Jocelyn Tan

Background
This study aimed to determine the self-reported impacts of COVID-19 on healthcare disruption for persons with multiple sclerosis (MS) in Australia and the personal characteristics and service factors associated with disruption.

Methods
We used 2020 data from the Australian MS Longitudinal Study survey. We used univariate and backward-stepwise regression to explore the disease-related and demographic predictors of: i) the self-perceived influence of COVID-19 on medical care; and ii) the impact of reduced access to health services on health. We also quantified the cumulative impact reduced access to each health service had on the cohort, incorporating the volume and severity of the impact on health.

Results
Of the 1484 participants who provided data, 548 (36.9 %) participants reported the pandemic influenced their medical care. Participants who reported the pandemic influenced their medical care had a younger age, more comorbidities and more disability. 454 (30.6 %) participants reported that reduced access to health services impacted their health. Reduced access was most commonly reported for general practice (311, 21 %), neurology (246, 16.6 %) and physiotherapy (214, 14.4 %). Reduced access to physiotherapy had the greatest cumulative impact on health. The cumulative personal impact of reduced access across all health services was associated with several factors, including younger age, female sex and disability.

Conclusions
One-third of Australians with MS experienced healthcare disruptions during the first year of the COVID-19 pandemic, with the reduced access to physiotherapy most significantly impacting health. The study underscores the importance of continuity of healthcare services during future crises and underscores the need for robust strategies such as hybrid healthcare models and telehealth frameworks to guard against risks to service delivery in the future.

Background: People with multiple sclerosis (MS) have unique needs during a disaster, increasing preparation requirements. The content and patient-level suitability of disaster preparation tools is unknown. This scoping review aimed to determine the range and content of disaster preparation resources that are freely available online and suitable to assist people with MS.

Methods: Resources were identified via the Turning Research Into Practice medical database, Google, and disability-related websites. The included resources were disability specific and have been published since 2017. Resources were inductively analyzed and presented according to the target audience and themes. Findings were compared with stakeholder preferences.

Results: Fifty-nine resources were identified, targeting carers (27.1%), health care professionals (10.2%), and people with disabilities (89.8%). Resource content themes were advanced planning, informing others, practical preparations, and review. Consumer involvement was reported in 2 resources. Stakeholder preferences for disaster preparedness content were not well reflected in the resources.

Conclusions: The review identified online disaster preparedness resources suitable for people with MS and highlighted important gaps. More inclusive resources can be created with consumer involvement in design. Identified themes inform professionals about resources to recommend to patients based on their needs. Health care professionals can aid preparation by addressing resource gaps, particularly regarding health condition management.

Background
Mobility impairments are common in persons with multiple sclerosis (MS), reducing independence and quality of life. Walking interventions can enhance mobility skills, with auditory-motor coupling (synchronising steps with auditory beats) serving as a promising method. Design and participants’ characteristics may impact intervention effectiveness, but have not yet been compared across studies in persons with MS.

Aims
This scoping review aims to determine what design and implementation features are present in studies involving auditory-motor coupling for mobility in persons with MS. Features being assessed include auditory stimuli, mobility variables, participants’ characteristics, and the acceptability and appropriateness of the interventions.

Methods
We searched eight scientific databases and three clinical trial registries for literature on auditory-motor coupling in studies of persons with MS. We extracted features related to study design, participants, and intervention acceptability.

Results
Fifteen original research articles were identified, including seven randomised controlled intervention studies. Most articles involved persons with mild to moderate disability. Auditory stimulation was provided via music or metronome. Few studies reported involving people with MS in the design (n=2) or allowed autonomy in music choice (n=2). Common outcomes were walking quality and speed. All studies reported that acceptability was high.

Conclusion
Review findings on existing evidence of auditory-motor coupling in persons with MS indicate good user acceptability. However consideration of participants’ characteristics, such as musical experience and MS symptoms, and auditory stimuli consideration, alongside inclusion of persons with MS in intervention development is needed to strength the evidence of auditory coupling as an intervention in MS.

