Catherine Mary Dean

Motor training at a high-dose may be an important approach for attaining meaningful improvements in post-stroke activity performance (Schneider, Lannin, Ada, and Schmidt, 2016). In this study, high...

Persistent mobility limitations remain a source of long-term disability for many stroke survivors, particularly those living in the community after discharge from rehabilitation services [1]. A sub...

Purpose: The incorporation of Entrustable Professional Activities (EPAs) into pre-certification medical education programs remains a subject of debate. The Macquarie Doctor of Medicine (Macquarie MD), a four-year program culminating in graduates becoming eligible to commence an internship in Australia, was designed with a programmatic assessment framework that integrates EPAs within a comprehensive capability development design that includes the aggregation of multiple low-stakes assessment data into an assessment portfolio. The purpose of this project was to evaluate the effectiveness of EPA integration within the Macquarie MD program. Design/methodology/approach: A mixed-methods design was used. Detailed reporting is provided on the decision-making processes underlying EPA implementation within the assessment framework. Quantitative data were obtained from student assessment outcomes across multiple cohorts. Qualitative insights were gleaned through surveys of students and clinical supervisors. Findings: Analysis of outcome data from four graduating cohorts (n = 224) demonstrated that 95% of students achieved the standards necessary for internship eligibility in Australia, receiving either an “Available” or “React” supervision rating for all Stage 2 EPAs. Feedback from clinical staff and students indicated that both the overall assessment scheme and the inclusion of EPAs were positively received. Practical implications: EPAs can be effectively implemented in a pre-certification medical education program. Inclusion of EPAs in the assessment framework is rated positively by students and clinicians. Graduates can meet the required EPA supervision levels for practice as an Intern in Australia. Originality/value: The implementation of EPAs in a pre-certification medical program provided focused attention on core clinical tasks, fostering student confidence and supporting the development of trust with clinical supervisors in preparation for future clinical responsibilities.

Objective: To determine the effect of falls-prevention exercise compared with nothing, sham or another exercise intervention on reducing falls after stroke. To also determine the effect of falls-prevention exercise on balance, mobility and quality of life. Data sources: Searches were conducted from inception to December 2025 on MEDLINE, EMBASE, Scopus and PEDro databases according to predefined search terms with details provided in supplementary materials. Review methods: Randomised trials were included if the intervention targeted falls and the primary outcome was the rate of falls or the number of people experiencing one or more falls. Other outcomes of interest were balance, mobility and quality of life. Methodological quality was rated with the PEDro scale. Two researchers independently extracted data, which was synthesised by meta-analysis. Results: Three trials (n = 677) were included in the review. Exercise trended towards a lower rate of falls compared to no/sham intervention (IRR 0.84, 95% CI 0.62 to 1.15, p = 0.29) with uncertainty in the estimate (confidence interval includes the possibility of no effect). Exercise did not reduce the number of individuals experiencing one or more falls (RR 0.98, 95% CI 0.81 to 1.18, p = 0.84). There was a trend towards improved balance (MD 0.49 steps in the Step Test, 95% CI −0.11 to 1.08, p = 0.11) and exercise did improve mobility a small amount (MD 0.04 m/s preferred walking speed, 95% CI 0.01 to 0.07, p < 0.01). No trials compared two exercise interventions. Conclusion: There is a suggestion that exercise can reduce the rate of falls after stroke but does not affect the number of individuals falling. Registration: PROSPERO CRD42024520272.

There is evidence goal-setting promotes self-efficacy and maximises outcomes for people living with disability. Effective goal-setting in the disability sector remains challenging due to organisational structure, resource limitations and stakeholder involvement. This study aimed to explore barriers/facilitators and enhance effective goal-setting guided by the Theoretical Domains Framework (TDF) and behaviour change techniques. A mixed methods implementation study was conducted within an allied health (AH) organisation (n = 213 staff). Goal-setting practices were assessed by auditing goals and surveying AH professionals (AHPs) at baseline. TDF guided development of tailored intervention including multimodal training/resources. The audit and survey were repeated post-intervention (6-months) and at follow-up (12-months). Goals set post-intervention had improved across all criteria (measurable/meaningful/time-bound/specific). At follow-up, improvements continued. Goals were more measurable (18%, pre-50%, post-68%), meaningful (23%, pre-54%, post-77%), time-bound (29%, pre-37%, post-66%) and specific (32%, pre-37%, post-69%). AHPs reported their goal-setting to be more collaborative, holistic and multidisciplinary (13%, pre-69%, post-82%) however, goals were less often shared with the person and their support network (-11%, pre-69%, post-58%). Multimodal intervention improved goal setting practices in AHPs, with most gains maintained at follow-up. The TDF informed intervention could be adapted for similar organisations seeking to strengthen goal-setting practice.

