Nora Shields

• Professor at La Trobe University

Introduction Participatory methods like experience‐based co‐design (EBCD) can be used to develop complex interventions, but may need adaptations when co‐designers include young people with disability, parents and community partners. We aimed to adapt EBCD through co‐production by involving people with lived experience of disability as co‐researcher...

Objective The objective of this scoping review is to identify evidence of collaboration between healthcare and recreational sectors aimed at supporting community-based physical activity participation among young people with childhood-onset physical disability. Introduction Most young people with physical disabilities do insufficient physical activi...

Purpose: Community participation is important for social inclusion and is a focus of government policies that aim to enhance the lives of people with disability, including those with Down syndrome. This scoping review aimed to synthesise research on community participation in adults with Down syndrome. Methods: A comprehensive search was complet...

Purpose: Social support is a known facilitator of exercise for people with disability. A qualitative approach was used to understand current social support practices in community gyms for young adults with disability. Methods: Embedded within a larger project "Getting Young adult Moving - Supporting Participation and Access to Recreation Centres...

Background and Purpose Motivational interviewing, an evidence-based person-centered counseling style, may help to facilitate increased mobility and physical activity after hip fracture. We explored contextual factors influencing the outcome, mechanism, and implementation of motivational interviewing after hip fracture. Methods A qualitative study...

Aim To synthesize the experiences of 15‐ to 34‐year‐olds with cerebral palsy (CP) as they participate in key life situations of young adulthood. Method A mixed‐methods scoping review was undertaken and six electronic databases searched (January 2001 to August 2023). Participation foci and thematic outcomes were mapped to the International Classifi...

Purpose: The primary objective was to investigate the experiences of young people with limb difference participating in sports and recreation. Materials and methods: A qualitative study using an interpretive description approach was undertaken with nine family dyads (n = 9 young people; n = 9 parents) recruited across Australia via convenience s...

Exercise for people with Prader-Willi syndrome (PWS) is important for their health and wellbeing and can provide opportunities for community participation. However, they may find it difficult to participate in some contexts, such as community gyms because social and environmental barriers in these settings may compound difficulties caused by physic...

Purpose Specialised group-based exercise rehabilitation is beneficial for cancer survivors but access to these services is limited. Telerehabilitation provides an opportunity to expand reach, but we do not know about the experiences of those who participate in this way. This study explored participant experiences of an exercise-based telerehabilita...

Background Hip fracture is a common and serious traumatic injury for older adults characterised by poor outcomes. Objective This systematic review aimed to synthesise qualitative evidence about the psychosocial impact of hip fracture on the people who sustain these injuries. Methods Five databases were searched for qualitative studies reporting o...

Background : Adults with physical or intellectual disability are less active than those without disability. Objective : To review literature regarding sport participation in adults with physical or intellectual disability. Specifically, to examine characteristics of available studies including participants, interventions, outcomes, and impact. Meth...

The Australian Centre for Health, Independence, Economic participation and Value Enhanced care for adolescents and young adults with Cerebral Palsy (CP-ACHIEVE) is a Centre of Research Excellence (CRE), funded for 5-year by the National Health and Medical Research Council of Australia. The vision of CP-ACHIEVE is an Australia where people with cere...

Background: Participation in organised and non-organised physical activities among adolescents and young adults with Down syndrome is underexplored. This study aimed to examine differences between organised and non-organised physical activities among adolescents and young adults with Down syndrome. Methods: Forty participants with Down syndrome...

Media coverage of spinal cord injury (SCI) is usually framed as a tragedy or inspiration. This has a negative impact on people with SCI. To understand why these frames persist, this study conducted qualitative interviews with journalists and sources to explore factors that influence media coverage of SCI. Using media agenda-building theory, study f...

Purpose: The primary aim was to establish feasibility of a home-based motorised cycling intervention in non-ambulant adults with cerebral palsy (CP). The secondary aim was to investigate perceived outcomes on pain, sleep, fatigue, and muscle stiffness. Materials and method: Non-ambulant adults with CP were recruited from a specialist clinic. Fea...

