OBJECTIVE:Acute Charcot neuro-osteoarthropathy (CN) is highly destructive, causing bone and joint damage that can result in devastating structural changes to the foot. The objective of this study was to determine the characteristics of assessment, diagnosis and management of people with acute CN attending a large regional Australian health service. DESIGN:Three-year retrospective medical record audit. SETTING:Large regional health service with catchment area of >250 000 people in regional Australia. PARTICIPANTS:People with acute CN who attended emergency, orthopaedic clinics or High Risk Foot Clinic (HRFC). MAIN OUTCOME MEASURES:Participant characteristics and acute CN assessment, diagnosis and management characteristics. Trends in characteristics were investigated according to rurality as measured by the Modified Monash Model (MMM) scale. RESULTS:Seventeen participants (20 presentations) of acute CN were identified. Mean age was 57.1 ± 10.8 years, with 11 female participants. Median duration to seek help was 31 (IQR 14-47) days. Total Contact Casting was undertaken for 85% of cases, with those who resided in MMM1-2 regions experienced significantly shorter time to TCC therapy compared to those residing in MMM3-7 regions (U = 3.0, p < 0.01). Resolution of acute CN with or without deformity occurred in 70% of cases. CONCLUSIONS:Those who lived in smaller regional and rural communities were more likely to experience delayed access to gold standard treatment for acute CN. Regional models of care for acute CN should include activities to improve the knowledge of people at risk of acute CN about the condition and upskill regional health professionals for timely and local TCC therapy.

AbstractIntroductionCharcot neuroarthropathy (CN) can result in fractures and dislocations of the foot and ankle in individuals with diabetes and neuropathy, leading to ulceration, amputation and a poor quality of life. Additional episodes of acute CN can lead to extended periods of physical and psychosocial distress. The aim of this scoping review was to identify and synthesise the evidence relating to factors associated with the development of recurrent and contralateral Charcot neuroarthropathy (CN) in individuals with diabetes.MethodsA systematic search of four electronic databases was conducted from inception to February 06, 2023. All relevant study designs, except single case studies, that had been published in full in peer‐reviewed journals were included. Studies were excluded if they were not published in English and did not provide data on individuals with diabetes.ResultsThe search identified two studies that investigated factors associated with the development of recurrent CN, but none that related to the development of contralateral CN. Ten factors were investigated for association with recurrent CN development: age, body mass index, diabetes type and duration, glycated haemoglobin, anatomical site affected, duration of offloading applied to treat the primary CN episode, use of pharmacological intervention, severity of neuropathy, and skin temperature. However, no significant associations were reported.ConclusionsThere is an alarming lack of evidence‐based findings in this research area to guide practice. Clearly, more research in the form of rigorous prospective studies is urgently required to identify risk factors for the development of recurrent and contralateral CN in individuals with diabetes.

AbstractBackgroundDiabetes‐related foot disease (DFD) is a leading cause of the Australian and global disease burdens and requires proportionate volumes of research to address. Bibliometric analyses are rigorous methods for exploring total research publications in a field to help identify volume trends, gaps and emerging areas of need. This bibliometric review aimed to explore the volume, authors, institutions, journals, collaborating countries, research types and funding sources of Australian publications investigating DFD over 50 years.MethodsA systematic search of the Scopus® database was conducted by two independent authors to identify all Australian DFD literature published between 1970 and 2023. Bibliometric meta‐data were extracted from Scopus®, analyzed in Biblioshiny, an R Statistical Software interface, and publication volumes, authors, institutions, journals and collaborative countries were described. Publications were also categorised for research type and funding source.ResultsOverall, 332 eligible publications were included. Publication volume increased steadily over time, with largest volumes (78%) and a 7‐fold increase over the last decade. Mean co‐authors per publication was 5.6, mean journal impact factor was 2.9 and median citation was 9 (IQR2‐24). Most frequent authors were Peter Lazzarini (14%), Vivienne Chuter (8%) and Jonathon Golledge (7%). Most frequent institutions affiliated were Queensland University Technology (33%), University Sydney (30%) and James Cook University (25%). Most frequent journals published in were Journal Foot and Ankle Research (17%), Diabetic Medicine (7%), Journal Diabetes and its Complications (4%) and International Wound Journal (4%). Most frequent collaborating countries were the United Kingdom (9%), the Netherlands (6%) and the United States (5%). Leading research types were etiology (38%), treatment evaluation (25%) and health services research (13%). Leading funding sources were no funding (60%), internal institution (16%) and industry/philanthropic/international (10%).ConclusionsAustralian DFD research increased steadily until more dramatic increases were seen over the past decade. Most research received no funding and mainly investigated etiology, existing treatments or health services. Australian DFD researchers appear to be very productive, particularly in recent times, despite minimal funding indicating their resilience. However, if the field is to continue to rapidly grow and address the very large national DFD burden, much more research funding is needed in Australia, especially targeting prevention and clinical trials of new treatments in DFD.

