Paola Chivers’s research while affiliated with The University of Notre Dame Australia and other places

Background People with intellectual disabilities living in group homes often have complex health needs, are high health service users and need support from their service provider to access health services. In Australia, little is known about the types and amounts of these supports. Methods A case study was conducted on a large Western Australian disability provider of group homes to 160 people with intellectual disability. Over an 18‐month period, including during the COVID‐19 pandemic, the study quantified health service use in hospital‐ and community‐based settings, ways by which the person was supported to access health care and the impact on other people supported by the provider. Economic costs of supporting access to health services were estimated. Findings Overall, the disability provider supported 160 people in accessing health services an average of 23 times each ( n = 3617, median = 20, interquartile range = 10–33) over the 18 months. Support included staff attending with the person (96%), following up with guardian/decision‐maker (50%), additional resourcing via overtime or staff backfills (6%) and transport (94%). The average cost of supporting one health visit was estimated at $78.51 AUD (2021). Impact on the person's household included loss of opportunity for housemates (30%), reduced supervision within the home (79%) and longer timeframes to complete care needs (32%). The impact of COVID‐19 restrictions saw a reduction in allied and mental health service use that did not return to prepandemic levels following the cessation of restrictions. Primary care, specialist, outpatient, pathology and emergency service use was also lower in the postrestriction period compared to the prepandemic period. Conclusions For people living in group homes, the disability provider plays an essential role in supporting health service access, primarily through the provision of support staff and transport. The change in health service utilisation following the COVID‐19 restriction period indicates that altered health system priorities can potentially exacerbate access inequality for people with intellectual disability.

Objective To evaluate the construct validity (structural validity and hypothesis testing), reliability (test–retest reliability, measurement error and internal consistency) and minimal important change (MIC) of the 13-item TENDINopathy Severity assessment–Achilles (TENDINS-A). Methods Participants with Achilles pain completed an online survey including: demographics, TENDINS-A, Foot and Ankle Outcome Score (FAOS) and Victorian Institute of Sport Assessment–Achilles (VISA-A). Exploratory factor analysis (EFA) assessed dimensionality. Confirmatory factor analysis (CFA) assessed structural validity (root mean square error of approximation (RMSEA); Comparative Fit Index (CFI); Tucker-Lewis Index (TLI); standardised root measure square (SRMS)). Correlations between TENDINS-A and the FAOS or VISA-A assessed hypothesis testing. Intraclass correlation (ICC) assessed test–retest reliability. Cronbach’s alpha assessed internal consistency. SE of the measurement (SEM) assessed measurement error. A distribution-based approach assessed MIC. Results 79 participants (51% female) with a mean (SD) age=42.6 (13.0) years, height=175.0 (11.7) cm and body mass=82.0 (19.1) kg were included. EFA identified three meaningful factors, proposed as pain, symptoms and function. The best model identified using CFA for TENDINS-A had structural validity (RMSEA=0.101, CFI=0.959, TLI=0.947, SRMS=0.068), which included three factors (pain, symptoms and function), but excluded three items from the original TENDINS-A. TENDINS-A exhibited moderate positive correlation with FAOS (r=0.598, p<0.001) and a moderate negative correlation with VISA-A (r=−0.639, p<0.001). Reliability of the TENDINS-A was excellent (ICC=0.930; Cronbach’s α=0.808; SEM=6.54 units), with an MIC of 12 units. Conclusions Our evaluation of the revised 10-item TENDINS-A determined it has construct validity and excellent reliability, compared with the VISA-A and FAOS which lack content and construct validity. The TENDINS-A is recommended as the preferred patient-reported outcome measure to assess disability in people with Achilles tendinopathy.

Introduction We evaluated construct validity (structural validity and hypothesis-testing) and reliability (test-retest reliability, measurement error and internal consistency) of the new TENDINopathy Severity assessment-Achilles (TENDINS-A), which is the only outcome measure with adequate content validity for assessment of disability in Achilles tendinopathy. Materials and Methods Participants with Achilles tendinopathy completed an online survey: demographics, TENDINS-A, Foot and Ankle Outcome Score (FAOS) and Victorian Institute of Sport Assessment-Achilles (VISA-A). Exploratory factor analysis (EFA) evaluated dimensionality. Confirmatory Factor Analysis (CFA) evaluated structural validity [Comparative Fit Index (CFI); Standardised Root Measure Square (SRMS)]. Correlations between TENDINS-A and the FAOS/VISA-A evaluated hypothesis-testing. Intraclass correlation co-efficient (ICC) represents test-retest reliability. Cronbach’s α represents internal consistency. Standard error of the measurement (SEM) represents measurement error. Results Seventy-nine participants (51% female) with a mean (SD) age= 42.6 (13.0) years, height= 175.0 (11.7) cm and body mass= 82.0 (19.1) kg were included. EFA identified three meaningful factors, proposed to be pain, symptoms and function. The best model identified using CFA had adequate structural validity (CFI= 0.959, SRMS=0.068), excluded three items from the original TENDINS-A and included three factors (Pain, Symptoms, and Function). The TENDINS-A exhibited moderate positive correlation with FAOS (rho=0.598,p<0.001), and moderate, negative correlation with VISA-A (r=-0.639,p<0.001). Reliability of the TENDINS-A is excellent (ICC=0.930; Cronbach’s α=0.808; SEM=6.54 units). Conclusions Our evaluation of the revised 10-item TENDINS-A has determined it has adequate validity and reliability. Thus, the TENDINS-A can be recommended for immediate use, being the preferred tool over all others to assess disability in Achilles tendinopathy.

