Health Sciences

A Centre for Allied Health Research in Victoria

Feasibility Study for an Australian Centre for Allied Health Research

Author: Professor Alison Perry Chair, School of Human Communication Sciences

June 2009

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Full Report

Feasibility Study for an Australian Centre for Allied Health Research

The Scoping Study

Background

Allied Health clinicians (physiotherapists, speech pathologists, occupational therapists, dietitians, podiatrists, orthoptists, social workers, and clinical-, neuro-, and health- psychologists) are still relatively young/new to research, and considerable work is needed to develop and promote a research culture among clinicians and to establish strong cross-disciplinary allied health research teams.

Other disciplines, such as nursing, have already developed centres of research, such as the Joanna Briggs Institute at the University of South Australia (http://www.joannabriggs.edu.au), which focuses on evidence-based healthcare. The Joanna Briggs Institute now includes allied health services as part of its research brief, but the focus remains on undertaking systematic reviews and contract work, rather than undertaking large scale RCTs and/or basic research into allied health interventions; establishing ‘best practice’ for rehabilitation; developing evidence-based models of care for managing chronic conditions, etc.

Allied Health (AH) staff practice can best be understood by using the International Classification of Functioning, Disability and Health (ICF), which provides a common framework and language for describing function and disability associated with different health conditions (WHO, 2001).  The ICF encompasses health domains, such as body structures and functions; the activities that people do (walking, speech, etc); and their societal participation.

Impairment of body structures and functions. ‘Body functions’ refers to the physiology of body systems, while ‘body structures’ are anatomical parts of the body, such as organs and limbs. In the ICF, an impairment is classified as a “problem in body function or structure, such as significant deviation or a loss” (WHO, 2001, pp 12).

Activity limitations. ‘Activity’ according to the ICF is, “the execution of a task or action by an individual” (WHO, 2001, p.12). Activities encompass a wide range of events, such as holding a conversation, or washing oneself. Activity limitations, therefore, are defined as “difficulties an individual may have in executing activities” (WHO, 2001, pp.12).

Participation restrictions. The term ‘participation’ refers to involvement in life situations. Life situations may include relationships with family, friends or in employment. Using the ICF, participation restriction is defined as “problems an individual may experience in involvement in life situations” (WHO, 2001, pp.12).

This ICF model neatly encompasses the work of AH clinicians who assess, and then assist, people who have impairment(s) of the body; resulting in change, or limitations, in activity; and restrictions to their societal participation that result from that disability.

As an example, someone who has had cancer of the jaw and undergone major surgery may have an impairment (such as a jaw resection); changes to activity (speech, swallowing are reduced) and limited social participation (because of an inability to eat in public, not being able to communicate clearly and, perhaps, being made redundant from work). Therapy, as provided by a team of AH staff, would usually be directed to all three ICF health domains, attempting to minimise the impairment, increase the individual’s activity, and to reduce their social isolation, in order to improve their overall quality of life/feelings of wellbeing.  

There are many examples of good research(ers) in AH in Australia, but generally research studies tend to be within each profession, rather than across disciplines – for example, there are NHMRC Centres of Clinical Research Excellence (CCREs) in gait analysis and rehabilitation, led by physio-therapists, and in aphasia rehabilitation with speech pathology researchers. Such research is extremely valuable, but the reality is that most patients present with co-morbid health problems that cross discipline areas. Despite this, clinical therapy tends not to be fully integrated. To date, there is no research centre where effective models of multi-disciplinary AH care can be developed, examined and promoted.

At a point where much healthcare is being transferred from hospitals to community or home settings, with concomitant changes to the Australian health workforce, there is a need for quality, integrated, managed healthcare. A Centre for Allied Health Research could contribute much to developing the research base that is necessary before developing such models of good practice.

This scoping study, funded by the Menzies Foundation, was designed to examine the views and concerns of potential stakeholders, to aggregate and report on those views, and to propose a model for a Centre that would meet the expressed needs of the population surveyed.

Method: Analysis Of Need

Staffing

A part-time Research Associate, Ms Carol Chenco, was appointed to the study on 1st October 2008 and Ms Deb Benetti provided part-time secretarial support. Carol designed and set up an informational website and contacted relevant key stakeholders (university Deans, academic groups, clinicians, health managers, professional and philanthropic organisations) to organise the running of focus groups (including the provision of refreshments) and the conduct of interviews across Victoria.

