Clinical research imperatives: principles and priorities from the perspective of Allied Health executives and managers.

Objective It is widely understood that a key means of improving health systems and patient outcomes is through research - accessing, understanding, generating and applying research evidence-based practice. To promote more targeted and strategic research in Allied Health practice, this study sought to establish the principles, areas and priorities for clinical research as perceived by Allied Health leaders in the South Australian public health system. Methods The study used a mixed-methods design (full, sequential and equal model). Participants were recruited from theSouth Australian Department of Health and Wellbeing employment lists for Allied Health senior leaders. Consenting participants attended face-to-face focus groups; after an overview presentation, they discussed the principles for Allied Health research, followed by areas and priorities for research. Summaries of the responses were themed descriptively and circulated electronically so participants could confirm the research areas and ascribe priority ratings, clinical populations and services. Results A total of 28 people attended the stakeholder forum (5 online); 20 responded to the second-round electronic summary. Nine principles of research action were agreed. Fourteen research areas were identified and prioritised. There was a relatively consistent prioritisation of measuring Allied Health value, Allied Health workforce, hospital avoidance and closing the gap for Aboriginal health outcomes - whether the individuals were thinking about their own service or the state as a whole. Conclusions Allied Health leadership identified key principles and priorities for research to improve service delivery and patient outcomes. These priorities should generate further discussion and interest for novice and experienced researchers and leaders and can be used to inform granting and project plans.

A head-to-head comparison of the de Morton Mobility Index (DEMMI) and Elderly Mobility Scale (EMS) in an older acute medical population.

PURPOSE: To compare the clinimetric properties of the de Morton Mobility Index (DEMMI®) and the Elderly Mobility Scale (EMS). METHOD: A head-to-head comparison of the EMS and DEMMI® with 120 consecutive older acute medical patients. The DEMMI® and EMS were administered within 48 h of hospital admission and discharge. RESULTS: At admission, 6% and 15% of participants scored the lowest scale score for the DEMMI® and EMS, respectively. For the DEMMI®, 17% of participants scored within the minimal detectable change of the lowest scale score compared to 20% for the EMS at admission. At hospital discharge, DEMMI® scores were normally distributed and the EMS had a ceiling effect. Similar evidence of convergent, discriminant and known groups validity were obtained for the DEMMI® and EMS. There was no significant difference in responsiveness to change between the DEMMI® and EMS. The EMS was significantly quicker to administer compared to the DEMMI®. CONCLUSION: The DEMMI® and EMS are both valid measures of mobility for older acute medical patients. The DEMMI® has a broader scale width than the EMS with interval level measurement and therefore provides a more accurate method for measuring and monitoring changes in mobility for older acute medical patients. Implications for Rehabilitation Mobility of older acute medical patients. Hospitalised older acute medical patients are at "high risk" of mobility decline. Accurate measurement of mobility is essential for preventing and treating mobility decline. Many existing mobility measures have significant measurement limitations. The DEMMI® is a more accurate measure of mobility than the EMS in an older acute medical population.

Unidimensionality of the Elderly Mobility Scale in older acute medical patients: different methods, different answers.

OBJECTIVE: To investigate the unidimensionality of the Elderly Mobility Scale (EMS) in an older acute medical population. STUDY DESIGN: EMS data were collected within 48 hours of hospital admission and discharge, respectively, from consecutive older acute medical patients. Rasch and factor analysis of EMS data were conducted. SETTING: Acute tertiary hospital, South Australia. RESULTS: Factor analysis identified a two-factor solution for both admission and discharge EMS data. At hospital admission (n=120), EMS data fitted the Rasch model (χ(2)=18.31, P=0.19, df=14). One item, the timed walk test, had a high positive fit residual (+3.93). At hospital discharge (n=105), EMS data did not fit the Rasch model (χ(2)=25.66, P=0.03, df=14). Item and person scores were not well matched because of a ceiling effect in discharge EMS scores. The functional reach item showed some misfit to the Rasch model and the gait item had a disordered threshold. After rescoring this disordered threshold, discharge EMS data fitted the Rasch model. CONCLUSION: Conflicting results were identified using a classical test theory and item response theory approach. Although the EMS fitted the Rasch model, an unacceptable ceiling effect at hospital discharge limits the validity of the EMS for measuring and monitoring the mobility of older acute medical patients in the hospital setting.

Targeted individual exercise programmes for older medical patients are feasible, and may change hospital and patient outcomes: a service improvement project.

BACKGROUND: The aim of this project was primarily to assess the feasibility of individual exercise programs for older hospitalised patients at risk of functional decline, and secondarily to evaluate impact on discharge outcomes. DESIGN: Cohort service improvement project. SETTING: 500 bed acute metropolitan hospital. SUBJECTS: Patients aged 70 and older admitted to Flinders Medical Centre under the general medical, aged care and respiratory units from June to November 2006, at intermediate or high risk of functional decline, and able to commence exercise within 48 hours of admission. INTERVENTION: Functional Maintenance Program (FMP); an individually tailored exercise program to maintain functional mobility, prescribed and progressed by a physiotherapist, and supervised by an Allied Health Assistant (AHA), provided in addition to usual physiotherapy care. OUTCOME MEASURES: Feasibility (number of admissions suitable, commencing and complying with FMP). Impact (length of hospital stay (LOS), Aged Care Assessment Team (ACAT) referrals and approvals, hospital readmissions within 28 days, and functional mobility (Elderly Mobility Scale)). DATA ANALYSIS: Descriptive and logistic regression analysis RESULTS: Of 1021 admissions of patients aged 70 or older to general medical, aged care and respiratory units, 22% (n = 220) were identified within 48 hours as suitable for FMP: 196 (89%) commenced FMP within 48 hours of admission (FMP patients); 24 (11%) received usual physiotherapy (usual care patients). Feasibility of individually tailored exercise programs for older medical patients was supported by high uptake (89%), low withdrawal (17%) shown by those who commenced FMP, and good compliance with exercise sessions (70%). Logistic regression analysis showed a statistically significant decreased likelihood of referral for nursing home admission (OR = 0.228, 95% CI 0.088-0.587) and decreased likelihood of approval for admission to residential care (OR = 0.307, 95% CI 0.115-0.822) in favour of FMP. Although trends of an average 15.7% LOS reduction, 8% fewer readmissions and improved functional mobility were demonstrated in favour of FMP patients, these results were not statistically significant. CONCLUSION: It is feasible to identify older medical patients likely to benefit from an exercise program to maintain functional abilities, and to commence within 48 hours of admission.