OBJECTIVE -The purpose of this study was to assess the effectiveness of a low-resourceintensive lifestyle modification program incorporating resistance training and to compare a gymnasium-based with a home-based resistance training program on diabetes diagnosis status and risk. RESEARCH DESIGN AND METHODS-A quasi-experimental two-group study was undertaken with 122 participants with diabetes risk factors; 36.9% had impaired glucose tolerance (IGT) or impaired fasting glucose (IFG) at baseline. The intervention included a 6-week group self-management education program, a gymnasium-based or home-based 12-week resistance training program, and a 34-week maintenance program. Fasting plasma glucose (FPG) and 2-h plasma glucose, blood lipids, blood pressure, body composition, physical activity, and diet were assessed at baseline and week 52.RESULTS -Mean 2-h plasma glucose and FPG fell by 0.34 mmol/l (95% CI Ϫ0.60 to Ϫ0.08) and 0.15 mmol/l (Ϫ0.23 to Ϫ0.07), respectively. The proportion of participants with IFG or IGT decreased from 36.9 to 23.0% (P ϭ 0.006). Mean weight loss was 4.07 kg (Ϫ4.99 to Ϫ3.15). The only significant difference between resistance training groups was a greater reduction in systolic blood pressure for the gymnasium-based group (P ϭ 0.008).CONCLUSIONS -This intervention significantly improved diabetes diagnostic status and reduced diabetes risk to a degree comparable to that of other low-resource-intensive lifestyle modification programs and more intensive interventions applied to individuals with IGT. The effects of home-based and gymnasium-based resistance training did not differ significantly.
Background: Allied health comprises multiple professional groups including dietetics, medical radiation practitioners, occupational therapists, optometrists and psychologists. Different to medical and nursing, Allied health are often organized in discipline specific departments and allocate budgets within these to provide services to a range of clinical areas. Little is known of how managers of allied health go about allocating these resources, the factors they consider when making these decisions, and the sources of information they rely upon. The purpose of this study was to identify the key factors that allied health consider when making resource allocation decisions and the sources of information they are based upon. Methods: Four forums were conducted each consisting of case studies, a large group discussion and two hypothetical scenarios to elicit data. A thematic content analysis commenced during post-forum discussions of key factors by forum facilitators. These factors were then presented to an expert working party for further discussion and refinement. Transcripts were generated of all data recordings and a detailed thematic analysis was undertaken by one author to ensure coded data matched the initial thematic analysis. Results: Twelve factors affecting the decision-making of allied health managers and clinicians were identified. One of these factors was disendorsed by the expert working party. The 11 remaining factors can be considered to be key decision-making principles that should be consistently applied to resource allocation. These principles were clustered into three overarching themes of readiness, impact and appropriateness. Conclusion: Understanding these principles now means further research can be completed to more effectively integrate research evidence into health policy and service delivery, create partnerships among policy-makers, managers, service providers and researchers, and to provide support to answer difficult questions that policy-makers, managers and service providers face.
The outcome following rehabilitation for 92 vascular amputees admitted to the Queen Elizabeth Geriatric Centre, Ballarat between 1 January 1982 and 31 December 1987 is presented. Data includes age, sex, concomitant disease, mortality, length of hospital stay and acceptance of prosthesis. Statistical analysis reveals no predictive factors for mobility levels attained by amputees other than amputation type, no predictive factors for acceptance of prostheses, and no predictive factors for total length of hospital stay. As a consequence, the Queen Elizabeth Geriatric Centre will continue the practice of admitting all amputees who wish to use artificial limbs to the prosthetic programme, regardless of age or concomitant disease.
Benchmark data for lower limb amputees is often limited to young subjects who have had their amputations as the result of trauma. The majority of trans-tibial amputees rehabilitated are, however, elderly vascular amputees who may have different gait characteristics than their younger counterparts. Without biomechanical analyses to provide such benchmark data for this group it is not possible to compare the effects of different rehabilitation programmes, gait training regimens, or prosthetic devices. Twenty elderly vascular trans-tibial amputees rehabilitated at The Queen Elizabeth Centre, Ballarat, Australia and at least six months post-amputation were measured in respect of kinetic and kinematic parameters, and relationships between gait speed, consistency, and function were demonstrated. Further, an unexplained vertical ground reaction force pattern was demonstrated in faster, more functional amputees.
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