The self-reported factors that influence Australian physiotherapists’ choice to promote non-treatment physical activity to patients with musculoskeletal conditions
- Authors: Kunstler, Breanne , Cook, Jill , Kemp, Joanne , O'Halloran, Paul , Finch, Caroline
- Date: 2019
- Type: Text , Journal article
- Relation: Journal of Science and Medicine in Sport Vol. 22, no. 3 (2019), p. 275-280
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- Description: Objectives: To determine the factors that influence physiotherapists’ choice to promote non-treatment physical activity to patients with musculoskeletal conditions. Design: Cross sectional survey. Methods: A national, online self report survey was targeted at Australian registered physiotherapists primarily treating patients with musculoskeletal conditions in private practice and outpatient settings. Likert scale questions were used to measure the factors influencing non-treatment physical activity promotion by physiotherapists. Results: Two hundred and sixteen full responses were received. Most (56.6%) respondents irregularly promoted non-treatment physical activity, whereas 43.4% always promoted non-treatment physical activity. Promotion of non-treatment physical activity was bivariately associated with respondents’ own physical activity level (x2[2] = 7.670, p = 0.022) and exercise science education (x2[1] = 4.613, p = 0.032). Multivariable analysis identified that Knowledge (knowing how to promote non-treatment physical activity) (OR = 1.60, 95%CI 1.026–2.502), Goals (other patient problems are more important) (OR = 0.62, 95%CI 0.424–0.897) and Innovation (compatibility of non-treatment physical activity promotion with the clinical environment) (OR = 1.75, 95%CI 1.027–2.985) were significantly and independently associated with non-treatment physical activity promotion. Conclusions: The majority of surveyed Australian physiotherapists irregularly promoted non-treatment physical activity. Lack of knowledge of how to promote non-treatment physical activity, prioritising other patient problems before non-treatment physical activity promotion and using promotion methods that are not compatible with current practice might reduce non-treatment physical activity promotion frequency by physiotherapists.
Subsequent injuries are more common than injury recurrences : An analysis of 1 season of prospectively collected injuries in professional Australian football
- Authors: Finch, Caroline , Cook, Jill , Kunstler, Breanne , Akram, Muhammad , Orchard, John
- Date: 2017
- Type: Text , Journal article
- Relation: The American Journal of Sports Medicine Vol. 45, no. 8 (2017), p. 1921-1927
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- Description: BACKGROUND: It is known that some people can, and do, sustain >1 injury over a playing season. However, there is currently little high-quality epidemiological evidence about the risk of, and relationships between, multiple and subsequent injuries. PURPOSE: To describe the subsequent injuries sustained by Australian Football League (AFL) players over 1 season, including their most common injury diagnoses. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Within-player linked injury data on all date-ordered match-loss injuries sustained by AFL players during 1 full season were obtained. The total number of injuries per player was determined, and in those with >1 injury, the Subsequent Injury Classification (SIC) model was used to code all subsequent injuries based on their Orchard Sports Injury Classification System (OSICS) codes and the dates of injury. RESULTS: There were 860 newly recorded injuries in 543 players; 247 players (45.5%) sustained >/=1 subsequent injuries after an earlier injury, with 317 subsequent injuries (36.9% of all injuries) recorded overall. A subsequent injury generally occurred to a different body region and was therefore superficially unrelated to an index injury. However, 32.2% of all subsequent injuries were related to a previous injury in the same season. Hamstring injuries were the most common subsequent injury. The mean time between injuries decreased with an increasing number of subsequent injuries. CONCLUSION: When relationships between injuries are taken into account, there is a high level of subsequent (and multiple) injuries leading to missed games in an elite athlete group.
Physical activity promotion in physiotherapy practice
- Authors: Kunstler, Breanne
- Date: 2018
- Type: Text , Thesis , PhD
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- Description: Australian physiotherapists promote non-treatment physical activity, which is physical activity used to improve or maintain general health, to patients with musculoskeletal conditions. However, it is unclear how physiotherapists promote non-treatment physical activity and the behaviour change techniques they use to do this. This thesis used four studies to: (i) review the efficacy of physiotherapist-led physical activity interventions; (ii) investigate the factors that influence physiotherapists’ choice to promote non-treatment physical activity; and (iii) identify the behaviour change techniques that private practice and outpatient physiotherapists use to promote non-treatment physical activity. Two systematic reviews identified that physiotherapist-led physical activity interventions are efficacious. However, effects were small and not maintained. Additionally, physiotherapists only used a small number of behaviour change techniques when promoting physical activity. National survey and interview studies were used to identify the factors that influence physiotherapists’ choice to promote non-treatment physical activity. The survey found that having poor knowledge of how to promote non-treatment physical activity, prioritising other patient problems before non-treatment physical activity and using promotion methods that were not compatible with daily practice significantly and independently reduced the odds of physiotherapists promoting non-treatment physical activity. Interpretative phenomenological analysis was used to design interviews that showed that having a perceived inability to motivate an unmotivated patient and believing that patients expect hands-on therapy instead of non-treatment physical activity promotion complicated treatment choices. The behaviour change techniques Australian physiotherapists used to promote non-treatment physical activity were compared to those used to encourage adherence to rehabilitation exercises in the survey too. The survey found that physiotherapists used similar behaviour change techniques to promote non-treatment physical activity and encourage adherence to rehabilitation exercises. This thesis provides clinicians and researchers with an understanding of the factors that influence Australian physiotherapists’ decision to promote non-treatment physical activity and the behaviour change techniques they use.
