Masters Practice Projects

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https://hdl.handle.net/10292/10895

The Masters Practice Projects collection contains digital copies of AUT masters practice projects deposited with the Library since 2017 and made available open access.

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Moving from Te Po (Night) and into Te Ao (Light): an Indigenous Framework to Support Māori Males Who Have Been Sexually Abused in New Zealand
(Auckland University of Technology, 2014) Stevens II, Alexander Windsor; Warren, Helen; Henry, Ella
Sexual abuse is a public health threat to the wellbeing of all people in New Zealand. The costs of sexual violence have been estimated by New Zealand Treasury in 2006 to be over a billion dollars a year. Current statistics suggest that females are more likely to be sexually abused than males. However research has indicated that men (in general) have separate challenges coming forward to discuss being sexually abused. For indigenous males the challenges are even more demanding than tauiwi (non-Māori) men. Excluding ethnicity, male experiences of being sexually abused in general are under reported in New Zealand. This can mean men present with on-going problems that may damage them physically, mentally, emotionally and spiritually. When indigenous men access health or social services Māori and Pacific frameworks are often used to ensure culturally appropriate care is given. This can include Te Whare Tapa Wha and Te Wheke. However there are limitations to these indigenous frameworks when sexual abuse is factored in. Given this a new approach is needed to understand the complexities of being sexually abused, and to find culturally appropriate ways forward. Effectively finding solutions that deal with prevention and recovery from sexual abuse will greatly reduce the mental health and addiction burden in New Zealand. To meet the gaps identified the researcher has developed a framework and tool based on ancestral knowledge of both Māori people (the indigenous peoples of New Zealand) and the Ojibwa people (one of the largest groups of indigenous people that are divided between the United States and Canada). The results of the project suggest a positive way forward, towards healing and recovering from sexual abuse. This will be used as the basis for on-going exploration and study.
'Birthplace - Your Choice' A Smartphone Application Designed to Aid Informed Decision Making on Birthplaces for Primigravida Women in New Zealand
(Auckland University of Technology, 2019) Ballard, Sarah; Gunn, Jackie
Birthplace choices influence maternal and neonatal outcomes. Despite popular belief, International, New Zealand and local research confirms that birthing in an obstetric hospital does not improve maternal or neonatal outcomes for healthy, low-risk women and their babies. Research evidence agrees that it instead, increases the likelihood of unnecessary medical interventions leading to maternal and neonatal morbidities. Health outcomes for birth planned at home or in midwife-led birthing units is safer for mothers and as safe as an obstetric hospital for babies, yet in New Zealand the majority of women choose to birth in an obstetric hospital. Knowledge on birthplace options and outcomes is hindered by a lack of easily accessible, user-friendly, evidence-based information. Worldwide ehealth technologies are increasing in use with Smartphone healthcare applications (Apps) being increasingly integrated into mainstream healthcare as monitoring and information tools. The main aim of this research was to develop an ehealth Smartphone App called 'Birthplace - Your Choice' This App would provide evidence based, accessible information that focused on: birthplace choices; outcomes for mothers and babies giving birth in hospital, midwife-led birthing units and at home; obstetric interventions; and the benefits of physiological birth. This prototype App was developed as a Patient Decision Aid Tool in collaboration with Centre for Learning and Teaching, Auckland University of Technology. International Patient Decision Aid Standards criteria, decisional-conflict measurements, information processing, ehealth frameworks and communication theories informed App development. An extensive literature search was conducted to provide evidence-based content. ‘Birthplace – Your Choice’ includes New Zealand specific statistical data which makes this project unique to the birthing population information needs. The statistical likelihood of vaginal birth, caesarean, water-birth, bleeding after birth, perineal trauma, Apgar score and admission to neonatal intensive care unit is presented. Information on transfer from home or midwife-led birthing units to hospital is also provided. Written text, drop-down information options, interactive quizzes and interactive infographics are provided to engage the user with the content. Prototype testing involved a small sample of four primigravida women who each answered a questionnaire before using the ‘Birthplace – Your Choice’ App and another a week after use. Observational notes were also recorded on navigation and usability while the App was being used. Results: Use of a New Zealand specific Smartphone App has potential in aiding low-risk primigravida women in making informed decisions on their birthplace and understanding childbirth choices. The four women desired information on Birthplace options and deemed this important to make informed decisions yet none was available that was easily accessible. The women expressed their frustration at having to rely on their midwife, family and friends for information which they recognised as potentially biased. The provision of credible information via a Smartphone was appreciated and validated as a suitable platform to deliver such information. The fact that this information could be shared and discussed with others and freely accessed, improved its acceptability. Three of the women stated that the content of the App increased their confidence that they had made the right choice to birth at a midwife-led birthing unit. One of these women who tested the App at 38 weeks’ gestation stated that had she had this information earlier she would have likely chosen a homebirth. The last woman had chosen to birth at a hospital but changed to a midwife-led birthing unit after using the App. This demonstrates that women prefer and may benefit from being able to access evidence-based information on birthplace options in New Zealand. New Zealand women make their birthplace decision early in, if not before, pregnancy. This demonstrates the need for high quality information on birthplace options and outcomes to be easily accessible if any improvements in informed decision making is to occur. By explaining the benefits of physiological birthing for mother and babies, along with information on birthplace options and outcomes, the ‘Birthplace – Your Choice’ App fills a gap not being met by any current Public Health initiatives in this country. Further App development and a larger sample size is needed for meaningful statistical analysis that can measure any effect of the App on choice of birthplace. ‘Birthplace – Your Choice’ offers potential as an ehealth tool to improve education on Birthplace options, obstetric interventions, maternal and neonatal outcomes and the benefits of physiological birth. Potential benefits for maternity Stakeholders include a reduction in costs and staffing demands if exposure to accurate birthplace information results in a shift away from birth in hospitals.
