Researchers in the Institute for Health Research are currently engaged in a number of research projects that include:
Personalised DVD home exercise programs to improve the physical and mental health of older patients after a fall related hip fracture.
Older people who fracture their hip have a 5 – 8 fold increase in all-cause mortality during the first three months after hip fracture and almost 50% have a walking disability within 12 months post-fracture often resulting in loss of independence and increased likelihood of moving into nursing home care. Optimum recovery has been linked to effective rehabilitation but there is lack of evidence what the ideal rehabilitation program should include. Digital versatile disc (DVD) technology has been used to provide training to healthy adult populations and these type of training programs generally result in increased adherence to exercise but no study has been undertaken among older patients after major surgery. In addition most DVD programs provide a standardised format and only a very few studies have evaluated the provision of tailored or individualised programs of exercise for patients. The hypothesis being tested by this project is that a tailored (personalised) exercise program recorded to DVD for use in the participant’s home will result in improved adherence to the Home Exercise Program and consequently better health outcomes. The primary aim of this study is to evaluate the effect of providing a tailored home exercise program using DVD technology on adherence to the Home Exercise Program and self-efficacy for exercise as well as functional outcomes (functional ability, strength and balance) and mental alertness compared to a group that continue with usual care.. The secondary aim is to determine whether participants who receive the intervention (DVD - Home Exercise Program) have reduced hospital re-admission rates compared to control participants.
AMPitup: Adolescent Movement Program
The Adolescent Movement Program is part of the wider Move.Grow.Engage program which has been running since 2010 as part of a longitudinal research program investigating the impact of movement difficulties on a range of physical, social and emotional health outcomes. The study involves adolescents aged between 13 and 18 years who are screened using a standardised test of motor development. They must also have a history of movement difficulties or withdrawal from movement opportunities. While most participants have Developmental Coordination Disorder, some have other conditions such as Cerebral Palsy, Autism Spectrum Disorder or ADHD. The primary focus of the AMPitup program is to determine how best to develop physical fitness and movement skills in adolescents with movement difficulties through exercising in a supportive, fun and non-competitive setting. A long term aim of the program is to develop the skill and confidence in the participants to participate as adults in community-based exercise settings. Participants train with a personal coach who is a student enrolled in the Graduate Diploma of Exercise Science, Bachelor of Exercise & Sport Science, Bachelor of Health & Physical Education or Bachelor of Physiotherapy / Bachelor of Exercise & Sport Science. The coaches develop individually designed programs incorporating cardio work, strength and resistance training and motor skill development. The program is overseen by experienced academics and an accredited exercise physiologist.
Developmental Coordination Disorder (DCD) describes a condition where an individual has difficulty coordinating movements and are often unable to perform common, everyday age appropriate tasks. Children with DCD do not necessarily outgrow this condition and it may persist throughout adolescence into adulthood. Although some movement skill may be achieved, but execution is often awkward, slow or less precise than their peers. For example individuals may bumps into things, have difficulty using stairs (holds on to railing), buttoning shirts, catching a ball, balancing etc. The motor difficulties may affect daily living. For example, getting dressed quickly and easily, eating with age appropriate utensils without a mess, using scissors, rulers and other tools, writing legibly and with appropriate speed, and playing team games. Researchers at Notre Dame are actively engaged in a collaborative research programme being undertaken by other researchers based at the University of Western Australian and Curtin University. More details can be found at this address: www.movegrowengage.com.au.
Study of the impact of homelessness on the health status and health needs of older homeless women in the Perth metropolitan area
Homelessness is a multi-faceted and complex issue, and people experiencing homelessness are a vulnerable population who have complex social and health related needs. Recent trends suggest that in Australia particularly in Perth, women over 50 years of age represent the most rapidly growing section of the homeless population, many of them becoming homeless for the first time in their lives. Whilst the plight of people experiencing homelessness is often seen in terms of obtaining appropriate housing, this overlooks the fact that for many homeless people, their health issues can be the initial cause of their homelessness and simultaneously exacerbated by their health conditions. This is supported by research that demonstrates that compared to people in the wider community, homeless people have difficulties accessing primary care, over utilise hospital services and suffer from premature death. Despite this, there is little research that provides clear guidance on how to best address this situation, particularly for older women. The purpose of this research is to explore the health needs of older women experiencing homelessness; how health influences and is impacted by their becoming homeless; and determine if current health services are adequately addressing the health needs of this growing population cohort. It is anticipated that the recommendations from this research will have implications for service delivery at the policy, planning and service commissioning level, as well as the service delivery level. Further details can be obtained from Gloria Sutherland.