Purpose: To explore whether psychological factors are associated with ability to meet recommended physical activity thresholds after hip fracture. Materials and methods: Cross-sectional observational study of 216 community-dwelling adults aged ≥65 years after hip fracture (mean age 79 SD 7 years, 70% female). Multiple ordinal regression analysis...

To examine whether physical activity can mitigate the mortality risk associated with disability in activities of daily living and instrumental activities in daily living among older adults. This analysis comprised 177,360 US participants (104,556 women), aged ≥ 60 years, with valid data from the 1997 through 2018 waves of the US National Health Int...

Objectives To evaluate the effects of sport or physical recreation on participation, mobility and quality of life for adults living with disabilities. Design Systematic review with meta-analysis. Data sources Six databases searched from inception to May 2022. Eligibility criteria Randomised controlled trials including adults living with a physic...

Background Across the care economy there are major shortages in the health and care workforce, as well as high rates of attrition and ill-defined career pathways. The aim of this study was to evaluate current evidence regarding methods to improve care worker recruitment, retention, safety, and education, for the professional care workforce. Method...

Background Supporting children and adolescents with cancer to be physically active can improve medium- and long-term health outcomes. Objective To assess the feasibility of CanMOVE, a 10-week complex, theoretically-informed, behaviour change intervention to promote physical activity for children and adolescents undergoing acute cancer treatment....

Purpose The purpose of this work was to describe input from key partners to inform the scope and priorities for a clinical practice guideline (CPG) pertaining to physical therapy services provided to children and youth with Down syndrome (DS). Methods A 68-item survey was completed by interventionists and parents (n = 296) of children and youth wi...

Purpose: To determine if a consumer co-designed infographic increased knowledge of physical activity and self-efficacy for exercise after total knee joint replacement surgery. Methods: Forty-four adults with primary knee joint replacement surgery were recruited from a public and a private hospital in Melbourne, Australia. Participants were rando...

Adapted cycles offer young people with disability a fun way to participate in over-ground cycling, but little is known about current practices to train and sustain cycling in this group. This study aimed to describe interventions used to introduce adaptive cycling to young people with disability and explore barriers and facilitators to adapted cycl...

SYNOPSIS: In parts 1 and 2 of this series, we highlighted the dominant impairment way of talking about osteoarthritis: talking that frames osteoarthritis as a disease of cartilage worsened by physical activity that can only be "cured" by replacing the joint. An alternative understanding that counters common misconceptions about osteoarthritis, and...

Introduction: Motivational interviewing (MI) proficiency may erode quickly, limiting its effectiveness. We examined whether health professionals completing a 2-day workshop, with 3 to 5 hours of personalized coaching, and twice-yearly group reflections sustained proficiency for the duration of a hip fracture rehabilitation trial and whether interv...

SYNOPSIS: How people talk about osteoarthritis may impact outcomes, including uptake of guideline recommendations related to activity-based lifestyles and interventions. In this editorial, we describe 2 key ways of talking, based on findings from our systematic review of 62 qualitative studies exploring the perceptions of people with knee osteoarth...

SYNOPSIS: This editorial series raises awareness among clinicians about how ways of talking about orthopaedic conditions can influence what people who are seeking health care (1) think about their health and (2) what they do to manage their health. In part 1, we introduce you to ways of talking about health, using osteoarthritis as a case study. In...

Purpose To investigate if a 12-week community-based exercise program (FitSkills) fostered positive attitudes towards disability among university student mentors. Methods A stepped-wedge cluster randomised trial was completed with 4 clusters. Students were eligible to be a mentor if enrolled in an entry-level health degree (any discipline, any year...

Aim To identify implementation strategies and safety outcomes (adverse events) of community‐based physical activity interventions for adolescents and adults with complex cerebral palsy (CP). Method Five electronic databases were systematically searched to April 2022. Data were extracted on the implementation and safety of physical activity interve...

Purpose: Identify and prioritise strategies to optimise physical activity participation in the community gym setting for young adults with cerebral palsy. Methods: An e-Delphi method was implemented over three rounds with four stakeholder groups (young adults with cerebral palsy, their families, gym staff or exercise professionals, and health pr...