The Prevalence, Characteristics and Impact of Chronic Pain in Patients with Muscular Dystrophies: A Systematic Review
(Auckland University of Technology, 2020) Huang, Meihuan; Magni, Nico; Rice, David
Background: Chronic pain is a frequent, yet under-recognised and under-assessed problem in people with muscular dystrophies (MDs). Knowledge of the prevalence and characteristics of chronic pain, and its impact on function and quality of life is limited and lacks systematic exploration. Purpose: This study aims to systematically review and synthesise existing literature that addresses chronic pain prevalence, characteristics and impact in people with different types of MDs. Methods: A systematic search of bibliographic electronic databases was performed for articles (up to March 2020) reporting chronic pain (pain persisting ≥ 3 months) in people with MDs. Quality assessment was conducted using the Risk of Bias Tool for Prevalence Studies. Pooled estimates of pain prevalence and average pain intensity were calculated for each diagnostic group and where the number of articles was sufficient, group comparison was performed. Results: The estimated prevalence of chronic pain is similar across diagnostic groups of MDs: 68% in FSHD, 65% in DM, 62% in BMD/DMD, and 60% in LGMD. Generally, chronic pain is reported as mild to moderate by most people with FSHD and DM, with a mean value of moderate pain intensity (4.1/10 in FSHD and 4.7/10 in DM, respectively). Lower back, shoulder and legs are the most frequent sites of chronic pain among people with FSHD, DM, BMD/DMD, and LGMD, with minor variations. Diffuse pain across multiple body sites was reported by a notable proportion of these individuals. No clear pattern of pain descriptors relating to a specific diagnostic group of MDs could be identified from the included studies. Chronic pain has a negative impact on daily life activities in people with MDs, and may also contribute decreased quality of life. Occupational and domestic activities, recreational activities and mobility are the daily life domains most commonly affected by chronic pain. In children with DMD, mood may be significantly affected. Consistently, sleep is the least affected domain by chronic pain across different forms of MDs. Implications: This is the first review that systematically explores the prevalence, characteristics and impact of chronic pain in people with MDs. It is also the first to attempt to quantitatively synthesise the prevalence and pain intensity data by diagnostic groups in this population. The present study demonstrates how common chronic pain is across various MD populations and highlights the need for better recognition and understanding of the nature and impact of pain from health professionals. Future studies should focus on chronic pain in lesser explored MDs (including CMD, EDMD, OPMD and Distal MDs), geographic regions outside the USA and Europe and younger age groups. Further investigations on pain phenotypes (e.g. neuropathic vs nociceptive pain) and the associated response to treatments are also recommended.
Toward an Operational Definition of an Informal Mindfulness Practice: A Scoping Review and Stakeholder Consultation
(Auckland University of Technology, 2020) Andersen, Nicole; Krägeloh, Chris; Bright, Charmaine
The current definitions of informal mindfulness practice proposed in the literature are inconsistent and obscure. It has been described by several studies yet, there has been no effort to establish the defining principles the constitute informal mindfulness practice. Therefore, there is no widely agreed on definition of informal mindfulness practice. Using a scoping literature review methodology, this research provides an overview of the various types of definitions of informal mindfulness. A content analysis of the scoping review identified 35 definitions that could be allocated into five categories. These five categories were: exposure of formal practice, intentionality, everyday activities, continuity, and awareness of breath. In addition, mindfulness teachers, as participating stakeholders, were interviewed about the extent to which these definitions have utility for their practice and teaching. Information from these interviews helped to determine to what degree these definitions need to be modified. The stakeholders agreed that “exposure to a formal practice” and “intentionality” are crucial components to informal practice. The stakeholders felt the remainder of the categories needed to be altered or expanded on. Lastly, the stakeholders expressed that “attitude” is a fundamental element that needs to be included in an operational definition of informal mindfulness practice. There was no current definition identified in the literature that included all of the fundamental elements identified from the research and stakeholder consultations. Therefore, the stakeholders provided an alternative operational definition of informal mindfulness practice. The researcher selected one definition from the five alternative definitions, that clearly represented all the fundamental facets identified by the scoping review and expressed by the stakeholders.
Improving Assessment Inter-rater Reliability of a Nursing ePortfolio: An Integrative Review
(Auckland University of Technology, 2021) Quiding, Janine; Healee, David
Nursing Council of New Zealand (NCNZ) are responsible in ensuring all nurses are registered, competent, safe and fit to practice, to protect the health and safety of the New Zealand public. The approval of Professional Development and Recognition Programmes (PDRP) by NCNZ enable organisations to provide a programme whereby nurses demonstrate continuing competence and/or progression to a higher level of practice by successfully having a portfolio of evidence assessed. Assessments of portfolios are completed by trained assessors internally or externally to the PDRP approved organisation. This practice project aims to seek clarity and provide recommendations to improve assessment inter-rater reliability of nursing ePortfolio’s. An integrative review methodology framework developed by Whittemore and Knafl (2005) was used along with Braun and Clarke (2006) thematic analysis to support the data analysis process. The dataset comprised of 13 articles which were selected through a rigorous literature search process and then data analysis occurred. There are two main themes that emerged out of the data. Firstly, ‘The Assessor’ and what they bring within themselves which has the potential to influence the assessment process and outcome. The second is ‘External Factors’ which are independent of the assessor and occur due to the nature of the nursing portfolio requirements, process and outcome. The assessment of nursing portfolios is a very complex process. It is clear that the very subjective nature of a nursing portfolio and what the assessor brings with them impacts the assessment process throughout. Assessment variability is inevitable due to the subjective nature of the evidence provided in a nursing portfolio. However, consideration of how to minimise this variability is important. By addressing, during training, what each assessor brings with them, acknowledging their own potential influences, biases and professional judgements, assessment reliability can be enhanced. Furthermore, inter-assessor discussion enables individual assessor’s assumptions and diverse views to be explored leading to a consensus of judgement. Finally, it must be accepted that variability between assessors will never be removed completely and we can only try to implement recommendations that may narrow the gap.