Diastolic dysfunction, pulmonary hypertension and mortality
Pulmonary hypertension is a major cause of mortality and morbidity with an estimated prevalence of 326 per 100,000 in the Western Australian community. The major cause of pulmonary hypertension is left heart disease with the prevalence of 250 in 100,000 in the Western Australian community. Estimated pulmonary artery systolic pressure (ePASP) is a well validated echocardiographic measure of pulmonary artery pressure. An elevated cut-off of 40mmHg is strongly correlated with pulmonary hypertension and leads to poor outcomes with median time to death of approximately four years whereas a higher ePASP of 60mmHg or more is associated with death in as little as three months due to irreversible damage to the pulmonary vasculature and right ventricular failure. The relationship between raised pulmonary artery pressure and diastolic dysfunction is well documented however, which echo markers best predict elevated pulmonary artery pressure due to left heart disease, and the role of these measure in predicting death, needs further refinement. The National Echo Database of Australia (NEDA) is a prospective observational cohort study with retrospective data capture, recruiting echo labs nationally to collect data. Using this data, the aim of this study is to identify diastolic echocardiographic (echo) markers that predict an increase in pulmonary artery pressure and establish a pattern of severity that can be used to predict mortality in the Australian community. Further details can be obtained from IHR@nd.edu.au.
The Prognostic Role of Histopathological Tumour Response to Neoadjuvant Chemotherapy in High Grade Serous Ovarian Carcinoma
A histopathologic scoring system for measuring response to neoadjuvant chemotherapy (NACT) in patients with high grade serous ovarian carcinoma (HGSOC) has recently been proposed in 2015. The purpose of this study is to validate the prognostic role of the chemotherapy response score (CRS) in predicting progression free survival (PFS) and overall survival (OS) in routine clinical practice in Western Australia. This retrospective study will incorporate patients with advanced stage HGSOC treated by NACT between 1 January 2010 and 30 June 2014. Omental sections will be independently reviewed by three gynaecologic pathologists and assigned a CRS according to the three-tier scoring system. Survival analysis will be performed using Cox proportional hazard models and the log-rank test. This research will provide for the first time, high quality information, externally validating the proposed CRS and the associated longitudinal health outcomes for HGSOC patients. Further details can be obtained from IHR@nd.edu.au.
AusCAN risk assessment for sitting acquired pressure ulcers
Pressure ulcers are localised areas of tissue breakdown in skin and/or underlying tissues, and they are a significant problem in individuals who have restricted mobility and diminished sensation. They have been categorised into four stages, according to the depth of injury, ranging from changes in the skin only (Stage I), to involvement of underlying muscle and/or bone (Stage IV). Sitting-acquired pressure ulcers (SAPUs) are a subset of pressure ulcers that occur in individuals who spend much of their time sitting. SAPUs occur over bony prominences of the pelvis that support weight in the sitting position. The common sites are the ischial tuberosities and greater trochanters. Other load bearing anatomical sites may be relevant in individuals who have an abnormal sitting position; the sacrum is the most common additional site. MRI studies have shown that many SAPUs are indeed DTIs that have their greatest impact on the tissues closest to the bone. The development of a SAPU is the most significant and common complication of spinal cord injury (SCI). Their incidence ranges from 23% to 33% or more per year and up to 85% over the course of a lifetime. In the United States, nearly 50% of the 1.4 million people who utilise wheelchairs for mobility develop tissue breakdown at the load bearing bony prominences of the pelvis. SAPUs generate significant direct and indirect health costs. For the individual, a SAPU interferes significantly with their ability to work, may require long periods where they are unable to sit, and may significantly affect their general health due to prolonged infection of their soft tissues and/or bone. The presence of a SAPU may lead to prolonged nursing care for dressings, extended hospitalisation, muscle flap surgery or even death due to sepsis. The aims of this study are to (1) identify intrinsic and extrinsic factors associated with the development of sitting-acquired pressure ulcers following spinal cord injury, and (2) develop a risk assessment tool that will identify high risk individuals for developing a sitting-acquired pressure ulcer within the first 3 years following spinal cord injury (acute stage) and after fifteen years following spinal cord injury (chronic stage). Further details can be obtained from Jillian Swaine.