Regular physical activity is an important component of diabetes management. However, there are limited data on the habitual physical activity of people with or at risk of diabetes-related foot complications. The aim of this study was to describe the habitual physical activity of people with or at risk of diabetes-related foot complications in regional Australia. Twenty-three participants with diabetes from regional Australia were recruited with twenty-two participants included in subsequent analyses: no history of ulcer (N = 11) and history of ulcer (N = 11). Each participant wore a triaxial accelerometer (GT3X+; ActiGraph LLC, Pensacola, FL, USA) on their non-dominant wrist for 14 days. There were no significant differences between groups according to both participant characteristics and physical activity outcomes. Median minutes per day of moderate-to-vigorous physical activity (MVPA) were 9.7 (IQR: 1.6–15.7) while participants recorded an average of 280 ± 78 min of low-intensity physical activity and 689 ± 114 min of sedentary behaviour. The sample accumulated on average 30 min of slow walking and 2 min of fast walking per day, respectively. Overall, participants spent very little time performing MVPA and were largely sedentary. It is important that strategies are put in place for people with or at risk of diabetes-related foot complications in order that they increase their physical activity significantly in accordance with established guidelines.

Diabetic foot ulceration (DFU) is common and highly recurrent, negatively impacting the individuals' quality of life. The 2023 guidelines of the International Working Group on the Diabetic Foot emphasise that adherence to foot self-care recommendations is one of the most important factors in DFU prevention. These guidelines also briefly mention that depression and other psychosocial problems can hamper treatment and ulcer healing. Moreover, a new clinical question was added on psychological interventions for ulcer prevention, although the evidence regarding the role of psychological and social factors is still limited. To help the field progress, this narrative overview discusses how a stronger focus on psychological factors by both researchers and clinicians could improve the care for people at high DFU risk. The review starts with a testimony of a person living with DFU, explaining that for him, the absence of shared decision-making has been a key barrier to successful foot self-care implementation. Intervention studies that address patient-reported barriers are still scarce, and are therefore urgently needed. Furthermore, the key elements of psychological interventions found to be successful in managing diabetes are yet to be implemented in DFU risk management. Importantly, research evidence indicates that commonly advocated foot self-care recommendations may be insufficient in preventing DFU recurrence, whereas digital technology appears to effectively reduce recurrent DFU. More research is therefore needed to identify determinants of patient acceptance of digital technology.

