Importance International guidelines recommend the integration of multidisciplinary rehabilitation into palliative care services but its impact on quality of life across disease types is not well understood. Objective To determine the effect of multidisciplinary palliative rehabilitation on quality of life and healthcare service outcomes for adults with an advanced, life-limiting illness. Data sources Electronic databases CINAHL, EMBASE, MEDLINE and PEDro were searched from the earliest records to February 2024. Study selection Randomised controlled trials examining the effect of multidisciplinary palliative rehabilitation in adults with an advanced, life-limiting illness and reported quality of life were eligible. Data extraction and synthesis Study characteristics, quality of life and health service usage data were extracted, and the methodological quality was assessed using PEDro. Meta-analyses using random effects were completed, and Grades of Recommendation, Assessment, Development and Evaluation criteria were applied. Main outcomes Quality of life and healthcare service outcomes. Results 27 randomised controlled trials (n=3571) were included. Palliative rehabilitation was associated with small improvements in quality of life (standardised mean difference (SMD) 0.40, 95% CI 0.23 to 0.56). These effects were significant across disease types: cancer (SMD 0.22, 95% CI 0.03 to 0.41), heart failure (SMD 0.37, 95% CI 0.61 to 0.05) and non-malignant respiratory diagnoses (SMD 0.77, 95% CI 0.29 to 1.24). Meta-analysis found low-certainty evidence, palliative rehabilitation reduced the length of stay by 1.84 readmission days. Conclusions and relevance Multidisciplinary palliative rehabilitation improves quality of life for adults with an advanced, life-limiting illness and can reduce time spent in hospital without costing more than usual care. Palliative rehabilitation should be incorporated into standard palliative care. PROSPERO registration number CRD42022372951.

QUESTIONS:What is the effect of group exercise-based telerehabilitation compared with a single session of in-person assessment and advice on health-related quality of life in cancer survivors? What are the effects on activity, function, safety and cost-effectiveness? DESIGN:An assessor-blinded, pragmatic randomised controlled trial with embedded cost analysis, concealed allocation and intention-to-treat analysis. PARTICIPANTS:Adult cancer survivors with any cancer diagnosis who were receiving treatment or within 12 months of treatment completion. INTERVENTION:The experimental group received an 8-week, twice-weekly, physiotherapist-led exercise group via videoconferencing, supplemented with support resources and a single in-person session of assessment and advice (TeleCaRe). The control group received a single in-person session of exercise assessment and advice. OUTCOME MEASURES:Assessments were completed at baseline, after the intervention (week 9) and at follow-up (week 26). The primary outcome was health-related quality of life, measured using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30, at week 9. Secondary measures were walking capacity (6-minute walk test), physical activity (accelerometer), self-efficacy (Health Action Process Approach Questionnaire), adverse events, and health service and cost data. RESULTS:In total, 117 participants were recruited. Their mean age was 59 years, 82 (70%) were female, and 47 (40%) had breast cancer. Participants attended an average of seven out of 16 sessions (SD 6). There were no major adverse events. Intention-to-treat analysis found that TeleCaRe was not superior for improving quality of life (MD -5.3 units, 95% CI -13.3 to 2.6) or any secondary outcomes. TeleCaRe cost AU$363 per participant. CONCLUSION:Group exercise-based cancer telerehabilitation was safe but attendance was poor. The addition of telerehabilitation to assessment and advice was not superior to a single in-person physiotherapy session alone for improving quality of life. REGISTRATION:ACTRN12621001417875.

