| 1. |
- Unsworth, Carolyn, et al.
(author)
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Views of American and Australian mobility device users and ambulant bus users regarding occupant restraint systems on public buses
- 2022
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In: Journal of Transport & Health. - : Elsevier. - 2214-1405 .- 2214-1413. ; 25
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Journal article (peer-reviewed)abstract
- Introduction: With an ageing population, increasing numbers of people are using mobility devices, such as wheelchairs or scooters, whilst travelling on public route buses. The regulations and availability of active (wheelchair tie down and occupant restraint systems or WTORS) and passive (rearward facing) mobility device restraint systems on buses varies between countries. To date few studies have investigated passenger feedback on the use of restraint systems. This study aimed to gather feedback about WTORS on buses from passengers where these are in use (United States) and not in routine use (Australia) to guide decisions on their introduction. Methods: A prospective study using a purpose-designed electronic survey. Participants, predominantly recruited by Qualtrics, comprised two groups; mobility device and ambulant bus users in two countries; Australia and the United States (US). Results: The 448 participants rated the top two most important factors when deciding if buses should have WTORS as safety and comfort. Ninety-two percent of respondents believed people using mobility devices should use a WTORS which was rated 7.66/10 (SD1.97) as effective to prevent injuries to self or others. Only a minority of participants (13.2%) had ever slid or fallen from their mobility device, or seen a person slide or fall (13.6%) while on a bus with no differences between countries despite WTORS not being in use in Australia. Respondents reported it was OK to delay a journey an average of 5.52 (SD 2.89) minutes to secure/release a restraint system, which compares favourably to literature-reported real time of one to 4 min. Conclusions: Although WTORS were widely perceived by participants as important for safety, questions concerning their effectiveness to prevent slide or tip remain. Prior to the introduction of any securement system in Australia, the effectiveness of passive occupant containment systems to prevent slide or tip also warrants investigation.
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| 2. |
- Lieshout, K., et al.
(author)
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Burden and preparedness amongst informal caregivers of adults with moderate to severe traumatic brain injury
- 2020
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In: International Journal of Environmental Research and Public Health. - : MDPI. - 1661-7827 .- 1660-4601. ; 17:17
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Journal article (peer-reviewed)abstract
- This study examined the patterns of informal (unpaid) caregiving provided to people after moderate to severe traumatic brain injury (TBI), explore the self-reported burden and preparedness for the caregiving role, and identify factors predictive of caregiver burden and preparedness. A cross-sectional cohort design was used. Informal caregivers completed the Demand and Difficulty subscales of the Caregiving Burden Scale; and the Mutuality, Preparedness, and Global Strain subscales of the Family Care Inventory. Chi-square tests and logistic regression were used to examine the relationships between caregiver and care recipient variables and preparedness for caregiving. Twenty-nine informal caregivers who reported data on themselves and people with a moderate to severe TBI were recruited (referred to as a dyad). Most caregivers were female (n = 21, 72%), lived with the care recipient (n = 20, 69%), and reported high levels of burden on both scales. While most caregivers (n = 21, 72%) felt “pretty well” or “very well” prepared for caregiving, they were least prepared to get help or information from the health system, and to deal with the stress of caregiving. No significant relationships or predictors for caregiver burden or preparedness were identified. While caregivers reported the provision of care as both highly difficult and demanding, further research is required to better understand the reasons for the variability in caregiver experience, and ultimately how to best prepare caregivers for this long-term role.
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| 3. |
- Hilton, G., et al.
(author)
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Longitudinal employment outcomes of an early intervention vocational rehabilitation service for people admitted to rehabilitation with a traumatic spinal cord injury
- 2017
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In: Spinal Cord. - : Nature Publishing Group. - 1362-4393 .- 1476-5624. ; 55:8, s. 743-752
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Journal article (peer-reviewed)abstract
- Study design: Longitudinal cohort design.Objectives: First, to explore the longitudinal outcomes for people who received early intervention vocational rehabilitation (EIVR); second, to examine the nature and extent of relationships between contextual factors and employment outcomes over time.Setting: Both inpatient and community-based clients of a Spinal Community Integration Service (SCIS).Methods: People of workforce age undergoing inpatient rehabilitation for traumatic spinal cord injury were invited to participate in EIVR as part of SCIS. Data were collected at the following three time points: Discharge and at 1 year and 2+ years post discharge. Measures included the spinal cord independence measure, hospital anxiety and depression scale, impact on participation and autonomy scale, numerical pain-rating scale and personal wellbeing index. A range of chi square, correlation and regression tests were undertaken to look for relationships between employment outcomes and demographic, emotional and physical characteristics.Results: Ninety-seven participants were recruited and 60 were available at the final time point where 33% (95% confidence interval (CI): 24-42%) had achieved an employment outcome. Greater social participation was strongly correlated with wellbeing (Ï =0.692), and reduced anxiety (Ï =â '0.522), depression (Ï =â '0.643) and pain (Ï =â '0.427) at the final time point. In a generalised linear mixed effect model, education status, relationship status and subjective wellbeing increased significantly the odds of being employed at the final time point. Tertiary education prior to injury was associated with eight times increased odds of being in employment at the final time point; being in a relationship at the time of injury was associated with increased odds of being in employment of more than 3.5; subjective wellbeing, while being the least powerful predictor was still associated with increased odds (1.8 times) of being employed at the final time point.Conclusions: EIVR shows promise in delivering similar return-to-work rates as those traditionally reported, but sooner. The dynamics around relationships, subjective wellbeing, social participation and employment outcomes require further exploration.