Influences on the Onset and Early Trajectory of Childhood Chronic Pain from a Developmental Perspective: An Integrative Review
(Auckland University of Technology, 2021) Meys, Amanda Nicole; Jone, Margaret
Chronic pain typically describes pain of longer than three months duration or that has exceeded expected tissue healing timeframes. For children, chronic pain consequences involve long-term social, emotional, physical and financial impacts, with lifelong heightened pain sensitivities and dysfunction. With the prevalence of chronic pain in childhood rapidly increasing, childhood chronic pain intervention plays a role in supporting wider population health. Primary healthcare is most often, the place of initial intervention for a child in pain, and initial treatment is predictive of chronic pain risk and outcomes. Further, children’s pain experiences and responses are thought to be more modifiable than those of adults. Therefore, quality, primary healthcare interventions have the potential to positively influence the onset and early trajectory of chronic pain in children. Childhood is a period of extensive development and learning, requiring practitioners’ acknowledgement and understanding of relevant cognitive, physical, psychological and social progressions in the children they work with. Yet, clinically, application of child development theory appears limited when working with children with chronic pain, creating an adult-centric approach to practice. With diverse biological risk factors, affective concerns and complex family factors thought to impact on childhood chronic pain trajectories, practitioners experience difficulty drawing together evidence to inform management. This practice project employed an integrative review methodology. It aimed to draw together and analyse the research literature about the biopsychosocial factors influencing chronic pain onset and its early trajectory in primary school aged children using a childhood developmental lens. The research evidence was critically considered in light of sociocultural and social cognitive developmental theories. Neuropsychological and neurophysiological developmental understandings were also employed to collectively highlight relevant biological, psychological and social developmental concerns. This review contributes novel understandings about childhood chronic pain that have implications for primary health care practice. The results suggest a range of interacting biological, psychological, and social factors play a role in the early trajectory and onset of chronic pain in children, and that many of these incorporate developmental considerations. Psychological factors in particular show interactions amongst outcomes for both parents and children. Such findings suggest that at a primary healthcare level, an interdisciplinary approach is essential. A key aspect that was predominantly absent from the current research, was the measure of change over time, needed to show the variations in presentation that might occur across a child’s development. Adopting a broader, more holistic conceptual understanding of childhood development would contribute to practitioner understandings of the biopsychosocial model as applied in childhood chronic pain, promote positive healthcare interventions and avoid pathologizing what is potentially developmentally normal. True, child-centred primary healthcare interventions have the potential to positively influence or interrupt childhood chronic pain trajectories.
Investigating Physiotherapy Management of Patients Undergoing Upper Abdominal Surgery at Waitemata District Health Board
(Auckland University of Technology, 2021) Owens, Victoria; Reeve, Julie
Post-operative pulmonary complications are one of the main complications following abdominal surgery (Patel et al., 2016), closely followed by cardiac complications (Jin et al., 2014) or wound infections (De Avila & Fenili, 2017). These complications increase hospital length of stay and mortality rates (Scholes, Browning, Sztendur, & Denehy, 2009). This, in turn, imposes a significant financial burden on healthcare resources and patient recovery (Perilli et al., 2018). Physiotherapy aims to prevent and remediate postoperative complications, including PPC’s, in patients undergoing major abdominal surgery (Boden et al., 2018). As part of a larger multicenter international observational study, North Shore Hospital has collected data from 100 patients relating to the prevalence of postoperative complications and provision of physiotherapy. This nested study will enable North Shore Hospital to determine its postoperative complication rate, audit interventions to prevent these, and determine physiotherapy interventions utilised in patients undergoing major abdominal surgery. In turn, this will guide a review of our service provision and inform a change of policy where/if needed.
The Effect of Internal Cueing Strategies on Gait in Parkinson’s Disease and Underlying Mechanisms: A Structured Review
(Auckland University of Technology, 2021) Wadhera, Meetu; Lord, Sue; Taylor, Denise
People with Parkinson’s (PWP) typically present with postural instability and gait impairment leading to a high number of falls. Gait rehabilitation that incorporates movement guidance training with sensory cueing and augmented feedback has been successfully investigated in the past to facilitate gait improvement in PWP. Despite showing clinical efficacy, there are limitations to the use of external cues such as device cost and the implementation of cue strategies in daily functional activities. An alternative approach is to use internal cueing which, although less commonly used, may yield similar benefits. This structured review examines the underlying mechanisms and efficacy for use of internal cues to reduce gait impairment among people living with Parkinson’s disease. Based on 14 studies, findings suggest that internal cueing improves gait speed and step length. Findings also suggest a selective response of cueing strategies on gait outcomes. While further research is required, internal cueing may offer a low-cost self-management tool to improve gait outcomes.
