Edition 70

Allied & Scientific Health News A bimonthly newsletter for members of all professions established and developing that assist in health care services

May – June 2012

EDITION 70

Guidelines with iCAHE

Guidelines for the use of support pessaries in the management of pelvic organ prolapse.

Pelvic organ prolapse (POP) is a common condition affecting the quality of life of women, not just as they age, but also after childbirth. The management is generally surgical but conservative management with pelvic floor muscle training has just achieved level 1 evidence status (Braekken et al 2009, Hagen et al 2011) and is likely to be recommended as first line management by the International Continence Society. Another method of conservative prolapse management is the fitting of a pessary, which is a procedure generally performed by a gynaecologist. However, there are increasing reports of pessaries being prescribed and fitted by nurses (Hanson et al 2006). In Australia, Continence & Women’s Health (C&WH) physiotherapists and Continence Nurses may have post-graduate training and be working at an advanced level of clinical practice, treating women with POP. The potential for C&WH physiotherapists and Continence nurses to be trained in pessary fitting, and extending their scope of practice, was identified as a way of making pessaries more widely available as a treatment option for women not wanting surgery for their POP.

als from a range of backgrounds, who have appropriate training in the prescription and fitting of pessaries. A team of experts and methodologists here at the iCAHE has been responsible for the literature searching and drafting and has collaborated with an expert working party, representing gynaecologists, general practitioners, C&WH physiotherapists and continence nurses, who have reviewed the drafts and contributed to the content development of the guideline. It is hoped that the publication of The Pessary Guideline and the accompanying Management Algorithm will provide an evidence-base for the safe prescription of pessaries by suitably trained health professionals in both the private and public sectors in Australia, allowing women with POP greater choice in the management of their condition. Training courses for health practitioners, who are already working in advanced scope practice in Women’s Health, are currently available through the Continence Foundation of Australia (www.continence.org.au).

A review of the literature revealed no published evidenceTrish Neumann PhD based guidelines and no accredited training courses in AustralSpecialist Continence & Women’s Health Physiotherapist ia, and possibly world-wide, on the prescription and fitting of (As awarded by the Australian College of Physiotherapists 2010) pessaries by non-gynaecologists. In response to this need, The International Centre for Allied Health Evidence, in collaboration You can access the guideline at http://w3.unisa.edu.au/cahe/ with the Continence Foundation of Australia, has produced an Resources/GuidelinesiCAHE/PessaryGuidelines.pdf evidence-based guideline suitable for use by health professionThis month's iCAHE guideline corner features a recently published policy statement by the American Academy of Paediatrics titled Climatic Heat Stress and Exercising Children and Adolescents. Although this policy statement has been described in news sources as a Clinical Guideline, there are important differences between policy statements and a clinical guideline. A policy statement is a suggested course of management for a specific diagnosis or a condition. Although the iCAHE guideline checklist was not designed to assess policy statements, applying the checklist can highlight the differences between these evidence summaries. A copy of this checklist is available on the iCAHE website. To see the policy statement and score sheet go to http://w3.unisa.edu.au/cahe/Resources/GuidelineCH/feature.asp

Action in Allied Health What’s happening in the world of AH

The Stroke Rehabilitation Pathway developed under the leadership of Susan Hillier has been endorsed by the Department for Health and Ageing. To see the guideline go to http://www.sahealth.sa.gov.au/wps/wcm/ connect/dd39a9804b32fb628730afe79043faf0/ Stroke+Rehabilitation+Pathway.pdf? MOD=AJPERES&CACHEID=dd39a9804b32fb628730afe79043faf0

Produced by the International Centre for Allied Health Evidence in conjunction with Department of Health, SA

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Allied & Scientific Health News EDITION 70

May – June 2012

iCAHE Presents….. Masterclass Clinical audit: its role in quality and safety of health care.

This masterclass is specifically tailored for South Australian allied and scientific health professionals seeking to gain a better understanding of clinical audits and how they can inform the quality and safety of health care. While clinical audits have been part of health care for a long time, with the emergence of evidence based practice and the need to improve the quality of health care service delivery, it is timely to revisit clinical audits types and processes. South Australia leads the way in allied and scientific health research and development, with the home of the International Centre for Allied Health Evidence (iCAHE) based at UniSA. This is a unique opportunity to access the expertise of world renowned researchers and presenters in a series of interactive and informative sessions. For more information or to book you place go to http://w3.unisa.edu.au/cahe/Resources/Masterclass/default.asp iCAHE researchers have been working with the Hong Kong Hospital Authority for the past 10 years to upskill clinicians in evidence-based practice and health research methodologies. A recent output from the teaching was a systematic review of the literature which was stimulated by a clinical question raised by Hong Kong psychologists. Janine Dizon, an iCAHE researcher, co-authored this publication with psychologist Sammy Cheng. This review will underpin clinical service decision in the Hospital Authority for the use of CBT for insomnia. Cheng SK, Dizon J 2012: Computerised Cognitive Behavioural Therapy for Insomnia: A Systematic Review and MetaAnalysis. Psychother Psychosom 2012;81:206–216