Purpose To quantify a perceived barrier to physical activity participation (proximity to exercise facilities) by investigating the distance a population-based cohort of young people with cerebral palsy aged 13–30 years lived from community gyms. Method We developed a web-based application using open-access software that could be used to complete a...

Background: Diastasis of the rectus abdominis muscle (DRAM) commonly occurs in pregnancy and postnatally. Physiotherapists routinely guide women in its management, although the effectiveness of these treatments is unknown. Objectives: To determine the effectiveness of conservative interventions to reduce the presence and width of DRAM in pregnan...

Study design: Qualitative reflective descriptive study. Objective: To evaluate a consumer engagement experience in the context of doctoral research. Setting: Full time doctoral research at an Australian university. Method: A reflective evaluation of consumer engagement was completed, presented using the Guidance for Reporting Involvement of...

People with disability report social support facilitates participation in physical activity. A scoping review explored social support strategies used to facilitate exercise participation for people with disability (aged ≥15 years) in community gym settings. Seven electronic databases were searched. Studies were screened for eligibility based on tit...

Introduction Preliminary evidence suggests that progressive resistance training may be beneficial for people with Prader-Willi Syndrome (PWS), a rare genetic condition that results in muscle weakness and low muscle tone.To establish whether community-based progressive resistance training is effective in improving the muscle strength of people with...

Objective: To understand the barriers and enablers to participation in family-assisted therapy for older people in Transition Care. Methods: A qualitative study, underpinned by interpretive description, was conducted at two public health services in Melbourne, Australia. Participants included patients in Transition Care, or their family members,...

Purpose Investigate the effect of exercise for adults with cerebral palsy (CP) on quality of life, participation (attendance and involvement in life situations), functional mobility, pain, fatigue, mood, and self-efficacy. Methods A systematic review was completed. Twelve databases were searched from inception to August 2022 for studies including...

Background Increasing participation in physical activity has the potential to improve outcomes for children and adolescents with cancer during treatment and into survivorship. The aim of this study is to outline the theoretical process behind development of CanMOVE, a behavior change intervention designed to increase physical activity for children...

Objective To test the feasibility of a walking programme for community-dwelling adults recovering from hip fracture. Design A randomized controlled trial with embedded qualitative analysis. Setting Community. Participants Aged at least 60 years and living in the community after hip fracture. Interventions In addition to standard care, the exper...

Background: Exercise has the potential to reduce cognitive decline in people with Down syndrome by maximising their cognitive function. The aim of the study was to determine the effect of regular exercise on cognitive functioning in young people with Down syndrome. Method: People with Down syndrome were eligible if aged between 13 and 35 years a...

Introduction Physical activity declines during adolescence, with the lowest levels of activity observed among those with disability. Schools are ideal settings to address this issue; however, few school-based interventions have been specifically designed for older adolescents with disability. Our aim is to investigate the effects of a school-based...

Objective To explore how older adults perceive motivational interviewing influences their walking and physical activity after hip fracture. Methods Qualitative study using an interpretive description framework. Twenty-four participants aged ≥65 years living in the community after hip fracture were interviewed. Participants had received at least 8...

Background Access to rehabilitation to support cancer survivors to exercise is poor. Group exercise–based rehabilitation may be delivered remotely, but no trials have currently evaluated their efficacy. Objective We aimed to evaluate the efficacy of a group exercise–based cancer rehabilitation program delivered via telehealth compared to usual car...

Purpose: To understand the factors influencing participation in community-based gym exercise for young adults with cerebral palsy (CP). Methods: A qualitative study using semi-structured interviews was conducted. Interviews were completed with 39 young adults with CP (15-30 years, GMFCS I-IV) following a peer-supported, gym-based exercise progra...

Purpose: To determine the prevalence of metabolic syndrome in patients attending outpatient community rehabilitation in Melbourne, Australia and to compare health literacy, physical activity, and dietary intake of people with and without metabolic syndrome. Materials and methods: A cross-sectional, multi-centre, observational study of adults (n...

BACKGROUND Access to rehabilitation to support cancer survivors to exercise is poor. Group exercise–based rehabilitation may be delivered remotely, but no trials have currently evaluated their efficacy. OBJECTIVE We aimed to evaluate the efficacy of a group exercise–based cancer rehabilitation program delivered via telehealth compared to usual car...

