Can supervise: YES
Torgbenu, E, Luckett, T, Buhagiar, MA, Chang, S & Phillips, JL 2020, 'Prevalence and incidence of cancer related lymphedema in low and middle-income countries: a systematic review and meta-analysis.', BMC cancer, vol. 20, no. 1.View/Download from: Publisher's site
BACKGROUND:Little is known about the prevalence and incidence in low and middle-income countries (LMICs) of secondary lymphedema due to cancer. The purpose of the study is to estimate the prevalence and incidence in LMICs of secondary lymphedema related to cancer and/or its treatment(s) and identify risk factors. METHOD:A systematic review and meta-analysis was conducted. Medline, EMBASE and CINAHL were searched in June 2019 for peer-reviewed articles that assessed prevalence and/or incidence of cancer-related lymphedema in LMICs. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Prevalence Studies. Estimates of pooled prevalence and incidence estimates were calculated with 95% confidence intervals (CI), with sub-group analyses grouping studies according to: country of origin, study design, risk of bias, setting, treatment, and lymphedema site and measurement. Heterogeneity was measured using X2 and I2, with interpretation guided by the Cochrane Handbook for Systematic Reviews. RESULTS:Of 8766 articles, 36 were included. Most reported on arm lymphedema secondary to breast cancer treatment (n = 31), with the remainder reporting on leg lymphedema following gynecological cancer treatment (n = 5). Arm lymphedema was mostly measured by arm circumference (n = 16/31 studies), and leg lymphedema through self-report (n = 3/5 studies). Eight studies used more than one lymphedema measurement. Only two studies that measured prevalence of leg lymphedema could be included in a meta-analysis (pooled prevalence =10.0, 95% CI 7.0-13.0, I2 = 0%). The pooled prevalence of arm lymphedema was 27%, with considerable heterogeneity (95% CI 20.0-34.0, I2 = 94.69%, n = 13 studies). The pooled incidence for arm lymphedema was 21%, also with considerable heterogeneity (95% CI 15.0-26.0, I2 = 95.29%, n = 11 studies). There was evidence that higher body mass index (> 25) was associated with increased risk of arm lymphedema (OR: 1.98, 95% CI 1.45-2.70...
Buhagiar, MA, Naylor, JM, Harris, IA, Xuan, W, Adie, S & Lewin, A 2019, 'Assessment of Outcomes of Inpatient or Clinic-Based vs Home-Based Rehabilitation After Total Knee Arthroplasty: A Systematic Review and Meta-analysis', JAMA network open, vol. 2, no. 4, p. e192810.View/Download from: Publisher's site
Importance: Recent publication of the largest trials to date investigating rehabilitation after total knee arthroplasty (TKA) necessitate an updated evidence review. Objective: To determine whether inpatient or clinic-based rehabilitation is associated with superior function and pain outcomes after TKA compared with any home-based program. Data Sources: MEDLINE, Embase, CINAHL, and PubMed were searched from inception to November 5, 2018. Search terms included knee arthroplasty, randomized controlled trial, physiotherapy, and rehabilitation. Study Selection: Published randomized clinical trials of adults who underwent primary unilateral TKA and commenced rehabilitation within 6 postoperative weeks in which those receiving postacute inpatient or clinic-based rehabilitation were compared with those receiving a home-based program. Data Extraction and Synthesis: Two reviewers extracted data independently and assessed data quality and validity according to the PRISMA guidelines. Data were pooled using a random-effects model. Data were analyzed from June 1, 2015, through June 4, 2018. Main Outcomes and Measures: Primary outcomes were mobility (6-minute walk test [6MWT]) and patient-reported pain and function (Oxford knee score [OKS] or Western Ontario and McMaster Universities Osteoarthritis Index) reported at 10 to 12 postoperative weeks. The GRADE assessment (Grading of Recommendations, Assessment, Development, and Evaluation) was applied to the primary outcomes. Results: Five unique studies involving 752 unique participants (451 [60%] female; mean [SD] age, 68.3 [8.5] years) compared clinic- and home-based rehabilitation, and 1 study involving 165 participants (112 [68%] female; mean [SD] age, 66.9 [8.0] years) compared inpatient and home-based rehabilitation. Low-quality evidence showed no clinically important difference between clinic- and home-based programs for mobility at 10 weeks (6MWT favoring home program; mean difference [MD], -11.89 m [95% CI, -35.94 to 12....