- Description: Doctor of Philosophy
The behaviour change techniques used by Australian physiotherapists to promote non-treatment physical activity to patients with musculoskeletal conditions
- Authors: Kunstler, Breanne , Cook, Jill , Kemp, Joanne , O'Halloran, Paul , Finch, Caroline
- Date: 2019
- Type: Text , Journal article
- Relation: Journal of Science and Medicine in Sport Vol. 22, no. 1 (2019), p. 2-10
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- Description: Objectives: To determine: (i) the behaviour change techniques used by a sample of Australian physiotherapists to promote non-treatment physical activity; and (ii) whether those behaviour change techniques are different to the techniques used to encourage adherence to rehabilitation exercises. Design: Cross-sectional survey. Method: An online self-report survey was advertised to private practice and outpatient physiotherapists treating patients with musculoskeletal conditions. The use of 50 behaviour change techniques were measured using five-point Likert-type scale questions. Results: Four-hundred and eighty-six physiotherapists responded to the survey, with 216 surveys fully completed. Most respondents (85.1%) promoted non-treatment physical activity often or all of the time. Respondents frequently used 29 behaviour change techniques to promote non-treatment physical activity or encourage adherence to rehabilitation exercises. A similar number of behaviour change techniques was frequently used to encourage adherence to rehabilitation exercises (n = 28) and promote non-treatment physical activity (n = 26). Half of the behaviour change techniques included in the survey were frequently used for both promoting non-treatment physical activity and encouraging adherence to rehabilitation exercises (n = 25). Graded tasks was the most, and punishment was the least, frequently reported technique used to promote non-treatment physical activity and encourage adherence to rehabilitation exercises. Conclusions: Respondents reported using similar behaviour change techniques to promote non-treatment physical activity and encourage adherence to rehabilitation exercises. The variability in behaviour change technique use suggests the behaviour the physiotherapist is promoting influences their behaviour change technique choice. Including the frequently-used behaviour change techniques in non-treatment physical activity promotion interventions might improve their efficacy. © 2018 Sports Medicine Australia
Physiotherapists use a small number of behaviour change techniques when promoting physical activity : A systematic review comparing experimental and observational studies
- Authors: Kunstler, Breanne , Cook, Jill , Freene, Nicole , Finch, Caroline , Kemp, Joanne , O'Halloran, Paul , Gaida, James
- Date: 2018
- Type: Text , Journal article , Review
- Relation: Journal of Science and Medicine in Sport Vol. 21, no. 6 (2018), p. 609-615
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- Description: Objectives: Physiotherapists promote physical activity as part of their practice. This study reviewed the behaviour change techniques physiotherapists use when promoting physical activity in experimental and observational studies. Design: Systematic review of experimental and observational studies. Methods: Twelve databases were searched using terms related to physiotherapy and physical activity. We included experimental studies evaluating the efficacy of physiotherapist-led physical activity interventions delivered to adults in clinic-based private practice and outpatient settings to individuals with, or at risk of, non-communicable diseases. Observational studies reporting the techniques physiotherapists use when promoting physical activity were also included. The behaviour change techniques used in all studies were identified using the Behaviour Change Technique Taxonomy. The behaviour change techniques appearing in efficacious and inefficacious experimental interventions were compared using a narrative approach. Results: Twelve studies (nine experimental and three observational) were retained from the initial search yield of 4141. Risk of bias ranged from low to high. Physiotherapists used seven behaviour change techniques in the observational studies, compared to 30 behaviour change techniques in the experimental studies. Social support (unspecified) was the most frequently identified behaviour change technique across both settings. Efficacious experimental interventions used more behaviour change techniques (n = 29) and functioned in more ways (n = 6) than did inefficacious experimental interventions (behaviour change techniques = 10 and functions = 1). Conclusions: Physiotherapists use a small number of behaviour change techniques. Less behaviour change techniques were identified in observational studies compared to experimental studies, suggesting physiotherapists use less BCTs clinically than experimentally.
