Falls prevention

Every day in Australia, an average of 364 people aged 65 and over are hospitalised due to falls.

The cost of treating these injuries is estimated to be $2.3 billion, a number expected to rise as the population ages (Centre of Research Excellence in the Prevention of Fall- related Injuries 2022).

Professor Cathie Sherrington FACP, a senior principal research fellow and professor at the University of Sydney and director of the Centre of Research Excellence in the Prevention of Fall-related Injuries, has worked as a physiotherapist and undertaken research in rehabilitation and aged-care settings for many years.

According to Cathie, many falls can actually be prevented.

‘Using the expertise of physios is important because tailored exercise is a key falls- prevention strategy.

'We need to focus on physical activity that maximises balance and functional abilities, in both the earlier and the later stages of life.

‘Initially, I was motivated to undertake research as a clinical physio because we didn’t always have the opportunity to offer the services we knew we could provide, particularly given the pressure placed on length of stay.

'Patients were often discharged even though there was more that could be done for them so I was interested to see if we could find further evidence for the benefits that physios could provide.

‘I’ve seen firsthand how falls have become a major public health issue, primarily in acute hospitals and for patients with complex needs,’ says Cathie.

‘But to date, no interventions have been successful in preventing them in these settings.’

Cathie’s new research project is titled ‘Quality coaching to implement a hospital fall prevention strategy: intervention development and evaluation in a stepped wedge trial’.

Stage 1 will involve the co- design of a quality coaching approach for falls prevention in the wards of the Sydney Local Health District, using data from pilot work and quality improvement initiatives around the country.

Stage 2 will then comprise a stepped-wedge trial to test the coaching approach.

Many factors can affect the prevalence of falls in hospital settings.

‘When people are in hospital due to illness or surgery, often their mobility is worse than usual and they may not even be aware of it,’ says Cathie.

‘Sometimes their walking aids or the usual shoes they wear at home may not have come into hospital with them and that can also play a part.’

The aim of the research project is to produce a model to support health professionals across different disciplines.

‘It’s important to have physios as key members of multidisciplinary teams at the acute-ward level because we can play a central role in helping to improve patients’ mobility.

'We hope to support wards to actively prevent falls,’ says Cathie.

As with all research grants, gaining funding through a National Health and Medical Research Council (NHMRC) grant is a competitive process and not all projects are successful.

‘Receiving an NHMRC grant is fantastic,’ says Cathie, ‘and a testament to the important role of physios in leading changes that improve our health systems.’

Knee osteoarthritis

Osteoarthritis (OA) is the most common type of arthritis in Australia, affecting around 10 per cent of the population, and knee OA is its most widespread form.

More than 53,000 knee replacements were performed in 2021–22 (Australian Institute of Health and Welfare 2023).

Professor Rana Hinman APAM is a research physiotherapist and National Health and Medical Research Council Investigator Fellow at the Centre for Health, Exercise and Sports Medicine at the University of Melbourne.

Ever since completing her PhD on OA two decades ago, she has had a deep interest in the subject, particularly in regards to researching non-pharmacological strategies for management.

‘While a cure for OA doesn’t exist and drugs to target joint structure have remained elusive, much progress has still been made in understanding it.

'There’s now a more focused biopsychosocial approach to management and the remit of physios and allied health has grown so that we’re now taking lead roles,’ says Rana.

Rana’s research program is called ‘Increasing lifestyle management of hip and knee osteoarthritis to improve health outcomes’.

The central focus of the research is on exploring ways to empower people with knee OA to manage it themselves, through education, exercise and—if necessary—weight management.

‘When we give people an exercise program, we know it’s burdensome,’ says Rana.

‘For many people, exercise is boring and their lives are busy enough already—if you prescribe 10 exercises that take an hour to do every second day, they may simply not complete them.

'So we will explore questions like: how much exercise is enough? Will fewer exercises still result in benefits? How many visits to a physio are ideal?’

The Investigator grant funds a program of research for five years, with a range of research projects involved including randomised controlled trials.

‘One area under investigation is the type of information that should be given to patients and whether it actually helps them to receive it,’ Rana explains.

‘So the program will also look at manipulating factors such as language to explore how we can give information to patients in the most useful manner.’

The predicted findings of the research will likely be relevant to people beyond OA.

Rana says, ‘There are many similarities between people with back pain and OA.

'What we’re learning from our research should apply to exercise in other conditions and professions.’

The final outcomes of the research are not always set in stone.

‘Another advantage of NHMRC funding is that you can take the program where the research findings lead you.

'Often new avenues of research emerge as one project is completed. The government is investing in the researcher, whereas many other grants invest in the project.’

NHMRC Investigator grants are very difficult to acquire and Rana says it’s a real privilege to receive one.

‘People in academic positions are employed in a teaching and research role but when you get an Investigator Grant, it allows you to be 100 per cent focused on your research,’ she says.

‘The project money supports you to employ research assistants or postdocs so it’s a big boost to your productivity.’

Stroke recovery

Stroke is a major health issue in Australia, causing more deaths than breast cancer in women or prostate cancer in men, and more than 400,000 Australians are currently living with the effects of stroke (Stroke Foundation 2024).

Survivors can experience a range of physical, cognitive and emotional impairments.

For many years, stroke recovery has been a professional focus for Dr Natalie Fini MACP, a senior research fellow at the University of Melbourne.

She is predominantly interested in exploring the benefits of physical activity for stroke survivors, along with the information that people receive about safe levels of activity.

‘People who survive a mild stroke may be discharged from hospital quite quickly,’ says Natalie.

‘They may then not get advice about whether it’s safe to go back to physical activity, which can actually help protect them from having another stroke.’

Natalie’s research project, ‘Tailoring physical activity interventions after stroke to promote lifelong adherence’, builds on her earlier work.

‘The intervention we co-designed prior to the NHMRC grant, called “Fit 4 Me After Stroke”, is what we’ll be testing in an early-phase adaptive trial.

'It involves a shared decision-making process to create a personalised physical activity plan and embeds behaviour-change support over six months,’ says Natalie.

She notes that many stroke rehabilitation trials have been ineffective and that some trials lump all stroke survivors together, no matter the severity of their stroke.

‘We’ll be starting with phase I/IIa trials, looking at dosage of physical activity for people with mild- to moderate-severity stroke, initially in the subacute phase.

'Using an adaptive trial, we can test a number of doses in small cohorts rather than jumping into testing 500 people when we don’t really know much about what dose will show the most promise of being effective.’

Natalie hopes that the outcomes for stroke survivors will be substantial.

‘We’ll move closer to helping people living with stroke to sustainably increase their long-term physical activity levels and health,’ she says.

‘Ultimately, we want to reduce people’s future risk of stroke and cardiovascular disease and to give them healthy lifelong habits.

'If they can find a physical activity that brings them joy, they’re more likely to keep doing it.’

There are also many potential benefits for the wider medical community.

‘For stroke clinicians, our research will help them determine the optimal dose of physical activity interventions for specific subgroups of stroke severity, incorporating personalisation and behaviour change,’ says Natalie.

‘For the health system, we can move towards finding an effective intervention to reduce secondary stroke risk, which will have an impact on hospitalisations and deaths.

'Our eventual goal would be to affect policy.’

Receiving an NHMRC grant will substantially benefit Natalie’s research.

‘The grant is for five years, which gives me protected research time and research assistant hours.

'I feel extremely privileged to have this opportunity.'

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