Elizabeth H Skinner

Monash University (Australia) · Department of Physiotherapy

Objective To assess the efficacy of a single preoperative physiotherapy session to reduce postoperative pulmonary complications (PPCs) after upper abdominal surgery. Design Prospective, pragmatic, multicentre, patient and assessor blinded, parallel group, randomised placebo controlled superiority trial. Setting Multidisciplinary preadmission clin...

Background: Disinvestment (removal, reduction, or reallocation) of routinely provided health services can be difficult when there is little published evidence examining whether the services are effective or not. Evidence is required to understand if removing these services produces outcomes that are inferior to keeping such services in place. Howe...

Objective: Achieving competency in critical care in entry-level physiotherapy courses across Australia and New Zealand is not essential, and accredited training for qualified physiotherapists working in critical care units is lacking. As a result, practice standards and training may vary. The objective was to establish consensus-based minimum clini...

Background It is widely acknowledged that health policy and management decisions rarely reflect research evidence. Therefore, it is important to determine how to improve evidence-informed decision-making. The primary aim of this systematic review was to evaluate the effectiveness of research implementation strategies for promoting evidence-informed...

Allied health professions have developed specialized advanced and extended scope roles over the past decade, for the benefit of patient outcomes, allied health professionals’ satisfaction and to meet labour and workforce demands. There is an essential need for formalized widely recognized training to support these roles and significant challenges t...

Objective: To determine the effectiveness of exercise rehabilitation in people with multimorbidity. Exercise capacity was the primary outcome. Secondary outcomes were: health-related quality of life, activities of daily living, cardiometabolic outcomes, mental health outcomes, symptom scores, resource utilization, health behaviours, economic outco...

Background: Activin A is a potent negative regulator of muscle mass elevated in critical illness. It is unclear whether muscle strength and physical function in critically ill humans are associated with elevated activin A levels. Objectives: The objective of this study was to investigate the relationship between serum activin A levels, muscle st...

Background: Limited research assessed the validity of the Activities-specific Balance Confidence, ABC) Scale in individuals with chronic obstructive pulmonary disease, COPD) at risk of falls. We report on the scale's construct and criterion validity. Methods: Construct validity was established by assessing known groups, convergent and divergent...

No previous research has examined age and sex differences in balance outcomes in individuals with chronic obstructive pulmonary disease (COPD) at risk of falls. A secondary analysis of baseline data from an ongoing trial of fall prevention in COPD was conducted. Age and sex differences were analyzed for the Berg Balance scale (BBS), Balance Evaluat...

Background Preoperative education and breathing exercise training by a physiotherapist minimises pulmonary complications after abdominal surgery. Effects on specific clinical outcomes such as antibiotic prescriptions, chest imaging, sputum cultures, oxygen requirements, and diagnostic coding are unknown. Methods This post hoc analysis of prospecti...

Objectives: Significant variability exists in physical rehabilitation modalities and dosage used in the ICU. Our objective was to investigate the effect of physical rehabilitation in ICU on patient outcomes, the impact of task-specific training, and the dose-response profile. Data sources: A systematic search of Ovid MEDLINE, Cochrane Library, E...

Physical rehabilitation programmes have face validity for their delivery following ICU discharge given the plethora of symptoms and disability experienced by patients and their families/carers as part of the post-intensive care syndrome. While improvements in muscle strength and physical function have been reported at hospital discharge, the majori...

Background: Stroke is a leading cause of disability worldwide and the cardiovascular fitness levels of stroke survivors are diminished to an extent that impairs functioning and activities of daily living performance. While cardiovascular training seems an empirically appropriate intervention, the optimal dosage and intensity of cardiovascular trai...

Question Is preoperative physiotherapy cost-effective in reducing postoperative pulmonary complications (PPC) and improving quality-adjusted life years (QALYs) after major abdominal surgery? Design Cost-effectiveness analysis from the hospitals' perspective within a multicentre randomised controlled trial with concealed allocation, blinded assesso...

