Jennie Mary Scarvell

Long wait-times for orthopaedic consultation in public hospitals, particularly for knee osteoarthritis patients, may be ameliorated when Advanced Practice Physiotherapists (APPs) are integrated into clinical pathways. APPs provide expert comprehensive assessment, accurately identifying patients not requiring surgery. This study aimed to quantify wait-time between general practitioner (GP) referral and consultation with an APP or surgeon outcomes following service changes including increased resourcing of the APP clinics. Method: This knowledge translation project was evaluated by comparing wait-time to consultation for three, 6-month cohorts from 1 March to 30 September, totalling 563 patients, at baseline in 2022, and post-intervention at year 1 (2023) and year 2 (2024). Evidence-based service changes included expanding APP clinic capacity and improving referral pathways to community osteoarthritis and obesity programs. The proportion of patients seen by APPs rose from 20% at baseline (2022) to 81% in 2023 and 76% in 2024. Concurrently, the health service implemented a digital medical records system. Data were analysed for patient characteristics, wait-times, care pathways (APP, surgeon, or both), and consultation outcomes. Results: Compared to 2022, wait-times to consultation significantly reduced. Median wait-time fell from 114 days in 2022 to 45 days (86% less) in 2023 and 46 days (90% less) in 2024. Patients seen by APPs experienced fewer delays (Incidence risk ratio (IRR): 0.55; 95% CI: 0.43–0.72), including those seen in both APP and surgeon clinics (IRR: 0.54; 95% CI: 0.41–0.70). Total patients listed for surgery declined from 48% in 2022, to 36% in 2023, and 35% in 2024, while patients directed to a surgeon were twice as likely to need knee replacement in 2023, 2024. Conclusions: Shorter wait-times appear linked to increased APP clinic activity, improved digital systems, and enhanced access to community programs. These changes supported clinical standards and timely care for patients with knee osteoarthritis.

Three-dimensional (3D) kinematic analysis plays an important role in improving diagnosis and in the evaluation of treatments and surgical procedures. For example, measuring the 3D kinematics of knee joints is essential for understanding their normal function and diagnosing any pathology, such as ligament injury and osteoarthritis. Image registration is a method which can be used to compute kinematic measurements without involving the introduction of instruments into the body. However, in these techniques, the trade-off between accuracy and computation time is still a challenging problem which needs to be addressed. In this paper, a fast and robust registration method is proposed for the measurement of post-operative knee joint kinematics. Using this method, after total knee arthroplasty (TKA) surgery, a 3D knee implant model can be registered with a number of single-plane fluoroscopy frames of the patients’ knee. Generally, when the number of fluoroscopy frames is quite high, the computation cost for the registration between the frames and a 3D model is expensive. Therefore, in order to speed up the registration process, we apply an interpolation-based prediction method, to initialize and estimate the 3D positions of the 3D model in each fluoroscopy frame. The estimated 3D positions are then fine-tuned. The experimental results, which were performed on the knee joints of 18 patients post surgery, show that the computational time required to register each frame for each bone using our proposed method is only 67 seconds, which is much faster (almost 6.5 times faster) than the best existing registration method (a registration method based on sum of conditional variance (SCV) similarity measure) while maintaining almost the same accuracy. The average of the mean difference +/- standard deviation of the proposed method for femoral and tibial bones for translation and rotation parameters are 0.0603 +/- 0.2966 (mm) and -0.0069 +/- 0.2922 (degree) respectively.

