Peter New | Monash University (original) (raw)

Papers by Peter New

Archives of Physical Medicine and Rehabilitation, 2011

Disability is a stigma in Pakistan, and cultural norms are a hindrance to the integration of the ... more Disability is a stigma in Pakistan, and cultural norms are a hindrance to the integration of the disabled into the community. Additional barriers to addressing the needs of the disabled include the lack of reliable disability epidemiologic data, inadequate funding and poor health care infrastructure, and workforce shortages. The aim of this report is to present an overview of Physical Medicine and Rehabilitation (PM&R) in Pakistan, covering its origins, current status, and future directions. An electronic literature search (1950-2009) was conducted using the Medline, ScienceDirect, Springer Link, CI-NAHL, and Google Scholar databases. The key words used were "disability," "persons with disability" (PWDs), "rehabilitation," "Pakistan," "developing countries," "stroke," "spinal cord injury," "causes," "attitudes," "physiotherapy," "occupational therapy," and "speech therapy." Only publications in English involving physical disability were selected. Statistical data were obtained from the Federal Bureau of Statistics. Interviews with pioneers of rehabilitation medicine in Pakistan, PWDs, and their families were conducted. The origins of PM&R in Pakistan date to the 1960s, but the formal training program began only in 1997. There are only a few rehabilitation departments, and none have all the standard components of a rehabilitation team. The number of practicing rehabilitation consultants is 38. There are an estimated 1000 physical therapists and 150 occupational therapists. There is a need to increase the number of rehabilitation facilities significantly, staff them appropriately, and make them accessible to all who need them, including rural and remote regions. Discrimination should be addressed by education and legislation.

Disability and Rehabilitation, Mar 29, 2019

Purpose: To investigate the level of agreement of neurobehavioral disability following stroke. Me... more Purpose: To investigate the level of agreement of neurobehavioral disability following stroke. Methods: Stroke patients and nurses were recruited from an inpatient neurorehabilitation facility. In total, 58 stroke patient-nurse pairs completed the St Andrew's-Swansea Neurobehavioral Outcome Scale questionnaire. Results: Agreement levels of neurobehavioral disability varied across five behavior subdomains. Cognition and Interpersonal behaviors were reported as more prevalent according to nurses (39% and 36%) versus patients (14% and 7%). Agreement levels between the two groups was fair for these domains (ICC <0.60). Percentage category agreement methods revealed high patient-nurse agreement for Communication, Inhibition, and Aggression behaviors but overall reporting of these problems was very low or absent. Patient demographics and stroke variables did not predict the pattern of results. Lower patient-nurse agreement was moderately associated with older age (r s ¼ 0.37, p ¼ 0.01) and increased experience of nurse (r s ¼ 0.38, p ¼ 0.01) but only for the Cognition-related domain. Agreement of impact of neurobehavioral disability was none to slight for both groups across all neurobehavioral domains (j <0.20). Conclusions: Neurobehavioral disability is common in the early recovery phase after stroke and is viewed differently with regards to frequency, type, and impact between patients and their nurses. Research and clinical training in the management of stroke-related neurobehavioral disability is required. ä IMPLICATIONS FOR REHABILITATION Neurobehavioral disability (NBD) following stroke is commonly seen in the early stages of recovery and requires careful evaluation by stroke survivors and rehabilitation staff. Many patients may disagree with their clinician that they are exhibiting NBD, which may compromise the therapeutic relationship. We need to better understand factors underlying lower reporting of NBD by patients (denial or reduced self-awareness) to help guide management in stroke rehabilitation settings.

