Recent academic posters
These academic posters and abstracts were prepared for our RECOVER Conference 2021: Research Driving Rehabilitation. Click on the links below to read the abstract and view the posters.
Engaging Consumers and Community Members across the Research Spectrum: A Stepped Approach to Implementation by the RECOVER Injury Research Centre
Abstract
Authors: Ms Alison Bell, Dr Atiyeh Vaezipour, Dr Carrie Ritchie, Ms Sarah Robins, Dr Esther Smits and Dr Jane Nikles.
Affiliation: RECOVER Injury Research Centre, The University of Queensland
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Background: Consumer involvement in research is fundamental in developing research priorities, healthcare policy, and clinical practice guidelines. RECOVER Injury Research Centre, embarked on a journey to develop and implement a genuine consumer involvement strategy. The aim of the strategy was to include consumers and community members with a lived experience of injury, their carers, and health professionals not only as research participants, but across the entire research spectrum. Method: Guided by the National Health and Medical Research Council’s Model Framework for Consumer and Community Participation in Health and Medical Research, we followed a stepped approach to facilitate consumer involvement in research at RECOVER. These steps included: learning from the experience of others; conducting an audit of existing consumer activities at the Centre; identifying consumers and community members who were interested in our research; conducting staff training; and, holding a collaborative workshop on consumer involvement in research for consumers. Results: The stepped approach to facilitate consumer involvement at RECOVER was a practical approach and proved successful. The strategy has seen the implementation of a genuine consumer involvement in research, whereby consumers and community member have engaged with researchers at different phases of the research spectrum. Conclusion: A number of lessons have been learned from the implementation strategy and different levels of RECOVER consumer involvement in research including: that it takes time for all members of the research team to reach a point of confidence to proceed; that it is possible to bring different consumers (e.g. injured persons, health professionals and industry regulators) to the same room and have meaningful discussions; to keep presentations (from researchers) in plain language; and, it is important to have an appropriate budget to support activities.
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Key elements to successful rapid uptake of telehealth in public hospital physiotherapy departments: clinician perspectives
Abstract
View poster here (PDF, 111.1 KB)
Authors: Dr Megan H Ross 1, Dr Mark Nelson 2 , Dr Nicole Hartley 3 , Matthew Weight 2, Vicki Parravicini 4, Ryan Tyrrell 2, Professor Trevor Russell 1
Affiliation: 1 RECOVER Injury Research Centre, The University of Queensland, Queensland, Australia, 2 QEII Jubilee Hospital, Metro South Hospital and Health Service, Queensland, Australia, 3 School of Business, The University of Queensland, Queensland, Australia, 4 Bayside Health Service, Metro South Hospital and Health Service, Queensland, Australia
Background: In March 2020, the COVID-19 pandemic triggered considerable, previously unforeseen changes to the delivery of community-based allied health services. The aim of this study was to investigate the experiences of physiotherapists in Brisbane public hospitals who rapidly transitioned to delivering physiotherapy via telerehabilitation due to COVID-19.
Method: Physiotherapists from two Brisbane hospital physiotherapy departments who delivered consultations using telerehabilitation during the COVID-19 restriction period were eligible to participate in semi-structured interviews if they had conducted telerehabilitation consultations between March and September 2020. Interviews were transcribed and analysed thematically.
Results: 25/28 (89%) of eligible physiotherapists participated in the interviews. Participants were 22-60 years of age (mean age 37), 67% female, with between 1 and 40 years of clinical experience (mean = 13 years). Six (24%) of the participants had some previous experience with telerehabilitation prior to COVID-19 restrictions being put in place. Qualitative analyses revealed 4 key factors facilitating success: People factors, technology, environmental factors, and systems and processes. On reflection, physiotherapists felt that training, education and formalised protocols have have further facilitated the transition.
Conclusion: Rapid uptake of telerehabilitation in a hospital setting is possible, and is facilitated by increased need, willingness, learning on the go and organisational, administrative and management support. Communication, demonstration, involving a third party to help during consultations and resources to provide to patients assist the effective delivery of telerehabilitation and training, education and formalised protocols may further facilitate the transition to and uptake of telerehabilitation for physiotherapy in hospital settings.