The Efficacy of Hypnosis in the Treatment of Chronic Musculoskeletal Pain: A Systematic Literature Review
(Auckland University of Technology, 2021) Taylor, Damian; Lewis, Gwyn
Hypnosis has a long history of use in the treatment of a variety of physical and psychological conditions. However, its effectiveness as a treatment for chronic musculoskeletal pain and the best method for delivery of the hypnotic intervention is still unclear. Therefore, the objective of this study is to review the research surrounding the efficacy of hypnosis for chronic musculoskeletal pain and to identify the most effective intervention delivery strategies. A systematic literature review was performed using the Scopus electronic database to locate all studies that had used hypnosis with a chronic, musculoskeletal pain condition. Thirteen studies met the inclusion criteria, of which 12 were randomised controlled trials. The total number of participants across the studies was 627, with a mean age of 48.3 years. The number of intervention sessions in the hypnosis group ranged from a single session to 14 weekly sessions, with a mean of seven sessions across the studies. The hypnotic intervention session durations ranged in length from 20 minutes up to 2.5 hours and were predominately given on a weekly basis. Collectively, the included studies provided high quality evidence that hypnosis has a positive effect in reducing pain intensity in chronic musculoskeletal conditions compared to standard care and waitlist controls. When compared to relaxation, differences between groups were less consistent but still tended to favour the hypnotherapy groups. Similarly, when compared to physical interventions such as physiotherapy or trigger point therapy, hypnosis was also shown to be more effective. The addition of hypnosis to other psychologically based interventions, such as cognitive behavioural therapy and pain education, created greater improvements in many outcome measures related to a person’s pain experience, such as average and worst pain intensity, and catastrophising. The studies that used a larger variety of hypnotic suggestions that targeted pain intensity, and the cognitive and emotional components of pain, achieved better outcomes. Hypnosis can, therefore, be recommended as a viable treatment option, either as a stand-alone-treatment or as an adjunct to other psychological interventions for the treatment of chronic musculoskeletal pain. Studies investigating the efficacy of specific components of the hypnotherapy interventions around dosage and delivery methods, with larger populations of a more homogenous sample are required to establish more robust conclusions regarding these parameters in a chronic musculoskeletal pain population.
Recruitment and Retention of the Rural Podiatric Workforce in New Zealand: Podiatrist Perceptions
(Auckland University of Technology, 2021) Beeler, Erin; Brenton-Rule, Angela
Background The role of podiatrist is important to the health and wellbeing of our rural communities. However, in New Zealand, there is a recognised shortage of podiatrists. Furthermore, the ability to recruit and retain primary care podiatrists in rural areas is thought to be challenging. The aim of this study is to find out what factors contribute to recruitment and retention of rural primary care podiatrists in New Zealand. Methods This study uses a Qualitative Descriptive approach. Semi-structured interviews were conducted with a number of podiatrists to better understand the factors contributing to recruitment and retention of rural primary care podiatrists in New Zealand. Results A rural background or family/whanau connections to a region were the strongest factors influencing recruitment to rural podiatry practice in New Zealand. This was also the principal factor in retention, however professional and social factors such as career fulfillment, nature of work and sense of belonging were also strong. Extensive travel, heavy workloads and professional isolation were factors that contributed to attrition. Conclusion This study provides the first insight into factors contributing to rural podiatrist's recruitment and retention in New Zealand. The most striking factor for recruitment is a rural background, and yet no work is being done nationally to promote podiatry as a career option to potential students from rural areas. Based on this study and given the key role podiatry can play in achieving greater health outcomes, it is essential that a strategic approach to workforce planning and retention by health policy makers and providers is undertaken if rural podiatry is to meet the needs of rural New Zealand.
Developing Patient Information for Women and Their Whanau Choosing to Electively End Their Second-Trimester Pregnancy Because of Foetal Abnormality
(Auckland University of Technology, 2021) Graham-Jones, Janine; Cook, Catherine
Medical terminations in the first trimester of pregnancy are one of the most commonly performed medical procedures undertaken in New Zealand. It is, however, far less common to electively end a pregnancy in the second trimester on the grounds of foetal abnormality. New Zealand data obtained in 2018 suggests that 238 women chose to electively end their pregnancy because of foetal abnormality. The diagnosis of a foetal abnormality presents the parents with a difficult and often traumatic decision ... to proceed with the pregnancy and give birth to a child with known disabilities, or to electively end the life of the foetus by terminating the pregnancy. When faced with a diagnosis of severe foetal abnormality, most women choose to electively end the pregnancy. A review of the current literature suggests that the incidence of medical terminations of pregnancy for foetal abnormality is increasing. This is thought to relate to advancing maternal age, the increased availability of antenatal screening, and the advances in diagnostic testing. Medical termination of pregnancy for foetal abnormality was considered a major life event for most women. The psychological consequences of making this decision came with a range of emotional consequences including (but not limited to) grief, sadness, doubt, anger, and regret. Research showed that written information given to women making this decision was considered inappropriate, did not support their emotional requirements, and failed to prepare them for the ordeal ahead. Providing sensitive and relevant patient literature can improve their psychological well-being, reduce the impact of their decision and improve their journey. Scrutiny of local literature revealed it to be inadequate, unsuitable, and insensitive. This quality improvement project aimed to develop a sensitive, informative, and supportive pamphlet to support women and their families/whanau through the labour and delivery of their pregnancy. The psychological consequences of choosing to end a wanted pregnancy because of foetal abnormality require specific regard to the development of a patient-centered resource to support women and their families/whanau as they navigate this difficult and isolating event in their lives.