Journal of the Neurological Sciences, Oct 1, 2015

American Journal of Physical Medicine & Rehabilitation, Jul 1, 2009

Case series of pressure ulcers in patients with spinal cord injury after inappropriate and prolon... more Case series of pressure ulcers in patients with spinal cord injury after inappropriate and prolonged application of graduated compression stockings are presented. Three adult patients with spinal cord injury were fitted with graduated compression stockings in the acute phase to prevent thromboembolism. Acute hospital staff did not monitor the skin for potential pressure ulcer because of the graduated compression stockings. Grade II pressure ulcers developed on the toes in all three cases. All pressure ulcers were managed conservatively and healed without complication. The manufacturers of graduated compression stockings did not include information about the need to monitor patients with sensory impairment for pressure ulcers. It is suggested that the manufacturers of graduated compression stockings include information about the need to monitor patients with sensory impairment for skin breakdown. When graduated compression stockings are applied to patients with sensory impairment, including spinal cord injury, staff needs to be vigilant for pressure ulcers occurring at the extremes of the graduated compression stockings, in addition to the more common areas where pressure ulcers occur.

Journal of Rehabilitation Medicine, 2019

Memory problems are commonly reported following stroke but receiving help for these difficulties ... more Memory problems are commonly reported following stroke but receiving help for these difficulties remains a high unmet need among survivors. Two different approaches to memory rehabilitation are available: memory skills group training and computerised cognitive training; however, it is unclear which approach is more effective. This study compared these two approaches in 65 stroke survivors who all reported memory difficulties. We found that participants who received memory group training were more likely to achieve their memory improvement goals than those who received computerised cognitive training. It was concluded that memory skills group training may be a more effective approach to improve memory function in daily life following stroke, but more research is required. Objectives: Memory deficits are common after stroke, yet remain a high unmet need within the community. The aim of this phase II randomized controlled trial was to determine whether group compensatory or computerized cognitive training approaches were effective in rehabilitating memory following stroke. Methods: A parallel, 3-group, single-blind, randomized controlled trial was used to compare the effectiveness of a compensatory memory skills group with restorative computerized training on functional goal attainment. Secondary outcomes explored change in neuropsychological measures of memory, subjective ratings of prospective and everyday memory failures and ratings of internal and external strategy use. Results: A total of 65 community dwelling survivors of stroke were randomized (24: memory group, 22: computerized cognitive training, and 19: wait-list control). Participants allocated to the memory group reported significantly greater attainment of memory goals and internal strategy use at 6-week follow-up relative to participants in computerized training and wait-list control conditions. However, groups did not differ significantly on any subjective or objective secondary outcomes. Conclusion: Preliminary evidence shows that memory skills groups, but not computerized training, may facilitate achievement of functional memory goals for community dwelling survivors of stroke. These findings require further replication, given the modest sample size, subjective nature of the outcomes and the absence of objective eligibility for inclusion.

Spinal Cord, Aug 10, 2010

Study design: The study design used is cross-sectional descriptive survey. Objectives: The aim of... more Study design: The study design used is cross-sectional descriptive survey. Objectives: The aim of this study is to describe the subjective and objective quality of life (QoL) of adults with chronic non-traumatic spinal cord injury (NT-SCI) and to compare the objective and subjective QoL of adults with chronic NT-SCI with adults who have a chronic traumatic spinal cord injury (T-SCI) and the general population. Setting: Living in the general community (non-residential care), Australia. Participants: The study included 443 adults with SCI (T-SCI, n ¼ 381) (NT-SCI, n ¼ 62), all SCI X6months duration. Intervention: Not applicable. Main Outcome Measures: Objective and subjective QoL domainsFComprehensive QoL Scale for Adults, version 5 (COMQoL-A5); acceptance subscaleFthe Spinal Cord Lesion Coping Strategies Questionnaire, version 1 Australia (SCL CSQ v1.0 Australia). Results: Despite demographic differences, only the objective QoL domain material (higher in NT-SCI) and the subjective QoL domain health (lower in NT-SCI) were significantly different between the SCI subgroups. In contrast, five of the seven objective domains and four of the seven subjective domains were significantly lower in the SCI sample as a whole, compared with the general population. Post hoc analyses suggested that aetiology of the SCI was not responsible for QoL differences within the cohort with SCI. Conclusion: On the whole, aetiology makes little difference to QoL outcomes after SCI. The QoL of adults with chronic T-SCI and NT-SCI fall significantly below that of the general population in most domains.