Australian Journal of Rural HealthVolume 31, Issue 4 p. 785-787 LETTER TO THE EDITOR Let us not forget what the Romans did do—The impact of RHMT Lisa Bourke BSc, BSW, MSc, PhD, Corresponding Author Lisa Bourke BSc, BSW, MSc, PhD [email protected] orcid.org/0000-0003-0411-6193 Department of Rural Health, University of Melbourne, Shepparton, Victoria, Australia Correspondence Lisa Bourke, Department of Rural Health, University of Melbourne, Shepparton, Victoria, Australia. Email: [email protected] Contribution: Conceptualization, Writing - original draft, Writing - review & editingSearch for more papers by this authorAnthea Brand BSc(Hons), MSc(N&D), PhD, APD, Anthea Brand BSc(Hons), MSc(N&D), PhD, APD Department of Rural Health (NT), Flinders University, Alice Springs, South Australia, Australia Contribution: Writing - review & editing, ConceptualizationSearch for more papers by this authorChristine Howard BSocSci, Dip.App.Sc, Mid, Christine Howard BSocSci, Dip.App.Sc, Mid Three Rivers Department of Rural Health, Charles Sturt University, Wagga Wagga, New South Wales, Australia Contribution: Writing - review & editing, Resources, ConceptualizationSearch for more papers by this authorRobyn Aitken RN, Cert Anaes & RR, BEd.St., PhD, Robyn Aitken RN, Cert Anaes & RR, BEd.St., PhD Rural and Remote Health Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia Contribution: Writing - review & editingSearch for more papers by this authorGeoff Argus BSc(Hons, H1), MPsych(Clin), Geoff Argus BSc(Hons, H1), MPsych(Clin) orcid.org/0000-0001-6849-1262 Southern Queensland Rural Health, Toowoomba, Queensland, Australia Contribution: Writing - review & editingSearch for more papers by this authorLeanne J Brown BHSc(N&D), GradCert Paed(N&D), GradCert Sports Nutrition, PhD, AdvAPD, Leanne J Brown BHSc(N&D), GradCert Paed(N&D), GradCert Sports Nutrition, PhD, AdvAPD orcid.org/0000-0002-4340-2320 Department of Rural Health, University of Newcastle, Tamworth, New South Wales, Australia Contribution: Writing - review & editingSearch for more papers by this authorJames Debenham BScPhysio(Hons), MSc(MT), PhD, James Debenham BScPhysio(Hons), MSc(MT), PhD Majarlin Kimberley Centre for Remote Health, The University of Notre Dame, Broome, Western Australia, Australia Contribution: Writing - review & editingSearch for more papers by this authorCatrina Felton-Busch BA, MPH, GradCert PHC Res, Catrina Felton-Busch BA, MPH, GradCert PHC Res Murtupuni Centre for Rural and Remote Health, James Cook University, Mount Isa, Queensland, Australia Contribution: Writing - review & editingSearch for more papers by this authorVicki Flood BApppSc, GradDip Nutr&Diet, MPH, PhD, Vicki Flood BApppSc, GradDip Nutr&Diet, MPH, PhD Northern Rivers University Department for Rural Health, University of Sydney, Lismore, New South Wales, Australia Contribution: Writing - review & editingSearch for more papers by this authorDebra Jones RN, BHSc(Gerontology), GradDip Aged Service Management, Masters of Indigenous Health (with Distinction), PhD, Debra Jones RN, BHSc(Gerontology), GradDip Aged Service Management, Masters of Indigenous Health (with Distinction), PhD Broken Hill University Department of Rural Health, University of Sydney, Broken Hill, New South Wales, Australia Contribution: Writing - review & editingSearch for more papers by this authorMartin Jones RN, MSc, D'Proff, Martin Jones RN, MSc, D'Proff orcid.org/0000-0002-6463-3574 Department of Rural Health, University of South Australia, Whyalla, South Australia, Australia Contribution: Writing - review & editingSearch for more papers by this authorSabina Knight RN, MTH, Sabina Knight RN, MTH orcid.org/0000-0002-9245-1428 Central Queensland Centre for Rural and Remote Health, James Cook University, Emerald, Queensland, Australia Contribution: Writing - review & editingSearch for more papers by this authorByron Perrin BPod, MHlthSc, PhD, Byron Perrin BPod, MHlthSc, PhD La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia Contribution: Writing - review & editingSearch for more papers by this authorSandra Thompson BSc(Med)(Hons), MBBS(Hons), PhD, MPH, FAFPHM, GradDip Health Management, Sandra Thompson BSc(Med)(Hons), MBBS(Hons), PhD, MPH, FAFPHM, GradDip Health Management orcid.org/0000-0003-0327-7155 Western Australia Centre for Rural Health, Geraldton, Western Australia, Australia Contribution: Writing - review & editingSearch for more papers by this authorVincent Versace BSc(Hons, H1), PhD, Vincent Versace BSc(Hons, H1), PhD orcid.org/0000-0002-8514-1763 Department of Rural Health, Deakin University, Warrnambool, Victoria, Australia Contribution: Writing - review & editingSearch for more papers by this author Lisa Bourke BSc, BSW, MSc, PhD, Corresponding Author Lisa Bourke BSc, BSW, MSc, PhD [email protected] orcid.org/0000-0003-0411-6193 Department of Rural Health, University of Melbourne, Shepparton, Victoria, Australia Correspondence Lisa Bourke, Department of Rural Health, University of Melbourne, Shepparton, Victoria, Australia. Email: [email protected] Contribution: Conceptualization, Writing - original draft, Writing - review & editingSearch for more papers by this authorAnthea Brand BSc(Hons), MSc(N&D), PhD, APD, Anthea Brand BSc(Hons), MSc(N&D), PhD, APD Department of Rural Health (NT), Flinders University, Alice Springs, South Australia, Australia Contribution: Writing - review & editing, ConceptualizationSearch for more papers by this authorChristine Howard BSocSci, Dip.App.Sc, Mid, Christine Howard BSocSci, Dip.App.Sc, Mid Three