to things; transcendence, and the substance problem; and correlation, or latent anthropocentrism. We consider how it might be possible to research with a process-based ontology in a world dominated by substance-based principles. And we conclude with four related recommendations: a focus on key principles, concept creation, deep reading and attention to ontological slippage, before reflecting on our own experiences researching walking for people living with persistent pain.
The Diagnostic Accuracy of Clinical Tests in Identifying Structural Change in Achilles Tendinopathy: A Pilot Study
(SAGE Publications, 2026-04-21) Matthews, W; Ellis, Richard; Furness, J; Rathbone, E; Hing, W
Background: With the development of a consensus agreement on the essential clinical diagnostic criteria for Achilles tendinopathy (AT), there is scope to investigate the diagnostic accuracy of clinical tests, their relationship to structural changes observed on ultrasound imaging (USI), and the potential role of USI in the clinical diagnosis of AT. Objectives. To evaluate the relationship between clinical tests and tendon structure via USI. Methods: A pilot cross-sectional study of 23 individuals (14 male, and 9 female) with unilateral, symptomatic AT were recruited from physiotherapy clinics. Assessment included subjective measures and patient-reported outcome measures (pain with loading, stiffness, self-reported function, Victorian Institute of Sport Assessment-Achilles [VISA-A], Pain Catastrophizing Scale, and 12-Item Short Form Survey). Objective tests included palpation, arc sign, Royal London Hospital Test, single-leg heel raise, and hopping. USI subcategorized tendon structure as normal or abnormal. Diagnostic accuracy (positivity rates, sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV]), receiver operating characteristic analysis, area under the curve (AUC), and effect sizes were calculated. Results: Stiffness and pain on palpation demonstrated high positivity rates (82.6%). Hopping pain demonstrated high positivity rates (78.3%). Pain on palpation and pain during hopping had high sensitivity (0.94) and PPV (0.84) for detecting structural abnormalities. VISA-A and self-reported function had excellent AUC (0.89) for detecting structural change. No test distinguished the degree of structural change. Conclusions: Pain on palpation and hopping pain are promising indicators of structural tendon pathology. Patient-reported outcome measures may aid in imaging decisions. Further studies are needed to validate findings. Level of Evidence: Level IV.
Orthopaedic Consultant's Experiences and Perceptions Regarding Advanced Practice Physiotherapists in Orthopaedic Clinics: A Qualitative Study
(Taylor and Francis Group, 2026-04-24) Rabey, Martin; Fortescue, Nicky; Barrett, Catherine; Reilly, Peter; O'Brien, Daniel
BACKGROUND: Perceptions of key stakeholders may be barriers or facilitators to advanced practice physiotherapy services. However, the experience and perception of orthopedic consultants regarding advanced practice physiotherapy roles is poorly understood. OBJECTIVE: Explore orthopedic consultants' experiences and perceptions regarding advanced practice physiotherapists in adult orthopedic clinics. METHODS: Qualitative study: Reflexive thematic analysis of data from semi-structured interviews with twelve orthopedic consultants practising at Royal Perth Hospital. Interviews were driven by indicative questions based upon contemporary literature regarding advanced practice physiotherapy and conducted using a constructivist lens to capture diverse perspectives. Themes/subthemes were reviewed by the entire research team. RESULTS: Four themes, capturing conflicting views, were derived: 1) APP role clarity. 2) Enhancement of orthopedic services. 3) Health system challenges. 4) Expectations of orthopedic services. Theme one reflected a lack of clarity, amongst orthopedic consultants interviewed, regarding the advanced practice physiotherapist's role, scope of practice and level of education, while complimenting their diagnostic skills. Theme two highlighted enhancement of orthopedic services through thorough biopsychosocial assessments, contrasting perceptions regarding advanced practice physiotherapist efficiency, and considered whether advanced practice physiotherapists are a burden on orthopedic clinics. Theme three considered shifting clinical responsibilities and the perceived need for clinical pathways. Theme four highlighted negative perceptions of patient and referrer feedback.