Archives of Physical Medicine and Rehabilitation, Oct 1, 2015

Spinal Cord, Feb 15, 2011

Methods: Hundreds of suicide attacks on civil and military forces have occurred over the last 6 y... more Methods: Hundreds of suicide attacks on civil and military forces have occurred over the last 6 years in Pakistan. These have resulted in thousands of death and many more injured. Six victims of terrorist suicide bombings were admitted over the years 2006 to 2009, who had a spinal cord injury (SCI). This is the first case series of SCI, secondary to terrorist suicide blast. Results: All patients were males. The mean age was 30±11 years. Most (five) were injured directly due to splinters from the blast. On admission to rehabilitation, all patients had thoracic complete paraplegia and their SCI was managed conservatively for their spinal injuries. Associated injuries included intestinal perforations, fracture metatarsals, humerus and brachial plexus injury. Pressure ulcer was the commonest complication (3 patients). Two patients had neurological improvement at 1-year follow-up. Conclusion: Suicide bombing is an effective weapon of terrorists in the modern world of today. The resulting injuries can be diverse and devastating. Spinal cord injury is an uncommon sequel of suicide bombing, which should be kept in mind while dealing with victims of suicide bombing.

Archives of Physical Medicine and Rehabilitation, Mar 1, 2008

Recent natural disasters have highlighted the lack of planning for rehabilitation and disability ... more Recent natural disasters have highlighted the lack of planning for rehabilitation and disability management in emergencies. A review of our experience with spinal cord injury (SCI) after the Pakistan earthquake of 2005, plus a review of other literature about SCI after natural disasters, shows that large numbers of people will incur SCIs in such disasters. The epidemiology of SCI after earthquakes has not been well studied and may vary with location, severity of the disaster, available resources, the expertise of the health care providers, and cultural issues. A lack of preparedness means that evacuation protocols, clinician training, dedicated acute management and rehabilitation facilities, specialist equipment, and supplies are not in place. The dearth of rehabilitation medicine specialists in developing regions further complicates the issue, as does the lack of national spinal cord registries. In our 3 makeshift SCI units, however, which are staffed by specialists and residents in rehabilitation medicine, there were no deaths, few complications, and a successful discharge for most patients. Technical concerns include air evacuation, early spinal fixation, aggressive management to optimize bowel and bladder care, and provision of appropriate skin care. Discharge planning requires substantial external support because SCI victims must often return to devastated communities and face changed vocational and social possibilities. Successful rehabilitation of victims of the Pakistan earthquake has important implications. The experience suggests that dedicated SCI centers are essential after a natural disaster. Furthermore, government and aid agency disaster planners are advised to consult with rehabilitation specialists experienced in SCI medicine in planning for the inevitable large number of people who will have disabilities after a natural disaster.

Journal of Spinal Cord Medicine, Jun 25, 2015

Context: Penile cleavage is a rare complication of spinal cord injury (SCI) in patients with a ch... more Context: Penile cleavage is a rare complication of spinal cord injury (SCI) in patients with a chronic indwelling catheter. We report two cases of chronic SCI who developed penile urethral cleavage after prolonged use of an indwelling catheter for bladder management. Findings: A 25-year-old wheelchair mobile male with T7 American Spinal Injury Association (ASIA) Impairment Scale (AIS) grade A paraplegia developed a 4 × 1.5 cm ventral urethral cleavage after using an indwelling catheter for four months with inadequate care. He had an associated urinary tract infection and undiagnosed diabetes mellitus. A suprapubic catheter was inserted and surgical repair recommended after resolution of UTI and adequate control of his diabetes mellitus. After initial treatment he was lost to follow-up. The second patient was a 15-year-old male with AIS grade B tetraplegia who presented with a 2.5 cm cleavage on the ventral aspect of penis for the preceding three months. He had been using an indwelling catheter for bladder management for the previous 18 months. He had modified Ashworth scale grade III spasticity in lower limbs resistant to conservative management. There was no history of trauma, infection or diabetes mellitus. The patient was advised penile urethral repair surgery but was lost to follow-up. Conclusion: Penile cleavage is a rare complication of neurogenic bladder in SCI patients. Patients and care givers should be trained in proper bladder management techniques during the hospital stay, counseled regarding the need for regular follow up, and be taught identification and prevention of common complications.