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| 4. |
- Lannin, Natasha A., et al.
(author)
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Public perspectives on acquired brain injury rehabilitation and components of care : A Citizens’ Jury
- 2021
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In: Health Expectations. - : John Wiley & Sons. - 1369-6513 .- 1369-7625. ; 24:2, s. 352-362
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Journal article (peer-reviewed)abstract
- Background: Brain injury rehabilitation is an expensive and long-term endeavour. Very little published information or debate has underpinned policy for service delivery in Australia. Within the context of finite health budgets and the challenges associated with providing optimal care to persons with brain injuries, members of the public were asked ‘What considerations are important to include in a model of care of brain injury rehabilitation?’.Methods: Qualitative study using the Citizen Jury method of participatory research. Twelve adult jurors from the community and seven witnesses participated including a health services funding model expert, peak body representative with lived experience of brain injury, carer of a person with a brain injury, and brain injury rehabilitation specialists. Witnesses were cross-examined by jurors over two days.Results: Key themes related to the need for a model of rehabilitation to: be consumer-focused and supporting the retention of hope; be long-term; provide equitable access to services irrespective of funding source; be inclusive of family; provide advocacy; raise public awareness; and be delivered by experts in a suitable environment. A set of eight recommendations were made.Conclusion: Instigating the recommendations made requires careful consideration of the need for new models of care with flexible services; family involvement; recruitment and retention of highly skilled staff; and providing consumer-focused services that prepare individuals and their carers for the long term.Patient and public contribution: As jury members, the public deliberated information provided by expert witnesses (including a person with a head injury) and wrote the key recommendations.
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| 5. |
- McGregor, Freya A., et al.
(author)
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Menstrual hygiene management strategies used by women who are blind or have low vision
- 2022
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In: Scandinavian Journal of Occupational Therapy. - : Taylor & Francis. - 1103-8128 .- 1651-2014. ; 29:7, s. 598-610
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Journal article (peer-reviewed)abstract
- Background: Menstrual hygiene management is a global public health issue that requires local and individualized support to reduce activity limitations and enable safe, independent task performance for people with impaired body functions.Aim: How do women with blindness or low vision self-manage their menstrual hygiene to promote independence, and what do they recommend occupational therapists incorporate in education for young women when working in this field?Methods: Phenomenological design revealing lived experience expertise. Semi-structured interviews were conducted with six women who are blind or have low vision aged 16–70 in Australia. The resulting data transcripts were coded and analyzed thematically using the Person-Environment Occupation Performance Model as an organizing framework.Results: Participants reported a range of personal (touch) and organizational strategies relying on environmental cues such as regular times for changing sanitary items, lining up pads using underwear seams and wearing dark clothing to disguise leaks. Participants suggested that group occupational therapy education sessions be used to promote self-management.Conclusions and significance: The lived experience of women who successfully self-manage menstrual hygiene with blindness or low vision has generated evidence to inform the development of therapist-mediated interventions and resources that could be applied with women across a range of clinical populations.
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| 6. |
- Timmer, Amanda J., et al.
