Allied Health

Listed below are a selection of research projects currently active within ISLHD.


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Gruber E, Anslow D, Beck E, Nutrition risk in Inflammatory Bowel Disease - are we identifying the correct patients?
Locations: Wollongong Hospital.
External Partners: University of Wollongong.

Malnutrition and micronutrient deficiencies are common in patients with Inflammatory Bowel Disease (IBD). In 2018, a new nutrition screening tool (SaskIBD-NR) was developed for use in patients with IBD. This study will compare the SaskIBD-NR to the screening tools currently used in the IBD clinic at Wollongong Hospital. Combined with dietary intake data obtained via 3-day food record and a food avoidance questionnaire, the research aims to determine whether this tool is sensitive enough to detect nutritional risk in patients with IBD


Amer V, Spicer N, Stefoska-Needham N, Stewart C, Validation of a diet quality tool to screen Osteoarthritis Chronic Care Program participants diet quality with the Australian Guide to Healthy Eating at the Wollongong and Shoalhaven Hospitals.
Locations: Wollongong Hospital, Shoalhaven District Memorial Hospital.
External Partners: University of Wollongong.

This project aims to validate a diet quality tool as a method of nutritional assessment in relation to adherence to the Australian Guide to Healthy Eating, through comparison to a four day food record.


Anscombe Y, Cleary J, Keep A, An observational study of feeding practices and growth outcomes for ELBW and VLBW infants in Australian and New Zealand neonatal intensive care units.
Locations: Wollongong Hospital.
External Partners: Australasian Network of Dietitians in NICU, John Hunter Hospital.

Faltering post-natal growth is frequently observed in infants born extremely premature and is associated with impaired neurodevelopment outcomes. Many factors impact on neonatal growth during hospital stay, however optimising early nutritional intake, particularly protein, is associated with improved overall weight gain. Wide variations in neonatal nutrition practices have been demonstrated, which may have implications for growth and long term outcomes. Limited studies exist on the nutrition practices across Australian and New Zealand neonatal units and standardisation of nutritional protocols may result in earlier achievement of recommended nutrient intake goals and therefore improved growth outcomes. The objectives of this Australasian survey are to determine the current nutrition practices used in Neonatal Intensive Care units for parenteral and enteral nutrition of VLBW infants and to compare differences between sites.


Barone L, Taylor C, Mason S, Davidson E, King P, Identifying Sarcopenia in our subacute patients- a multidisciplinary team effort.
Locations: Port Kembla Hospital, Coledale Hospital.

Sarcopenia is a muscle disease that results in decreased  muscle strength and mass, ultimately affecting physical function. It is recognised as a substantial contributor to disability and loss of independence particularly amongst older persons. The negative impact of sarcopenia includes increased risk of falls and fractures, increased difficulties with activities of daily living, issues with mobility, poorer quality of life and ultimately increased risk of morbidity and mortality. Sarcopenia has been identified as a major health problem associated with increased health care costs.  The presence of sarcopenia increases risk for hospitalisation and can increases cost of hospital care up to 5-fold. The screening for and identifying patients with sarcopenia should be a priority in health care, therefore this project aims to implement a screening pilot to identify sarcopenia in patients admitted into Port Kembla and Coledale Hospitals.


Barone L, Mason S, Teng J, Charlton K, Spicer N, Is this what they need? Assessing the experiences and needs of clients of a community based palliative care service.
Locations: Port Kembla Hospital, Shoalhaven District Memorial Hospital.
External Partners: University of Wollongong.

This project aims to investigate staff, clients and carer experiences of the ISLHD community based palliative care service, and to evaluate ISLHD community based palliative care service against evidence based service guidelines.


Beck E, Talley N, Apte M, McDonald J, Prakoso E, Duncanson K, Williams G, Herath C, Shackel N, Kapur A, Manifestation of metabolic disease including non-alcoholic fatty liver disease (NAFLD).
Locations: Wollongong Hospital.
External Partners: University of Wollongong, University of Newcastle, John Hunter Hospital, University of New South Wales, Liverpool Hospital, South Western Sydney Local Health District.

Non-alcoholic fatty liver disease (NAFLD) is associated with metabolic conditions, including obesity and type two diabetes, known to be influenced by dietary patterns. Dietary patterns are also known to influence the gut microbiome. Diet appears to influence the gut microbiome which in turn appears to modulate the liver with clear data implicating the gut microbiome in NAFLD onset and progression. However, it is poorly understood how diet composition influences subsequent outcomes of NAFLD through the microbiome. Furthermore, it is not known if dietary composition can be successfully changed to directly impact NAFLD outcomes. Therefore, the principal aim of this study is to better understand how diet may be used to modify the microbiome in NAFLD. This initial observational study will establish and characterise a patient cohort (clinical, dietary and microbiome) to better understand diet and dysbiosis in NAFLD and direct future clinical trials of dietary interventions in this patient cohort.