Objectives To i) identify physiotherapists’ needs for professional development support and ii) address the educational need to support mid-level physiotherapists to transition to a highly-developed physiotherapist within a specialty area, by creating a structured clinical education pathway. Design Experience-based co-design (EBCD) with three interactive co-design workshops (one to identify learning needs, two to develop the pathway) conducted over four months. Setting Large public hospital service Participants Physiotherapists of varied experience levels were included Data collection Workshops were audio-recorded and transcribed verbatim, and field notes taken. A clinical education pathway was developed iteratively through feedback provided at workshops and by key stakeholders. Results Nineteen physiotherapists participated in the workshops. The primary theme of Workshop 1 was, “Opportunities to advance are often serendipitous”, in which a tension emerged between clinical and non-clinical demands, impeding participation in professional development. A clinical education pathway was described as needing structure, clear expectations, and managerial support. The resulting clinical education pathway was comprised of four elements: 1) study days (with focus on specialty-specific and non-clinical skills), 2) mentoring, 3) experiential learning including project work, and 4) assessment of ‘on the job’ capabilities. Conclusion A clinical education pathway comprising study days, mentoring, experiential learning, and competency assessment was designed in collaboration with end-users to support transition of mid-level physiotherapists into specialty areas of practice. This pathway seeks to improve skills, confidence and evidence-based behaviours in specialty areas of physiotherapy. Contribution of the paper •Physiotherapists need structured professional development with clear expectations that is supported by managers to support career advancement.•Physiotherapists require knowledge and experience in both non-clinical and clinical skills when transitioning to areas of specialty practice.•Physiotherapists value experiential learning experiences supported by skilled mentors.

Although telerehabilitation can improve access to exercise programs for cancer survivors, it is not known if these programs lead to ongoing change in exercise habits. This study explored participant experiences of exercise 4 months after finishing specialized cancer exercise-based telerehabilitation. A qualitative study embedded in a randomized controlled trial evaluated exercise-based cancer telerehabilitation delivered in groups. Data were collected via semistructured interviews that were audio-recorded and transcribed verbatim. Seventeen adult cancer survivors (age 21 to 80) were purposively sampled 4 months after completing exercise-based cancer telerehabilitation. Data were coded independently by two researchers and analyzed inductively within an interpretive description framework. The overarching theme was telerehabilitation was perceived to facilitate positive exercise intentions. Participants said they were empowered to exercise through knowledge, opportunity, and connection gained through telerehabilitation. They described acting on their positive intentions to exercise to varying degrees following telerehabilitation, depending on their context. A subtheme was that exercise was challenging in their new reality created by cancer. Comorbidities, ongoing side effects, previous exercise experience, and personal factors were considered by some to influence their ability to exercise. Telerehabilitation may facilitate positive intent to maintain exercise. Cancer survivors may need ongoing support after telerehabilitation to act on positive exercise intentions due to health-related difficulties. Participation in telerehabilitation may be a positive first step to initiate exercise, but ongoing support to maintain positive behavior changes is likely to be needed for people without previous exercise experience.

OBJECTIVE:To determine the effect of earlier vs. later initiation of exercise rehabilitation on patient and health service outcomes in individuals with cancer. DATA SOURCES:CINAHL, Embase, MEDLINE and PubMed were searched until October 2025. STUDY SELECTION/ELIGIBILITY CRITERIA:Randomised controlled trials including adults and/or children with cancer that compared exercise rehabilitation initiated at different times were eligible. The primary outcome was physical activity. Secondary outcomes included cardiorespiratory fitness, walking capacity, fatigue and quality of life; and health service outcomes such as hospital length of stay. DATA EXTRACTION AND DATA SYNTHESIS:Outcome data were extracted, and the methodological quality assessed using PEDro. Clinically homogenous data were combined in meta-analyses; overall quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations approach. RESULTS:Fifteen trials involving 1270 participants most commonly with breast (n = 6), colorectal (n = 3) and haematological (n = 3) cancers were included. There was low to moderate certainty evidence demonstrating similar improvements in physical activity (SMD -0.03, 95% CI -0.60 to 0.54), fitness (SMD 0.17, 95% CI -0.14 to 0.48), walking capacity (SMD 0.78, 95% CI -0.6 to 0.54), fatigue (SMD -0.11, 95% CI -0.55 to 0.33) and quality of life (SMD 0.17, 95% CI -0.17 to 0.50) when comparing earlier to later initiation. No differences were found in hospital length of stay (MD 0 days, 95% CI -0.9 to 0.9). CONCLUSION:People with cancer can achieve comparable health benefits, regardless of when exercise rehabilitation is initiated. SYSTEMATIC REVIEW REGISTRATION NUMBER:PROSPERO Registration Number CRD42024518878. CONTRIBUTION OF PAPER.