Stanhope J, Beaton K, Grimmer-Somers K, Morris J (2012) The role of extended scope physiotherapists in managing patients with inflammatory arthropathies: a systematic review. Open Access Rheumatology: Research and Reviews; 2012(4) 49-55. Guerin M, Grimmer-Somers K, Kumar S, Dolejs W (2012) The discharge of individuals from hospital: Do we need to refocus our research? Journal of Nursing Education and Practice; 2(3): 1-8 Walters J, Mackintosh S, Sheppard L (2012) The journey to total hip or knee replacement. Australian Health Review 36, 130–135 Batchelor FA, Hill KD, Mackintosh SF, Said CM (2012) Falls efficacy and fear of falling in stroke: issues with measurement and interpretation. Disability & Rehabilitation 34(8)704 Thomas S, Halbert J, Mackintosh S, Quinn S, Crotty M (2012): Socio-demographic factors associated with self-reported exercise and physical activity behaviours and attitudes of South Australians: results of a population based survey Journal of Aging and Health 24(2): 287-306 Fryer C, Mackintosh S, Hill K, Batchelor F, Said C (2012): The effect of limited English proficiency on falls risk and falls prevention after stroke. Age and Ageing 41: 104-107 Fryer C, Mackintosh S, Stanley M, Critchon J (2012): Qualitative studies using in-depth interviews with older people from multiple language groups: methodological systematic review Journal

PhD Corner….

Investigations of individually prescribed custom made foot orthoses by podiatrists in adults with symptomatic pes planus (flat feet).

PhD Candidate: Flexible pes planus (flat feet) is a descriptive term for feet that have a visually lowered medial longitudinal arch often in association with rearfoot eversion1. Reported to affect approximately 15% of the adult population2 pes planus can be categorised as either symptomatic (painful, non-functional) or non-symptomatic (non-

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Allied & Scientific Health News EDITION 70

May – June 2012

From page 2 painful, functional) with the literature pur- tor capability in addition to cognitive abilities in order to sucporting that flexible non-symptomatic pes planus is a predomi- ceed. A large part of the required skill set can be attributed nantly benign condition with no justification for intervention 3. directly to dexterity. When pes planus is symptomatic how Dexterity is defined as “manual ability that requires rapid coordination of gross or fine voluntary movements, based on a certain number of capacities, which are developed through learnever, functional foot orthoses (FO) are often prescribed and remain the most commonly quoted intervention within the lit- ing, training and experience” (Poirier 1988, p71). erature4. However, currently there is little evidence to support this use of FO for symptomatic pes planus nor a demonstrative understanding of their mechanism of action. Underlying this is also the ongoing concern that, as a profession, podiatrists have not established practice guidelines or alike for the prescription of FO for pes planus.

Teaching manual skills across disciplines and across programs is inconsistent and may lack an evidence-based approach. To date there is very little literature on clinical teaching and assessment of manual skills in the Podiatry profession. It seems pertinent in the age of evidence-based practice to investigate the teaching of manual clinical skills and the psychomotor elements The proposed PhD studies will investigate a number of clinical which relate to them. Consequently the overall aim of Ryan’s issues for orthosis prescription for symptomatic pes planus by project is: podiatrists. To establish how manual clinical skills, particularly scalpel Stage one will establish the current prescription habits and use skills, are taught in Podiatry schools throughout Ausof foot orthosis by a retrospective clinical note audit of the largtralia and New Zealand est prescription clinic in South Australia (UniSA’s podiatry bioDetermine appropriate objective psychomotor tests of dexmechanics clinic). Stage two will be a systematic review of evidence for the use of foot orthosis in the pes planus population. terity, and establish a correlation with manual clinical Stage three will involve a Delphi consensus (three or four round skills in novice, intermediate and experienced Podiatry survey) to determine best practice prescription methods for practitioners customising the foot orthoses and stage four will investigate if Determine if specific manual training improves dexterity the use of ‘best practice’ prescribed foot orthosis has an influand subsequent skill acquisition in Podiatry students ence on the commonly reported symptoms of pes planus around pain, Helen Banwell By doing this it is hoped that we can establish a method to obfatigue and function. jectively identify struggling students and implement techniques to improve their dexterity and subsequent performance withTeaching manual skills to Podiatrists out putting the public at risk. Furthermore, in the future we may use the findings from this project to investigate and evaluate further teaching tools. Manual skills are of significant importance amongst many health professions. Dentistry, Poirier, F 1988, 'Dexterity as a Valid Measure of Hand Function', Occupational Therapy in Health Care, vol. 4, no. 3-4, pp. 69-83. Surgery, Nursing and Podiatry are all profesRyan Causby sions which require a high level of psychomo-

