Allied Health research

Since late 2016 the Bupa Research Fellow (Allied Health) John Parsons and the Bupa (Allied Health) Research Associate Laura Stratton (Victoria Donoghue August 2017 - May 2018)  have been actively engaged in fostering a research culture within allied health through

• Facilitating and conducting research projects within Allied Health

• Promoting research amongst Allied Health clinicians and the broader Waikato DHB community

• Providing research education opportunities to allied health clinicians and advising and supporting Allied Health clinicians interested in undertaking higher education in research

• Encouraging and supporting Allied Health Clinicians to disseminate results of research activities through conference presentations and publications.

In total there are 24 research projects being undertaken within allied health currently. Some of these projects are:

Developing a vision for the future. 
Exploring and looking at the development of the Allied Health workforce.

What is the scope of practice for the social worker in the acute setting to facilitate the patient's social and emotional wellbeing in health.
Research which focuses on improving the quality and timeliness of referral to social work for patients acutely admitted to Waikato Hospital

The role and perceived function of the acute medical physiotherapist within the multidisciplinary team at Waikato Hospital.
This research will look at the role of the physiotherapist and therapy assistants but distinguish the current culture and responsibility of initiating and maintaining mobility for patients admitted to the acute medical wards.

Swallow function in acute lymphoblastic lymphoma and graft vs Host disease: the effects of total body radiation therapy. 
A case study being completed by the Speech Language Therapy team

A prospective randomized control trial evaluating the clinical efficacy and patient satisfaction scores of a novel adjustable wrist splint (Zero-Cast) for the treatment of distal radius fractures. 
Zero Cast is an experimental no cast wrist splint that will be trialled in the over 65 population presenting with undisplaced distal radius fractures.

Clinician knowledge in amputee rehabilitation at Waikato District Health Board.
This research examines physiotherapists and occupational therapists knowledge of both upper and lower amputation post prosthesis amputee rehabilitation across the care continuum.

Early mobility in ICU ventilated patients and physiotherapy practice.
This research aims to identify the current culture for early mobilisation and explore enablers and barriers to change in practice.

Communication accessible environments.
This is an evaluation of a training package which was designed and delivered on OPR4. It emphasized the importance of communication access in the wards and how this can be integrated into daily practice.

An exploratory study to examine the facilitators and barriers that influence patients with non-cystic fibrosis bronchiectasis attending the physiotherapy outpatient respiratory clinic.
This study will examine both health inequities for people living in rural communities and also Maori health outcomes as outlined in Waikato DHB's strategy.

If you would like to discuss any of this research or ideas for other research, please contact Laura Stratton, Research Associate on Laura.Stratton@waikatodhb.health.nz  or Associate Professor John Parsons, Research Fellow on j.parsons@auckland.ac.nz 

Clinician knowledge in amputee rehabilitation at Waikato District Health Board

This study aims to examine physiotherapists and occupational therapists knowledge of both upper and lower post prosthesis amputee rehabilitation across the care continuum within Waikato District Health Board. Determining the knowledge base and identifying any barriers to implementing best practice will inform future educational opportunities and initiatives to deliver quality patient care across service provision.

Factors associated with length of stay of bariatric patients in Waikato DHB

Aims: The study aimed to explore how factors impacted prolonged hospital length of stay amongst people considered having bariatric needs, or extreme obesity within a New Zealand tertiary hospital.
Outcomes: Thematic analysis defined three main themes impacting LOS, these were Insufficient Equipment, Medical complications, and Skin injuries.
Recommendations: Identifying the factors which are associated with prolonged LOS among patients who have bariatric inpatient needs provide useful insights into a bariatric inpatient population profile in a NZ tertiary hospital and could initiate future pre-planning efforts to enhance the quality and safety of healthcare for at-risk patient group.

To investigate the efficacy of community dietetic interventions in care of the elderly

This study aims to review community dietitian’s interventions and outcomes in the community dwelling older population. The study will determine what interventions are used and which ones provide a positive outcome for the patient.

Enhanced recovery after surgery: an evaluation of pre-operative education provided by the OT service

Aims: This study’s aims were to evaluate the pre-operative educational intervention versus no pre-operative educational intervention for patients who had elective hip and knee surgery.
Outcome: Low response rate to patient survey. Only 44% of elective hip/knee patients attended the pre surgery education. Findings demonstrated that education was well received by patients whether received pre or post operatively. There were no differences in length of stay for those who received pre-operative education.
Recommendations: To review the pre-operative service provision pathway across OT and identify clear clinical questions for review of service efficacy.

Does attendance to the memory and fatigue clinic improve patient outcomes?