Background:Exercise-based rehabilitation is recommended as best-practice cancer care. However, implementing such programs is challenging. This review evaluated the availability and content of exercise-based cancer rehabilitation programs worldwide.Methods:A systematic review of surveys and/or qualitative studies evaluating the number and/or content of cancer-specific, exercise-based rehabilitation programs was conducted. Electronic databases-MEDLINE, CINAHL, EMBASE, and PEDro-were searched from their inception to October 2023. Data were extracted independently by two reviewers. The quality of evidence was assessed using the Risk of Bias Instrument for Cross-Sectional Surveys of Attitudes and Practices. Quantitative data were analyzed descriptively; qualitative data reporting implementation challenges and facilitators were analyzed using content analysis.Methods:A systematic review of surveys and/or qualitative studies evaluating the number and/or content of cancer-specific, exercise-based rehabilitation programs was conducted. Electronic databases-MEDLINE, CINAHL, EMBASE, and PEDro-were searched from their inception to October 2023. Data were extracted independently by two reviewers. The quality of evidence was assessed using the Risk of Bias Instrument for Cross-Sectional Surveys of Attitudes and Practices. Quantitative data were analyzed descriptively; qualitative data reporting implementation challenges and facilitators were analyzed using content analysis.Results:Data from 13 high-income countries (n = 25 studies) identified 2111 exercise-based cancer rehabilitation programs. Most were multidisciplinary programs (88%) for adult cancer survivors, usually for breast, lung and gastrointestinal cancer at any stage of cancer treatment. On average, programs ran twice-weekly up to 8 weeks using a group format, but exercise content was poorly reported. The main facilitators of program implementation were having exercise specialists as part of the cancer care team and strong links between hospitals and the community. Programs with strong evidence also facilitated translation. Key barriers were a lack of resources and skilled staff.Conclusion:Moderate-quality evidence indicates that few exercise-based cancer rehabilitation programs exist globally. However, the availability of cancer rehabilitation is likely greater than reported due to inadequate quality and the scarcity of national reports. Improved reporting of exercise programs could assist in standardizing care.

OBJECTIVES:This trial aimed to provide estimates of effect and feasibility of a physical activity intervention for hospitalized cancer survivors using smartwatches for goal-setting and feedback. DESIGN:A feasibility, single-blinded, randomized trial. SETTING:Acute cancer unit in a tertiary hospital. PARTICIPANTS:Adult hospitalized cancer survivors undergoing cancer treatment (n = 24). INTERVENTIONS:Participants were randomized to usual care or 2 sessions of a behavioural intervention using goal setting and feedback. MAIN OUTCOME MEASURES:Blinded assessments occurred at admission (T0), discharge (T1) and 4-weeks post-discharge (T2). The primary outcome was accelerometer-measured daily step count and sedentary time. Secondary measures evaluated feasibility (demand, implementation, acceptability, practicality), mobility, self-efficacy, and health service outcomes. RESULTS:The trial was hampered by low recruitment rate (n = 24, 29% of target). There were moderate estimates of effect favouring the experimental group for mobility at T1 (mean difference [MD] 11 points, 95% CI -1 to 22). No other effects favored the experimental group. Estimates of step counts (T1 MD -284, 95% CI -1491 to +943; T2 -2249, 95% CI -6062 to +1565) and sedentary time (T1 MD +0.9 hours, 95% CI +0.1 to +2; T2 +2.8 hours, 95% CI -0.3 to +5.2) favored the usual care group. There was no difference in health service outcomes. The intervention was well accepted and no adverse events occurred. CONCLUSION:A physical activity intervention for cancer survivors admitted to hospital was safe and acceptable but slow recruitment and uncertainty surrounding its efficacy hampered trial feasibility. Future trials should consider whole-of-ward interventions using novel trial designs. TRIAL REGISTRATION:ACTRN12622001007729. CONTRIBUTION OF THE PAPER.