Objective: To investigate the effectiveness of a multidisciplinary, home based, tailored intervention to reduce falls after stroke. Design: Two armed, randomised trial. Setting: Three states in Australia. Participants: People within 5 years of stroke, aged >50 years, discharged from formal rehabilitation to the community, and able to walk 10 m across flat ground with or without an aid. Those with moderate-to-severe receptive aphasia or walking speed >1.4 m/s without falls in the previous year were excluded. Intervention: Over 6 months, the experimental group received a habit forming functional exercise, home fall hazard reduction, and goal directed community mobility coaching; the control group received usual care. Physiotherapist and occupational therapist dyadic teams worked collaboratively to deliver the intervention. Main outcome measures: The primary outcome was rate of falls over 12 months. Secondary outcomes were proportion of participants having a fall, community participation, self-efficacy, balance, mobility, physical activity, activities of daily living, depression, and health related quality of life. Results: Between August 2019 and December 2023, 370 people with stroke were enrolled. At 12 months, a significant between group difference was seen in the rate of falls in favour of the experimental group, representing a 33% reduction in falls (incidence rate ratio 0.67, 95% confidence interval (CI) 0.48 to 0.94; P=0.02). No significant between group difference was seen in the number of participants having a fall (absolute risk reduction 0.03, 95% CI −0.07 to 0.13; P=0.52). The main between group differences in favour of the experimental group were in community participation (Late Life Function and Disability Instrument disability limitation: mean difference 3% (95% CI 1% to 6%); P=0.02), self-efficacy (mean difference 0.6 (0.2 to 1.0); P=0.004), mobility (fast walking speed: mean difference 0.13 (0.06 to 0.19) m/s (P<0.001); preferred walking speed: 0.06 (0.02 to 0.10) m/s (P=0.02)), and balance (Step Test: mean difference 0.06 (0.01 to 0.12) steps/s; P=0.03). Conclusion: A tailored intervention prevented falls in community dwelling, ambulatory people with stroke. The decrease in the rate of falls was underpinned by clinically worthwhile improvements in self-efficacy, mobility, community participation, and balance. Trial registration: Australian New Zealand Clinical Trials Registry ACTRN12619001114134.

BACKGROUND: Maintaining walking ability in the long term after a stroke is challenging. Furthermore, access to ongoing physiotherapy is limited. This trial determined the feasibility of a clinical trial of a high-dose walking booster program (HiWalk) and measured clinical outcomes. METHODS: A multisite, assessor-blinded pilot and feasibility randomized trial was conducted in Australia (June 2023 to July 2024). Participants had a stroke 6 months to 8 years prior and could walk unaided at 0.4 m/s to 1.0 m/s. The experimental group received HiWalk plus usual care, while the control group received usual care alone. HiWalk was group-based motor training to improve walking, 43 hours over 3 weeks. Feasibility outcomes included recruitment and retention. Clinical outcomes included walking speed (preferred and fast over 5 m, fast over 6 minutes), and self-efficacy at 1 and 6 months. RESULTS: Eighty-two individuals were screened, and 47 participated: age 58 (SD, 16), time poststroke 2.7 years (SD, 2.1), and baseline fast walking speed 0.9 m/s (SD, 0.4). Feasibility outcomes: the HiWalk trial was feasible in terms of recruitment (refusal rate 27%), retention at 1 month (98%), adherence (mean 91% [SD 13] attendance once commenced), safety (minor adverse events 0.4/wk), and measurement (98% of data collected at 1 month). Clinical outcomes: at month 1, there was a beneficial effect on a 30-point self-efficacy scale (mean difference, 3.0 [95% CI, 0.1–5.9]). However, despite a small positive mean effect of HiWalk on fast walking speed (mean difference, 0.05 m/s [95% CI, −0.09 to 0.19]), there were no other significant between group differences. Exploratory analysis suggests the effect on walking speed for those not undertaking rehabilitation was 0.24 m/s (95% CI, 0.06–0.43) more than for those who were. CONCLUSIONS: The HiWalk booster program was a feasible way to deliver mobility training in the community after stroke. Benefits in clinical outcomes were found for the subgroup of participants no longer undertaking rehabilitation. Therefore, future research should target this subpopulation. REGISTRATION: URL: https://www.anzctr.org.au ; Unique identifier: ACTRN12623000316606.

This paper describes the design, implementation, and evaluation of a medical degree which uses a capability framework, programmatic assessment, and an assessment portfolio to facilitate feedback literacy and self-directed learning. The Macquarie MD outcomes are expressed through four graduate capabilities, each having two aspects and defined expectation standards for the two two-year stages. Assessments of capability development and Entrustable Professional Activities (EPAs) are embedded in each stage. Assessment data are stored in the student’s online portfolio with data summarised on dashboards presented chronologically and mapped to capability aspects and EPAs. A retrospective audit of curricula and graduate portfolios (n = 104) was undertaken and analysed descriptively. All students met the expectations for capability aspects and EPAs. All students voluntarily undertook additional assessments to strengthen their evidence for capability development and entrustment. On average, students completed 119% (SD = 6) of the required number of assessments: 107% (SD = 3) and 130% (SD = 11) for Stages 1 and 2, respectively. Using a capability framework to explicitly communicate the constructive alignment between capability and EPA outcomes at the degree, stage, and assessment level, as well as student access to future-focused performance standards and all their assessment data, is a powerful way to facilitate self-directed learning.

The COVID-19 pandemic has highlighted the importance of being adaptable and flexible in our teaching practices in higher education. Traditionally, a siloed approach to curriculum development has dominated in higher education institutions. These silos are known to create inefficiencies and, in the context of developing teaching resources, often result in the duplication of curricula, resulting in wasted effort and time, and inconsistent teaching practices. In this short communication, we put forward a sustainable and innovative approach to cross-disciplinary curriculum development, known as the Connected Curriculum for Professionals in Health initiative. This ongoing initiative was launched in 2018 and brought together teaching academics and students to co-design a centralized online repository of high-quality, evidence-based online educational modules that support student learning across disciplines. A mixed-methods evaluation of this initiative found that this is a well-utilized repository of engaging modules (n = 46) that have enhanced learning outcomes for both undergraduate and postgraduate health professional students. The Connected Curriculum for Professionals in Health initiative has wide-ranging applicability, beyond disciplines, and is a sustainable, efficient, and strategic approach to enhance pedagogy and the student experience.