Spicer N, Stefoska-Needham A, Cross E, Komninos R, What do we know about nutrition for colorectal surgery? A consumer’s perspective.
Locations: Shoalhaven District Memorial Hospital.
External Partners: University of Wollongong.

The ERAS program includes small interventions which collectively improve surgical outcomes.  The majority of these interventions are either directly or indirectly related to Nutrition.  We have previously completed a clinical audit on ERAS in colorectal surgical patients at SDMH which has shown that there are gaps in the nutrition care provided to colorectal surgical patient during the perioperative period.  We aim to use data from a previously completed clinical audit to assist direct patient interviews post-operative to understand the consumers experience in the perioperative period in relation to nutrition. 


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Dennis S, Roberson C, Short videos for patients to increase uptake of referral of pulmonary rehabilitation: a multi-centre randomised controlled trial.
Locations: Wollongong Hospital.
External Partners: South Western Sydney Local Health District.

The COPD-X Guidelines recommend pulmonary rehabilitation (PR) as a cost-effective way of improving exercise capacity and quality of life for people with COPD.  In spite of the strong evidence for the effectiveness of pulmonary rehabilitation many people are not referred and if they are referred do not attend. We have developed and tested a series of four short patient videos that address known barriers to attending PR.  These videos have been piloted at Liverpool Hospital and we have been awarded funding from Agency for Clinical Innovation (ACI) to test their effectiveness at increasing the uptake of referral to PR.  The aim of this multi-centre cluster randomised controlled trial (RCT) is to determine whether the use of short videos, informed by behaviour change theory, delivered to people with COPD during a hospital admission increases uptake of PR.


Kennedy D, Getley A, Fisher G, Quel de Oliveira C, Bushell L, Gandevia S, Power E, The Clinical Experience of Unilateral Neglect Assessment in Practice - A Pilot Study.
Locations: Coledale District Hospital.
External Partners: University of Technology Sydney.

Unilateral Neglect (UN) is a condition where people fail to perceive or respond to stimuli on the opposite side of a stroke. Despite the clinical importance of UN, there are significant limitations in its assessment. This is a multi-site observational study using mixed-methods aiming to describe physiotherapists’ and occupational therapists’ experiences of implementing validated UN assessment tools, and also describe the barriers and facilitators to the implementation of UN assessment tools in clinical practice. 


Brown P, Fitzpatrick S, Andersen K, Allied Health experience of an inter-disciplinary home-based pilot program targeting elderly patients discharged from the ED: A mixed method study.
Locations: Illawarra Shoalhaven Local Health District.

In ISLHD, we will pilot a novel Allied Health service providing timely, short-term at-home care to elderly (>65 years) patients, either acutely admitted or presenting to two ISLHD ED’s.  The aim of the pilot is to avoid hospitalization. Our purpose in this study will be to explore the inter-disciplinary experience of this Allied Health team over the life of the pilot. We will assess the extent to which interdisciplinary collaboration has occurred, and examine the challenges and benefits of incorporating interdisciplinary competencies from the perspective of the clinician.


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Burgess A, Hawkins J, Duncanson K, Baytieh L, A Patient Reported Outcome Measure (PROM) for Diabetes with Aboriginal Communities in the Southern Shoalhaven region.
Locations: Shellharbour Hospital.
External Partners: University of Newcastle.

Patient Reported Outcome Measures (PROMs) are emerging and becoming embedded in Australian health care. These surveys are completed by patients to report on how health services affect the patient’s quality of life and health conditions, delivering a holistic approach to patient centred care. There are no validated PROMs specific to the Aboriginal Community reported in the literature, nor has cultural appropriateness been addressed. Given the major disparity in incidence and prevalence of diabetes between Aboriginal and non-Aboriginal people, this study will explore the perceptions of the cultural appropriateness of a diabetes PROM set for Aboriginal people in the Southern Shoalhaven region and co-design an Aboriginal PROM if this outcome is an agreed outcome of the research process.


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Broyd S, Feros D, New therapies for functional neurological disorder: Evaluating a multidisciplinary and cognitive behavioural therapy approach.
Locations: Port Kembla Hospital.

This study aims to evaluate the effectiveness of a 6 week multidisciplinary and cognitive behavioural therapy (CBT) group on the self-management of symptoms, psychological and psychosocial wellbeing and adjustment in adults with Functional Neurological Disorder (FND). Participants will be assessed on the nature, frequency and severity of their FND symptoms, psychological wellbeing and psychosocial adjustment.  