Rivers Department of Rural Health, Charles Sturt University, Wagga Wagga, New South Wales, Australia Contribution: Writing - review & editing, Resources, ConceptualizationSearch for more papers by this authorRobyn Aitken RN, Cert Anaes & RR, BEd.St., PhD, Robyn Aitken RN, Cert Anaes & RR, BEd.St., PhD Rural and Remote Health Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia Contribution: Writing - review & editingSearch for more papers by this authorGeoff Argus BSc(Hons, H1), MPsych(Clin), Geoff Argus BSc(Hons, H1), MPsych(Clin) orcid.org/0000-0001-6849-1262 Southern Queensland Rural Health, Toowoomba, Queensland, Australia Contribution: Writing - review & editingSearch for more papers by this authorLeanne J Brown BHSc(N&D), GradCert Paed(N&D), GradCert Sports Nutrition, PhD, AdvAPD, Leanne J Brown BHSc(N&D), GradCert Paed(N&D), GradCert Sports Nutrition, PhD, AdvAPD orcid.org/0000-0002-4340-2320 Department of Rural Health, University of Newcastle, Tamworth, New South Wales, Australia Contribution: Writing - review & editingSearch for more papers by this authorJames Debenham BScPhysio(Hons), MSc(MT), PhD, James Debenham BScPhysio(Hons), MSc(MT), PhD Majarlin Kimberley Centre for Remote Health, The University of Notre Dame, Broome, Western Australia, Australia Contribution: Writing - review & editingSearch for more papers by this authorCatrina Felton-Busch BA, MPH, GradCert PHC Res, Catrina Felton-Busch BA, MPH, GradCert PHC Res Murtupuni Centre for Rural and Remote Health, James Cook University, Mount Isa, Queensland, Australia Contribution: Writing - review & editingSearch for more papers by this authorVicki Flood BApppSc, GradDip Nutr&Diet, MPH, PhD, Vicki Flood BApppSc, GradDip Nutr&Diet, MPH, PhD Northern Rivers University Department for Rural Health, University of Sydney, Lismore, New South Wales, Australia Contribution: Writing - review & editingSearch for more papers by this authorDebra Jones RN, BHSc(Gerontology), GradDip Aged Service Management, Masters of Indigenous Health (with Distinction), PhD, Debra Jones RN, BHSc(Gerontology), GradDip Aged Service Management, Masters of Indigenous Health (with Distinction), PhD Broken Hill University Department of Rural Health, University of Sydney, Broken Hill, New South Wales, Australia Contribution: Writing - review & editingSearch for more papers by this authorMartin Jones RN, MSc, D'Proff, Martin Jones RN, MSc, D'Proff orcid.org/0000-0002-6463-3574 Department of Rural Health, University of South Australia, Whyalla, South Australia, Australia Contribution: Writing - review & editingSearch for more papers by this authorSabina Knight RN, MTH, Sabina Knight RN, MTH orcid.org/0000-0002-9245-1428 Central Queensland Centre for Rural and Remote Health, James Cook University, Emerald, Queensland, Australia Contribution: Writing - review & editingSearch for more papers by this authorByron Perrin BPod, MHlthSc, PhD, Byron Perrin BPod, MHlthSc, PhD La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia Contribution: Writing - review & editingSearch for more papers by this authorSandra Thompson BSc(Med)(Hons), MBBS(Hons), PhD, MPH, FAFPHM, GradDip Health Management, Sandra Thompson BSc(Med)(Hons), MBBS(Hons), PhD, MPH, FAFPHM, GradDip Health Management orcid.org/0000-0003-0327-7155 Western Australia Centre for Rural Health, Geraldton, Western Australia, Australia Contribution: Writing - review & editingSearch for more papers by this authorVincent Versace BSc(Hons, H1), PhD, Vincent Versace BSc(Hons, H1), PhD orcid.org/0000-0002-8514-1763 Department of Rural Health, Deakin University, Warrnambool, Victoria, Australia Contribution: Writing - review & editingSearch for more papers by this author First published: 25 July 2023 https://doi.org/10.1111/ajr.13023Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. REFERENCES 1Skinner TC. What have the Romans ever done for us? Aust J Rural Health. 2023; 31(2): 169–170. https://doi.org/10.1111/ajr.12990 2Gausia K, Thompson SC, Lindeman MA, Brown LJ, Perkins D. Contribution of university departments of rural health to rural health research: an analysis of outputs. Aust J Rural Health. 2015; 23(2): 101–106. https://doi.org/10.1111/ajr.12142 3O'Sullivan B, Cairns A, Gurney T. Exploring how to sustain ‘place-based’ rural health academic research for informing rural health systems: a qualitative investigation. Health Res Policy Sys. 2020; 18: 90. https://doi.org/10.1186/s12961-020-00608-7 4Lyle D, Greenhill J. Two decades of building capacity in rural health education, training and research in Australia: university departments of rural health and rural clinical schools. 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Independent evaluation of the Rural Health Multidisciplinary Training Program; Final Report to the Commonwealth Department of Health. 2020. Available from: https://www.health.gov.au/resources/publications/evaluation-of-the-rural-health-multidisciplinary-training-rhmt-program. Accessed 25 Aug 2020. 9Wakerman J, Humphreys JS, Wells R, Kuipers P, Entwistle P, Jones J. Primary health care delivery models in rural and remote Australia – a systematic review. BMC Health Serv Res. 2008; 8:276. https://doi.org/10.1186/1472-6963-8-276 10 Australian Institute of Health and Welfare. Rural and remote health. Canberra: Australian Institute of Health and Welfare; 2022 [Accessed 20 June 2023]. Available from: https://www.aihw.gov.au/reports/rural-remote-australians/rural-and-remote-health Volume31, Issue4August 2023Pages 785-787 ReferencesRelatedInformation