Objective The study aimed to explore patient perceptions of and motivations for physical activity after total knee joint replacement. Methods Participants were purposively sampled after completing a public outpatient rehabilitation exercise group. Semistructured interviews were completed with 22 participants (mean age 70 years, 45% women) 6 to 12...

Purpose: To understand how healthcare professionals' perceptions of supports and barriers to routine clinical assessment, for children aged 3-18 years with cerebral palsy, evolved in the presence of a knowledge translation intervention. Methods: A prospective longitudinal mixed-methods study was completed. The intervention comprised knowledge br...

Purpose: To explore gym staff perspectives on the inclusion of people with disability in the gym setting. Materials and methods: Semi-structured interviews were conducted with 16 staff at four urban gym facilities, exploring perspectives on disability inclusion. An interpretive descriptive approach was adopted with reflexive thematic analysis of...

Synopsis: In part 5 of this series, we turn our attention to concepts of rigor in qualitative research. In doing so, the use of quality appraisal tools and reporting checklists for qualitative studies is explored. Issues regarding a one-size-fits-all approach to these tools and checklists are discussed. Trustworthiness criteria are also described...

Background/aims Factors that influence functional ability in older adults after rehabilitation are not well understood. The aim of this study was to investigate how older people function in their community after being discharged from inpatient rehabilitation. Methods A cross-sectional study was undertaken of community-dwelling older adults (n=86,...

Synopsis: In this editorial, we discuss common methods used in musculoskeletal qualitative research, including approaches to sampling, data collection, and data analysis. We take a particular focus in this editorial on methods that involve "speaking to people." We highlight the back-and-forth or cyclic nature of qualitative research, and introduce...

Synopsis: In part 3 of "Demystifying Qualitative Research for Musculoskeletal Practitioners," we introduce the concept of "methodological approach" to encompass the plan of action that underpins the use of methods and desired outcomes, as well as the use of theory. Understanding the methodological approach in a qualitative study gives the reader a...

BACKGROUND Access to rehabilitation to support cancer survivors to exercise is poor. Exercise-based rehabilitation may be delivered remotely but it is unknown how it compares to in-person cancer rehabilitation. OBJECTIVE To evaluate the effectiveness of an exercise-based cancer rehabilitation program delivered via telehealth compared to a traditio...

PurposeTo explore the clinician experience of the feasibility of a supervised, exercise-based rehabilitation program co-located within a cancer treatment unit.MethodA qualitative study using individual semi-structured interviews was completed. Fifteen clinicians were purposively sampled from a cancer unit at a tertiary hospital where a new, exercis...

Synopsis: In this second editorial about qualitative research for musculoskeletal practitioners, we turn our attention to the foundational assumptions that underpin all qualitative research. Specifically, we discuss research paradigms, which consist of ontological and epistemological assumptions, as well as the "lens" of the researcher. Understand...

Synopsis: A progressive understanding of pain, disability, and health requires consideration of factors that may not easily be captured quantitatively. Qualitative research is a valuable tool to explore these "uncountable" phenomena and inform high-quality patient-centered care. Despite the utility of qualitative research in a musculoskeletal cont...

Objective To explore how process evaluations were conducted alongside randomised controlled trials (RCTs) involving motivational interviewing (MI) as an intervention to manage health conditions. Methods A scoping review was conducted. We searched 7 databases (to May 2021) for studies that incorporated at least one aspect of process evaluation of R...

Background Adolescents with disability are less active and have lower levels of physical fitness than their typically developing peers. Schools are ideal settings to address this; however, few school-based interventions have been designed and evaluated among this group. Therefore, the aim of this pilot study was to determine the feasibility of a ti...

Introduction Community-dwelling people recovering from hip fracture have the physical capacity to walk in their community but lack the confidence to do so. The primary aim of this trial is to determine whether motivational interviewing increases time spent walking at 12 months in community-dwelling people after hip fracture compared with an attenti...

Adopting complexity thinking in the design, implementation and evaluation of health and social development programmes is of increasing interest. Understanding institutional contexts in which these programmes are located directly influences shaping and eventual uptake of evaluations and relevant findings. A nuanced appreciation of the relationship b...