© 2018, OmniaMed Communications Ltd. All rights reserved. Objectives: Oedema at the end of life is an undertreated and burdensome problem in palliative care patients, but its prevalence and association with risk factors is unknown. The authors aimed to investigate the prevalence of lower-limb oedema at the end of life in a palliative care population and measure the associated risk factors. Methods: A cross-sectional cohort study was carried out in two palliative care units of pitting lower-limb oedema at the end of life and associated risk factorsThis was the first stage of a larger interventional study for treatment of oedema at the end of life in palliative care patients. Results: Fifty-nine participants were admitted during the 1-month study period. Of these, 50.8% had pitting oedema in one or both legs on clinical assessment. The mean age was 67.4 years and 64% were male. All patients had at least one risk factor for oedema at the end of life (mean 3.4). Conclusion: Lower-limb oedema at the end of life is a common problem in the palliative care population. Early recognition and further research on risk factors may enable the introduction of preventative strategies to reduce the incidence of this burdensome problem.
Buhagiar, MA, Naylor, JM, Harris, IA, Xuan, W, Kohler, F, Wright, R & Fortunato, R 2017, 'Effect of inpatient rehabilitation vs a monitored home-based program on mobility in patients with total knee arthroplasty the HIHO randomized clinical trial', JAMA - Journal of the American Medical Association, vol. 317, no. 10, pp. 1037-1046.View/Download from: Publisher's site
©2017 American Medical Association. All rights reserved. IMPORTANCE Formal rehabilitation programs, including inpatient programs, are often assumed to optimize recovery among patients after undergoing total knee arthroplasty.However, these programs have not been compared with any outpatient or home-based programs. OBJECTIVE To determine whether 10 days of inpatient rehabilitation followed by a monitored home-based program after total knee arthroplasty provided greater improvements than a monitored home-based program alone in mobility, function, and quality of life. DESIGN, SETTING, AND PARTICIPANTS In this 2-group, parallel, randomized clinical trial, including a nonrandomized observational group, conducted at 2 public, high-volume arthroplasty hospitals in Sydney, Australia (July 2012-December 2015), 940 patients with osteoarthritis undergoing primary total knee arthroplasty were screened for eligibility. Of the 525 eligible patients consecutively invited to participate, 165 were randomized either to receive inpatient hospital rehabilitation and home-based rehabilitation or to receive home-based rehabilitation alone, and 87 patients enrolled in the observation group. INTERVENTIONS Eighty-one patients were randomized to receive 10 days of hospital inpatient rehabilitation followed by an 8-week clinician-monitored home-based program, 84 were randomized to receive the home-based program alone, and 87 agreed to be in the observational group, which included only the home-based program. MAIN OUTCOMES AND MEASURES Mobility at 26weeks after surgery, measured with the 6-minutewalk test. Secondary outcomes included the Oxford Knee Score, which ranges from 0 (worst) to 48 (best) and has a minimal clinically important difference of 5 points; and EuroQol Group 5-Dimension Self-Report Questionnaire (EQ-5D) visual analog scale, which ranges from 0 (worst) to 100 (best), and has a minimal clinically important difference of 23 points. RESULTS Among the 165 randomized participant...
Buhagiar, MA, Naylor, JM, Simpson, G, Harris, IA & Kohler, F 2017, 'Understanding consumer and clinician preferences and decision making for rehabilitation following arthroplasty in the private sector', BMC Health Services Research, vol. 17, no. 1.View/Download from: Publisher's site
© 2017 The Author(s). Background: To understand private consumer and clinician preferences towards different rehabilitation modes following knee or hip arthroplasty, and identify factors which influence the chosen rehabilitation pathway. Methods: Mixed methods cross-sectional study involving 95 semi-structured interviews of consumers (patients and carers) and clinicians (arthroplasty surgeons, physiotherapists and rehabilitation physicians) in Sydney, Australia, during 2014-2015. Participants were asked about the acceptability of different modes of rehabilitation provision, and factors influencing their chosen rehabilitation pathway. Interviews were in person or via the telephone. Qualitative analysis software was used to electronically manage qualitative data. An analytical approach guided data analysis. Results: Pre-operative preferences strongly influenced the type of rehabilitation chosen by consumers. Key factors that influenced this were both intrinsic and extrinsic, including; the previous experience of self or known others, the perceived benefits of the chosen mode, a sense of entitlement, the role of orthopaedic surgeons and influence of patient preference, a patient's clinical status post-surgery, the private hospital business model and insurance provider involvement. The acceptability of rehabilitation modes varied between clinician groups. Conclusions: No one rehabilitation mode provided following arthroplasty is singularly preferred by stakeholders. Factors other than the belief that a particular mode was more effective than another appear to dominate the pathway followed by private arthroplasty consumers, indicating evidence-based policies around rehabilitation provision may have limited appeal in the private sector.
