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Harvey S, Stone M, Zingelman S, Copland DA, Kilkenny MF, Godecke E, Cadilhac DA, Kim J, Olaiya MT, Rose ML, Breitenstein C, Shrubsole K, O'Halloran R, Hill AJ, Hersh D, Mainstone K, Mainstone P, Unsworth CA, Brogan E, Short KJ, Burns CL, Baker C, Wallace SJ. Comprehensive quality assessment for aphasia rehabilitation after stroke: protocol for a multicentre, mixed-methods study. BMJ Open 2024; 14:e080532. [PMID: 38514146 PMCID: PMC10961567 DOI: 10.1136/bmjopen-2023-080532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 02/27/2024] [Indexed: 03/23/2024] Open
Abstract
INTRODUCTION People with aphasia following stroke experience disproportionally poor outcomes, yet there is no comprehensive approach to measuring the quality of aphasia services. The Meaningful Evaluation of Aphasia SeRvicES (MEASuRES) minimum dataset was developed in partnership with people with lived experience of aphasia, clinicians and researchers to address this gap. It comprises sociodemographic characteristics, quality indicators, treatment descriptors and outcome measurement instruments. We present a protocol to pilot the MEASuRES minimum dataset in clinical practice, describe the factors that hinder or support implementation and determine meaningful thresholds of clinical change for core outcome measurement instruments. METHODS AND ANALYSIS This research aims to deliver a comprehensive quality assessment toolkit for poststroke aphasia services in four studies. A multicentre pilot study (study 1) will test the administration of the MEASuRES minimum dataset within five Australian health services. An embedded mixed-methods process evaluation (study 2) will evaluate the performance of the minimum dataset and explore its clinical applicability. A consensus study (study 3) will establish consumer-informed thresholds of meaningful change on core aphasia outcome constructs, which will then be used to establish minimal important change values for corresponding core outcome measurement instruments (study 4). ETHICS AND DISSEMINATION Studies 1 and 2 have been registered with the Australian and New Zealand Clinical Trial Registry (ACTRN12623001313628). Ethics approval has been obtained from the Royal Brisbane and Women's Hospital (HREC/2023/MNHB/95293) and The University of Queensland (2022/HE001946 and 2023/HE001175). Study findings will be disseminated through peer-reviewed publications, conference presentations and engagement with relevant stakeholders including healthcare providers, policy-makers, stroke and rehabilitation audit and clinical quality registry custodians, consumer support organisations, and individuals with aphasia and their families.
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Affiliation(s)
- Sam Harvey
- Queensland Aphasia Research Centre, The University of Queensland, Saint Lucia, Queensland, Australia
- Surgical, Treatment and Rehabilitation Service Education and Research Alliance, The University of Queensland and Metro North Hospital and Health Service, Herston, Queensland, Australia
| | - Marissa Stone
- Queensland Aphasia Research Centre, The University of Queensland, Saint Lucia, Queensland, Australia
- St Vincent's Hospital Melbourne Pty Ltd, Fitzroy, Victoria, Australia
| | - Sally Zingelman
- Queensland Aphasia Research Centre, The University of Queensland, Saint Lucia, Queensland, Australia
- Surgical, Treatment and Rehabilitation Service Education and Research Alliance, The University of Queensland and Metro North Hospital and Health Service, Herston, Queensland, Australia
| | - David A Copland
- Queensland Aphasia Research Centre, The University of Queensland, Saint Lucia, Queensland, Australia
- Surgical, Treatment and Rehabilitation Service Education and Research Alliance, The University of Queensland and Metro North Hospital and Health Service, Herston, Queensland, Australia
| | - Monique F Kilkenny
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- Stroke Theme, The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
| | - Erin Godecke
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
- Centre for Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Victoria, Australia
| | - Dominique A Cadilhac
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- Stroke Theme, The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
| | - Joosup Kim
- Stroke Theme, The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - Muideen T Olaiya
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Miranda L Rose
- Centre for Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Victoria, Australia
- School of Allied Health, Human Services and Sport, La Trobe University College of Science Health and Engineering, Bundoora, Victoria, Australia