Invisible Men: When Men Are the Recipients of Non-reciprocal Intimate Partner Violence in Heterosexual Relationships
(Auckland University of Technology, 2021) Amundsen, Sharon; Andajani, Sari
This modified qualitative systematic review (MQSR) examines if socio-cultural aspects of masculinity norms and attitudes create barriers that prevent men as recipients of non-reciprocated female intimate partner violence (IPV) from reporting and help-seeking. Predominantly family violence literature focuses on women's experiences as the recipients of IPV rather than men. Men's voices contributing to the research of their IPV experienced by their female partners, and the responses to their experiences of seeking help, are seldom heard. On the occasions that these men's stories are told, they create confusion and discord. A literature search was undertaken using EBSCO CINAHL, EBSCO SocINDEX, and OVID PyscARTICLES databases. A Google Scholar search was also initiated as a more informal type of search. The requisites of the search included: men as victims of IPV, women as perpetrators of IPV, barriers to reporting and help-seeking, and socio-cultural influence on reporting and help-seeking. The inclusion criteria for the search used statements such as men as recipients of IPV from female partners, women perpetrators, heterosexual relationships, barriers in men reporting IPV, and reference to masculinity. From these criteria, a total of 7 articles were selected and analysed. These articles came from the United States, the United Kingdom, Portugal, and Finland. There were no Aotearoa New Zealand articles included due to the paucity of research in this area. The themes that emerged from the MQSR for discussion are the types of violence used against men by women, descriptions of the types of help-seeking, double standards in professional service, and barriers to reporting and help-seeking for men. Masculinity as a cultural space and the need to break down barriers to reporting is discussed in conclusion, followed by recommendations on how this could be achieved. These recommendations include implications for practice, policy, and future research. My study concludes that men's needs in terms of finding support and disclosing IPV are not inexorably linked to those of women; men, too, want to be heard and believed.
Fear of Falling After Hip Fracture: A Systematic Review of Prevalence, Measurement, Associations with Physical Function, and Interventions
(Auckland University of Technology, 2021) Gadhvi, Chandini; Bean, Debbie; Rice, David
Background Hip fracture is a common and debilitating injury amongst older adults. Fear of falling (FoF) may impede rehabilitation after hip fracture. An updated systematic review to synthesize the existing literature on FoF after hip fracture is needed. Aim This study aims to review and synthesize existing literature to answer four research questions about the 1.) prevalence of FoF, 2.) psychometric properties of measurement instruments, 3.) association with physical function, and 4.) effectiveness of interventions in reducing FoF, in hip fracture patients. Methods A systematic electronic search was undertaken in the EBSCO Health, Scopus and PsychINFO databases in January 2021 for articles on FoF after hip fracture. Data in relation to each research question was extracted and analysed. The methodological quality of the studies was critically appraised using the ‘Risk of Bias Tool for Prevalence Studies’, ‘COSMIN Risk of Bias checklist for Patient-reported outcome measures’, modified version of the ‘Appraisal Tool for Cross-sectional studies’, and the ‘Cochrane Risk of Bias 2’ tools for each research question, respectively. Results 35 articles (34 studies) with 3809 participants were included. Prevalence rates for FoF after hip fracture ranged between 22.5% and 100%, and the prevalence tended to decrease as time progressed post hip fracture. The ‘Falls Efficacy Scale – International’ (FES-I) and ‘Fear of Falling Questionnaire – Revised’ (FFQ-R) were found to be reliable, internally consistent, and valid tools in hip fracture patients. FoF after hip fracture was consistently associated with measures of physical function including balance, gait speed, composite physical performance measures and self-reported function. Exercise-based interventions with or without a psychological component were not effective in reducing FoF after hip fracture. Motivational interviewing and accelerated/ supported discharge with home based rehabilitation may have some impact on FoF, however, more high quality trials are needed to confirm this finding. Overall, there was insufficient evidence to conclude about the effectiveness of interventions in reducing FoF after hip fracture. Conclusion The literature on FoF after hip fracture has grown in the last decade. FoF is prevalent after hip fracture and is associated with poorer physical function. Only two instruments have been validated for measuring FoF in the hip fracture population. However, there is a need for more robust and larger studies to guide clinical practice regarding interventions to address FoF after hip fracture.
Virtual Reality for Improving Activity Levels in People With Chronic Pain: A Feasibility Study
(Auckland University of Technology, 2021) Pollard, Catherine; Tuck, Natalie; Lewis, Gwyn
Background People with chronic pain can develop a more sedentary lifestyle. Activity-based virtual reality (AVR) interventions may help increase activity and improve outcomes for people with chronic pain. Aim This study explored the acceptability and feasibility of AVR for improving activity levels and other pain relevant outcome measures among people with chronic pain. Participants Thirteen people with chronic musculoskeletal pain were recruited and randomised into a physiotherapy treatment as usual group (TAU) or AVR group. Design Randomised, non-blinded, pilot study involving within subject testing pre- and post-intervention. In addition, the TAU group underwent a pre-intervention waiting time to act as a control. Methods Each treatment arm (AVR, TAU or wait-time) lasted six weeks. Outcome measures were collected at the start and end of each six-week period and included self-report questionnaires, activity monitoring and physical function measures. Effect sizes were calculated and minimal clinical important differences in activity levels and pain relevant outcomes were documented where available. Feasibility was determined through recruitment and retention rates and acceptability through participant’s evaluation of sessions, perceived benefit and adherence to data collection processes. Results Recruitment was low and indicated a need for change in the exclusion criteria and recruitment sourcing when conducting a larger study. Retention rates, however, were reasonable and participants enjoyed the sessions and perceived to gain benefit from the AVR. Preliminary analysis of activity levels and other outcomes indicated that AVR was somewhat less effective than TAU, but effect sizes across the groups were small, though several limitations to the study protocol demand further research to quantify this. Conclusion The study confirmed that AVR was acceptable for a chronic pain population, but the study protocol as it stands would not be feasible for a large randomised controlled trial. Revisions may improve standardisation, and changes to the recruitment process are needed to increase participant numbers. Initial findings indicate that AVR is an enjoyable intervention for people with chronic pain, but pain relevant outcome measures did not indicate substantial differences in outcomes compared to standard physiotherapy or a waiting list control.
