Impacts of a Dysphagia Screening Questionnaire on Speech Pathology Input Using a Transdisciplinary Approach for Patients with Chronic Obstructive Pulmonary Disease in a Pulmonary Rehabilitation Program.

Patients with chronic obstructive pulmonary disease (COPD) in pulmonary rehabilitation programs (PRPs) are not routinely screened for dysphagia. An Australian regional health service audit revealed that patients with COPD are frequently referred to speech pathology during acute admissions, rather than proactively to mitigate the risk of dysphagia-related consequences. Referral patterns to speech pathology using a novel transdisciplinary approach for identifying at risk for dysphagia patients in a PRP were explored. The aim of this study was to investigate the impact of a transdisciplinary dysphagia screening questionnaire on speech pathology referrals within a cohort of patients with COPD enrolled in a PRP. This quasi-experimental study introduced a dysphagia screening questionnaire in a PRP using a transdisciplinary approach. A retrospective audit of PRP patients (n = 563) between 01/01/2014 and 31/12/2018 was conducted to identify the frequency of referrals to speech pathology for dysphagia. Data was compared to a cohort of patients (n = 50) enrolled in the PRP (from 01/02/21 to 30/11/21) after introduction of the questionnaire using Fisher's exact test. Less than 1% (n = 4/563) of PRP patients were referred to speech pathology prior to implementation of the questionnaire. Following the implementation, referrals to speech pathology significantly increased to 16% (8/50) (X2 = 7.72, P < 0.05; odds ratio = 7.89 95% CI [1.94, 32.1]). Introducing a dysphagia screening questionnaire increased referrals to speech pathology from a PRP. This study demonstrated the potential for a transdisciplinary approach in early screening for patients at risk of dysphagia for patients with COPD. Further research is encouraged to explore patient motivation towards speech pathology input with COPD-related dysphagia and clinicians' perceived self-efficacy in using the questionnaire.

Continuing professional development training needs of allied health professionals in regional and rural Victoria.

OBJECTIVE: The aim of the study was to identify continuing professional development (CPD) needs of allied health professionals (AHP) in regional and rural Victoria. DESIGN: This study was an online cross-sectional design conducted between December 2022 and February 2023. SETTINGS AND PARTICIPANTS: AHPs employed at a large multi-site regional public health service providing acute, subacute, community and outpatient care in Victoria, Australia. MAIN OUTCOME MEASURE(S): The online questionnaire included four sections investigating satisfaction of CPD, prioritised topics for CPD, preference for CPD sourcing and perceived capabilities in delivering education. To investigate prioritised topics of CPD, a tool was adapted from the Hennessy Hicks Training Needs Analysis questionnaire to align with allied health (AH) career pathways. For organisational alignment, a second questionnaire was sent to AH managers. RESULTS: The response rate was 17% (53/316 AHPs) from members of 10 AH professions. The median years of clinical experience for participants was between 2 and 5 years. Participants with 6-10 years of clinical experience reported the lowest level of satisfaction. Research and education were identified as areas of highest training need. Self-perceived competence in education delivery was proportionately lower in areas of assessment, developing digital learning and constructive alignment. CONCLUSION: CPD needs for AHPs in a regional and rural health service were shown to vary by career stage and weighted towards developing research and education delivery capabilities. Findings from this study may support public health sector and policy investment in CPD opportunities to support horizontal career progression opportunities, a balance of internal and externally sourced professional development and strategic investment in education delivery capabilities.

Models and approaches for building knowledge translation capacity and capability in health services: a scoping review.