Evaluation of a theory-driven physical activity intervention for individuals with whiplash associated disorders using a single case experimental design
Abstract
View poster here (PDF, 213.9 KB)
Authors: Ritchie C1,2, Clanchy K3, Sterling M1,2, Tate R5, Smits, E1, Day M6, Nikles J1,2, Liimatainen, J1,4, Tweedy S4
Affiliation: 1 RECOVER Injury Research Centre, University of Queensland (UQ), 2 NHMRC Centre of Research Excellence in Recovery after Road Traffic Injury, UQ, 3 School of Allied Health Sciences, Griffith University, 4 School of Human Movement and Nutrition Sciences, UQ, 5 University of Sydney, 6 School of Psychology, UQ
Background: There is considerable variation in the physical and psychological presentations of people with whiplash associated disorder (WAD). Optimal treatment continues to be a challenge. The aim of the present study was to evaluate the efficacy of a community-located, theory-based intervention designed to promote physically active behaviour in people with persistent WAD.
Method:
A multiple-baseline, single-case experimental design was used to evaluate a 16 week intervention with 12 sessions conducted by an accredited exercise physiologist. Each session included evidence-based strategies with individualized exercise and lifestyle physical activity prescription tailored to the participant’s knowledge, beliefs, and motivational readiness for regular physical activity.
Results:
At baseline, all participants had moderate/severe neck disability (neck disability index >30/100) and self-reported low levels of daily physical activity. A structured visual analysis supplemented with Tau-U statistical analyses showed significantly increased accelerometer-measured physical activity in three participants with moderate to large effect sizes (> 0.5), with increased confidence in one participant (ES > 0.5), and reduced pain interference in another participant (ES > 0.7). Changes in other behaviours included clinically important improvements in quality of life for five participants and, in those participants with baseline symptom levels outside threshold levels, improvements in pain catastrophizing and pain self-efficacy.
Conclusion:
Participation in a theory-based intervention resulted in significant improvements in physical and psychological health for five of six participants. Providing this type of community-located physical activity promotion strategy, to individuals with persistent WAD, may help address physical impairments and psychological distress commonly experienced in WAD.
Factors influencing the successful clinical implementation of electronic patient report outcome / experience measures (ePROMs/ePREMs)
Abstract
View poster here (PDF, 228.7 KB)
Title: Factors influencing the successful clinical implementation of electronic patient report outcome / experience measures (ePROMs/ePREMs)
Authors: Joshua Simmich1, Ben Glenwright2,3, Michelle Cottrell2,4, Shaun O’Leary1,2, Jason Pole5, Clair Sullivan5, Trevor Russell1
Affiliation: 1RECOVER Injury Research Centre, The University of Queensland, 2School of Health & Rehabilitation Sciences, The University of Queensland, 3Physiotherapy Department, Cairns Hospital, Queensland Health, 4Physiotherapy Department, Royal Brisbane and Women’s Hospital, 5Centre for Health Services Research, The University of Queensland
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Background: Patient-reported outcome measures (PROMs) and patient reported experience measures (PREMs) gather information on a patient’s views on their health outcomes and experience of care. PROMs and PREMs allow health services to better assess quality of care and can improve communication between patients and clinicians. Recently, there has been a push to implement electronic versions of PROMs and PREMs (ePROMS and ePREMS). This systematic review aims to assess the facilitators and barriers to implementing ePROMs and ePREMs in health care settings. Method: A systematic search of five databases was conducted (PubMed, CINAHL, PsycINFO, Web of Science and Scopus) in October 2020. Studies were included in the review if they reported on factors that affected the implementation of ePROMs or ePREMS in a health care setting. Two reviewers conducted a thematic synthesis of the findings and assessed the quality of the included studies with the mixed-methods appraisal tool (MMAT). Results: The systematic search identified 659 studies, of which 19 met the inclusion criteria. The thematic synthesis resulted in 36 barriers and 52 facilitators related to implementation of ePROMs or ePREMs, which were each mapped to the constructs of the Consolidated Framework for Implementation Research (CFIR). There were 5 studies rated as high quality, 5 as moderate quality, 5 as average quality and 4 as very low quality. Conclusion: This study identified a list of facilitators and barriers that can assist organisations in successfully implementing, and sustaining the implementation of, ePROMs and ePREMs within health care settings.
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The use of game elements in a home exercise diary smartphone app to improve engagement
Abstract
Authors: Joshua Simmich1, Nicole Andrews1,2, Trevor Russell1
Affiliation: 1RECOVER Injury Research Centre, The University of Queensland, 2The Professor Tess Cramond Multidisciplinary Pain Centre, Royal Brisbane and Women’s Hospital
Background: Adherence to home exercise programs can be a challenge for people undergoing rehabilitation. Mobile health apps for smartphones and tablet devices could improve adherence by facilitating supervision and enhancing motivation. The motivating effect of health apps could be enhanced by incorporating game elements, also known as gamification. This work describes the use of game elements in a home exercise diary app named Grow Stronger.