Icentral….with Dr Saravana Kumar

clinical guidelines clearing houses, appraisal instruIt has been a while since I have had a chance to update the iCA- ments for clinical guidelines, HE newsletter readers about an important resource, the imple- guideline implementation mentation central website (www.implementationcentral.com). resources, links to useful For those who are unfamiliar with this website, implementation websites, just to name a few. central was created as a dedicated website for resources specifi- In 2012, we plan to continue cally targeted at putting evidence into practice (evidence imple- growing this web resource as mentation). This website was created as part of my NHMRC increasingly health care NICS MAC Fellowship and over the years, it has been updated stakeholders are explicitly demanding health care services are with a number of new resources. The website contains a list of underpinned by evidence. Couple of resources that will form

Implementation central – a voice from the past

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Allied & Scientific Health News EDITION 70 From page 3 the primary focus in 2012 are “Feature Article” section where every fortnight we will feature a new and interesting article relating to implementation science and “Evidence Talk” section where we will be addressing a number of topics relevant to evidence implementation specifically, and evidence-based practice

The 5th Biennial Australi-an and New Zealand falls prevention conference ‘Translating research into practice’ will be held at the Adelaide Convention Centre, in Adelaide, SA from the 28th-30th of October this year. The conference will provide dele-gates with a high caliber scientific program that aims to pre-sent leading research in falls prevention. International plenary speakers include Dr Olivier Beauchet, head of the geri-

May – June 2012 more broadly, in an audio format, each lasting a few minutes. Using these resources as vehicles, we plan to introduce some of our emerging researchers in this area to our wider audiences. So, please keep a look out for some new, interesting and fresh perspectives in the area of evidence implementation. Saravana Kumar

atrics division in the Department of Neuroscience at Angers University Hospital in France, and Dr Frances Healey, a Registered Nurse based in England with a career-long clinical, managerial and research interest in falls prevention in hospi-tals. Other speakers include Associate Proffessior Sandy Brauer, Dr Leslie Day, Professor Meg Morris, and many others.

For more details and to book your place, go to http:// www.anzfpsconference.com.au/index.php

Outcome Measure Corner: Goal Attainment Scale (GAS) Scale: Goal Attainment Scale (GAS) A criterion-referenced measure Has acceptable reliability and responsiveness to change; validity of scale can be influenced by the expertise of the clinician

1. What it measures The Goal Attainment Scale (GAS) is a method for evaluating the extent to which individual goals are achieved in the course of intervention. An important feature of GAS is the establishment of goals which are agreed with the patient and family before intervention starts. The goals are individually identified to suit the patient, and the levels are individually set around their current and expected levels of performance.

2. How it is scored and what the score means Problems are identified and goals are determined for those areas in which interventions will be given. It involves a 5-point scale where the expected outcome becomes the zero point on the scale. Then other relative levels of goal attainment are placed on the scale in reference to this expected outcome. Ratings of +1 and +2 refer to outcome better than expected post-intervention and much better than expected. -2 is the client’s baseline level, and -1 refers to improvement that is less than expected. Each goal attainment is rated as: -2 baseline

-1 less than expected level of goal attainment 0 expected goal attainment +1 criterion-referenced goal that partially exceeds target goal expectations +2 criterion-referenced goal that completely exceeds target goal expectations

References: Brown DA, Effgen SK, Palisano RJ (1998) Performance following abilityfocused physical therapy intervention in individuals with severely limited physical and cognitive abilities. Phys Ther 78(9); 934-950. Cox R, Amsters D. (2002) Goal Attainment Scaling: An effective outcome Measure for rural and remote health services. Aust J Rural Health. 10:256261. King GA, McDougal J, Palisano RJ, Gritzan J, Tucker MA (1999). Goal attainment scaling: its use in evaluating pediatric programs. Physical and Occupational Therapy Pediatrics. 19:2. Kiresuk TJ, (1994). Goal attainment Scaling: Applications, theory and measurement. Lawrence Earlbaum Associates, Inc. ISN 0898598893. Schlosser R (2004). Goal attainment scaling as a clinical measurement technique in communication disorders: a critical review. J Comm Dis, 37:217-239. Trombly CA, MA HI. (2002). A synthesis of the effects of Occupational therapy for Persons with Stroke, Part 1: Restoration of roles, tasks and activities for persons with Stroke. The Am J of OT, 56:250-259. Turner-Stokes L, (2009). Goal attainment scaling (GAS) in rehabilitation: a practical guide. Clin Rehabil, 23:362-370. Zweber B, Malec J (1990) Goal attainment scaling in post-acute outpatient brain injury rehabilitation. Occ Ther in Health Care, 7:45-53.

Please refer to page 39 of the Neurological Outcomes Calculator user manual for a copy of the GAS questionnaire.

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