Naylor, JM, Mills, K, Buhagiar, M, Fortunato, R & Wright, R 2016, 'Minimal important improvement thresholds for the six-minute walk test in a knee arthroplasty cohort: triangulation of anchor- and distribution-based methods', BMC MUSCULOSKELETAL DISORDERS, vol. 17.View/Download from: Publisher's site
Buhagiar, MA, Naylor, JM, Harris, IA, Xuan, W, Kohler, F, Wright, RJ & Fortunato, R 2013, 'Hospital Inpatient versus HOme-based rehabilitation after knee arthroplasty (The HIHO study): Study protocol for a randomized controlled trial', Trials, vol. 14, no. 1.View/Download from: Publisher's site
Background: Formal rehabilitation programs are often assumed to be required after total knee arthroplasty to optimize patient recovery. Inpatient rehabilitation is a costly rehabilitation option after total knee arthroplasty and, in Australia, is utilized most frequently for privately insured patients. With the exception of comparisons with domiciliary services, no randomized trial has compared inpatient rehabilitation to any outpatient based program. The Hospital Inpatient versus HOme (HIHO) study primarily aims to determine whether 10 days of post-acute inpatient rehabilitation followed by a hybrid home program provides superior recovery of functional mobility on the 6-minute walk test (6MWT) compared to a hybrid home program alone following total knee arthroplasty. Secondarily, the trial aims to determine whether inpatient rehabilitation yields superior recovery in patient-reported function. Methods/Design: This is a two-arm parallel randomized controlled trial (RCT), with a third, non-randomized, observational group. One hundred and forty eligible, consenting participants who have undergone a primary total knee arthroplasty at a high-volume joint replacement center will be randomly allocated when cleared for discharge from acute care to either 10 days of inpatient rehabilitation followed by usual care (a 6-week hybrid home program) or to usual care. Seventy participants in each group (140 in total) will provide 80% power at a significance level of 5% to detect an increase in walking capacity from 400 m to 460 m between the Home and Inpatient groups, respectively, in the 6MWT at 6 months post-surgery, assuming a SD of 120 m and a drop-out rate of <10%.The outcome assessor will assess participants at 10, 26 and 52 weeks post-operatively, and will remain blind to group allocation for the duration of the study, as will the statistician. Participant preference for rehabilitation mode stated prior to randomization will be accounted for in the analysis together with...
Kohler, F, Connolly, C, Sakaria, A, Stendara, K, Buhagiar, M & Mojaddidi, M 2013, 'CAN THE ICF BE USED AS A REHABILITATION OUTCOME MEASURE? A STUDY LOOKING AT THE INTER- AND INTRA-RATER RELIABILITY OF ICF CATEGORIES DERIVED FROM AN ADL ASSESSMENT TOOL', JOURNAL OF REHABILITATION MEDICINE, vol. 45, no. 9, pp. 881-887.View/Download from: Publisher's site
Kohler, F, Connolly, C, Sakaria, A, Stendara, K, Buhagiar, M & Mojaddidi, M 2013, 'Response to letter to the Editor by Gunnar Grimby and Åsa Lundgren-Nilsson, 'Comments on the article "can the ICF be used as a rehabilitation outcome measure ? A study looking at the inter - And intra -rater reliability of the ICF categories derived from an ADL assessment tool"', Journal of Rehabilitation Medicine, vol. 45, no. 10, p. 931.
Kohler, F, Connolly, C, Sakaria, A, Stendara, K, Buhagiar, M & Mojaddidi, M 2013, 'RESPONSE TO LETTER TO THE EDITOR BY GUNNAR GRIMBY AND ASA LUNDGREN-NILSSON, 'COMMENTS ON THE ARTICLE "CAN THE ICF BE USED AS A REHABILITATION OUTCOME MEASURE? A STUDY LOOKING AT THE INTER- AND INTRA-RATER RELIABILITY OF THE ICF CATEGORIES DERIVED FROM AN ADL ASSESSMENT TOOL"', JOURNAL OF REHABILITATION MEDICINE, vol. 45, no. 9, pp. 931-931.View/Download from: Publisher's site
Grady, A, Karunaratne, S, Fortunato, R, Bowron, P, Buhagiar, M & Chipchase, L 2017, 'The effectiveness of a student-led outpatient rehabilitation clinic in a hospital setting', INTERNATIONAL JOURNAL OF STROKE, SAGE PUBLICATIONS LTD, pp. 11-11.
Leithhead, I, Nguyen, M, Thomson, K & Buhagiar, M 2014, 'The effect of a specific balance-strategy training program in reducing the falls risk among low level care residents of a residential aged care facility.', AUSTRALASIAN JOURNAL ON AGEING, WILEY-BLACKWELL, pp. 38-39.