Method: Grow Stronger was initially developed as part of a co-design process with older adults with respiratory disease and clinicians with experience in pulmonary rehabilitation. The app is presently being redesigned for broader use in rehabilitation of other health conditions. Grow Stronger rewards players who complete exercises with in-game rewards that are used to grow a virtual garden. The app also promotes engagement and social support by allowing users to communicate with one another on a message-board. The app involves clinicians in a supervisory role, with all reported exercises displayed on a website accessible to clinicians. Through this interface, clinicians can communicate with the patients via the app.
Results: The redevelopment of the Grow Stronger app is due to be completed later in 2021. Pilot testing is also ongoing with persons having undergone total knee replacement surgery, and findings from pilot testing will be incorporated in the final design of Grow Stronger.
Conclusion: It is anticipated that the game elements, along with clinician supervision, will motivate participants to engage with the app and complete their home exercise program. Further trials will be conducted to confirm this hypothesis.
An evaluation framework for unconstrained conversational agents in healthcare: a scoping review
Abstract
View poster here (PDF, 1.1 MB)
Authors: Hang Ding1, Joshua Simmich1, Atiyeh Vaezipour1, Nicole Andrews1, Trevor Russell1
Affiliation: 1RECOVER Injury Research Centre, The University of Queensland
Background: Conversational agents (CAs) present new opportunities to address care burdens and service needs in healthcare delivery. To use CAs safely and effectively, rigorous evaluations are essential but challenging to achieve because of complex and diverse health interventions. We aimed to synthesise existing knowledge and outline a framework for evaluating CAs in healthcare.
Method: We searched CINAHL, Medline, Scopus, Embase and IEEE Xplore, focusing on CAs which were unconstrained by predefined answers or options. We reviewed study designs, categorised outcome measures, and finally outlined an evaluation framework which can be used to evaluate CAs in healthcare.
Results: The search identified 1553 articles, of which 43 studies were included in the review. We identified 23 quasi-experimental studies (single-arm, n=20; two-arm, n=1 and case-control, n=2), nine randomised controlled trials (crossover, n=1 and parallel, n=8), four observational studies (cross-sectional, n=4), and seven test-based studies where investigators, rather than participants in conventional study designs, tested CAs to evaluate their safety and information quality. A total of 175 outcome measures which were used in the reviewed studies were nested into seven categories: 1) functionality, 2) clinical / health outcomes, 3) user experience, 4) costs and cost benefits, 5) safety and information quality, 6) usage, adherence and uptake, and 7) user characteristics for implementation research. The framework comprised the outcomes across four evaluation stages: I) feasibility/usability, II) efficacy, III) effectiveness, and IV) implementation science.
Conclusion: This systematic review presents a consolidated evaluation framework which can be used to evaluate the performance of CAs in healthcare.
Brain structure differences in chronic pain are influenced by genetic differences
Abstract
View poster here (PDF, 578.3 KB)
Authors: Scott F. Farrell1,2,3, Adrián I. Campos4,5, Pik-Fang Kho6,7, Rutger M. J. de Zoete8, Michele Sterling1,2, Miguel E. Rentería4,5, Trung Thanh Ngo9,† & Gabriel Cuéllar-Partida9,†*
Affiliation: 1RECOVER Injury Research Centre, The University of Queensland, Herston QLD, Australia, 2NHMRC Centre for Research Excellence in Road Traffic Injury Recovery, The University of Queensland, Herston QLD, Australia, 3Menzies Health Institute Queensland, Griffith University, Gold Coast QLD, Australia, 4School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, St Lucia QLD, Australia, 5Genetic Epidemiology Laboratory, Department of Genetics & Computational Biology, QIMR Berghofer Medical Research Institute, Herston QLD, Australia, 6Molecular Cancer Epidemiology Laboratory, Department of Genetics & Computational Biology, QIMR Berghofer Medical Research Institute, Herston QLD, Australia, 7School of Biomedical Sciences, Queensland University of Technology, Brisbane QLD, Australia, 8School of Allied Health Science & Practice, The University of Adelaide, Adelaide SA, Australia, 9Diamantina Institute, The University of Queensland & Translational Research Institute, Woolloongabba QLD, Australia
†These authors contributed equally to this work.
*Current address: 23andMe Inc., Sunnyvale, CA, United States of America
Background: Clinical studies of chronic pain using structural magnetic resonance imaging (MRI) have often shown reduced grey matter (GM) across a number of brain regions. However, it is not known whether these associations may be due to underlying genetic differences. Here we employed a large-scale data-driven approach to investigate this hypothesis.