Internalised Homophobia: Correlations With Depression, Anxiety, Suicidal Ideation and Coming Out Age in the Gay, Lesbian, and Bisexual Community of Aotearoa New Zealand
(Auckland University of Technology, 2021) Hanekom, Johannes; Csako, Rita
Internalised homophobia is defined as negative attitudes and feelings towards homosexuality that many lesbian, gay and bisexual (LGB) individuals hold within themselves. Studies have shown that internalised homophobia is linked to the development of mental health problems such as anxiety, depression and suicidal ideation. No studies have been conducted to investigate the relationship between internalised homophobia and psychological distress in the New Zealand LGB community. This study aimed to be the first of its kind to quantitatively investigate the relationship between internalised homophobia, anxiety, depression, and suicidal ideation symptoms in the New Zealand LGB community. The study also aimed to investigate how age and the age of coming out influenced feelings of internalised homophobia. A quantitative cross-sectional study of 359 LGB participants from the New Zealand general population was conducted. Participants completed an online survey containing measures of psychological distress, including SIDAS, DASS-21 and IHS. Multiple regression analyses were performed to assess relationships between internalised homophobia, psychological distress, age and coming out age. A total of 98% of participants reported feelings of internalised homophobia. The study found that internalised homophobia significantly contributed to anxiety and depression in gay men, lesbians and bisexual women and contributed to symptoms of depression in gay men and bisexual women. Internalised homophobia only predicted suicidal ideation in lesbians and bisexual women. LGB participants aged 16-19 years reported significantly higher levels of internalised homophobia compared to older age groups, but a significant negative correlation between age and internalised homophobia was only observed in gay men and bisexual women. The study results also found that coming out at a younger age did not reduce feelings of internalised homophobia. However, the number of years since disclosing sexual orientation did significantly correlate with lower levels of internalised homophobia in gay men. These results may prove to have clinical implications for developing interventions to reduce the levels of internalised homophobia in LGB individuals that could improve mental health outcomes.
Improving the Time to Antibiotic Administration in Paediatric Febrile Neutropenia: Implementation of a Clinical Care Pathway in Saudi Arabia
(Auckland University of Technology, 2021) Pole, Maddi; Blamires, Julie
Febrile neutropenia is a commonly experienced condition in patients undergoing chemotherapy treatment or immunosuppressive therapies. Most chemotherapy patients will experience febrile neutropenia at least once in their treatment course. Febrile neutropenic infections develop and spread faster in those with inadequate immunity. In the paediatric population, timeliness and effective antibiotic treatment is paramount to avoiding long term organ damage, and septic related deaths. Best evidence suggests that antibiotic treatment, intravenous fluid resuscitation and blood test investigations should be completed within an hour of arrival to an emergency department for febrile neutropenic patients. This time frame is crucial in the prevention of potential organ damage, which can occur with as little as 3 hours of uncontrolled and untreated febrile neutropenia. Saudi Arabia had an average time to antibiotic administration of 3 hours and 48 minutes. The aim of this project was to develop and implement a clinical care pathway to guide health care professionals to adequately treat febrile neutropenia in the paediatric population in Saudi Arabia. Through a synthesis of current evidence, international best care practice and local guidelines, a pathway was developed. This pathway was implemented and reviewed in accordance with Rosswurm and Larrabee’s (1999) 6-step model for change to evidence practice, and the success and results of this project initiative are described in full below.