South Asian Migrants' Perception and Experiences of Physical Activity, Exercise and Exercise Therapy: A Scoping Review and Qualitative Analysis
(Springer, 2026-04-29) Hussain, Syed Alamdar; Holroyd, Eleanor; Niazi, Imran Khan; Signal, Nada
This scoping review explored the perceptions and experiences of South Asian Migrants (SAM) regarding Physical Activity (PA), Exercise, and Exercise Therapy (ET). Existing evidence is disparate and limits a comprehensive understanding of SAM perception and experiences. The review aimed to map the existing literature to better understand various factors that influence participation in exercise-related activities. The systematic search strategy was implemented across eight databases using key search terms. A total of 18, qualitative (n = 15) and quantitative (n = 3) studies were included in this review. Reflexive thematic analysis revealed five overarching themes, including: (1) Upholding deep-rooted cultural identities, (2) Influence of religious beliefs in shaping PA, (3) PA across the lifespan, (4) A gateway to holistic well-being, and (5) Pathway to personal empowerment. The review underscored how multiple factors shape SA migrants' perceptions and experiences of PA, exercise, and ET, and highlights the importance of culturally tailored ET approaches to address the needs of SA migrants.
Reflecting on Challenges and Opportunities for the Practice of Person-Centred Rehabilitation
(SAGE Publications, 2023-02-01) Kayes, NM; Papadimitriou, Christina
OBJECTIVES: To (1) reflect on challenges to the practice of person-centred rehabilitation; and (2) propose opportunities for the development of person-centred rehabilitation. CHALLENGES: Person-centred practice has received widespread endorsement across healthcare settings and is understood to be an important, positive approach in rehabilitation. However, the rhetoric of this approach does not always translate meaningfully into practice. Emphasis on patient choice, patient involvement in decision making, and increasing patient capacity for self-management have become a proxy for person-centred rehabilitation in lieu of a more fundamental shift in practice and healthcare structures. System (e.g. biomedical orientation), organisational (e.g. key performance indicators) and professional (e.g. identity as expert) factors compete with person-centred rehabilitation. OPPORTUNITIES: Four key recommendations for the development of person-centred rehabilitation are proposed including to: (1) develop a principles-based approach to person-centred rehabilitation; (2) move away from the dichotomy of person-centred (or not) rehabilitation; (3) build person-centred cultures of care in rehabilitation; and (4) learn from diverse perspectives of person-centred rehabilitation. CONCLUSION: Fixed assumptions about what constitutes person-centred rehabilitation may limit our ability to respond to the needs of persons and families. Embedding person-centred ways of working is challenging due to the competing drivers and interests of healthcare systems and organisations. A principles-based approach, enabled by person-centred cultures of care, may achieve the aspirations of person-centred rehabilitation.
Preoperative Predictors for Return to Physical Activity Following Anterior Cruciate Ligament Reconstruction (ACLR): A Systematic Review
(BMC, 2023-06-09) Carter, Hayley; Lewis, Gwyn; Smith, Benjamin
BACKGROUND: Rates of return to physical activity after anterior cruciate ligament reconstruction surgery are sub-optimal. Optimising presurgical treatment may improve return rates. The purpose of this systematic review was to identify modifiable preoperative predictors for return to physical activity after anterior cruciate ligament reconstruction. METHODS: Seven electronic databases (CINAHL, MEDLINE and SPORTDiscus via EBSCOhost, AMED, PsycINFO and EMBASE via OVID and Web of Science) were searched from inception to 31 March 2023. The population of focus was adults aged 18-65 who had undergone primary anterior cruciate ligament reconstruction. Studies needed to identify at least one potential modifiable preoperative predictor variable and the relationship between the predictor(s) and return to physical activity. All time-points of assessment and study designs were included. Data extraction was completed by one reviewer and verified by a second reviewer. Two reviewers completed the risk of bias assessment using the Quality in Prognostic Studies tool and Grading of Recommendations Assessment, Development and Evaluation system. RESULTS: The search identified 2281 studies, eight met the inclusion criteria. Five studies scored 'high', and three studies scored 'moderate' risk-of-bias. All preoperative predictors were of very low-quality evidence. Five different outcome measures were used to assess return to physical activity including Tegner, Marx, Physical Activity Scale, return to play at the elite level and return to preinjury level (undefined). This was measured between 1- and 10-years post-surgery. Nine preoperative physical, six psychosocial and five demographic/clinical factors were assessed and four were found to be predictive. These included quadriceps strength, psychological profile, patient estimated ability to return and graft type (patella tendon, BPTB). CONCLUSION: Very-low level evidence suggests that increasing quadriceps strength, managing patient expectations of their treatment outcomes, improving motivation to resume preinjury activity levels and considering the use of a BPTB graft will support return to physical activity after ACLR. TRIAL REGISTRATION: This study was prospectively registered in PROSPERO: CRD 42020222567.
