Marnie Graco

Background: Prehabilitation aims to increase functional capacity and physiological reserve prior to surgery, to improve post‐operative outcomes. Despite growing research on prehabilitation for total hip arthroplasty (THA) and total knee arthroplasty (TKA), its acceptability and barriers and enablers to implementation in clinical settings are not well understood. Objective: This study, involving patients and healthcare professionals (HCPs), aimed to explore the acceptability of prehabilitation, identify factors affecting prehabilitation access, uptake and delivery, and investigate perspectives on feasible and preferred care models, and prehabilitation content. Methods: Semi‐structured interviews were conducted with patients who had undergone or were awaiting THA or TKA and HCPs involved in their care at a public hospital in Melbourne, Australia. Interview guides were informed by the Theoretical Framework of Acceptability and the Theoretical Domains Framework. Data were analysed using an inductive‐deductive approach. Results: Thirty interviews were completed with patients ( n = 15) and HCPs ( n = 15). Three major concepts emerged: (1) Understanding and beliefs —while knowledge varied, prehabilitation was generally viewed as acceptable and beneficial; (2) Barriers and enablers —factors influencing uptake and delivery were identified at three levels of care; patient‐level (e.g., mindset), HCP‐level (e.g., confidence discussing prehabilitation with patients), and system‐level (e.g., long surgical waitlists making prehabilitation timing challenging); (3) Strategies for success —both groups emphasised tailored prehabilitation, multi‐modal delivery, and support throughout the surgical pathway as important intervention components. Conclusion: This study identified factors influencing acceptability, uptake, and delivery of prehabilitation at various care levels. The findings will inform the development of a flexible, stakeholder‐informed prehabilitation model to empower and optimise patients prior to THA and TKA.

Introduction: Intensive care unit (ICU) physiotherapy practice requires additional skills and knowledge that is not mandated within entry-level physiotherapy education. Therefore, the training of ICU physiotherapists occurs in the workplace. The need to standardize the training requirements has led researchers to develop minimum practice standards. The extent to which these minimum practice standards are used in ICU training programs remains unclear. The aim of this review was to identify ICU physiotherapy training programs that use minimum practice standards for trainees. Methods: A scoping review following the Johanna Briggs Institute methodology was conducted. Six bibliographic databases and university and professional association websites were searched for ICU physiotherapy minimum practice standards and education programs. Two authors screened all relevant articles for inclusion, and data on setting, minimum standards, training-program duration, and qualifications/titles recognized were extracted. Results: Twenty-two studies met the inclusion criteria from the 2081 screened studies. These comprised 12 standalone minimum practice standards, 9 standalone education programs, and one combined standard and education program from both published and gray literature sources. Only one study reported an education program that used a minimum performance standard. Qualification on completion varied between education program types. Discussion: Minimum practice standards are rarely used in ICU physiotherapy training. To support high-quality care, an ICU physiotherapy training program that integrates minimum performance standards should be developed. Accreditation of such a program may assist in supporting recognition between centers.

Motor neurone disease (MND) is a neurodegenerative disorder that causes progressive muscle weakness and severe disability. Median age of onset is 65 years, and life expectancy is typically two to t...

Insomnia is highly comorbid with mental health conditions, yet graduate psychology students receive limited training in sleep and insomnia management. An online introductory sleep workshop focused on insomnia management with Cognitive Behavioral Therapy for Insomnia (CBT-I) was developed for Australian graduate psychology students to address this training gap. However, some students reported difficulties applying CBT-I knowledge to clinical practice. This study explored the barriers and facilitators to implementing CBT-I knowledge into graduate psychology students' practice post-workshop. Semi-structured interviews were conducted with 15 graduate psychology students who attended an online introductory sleep and CBT-I workshop. Data were analyzed using reflexive thematic analysis. Facilitators of CBT-I implementation included: (1) Helpful workshop resources; (2) Increased awareness of the importance of sleep's role in mental health; (3) Enhanced self-efficacy with introductory sleep skills (e.g. sleep history taking); and (4) Knowing where to access further training. Barriers included: (1) Limited ongoing training and clinical supervision; (2) Accessibility challenges; (3) Clinical implementation challenges; and (4) Constraints of being a graduate student. The introductory workshop facilitated the development of introductory CBT-I skills among graduate psychology students, but ongoing training and supervision are needed to enhance implementation and expand Australia's CBT-I workforce.