Spinal Cord, Apr 14, 2009

Study design: Prospective, observational study. Objectives: To determine the proportion of patien... more Study design: Prospective, observational study. Objectives: To determine the proportion of patients with non-traumatic spinal cord injury (NTSCI) who regain the ability to walk and to describe walking outcomes with reference to three commonly used clinical measures of walking capacity.

Spinal Cord, Jan 29, 2008

Study design: Prospective observational study. Objectives: To assess the prevalence of symptomati... more Study design: Prospective observational study. Objectives: To assess the prevalence of symptomatic deep vein thrombosis (DVT) in earthquake survivors with spinal cord injury (SCI). Settings: Rawalpindi, Pakistan, in the months after the October 2005 earthquake. Methods: Earthquake survivors (n ¼ 187) with acute SCI were enrolled after verbal informed consent. Information on mechanism of injury, mode of evacuation, associated injuries was gathered, and a detailed clinical and radiological assessment was performed. They were followed for 10 weeks for clinical signs and symptoms suggestive of DVT. Case with clinical suspicion of a DVT underwent a duplex scan of both legs to confirm the diagnosis. The influence of age, gender, American Spinal Injury Association (ASIA) grade and lower limb fractures on occurrence of DVT was determined. Results: There were 80 men and 107 women with a mean age of 28.3 ± 12.4 years. Seventeen patients were clinically suspected to have a DVT and ultrasound was positive in nine (4.8%). There was no influence of age (P ¼ 0.4), gender (P ¼ 0.4), ASIA grade (P ¼ 0.1) or presence of a lower limb fracture (P ¼ 0.6) on the occurrence of a DVT. Conclusion: This study adds further evidence to support the belief that the incidence of DVT in Southeast Asian patients with an SCI is lower than the reported incidence in the West. It may not be necessary to apply the recommendations for DVT prophylaxis in Caucasians with SCI to other groups, including Southeast Asians.

Spinal Cord, Oct 1, 1997

There has been little research on pain in the acute phase of spinal cord injury (SCI) rehabilitat... more There has been little research on pain in the acute phase of spinal cord injury (SCI) rehabilitation. This study surveyed the pain experience and management strategies in such patients. The subjects consisted of inpatients who were undergoing rehabilitation following their acute injury, and were assessed regarding the presence and type of any pain upon admission to the rehabilitation ward, and reviewed weekly during their stay. They were reassessed on reporting any new pain. Pain intensity was recorded on a Visual Analogue Scale. The maximum intensity of pain during admission was compared to that at discharge. All interventions directed at pain management were documented. Patients were reviewed one year after discharge regarding current pain experience. Almost all of the patients (n=23; 96%) experienced pain at some stage during their inpatient rehabilitation. Overall pain intensity for those patients with pain during inpatient admission decreased by the time of discharge. At the one year review however, pain intensity tended towards that seen on admission. The reasons for pain tending to increase after discharge were not apparent. Neuropathic and Myofascial Pain Syndrome (MPS) were the most common types of pain experienced. A combination of pharmacological, interventional, physical and psychological approaches were used in pain management. At one year review, neuropathic pain remained common while MPS and orthopaedic pain had decreased. Pain is a common and signi®cant problem for many SCI patients and is a challenge for the treating team to manage.

International Journal of Stroke, Aug 1, 2018

Spinal Cord, Apr 14, 2020

Stroke, 2021

Background and Purpose: The AFFINITY trial (Assessment of Fluoxetine in Stroke Recovery) reported... more Background and Purpose: The AFFINITY trial (Assessment of Fluoxetine in Stroke Recovery) reported that oral fluoxetine 20 mg daily for 6 months after acute stroke did not improve functional outcome and increased the risk of falls, bone fractures, and seizures. After trial medication was ceased at 6 months, survivors were followed to 12 months post-randomization. This preplanned secondary analysis aimed to determine any sustained or delayed effects of fluoxetine at 12 months post-randomization. Methods: AFFINITY was a randomized, parallel-group, double-blind, placebo-controlled trial in adults (n=1280) with a clinical diagnosis of stroke in the previous 2 to 15 days and persisting neurological deficit who were recruited at 43 hospital stroke units in Australia (n=29), New Zealand (4), and Vietnam (10) between 2013 and 2019. Participants were randomized to oral fluoxetine 20 mg once daily (n=642) or matching placebo (n=638) for 6 months and followed until 12 months after randomization...