This is a qualitative, phenomenological study. To investigate media portrayal of spinal cord injury (SCI) as perceived by people with SCI and explore its impact on their lived experience. People with SCI living in Australia. Twenty-four participants, recruited using purposive and snowball sampling, completed in-depth, semi-structured interviews. Th...

Purpose To evaluate feasibility of scaling up a 12-week community-based exercise program (FitSkills) in which young people with disability exercise with a student mentor. Method Within a stepped wedge cluster randomised trial, seven domains of feasibility were assessed: demand, implementation, acceptability, practicality, adaptation, integration,...

Purpose This study compared the differences in foot dimensions between children with and without Down syndrome using three-dimensional (3D) foot scans. Methods 51 children with and 51 children without Down syndrome had a 3D scan taken of their right foot to compare the absolute and normalised (for height or foot length) measurements. Results Norm...

Aim To understand the attitudes, barriers, and facilitators to physical activity participation for young people and adults with childhood‐onset physical disability. Method Seven electronic databases (Embase, MEDLINE, PsychINFO, AMED, CINAHL, SPORTDiscus, and ERIC) were searched to November 2019. English language studies were included if they inves...

: Children with Down syndrome (DS) often have lower physical activity (PA) levels compared with their peers with typical development, and face challenges to being physically active such as medical comorbidities, access issues, and societal stigma. Physical therapists are experts in exercise prescription and PA and are thus uniquely qualified to su...

Objectives Determine physiotherapists’ (i) awareness of physical activity, and exercise prescription guidelines; (ii) perceived role, knowledge, confidence, skills and training in prescribing and progressing aerobic exercise and resistance training to people with musculoskeletal pain; (iii) professional development preferences; and (iv) perceived i...

Objective To explore the ways in which people talk about knee osteoarthritis and how this may influence engagement in physical activity and activity-based interventions as recommended by clinical practice guidelines. Design A qualitative synthesis using discourse analysis methods. Methods Systematic review methods were used to identify qualitativ...

BACKGROUND AND PURPOSE: Fractures of the proximal humerus are characterised by slow recovery and ongoing disability. We aimed to describe the recovery of patients referred to community physiotherapy after proximal humeral fracture and determine if activity thresholds based on the Shoulder Function Index (SFInX) could inform physiotherapist decision...

Objectives The objective of this study was to describe and compare the amount and type of leisure-time physical activity, and motivations and barriers to participation among adults with and without a disability. Methods Analysis of deidentified data from an Australian cross-sectional national telephone-based survey (October 2015 to June 2018) of s...

Background The adoption of research evidence to improve client outcomes may be enhanced using the principles of implementation science. This systematic review aimed to understand the effect of involving consumers to change health professional behaviours and practice. The barriers and enablers to consumer engagement will also be examined. Methods W...

Background: Children and adolescents with Down syndrome have a distinctive foot shape (such as wide and flat feet) that often leads to difficulty with footwear fitting. 3-dimensional (3D) scanning can accurately measure the foot dimensions of individuals with Down syndrome, which may assist shoe fit. However, the reproducibility of measuring foot...

An amendment to this paper has been published and can be accessed via the original article.

Question What is the effect of multidisciplinary, exercise-based, group oncology rehabilitation programs on healthcare service outcomes and patient-level outcomes, including quality of life and physical and psychosocial function? Design Systematic review with meta-analysis of randomised controlled trials. Participants Adults diagnosed with cancer...

Purpose To determine if eccentric exercise was effective, safe and feasible in increasing function and quality of life in people with heart failure compared to usual care and a waitlist control group. Methods A prospective, three-armed, parallel-design, assessor-blind, pilot randomised controlled trial with 1:1:1 allocation. Forty-seven participan...

Background and purpose Due to global ageing, more people will suffer from hip fracture in the future, and many will be left with permanent physical impairments. The care burden for people post hip fracture is high. The aim of this study is to measure longitudinal changes in physical activity levels and fear of falling in people after hip fracture w...

Question In women with gestational diabetes mellitus, does the addition of a consumer co-created infographic to usual education about gestational diabetes mellitus improve knowledge about physical activity and self-efficacy to exercise? Design A randomised trial with concealed allocation, a blinded assessor and intention-to-treat analysis. Partic...