Background: Junior physiotherapists require satisfactory clinical skills to work effectively within the acute hospital setting for service quality and consistency. Objective: To investigate the effects of stream-specific clinical training on junior physiotherapist self-efficacy, self-rated confidence, and self-rated ability to work independently...

Background: Community-acquired pneumonia (CAP) is a leading cause of morbidity and mortality worldwide, but few studies have evaluated the feasibility of routine patient-reported outcome measures (PROMs) in this illness. This study investigates the feasibility and limitations of three credible PROM instruments in a representative hospitalized coho...

Background Implementation research is increasingly being recognised for optimising the outcomes of clinical practice. Frequently, the benefits of new evidence are not implemented due to the difficulties applying traditional research methodologies to implementation settings. Randomised controlled trials are not always practical for the implementatio...

To use experience-based co-design to identify the key design requirements of a peer support model for critical care survivors; understand the use of the experience-based co-design method from clinician, patients, and family perspectives. Design: Using experience-based co-design, qualitative data about participants' preferences for a peer support...

It has been suggested that interprofessional tracheostomy teams improve safety, enhance outcomes and promote excellence. This study evaluated the effect of a Tracheostomy Review Service (TRS) on patient outcomes and staff attitudes. The TRS reviewed patients with a tracheostomy tube (TT) in situ on our wards. Data was collected via medical record a...

Background Multimorbidity (the co-existence of two or more chronic conditions in an individual) is a growing healthcare burden internationally; however, healthcare and disease management, including rehabilitation, is often delivered in single-disease siloes. The aims of this study were to (1) evaluate the safety and feasibility of multimorbidity re...

Objectives: To develop a decision tree that objectively identifies the most discriminative variables in the decision to provide out-of-bed rehabilitation, measure the impact of this decision and to identify the factors that intensive care unit (ICU) practitioners think most influential in that clinical decision. Design: A prospective three-part...

Background Multimorbidity, the coexistence of two or more chronic conditions, is common in clinical practice. Rehabilitation for people with multimorbidity may provide access to a rehabilitation programme that can address common symptoms and risk factors for multiple chronic diseases. Objective The aims of this study were to (1) evaluate the feasi...

Supplemental Material, Supplement_multimorbidity_usual_care_Final - A rehabilitation programme for people with multimorbidity versus usual care: A pilot randomized controlled trial

Background: Improved donor management, including respiratory physiotherapy, may optimize donor suitability and increase successful lung procurement. This review aimed to determine the efficacy of lung management protocols on the incidence of successful lung procurement and transplantation. Methods: Searches were completed in MEDLINE, CINAHL, EMB...

Background: It is widely acknowledged that health policy and practice do not always reflect current research evidence. Whether knowledge transfer from research to practice is more successful when specific implementation approaches are used remains unclear. A model to assist engagement of allied health managers and clinicians with research implemen...

Background: Community-acquired pneumonia is a leading worldwide cause of hospital admissions and healthcare resource consumption. The largest proportion of hospitalisations now occurs in older patients, with high rates of multimorbidity and complex care needs. In Australia, this population is usually managed by hospital inpatient general internal...

Supplementary appendix: additional information

Background: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. A growing body of evidence shows that individuals with COPD have important deficits in balance control that may be associated with an increased risk of falls. Pulmonary rehabilitation (PR) is a key therapeutic intervention for individu...

We sought to estimate the proportion of patients admitted to a metropolitan intensive care unit (ICU) who were current smokers, and the relationships between ICU survivors who smoked and smoking cessation and/or reduction six months post-ICU discharge. We conducted a prospective cohort study at a metropolitan level III ICU in Melbourne, Victoria. O...

Patient-level data. (XLSX)

Blinded statistician data. (XLSX)

Analyses unadjusted for monthly ward data from previous 2 years. Effect size estimates of main and trial-by-site interaction effects from each trial for primary and secondary outcomes. Main effects are interpreted as the impact of being exposed to the no weekend allied health condition compared to the current or newly developed weekend allied healt...