Background: Removable cast walkers (RCWs), with or without modifications, are used to offload diabetes-related foot ulcers (DRFUs), however there is limited data relating to their offloading effects. This study aimed to quantify plantar pressure reductions with an RCW with and without modification for DRFUs. Methods: This within-participant, repeated measures study included 16 participants with plantar neuropathic DRFUs. Walking peak plantar pressures at DRFU sites were measured for four conditions: post-operative boot (control condition), RCW alone, RCW with 20 mm of felt adhered to an orthosis, and RCW with 20 mm of felt adhered to the foot. Results: Compared to the control condition, the greatest amount of peak plantar pressure reduction occurred with the RCW with felt adhered to the foot (83.1% reduction, p < .001). The RCW with felt adhered to the foot also offered greater peak plantar pressure reduction than the RCW alone (51.3%, p = .021) and the RCW with felt adhered to an orthosis (31.4%, p = .009). Conclusion: The largest offloading effect recorded was with the RCW with felt adhered to the foot. High-quality randomised trials are now needed to evaluate the effectiveness of this device for healing DRFUs.

OBJECTIVE:To explore and describe strategies to enhance the implementation of an organisational clinical supervision framework and subsequently inform the development of a model of implementation of clinical supervision for allied health professionals in a regional health care setting.SETTING:A large regional health service in Victoria, providing hospital, rehabilitation, community, mental health and aged care services.PARTICIPANTS:Allied health managers employed at the health service were members of an action research group.DESIGN:This longitudinal study used an action research approach. The action research group informed the repeated cycles of planning, action and reflection. Data from recorded action research meetings were analysed using content analysis.RESULTS:The action research group met 11 times over a 5-year period informing four action research cycles. Six main themes relating to factors that enhanced the quality of clinical supervision emerged from the analysis of the action research group data: purpose and value of clinical supervision; clinical supervision characteristics; differences between disciplines; framework development; training and support and implementation of clinical supervision.CONCLUSION:The findings from this comprehensive longitudinal study provide evidence-based approaches to the implementation of allied health clinical supervision. The action research approach used ensures that the strategies described are realistic and sustainable. A model has been developed to inform the implementation of clinical supervision for allied health.

The health-related quality of life (HRQoL) of people with diabetes-related foot complications has been increasingly reported, mostly from studies of people with a foot ulcer. The aim of this study was to assess HRQoL and determine factors associated with HRQoL in people with diabetes at high risk of foot ulceration. In all, 304 participants enrolled in the Diabetic Foot Temperature Trial (DIATEMP) were included in the cross-sectional analysis. HRQoL was measured by the RAND® 36-Item Short Form Health Survey (SF-36) at baseline. Potential factors associated with HRQoL were analysed using multiple linear regression analyses for the eight domains of the SF-36. Participants were predominantly male (72%), mean age 64.6 (±10.5) years, 77% type 2 diabetes and mean duration of diabetes 20 (±14) years. Mean SF-36 domain scores for the General Health (49.2 ± 20.1), Role Physical (50.9 ± 44.7), Physical Function (58.5 ± 27.9) and Vitality domains (59.8 ± 21.6) were lower compared to the Mental Health (78.4 ± 18.0), Social Functioning (75.3 ± 24.2), Role Emotional (73.5 ± 38.9) and Bodily Pain (67.0 ± 27.0) domains. HRQoL was lower than Dutch population-based and general diabetes samples, but higher than in samples with an ulcer. Use of a walking aid was associated with lower HRQoL across all 8 SF-36 domains (β range − 0.20 to − 0.50), non-Caucasian descent was associated with lower HRQoL in 5 domains (β range − 0.13 to − 0.17). Not working, higher BMI and younger age were associated with lower HRQoL in 3 domains. People at high risk of diabetes-related foot ulceration have reduced HRQoL that varies across domains, with the physical domains most affected. Assessing mobility, ethnicity, BMI and job status may be useful in daily practice to screen for people who might benefit from interventions targeting HRQoL. Netherlands Trial Registration: NTR5403. Registered on 8 September 2015.

Background and Objectives: Lifestyle interventions such as exercise prescription and education may play a role in the management of peripheral neuropathy in people with diabetes. The aim of this study was to determine the effect of undertaking an exercise program in comparison with an education program on the signs and symptoms of peripheral neuropathy in people with diabetes at risk of neuropathic foot ulceration. Materials and Methods: Twenty-four adult participants with diabetes and peripheral neuropathy were enrolled in this parallel-group, assessor blinded, randomised clinical trial. Participants were randomly allocated to one of two 8-week lifestyle interventions, exercise or education. The primary outcome measures were the two-part Michigan Neuropathy Screening Instrument (MNSI) and vibratory perception threshold (VPT). Secondary outcome measures included aerobic fitness, balance and lower limb muscular endurance. Results: Participants in both lifestyle interventions significantly improved over time for MNSI clinical signs (MD: −1.04, 95% CI: −1.68 to −0.40), MNSI symptoms (MD: −1.11, 95% CI: −1.89 to −0.33) and VPT (MD: −4.22, 95% CI: −8.04 to −0.40). Although the interaction effects did not reach significance, changes in values from pre to post intervention favoured exercise in comparison to control for MNSI clinical signs (MD −0.42, 95% CI −1.72 to 0.90), MNSI clinical symptoms (MD −0.38, 95% CI −1.96 to 1.2) and VPT (MD −4.22, 95% CI −12.09 to 3.65). Conclusions: Eight weeks of exercise training or lifestyle education can improve neuropathic signs and symptoms in people with diabetes and peripheral neuropathy. These findings support a role for lifestyle interventions in the management of peripheral neuropathy.