A multi-disciplinary project planning team was formed, to provide advice and to progress this study. Membership included:

• Ms Jenelle Loeliger, Senior Dietitian, Peter MacCallum Cancer Centre
• Dr Carol McKinstry, School of Occupational Therapy, La Trobe University
• Professor Meg Morris, Head of the School of Physiotherapy, The University of Melbourne
• Professor Susan Paxton, Head of the School of Psychology, La Trobe University
• Professor Alison Perry (Principal Investigator), School of Human Communication Sciences, La Trobe University

The planning team was committed to inclusion and collaboration across all Allied Health disciplines in the development of the proposed Research Centre.  We examined the need for such a Centre; what services it could/should provide; who should be involved; where it should be sited; how it should be operated and be funded, and the likely arrangements for its governance / ongoing management. To encourage input from all interested parties, a website was established to keep people apprised of the progress of the study and to enable feedback from anyone who wished to provide comment and could not attend a focus group. See: http://www.latrobe.edu.au/hcs/centreallied/index.html

Participants

The need and support for a proposed Centre was explored, using the following methods:

Facilitated by two members of the planning team, a series of focus groups were run across Victoria, with:

• National representatives from all pertinent Allied Health professional associations
• Managers of Allied Health services in Victoria.
• Academic staff members at universities in Victoria where Allied Health courses are offered/ taught.
• Allied Health senior clinicians, representing differing service providers in Victoria (e.g., paediatrics, rehabilitation, aged care, acute care).
• Representatives of disability charities and/or consumer advocacy groups.

A series of individual interviews with:

• Deans and/or Heads of Schools at all universities where Allied Health courses are offered in Victoria, to (i) identify their interest; and (ii) assess if/how they would like to progress this proposal.
• The Director and Administration Manager of the Menzies Research Institute in Hobart, to (i) examine opportunities for research partnerships with such an established Institute; and (ii) to document their experiences of starting up and running such a Centre.
• Representatives of the Joanna Briggs Institute, South Australia, to (i) examine the setting up and running of the Institute; and (ii) to assess the scope for collaboration.
• Staff at the Department of Human Services (DHS), Victoria
• The CEO of a Community Health Service (Inner East City Health Service, Melbourne)
• Staff at the National Health & Medical Research Council (NH&MRC)

From the data provided by the above methods, we have examined the need, and suggested a ‘preferred model’ for a proposed Australian Centre for Allied Health Research - which we anticipate will be an integrated Centre, offering advice, teaching and practice in AH research.

Focus Groups

All focus groups were run with two members of the planning team in attendance. Participants’ views were either tape-recorded for later transcription, or documented in vivo by one of the team, while the second member of the team ran the group and noted key points. Refreshments for each group were provided at each venue. A brief introduction to the Menzies Foundation and the study was given to each group by one of the team at the start, and the purpose and aims of the study were explained. A qualitative methodology was used for data capture and analysis. The main aim of a qualitative study is usually to explore, in order to generate information which can be used to plan or develop further research, and therefore it is a very suitable method to use for this scoping project. Most focus groups were organised at local sites, for staff convenience, but three focus groups were run at Clarendon House – these included (i) the Menzies’ allied health scholars; (ii) the representatives from disability charities; and (iii) the national representatives from all pertinent allied health professional associations. 

At each group, open discussion was encouraged around five themes: (i) the need for a Centre; (ii) the site for a Centre; (iii) what a Centre could/should provide; (iv) how should it be organised (i.e., governance); and (v) what research would the Centre embrace.

All key points raised were identified, recorded and later typed, and the summary was then compiled and returned to all participants. In this way, everyone who participated had the opportunity to amend/agree on their comments before the data were logged. At the end of the whole process, all the points raised at all the focus groups were examined and aggregated, then analysed according to recurring themes and points of concordance. Disagreement/divergent views were also documented.

People who were unable to attend focus groups or discussions, and/or people who had an interest in contributing independently to the consultations, were encouraged to make written submissions via the pertinent section of the website. These comments were added to the data collected from the focus groups.

By the end of the process, data saturation was reached with no new ideas or comments emerging from the last two focus groups (that had not been expressed previously).

Analysis of the aggregated data was undertaken independently by the Research Associate (Carol Chenco) and an experienced qualitative methodologist who was not involved in the study (Dr Jemma Skeat).

Two methods were used in analysis: one to describe the emergent themes (qualitative analysis), and the other to examine the weighting of each theme, giving a quantitative perspective.

The results were then examined, compared and discussed with the Principal Investigator (Prof Alison Perry) before the data were reported (below).