Exercise and nutrition interventions are not part of routine care for those undergoing autologous stem cell transplant (autoSCT). We aimed to explore estimates of effect, safety and feasibility of multidisciplinary prehabilitation for improving physical capacity after autoSCT. This single-blinded, parallel, two-armed pilot randomized trial included adults receiving autoSCT. Participants were randomized to twice-weekly, supervised, tailored exercise and fortnightly telephone-based nutrition education, for up to 8-weeks prior to autoSCT (n = 11) or usual care (n = 11). Blinded assessments occurred at baseline (T0), pre-transplant (T1), and 4-weeks post-transplant (T2). The primary outcome was physical capacity (6-min walk test). Secondary measures included recruitment rate, adverse events, exercise adherence, physical status, nutritional status, health-related quality of life, and health service outcomes. Positive estimates of effect for walking capacity in favour of the experimental group were demonstrated at T2 (MD + 141 m, 95

INTRODUCTION:Shoulder pathology is common, with many people referred for general radiography examinations. In performing these examinations, radiographers have a choice of more than 15 views to demonstrate the anatomy and pathology. The lack of guidelines for the best combination of orthogonal views in specific scenarios raises concerns for effectiveness, efficiency, and radiation safety. The aim of this study was to gain an understanding of the current practice by radiographers across Australia. METHODS:A national, cross-sectional online survey obtained data on the views and combination of views, (protocols) preferred by Australian radiographers across five common pathological presentations. The data were analysed descriptively. RESULTS:Data from 164 radiographers found a wide variation in shoulder imaging preferences; however, some common shoulder imaging protocols were identified for shoulder trauma presentations. The most variation and highest number of imaging protocols selected were for shoulder arthritis and impingement. Trauma and glenohumeral dislocation had the least variation and number of views selected. The three most common views across all pathologies were lateral Y scapula, anteroposterior general survey (neutral rotation), and true anteroposterior/Grashey (internal rotation). Radiographers working in private settings selected more views than those in public settings. CONCLUSION:This study demonstrates a wide variation in image preferences of Australian radiographers performing shoulder imaging. However, some common shoulder imaging protocols were identified for shoulder trauma presentations. Greater standardisation of shoulder imaging protocols may reduce unnecessary patient risk and improve the patient experience.

ABSTRACT Introduction X‐rays of bone fractures immobilised with Plaster of Paris (POP) produce images of reduced diagnostic quality due to the increased density and irregular pattern of the POP overlying the anatomy of interest. Post‐processing parameters in digital radiography (DR) can be applied to POP images to increase diagnostic quality without increasing radiation dose. The aim of this study was to evaluate the preferred image quality of POP immobilised distal radius fractures using optimised digital image manipulation algorithms. Methods A cross‐sectional, quantitative survey study was conducted between November 2021 and December 2023 at a large metropolitan health network. The manufacturer standard algorithm and three new image post‐processing algorithms were applied to pre‐selected image sets. Orthopaedic surgeons ( n = 34) and radiologists ( n = 35) were surveyed to rank image quality of 10 random image sets (80 images in total). Data were described and analysed using median rankings, Mann–Whitney U tests and Friedman rank tests with post hoc Wilcoxin rank tests. Results A total of 13 orthopaedic surgeons and 14 radiologists participated. A highly enhanced algorithm using contrast boost (Algorithm D) was the most preferred set ( n = 18/27) due to better visibility of bony detail and fracture sites. There was no difference in rankings between clinician groups. Conclusion In this single site survey, both orthopaedic surgeons and radiologists preferred the highly enhanced post‐processing algorithm (D) indicating that image quality can be improved using optimised digital manipulation. POP post‐processing parameters with contrast boosting could be implemented to potentially increase diagnostic accuracy without increasing radiation dose for x‐ray imaging of the wrist with POP.

To perform a process evaluation of the acceptability, adoption, costs, feasibility, safety, timeliness, and satisfaction of a novel allied health program in Hospital in the Home (HITH) cancer services. A mixed-methods process evaluation using the proctor model for implementation was completed. Quantitative data from routinely collected service data, patient satisfaction surveys, and qualitative focus group data from cancer services’ staff over a 6-month period were analysed. Quantitative data were described, and qualitative data thematically analysed and mapped to seven key domains: acceptability, adoption, costs, feasibility, safety, timeliness, and satisfaction. A total of 90 adults with cancer were referred to the allied health program in HITH cancer services, of which 69 (77