Whiting D, Simpson G, Deane F, Chuah S, Maitz M, Gordon I, Cusack J, Evaluation and feasibility of eHealth for individuals with a traumatic brain injury (TBI) experiencing psychological distress: ACT-Adjust via video consulting.
Locations: Port Kembla Hospital.
External Partners: Ingham Institute for Applied Medical Research, University of Wollongong, Western Sydney University, Liverpool Hospital.

This study delivers and evaluates the effectiveness of an evidence-based psychological treatment, ACT-Adjust, in alleviating psychological distress, increasing psychological flexibility and improving quality of life for adults with moderate to severe traumatic brain injury (TBI). The study is the first to evaluate technology knowledge and access for people living with moderate to severe TBI and measures compares the effectiveness of ACT-Adjust delivered face-to-face and via video consulting (eHealth), with a wait list control group. 


Thinn MM, Parab C, Sadozai A, McKeon B, Piper S, A retrospective audit to analyze factors impacting wait times to access multidisciplinary developmental and autism assessment. What we have learnt and how could we improve timely diagnostic assessment?
Locations: Illawarra Shoalhaven Local Health District.

The research aims to identify factors contributing to longer wait times for children who were referred for developmental and autism assessment in the multidisciplinary clinic at Illawarra Shoalhaven Diagnostic and Assessment Service from January 2015 to December 2019. The main objective is to analyze the waiting time from point of referral over five years. The retrospective study data will allow identification of trends and patterns of change in intake criteria from 2015 to 2019. The secondary objective of the study is to discuss improvement in future service planning and policy making. Timely assessment service is crucial for early diagnoses and consequent appropriate early intervention.

Speech Pathology

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Shrubsole S, Hogg S-E, Sustaining acute speech pathologists' implementation of recommended aphasia practices: Follow-up of a cluster RCT.
Locations: Illawarra Shoalhaven Local Health District.
External Partners: Southern Cross University.

The aims of this project are to investigate whether the effects of the implementation strategy/ies on acute speech pathologists’ aphasia management practice have been sustained 2-3 years following the original project, to determine what factors (including contextual/organisational factors, clinician factors) may have influenced whether the effects were sustained, and to explore what elements may be essential to refine the interventions to maximise sustainability of change.


Clayton N, Walker E, Maclean J, Hamilton-Foster E, Donovan G, Melbourne L, Absalom N, Mogg P, Mann B, Rolfe D, Walter A, Goers K, Kostal K, Black R, Freeman-Sanderson A, Clinical profile and recovery pattern of dysphagia in the ICU COVID-19 patient: the NSW experience.
Locations: Wollongong Hospital.
External Partners: Concord Repatriation General Hospital, University of Queensland, University of Sydney, Royal Prince Alfred Hospital, St George Hospital, Westmead Hospital, Liverpool Hospital, Sutherland Hospital, Prince of Wales Hospital, Royal North Shore Hospital, Hornsby Hospital, WNSWLHD, Nepean Hospital, NNSWLHD, St Vincent's Hospital (Sydney), University of Technology Sydney, The George Institute for Global Health.

The impact of COVID-19 on swallowing function is not well understood. Currently in Australia, we have a relatively low rate of ICU admissions compared to our international colleagues, however we are still seeing that the virus and its subsequent treatment, can affect swallow function in those who require ICU admission. As such, these patients require Speech Pathology assessment and treatment of their dysphagia. The current COVID-19 pandemic provides us with the unique opportunity to describe swallowing function in this cohort and outline their clinical dysphagia characteristics and trajectory of recovery for a series of cases that have been managed by Speech Pathology in the ICU across NSW. The overall objective of this study is to investigate the physiological characteristics and pattern of recovery of swallowing function during the acute care period, for a cohort of COVID-19 patients who required ICU admission as part of their treatment


Rowntree K, Brown A, Woods E, Tsaccounis K, Edwards M, Boehm-Leslie J, Use of Expiratory Muscle Strength Training (EMST) in the treatment of dysarthria associated with Parkinsons Disease.
Locations: Illawarra Shoalhaven Local Health District.

Individuals with Parkinsons Disease typically experience changes to speech and voice associated with poor breath support. While it may be hypothesised that breathing exercises could improve communication function, available evidence does not support this. Expiratory Muscle Strength Training (EMST) devices encourage a specific style of breathing training, where individuals must use maximal strength of expiration to overcome a high level of resistance. It is hypothesised that this high challenge is more likely to lead to gains than training without a device. Training with EMST in isolation has seen improvements in voice and speech in some other populations, however is no known evidence to support its use for people with Parkinsons Disease.

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