Katharine Scrivener's research while affiliated with Macquarie University and other places

Question What is the effect of Bobath therapy on arm activity and arm strength compared with a dose-matched comparison intervention or no intervention after stroke? Design Systematic review of randomised trials with meta-analysis. Participants Adults after stroke. Intervention Bobath therapy compared with no intervention or other interventions delivered at the same dose as the Bobath therapy. Outcome measures Arm activity outcomes and arm strength outcomes. Trial quality was assessed with the PEDro scale. Results Thirteen trials were included; all compared Bobath with another intervention, which were categorised as: task-specific training (five trials), arm movements (five trials), robotics (two trials) and mental practice (one trial). The PEDro scale scores ranged from 5 to 8. Pooled data from five trials indicated that Bobath therapy was less effective than task-specific training for improving arm activities (SMD –1.07, 95% CI –1.59 to –0.55). Pooled data from five trials indicated that Bobath therapy was similar to or less effective than arm movements for improving arm activities (SMD –0.18, 95% CI –0.44 to 0.09). One trial indicated that Bobath therapy was less effective than robotics for improving arm activities and one trial indicated similar effects of Bobath therapy and mental practice on arm activities. For strength outcomes, pooled data from two trials indicated a large benefit of task-specific training over Bobath therapy (SMD –1.08); however, this estimate had substantial uncertainty (95% CI –3.17 to 1.01). The pooled data of three trials indicated that Bobath therapy was less effective than task-specific training for improving Fugl-Meyer scores (MD –7.84, 95% CI –12.99 to –2.69). The effects of Bobath therapy relative to other interventions on strength outcomes remained uncertain. Conclusions After stroke, Bobath therapy is less effective than task-specific training and robotics in improving arm activity and less effective than task-specific training on the Fugl-Meyer score. Registration PROSPERO CRD42021251630.

Objective To investigate the trial-based cost-effectiveness of the addition of a tailored digitally enabled exercise intervention to usual care shown to be clinically effective in improving mobility in the Activity and MObility UsiNg Technology (AMOUNT) rehabilitation trial compared to usual care alone. Design Economic evaluation alongside a pragmatic randomized controlled trial. Participants 300 people receiving inpatient aged and neurological rehabilitation were randomized to the intervention ( n = 149) or usual care control group ( n = 151). Main measures Incremental cost effectiveness ratios were calculated for the additional costs per additional person demonstrating a meaningful improvement in mobility (3-point in Short Physical Performance Battery) and quality-adjusted life years gained at 6 months (primary analysis). The joint probability distribution of costs and outcomes was examined using bootstrapping. Results The mean cost saving for the intervention group at 6 months was AU$2286 (95% Bootstrapped cost CI: −$11,190 to $6410) per participant; 68% and 67% of bootstraps showed the intervention to be dominant (i.e. more effective and cost saving) for mobility and quality-adjusted life years, respectively. The probability of the intervention being cost-effective considering a willingness to pay threshold of AU$50,000 per additional person with a meaningful improvement in mobility or quality-adjusted life year gained was 93% and 77%, respectively. Conclusions The AMOUNT intervention had a high probability of being cost-effective if decision makers are willing to pay AU$50,000 per meaningful improvement in mobility or per quality-adjusted life year gained, and a moderate probability of being cost-saving and effective considering both outcomes at 6 months post randomization.

To assess if cyclical electrical stimulation (CES) is effective at increasing voluntary strength, and functional electrical stimulation (FES) is effective at improving activity aſter stroke.

Objective To determine if home-based exercise programmes for older adults after hospitalisation are effective at improving physical activity, quality of life, activities of daily living (ADL) and mobility compared to no intervention, standard care or centre-based exercise. Methods Databases were searched from inception to March 2022. Randomised controlled trials which included home-based exercise in older adults recently discharged from hospital were included. The primary outcome was physical activity. Secondary outcomes were quality of life, ADL performance, mobility, adverse events and hospital readmissions. Two reviewers independently selected relevant studies and extracted data. Quantitative synthesis with meta-analyses using a random-effects model and qualitative synthesis were performed. Results Ten trials (PEDro score 6-8) were included. Three trials reported on physical activity but meta-analysis was not possible due to heterogeneity. Home-based exercise was more effective than no intervention at improving ADL performance (SMD 0.60, 95% CI 0.03 to 1.17); and standard care at improving quality of life (SMD 0.30, 95% CI 0.11 to 0.49) and mobility (SMD 0.23, 95% CI 0.00 to 0.45). Few and minor adverse events were associated with home-based exercise. Conclusion Based on individual trials, home-based exercise has the potential to improve physical activity compared to no intervention or standard care. Meta-analyses indicate that home-based exercise is more effective than no intervention at improving activities of daily living performance, and standard care at improving mobility and quality of life. It is unclear if home-based exercise is more effective than centre-based exercise at improving these outcomes.

Background and purpose: Investigating physical therapy in amputation management offers insights into clinical practice. This study explores the self-reported clinical practice of physical therapists in amputation management and compares it to established clinical practice guidelines to determine whether physical therapists are delivering care that is considered recommended clinical practice. Method: An online survey of Australian physical therapists with limited or extensive experience in managing individuals following amputation. Results: A total of 110 responses were received. The majority of Australian physical therapists (83%) reported their skills were adequate however, reported a lack of professional development opportunities. Physical therapists reported coordinating care with other health and medical professionals across all phases of care. They report providing comprehensive care in the following areas: residual limb management, pain management, falls prevention, education, counselling, psychological and peer support, and discharge planning. The majority of physical therapists were not aware if a comprehensive care plan was in place following a transition of care from a previous health service. Discussion: Overall, physical therapists displayed clinical practice meeting the guidelines across most areas of amputation management. Future research into alternate data collection of clinical practice, and the development of physical therapy-specific clinical practice guidelines is needed.

Introduction Hearing impairment is associated with reduced balance and walking performance whilst multitasking. Multitask training to improve performance, has not been assessed in this population. Methods This feasibility study recruited participants from a University Hearing Clinic who attended weekly group multitask training for one month. Feasibility outcomes included training completion rates, participant-reported acceptability and adverse events. Walking outcomes were the 6-minute walk test (6MWT) and multitask performance. Results Twenty-two individuals were invited and eight agreed to participate. Six participants attended all testing (baseline, post and retention) and 79% of training. Participants enjoyed the program. Muscle soreness caused one withdrawal. No other adverse events occurred. 6MWT improved significantly following training (58m, 95% CI 17 to 98), as did walking speed during dual-tasks (12 cm/s, 95% CI 2 to 23). Conclusions This study suggests multitask training may improve walking performance in older adults with hearing impairments. These preliminary findings warrant further investigation.