Rehabilitation

Alfred Health ARCH project

Post-stroke incontinence

Incontinence is a common clinical problem experienced by people following stroke. This project uses longitudinal data to examine the impact of incontinence on wellbeing and quality of life.

The study also examines feasibility of using electric stimulation therapy to manage incontinence. This also includes the utility of implementing transcutaneous electric stimulation in the rehabilitation setting, along with the data collection method.

Austin Health ARCH projects

Improving arm function after stroke using task-specific training: Task-AT-Home

Many people who have a stroke have difficulty moving their arm and hand. Despite currently available treatments, many people have not regained enough movement to use their affected arm easily in their daily life at six months after stroke.

Task-specific training is potentially more effective than current practice. It can be done at home, permits increased repetition of tasks through independent practice, and can be done even by stroke survivors that have been severely affected.

Task-AT-Home is a randomised controlled trial that aims to deliver task-specific training within the home to improve upper limb motor function. It is a Phase III two-arm, multicentre randomised controlled study, with 300 participants, to test the hypothesis that task-specific training is more effective in improving upper limb function compared to current practice.

The Melbourne arm of the study is being conducted by La Trobe University through Austin Health.

A network of sites and ‘up-skilled’ therapists to deliver best practice stroke rehabilitation of the upper limb

One in two people who experience stroke lose the sense of touch. An effective, science-based approach to this problem, known as SENSe, is available and recommended in clinical practice guidelines. However, stroke survivors are currently not receiving this therapy, highlighting a clear evidence-practice gap.

Therapists at Alfred Health are being up-skilled to deliver best practice SENSe therapy to more people with stroke. A centralised knowledge-translation centre, based at Austin Health, is training therapists thanks to a partnership between La Trobe University, Austin Health and the Florey Institute.

Through this partnership, a community of therapists and network of clinical practice settings and specialist services will be established to ensure sustained implementation.

Find out more about this research initiative.

Eastern Health ARCH projects

Improving mobility after hip fracture

Each year more than 23,000 Australians suffer a hip fracture. One in five patients with hip fracture dies within 12 months, one in three patients do not return to living independently in the community, and one in two patients have markedly reduced levels of walking.

Current rehabilitation protocols focus on the physical capacity to walk and do not address the issue of lack of confidence. The MIHip project has demonstrated that people recovering from a hip fracture do not lack the physical capacity to walk in their community but lack the confidence to do so.

Pilot trials – featuring eight weekly motivational telephone sessions with people recovering from a hip fracture – resulted in participants increasing walking and confidence about walking. A randomised placebo-controlled trial of 270 participants, with 12-month follow-up and a full health economic analysis is now underway.

From September 2019, hip fracture patients receiving outpatient rehabilitation at Eastern Health, Alfred Health and Peninsula Health will be invited to participate in the trial, which will be completed in 2022.

Physical activity for cancer survivors

Cancer survivors who are more physically active have a greater chance of survival and less risk of disease recurrence. Rehabilitation improves quality of life, mood, strength and fitness, and reduces the side effects of treatment.

Findings have shown that less than 0.5% of cancer survivors have access to oncology rehabilitation programs. A randomised controlled trial has shown that oncology rehabilitation helps people ‘return to normal’ during and after cancer treatment by improving functional ability, social wellbeing and quality of life. Motivational interviewing, used in tandem with oncology rehabilitation, may help to further increase activity.

Healthscope ARCH project

Rehabilitation therapy

A major collaboration between Healthscope, La Trobe University and Monash University aims to increase the amount of evidence-based therapies that patients undertake while in rehabilitation hospital.

The “My Therapy” project is a consumer driven, self-management rehabilitation program. It is tailored to individual needs, prescribed by the treating occupational therapist and physiotherapist, and can be practiced at any time. It can also be delivered safely to people with cognitive impairment.

Pilot trials have shown that patients in the My Therapy project achieved better outcomes by having personalised therapy and very frequent practice, compared to usual care. Our researchers are now working on a randomised controlled clinical trial. In collaboration with clinicians and patients, the trial will increase the dosage of rehabilitation, with an anticipated reduction in length of hospital stay and cost, higher functional status achieved by discharge, and improved patient self-management.

The partnership hopes to establish the My Therapy program in a broad range of inpatient rehabilitation wards in Australian hospitals to evaluate the program benefits when scaled, the mechanisms of successful scaling, and cost effectiveness of the program.