Objective: This scoping review aimed to map outcome measures collected in randomised controlled trials investigating prehabilitation interventions in total hip and knee arthroplasty, and timepoints of collection. Data sources: A systematic search of MEDLINE, EMBASE, Web of Science, Cochrane, and CINAHL was conducted. Methods: This review followed the Joanna Briggs Institute Scoping Review methodology. Outcome domains, concepts of interest and assessment tools were characterised using the International Society for Pharmacoeconomics and Outcomes Research Framework, and timepoints for data collection were extracted. Results: Ninety-two trials (published between June 2001 and March 2025) were included. Most delivered unimodal prehabilitation, with exercise the most common intervention ( n = 37). The review identified 36 outcome concepts measured with 219 assessment tools. Patient-reported outcomes were collected in 92% of trials ( n = 85), and was the most heterogenous domain with 102 assessment tools. Performance-based outcomes, most commonly muscle strength, were collected in 66% of trials ( n = 61) and utilised 47 different tools. Observer-reported outcomes were reported in 60% of trials ( n = 55), with healthcare utilisation (e.g. hospital length of stay) the most common concept. Clinician-reported outcomes were reported in 48% of trials ( n = 44) and most frequently included post-operative complications. Biomarker outcomes were rare ( n = 7, 8%). Timing of outcome collection varied, with just over half the trials collecting both a pre-operative and post-operative timepoint. Conclusion: This review identified significant variability in outcome measures collected in prehabilitation trials for total hip and knee arthroplasty, highlighting the need for a core set of assessments to facilitate consistent reporting and robust meta-analyses of prehabilitation efficacy.

The aim of this study was to evaluate the feasibility of an alternative, rehabilitation-led model for managing obstructive sleep apnoea (OSA) in an Australian spinal cord injury (SCI) inpatient rehabilitation centre. The mixed-methods evaluation included quantitative analysis of clinical data and qualitative interviews with staff and patients to assess reach, effectiveness, adoption, acceptability, implementation, and sustainability (RE-AIM framework) of the OSA care model. During the 12-month pilot, 48 inpatients were screened, 24 were assessed for OSA, 12 were diagnosed and recommended treatment, 6 commenced continuous positive airway pressure (CPAP) therapy, and 4 were discharged on CPAP. No adverse events were recorded. Clinical staff reported significant benefits to patient care and improved knowledge about sleep and respiratory issues. Insufficient staff time and skills resulted in significant barriers to initiating treatment with CPAP. This is the first time an Australian SCI rehabilitation centre has implemented a rehabilitation-led OSA care model. Assessing and diagnosing OSA in the inpatient unit was feasible and sustainable but initiating treatment required additional staffing and ongoing training. Scaled implementation of rehabilitation-led OSA care could significantly improve access to OSA treatments and quality of life for people living with SCI.Implications for rehabilitationObstructive sleep apnoea (OSA) is the most common sleep disorder in spinal cord injury (SCI); yet it is under-diagnosed and under-treated.To improve access to care, an Australian SCI inpatient rehabilitation centre adapted and implemented an alternative, rehabilitation-led model of managing OSA.The alternative care model was safe, acceptable to staff and patients, and improved access to OSA assessments and treatments.Rehabilitation-led management of non-complicated OSA has the potential to improve outcomes for people living with SCI.To be sustainable, the rehabilitation-led care model should be adequately staffed with ongoing staff training opportunities available.

Objective: Noninvasive ventilation (NIV) improves quality of life and extends survival in amyotrophic lateral sclerosis (ALS), yet NIV uptake among Australians with ALS has been estimated at 19%. This study aimed to identify demographic and disease-related factors associated with NIV uptake among people with ALS (pwALS). Methods: A national cross-sectional survey. PwALS (or their family caregivers) completed an online survey about their NIV use and healthcare experiences. Survey data were analyzed descriptively. Associations between demographic factors and three dichotomous NIV outcomes: "using NIV"; "offered and accepted NIV"; and "discussed NIV with a healthcare professional (HCP)" were investigated using multivariate logistic regression modeling. Results: A total of 224 responses were received, of which 201 completed the demographic questions. Mean (SD) age was 64 (11) years, 62% were male, and median (IQR) time since diagnosis was 2 (1-5) years. Forty-six percent were using NIV; 6% had started NIV and stopped; 4% had accepted a referral but not started; 3% had declined NIV; and 26% had never discussed NIV with a HCP. Demographic factors positively associated (p < 0.05) with at least one NIV outcome included: being male, age < 65 years, residing in a metropolitan/regional area, attending a ALS multidisciplinary clinic, and longer time since diagnosis. Conclusion: NIV uptake among Australians with ALS appears to have increased in the last decade, however this survey identified concerning disparities related to sex, age, and location of residence. Research exploring the underlying causes of these disparities is urgently required so that targeted interventions can be designed and implemented.