Using the Modified Wingate Test to Assess Unilateral Lower Limb Muscle Power in a Healthy and Knee Injury Population: An Exploratory Pilot Study
(Auckland University of Technology, 2022) Vazhapandal Nandakumar, Avinash; Mawston, Grant; McNair, Peter
Objective The primary objective of this study was to explore the use of the modified unilateral Wingate anaerobic cycle test to assess unilateral lower limb power in a healthy population; and to determine if any significant relationship exists with a 30-repetition isokinetic measure of knee extensor power and functional hop and jump tests. A secondary objective was to examine the power profiles of two participants with anterior cruciate ligament (ACL) reconstruction using the unilateral Wingate test. Study design An exploratory cross-sectional pilot study, involving assessment of power variables (peak power, mean power, and fatigue index) across limbs during a unilateral version of the Wingate test was undertaken by 11 healthy participants with no previous history of knee ligament injury. Comparison of Wingate power measures were made with knee extensor power produced during a 30-repetition isokinetic knee extension test. Two ACL reconstruction participants were also assessed for descriptive comparison. Background Many team sports and recreational activities require significant muscle power. Lack of adequate muscle power might impact a players’ performance. Additionally, deficits in unilateral lower limb power may contribute to injury. To improve player performance, a tool to evaluate unilateral lower limb power in a rehabilitation context is required to construct power-focused exercise programmes. The Wingate anaerobic cycle test has been used previously to assess bilateral lower limb muscle power. However, to date, no study has used the Wingate test to assess unilateral lower limb power in recreational young adults and knee injured participants. Method Ten men and one women (mean age of 26 years) with no previous history of knee injury, and one man and one woman two years following ACL reconstruction took part in the study. A Watt bike was used for the unilateral Wingate test to assess peak power, mean power, and fatigue index. A Biodex isokinetic dynamometry was used to assess isokinetic peak and average power of knee extensors over 30 repetitions. Functional performance tests, including the single-leg hop, triple hop for distance, and vertical jump test were also undertaken to evaluate distance reached, and power was calculated from peak height during the single leg vertical jump. Self-reported outcomes were assessed using the Lower Limb Task Questionnaire (LLTQ) and Knee and Osteoarthritis Outcome Score (KOOS). All testing procedures were performed in one session that lasted for 60 minutes (approximately). Statistical analyses was performed using SPSS software. Descriptive statistics were calculated for all measures and for comparisons of the two ACL case studies with healthy subject data. Paired t-tests were used for inter-limb comparison in healthy participants and Pearson correlation coefficients were used to identify significant relationships between functional, isokinetic and Wingate test results. The alpha value was set at <0.05. Results No significant difference in muscle power and fatigue index was identified between dominant and non-dominant leg in the healthy participants for the modified Wingate test, isokinetic assessment, and functional performance testing. One ACL reconstruction participant had deficits in lower limb muscle power in the injured side compared with the non-injured side across all tests; whereas no deficits were identified in the other participant across limbs for all tests. There was a significant moderate correlation between the peak power in the Wingate test and peak power in the isokinetic testing (r=0.57; P<0.05). Further, there was a strong correlation between the peak power in the Wingate test and power calculated from the vertical jump test (left r=0.84; right r=0.86). However, there were low to moderate correlations between the Wingate test and the single leg hop test (left r=0.2; right r=0.5) and the Wingate test and the triple hop for distance (left r=0.42; right r=0.54; P<0.5). A moderate to poor correlation was identified between the fatigue index of the Wingate test and the isokinetic test (left r=0.438; right r=0.25). Conclusion The unilateral Wingate test was able to detect key measures of unilateral lower limb power (peak and average power, and fatigue index) that were typically assessed during the bilateral version of the test with no significant interlimb differences in these measures in uninjured healthy participants. Power profiles during the unilateral Wingate test were similar to that produced during repeated isokinetic knee extension test, further indicating that this test assesses power and targets the anaerobic energy system. The low to moderate correlations between power measures in the unilateral Wingate and traditional hop tests may indicate that these tests measure different constructs of power and place dynamic balance, and neuromuscular co-ordination demands that differ to Wingate test; whereas the high correlation with vertical jump power indicates that both tests measure a similar construct of muscle power and anaerobic capacity. Findings from the two ACL reconstruction case studies indicate the potential of the unilateral Wingate test to detect unilateral lower limb power deficits following ACL reconstruction. However, this remains speculative and a larger study with increased statistical power is required to substantiate these case study findings.
A Clinical Audit of the ReAktiv™ Posterior Dynamic Element (PDE) Orthosis on Ankle Trauma
(Auckland University of Technology, 2022) Gardner, Sarah Louise; Frecklington, Mike
Background: Injuries sustained during High Energy Trauma (HET) often require complex surgery and extensive rehabilitation and can result in long-term issues such as pain, loss of function and limitations in physical activity. The ReAktiv Posterior Dynamic Element™ orthosis is a custom-made Passive-Dynamic Ankle-Foot-Orthosis (PDAFO) that aims to alter impact and loading through the foot and ankle, reducing pain and allowing users to return to high levels of physical activity. The aim of this study was to conduct a case series on the clinical effectiveness of the ReAktiv PDE orthosis on pain and function for people that had sustained a HET injury to the lower limb. Methods: This case series retrospectively reviewed the results of three patients that had received the ReAktiv PDE Orthosis as a treatment intervention to alleviate pain and improve physical function following a HET injury to the ankle. To determine any changes in pain all participants completed the LEFS and completed a 2MWT prior to receiving the orthosis as part of the initial assessment. The PDQ and PSEQ were completed at the final fitting of the orthosis (2 weeks) and provided a baseline measure of how much the pain from their injury affected them on a day-to-day basis. A 6-week physiotherapy-led rehabilitation programme was established to help patients with gait retraining, functional movement patterns and returning to physical activity. Physical function was assessed using the 2MWT, FSST, TSA and SLB. The questionnaires (LEFS, PDQ, PSEQ) were re-recorded at the conclusion of the rehabilitation programme to determine any self-reported changes in pain since receiving the orthosis. All physical tests were re-recorded at the conclusion of the rehabilitation programme (6-weeks). Results: The ReAktiv PDE orthosis shows promise in improving self-reported pain levels in those who have sustained HET injuries to the ankle. Tracking of pain prior to receiving the orthosis, and again at the conclusion of the rehabilitation programme was recorded on 1 participant. The PDQ and PSEQ showed an improvement when using the orthosis and how much pain interfered with their life. The LEFS was recorded on two participants and showed improvement with both participants reporting a higher score at the conclusion of rehabilitation with the orthosis compared to baseline with no orthosis. Physical walking performance improved as indicated by the improvement seen in the 2MWT. Improvement in mobility and balance, measured through recording of the FSST, TSA and the SLB test at the commencement and conclusion of the rehabilitation programme was also seen. Conclusion: The ReAktiv PDE orthosis shows potential as a treatment option to improve pain levels and walking performance in those who have sustained a unilateral, HET injury to the lower limb. In addition to the application of the orthosis, the use of a 6-week physiotherapy-led rehabilitation programme, recorded further improvements in walking performance, physical mobility and balance. Further research conducted on a larger and more diverse cohort of ReAktiv PDE orthosis wearers, would help to determine the significance of the orthosis design on pain and physical performance, and the impact that the rehabilitation programme has on pain and physical function. Long-term follow up of users would also indicate whether the improvements that have been obtained during this short time frame are sustained in the long-term or whether participants experience regression due to further deterioration to their injured limb.