Time Trends and Predictors of Gout Remission Over Six Years
(Wiley, 2025-06-18) Tabi-Amponsah, Adwoa Dansoa; Stewart, Sarah; Gamble, Greg; Stamp, Lisa K; Taylor, William J; Dalbeth, Nicola
OBJECTIVES: This study aims to describe the trends in remission rates over six years of follow-up among people with gout taking urate-lowering therapy (ULT), and to identify variables that predict remission. METHODS: A post hoc analysis was conducted using data from the Cardiovascular Safety of Febuxostat or Allopurinol in Patients with Gout (CARES) trial, which enrolled people with gout and cardiovascular disease randomised to febuxostat or allopurinol. Gout remission over six years of follow-up was measured in participants with at least one year of follow-up data using the simplified gout remission definition, requiring the fulfilment of three domains, a) no gout flares during the past year, b) at least two serum urate measurements <0.36mmol/l during the past year, and c) no tophus. Logistic regression was used to identify baseline predictors of remission. RESULTS: Achievement of remission increased from 37.4% of participants (1593/4259) at year 1 to 63.1% (322/510) at year 6. Across the six years, 59.4% of participants achieved remission at least once. More participants on febuxostat achieved remission during the first two years, primarily due to a higher number achieving the serum urate remission domain. In multivariable analysis, baseline age, race, greater disease severity, presence of comorbidities, and febuxostat treatment were variables significantly associated with remission. CONCLUSION: On ULT, fulfilment of remission increases over time and remission can be achieved in the majority of patients. Baseline predictors, including demographics, comorbidities and disease severity, may be useful to identify people with gout who need more proactive management to achieve remission.
Psychometric Evaluation of the Comprehensive Autistic Trait Inventory in Autistic and Non-Autistic Adults
(SAGE Publications, 2025-07-16) English, Michael; Poulsen, Rebecca; Maybery, Murray; McAlpine, David; Sowman, Paul; Pellicano, Elizabeth
Measures of autistic traits are only useful - for pre-diagnostic screening, exploring individual differences, and gaining personal insight - if they efficiently and accurately assess autism as currently conceptualised while maintaining psychometric validity across different demographic groups. We recruited 1322 autistic and 1279 non-autistic adults who varied in autism status (non-autistic, diagnosed autistic, self-identifying autistic) and gender (cisgender men, cisgender women, gender diverse) to assess the psychometric properties of the Comprehensive Autistic Trait Inventory, a recently developed measure of autistic traits that examines six trait domains using 42 self-report statements. Factor fit for the six subscales was appropriate, as was total-scale and subscale reliability. Importantly, measurement invariance was demonstrated based on both autism status and gender, indicating that Comprehensive Autistic Trait Inventory scores of these group members can be directly compared. Autistic traits were highly similar between diagnosed and self-identifying autistic adults, while gender-diverse participants showed more autistic traits than their cisgender counterparts. A total-scale discrimination threshold of 147.5 calculated was suggested which corresponded to sensitivity and specificity of 77.20 and 87.41, respectively. Our analysis indicates that the Comprehensive Autistic Trait Inventory is a practical measure of autistic traits in non-autistic and autistic participants that is useful for researchers and clinicians and for affirming self-identity.Lay abstractThe Comprehensive Autistic Trait Inventory (CATI) is a free questionnaire designed to measure autistic traits in both autistic and non-autistic adults. The CATI includes 42 items focusing on six areas: Social Interactions, Communication, Social Camouflage, Self-Regulating Behaviours, Cognitive Flexibility, and Sensory Sensitivity. Here, we set out to determine whether the CATI can accurately measure autistic traits in both autistic (both diagnosed and self-identifying) and non-autistic people, as well as people of different genders. We also wanted to explore the extent to which trait scores differed between these groups of individuals. Our study recruited over 2600 participants, including 1322 autistic and 1279 non-autistic adults. Our findings suggest that the CATI works the way it was designed to. It is a reliable and accurate tool for measuring autistic traits, can distinguish between autistic and non-autistic people, and appears appropriate for people of different genders. Notably, we found that people who self-identify as autistic have similar trait scores to those with a clinical diagnosis of autism and that gender-diverse people scored higher on autistic traits compared to cisgender people. Our data suggest that the CATI is a useful tool for measuring autistic traits in autistic and non-autistic people and for understanding the way that autistic people vary from one another. It should be helpful for researchers and clinicians, and support a public understanding of autism.

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