BACKGROUND: Building healthcare service and health professionals' capacity and capability to rapidly translate research evidence into health practice is critical to the effectiveness and sustainability of healthcare systems. This review scoped the literature describing programmes to build knowledge translation capacity and capability in health professionals and healthcare services, and the evidence supporting these. METHODS: This scoping review was undertaken using the Joanna Briggs Institute scoping review methodology. Four research databases (Ovid MEDLINE, CINAHL, Embase, and PsycInfo) were searched using a pre-determined strategy. Eligible studies described a programme implemented in healthcare settings to build health professional or healthcare service knowledge translation capacity and capability. Abstracts and full texts considered for inclusion were screened by two researchers. Data from included papers were extracted using a bespoke tool informed by the scoping review questions. RESULTS: Database searches yielded 10,509 unique citations, of which 136 full texts were reviewed. Thirty-four papers were included, with three additional papers identified on citation searching, resulting in 37 papers describing 34 knowledge translation capability building programmes. Programmes were often multifaceted, comprising a combination of two or more strategies including education, dedicated implementation support roles, strategic research-practice partnerships and collaborations, co-designed knowledge translation capability building programmes, and dedicated funding for knowledge translation. Many programmes utilised experiential and collaborative learning, and targeted either individual, team, organisational, or system levels of impact. Twenty-seven programmes were evaluated formally using one or more data collection methods. Outcomes measured varied significantly and included participant self-reported outcomes, perceived barriers and enablers of knowledge translation, milestone achievement and behaviour change. All papers reported that programme objectives were achieved to varying degrees. CONCLUSIONS: Knowledge translation capacity and capability building programmes in healthcare settings are multifaceted, often include education to facilitate experiential and collaborative learning, and target individual, team, organisational, or supra-organisational levels of impact. Although measured differently across the programmes, the outcomes were positive. The sustainability of programmes and outcomes may be undermined by the lack of long-term funding and inconsistent evaluation. Future research is required to develop evidence-informed frameworks to guide methods and outcome measures for short-, medium- and longer-term programme evaluation at the different structural levels.

Translating research into rural health practice: a qualitative study of perceived capability-building needs.

INTRODUCTION: The timely translation of research into practice and local policy is critical to improving healthcare delivery in rural and regional settings, and remains a concern for researchers, health professionals, health managers and policymakers alike. Successful and sustained research translation does not occur without concerted effort, support and strategies to build research translation capacity and capability. Research capacity comprises individual and organisational capabilities. This study is primarily focused on individual capabilities. Health professionals working in rural and regional settings, where research activity and infrastructure are generally less mature than that seen in metropolitan areas, need additional support and skills to build their capability to engage in translation-focused research. This study aimed to explore rural health research stakeholders' perspectives on capability-building needs for emerging researchers to enable the translation of research into health practice. METHODS: A qualitative description methodology was used to conduct three online focus groups to explore participants' understanding of research translation, and their perceptions of the supports that are needed to build capability for emerging health professional researchers to undertake translation-focused research. Emerging health professional researchers (emerging researchers hereafter) are health professionals who have little or no formal training or experience undertaking research. Data were analysed by a five-stage framework approach. RESULTS: Participants included emerging researchers (n=12), research mentors (n=3) and health managers (n=4) from six rural or regional organisations, including four health services, one university and one primary health network in Victoria, Australia. Participants' conceptualisation of research translation reflected previously documented definitions; that is, research grounded in health practice and characterised by adaptation of existing research evidence to local settings via implementation. Four key themes related to research translation support for rural and regional health researchers were identified: understanding the study and translation context is vital to enacting change; engaging with stakeholders identifies research and translation priorities and suitable approaches; mentor and managerial support assists navigation of research translation activities; and access to clinical and research networks promotes research translation partnerships and collaborations. Participants highlighted the need to identify and train appropriate research mentors and health leaders who can support translation-focused research at the emerging researcher level. The need for training that targets fundamental research translation skills, including systematic processes for engaging stakeholders and collaborative priority setting, and the processes to analyse both the research study and research translation contexts, were also identified as important. CONCLUSION: Given their understanding of the local community and health context, rural and regional health professionals are ideally placed to engage in translation-focused research; however, they require multiple types of research capability development through several levels of influence. This includes support and guidance to ensure their endeavours align with and leverage organisational and regional priorities for research translation. These findings can inform approaches to research capability building through training and resource provision, and organisational infrastructure development and capacity building, to support the rapid translation of research into clinical practice.

Research translation mentoring for emerging clinician researchers in rural and regional health settings: a qualitative study.