Objective: The purpose of this study is to explore academic faculty, employer, and recent graduate perspectives of the work readiness of Australian new graduate physical therapists for private practice and factors that influence new graduate preparation and transition to private practice. Methods: This study used a mixed-methods design with 3 surveys and 12 focus groups. A total of 112 participants completed a survey, and 52 participated in focus groups. Descriptive statistics were used to summarize the quantitative data, and thematic analysis was used to analyze the qualitative data. Triangulation across participant groups and data sources was undertaken. Results: Australian new graduate physical therapists were perceived to be “somewhat ready” for private practice and “ready” by their third year of employment. Participants proposed that new graduates bring enthusiasm, readiness to learn, and contemporary, research-informed knowledge. New graduates were also perceived to find autonomous clinical reasoning and timely caseload management difficult; to have limited business, marketing, and administration knowledge and skills; and to present with underdeveloped confidence, communication, and interpersonal skills. Factors perceived to influence graduate transition included private practice experience, such as clinical placements and employment; employer and client expectations of graduate capabilities; workplace support; university academic preparation and continuing education; and individual graduate attributes and skills. Conclusion: Australian new graduate physical therapists have strengths and limitations in relation to clinical, business, and employability knowledge and skills. New graduate work readiness and transition may be enhanced by additional private practice experience, employer and client expectation management, provision of workplace support, and tailored university and continuing education. Impact: The number of new graduate physical therapists employed in private practice in Australia is increasing; however, until this study, their work readiness for this setting was unknown. This exploration of new graduate performance in private practice and transition can help to increase understanding and enhancement of work-readiness.

Background: Physical therapists assess joint movement by observation and palpation. New imaging technologies that enable vision of bones and joints during functional activities can be used to analyze joint kinematics and review traditional assumptions. Purpose: The purpose was to measure relations between flexion, rotation, and translation at the knee and to validate these visually. Design: This was a prospective, observational study. Methods: Twenty-five healthy participants aged >45 years (13 males) knelt from upright kneeling to full flexion with the foot free. Fluoroscopy recorded movement at 30 frames per second of x-ray. A computed tomography scan provided 3-dimensional data, which were registered to the fluoroscopy frames to provide a moving model. Motion in 6 degrees of freedom was analyzed for coupling of movements. Results: Mean (standard deviation) flexion reached by participants was 142 (6)° in kneeling. Posterior femoral translation was coupled to flexion (r = 0.96). From 90° to 150° flexion, the femur translated posteriorly by 36 (3) mm to finish 23 (3) mm posterior to the center of the tibia at 150° flexion. From 90° to 150° flexion, the femur externally rotated from 8 (6)° to 16 (5)°. Flexion was coupled to rotation (r = 0.47). Abduction was <3° and lateral translation was <3 mm. Visually, the femur appeared to translate posteriorly until the femoral condyles rested on the posterior rim of the tibial plateau with concurrent external rotation so that the popliteal fossa aligned with the posterior margin of the medial tibial plateau. Limitations: A limitation of the study is that knee flexion can include squat and lunge as well as kneeling. Conclusion: Deep flexion requires femoral posterior translation and external rotation. These findings invite review of the concave-convex rule as it might apply to manual therapy of the knee.

Background/aim: Occupation and an occupational perspective of health and wellbeing are required to be taught in accredited occupational therapy programmes internationally. Current research into occupational therapy education has commonly focused on curriculum design and the experience of students and their developing skills for practice. Little research has focused on the perspectives of educators and in particular their own reflections and beliefs on the use of occupation in occupational therapy education. The aim of this study was to uncover Australian educator perspectives of occupation in occupational therapy education.Method: This study utilised a qualitative research framework. Eight occupational therapy educators and practice education coordinators completed semi‐structured interviews. Educators ranged in experience from two to over 20 years in the university sector. The interview transcripts were transcribed verbatim, forming the data for analysis. Braun and Clarke's thematic analysis was used to analyse the dataset.Results: Three themes emerged from the data: occupation is our framework; the balance between practice education and occupation‐centred education; and educators changing the focus. Overall, educators believed that the ‘occupation for health’ philosophy and its application are important foundations for education. However, educators provided varied responses on how to teach these concepts to students.Conclusion: Gaining educators’ opinions on the importance of occupation in education is beneficial for ensuring consistency throughout occupational therapy curricula. Theoretical models were endorsed by educators to foster occupation‐based practice. Educators must continue to innovate within the profession for occupation‐based approaches in practice and education to be strengthened in the future.