Hours of service by discipline. Hours of allied health service provision offered under current and newly developed weekend allied health service delivery models at each site. (DOCX)

Clinical exceptions. (DOCX)

Trial protocol. Study protocol for 2 randomised controlled trials examining the effectiveness and safety of current weekend allied health services and a new stakeholder-driven model of weekend allied health services for acute medical/surgical patients versus no weekend allied health services. (PDF)

Objectives To (1) assess memorability and treatment fidelity of pre-operative physiotherapy education prior to elective upper abdominal surgery and, (2) to explore patient opinions on pre-operative education. Design Mixed-methods analysis of a convenience sample within a larger parallel-group, double-blinded, randomised controlled trial with conce...

Context: There is a critical shortage of donor lungs however, considerable ethical considerations are associated with the conduct of research to optimize care of the potential organ donor. Objective: To investigate pathways of consent, respiratory care by physiotherapists and donation rates to contextualize future research on physiotherapy effec...

Background There is strong public support for acute hospital services to move to genuine 7-day models, including access to multidisciplinary team assessment. This study aimed to identify factors that might enable an effective and cost-effective weekend allied health services on acute hospital wards. Methods This qualitative study included 22 focus...

Objective: There is growing interest in patient and family participation in critical care-not just as part of the bedside, but as part of educational and management organization and infrastructure. This offers tremendous opportunities for change but carries risk to patients, families, and the institution. The objective is to provide a concise defi...

Comparative effectiveness research compares two active forms of treatment or usual care in comparison with usual care with an additional intervention element. These types of study are commonly conducted following a placebo or no active treatment trial. Research designs with a placebo or non-active treatment arm can be challenging for the clinician...

Background: Falls are associated with morbidity, loss of independence and mortality. While land-based group exercise and Tai Chi programs reduce the risk of falls, aquatic therapy may allow patients to complete balance exercises with less pain and fear of falling however limited data exist. Objective: The objective of the study was to pilot the i...

Aim: This pilot study aimed to examine the difference in energy and protein intake of the midday meal in two different eating environments-the communal dining room and patient bedside-and to obtain feedback on patient preference at each location. Methods: Elderly patients in two rehabilitation wards were observed consuming the midday meal on two...

Objective: The study investigated the effect of prehabilitation on quality of life and function. Methods: A pilot randomised controlled trial with concealed allocation, assessor blinding and intention-to-treat analysis was conducted. Sixty-four people undergoing elective lower-limb arthroplasty were included. Prehabilitation included one-hour twice...

Rationale, aims and objectives: The aim of this study was to determine if the addition of daily ward interview data improves the capture of hospital quality and safety indicators compared with incident reporting systems alone. An additional aim was to determine the potential characteristics influencing under-reporting of hospital quality and safet...

Introduction: Supervision of students is a key role of senior physiotherapy clinicians in teaching hospitals. The objective of this study was to test the effect of simulated learning environments (SLE) on educators' self-efficacy in student supervision skills. Methods: A pilot prospective randomized controlled trial with concealed allocation was...

Objective: The study investigated the effect of prehabilitation on the quality of life and function in patients having total knee replacement (TKR)/total hip replacement (THR). Methods: A pilot randomized controlled trial with concealed allocation, assessor blinding, and intention-to-treat analysis was conducted. Sixty-four people undergoing ele...

Rationale: The ICU Mobility Scale (IMS) is a measure of mobility milestones in critically ill patients. Objectives: This study aimed to determine the validity and responsiveness of the IMS from a prospective cohort study of adults admitted to the intensive care unit (ICU). Methods: Construct and predictive validity were assessed by comparing I...

Background: Physical therapists working in acute care hospitals require unique skills to adapt to the challenging environment and short patient length of stay. Previous literature has reported burnout of clinicians and difficulty with staff retention, however no systematic reviews have investigated qualitative literature in the area. Purpose: To...

Objectives: To determine if the early goal-directed mobilization intervention could be delivered to patients receiving mechanical ventilation with increased maximal levels of activity compared with standard care. Design: A pilot randomized controlled trial. Setting: Five ICUs in Australia and New Zealand. Participants: Fifty critically ill a...