This project aims to review the efficacy of the memory and fatigue clinic provided by the older persons and rehabilitation OT and psychology services.

What is the efficacy of community OT input as evaluated using the TOMs outcome measure?

This project aims to look at the effectiveness of community OT interventions as measured by the TOM’s outcome measure and identify how patient cohorts respond to interventions in the different domain of the TOM’s measure.

Enhanced recovery after surgery: an evaluation of pre-operative education provided by the OT service

Aims: This study’s aims were to evaluate the pre-operative educational intervention versus no pre-operative educational intervention for patients who had elective hip and knee surgery.
Outcome: Low response rate to patient survey. Only 44% of elective hip/knee patients attended the pre surgery education. Findings demonstrated that education was well received by patients whether received pre or post operatively. There were no differences in length of stay for those who received pre-operative education.
Recommendations: To review the pre-operative service provision pathway across OT and identify clear clinical questions for review of service efficacy.

What is the impact of a physiotherapy led paediatric gait clinic?

This project aims to review the impact of a physiotherapy led first specialist appointment (FSA) clinic on orthopaedic waitlists. It also aims to review both orthopaedic consultant and patient satisfaction with the service provided by the paediatric physiotherapists.

What is the impact of a physiotherapy-led paediatric gait clinic?

This project aims to review the impact of a physiotherapy led first specialist appointment (FSA) clinic on orthopaedic waitlists. It also aims to review both orthopaedic consultant and patient satisfaction with the service provided by the paediatric physiotherapists.

Has the implementation of the high risk infant pathway improved patient outcomes?

Aims:  The High Risk Infant Pathway was set up in March 2017 to improve the way infants are screened for developmental and neurological impairments, ensuring timely access to diagnosis-specific therapy intervention. The pathway involves high risk infants being assessed using the General Movements Assessment prior to NICU discharge and again at 12 weeks post-term age. This project aims to review the one year outcomes of these patients and their access to early intervention.

Outcomes: The total number of NICU graduates with completed assessments using the General Movements Assessment was 105 infants.  Of these 11 were identified as High Risk of developmental and neurological impairments. All 11 of those identified as High Risk had on-going neurological concerns such as cerebral palsy, motor delay and global developmental delay. 100% of the children eligible for Waikato DHB services were referred to Visiting Neurodevelopmental Therapy (VNT)  and received home based, intensive and evidence based intervention.  Hammersmith Infant Neurological Examination (HINE) has not been completed routinely.

Recommendations: The General Movements Assessment is now standard practice for those infants meeting the criteria and should continue to be so. The Hammersmith Infant Neurological Examination (HINE) should be used to support and define diagnosis, document the longitudinal history of the condition and document effects of intervention. This assessment should be completed at 3-4, 6, 9 and 12 months.   All interventions provided by VNT services are evidence based and appropriate, however Parent Coaching, Enriched Environments and GAME model of care should be more often implemented due to emerging evidence of improved motor and cognitive outcomes for infants. It is too early to see if patient outcomes are improved however all babies received access to early intervention. Evaluation of 1 and 2 year Baby Clinic outcomes should be evaluated when these assessments are completed in large enough numbers.

What is the impact of a physiotherapy-led paediatric gait clinic?

This project aims to review the impact of a physiotherapy led first specialist appointment (FSA) clinic on orthopaedic waitlists. It also aims to review both orthopaedic consultant and patient satisfaction with the service provided by the paediatric physiotherapists.

The role and perceived function of the acute medical physiotherapist within the multidisciplinary team at Waikato Hospital

The aim of this study is to investigate the role and perceived function of the acute medical physiotherapist within the multidisciplinary team at Waikato Hospital with the intention of improving awareness of the role and scope of physiotherapy practice

Has the implementation of the high risk infant pathway improved patient outcomes?

Aims:  The High Risk Infant Pathway was set up in March 2017 to improve the way infants are screened for developmental and neurological impairments, ensuring timely access to diagnosis-specific therapy intervention. The pathway involves high risk infants being assessed using the General Movements Assessment prior to NICU discharge and again at 12 weeks post-term age. This project aims to review the one year outcomes of these patients and their access to early intervention.

Outcomes: The total number of NICU graduates with completed assessments using the General Movements Assessment was 105 infants.  Of these 11 were identified as High Risk of developmental and neurological impairments. All 11 of those identified as High Risk had on-going neurological concerns such as cerebral palsy, motor delay and global developmental delay. 100% of the children eligible for Waikato DHB services were referred to Visiting Neurodevelopmental Therapy (VNT)  and received home based, intensive and evidence based intervention.  Hammersmith Infant Neurological Examination (HINE) has not been completed routinely.