BACKGROUND:Clinical supervision makes an important contribution to high quality patient care and professional wellbeing for the allied health workforce. However, there is limited research examining the longitudinal implementation of clinical supervision for allied health. The aim of this study was to determine the effectiveness of clinical supervision for allied health at a regional health service and clinicians' perceptions of the implementation of an organisational clinical supervision framework.METHODS:A cross-sectional study was conducted as a phase of an overarching participatory action research study. The Manchester Clinical Supervision Scale (MCSS-26) tool was used to measure clinical supervision effectiveness with additional open-ended questions included to explore the implementation of the clinical supervision framework. MCSS-26 findings were compared with an initial administration of the MCSS-26 5 years earlier. MCSS-26 data (total scores, summed domain and sub-scale scores) were analysed descriptively and reported as mean and standard deviation values. Differences between groups were analysed with independent-samples t-test (t) and one-way between groups ANOVA.RESULTS:There were 125 responses to the survey (response rate 50%). The total MCSS-26 score was 78.5 (S.D. 14.5). The total MCSS-26 score was unchanged compared with the initial administration. There was a statistically significant difference in clinical supervision effectiveness between speech pathology and physiotherapy (F = 2.9, p = 0.03) and higher MCSS-26 scores for participants whose clinical supervisor was a senior clinician and those who chose their clinical supervisor. Seventy percent of participants perceived that the organisation's clinical supervision framework was useful and provided structure and consistent expectations for clinical supervision.CONCLUSIONS:Clinical supervision was effective for allied health in this regional setting and clinical supervision effectiveness was maintained over a 5 year period. The implementation of an organisational clinical supervision framework may have a positive effect on clinical supervision for some professions.

BACKGROUND:Acute Charcot Neuroarthropathy (CN) is a destructive condition that is characterised by acute fractures, dislocations and joint destruction in the weight-bearing foot. The acute phase is often misdiagnosed and can rapidly lead to devastating health outcomes. Early diagnosis and management of CN is imperative to attenuate progression of this condition. Consequently, timely evidence-based assessment, diagnosis and management of acute CN is imperative.OBJECTIVE:To identify the factors that impact the delivery of evidence-based care in assessment, diagnosis and management of people with acute CN.METHOD:Systematic searches were conducted in four databases to identify studies in English that included factors that impact the delivery of evidence-based care in the assessment, diagnosis and management of people with acute CN. Articles and consensus/guideline documents were assessed for inclusion by the researchers and disagreements were resolved through consensus. Additionally backward citation searching was used to source other potentially relevant documents. Information relevant to the research question was extracted and thematic analyses were performed using qualitative synthesis.RESULTS:Thirty-two articles and four additional consensus/guideline documents were included for data extraction and analyses. Information related to the research question was of expert opinion using the National Health and Medical Research Council (NHMRC) Levels of Evidence guidelines. Themes explaining practices that deviated from evidence-based care in assessment, diagnosis and management of acute CN centred around patient, health professional and health organisation/environmental. Delay to diagnosis is particularly influenced by the patient's knowledge of when to seek help, practitioner knowledge in knowing how to recognise and refer for appropriate immediate care, confusion in imaging and offloading and geographical and local health service resources to appropriately manage the condition.CONCLUSION:Individual and health professional awareness and geographical barriers are key challenges to the effective delivery of evidence-based assessment, diagnosis and management of people with acute CN. Acute CN represents a medical emergency warranting the need for expedited assessment, diagnosis and management by appropriately trained health professionals in the appropriate.

Introduction Diabetes-related foot disease is a large cause of the global disease burden yet receives very little research funding to address this large burden. To help address this gap, it is recommended to first identify the consensus priority research questions of relevant stakeholders, yet this has not been performed for diabetes-related foot disease. The aim of this study was to determine the national top 10 priority research questions for diabetes-related foot health and disease from relevant Australian stakeholders. Research design and methods A modified three-round Delphi online survey design was used to seek opinions from relevant Australian stakeholders including those with diabetes or diabetes-related foot disease or their carers (consumers), health professionals, researchers and industry. Participants were recruited via multiple public invitations and invited to propose three research questions of most importance to them (Round 1), prioritize their 10 most important questions from all proposed questions (Round 2), and then rank questions in order of importance (Round 3). Results After Round 1, a total of 226 unique questions were proposed by 210 participants (including 121 health professionals and 72 consumers). Of those participants, 95 completed Round 2 and 69 completed Round 3. The top 10 priority research questions covered a range of topics, including health economics, peripheral neuropathy, education, infection, technology, exercise, and nutrition. Consumers prioritized peripheral neuropathy and prevention-related questions. Health professionals prioritized management-related questions including Australia’s First Peoples foot health, health economics and infection questions. Conclusions These priority research questions should guide future national research agendas, funding and projects to improve diabetes-related foot disease burdens in Australia and globally. Future research should focus on consumer priority research questions to improve the burden of diabetes-related foot disease on patients and nations. Further research should also investigate reasons for different priorities between consumers and health professionals.