BACKGROUND: Building clinician and organisation-level research translation capacity and capability is fundamental for increasing the implementation of research into health practice and policy and improving health outcomes. Research translation capacity and capability building is particularly crucial in rural and regional settings to address complex problems impacting these socially and economically disadvantaged communities. Programs to build clinicians' research translation capability typically involve training and mentoring. Little is known about the features of and influences on mentorships in the context of training for emerging clinician-researchers working in rural and regional healthcare settings. Research translation mentorships were established as part of the Supporting Translation Research in Rural and Regional settings (STaRR) program developed and delivered in Victoria, Australia from 2020 to 2021. The study sought to address the following research questions: 1) What context-specific types of support do research translation mentors provide to emerging researchers?. 2) How does the mentoring element of a rural research translational training program influence research translation capacity and capability development in rural emerging researchers and mentors, if at all?. 3) How does the mentoring element of the program influence translation capacity and capability at the organisational and regional level, if at all? METHODS: We conducted a qualitative descriptive study. Interviews with individuals involved in the STaRR program took place approximately 12 months after the program and explored participants' experiences of the mentored training. Interviews were undertaken via telephone, audio-recorded, and transcribed. Data were analysed using a team-based five-stage framework approach. RESULTS: Participants included emerging researchers (n = 9), mentors (n = 5), and managers (n = 4), from five health services and two universities. We identified four themes in the interview data: (1) Mentors play an educative role; (2) Mentoring enhanced by a collaborative environment; (3) Organisational challenges can influence mentorships, and (4) Mentorships help develop research networks and collective research and translation capacity. CONCLUSIONS: Mentorships contributed to the development of research translation capabilities. The capabilities were developed through mentors' deepened understanding of the rural and regional healthcare contexts in which their emerging researchers worked, the broadening and strengthening of rural and regional research networks, and building and sharing research translation knowledge and skills.

The Effects of Multimodal Prehabilitation Interventions in Men Affected by Prostate Cancer on Physical, Clinical and Patient Reported Outcome Measures: A Systematic Review.

OBJECTIVES: To synthesize existing evidence on the effects of multimodal prehabilitation interventions in men affected by prostate cancer on physical, clinical, and patient-reported outcome measures. DATA SOURCES: A systematic review was conducted according to the PRISMA 2020 Statement Guidelines. Electronic databases (ie, Medline, Embase, CINAHL and Cochrane CENTRAL, and clinicaltrials.gov) were searched using key search terms. Articles were assessed according to prespecified eligibility criteria. Data extraction and quality appraisal was conducted. The findings were integrated in a narrative synthesis. CONCLUSION: Of the 5863 publications screened, 118 articles were assessed in full text and 17 studies met the prescreening eligibility criteria. There were a range of study designs that included randomized controlled clinical trials (n = 11), quasi experimental (n = 4), cohort (n = 1), and case series (n = 1), covering a total of 1739 participants. The prehabilitation interventions included physical activity, peer support, pelvic floor muscle training, diet, nurse-led prehabilitation, psychological, and prehabilitation administration of phosphodiesterase-5 inhibitors. IMPLICATIONS FOR NURSING PRACTICE: Significant heterogeneity existed in the prehabilitation intervention programs for men affected by prostate cancer in terms of the composition, duration, method of administration, and the outcomes measured to quantify their impact. This systematic review has identified that multimodal prehabilitation interventions are an emerging area for practice and research among men affected by prostate cancer. Importantly, there has been a lack of focus on the inclusion of partners as critical companions during this distressing phase of the cancer care continuum. For the moment, all members of the multidisciplinary team caring for people affected by prostate cancer are encouraged to use the findings in this review to inform holistic models of care.

Opportunities and Capabilities to Perform Pelvic Floor Muscle Training Are Critical for Participation: A Systematic Review and Qualitative Meta-Synthesis.

OBJECTIVE: Pelvic floor muscle training (PFMT) is considered a behavioral task that requires the interaction of physical, social, and cognitive processes. Enablers and barriers to participation in PFMT have been explored primarily in women. This review aimed to identify the barriers and enablers that influence participation in PFMT in all adult populations. METHODS: A systematic review and meta-synthesis of qualitative literature was conducted. The inclusion criteria comprised qualitative studies with populations of people aged 18 years and older who have been recommended for PFMT. Line-by-line coding and an inductive thematic analysis identified themes that were applied to the Theoretical Domains Framework and Capabilities, Opportunities, and Motivation Behavioral Model to determine behavioral influences on PFMT. RESULTS: Twenty full-text articles met inclusion criteria. PFMT was mostly influenced by individual opportunities impacted by social determinants and competing demands. Capability of carrying out PFMT was impacted by knowledge, understanding, and appropriate skill acquisition linked to self-efficacy. CONCLUSION: Increasing opportunities and capabilities for engagement in PFMT are the most important factors in optimizing positive behavior changes. Ways to address these factors include clear patient communication to boost confidence in skill acquisition and using technology to encourage autonomy and improve convenience. Future research should address the impact of health professionals' beliefs about patient participation, assess the role of social values and gender roles, and explore the timing of the implementation of behavioral change strategies to improve PFMT. IMPACT: This is believed to be the first systematic review and qualitative meta-synthesis to consider the enablers and barriers to participation in PFMT for all adult populations, purposes, and symptom complexes. Patient opportunities and capabilities are the greatest influencers on participation and self-efficacy. Individualized treatment approaches that acknowledge and address social influencers and competing demands will optimize self-efficacy and participation. LAY SUMMARY: If you have pelvic floor muscle dysfunction, your opportunities and capabilities are the greatest influencers on participation and self-efficacy in PFMT. Your physical therapist can design individualized treatment approaches that acknowledge and address social influencers and competing demands to help you optimize participation.