Background: Understanding how the COVID-19 pandemic impacted healthcare delivery for people with multiple sclerosis (MS) may inform crisis planning and response. This study aimed to determine 1) the extent to which the COVID-19 pandemic disrupted the healthcare of individuals with MS in Australia; and 2) the personal and service-related factors associated with the impact of healthcare disruption.

Method: Using 2022 data from the Australian MS Longitudinal Study survey, participants reported on disruption to relevant healthcare services during the pandemic, and the impact of disruption on their health. Impact of disruption on health was scored on a scale from 1 (no impact) to 5 (extreme impact). An overall impact score was calculated for participants by multiplying the number of services they used by impact score. Analysis was performed using chi-square and t-tests or Kruskal-Wallis tests.

Results: Of the 1,484 survey participants, 36.9% reported healthcare disruption, with disruption reported in a mean of 2.85 services. Higher frequency of disruption was experienced for physiotherapy (63.5%) and neurology (54.1%). Severe impact was seen for the “other” services category which included exercise physiologists, massage and in-home support. Disruption to pharmaceutical access, allied health (including physiotherapy and occupational therapy), and support services (including in home care and respite care) had a moderate impact on health. Higher overall impact was experienced by people with four or more comorbidities (dcohen=0.5 95% CI 0.2 to 0.7), more severe symptom loads (dcohen=1.7 95% CI 1.0 to 2.4) and disability (dcohen=0.7 95% CI 0.4 to 0.9).

Conclusion: Our findings indicate that disruption to allied health and support services during the COVID-19 impacted the health of people with MS the most. Planning for future crisis should prioritise access to these services and prioritise those most vulnerable from healthcare disruption, particularly those with more severe symptoms, disabilities and comorbidities.

Although suboptimal bone health has been reported in children and adolescents with low motor competence (LMC), it is not known whether such deficits are present at the time of peak bone mass. We examined the impact of LMC on bone mineral density (BMD) in 1043 participants (484 females) from the Raine Cohort Study. Participants had motor competence assessed using the McCarron Assessment of Neuromuscular Development at 10, 14, and 17 years, and a whole‐body dual‐energy X‐ray absorptiometry (DXA) scan at 20 years. Bone loading from physical activity was estimated from the International Physical Activity Questionnaire at the age of 17 years. The association between LMC and BMD was determined using general linear models that controlled for sex, age, body mass index, vitamin D status, and prior bone loading. Results indicated LMC status (present in 29.6% males and 21.9% females) was associated with a 1.8% to 2.6% decrease in BMD at all load‐bearing bone sites. Assessment by sex showed that the association was mainly in males. Osteogenic potential of physical activity was associated with increased BMD dependent on sex and LMC status, with males with LMC showing a reduced effect from increasing bone loading. As such, although engagement in osteogenic physical activity is associated with BMD, other factors involved in physical activity, eg, diversity, movement quality, may also contribute to BMD differences based upon LMC status. The finding of lower peak bone mass for individuals with LMC may reflect a higher risk of osteoporosis, especially for males; however, further research is required.

Individuals at risk of Developmental Coordination Disorder (DCD) have low levels of physical activity in childhood due to impaired motor competence; however, physical activity levels in adulthood have not been established. This study sought to determine the impact of DCD risk on physical activity levels in adults using accelerometry measurement. Participants (n = 656) from the Arvo Ylppö Longitudinal Study cohort had their motor competence assessed at the age of five years, and their physical activity quantified via device assessment at the age of 25 years. Between group differences were assessed to differentiate physical activity measures for individuals based on DCD risk status, with general linear modeling performed to control for the effects of sex, body mass index (BMI), and maternal education. Participants at risk of DCD were found to have a lower total number of steps (d = 0.3, p = 0.022) than those not at risk. Statistical modeling indicated that DCD risk status increased time spent in sedentary light activity (β = 0.1, 95% CI 0.02 to 0.3, p = 0.026) and decreased time spent in vigorous physical activity via interaction with BMI (β = 0.04, 95% CI 0.001 to 0.1, p = 0.025). Sensitivity analysis found that visuomotor impairment did not significantly impact physical activity but did increase the role of DCD risk status in some models. This 20-year-longitudinal study indicated that DCD risk status continues to negatively impact on levels of physical activity into early adulthood.