Background The challenges of providing and accessing quality health care in rural regions have long been identified. Innovative solutions are not only required but are also vital if effective, timely and equitable access to sustainable health care in rural communities is to be realised. Despite trial implementation of some alternative models of health care delivery, not all have been evaluated and their impacts are not well understood. The aim of this study was to explore the views of staff and stakeholders of a rural health service in relation to the implementation of an after-hours nurse practitioner model of health care delivery in its Urgent Care Centre. Methods This qualitative study included semi-structured individual and group interviews with professional stakeholders of a rural health service in Victoria, Australia and included hospital managers and hospital staff who worked directly or indirectly with the after-hours NPs in addition to local GPs, GP practice nurses, and paramedics. Thematic analysis was used to generate key themes from the data. Results Four themes emerged from the data analysis: transition to change; acceptance of the after-hours nurse practitioner role; workforce sustainability; and rural context. Conclusions This study suggests that the nurse practitioner-led model is valued by rural health practitioners and could reduce the burden of excessive after-hour on-call duties for rural GPs while improving access to quality health care for community members. As pressure on rural urgent care centres further intensifies with the presence of the COVID-19 pandemic, serious consideration of the nurse practitioner-led model is recommended as a desirable and effective alternative.

Purpose: Clinical supervision is an important element of professional support for allied health professionals and contributes to the provision of safe, high quality patient care and health professional wellbeing. Structured clinical supervision frameworks have been recommended to improve access and effectiveness of clinical supervision for allied health professionals by providing practical guidance and increased consistency. However, there is limited evidence relating to the availability and quality of clinical supervision frameworks for allied health. Method: A systematic and critical review was conducted to identify and appraise clinical supervision frameworks for allied health. Included were peer-reviewed studies and grey literature documents, available in full text and written in English. Six databases and government and professional association websites were searched. The AGREE Health Systems Guidance (AGREE-HS) tool was used to appraise framework quality. Three researchers independently reviewed the frameworks and reached consensus on scores through discussion. AGREE-HS scores were analysed descriptively. Results: Twenty-six frameworks were appraised by the AGREE-HS including 7 peer-reviewed studies and 19 grey literature documents. Over half of all frameworks were from Australia, and the profession/s that they related to were most commonly allied health, social work, or psychology. The combined mean of the AGREE-HS final items scores for all studies/documents was 14.5 (SD = 4.0) out of a possible score of 35. Frameworks published in peer-reviewed studies used more robust methods to inform their development than frameworks sourced from the grey literature. In contrast, grey literature frameworks were often more clearly outlined, succinct, practical, and flexible for stakeholders to implement. Conclusions: There are limited published frameworks available for allied health professionals, and the frameworks that do exist are generally of low quality. As a result, many existing frameworks may not provide the practical guidance required to improve clinical supervision practice and optimise the benefits of clinical supervision. It is recommended that future policy relating clinical supervision needs to focus on the development of common, evidence-based allied health clinical supervision frameworks. Future frameworks should be practically orientated and use robust methods and evaluation to inform their development and implementation.

This trial evaluated the feasibility of podiatrist-led health coaching (HC) to facilitate smart-insole adoption and foot monitoring in adults with diabetes-related neuropathy. Adults aged 69.9 ± 5.6 years with diabetes for 13.7 ± 10.3 years participated in this 4-week explanatory sequential mixed-methods intervention. An HC training package was delivered to podiatrists, who used HC to issue a smart insole to support foot monitoring. Insole usage data monitored adoption. Changes in participant understanding of neuropathy, foot care behaviours, and intention to adopt the smart insole were measured. Focus group and in-depth interviews explored quantitative data. Initial HC appointments took a mean of 43.8 ± 8.8 min. HC fidelity was strong for empathy/rapport and knowledge provision but weak for assessing motivational elements. Mean smart-insole wear was 12.53 ± 3.46 h/day with 71.2 ± 13.9% alerts not effectively off-loaded, with no significant effect for time on usage F(3,6) = 1.194 (p = 0.389) or alert responses F(3,6) = 0.272 (p = 0.843). Improvements in post-trial questionnaire mean scores and focus group responses indicate podiatrist-led HC improved participants’ understanding of neuropathy and implementation of footcare practices. Podiatrist-led HC is feasible, supporting smart-insole adoption and foot monitoring as evidenced by wear time, and improvements in self-reported footcare practices. However, podiatrists require additional feedback to better consolidate some unfamiliar health coaching skills. ACTRN12618002053202.

