The Effectiveness of Multicomponent Functional Maintenance Initiatives for Acutely Hospitalized Older Adults: A Systematic Review and Meta-analysis.

BACKGROUND AND PURPOSE: To evaluate the effectiveness of multicomponent functional maintenance initiatives (MFMIs) on functional outcomes and adverse events associated with functional decline among acutely hospitalized older adults. DATA SOURCES: Studies were sourced from OVID Medline, PubMed, Embase, CINAHL, the Cochrane Library, and PEDro databases from inception to April 15, 2020, and their bibliographies. STUDY SELECTION: Randomized controlled trials were included if they investigated multicomponent interventions comprising more than one nonpharmacological intervention targeting physical functional decline and another shared risk factor for geriatric syndromes in acutely hospitalized medical or nonelective surgical patients 65 years and older. DATA EXTRACTION: Two reviewers independently assessed for eligibility, extracted data, and conducted risk of bias assessments. DATA SYNTHESIS: Eight studies involving 5534 patients were included. Multicomponent functional maintenance initiatives did not appear to confer significant effects on functional status, length of stay, or 30-day hospital readmissions; however, clinical heterogeneity limited meta-analysis for some specific functional outcomes. Patients who did not receive MFMIs were more likely to be discharged to a nursing staff facility (odds ratio = 1.53; 95% confidence interval, 1.23 to 1.90). No effect of MFMI on all-cause mortality was observed, and adverse events were rare and unlikely attributed to nonpharmacological interventions. CONCLUSIONS: Data from a small number of studies suggest MFMIs reduce the likelihood of discharge to a nursing staff facility in acutely hospitalized older adults; however, this effect may not be driven via improvements in physical function. Standardized evaluation methods to determine MFMI effectiveness appear indicated to assist decision-making regarding their implementation in clinical practice.

Barriers and facilitators to adopting functional maintenance initiatives for acutely hospitalised older adults.

Purpose: To determine perceived barriers and facilitators to adopting and sustaining functional maintenance initiatives for acutely hospitalised older adults.Methods: A qualitative descriptive study using semi-structured interviews and initiative observations was conducted at five international and four Victorian acute hospitals. Purposive snowball sampling was used to recruit clinical, research, managerial, and volunteer staff who were involved in implementing and/or sustaining the initiatives. Emergent themes from audio-recorded interviews were developed and categorised as staff-perceived barriers or facilitators to adopting and sustaining initiatives using inductive thematic analysis.Results: Twenty-seven medical, nursing, allied health, and volunteer staff participated in interviews. Staff resistance and turnover, especially the loss of staff considered to be change drivers, were commonly reported barriers. A lack of professional autonomy was perceived to threaten longevity in allied health assistant led initiatives. Facilitators included support from change drivers, use of collaborative approaches and opinion leaders, integration of initiatives into usual care, alignment with institutional priorities, use of "internal" evidence to justify ongoing institutional investment, and use of an accompanying training and evaluation strategy.Conclusions: Successful adoption and sustainability of functional maintenance initiatives for acutely hospitalised older adults are influenced by a range of "non-clinical" factors, such as the ongoing effectiveness of change drivers. These factors should be considered when deciding upon future innovations to address functional decline and its associated economic impact.IMPLICATIONS FOR REHABILITATIONConsidering barriers and facilitators to successful adoption of functional maintenance initiatives is important for implementing evidence-based practice targeting the prevention of functional decline in acutely hospitalised older adults.Change drivers who remain actively involved are core facilitators of successful functional maintenance initiative adoption.Credible "internal" evaluation data are essential for ongoing sustainability of functional maintenance initiatives.Continual staff training is a key feature of successful functional maintenance initiatives.Perceived financial barriers to adopting functional maintenance initiatives can be overcome by other facilitating influences.

Student-clinician agreement in clinical competence as a predictor of clinical placement performance in Australian undergraduate physiotherapy students.

OBJECTIVES: The opportunity for student self-reflection and the accuracy of that reflection are critical to the acquisition of professional competencies. The relationship between student-clinician agreement and clinical performance in physiotherapy students has not yet been investigated. The aim was to determine whether a simple measure of student-clinician agreement assessed midway during a clinical placement predicts final placement score. PARTICIPANTS: 100 undergraduate Monash University Bachelors of Physiotherapy students and their clinical educators. MAIN OUTCOME MEASURES: Assessment of Physiotherapy Practice (APP). METHOD: Clinician and student ratings of student performance across all clinical placements from January 2012-June 2013 at two time-points (midway and final) were entered into a purpose-built, web-based platform, and then averaged across the number of placements undertaken. The relationship between midway student-clinician agreement (student minus clinician APP score) and final APP score (determined by the clinician) was analyzed via forward regression. Sub-group comparisons were performed investigating the stability of the relationship across placements. RESULTS: On average, midway agreement was associated with a -0.50 (95% CI -0.67 to -0.33) unit decrease in final placement APP% score. This model was highly statistically significant (p < 0.001) but only explained 24% of the total variance (based on the adjusted r-squared statistic). This relationship was similar in early and late placements. CONCLUSIONS: Student-clinician agreement is related to clinical performance. A midway evaluation may provide an important opportunity to identify students "at risk" of poor clinical outcomes enabling timely implementation of support strategies. Further work is required to improve the predictive accuracy of the proposed model.

Compression socks and functional recovery following marathon running: a randomized controlled trial.

Compression socks have become a popular recovery aid for distance running athletes. Although some physiological markers have been shown to be influenced by wearing these garments, scant evidence exists on their effects on functional recovery. This research aims to shed light onto whether the wearing of compression socks for 48 hours after marathon running can improve functional recovery, as measured by a timed treadmill test to exhaustion 14 days following marathon running. Athletes (n = 33, age, 38.5 ± 7.2 years) participating in the 2012 Melbourne, 2013 Canberra, or 2013 Gold Coast marathons were recruited and randomized into the compression sock or placebo group. A graded treadmill test to exhaustion was performed 2 weeks before and 2 weeks after each marathon. Time to exhaustion, average and maximum heart rates were recorded. Participants were asked to wear their socks for 48 hours immediately after completion of the marathon. The change in treadmill times (seconds) was recorded for each participant. Thirty-three participants completed the treadmill protocols. In the compression group, average treadmill run to exhaustion time 2 weeks after the marathon increased by 2.6% (52 ± 103 seconds). In the placebo group, run to exhaustion time decreased by 3.4% (-62 ± 130 seconds), P = 0.009. This shows a significant beneficial effect of compression socks on recovery compared with placebo. The wearing of below-knee compression socks for 48 hours after marathon running has been shown to improve functional recovery as measured by a graduated treadmill test to exhaustion 2 weeks after the event.