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Claudia Meyer, Susan Williams, Frances Batchelor and Keith Hill

Introduction:

The aim was to identify barriers and opportunities facing community health physiotherapists in delivering a home-based balance exercise program to address mild balance dysfunction and, secondly, to understand the perspectives of older people in adopting this program.

Method:

Focus groups, written surveys, and data recording sheets were used with nine older people and five physiotherapists. Focus groups were audio taped, transcribed, and coded independently by two researchers.

Results:

Thematic content analysis was undertaken. Emerging themes were: engaging in preventive health (various benefits, enhancing independence); adoption of strategies (acceptable design and implementation feasibility); exercising in context (convenience, practicality, and safety); and broader implementation issues (program design, proactive health messages, and a solid evidence base).

Conclusion:

The views of older people and physiotherapists were sought to understand the adoption of a previously successful home-based program for mild balance dysfunction. Understanding the unique context and circumstances for individuals and organizations will enhance adoption.

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Susan Williams, Claudia Meyer, Frances Batchelor and Keith Hill

The objective of this study was to determine whether improved balance outcomes achieved in a randomized controlled trial (RCT) using balance screening to identify mild balance dysfunction and home exercises could be translated into community settings. Community-dwelling people aged over 65 who expressed concerns about their balance, had less than two falls in the preceding 12 months, and who had mild balance impairment on screening were given an individualized home-based balance and strengthening exercise program with intermittent home-visit support by a physiotherapist. Of 71 participants assessed (mean age 77.3 years, 76% female), 58 (82%) completed the six-month intervention. Twenty six percent of participants regained balance performance within normal limits—similar to those achieved in the previous RCT. Successful results from a previous RCT were able to be translated into community settings, with a similar magnitude of effect on balance and mobility.

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Claudia Meyer, Sophie Hill, Keith D. Hill and Briony Dow

Provision of choice and participation in falls prevention strategies is challenging for people with dementia. This study outlines development of a discussion tool to aid engagement of people with dementia and their caregivers in falls prevention strategies. The tool is based on a literature review of falls prevention and dementia care (1990–2016) and decision aid principles and was trialed over 6 months. A total of 25 community-dwelling people with dementia (M age = 80 years, SD = 7.7, 52% male) and their caregivers (M age = 73 years, SD = 12.3, 36% male) underwent falls risk assessment and evaluation of their preparedness to change falls risk behaviors. Most commonly rated, and prioritized for intervention, high falls risk factors were impaired balance/mobility (92%), polypharmacy (60%), and incontinence (56%). This discussion tool facilitated collaboration between people with dementia, their caregivers, and health professionals, to increase uptake of acceptable and feasible evidence-based falls prevention strategies.

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Emma Renehan, Claudia Meyer, Rohan A. Elliott, Frances Batchelor, Catherine Said, Terry Haines and Dianne Goeman

Objective: Posthospital discharge shows increased risk for falls in older people. This pilot study was created to determine feasibility and acceptability of a community-delivered posthospital multifactorial program. Method: This mixed-method study used randomized controlled design (quantitative component) and interviews (qualitative component). People aged ≥65 years, hospitalized for a fall, underwent assessment for quality of life and falls-related outcomes, followed by interviews, randomization into intervention (exercise, medication review, and education) or control group, and follow-up at 6 months. Results: Thirteen people commenced, with 10 people assessed at 6 months. Participants were complex with high degrees of frailty, multimorbidity, polypharmacy, and falls risk. Interview data related to intervention, impacts on quality of life, and fall-related outcomes. Conclusion: Preliminary findings suggest suitability of a multifactorial program for older people posthospital discharge following a fall. A social component would be a useful addition to falls prevention strategies, utilizing existing community nursing organizations.

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Orlando Laitano, Jocelito Martins, Rita Mattiello, Claudia Perrone, Gilberto B. Fischer and Flavia Meyer

This study assessed sweat electrolyte concentration and losses in asthmatic children during exercise in the heat. Eleven asthmatics (AG; 11 ± 2 years old) and 11 nonasthmatics (CG; 10 ± 1 year old) underwent a maximal progressive cycle-ergometer test. During a second session, participants cycled in the heat (35°C, 60% RH) of a climatic chamber for 30 min at 50–60% of maximal workload. Sweat was collected using sweat patches attached to the dorsal region. No differences were observed in sweat [Na+] (AG = 35 ± 12.9 and CG = 43.4 ± 18 mmol/L) and [Cl-] (AG = 27.3 ± 10.4 and CG = 38.5 ± 19.1 mmol/L). There was no difference in sweat Na+ losses (AG = 0.47 ± 0.36 and CG = 0.66 ± 0.68 mmol/kg/h) and Cl- losses (AG = 0.37 ± 0.29 and CG = 0.59 ± 0.62 mmol/kg/h) between groups. Asthmatic children did not differ from nonasthmatics in their sweat electrolyte concentrations and electrolyte losses.