Transcutaneous Tibial Nerve Stimulation in the Management of Overactive Bladder: A Scoping Review.

OBJECTIVE: Overactive bladder (OAB) is a condition that has physical, social, psychosocial, and financial impacts. Transcutaneous tibial nerve stimulation (TTNS) is a modality that stimulates the nerve root fibers of L5-S3, the same spinal segments of the parasympathetic nervous system as the bladder. This scoping review aims to identify current literature available on the feasibility and outcomes of TTNS as a first-line treatment option for OAB. MATERIALS AND METHODS: A scoping review of six electronic data bases was performed to identify full-text articles from 2015 that explored the impact of TTNS on OAB and bladder dysfunction in people aged >18 years. RESULTS: A total of 15 articles met the inclusion criteria. TTNS was compared with sham treatment, parasacral stimulation, pelvic floor muscle training (PFMT), anticholinergic medication, and percutaneous tibial nerve stimulation (PTNS). Heterogeneity in treatment application and parameters existed, with variations in treatment duration, frequency of use, and treatment settings such as pulse width (µs) and frequency (Hz). Results indicated that TTNS has efficacy equal to PFMT and PTNS in the management of OAB; however, it is not as efficacious as anticholinergic medication. CONCLUSIONS: TTNS is a promising first-line management option for people with OAB, particularly in the older population and for those with neurogenic bladder. It can provide symptomatic relief from urinary incontinence, frequency, urgency, and nocturia, while avoiding the bothersome side effects of more invasive or pharmaceutical therapies. Heterogeneity in treatment parameters limits generalizability and translation of the most appropriate clinical application and should be considered in future trials.

A national survey of oncology physiotherapy services for cancer survivors in Australia.

BACKGROUND: Cancer is a leading cause of illness globally. Advancements in screening and treatment have led to improved survivorship. Physiotherapy is integral in improving survivorship for people with cancer, with strong evidence supporting the use of various physiotherapy services. However, the scope and extent of these services within clinical practice in Australia is unknown. AIM: Identify and describe physiotherapy service provision for cancer survivors in Australia and describe the scope of physiotherapy services provided to cancer survivors. METHODS: This cross-sectional study recruited physiotherapists and their respective managers involved in cancer service/s provision across Australia. Physiotherapy departments of tertiary hospitals and known oncology rehabilitation programs were contacted through a government directory and snowball sampling. The online survey included questions related to the extent and scope of service provision of physiotherapy for cancer survivors. Quantitative data were descriptively analyzed whereas open-ended responses were analyzed and presented narratively. RESULTS: Seventy-nine physiotherapy services were identified from 159 hospitals and/or health networks. Of the 55 (70%) responses received, 87% were from metropolitan areas, whereas 13% were regionally/rurally based services. Prehabilitation services mostly offered individual programs whereas rehabilitation programs had a mix of individual and group-based programs. The service content between prehabilitation and rehabilitation were similar, comprising primarily exercise-based interventions, followed by education and impairment-based therapies. CONCLUSION: Few designated physiotherapy services for cancer survivors exist in Australia. There is also disparity between service provision between metropolitan and regional/rural areas highlighting a need for clinicians, managers, and policy makers to invest more resources in establishing oncology physiotherapy services.

The Impact of Exercise and Nutrition as Part of a Person-Centered Approach to Prehabilitation in Patients with Bladder Cancer.