Introduction: Physiotherapy is integral in the care of people with spinal cord injury (SCI). However, physiotherapy management in SCI is potentially challenging due to the low prevalence of SCI, complexity of presentations, and broad scope of physiotherapy interventions. Objective: This study aimed to explore barriers and enablers of using a physiotherapy clinical guideline as perceived by therapists who deliver physical therapies to people with SCI in local health care settings. Method: Following guideline dissemination, therapists were invited to participate in a survey. The survey examined barriers and enablers of following the recommendations in the physiotherapy guideline. Guided by the Theoretical Domains Framework, the survey asked participants to rate their agreement with 18 statements and to answer free-text questions about barriers and enablers. Data analysis adopted a mixed methods approach, including triangulation of quantitative and qualitative data. Results: Fifty-three therapists responded to the survey, representing regional and metropolitan health care settings, as well as public and private sectors. All respondents believed that delivering an intervention according to the guideline was worthwhile. The quantitative and qualitative findings highlighted several conditions under which therapists may find it difficult to follow guideline recommendations. These included potential conflict between patient expectations of therapy and care recommended by the guideline. Conclusion: The findings offer insights into how therapists can be supported to provide evidence-based physical therapies to people with SCI in rehabilitation settings. Recommendations include targeting therapists who see few people with SCI, such as those who work in regional settings; delivering education alongside that of SCI psychosocial care; and including people with SCI as co-educators. Spanish http://links.lww.com/IJEBH/A363

We are undertaking a multicentre randomised controlled trial to determine the effectiveness of including a sleep study (polysomnography (PSG)) to assist the commencement of non-invasive ventilation (NIV) in people with motor neurone disease (MND): the Polysomnographic titration of non-invasive ventilation in motor neurone disease (PSG4NIVinMND; 3-three letter acronym; 3TLA) trial. A process evaluation will be conducted alongside the clinical trial to understand: (1) the implementation of the 3TLA intervention in the trial sites, including barriers and enablers, and (2) the mechanisms through which the 3TLA intervention produces change. This protocol paper describes the rationale, aims and methods of the 3TLA process evaluation. To guide the design of the process evaluation, a logic model representing the 3TLA intervention, the likely mechanisms of impact, potential external contextual factors and assumptions, and the anticipated outcomes was developed by the researchers in collaboration with the 3TLA Trial Steering Committee. From this, five key process evaluation research questions were identified, a priori. The mixed-methods design is guided by three implementation frameworks: the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework, the Theoretical Domains Framework (TDF), and the Theoretical Framework of Acceptability (TFA). We will conduct semi-structured interviews with approximately 20–30 clinical trial participants (people with MND) and their carers, and focus groups and surveys with approximately 60 health professionals involved in delivering the intervention at each site. Quantitative process data will also be collected from the main clinical trial. Qualitative and quantitative data will be analysed iteratively throughout the trial, independent of the main trial outcome analyses. Process evaluation findings will be triangulated with the results of the clinical trial. This process evaluation incorporates a mixed-methods design and is informed by three theoretical frameworks. It will provide insights into how the 3TLA intervention was implemented, for whom and how the 3TLA intervention was (and was not) effective, and what adaptations may be needed to facilitate future implementation into routine clinical practice. ClinicalTrials.gov NCT05136222. Registered on November 25, 2021.

Objective: Noninvasive ventilation (NIV) is the primary treatment for respiratory insufficiency in neuromuscular disease. NIV implementation is usually conducted within hospitals; however, in-home implementation with intensive follow-up is an effective alternative. This pilot study aimed to assess model feasibility, acceptability, and NIV usage at 12-weeks after a single visit in-home implementation of NIV with remote monitoring follow-up (NIV@Home) compared to an in-hospital day admission NIV initiation plus planned polysomnography (Usual care). Methods: A single-blinded randomized controlled trial (www.anzctr.org.au ACTRN12620000682943) of adults with neuromuscular disease referred for NIV implementation. Participants were stratified by disease (MND or Other diagnoses) and bulbar symptoms before randomization to NIV@Home or Usual care, with follow-up at 12-weeks. The primary outcome was NIV usage. Secondary outcomes included feasibility, health-related quality of life, symptoms, carer burden, and NIV experience (semi-structured qualitative interviews). Results: Twenty-three participants (MND bulbar = 9, MND non-bulbar = 11, Other = 3) were randomized (NIV@Home = 9). No statistical differences were observed in the percentage of MND participants using NIV for >4 hours/day (NIV@Home = 33% vs. Usual care = 60%, p = 0.370), average use (NIV@Home = 2.4 [1.5-9.3] vs. 5.3 [1.8-7.0] hours/day, p = 0.568), or secondary outcomes. In-home NIV implementation was feasible and safe but took more therapist time (NIV@Home = 278 [270-305] vs. 172 [130-200] minutes, p < 0.001). Participants in the NIV@Home group reported substantial advantages to receiving care in home. Conclusion: In-home NIV implementation is feasible and acceptable to people with MND but requires more therapist time. Larger studies are required to determine whether there are clinically important differences between this model of NIV initiation and a traditional hospital-based model.