A Critical Review Of The Task Related Training (TRT) Mobile App Prototype And Its Suitability For The Delivery Of TRT Locomotor Circuit Class Training For People With Stroke In An Inpatient Hospital Setting In Singapore: A Physiotherapy Perspective
(Auckland University of Technology, 2022) Mohamed Noor, Nurzahidah; Alder, Gemma; Signal, Nada
Background: Stroke is the leading cause of adult disability worldwide (Tetzlaff et al., 2020), and can result in locomotor disability, impacting functional independence and participation (Knox et al., 2018). As a result, identifying interventions that reduce locomotor disability while increasing functional independence is critical. The rise of digital health has resulted in a plethora of mobile technology-based innovations that open up new avenues for stroke rehabilitation (Henson et al., 2019). By facilitating physical, cognitive, and social activity, the use of tablet technology and mobile apps provides a platform for increasing the variety (Rinne et al., 2016), dose (Stütz et al., 2017) and intensity (Norouzi-Gheidari et al., 2012) of stroke rehabilitation in the hospital and community setting (White et al., 2015). Mobile apps have the potential to support the delivery of evidenced based interventions like task-related circuit class training (CCT) which has been shown to be more effective than conventional physiotherapy in improving walking speed, walking endurance and some aspects of balance in people with stroke (English et al., 2017). The physiotherapy department at Jurong Community Hospital (JCH), National University Health System in Singapore, wanted to see if their current stroke CCT programme could be delivered digitally to keep up with technological advancements. The purpose of this critical review was to determine the suitability of Task Related Training (TRT), an app in its early prototype stage, to support locomotor CCT for stroke patients at JCH. Method: This critical review used 1) a think-aloud usability method to assess the usability and suitability of the TRT app prototype from a physiotherapy perspective, and (2) comparator methods that critiqued the app's content using motor learning and task-related training principles, and tasks reported in the CCT literature for people with stroke. Results: Initial user testing revealed that the TRT app was well-received in terms of usability and suitability. Examining the app's content revealed that it is closely aligned with motor learning and TRT principles, as well as the tasks in the CCT evidence base. From the perspective of a physiotherapy user, the TRT App has the potential to support the delivery of the JCH CCT programme. Conclusion: Future directions should see designers of rehabilitation technology consider the recommendations outlined in this review and conduct future iterative user testing with physiotherapists, therapy associates and people with stroke in Singapore. Near-live encounters with the device over extended periods of time in the CCT context would also be important. Future research should also look at validating the device's efficacy for delivering locomotor CCT programmes in people with stroke.
The Efficacy of Repeat Botulinum Toxin Injections in the Management of Spasticity in Children and Young Adults with Cerebral Palsy: A Systematic Review
(Auckland University of Technology, 2022) Marlowe, Brittney Lee; Olsen, Sharon; Taylor, Denise
Background: Botulinum toxin (BT) is a common treatment intervention for the management of spasticity in children with Cerebral Palsy (CP). There are no national or internationally recognised clinical guidelines that provide clear information about the recommended frequency of repeat doses of BT and there are inconsistencies in clinical practice. The primary aim of this review was to determine the efficacy of repeat BT injections in the management of clinical outcomes in children with CP. The secondary aim was to compare the efficacy findings with the current National Institute for Health and Care Excellence (NICE) clinical guidelines to determine if the guidelines incorporate evidence-based recommendations concerning the timing and frequency of botulinum toxin injections. Method: A systematic literature search was conducted across five databases to identify relevant articles. Eligibility criteria included participants aged between birth to 21 years old at time of enrolment, clinical diagnosis of CP, presence of spasticity, treatment intervention of two or more BT treatments, and a comparison intervention of either a different frequency of BT, other interventions, or no BT treatment. Three independent reviewers identified eligible studies. Nineteen randomised controlled trials (RCTs) and 17 observational studies met the inclusion criteria, and the 19 RCTs were analysed in this project. Study characteristics and findings were extracted, and methodological quality was assessed using Version 2 of the Cochrane risk-of-bias tool for randomised controlled trials (RoB 2). A descriptive analysis was performed to assess outcomes and determine the efficacy of i) different frequencies of repeat BT injections, ii) repeated BT versus no BT, and iii) repeated BT versus other interventions. Results: A higher frequency of BT (4-monthly versus 12-monthly) resulted in significant short-term improvements in gait and adverse events were found to be twice as frequent. Reduced frequency of BT was found to improve outcomes in occupational performance when compared to OT only. Repeated BT compared with placebo injection resulted in improvements in gait and active ROM. Repeated BT compared with other interventions such as BT only, OT only or surgical intervention resulted in significant improvements in ROM and spasticity. Implications: The findings of this review provide evidence to support repeated BT improves spasticity, ROM and gait in the short-term only when compared to physiotherapy (PT) only, OT only or placebo injection. The recommended treatment frequency of BT is 12-monthly when the goal is to improve ROM and spasticity and 4-monthly when goal is to improve gait in the short-term only. Seven future recommendations suggest additional guidelines and changes to current NICE guidelines for translation to clinical practice. Future studies to investigate the long-term effectiveness of repeated BT in children with CP is required ensuring findings capture health related quality of life (HRQL) as a measure of participation.

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