INTRODUCTION:Clinical practice guidelines are an important mechanism for synthesising evidence for healthcare providers, but implementing the required changes in procedures to align with evidence in nuclear medicine and other healthcare fields is challenging. This study aimed to describe and evaluate an implementation strategy combining principles of implementation science with a modified quality improvement framework to efficiently align clinical guideline recommendations with practice for the timing of parathyroid scintigraphy scan phases, in a public hospital nuclear medicine service. METHODS:A structured process using a framework based on a modified version of the A3 tool for improvement tailored for evidence translation using implementation science principles was used to close the gap between practice and evidence-based guidelines. Barriers to translation were explored and an implementation strategy developed. The impact of the change was evaluated using a pre-post audit of routinely collected data. RESULTS:Working through the modified A3 framework, the team identified barriers including lack of alignment between the local protocol and European Association of Nuclear Medicine (EANM) guidelines; lack of knowledge of the guidelines among nuclear medicine technologists; scheduling barriers; and resistance from physicians. Targeted strategies were successfully implemented to address these barriers focusing on the COM-B domains of capability (education), opportunity (update to policies and procedures) and motivation (feedback and celebration of success). The audit of delayed scan timing indicated improved compliance with the EANM guidelines from 18% pre-intervention to 98% post-intervention (OR 205.3, 95% CI 24.9 to 1691.7, p < 0.01). CONCLUSION:This study demonstrated successful implementation of updated recommendations from the EANM guideline in a nuclear medicine department of a large metropolitan health network using a robust intervention for evidence translation. Similar approaches, bringing together elements of continuous improvement tools, implementation science and research methodology, could be used to improve other aspects of evidence-based practice in nuclear medicine.

INTRODUCTION:Few exercise-based oncology rehabilitation programs were available across Australia in 2015. Clinical guidelines have since recommended that exercise be included in standard cancer care. This study aimed to (1) identify and describe exercise-based oncology rehabilitation programs in Australia, (2) determine whether there have been changes in the number or content of programs since 2015, and (3) describe factors associated with program implementation. METHODS:A cross-sectional survey collected data from program coordinators of Australian oncology rehabilitation programs. Quantitative data were analysed descriptively and using independent t-tests and chi-squared tests. Qualitative data underwent content analysis. RESULTS:The number of oncology rehabilitation programs in Australia increased from 31 programs in 2015 to 76 programs in 2024, equating to an 88% increase from 8 to 15 programs per 100,000 cancer survivors. Sixty-two completed surveys were returned (62/76, 82% response rate). Programs were typically for people with any cancer at any stage of treatment. The proportion of programs offering education decreased by 29% since 2015 [χ2(1) = 6.011, p = 0.014]. On average, programs ran three times per week (standard deviation [SD] 4) for 11 weeks (SD 10). There was increased use of exercise testing in 2024. Program implementation was supported by an increasing presentation of cancer survivors in general rehabilitation programs (30/62, 48%) and challenged by a lack of funding (27/62, 44%). CONCLUSION:Oncology rehabilitation programs in Australia have more than doubled in the past decade, but availability remains poor. Programs were mainly exercise-only, with an increased use of objective criteria for exercise dosage and progression.

People who experience a stroke are at a higher risk of recurrent stroke when compared with people who have not had a stroke. Addressing modifiable risk factors like physical inactivity and poor diet has been shown to improve blood pressure, a leading contributor to stroke. However, survivors of stroke often experience challenges with accessing risk reduction services including long wait lists, difficulty with transportation, fatigue, impaired function, and diminished exercise capacity. Providing health interventions via a website can extend the reach when compared with programs that are only offered face to face or via real-time telehealth. Given global challenges of accessing secondary prevention programs, it is important to consider alternative ways that this information can be made available to survivors of stroke worldwide. Using the “design thinking” framework and drawing on principles of the integrated knowledge translation approach, we adapted 2 co-designed telehealth programs called i-REBOUND – Let’s get moving (physical activity intervention) and i-REBOUND – Eat for health (diet Intervention) to create the i-REBOUND after stroke website. The aim of this paper is to describe the systematic process undertaken to adapt resources from the telehealth delivered i-REBOUND – Let’s get moving and i-REBOUND – Eat for health programs to a website prototype with a focus on navigation requirements and accessibility for survivors of stroke. We engaged a variety of key stakeholders with diverse skills and expertise in areas of stroke recovery, research, and digital health. We established a governance structure, formed a consumer advisory group, appointed a diverse project team, and agreed on scope of the project. Our process of adaptation had the following 3 phases: (1) understand, (2) explore, (3) materialize. Our approach considered the survivor of stroke at the center of all decisions, which helped establish guiding principles related to our prototype design. Careful and iterative engagement with survivors of stroke together with the application of design thinking principles allowed us to establish the functional requirements for our website prototype. Through user testing, we were able to confirm the technical requirements needed to build an accessible and easy-to-navigate website catering to the unique needs of survivors of stroke. We describe the process of adapting existing content and co-creating new digital content in partnership with, and featuring, people who have lived experience of stroke. In this paper, we provide a road map for the steps taken to adapt resources from 2 telehealth-delivered programs to a website format that meets specific navigation and accessibility needs of survivors of stroke.