Method: Using genome-wide association study summary statistics for regional chronic pain conditions (N=196,963 cases vs N=239,125 controls) and structural MRI measures (N=19,629–34,000), we applied bivariate linkage disequilibrium-score regression and latent causal variable analysis (FDR<5%) to determine the genetic correlations (rG) and genetic causal proportion (GCP) between these complex traits (respectively). Five brain regions were selected a priori based on systematic reviews of GM studies in chronic pain (i.e., prefrontal, cingulate & insula cortices, thalamus, superior temporal gyrus).
Results: Ten significant genetic correlations (out of 369) revealed a shared genetic basis to both the presence of chronic pain (i.e., neck/shoulder, hip, abdominal, widespread pain & pain at any site) and reduced GM in pars triangularis, insula & posterior cingulate cortex. A significant genetic causal relationship was also found suggesting the genes underlying reduced insula cortical thickness causally contribute to an increased risk of chronic abdominal pain (rG [S.E.] = -0.25 [0.08], p=1.06E-03; GCP [S.E.] = -0.69 [0.20], p=4.96E-04).
Conclusion: This study shows for the first time that structural brain differences in chronic pain conditions are mediated (in part) by genetic factors, which paves the way for further mechanistic studies into objective biomarkers of chronic pain and their clinical translation.
Developmental trajectories of pain sensitivity and disability following whiplash injury
Abstract
View poster here (PDF, 401.8 KB)
Authors: Scott F Farrell1,2, Nigel Armfield1,3 & Michele Sterling1,2
Affiliation: 1RECOVER Injury Research Centre, The University of Queensland, Herston QLD, Australia, 2 NHMRC Centre for Research Excellence in Road Traffic Injury Recovery, The University of Queensland, Herston QLD, Australia, 3Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
Aims: To explore (i) trajectories of quantitative sensory testing (QST) measures, and (ii) co-development of QST and Neck Disability Index (NDI) trajectories, in people with whiplash to 12m post-injury.
Method: Group-based trajectory modelling (n=197, assessed at 1,3,6,12m). QST measures were C2/C3 cold pain threshold (CPT), and pressure pain threshold (PPT) at C2/C3, median nerve (MN) and tibialis anterior (TA). We modelled discrete trajectory groups (DTGs) of QST measures and NDI individually. We then jointly-modelled QST measures and NDI to explore whether they co-develop. We selected models using model fit statistics, non-overlapping DTG confidence intervals, and probability of DTG membership ≥10%. We report number of DTGs and probabilities of DTG membership.
Results: All QST measures followed linear trajectories. DTGs: CPT (3 groups; low 52.3%, moderate 29.5%, high 18.2%); PPT C2/C3 (2 groups; low 86.0%, high 14.0%), MN (2 groups; low 81.7%; high 18.3%); TA (3 groups; low 33.8%, moderate 40.0%, high 26.2%). NDI DTGs were comparable with those previously reported in the literature (mild 49.5%, moderate, 33.3%, chronic-severe 17.1%). While all QST DTGs were linear, the number of DTGs, and probability of DTG membership for CPT and NDI were similar. In the joint-trajectory modelling (CPT+NDI) three DTGs were identified (low CPT modelled with mild disability (48.4%), while cold hyperalgesia grouped with both recovering moderate disability (29.6%) and chronic-severe disability (22.0%). We did not identify any joint DTGs for PPT+NDI.
Conclusion: QST measures follow linear trajectories. Joint modelling of CPT+NDI confirm cold hyperalgesia as a risk factor for fair and poor recovery.
Review of Content and Quality of Mobile Apps for Speech Language Therapy
Abstract
View poster here (PDF, 2.4 MB)
Authors: Atiyeh Vaezipour1, Jessica Campbell2, Deborah Theodoros1, Trevor Russell1
Affiliation: 1 RECOVER Injury Research Centre, The University of Queensland, Australia, 2 Queensland Aphasia Research Centre, The University of Queensland, Australia
Background: Worldwide, more than 75% of people with acquired brain injury (ABI) experience communication disorders. Technology-enabled interventions such as mobile apps have the potential to increase the reach of speech-language therapy. However, ensuring that apps are of high quality is critical for facilitating safe and effective treatment. The aim of this review is to identify mobile apps that are currently available to adults for speech-language therapy and to assess their content and quality.
Method: Google Play Store, Apple App Store, and webpages were searched to identify mobile apps that were designed for the treatment of adult communication disorders after ABI, and were in English. Certified speech-language pathologists used the Mobile App Rating Scale (MARS) to assess the quality of the apps.
Results: A total of 70 apps met the eligibility criteria for inclusion. A content analysis of the apps revealed 43 apps for language, 17 apps for speech, 8 apps for cognitive communication, 6 apps for voice, and 5 apps for oromotor function or numeracy. The overall MARS mean score was 3.7 out of 5, with functionality being the highest-scored subscale (4.3), followed by aesthetics (3.8), information (3.4), and engagement (3.3).