Workplace exercise programs are imperative for improving employee health and wellbeing. Employee cognition and productivity can also benefit from such programs; however, the practical application of interventions to influence these outcomes is poorly understood. This research aimed to assess the suitability of a university Staff Fitness Program for improving employee productivity and cognition. Forty-seven participants were included in the study, comprising 27 Staff Fitness participants and 20 control group participants. A two (groups) x three (time-points) between-subjects/within-subjects design was employed over 14 weeks, comprising ten weeks of once-weekly exercise intervention for Staff Fitness participants. All participants completed the Victoria Stroop Colour and Word Test and the Health and Work Questionnaire at each time-point, to assess cognition and productivity, respectively. Participants also completed the International Physical Activity Questionnaire (short form) at time-point one, three and during training weeks (excluding week one) to measure physical activity. Appropriate T-tests and non-parametric equivalents were used to assess group differences in outcome measures and across time-points. There were no significant between group or longitudinal differences indicative of improved productivity or cognition. The Staff Fitness group demonstrated a non-significant improvement (Z = 73.00, p = .055) in physical activity from time-point one (M = 1540.93 MET-min-week, SD = 1083.74) to three (M = 2077.32 MET-min-week, SD = 1401.48) with a large effect size (d = 0.97), while control group physical activity significantly decreased (Z = 10.00, p = .013). The present Staff Fitness Program benefited employees by improving physical activity, despite no improvements in productivity or cognition. Future research should further explore the application of workplace exercise programs and the manipulation of exercise parameters to show improvements in employee productivity and cognition.

Introduction This study explored the behavioral profiles of residing Western Australians during a COVID-19 lockdown period and transitions in behavior post-lockdown. Methods A total of 313 participants (76% female, age: M = 50.1, SD = 15.7 years) completed behavioral and mental health questionnaire items ~2 months after a 3-month COVID-19 lockdown in October 2020, using a retrospective recall to assess their experience during the lockdown period. Latent transition analysis (LTA) was used to identify behavioral profiles and transitions. Indicators were identified by assessing during–post-lockdown group differences (Kruskal–Wallis, chi-square tests) and profiles described using qualitative open-ended questions. Results Significant indicators included changes in physical activity, leisure screen time, alcohol intake, psychological distress, and loneliness, but not fast food consumption. The significant indicators were used to form LTA models. The five latent class model showed the best model fit (Log-likelihood = −1301.66, AIC = 426.12, BIC = 609.68). Approximately one in four participants reported a change in their behavior profiles after the lockdown ceased. Key differences between the profiles were age, household income, education, resilience, sense of control, existing mental health issues, and social relations. Washing hands and social distancing were the most recalled and effective health campaigns across the classes, with health campaigns encompassing physical activity/alcohol consumption, or domestic violence having the least attention. Discussion Overall, while most participants recovered relatively well after the lockdown period, LTA did identify subgroups such as those who were inactive and lonely experienced more difficulties than other groups, and engagement with public health campaigns differed. The results provide important insights for future public health campaigns on how these campaigns might be diversified to effectively target more people and particular groups to maximize engagement for maintaining people's mental health with additional focus on physical activity, alcohol consumption, and domestic violence.

Background: during pain assessment in persons unable to self-report, such as people living with dementia, vocalisations are commonly used as pain indicators. However, there is a lack of evidence from clinical practice regarding their diagnostic value and relationship with pain. We aimed to explore vocalisations and pain in people with dementia undergoing pain assessments in clinical practice settings. Methods: a total of 22,194 pain assessments were reviewed in people with dementia (n = 3,144) from 34 different Australian aged care homes and two dementia specific programs. Pain assessments were conducted by 389 purposely trained health care professionals and cares using PainChek pain assessment tool. Vocalised expressions were determined based on nine vocalisation features included in the tool. Linear mixed models were used to examine the relationship of pain scores with vocalisation features. Using a single pain assessment for each of the 3,144 people with dementia, additional data analysis was conducted via Receiver Operator Characteristic (ROC) analysis and Principal Component Analysis. Results: vocalisation scores increased with increasing pain intensity. High pain scores were more likely with the presence of sighing and screaming (8 times). The presence of vocalisation features varied depending on the intensity of pain. The ROC optimal criterion for the voice domain yielded a cut-off score of ≥2.0 with a Youden index of 0.637. The corresponding sensitivity and specificity were 79.7% [confidence interval (CI): 76.8-82.4%] and 84.0% (CI: 82.5-85.5%), respectively. Conclusion: we describe vocalisation features during presence of different levels of pain in people with dementia unable to self-report, therefore providing evidence in regard to their diagnostic value in clinical practice.