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• W2935673977 abstract "With an ageing population, health services are striving to increase efficiency without negatively impacting patient care.  Implementing weekend allied health rehabilitation therapy services could assist with this.  Randomised controlled trials have demonstrated the efficacy of weekend rehabilitation services, showing improved functional independence and quality of life, a possible reduction in length of stay, and likely cost effectiveness.   However, weekend rehabilitation service models have mainly been investigated in publicly funded hospitals, with limited research of their effectiveness or implementation in real world contexts.  Weekend rehabilitation services in Australia were last surveyed in 2011.  Since then, the publication of several studies may have influenced weekend rehabilitation therapy provision.  It is therefore timely to explore the current status of Australian weekend rehabilitation service provision.  Clinician perspectives on service implementation are also important to understand, as clinicians are key influencers of the development of new services. This thesis aimed to investigate current Australian rehabilitation weekend therapy provision; the effectiveness of different service delivery models on functional independence, length of stay, patient outcomes, and staff perspectives, and the implementation costs of weekend service provision in a real world setting.To address these aims, a pilot and five studies were conducted. A pilot survey (Chapter 3) of senior physiotherapists in purposively selected inpatient rehabilitation units in Australia (n=36) was conducted to investigate the feasibility of providing a weekend therapy service in the rehabilitation setting, and inform the service design for implementing this service at a private metropolitan rehabilitation unit.  Most responding facilities (63%) provided a weekend service, most commonly as a half-day, Saturday physiotherapy service, in privately funded, metropolitan facilities.  These findings suggested that it was feasible to trial a Saturday physiotherapy service in a private rehabilitation service.Studies 1, 2 and 5 of this thesis investigated the effectiveness of implementing different models of a 6-day rehabilitation service in a private mixed rehabilitation unit using a 20-week prospective cohort study design with a historical control.  Study 1 (Chapter 4) compared 6-day physiotherapy service provision with usual 5-day services.  Patients receiving 6-day physiotherapy achieved greater functional independence and better balance compared to those receiving 5-day physiotherapy, with a trend towards a shorter length of stay by 1.7 days (95%CI -3.92 to 0.53). Study 2 (Chapter 5) investigated the impact of staff currency of practice on 6-day rehabilitation physiotherapy service provision. Weekend services were either provided by rehabilitation staff or acute ward staff. More patients attended Saturday therapy sessions, were in Saturday therapy for longer, and achieved greater functional improvements with rehabilitation staffing compared with acute.  There was no difference in gait or balance outcomes, with a trend towards a shorter length of stay by 1.5 days (95%CI -4.4 to 1.3) with rehabilitation staffing. Outcomes were also evaluated by diagnosis; patients with orthopaedic diagnoses achieved greater change in functional independence, while patients with reconditioning or neurological diagnoses demonstrated a trend towards a reduction in length of stay by four days with rehabilitation staffing.Study 3 (Chapter 6) is a formative evaluation of rehabilitation staff perspectives of the implementation of a 6-day physiotherapy service at three time points; pre-implementation (Study 1), post-implementation (Study 1), and following modification (Study 2).  Staff were surveyed regarding barriers, facilitators, improvements and the perceived impact of the 6-day physiotherapy service on length of stay and patient goal attainment.  Initially, all staff identified barriers, which focused mainly on staffing and patient selection.  Following service implementation and modification, only 30% of staff suggested service improvements, mainly regarding efficiencies and expansion.  Prior to implementation of the 6-day service, staff were unsure of the impact on length of stay and goal attainment.  However, following implementation and modification of the service, staff perceived a positive effect on both length of stay and goal attainment.Study 4 (Chapter 7) presents a survey of Australian rehabilitation units to determine current allied health weekend rehabilitation service provision and identify senior clinician perspectives of barriers and facilitators of weekend service provision. Eighty-three percent (n=179) of units responded, with 57% providing a weekend service, the majority providing a 6-day physiotherapy service.  Barriers and facilitators to providing a weekend service were focused on budget, staff availability and support.Finally, Study 5 (Chapter 8) compared a physiotherapy-only service to a multidisciplinary (physiotherapy, occupational therapy and allied health assistant) 6-day service.  More patients attended the weekend service, received more Saturday therapy sessions and spent more time in Saturday therapy with multidisciplinary compared to physiotherapy-only staffing.  Patients receiving multidisciplinary 6-day therapy had a shorter length of stay by 3.5 days (95%CI 1.33 to 5.67) compared to those receiving 6-day physiotherapy.  Cost-minimisation analysis revealed that the multidisciplinary 6-day service resulted in cost savings for the hospital of over $280,000 over twenty-weeks compared to 6-day physiotherapy service.Through these studies, current rehabilitation weekend service delivery, clinician perspectives and the effectiveness of different weekend service provision models have been explored.  This thesis recommends a 6-day physiotherapy and occupational therapy service with staff experienced or currently working in rehabilitation be provided in Australian rehabilitation facilities to help address the current issues facing health services with the increased ageing population." @default.
• W2935673977 created "2019-04-11" @default.
• W2935673977 creator A5016602650 @default.
• W2935673977 date "2019-02-26" @default.
• W2935673977 modified "2023-09-24" @default.
• W2935673977 title "An investigation of the pragmatic implementation of weekend rehabilitation services in Australia" @default.
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