(author)
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Rehabilitation interventions with deconditioned older adults following an acute hospital admission : a systematic review
- 2014
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In: Clinical Rehabilitation. - : SAGE Publications. - 0269-2155 .- 1477-0873. ; 28:11, s. 1078-1086
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Research review (peer-reviewed)abstract
- Objective: To determine effectiveness of inpatient rehabilitation interventions with older deconditioned adults following an acute hospital admission. Data sources: Systematic review of randomised controlled trials (RCTs) from 14 electronic databases from their inception to February 2014. Review methods: Studies selected concerned inpatient rehabilitation, single or multi-factorial interventions, conducted by any discipline, where participants were aged 55 years or older and 50% or more could be classed as deconditioned. Studies were excluded if they focused on acute onset of disability conditions. Data were extracted using the McMaster Quantitative Review Form and appraised using the PEDro Rating Scale. Results: No RCTs were found that specifically addressed the aim. Four studies were reviewed describing multi-disciplinary rehabilitation programs that aimed to reduce functional decline in older adults, with inconsistent findings. However, in two studies participants showed a positive improvement in completing basic activities of daily living (ADL) following multi-disciplinary rehabilitation, one at discharge (median change score Intervention (I)0.23:Control (C)0.15,P=<0.001) and one at 12-months post discharge (I-48.4%: C-25.4% (P 0.001) Relative Risk (RR)1.90 95%CI: 1.15-3.16 (reviewer calculated)). Discharge to home was also measured in two studies with participants in the intervention groups having a higher probability of going home (I-55.6%: C-36.7 %, RR 1.52 95%CI: 1.02-2.26 (reviewer calculated) and I-60%: C-20%, RR 3.00 95%CI: 1.16-7.73(reviewer calculated)). Conclusion: No RCTs have been conducted to examine the effectiveness of specific recondition-ing interventions in rehabilitation, and there is currently insufficient evidence to support the use of geriatric rehabilitation programs to reduce functional decline in older adults who are deconditioned.
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| 7. |
- Unsworth, Carolyn A., et al.
(author)
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Development of a standardised Occupational Therapy - Driver Off-Road Assessment Battery to assess older and/or functionally impaired drivers
- 2012
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In: Australian Occupational Therapy Journal. - : Wiley. - 0045-0766 .- 1440-1630. ; 59:1, s. 23-36
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Journal article (peer-reviewed)abstract
- Introduction: Research has been conducted over several years to develop a new off-road assessment battery referred to as the Occupational Therapy - Driver Off-Road Assessment Battery. This article documents the development of the Battery, and provides preliminary research evidence to support its content and predictive validity. Methods: Literature reviews and a focus group with nine driver assessor occupational therapists were undertaken, as well as data collection using the Occupational Therapy Driver Off-Road Assessment Battery with 246 clients. A Classification and Regression Tree model was constructed to ascertain the predictive validity of the Battery, with fitness- to-drive as the outcome. Results: Twenty-one physical, 13 sensory and seven assessments of cognition / perception were identified as being reflective of the skills required for driving. Following rating of their psychometric properties, the best assessments were presented to focus group members. The driver assessors supported the inclusion of several assessments and encouraged the development of new assessments. A draft version of the Occupational Therapy -Driver Off-Road Assessment Battery was tested and found to have excellent predictive validity for client on-road performance of 82.6%. The Classification and Regression Tree model showed that client performance on tests included in the Battery should be used together, rather than in isolation, to support fitness-to-drive recommendations. Conclusion: This research identified the most suitable physical, sensory and cognitive assessments to include in the Occupational Therapy -Driver Off-Road Assessment Battery, and provided support for its validity. The development of this standardised battery assists driver assessors to accurately and consistently assess and report the offroad driving capacity of clients.
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| 8. |
- Unsworth, Carolyn A., et al.
(author)
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Driver rehabilitation : A systematic review of the types and effectiveness of interventions used by occupational therapists to improve on-road fitness-to-drive
- 2014
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In: Accident Analysis and Prevention. - : Elsevier BV. - 0001-4575 .- 1879-2057. ; 71, s. 106-114
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Research review (peer-reviewed)abstract
- Objective: Driver rehabilitation has the potential to improve on-road safety and is commonly recommended to clients. The aim of this systematic review was to identify what intervention approaches are used by occupational therapists as part of driver rehabilitation programmes, and to determine the effectiveness of these interventions. Method: Six electronic databases (MEDLINE, CINAHL, Psycinfo, Embase, The Cochrane Library, and OTD-Base) were searched. Two authors independently reviewed studies reporting all types of research designs and for all patient populations, provided the interventions could be administered by occupational therapists. The methodological quality of studies was assessed using the 'Downs and Black Instrument', and the level of evidence for each intervention approach was established using 'Centre for Evidence Based Medicine' criteria. Results: Sixteen studies were included in the review. The most common type of intervention approach used was computer-based driving simulator training (n=8), followed by off-road skill-specific training (n=4), and off-road education programmes (n=3). Car adaptations/modifications were used in one of the included studies. There was significant variability between studies with regards to frequency, duration, and total number of intervention sessions, and the diagnoses of the participants. Of the four intervention approaches, there is evidence to support the effectiveness of off-road skill-specific training (with older clients), and computer-based driving simulator training (with both older clients and participants with acquired brain injury). Conclusion: Three types of intervention approaches are commonly reported, however, there is limited evidence to determine to effectiveness of these in improving fitness-to-drive. Further research is required, with clients from a range of diagnostic groups to establish evidence-based interventions and determine their effectiveness in improving these clients' on-road fitness-to-drive. Crown Copyright (C) 2014 Published by Elsevier Ltd. All rights reserved.
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