Recommendations: The General Movements Assessment is now standard practice for those infants meeting the criteria and should continue to be so. The Hammersmith Infant Neurological Examination (HINE) should be used to support and define diagnosis, document the longitudinal history of the condition and document effects of intervention. This assessment should be completed at 3-4, 6, 9 and 12 months.   All interventions provided by VNT services are evidence based and appropriate, however Parent Coaching, Enriched Environments and GAME model of care should be more often implemented due to emerging evidence of improved motor and cognitive outcomes for infants. It is too early to see if patient outcomes are improved however all babies received access to early intervention. Evaluation of 1 and 2 year Baby Clinic outcomes should be evaluated when these assessments are completed in large enough numbers.

The use of pessaries as a treatment adjunct by physiotherapists

This project is leading the way for DHB-provided Women’s Health physiotherapy. The team based at Waikato Hospital are the first NZ DHB employed physios to begin using pessaries as a treatment adjunct that they can complete themselves rather than a gynaecologist. Two of the Women’s Health physiotherapists have undertaken training to be able to offer this service which is fully supported by the Waikato gynae team. The Women’s Health physio team are also completing a study to look at the effectiveness and patient satisfaction of the implementation of this new service.

An exploration of the amount of physiotherapy received in the first six months following stroke.

Aims: The aim of this study was to explore the amount of physiotherapy received by patients in the first six months following stroke. The study also aimed to identify if amount of therapy received was congruent with guideline recommendations and therapists perceptions about guideline recommendations.

Outcomes: 80% of patients receive physiotherapy in the first six months following stroke, however the amount of physiotherapy provided is below guidelines, yet comparable with other areas of New Zealand and internationally. Stroke severity and functional outcome measures were found to be inconsistently used by the stroke services, therefore limiting the evaluation of who physiotherapy is mostly provided to. Therapists felt that they were unable to provide adequate therapy secondary to a combination of patient, service and individual therapist related factors.

Recommendations: To establish routine clinical use of stroke severity and functional outcome measures so that effective service evaluations can be completed. To review the clinical practices of therapists to maximise face to face therapy delivery to patients following stroke.

Is the older persons and rehabilitation vestibular service provision effective?

Aims: To review the effectiveness of the OPR physiotherapy BPPV vestibular service provision.

Outcome: Only five patients presented with BPPV during the project time frame. All of the patients were seen within 2 weeks of referral meeting KPI.  All patients received follow up within one month. All patients’ symptoms had resolved. Not all patients received education and information regarding symptom reoccurrence and management

Recommendations: OPR services to continue to monitor that BPPV patients are seen within 2 weeks of referral and be reviewed at one month post intervention. All patients should receive education and information regarding symptom reoccurrence that should be clearly documented in the electronic casefile.

'Having the conversation’: Health care practitioners’ experiences of discussing pelvic floor problems with patients.

Aim: The focus of this study was to explore the current practice experiences of health care practitioners in regard to conversations about pelvic floor problems with their patients. 

Outcomes: Undergraduate and work-based learning enabled practitioners to feel confident in their abilities to engage in conversations about pelvic floor problems as well as providing awareness in limitations and abilities to partake in these conversations. Providing a safe, confidential space to allow patients to talk was valuable for participants to enable conversations about pelvic floor problems with their patients. The value of engaging in discussions provided positive patient experiences which encourages further integration into practice. 

Recommendations:

For practice:

• Supporting practitioners to engage in conversations about pelvic floor problems will facilitate these conversations to occur within the work setting.
• Provide a safe, confidential space to allow patients to talk, and support practitioners to learn more about assessing and managing, as well as understanding available resources that can contribute and provide practitioners with a sense of making a difference to their patients’ lives.
• Looking at alternative spaces to facilitate discussions (such as group education or discussions) may also promote healthy conversations about pelvic floor problems.
• Providing resources such as assessment tools, educational material, knowledge and appropriate training as well as clear clinical expectations of practitioners’ roles can create opportunities and contribute to practice meaning.

For education:
In order to prepare health care practitioners for readiness and to feel confident to engage in these conversations within their practice, education and training provided at undergraduate level is imperative. Supporting learning that provides meaningful experiences and creating the space to learn creates willingness to participate in these conversations and develop confidence and awareness of abilities. 

Does attendance to the memory and fatigue clinic improve patient outcomes?

This project aims to review the efficacy of the memory and fatigue clinic provided by the older persons and rehabilitation OT and psychology services.

Developing a communication accessible environment for people with aphasia.