"...like you're pushing the snowball back up hill"-the experiences of Australian physiotherapists promoting non-treatment physical activity : A qualitative study
- Authors: Kunstler, Breanne , O'Halloran, Paul , Cook, Jill , Kemp, Joanne , Finch, Caroline
- Date: 2018
- Type: Text , Journal article
- Relation: Aims Medical Science Vol. 5, no. 3 (2018), p. 224-237
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- Description: Participating in physical activity is important for maintaining general health. When physiotherapists promote physical activity for the purposes of maintaining or improving a patient’s general health, they are promoting non-treatment physical activity. Physiotherapists have a responsibility to promote non-treatment physical activity to their patients while also providing the patient with treatment for their presenting complaint. This qualitative study explored the experiences of Australian physiotherapists promoting non-treatment physical activity to patients with musculoskeletal conditions. Ten Australian physiotherapists treating patients with musculoskeletal conditions in private practice and outpatient settings were recruited using a social media campaign and snowballing. All interviewees received one $AU20 gift card for participating. Sixty-minute semi-structured interviews were conducted and were transcribed verbatim. Interpretative phenomenological analysis was used to design the interview guide and analyse data. Transcripts were used to identify emergent and superordinate themes. Most interviewees were female, aged between 25–34 years, physically active and reported promoting NTPA. The superordinate themes that emerged from the transcripts included: Internal and external influences on NTPA promotion, approach taken by the physiotherapist towards NTPA promotion, challenges experienced when promoting NTPA, and skills and training. In conclusion, physiotherapists reported they were well-placed to promote NTPA, but they face many challenges. The perceived inability to motivate patients to become physically active and the need to prioritise patient expectations of hands-on therapy made NTPA promotion difficult. Workplace specific factors, such as having an open-plan clinic environment and having other staff who promote NTPA, were perceived to make NTPA promotion easier. Using effective marketing strategies that portray the physiotherapy clinic as a physically active environment might see patients expect NTPA promotion, making NTPA promotion easier for Australian physiotherapists in the future.
Nursing perspectives on reducing sedentary behaviour in sub-acute hospital settings : a mixed methods study
- Authors: Hills, Danny , Ekegren, Christina , Plummer, Virginia , Freene, Nicole , Kunstler, Breanne , Robinson, Tracy , Healy, Ellen , Vo, Jennifer , Gasevic, Danijela , Crabtree, Amelia
- Date: 2022
- Type: Text , Journal article
- Relation: Journal of Clinical Nursing Vol. 31, no. 9-10 (2022), p. 1348-1361
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- Description: Aim and objectives: To determine the factors influencing nurses’ decisions and capacity to reduce sedentary behaviour in hospital inpatients in sub-acute hospital settings. Background: Sedentary behaviour in hospital inpatients is a complex issue that can be resistant to resolution. There is little research investigating factors influencing nurses’ promotion of reduced levels of sedentary behaviour in sub-acute hospital settings. Design: An explanatory sequential design was employed, comprising quantitative and qualitative phases. Methods: An online survey was conducted with a convenience sample of 138 nurses from five Australian states. Logistic regression modelling identified demographic and behavioural characteristics of nurses who often encouraged patients to reduce their sedentary behaviour. In-depth interviews were conducted with 11 ward nurses and nurse managers, with the content subjected to thematic analysis. STROBE and GRAMMS checklists were employed. Results: Nurses recognised their role in promoting reduced sedentary behaviour but faced a range of personal and organisational barriers in achieving this outcome for patients. Few nurses were aware of national physical activity and sedentary behaviour guidelines. Five themes emerged from interviews (nursing role, care challenges, expectations of advocates, teamwork and improving the experience). Overall, many nurses experienced a lack of agency in promoting reduced sedentary behaviour and cognitive dissonance in feeling unable to undertake this role. Conclusions: The results of this study are significant in confirming that reducing sedentary behaviour in hospital inpatients is influenced by a range of complex and multi-level factors. There is a fundamental need for organisational and clinical leadership in building a culture and climate in which staff feel empowered to promote reduced sedentary behaviour in their patients. Relevance to clinical practice: The results of this study highlight the importance of taking action to reduce sedentary behaviour in sub-acute hospital settings. A co-design approach to developing interventions in local health services is warranted. © 2021 John Wiley & Sons Ltd.