Spinal Cord, 2015

Study design: Prospective parallel waitlist randomised controlled trial. Objectives: Evaluate the... more Study design: Prospective parallel waitlist randomised controlled trial. Objectives: Evaluate the feasibility and effectiveness of an Internet-based psychological intervention treating comorbid mood disorder in adults with spinal cord injury (SCI). Improved mood and satisfaction with life were primary outcomes. Setting: Victoria, Australia. Intervention: Electronic Personal Administration of Cognitive Therapy (ePACT). Measures: Depression, Anxiety and Stress Scale-Short Form (DASS21), Personal Well-being Index, Helplessness subscale of the Spinal Cord Lesion Emotional Well-being Scale v1 Australia, at each time point. Participant qualifying criteria: Adults (18-70 years), chronic SCI, attend SCI review clinic at Austin or Caulfield Hospital and score above normative threshold of the Depression, Anxiety and Stress Scale-Short Form (DASS21). Methods: Forty-eight participants completed Time 2 post intervention (n = 23) or time equivalent for waitlist control group (n = 25) telephone interviews. The measures were repeated a third time (Time 3) for a small subgroup (n = 12) at 6 months post intervention within the study implementation time frame. Results: Univariate within group analyses revealed significant improvement in mood in the intervention group at Time 2: (lower depression (effect size (ES) = 0.4), anxiety (ES = 0.4) and stress (ES = 0.3)) and higher satisfaction with life (ES = 0.2). Waitlist control group improved in depression only (ES = 0.3) by Time 2. Multilevel variance components analyses, although not as positive, were still encouraging. Improvement in mood symptoms was maintained in the small group reinterviewed at Time 3. Conclusion: Although Internet-based interventions for mental health issues in SCI not a solution for all, our results indicate that they are a potentially valuable addition to the currently available options.

Spinal Cord Series and Cases, 2020

Intermittent catheterization (IMC) is the accepted evidence-based best practice for bladder manag... more Intermittent catheterization (IMC) is the accepted evidence-based best practice for bladder management in people with voiding dysfunction due to neurogenic bladder. The two methods for performing IMC over the decades since this practice was introduced are reuse and single-use catheters. There are perceived advantages and disadvantages of each method of performing IMC. There is considerable evidence that single-use IMC is associated with better health outcomes, including reduced risk of urinary tract infection, urethral trauma, and quality of life. People performing IMC also indicate a preference for single-use, although there are advantages of reuse that need to be acknowledged. Ideally, further research is needed in this area, particularly around the washing and storage of reuse catheters, as well as an adequately powered multicenter RCT comparing reuse with single-use IMC, but there are numerous challenges associated with progressing this research.

Clinical Rehabilitation, 2019

Objective: To determine the size of the effects and feasibility (recruitment and retention rates)... more Objective: To determine the size of the effects and feasibility (recruitment and retention rates) of a therapeutic songwriting protocol for in-patients and community-dwelling people with acquired brain injury or spinal cord injury. Design: Randomized controlled trial with songwriting intervention and care-as-usual control groups, in a mixed measures design assessed at three time points. Participants: A total of 47 participants (3 in-patients with acquired brain injury, 20 community participants with acquired brain injury, 12 in-patients with spinal cord injury, and 12 community participants with spinal cord injury: 23 1208 days post injury). Interventions: The intervention group received a 12-session identity-targeted songwriting programme, where participants created three songs reflecting on perceptions of past, present, and future self. Control participants received care as usual. Measures: Baseline, postintervention, and follow-up measures comprised the Head Injury Semantic Diffe...