BACKGROUND: Muscle invasive bladder cancer (MIBC) is commonly treated with radical cystectomy. Patients who require radical cystectomy are often frail, unwell, have multiple comorbidities, and can experience unmet supportive care needs. Due to these complexities, patients requiring radical cystectomy are often considered high risk for anesthetics, and therefore improving their physical and psychological well-being is crucial prior to radical surgery. Prehabilitation is the practice of enhancing a patient's functional and psychological capacity before surgery, with the aim of improving postoperative outcomes. This narrative review aims to identify and evaluate the role of physical exercise, nutritional intervention, and person-centered holistic approaches to prehabilitation in people affected by MIBC treated by radical cystectomy. DATA SOURCES: Electronic databases including CINAHL, MEDLINE, PsychINFO, Scopus, and grey literature were searched using Google scholar until June 2020. CONCLUSION: Evidence to support specific prehabilitation clinical recommendations in people affected by MIBC is emerging. Prehabilitation including exercise prescription, nutritional intervention, and person-centered holistic support is an important part of the clinical pathway for people affected by MIBC. Individualized prehabilitation programs across the multidisciplinary team should be considered to provide specific individual recommendations to avoid "one size fits all". Given the limited research in this clinical area, future high-quality multi-center prospective trials are urgently needed. IMPLICATIONS FOR NURSING PRACTICE: People affected by MIBC can experience a range of unmet supportive care needs in routine clinical care delivery at the time of diagnosis and into survivorship. Evidence is emerging around the role of multidisciplinary interventions in the form of exercise, nutritional input, and holistic supportive care to improve physical and psychological well-being prior to major surgery. Specialist nurses are ideally placed to ensure that individual holistic care needs are addressed, and appropriate care and support is provided. Nurses can trigger timely referrals to members of the multidisciplinary team to coordinate an integrated person-centered approach to prehabilitation service provision to address the unmet needs of people undergoing treatment for MIBC.

Pelvic Floor Muscle Training in Radical Prostatectomy and Recent Understanding of the Male Continence Mechanism: A Review.

OBJECTIVE: Pelvic floor muscle training (PFMT) is recommended as part of supportive care for patients with prostate cancer. It can assist in reducing treatment-related symptoms such as urinary incontinence. This literature review aims to discuss recent innovative findings on the pathophysiology of the male continence mechanism and implications for PFMT in radical prostatectomy. DATA SOURCES: CINAHL, Embase, Web of Science, Emcare and PsycINFO were searched until January 2020. CONCLUSION: Nurses providing supportive care for patients undergoing radical prostatectomy can engage in-clinic in the instruction and recommendation of pre- and postoperative PFMT and delivering guidance on home-based programs to promote motor learning. IMPLICATIONS FOR NURSING PRACTICE: Optimal postoperative urinary incontinence outcomes are suggested to be promoted by preoperative PFMT. Training focused on the urethral and anterior pelvic floor muscle complex has been shown to facilitate mid urethral occlusion required for continence. Prescription of PFMT should be individualised, focusing on skill acquisition and motor learning, which is in line with recent knowledge developments in male pelvic floor anatomy.

Adopting a collaborative approach in developing a prehabilitation program for patients with prostate cancer utilising experience-based co-design methodology.

PURPOSE: Engaging patients in a prehabilitation program prior to commencement of cancer treatment is a known challenge. Utilising experience-based co-design (EBCD) methodology, this study aimed to explore the prostate cancer treatment journey from the perspectives of the patient and health professionals and collaboratively develop a prehabilitation program for patients with prostate cancer. METHODS: EBCD was utilised for this study. Patients, support persons and health professionals were selectively identified and recruited from two metropolitan health services in Melbourne. Selection criteria included (i) recent clinical/patient experience with prostate cancer treatment and (ii) willingness to share positive experiences and challenges in two 2-hour face-to-face workshops. Findings from these workshops were thematically analysed to identify key themes addressing aims of the study. RESULTS: Twenty participants including eight patients, one support person and 11 health professionals were recruited. Four key touchpoints were identified. All participants acknowledged positive interactions between patients and health professionals. Patients often described the journey as lonely, stressful and frustrating especially prior to commencement of treatment. A lack of a consistent approach in identifying and preparing patients with prostate cancer for treatment was identified. A structured prehabilitation program was proposed as a solution. Practical ideas to be implemented including timing of commencement, educational content and strategies to boost engagement were formulated. CONCLUSIONS: The findings from the study provided practical guidance for future clinicians when implementing a prehabilitation program. Future study is required to evaluate the effectiveness of such a prehabilitation program in improving patient engagement and preparedness for prostate cancer treatment.