Background Wound classification systems are useful tools to characterise diabetes-related foot ulcers (DFU) and are utilised for the purpose of clinical assessment, to promote effective communication between health professionals, and to support clinical audit and benchmarking. Australian guidelines regarding wound classification in patients with DFU are outdated. We aimed to adapt existing international guidelines for wound classification to develop new evidence-based Australian guidelines for wound classification in people with diabetes and DFU. Methods Recommended NHRMC procedures were followed to adapt suitable International Working Group on the Diabetic Foot (IWGDF) guidelines on wound classification to the Australian health context. Five IWGDF wound classification recommendations were evaluated and assessed according to the ADAPTE and GRADE systems. We compared our judgements with IWGDF judgements to decide if recommendations should be adopted, adapted or excluded in an Australian context. We re-evaluated the quality of evidence and strength of recommendation ratings, provided justifications for the recommendation and outlined any special considerations for implementation, subgroups, monitoring and future research in an Australian setting. Results After the five recommendations from the IWGDF 2019 guidelines on the classification of DFUs were evaluated by the panel, two were adopted and three were adapted to be more suitable for Australia. The main reasons for adapting, were to align the recommendations to existing Australian standards of care, especially in specialist settings, to maintain consistency with existing recommendations for documentation, audit and benchmarking and to be more appropriate, acceptable and applicable to an Australian context. In Australia, we recommend the use of the SINBAD system as a minimum standard to document the characteristics of a DFU for the purposes of communication among health professionals and for regional/national/international audit. In contrast to the IWGDF who recommend against usage, in Australia we recommend caution in the use of existing wound classification systems to provide an individual prognosis for a person with diabetes and a foot ulcer. Conclusions We have developed new guidelines for wound classification for people with diabetes and a foot ulcer that are appropriate and applicable for use across diverse care settings and geographical locations in Australia.

Background Diabetes is the leading cause of lower limb amputation in Australia, costing the Australian health care system an estimated A$1.6 billion annually. Podiatrists are the primary foot health care provider in Australia. Research suggests that health professional attitudes can impact patient utilisation of e-health technologies, such as wearable foot monitoring devices aimed at preventing foot ulceration. The aim of this study was to explore factors that impact the intentions of Australian podiatrists to adopt smart insole foot monitoring technology. Methods A mixed methods explanatory sequential design was undertaken. One hundred and eleven Australian podiatrists completed an online version of the validated Unified Theory of Acceptance and Use of Technology (UTAUT) questionnaire. Multiple regression analysis was used to determine the strongest predictive model of podiatrists' behavioural intention to adopt technology. Additionally, two focus groups were conducted, and thematic analysis was performed to explore podiatrists' perceived barriers and enablers to smart insole adoption. Results One hundred and eleven Australian podiatrists completed the online UTAUT questionnaire. The majority of respondents practiced in the private sector (58.6%) and were female (50.5%), with Victoria the most common practice location (39.6%). Significant positive correlations existed between behavioural intention and six psychosocial domains including performance expectancy (r = 0.64, p < 0.001), effort expectancy (r = 0.47, p < 0.001), attitude (r = 0.55, p < 0.001), social influence (r = 0.45, p < 0.001), facilitating conditions (r = 0.36, p < 0.001), and self-efficacy (r = 0.30, p < 0.002). Multiple regression analysis determined that performance expectancy alone was most predictive of behavioural intention to adopt a smart insole into clinical practice (adjusted R-2 = 42%, p < 0.001). Qualitative analyses revealed that podiatrists believed that the insole would increase patient knowledge, engagement and self-efficacy. However, concerns were raised about cost, footwear issues and the device's utility with elderly and remote populations. Conclusions Performance expectancy was the most important psychosocial factor predicting the intentions of Australian podiatrists to adopt smart insole foot monitoring technologies. While Australian podiatrists are open to adopting smart insoles into clinical practice, evidence of the device's efficacy is a precursor to adoption. Other perceived barriers to adoption including device cost, compatibility with off-loading, footwear issues and patient age also need to be addressed prior to implementation and clinical adoption.

Smart insole technologies that provide biofeedback on foot health can support foot-care in adults with diabetes. However, the factors that influence patient uptake and acceptance of this technology are unclear. Therefore, the aim of this mixed-methods study was to use an established theoretical framework to determine a model of psychosocial factors that best predicts participant intention to use smart insoles. Fifty-three adults with diabetes from regional Australia completed the validated Unified Theory of Acceptance and Use of Technology (UTAUT) questionnaire. Multiple regression analysis was used to determine the psychosocial factors that best predict behavioural intention to adopt a smart insole. Additionally, a focus group was conducted and thematic analysis was performed to explore barriers and enablers to adopting this technology. The multiple regression model that best predicted intention to adopt the smart insole (adjusted R2 = 0.51, p < 0.001) identified that self-efficacy (β = 0.67, p = 0.001) and attitude (β = 0.72, p < 0.001) were significant predictors of behavioural intention, while effort expectancy (β = − 0.52, p = 0.003) and performance expectancy (β = − 0.40, p = 0.040) were moderating factors. Thematic analysis illustrates the importance of attitude and self-efficacy on participants’ behavioural intentions, influenced by participant’s belief in the device’s clinical efficacy and anticipated effort expectancy. This mixed-methods study demonstrates that attitude, self-efficacy, performance expectancy and effort expectancy combine to predict intention to adopt smart insole technology. Clinicians should consider these psychosocial factors when they prescribe and implement smart soles with patients at high risk of foot ulceration.