Background and purpose: To investigate whether physical activity levels are predictive of short-term changes in physical function for people discharged to independent living in the community following withdrawal of rehabilitation services after hip fracture; and to describe short-term recovery in physical activity, physical function, walking confi...

Participation in adequate physical activity improves the health status of cancer survivors, enhances their survival and reduces their risk of cancer recurrence. However, cancer survivors engage in low levels of physical activity and have limited access to rehabilitation services that could increase their participation. No optimal framework has been...

Spinal cord injury has evolved from a condition not to be treated, to one that is treated and rehabilitated. People with spinal cord injury now live longer active lives; however, barriers to participation such as attitudes and misunderstandings of spinal cord injury still exist. Acknowledging that media can shape attitudes and understanding of disa...

Introduction There is a need to develop relevant, acceptable initiatives that facilitate physical activity participation in young people with disability. FitSkills was developed to support young people with disability to exercise. The primary aims are to investigate if FitSkills can be scaled up from a small, university-led programme to run as a la...

Purpose: The purpose of this study was to determine whether positive changes in self-reported attitudes toward disability were retained after students had participated in a 12-week voluntary community-based exercise programme for young people with disability. Method: Sixty-eight physiotherapy and exercise physiology students (45 women, 23 men; mean...

Purpose: To investigate modifiable child and caregiver factors influencing community participation among children with Down syndrome. Methods: Cross-sectional data from a study investigating quality of life of children with intellectual disability were analysed. Participants were caregivers of 89 children with Down syndrome (54 females; 83 school a...

Background Diastasis of the rectus abdominis muscle is often evaluated in clinical practice but it is unknown which clinical method has the best measurement properties. Objective The aim of this study was to determine: (i) the criterion validity of the callipers, tape measure and finger-width to evaluate the inter-recti distance of the abdominal m...

Background Little is known about how to facilitate participation in physical activity among children receiving acute cancer treatment. Objective To understand the parental perspectives on physical activity for children during acute cancer treatment and explore strategies to overcome physical inactivity. Methods A qualitative study was completed....

Purpose: To investigate the effect of a knowledge translation intervention on knowledge and frequency of routine evidence-based assessment behaviours of healthcare professionals working with children with cerebral palsy. Methods: A before-and-after longitudinal study was conducted in five disability organisations. Four organisations (Commencing Kno...

Background. Measuring physical activity behaviours of stroke survivors in the inpatient setting is challenging. Authors of observational studies of early poststroke report that stroke survivors are “inactive and alone”. Using activity monitoring devices may help refine clinical practice and inform therapeutic activity targets. Aim. To measure the p...

Purpose: To determine the feasibility of conducting a definitive randomised trial to evaluate the efficacy of custom-fitted footwear for increasing physical activity in children and adolescents with Down syndrome. Methods: Assessor-blinded, parallel-group randomised pilot study. Thirty-three children and adolescents with Down syndrome were randomly...

Objective: To determine if body mass index (BMI), smoking status, prehabilitation or time to reconstruction are associated with recovery of self-reported knee function and activity after ACL reconstruction (ACLR). Data Sources: Four electronic databases were systematically searched. Study Selection: English language articles were included if: (1) p...

Objectives Systematically review the qualitative literature on living with knee osteoarthritis from patient and carer perspectives. Design Systematic review of qualitative studies. Five electronic databases (CINAHL, Embase, MEDLINE, PsycINFO, SPORTDiscus) were searched from inception until October 2018. Data were synthesised using thematic and con...

Purpose: We systematically reviewed the effectiveness of interventions to increase physical activity in older adults (aged ≥ 60 y), admitted for inpatient rehabilitation, without increasing the amount of therapy. Method: Five electronic databases were systematically searched to identify English-language articles reporting controlled trials of inter...

Prader‐Willi syndrome (PWS) is a rare genetic condition with multi‐system involvement. The literature was reviewed to describe neurodevelopment and the behavioural phenotype, endocrine and metabolic disorders and respiratory and sleep functioning. Implications for child and family quality of life were explored. Challenging behaviours contribute to...