Summary of: Panwar R, Hardie M, Bellomo R, Barrot L, Eastwood GM, Young PJ, et al. Conservative versus liberal oxygenation targets for mechanically ventilated patients – a pilot multicenter randomized controlled trial. Am J Respir Crit Care Med. 2015; in press. Question: Is a conservative oxygenation strategy a feasible and safe alternative to lib...

Rationale: Early rehabilitation in an intensive care unit (ICU) is associated with improved physical functioning and patient outcomes. However, relatively little data have been reported on physical therapy interventions during continuous renal replacement therapy (CRRT) for patients in ICUs. Objectives: To evaluate the feasibility and safety of...

Background: Post-operative pulmonary complications are a significant problem following open upper abdominal surgery. Preliminary evidence suggests that a single pre-operative physiotherapy education and preparatory lung expansion training session alone may prevent respiratory complications more effectively than supervised post-operative breathing a...

Background Post-operative pulmonary complications are a significant problem following open upper abdominal surgery. Preliminary evidence suggests that a single pre-operative physiotherapy education and preparatory lung expansion training session alone may prevent respiratory complications more effectively than supervised post-operative breathing an...

Objectives: To determine associations of inter- and intra-muscular adipose tissue (IMAT) with cardiometabolic health and physical function in older adults. Methods: 48 community-dwelling older adults aged ⋝65 years (mean 71.6±4.8 years; 52% women) underwent whole-body dual-energy X-ray absorptiometry, to assess appendicular lean mass (ALM), and...

It is well established that admission to intensive care can result in physical, cognitive and psychological impairments. To assess and treat these impairments competently requires the use of outcome measures in clinical practice. To date, there are no evidence-based recommendations for specific measures to use at different time points on the trajec...

Selection of appropriate outcome measures to assess progress in physical rehabilitation across the complete recovery continuum is essential but may pose challenges in clinical practice. This paper examines key measurement and feasibility characteristics for outcome measures, using critical care survivors as an exemplar. With increased survivorship...

Background: Interdisciplinary tracheostomy teams have reduced hospital length of stay, cost, and improved patient safety. The allied health component of this service is not always delivered seven days per week, as not all health services provide weekend allied health or only provide to patients meeting specific weekend allied health referral criter...

This study aimed to develop a low-cost real-time biofeedback system to assist with rehabilitation for patients following total knee replacement (TKR) and to assess its feasibility of use in a post-TKR patient case study design with a comparison group. The biofeedback system consisted of Microsoft Kinect(TM) and Nintendo Wii balance board with a ded...

RATIONALE: Recent meta-analyses have demonstrated that early rehabilitation in the intensive care unit (ICU), including mobilisation of intubated and ventilated patients, is safe, feasible and reduces mechanical ventilation duration and ICU and hospital length of stay. However, practice and attitudes surrounding mobilizing this patient cohort vary,...

Introduction Physiotherapists play an important role in the provision of multi-disciplinary team-based care in the intensive care unit (ICU). No studies have reported usual care respiratory management or usual care on the wards following ICU discharge. This study aimed to investigate physiotherapy usual care in ICU patients during acute hospitaliza...

Disinvestment from inefficient or ineffective health services is a growing priority for health care systems. Provision of allied health services over the weekend is now commonplace despite a relative paucity of evidence supporting their provision. The relatively high cost of providing this service combined with the paucity of evidence supporting it...

Background/Aim: Patients are admitted to an intensive care unit (ICU) for critical care not available to patients in the general wards, with the potential for reversible organ failure as a key admission criterion. The objective of this integrative review was to examine and discuss the literature pertaining to the environment of the ICU, including u...

Few studies have investigated research culture in the Australian hospital system. Whilst physiotherapists working in tertiary hospital departments conduct and publish research, a conflict between service delivery and research productivity remains. Few departments record research achievements, which limits the accuracy of investigating factors assoc...