Objective
To examine the prevalence of a history of polycystic ovary syndrome (PCOS) in women with type 2 diabetes (DM2) and to compare metabolic and reproductive outcomes between women with and without PCOS.

Design
Cross-sectional study.

Setting
Tertiary hospital.

Patient(s)
Female inpatients age 18–75 years with DM2.

Intervention(s)
A face-to-face questionnaire was administered.

Main Outcome Measure(s)
Age at diagnosis of diabetes, history of gestational diabetes, family history of diabetes, and reproductive history, fertility history, number of miscarriages, and morbidity in pregnancy.

Result(s)
One hundred seventy-one inpatients with DM2 participated. The prevalence of a history of PCOS was 37%. Women with PCOS had an earlier mean age of diagnosis of DM2 (44.2 vs. 48.8 years), higher recalled peak body mass index (BMI; 43.1 kg/m2 vs. 36.8 kg/m2), higher rate of gestational diabetes (28% vs. 18%), and higher rate of hypertension in pregnancy (40% vs. 22%). Women with PCOS were less likely to have a family history of DM2 than those without PCOS (45% vs. 67%).

Conclusion(s)
A history of PCOS in women with DM2 is associated with earlier onset of DM2, higher BMI, and a more severe phenotype. Since PCOS subjects were less likely to have a family history of DM2, lack of a family history of DM2 in women with PCOS is not reassuring for DM2 risk. We recommend identifying PCOS in early life and intervening to reduce the risk of diabetes and its comorbidities and suboptimal reproductive outcomes.

Background: Increasing demands on general practice to manage chronic disease may warrant organisational change at the practice level. Staff's readiness for organisational change can act as a facilitator or barrier to implementing interventions aimed at organisational change.

Objectives: To explore general practice staff readiness for organisational change and its association with staff and practices characteristics.

Methods: This is a cross-sectional study of practices in three Australian states involved in a randomised control trial on the effectiveness of an intervention to enhance the role of non-general practitioner staff in chronic disease management. Readiness for organisational change, job satisfaction and practice characteristics were assessed using questionnaires.

Results: 502 staff from 58 practices completed questionnaires. Practice characteristics were not associated with staff readiness for change. A multilevel regression analysis showed statistically significant associations between staff readiness for organisational change (range 1 to 5) and having a non-clinical staff role (vs general practitioner; B=-0.315; 95% CI -0.47 to -0.16; p<0.001), full-time employment (vs part-time; B=0.175, 95% CI 0.06 to 0.29; p<0.01) and lower job satisfaction (B=-0.277, 95% CI -0.40 to -0.15; p<0.001).

Conclusions: The results suggest that different approaches are needed to facilitate change which addresses the mix of practice staff. Moderately low job satisfaction may be an opportunity for organisational change.

Background: The paper examines the key issues experienced in recruiting and retaining practice involvement in a large complex intervention trial in Australian
General Practice Methods: Reflective notes made by research staff and telephone interviews with staff from general practices which expressed interest, took part or withdrew from a trial of a complex general practice intervention.

Results: Recruitment and retention difficulties were due to factors inherent in the demands and context of general practice, the degree of engagement of primary care organisations (Divisions of General Practice), perceived benefits by practices, the design of the trial and the timing and complexity of data collection.

Conclusion: There needs to be clearer articulation to practices of the benefits of the research to participants and streamlining of the design and processes of data collection and intervention to fit in with their work practices. Ultimately deeper engagement may require additional funding and ongoing participation through practice research networks.

Trial Registration: Current Controlled Trials ACTRN12605000788673.