Conclusion: To our knowledge, this is the first study to systematically identify and evaluate a broad range of mobile apps for speech-language therapy for adults with communication disorders. We found a lack of interactive and engaging elements in the apps, a critical factor in sustaining self-managed speech-language therapy. More evidence-based apps focusing on human factors, user experience, and a patient-led design approach are required to enhance effectiveness and long-term use.
Overactivity assessment in chronic pain: the development and psychometric evaluation of a multifaceted self-report assessment
Abstract
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Authors: Andrews, N.E.1,2,3, Chien, C.W.4, Ireland, D.5, Varnfield M.5
Affiliation: 1 RECOVER Injury Research Centre, The University of Queensland, 2 Department of Occupational Therapy, The Royal Brisbane and Women’s Hospital, 3 Tess Cramond Pain and Research Centre, Metro North Hospital and Health Service, 4 Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, 5 The Australian eHealth Research Centre, CSIRO
Background: Overactivity in the context of chronic pain (i.e. activity engagement that significantly exacerbates pain) is an important clinical construct. Current assessment concepts of overactivity tend to solely focus on frequency to quantify the severity of the pain behaviour. This study aimed to develop a more comprehensive self-report overactivity assessment tool (i.e. the OPPA) and examine its psychometric properties.
Method: A deconstruction of the overactivity concept was first undertaken using qualitative data, theory and clinical observations. A draft assessment tool was developed and initial feedback was obtained from clinicians and individuals with chronic pain. The final assessment tool was administered to 333 individuals with chronic pain. A subset of 202 individuals also completed a set of existing measures of pain-related outcomes and activity patterns. The remaining 131 participants were provided with a second copy of the OPPA to fill in one week following their initial assessment.
Results: The final version of the OPPA measures five quantifiable overactivity severity features: severity of pain exacerbation, maladaptive coping strategies used, impact on occupational performance, recovery time and frequency. The OPPA was psychometrically sound in terms of its structural validity, construct validity, test-retest reliability, and internal consistency. When compared to existing overactivity measures, the OPPA was the only measure to contribute significantly to the regression models predicting higher levels of pain severity and more pain interference.
Conclusion: This study supports the application of a self-report assessment tool, that provides a comprehensive assessment of overactivity severity features, in clinical and research settings.
The association between spousal reactions to chronic pain and pain-related outcomes: a systematic review
Abstract
View poster here (PDF, 721.8 KB)
Authors: Donohue, G.F2., Meredith, P.J.3,4, Strong, J.4,5, Page, L.2, Andrews, N.E,1,5,6
Affiliation: 1 RECOVER Injury Research Centre, The University of Queensland, 2 Central Queensland University, 3 School of Health and Behavioural Sciences, University of the Sunshine Coast, 4 School of Health and Rehabilitation Sciences, The University of Queensland, 5 Royal Brisbane and Women’s Hospital, Occupational Therapy Department, 6Tess Cramond Pain and Research Centre, Metro North Hospital and Health Service
Background: Interest in the impact of spousal reactions to persistent pain is regaining momentum. Early theoretical perspectives, based on operant conditioning, argued that partner solicitous behaviour (expressing excessive concern) increases pain behaviour, while punishing responses (e.g., expressing negative affect) decrease pain behaviour. More recent research considers spousal responses such as validation, invalidation, empathy, compassion, and spousal autonomy support. Evidence regarding the relationship between spousal responses to pain and pain-related outcomes is contradictory, however, necessitating a systematic review to guide future directions.
Method: Included studies were: (1) about adults (>18yrs) in a relationship experiencing persistent pain; (2) about the relationship between spousal response (or perceived spousal response) and a pain-related outcome (disability, pain severity, quality-of-life, functioning); (3) in English. Studies investigating cancer pain or participants under 18 years were excluded. Five databases were searched using key words, with no date restrictions. One author screened abstract and titles. Two authors reviewed full articles for eligibility and assessed studies using a modified version of the Downs and Black checklist. Results were tabulated.
Results: Sixty-four papers were retained, with most approaches towards partners experiencing persistent pain associated with negative pain outcomes. Contrary to theoretical expectations, punishing responses were not associated with decreased pain behaviours. Solicitous behaviours were consistently associated with negative outcomes.
Conclusion: This review highlights varied responses to pain behaviours from partners, many that were inconsistent with theoretical expectations. Further research is required to ascertain effective spousal reactions to pain behaviours, which may inform new theoretical models and treatment within this population.