Background: Myocardial perfusion imaging (MPI) is a wellestablished, non-invasive imaging procedure for the diagnosis and evaluation of patients with known or suspected coronary artery disease. With the increasing use of pharmacologic stress agents in myocardial perfusion imaging, strict preparation, including caffeine abstinence, is required. The aim of this review was to determine the effect of caffeine consumed prior to nuclear cardiac stress testing on the diagnostic accuracy. Methods: Medline, Embase and CINAHL were searched from the earliest available time until August 2022. Methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies version 2. Data pertaining to diagnostic accuracy were analysed using meta-analysis where appropriate and overall certainty of evidence evaluated using the Grades of Research, Assessment, Development and Evaluation approach. Results: Six studies (307 participants) from a yield of 735 articles were identified. Meta-analysis of two studies found no difference in the left ventricular ejection fraction of patients pre and post caffeine consumption (MD -0.31 %, 95% CI -4.32% to 3.7%). Meta-analysis of three studies found there was uncertainty as to whether caffeine consumption affected reversibility (MD -2.16 segments 95% CI -4.61 to 0.28) and descriptive summary of three studies found mixed results for size of stress defects. Conclusion: The low quality evidence synthesized in this systematic review suggests caffeine may affect the diagnostic accuracy in myocardial perfusion imaging for ischemia detection in patients with chest pain and intermediate-to-high risk of coronary artery disease.

INTRODUCTION:In-person physiotherapy services are not readily available to all individuals with musculoskeletal conditions, especially those in rural regions or with time-intensive responsibilities. The COVID-19 pandemic highlighted that telehealth may facilitate access to, and continuity of care, yet many physiotherapists lack telehealth confidence and training. This project co-developed and evaluated a web-based professional development toolkit supporting physiotherapists to provide telehealth services for musculoskeletal conditions.METHODS:A mixed-methods exploratory sequential design applied modified experience-based co-design methods (physiotherapists [n = 13], clinic administrators [n = 2], and people with musculoskeletal conditions [n = 7]) to develop an evidence-informed toolkit. Semi-structured workshops were conducted, recorded, transcribed, and thematically analysed, refining the toolkit prototype. Subsequently, the toolkit was promoted via webinars and social media. The usability of the toolkit was examined with pre-post surveys examining changes in confidence, knowledge, and perceived telehealth competence (19 statements modelled from the theoretical domains framework) between toolkit users (>30 min) and non-users (0 min) using chi-squared tests for independence. Website analytics were summarised.RESULTS:Twenty-two participants engaged in co-design workshops. Feedback led to the inclusion of more patient-facing resources, increased assessment-related visual content, streamlined toolkit organisation, and simplified, downloadable infographics. Three hundred and twenty-nine physiotherapists from 21 countries completed the baseline survey, with 172 (52%) completing the 3-month survey. Toolkit users had greater improvement in knowledge, confidence, and competence than non-users in 42% of statements. Seventy-two percentage of toolkit users said it changed their practice, and 95% would recommend the toolkit to colleagues. During the evaluation period, the toolkit received 5486 total views.DISCUSSION:The co-designed web-based Musculoskeletal Telehealth Toolkit is a professional development resource that may increase physiotherapist's confidence, knowledge, and competence in telehealth.