This project aims to follow the communication access project completed by Simons-Mackie et al. (2007)-It “aims to improve the communicative access to information and decision making for people with aphasia” by increasing the OPR-4 stroke unit team’s knowledge of, and skills in providing communicative supports by facilitating implementation of facility- specific communicative access goals.” Additionally, it aims to develop audit guidelines for communicative access in Waikato DHB.

Developing a communication accessible environment for people with aphasia.

This project aims to follow the communication access project completed by Simons-Mackie et al. (2007). It “aims to improve the communicative access to information and decision making for people with aphasia” by increasing the OPR-4 stroke unit team’s knowledge of, and skills in providing communicative supports by facilitating implementation of facility- specific communicative access goals.” Additionally, it aims to develop audit guidelines for communicative access in Waikato DHB.

Health professional’s knowledge of driving restrictions following a cardiovascular event

This study being led by Waikato University aims to explore the driving-related advice health professionals provide to patients with after a cardiovascular event, and how they deliver this information to patients.

Implementing early family meetings during inpatient stroke rehabilitation

This implementation research is using a mixed methodology to develop and provide education and training to staff to become early family meeting facilitators. Once the early family meetings have been implemented patient and staff experience of these will be used along clinical data to establish the satisfaction and effectiveness of providing early family meetings during inpatient stroke rehabilitation.

Implementation of the PREP 2 upper limb recovery algorithm in clinical practice

This project aims to evaluate the implementation process of a new assessment tool for recovery of the upper limb following stroke. This project includes the use of stakeholder focus groups and interviews, staff education packages and clinical audit to review the effectiveness of implementing a new process into routine clinical practice.

An exploration of the amount of physiotherapy received in the first six months following stroke.

Aims: The aim of this study was to explore the amount of physiotherapy received by patients in the first six months following stroke. The study also aimed to identify if amount of therapy received was congruent with guideline recommendations and therapists perceptions about guideline recommendations.

Outcomes: 80% of patients receive physiotherapy in the first six months following stroke, however the amount of physiotherapy provided is below guidelines, yet comparable with other areas of New Zealand and internationally. Stroke severity and functional outcome measures were found to be inconsistently used by the stroke services, therefore limiting the evaluation of who physiotherapy is mostly provided to. Therapists felt that they were unable to provide adequate therapy secondary to a combination of patient, service and individual therapist related factors.

Recommendations: To establish routine clinical use of stroke severity and functional outcome measures so that effective service evaluations can be completed. To review the clinical practices of therapists to maximise face to face therapy delivery to patients following stroke.

The use of pessaries as a treatment adjunct by physiotherapists

This project is leading the way for DHB-provided Women’s Health physiotherapy. The team based at Waikato Hospital are the first NZ DHB employed physios to begin using pessaries as a treatment adjunct that they can complete themselves rather than a gynaecologist. Two of the Women’s Health physiotherapists have undertaken training to be able to offer this service which is fully supported by the Waikato gynae team. The Women’s Health physio team are also completing a study to look at the effectiveness and patient satisfaction of the implementation of this new service.

'Having the conversation’: Health care practitioners’ experiences of discussing pelvic floor problems with patients.

Aim: The focus of this study was to explore the current practice experiences of health care practitioners in regard to conversations about pelvic floor problems with their patients. 

Outcomes: Undergraduate and work-based learning enabled practitioners to feel confident in their abilities to engage in conversations about pelvic floor problems as well as providing awareness in limitations and abilities to partake in these conversations. Providing a safe, confidential space to allow patients to talk was valuable for participants to enable conversations about pelvic floor problems with their patients. The value of engaging in discussions provided positive patient experiences which encourages further integration into practice. 

Recommendations:

For practice:

• Supporting practitioners to engage in conversations about pelvic floor problems will facilitate these conversations to occur within the work setting.
• Provide a safe, confidential space to allow patients to talk, and support practitioners to learn more about assessing and managing, as well as understanding available resources that can contribute and provide practitioners with a sense of making a difference to their patients’ lives.
• Looking at alternative spaces to facilitate discussions (such as group education or discussions) may also promote healthy conversations about pelvic floor problems.
• Providing resources such as assessment tools, educational material, knowledge and appropriate training as well as clear clinical expectations of practitioners’ roles can create opportunities and contribute to practice meaning.

For education:
In order to prepare health care practitioners for readiness and to feel confident to engage in these conversations within their practice, education and training provided at undergraduate level is imperative. Supporting learning that provides meaningful experiences and creating the space to learn creates willingness to participate in these conversations and develop confidence and awareness of abilities.