| | - Caterina Breitenstein
- Department of Neurology with Institute of Translational Neurology, University of Muenster, Muenster, Germany
| | - Kirstine Shrubsole
- Queensland Aphasia Research Centre, The University of Queensland, Saint Lucia, Queensland, Australia
- Metro South Hospital and Health Service, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Robyn O'Halloran
- Centre for Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Victoria, Australia
- School of Allied Health, Human Services and Sport, La Trobe University College of Science Health and Engineering, Bundoora, Victoria, Australia
| | - Annie J Hill
- Centre for Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Victoria, Australia
- School of Allied Health, Human Services and Sport, La Trobe University College of Science Health and Engineering, Bundoora, Victoria, Australia
| | - Deborah Hersh
- Curtin School of Allied Health and EnAble Institute, Curtin University, Perth, Western Australia, Australia
- Australian Aphasia Association, Perth, Western Australia, Australia
| | - Kathryn Mainstone
- Queensland Aphasia Research Centre, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Penelope Mainstone
- Queensland Aphasia Research Centre, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Carolyn A Unsworth
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- Institute of Health and Wellbeing, Federation University, Ballarat, Victoria, Australia
| | - Emily Brogan
- Edith Cowan University, Joondalup, Western Australia, Australia
- Fiona Stanley Fremantle Hospitals Group, South Metropolitan Health Service, Palmyra, Western Australia, Australia
| | - Kylie J Short
- Surgical, Treatment and Rehabilitation Service Education and Research Alliance, The University of Queensland and Metro North Hospital and Health Service, Herston, Queensland, Australia
| | - Clare L Burns
- Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Herston, Queensland, Australia
| | - Caroline Baker
- Centre for Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Victoria, Australia
- Speech Pathology Department, Monash Health, Clayton, Victoria, Australia
| | - Sarah J Wallace
- Queensland Aphasia Research Centre, The University of Queensland, Saint Lucia, Queensland, Australia
- Surgical, Treatment and Rehabilitation Service Education and Research Alliance, The University of Queensland and Metro North Hospital and Health Service, Herston, Queensland, Australia
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Farries K, Baldock M, Thompson J, Stokes C, Unsworth CA. Entrapment and extraction of wheelchairs at flange gaps with and without flange gap fillers at pedestrian railway crossings. Disabil Rehabil Assist Technol 2023:1-11. [PMID: 38140983 DOI: 10.1080/17483107.2023.2296954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 12/13/2023] [Indexed: 12/24/2023]
Abstract
PURPOSE Where pedestrian crossings meet rail tracks, a flange gap allows the train wheel flanges to pass. This gap can be hazardous for wheelchair users as castor wheels may become trapped. While compressible gap fillers can eliminate the flange gap, fillers are subject to wear, pose a derailment hazard to light rail vehicles and can strip grease from passing wheels. These issues could be mitigated by partially filling the flange gap with a compressible filler. The aim was to investigate the risk of entrapment and ease of extraction of wheelchair castors from flange gaps fully and partially filled with compressible fillers, and assess ride quality. MATERIALS AND METHODS Entrapment risk and ease of extraction for four wheelchairs were tested at various crossing angles with flange gap fillers. Twelve wheelchair users tested ease of extraction and ride quality for partially and fully filled flange gaps. RESULTS It was found that risk of entrapment is low if a standards-compliant crossing with open flange gaps is traversed in a straight line. However, castors can become trapped if the user alters direction to avoid an obstacle or if the crossing surface is uneven. Once trapped, castors are extremely difficult to remove without external assistance. CONCLUSIONS Flange gap fillers that reduce the gap to 10 mm or less eliminate entrapment while retaining acceptable ride quality. Filling flange gaps or leaving a residual gap depth of less than 10 mm is the best option to eliminate risk of entrapment and ensure good ride quality for wheelchair users.IMPLICATIONS FOR REHABILITATIONRail crossings flange gaps pose an entrapment hazard for wheelchair usersPartial or complete flange gap fillers may reduce entrapment but require researchRehabilitation professionals need to educate wheelchair users on techniques to cross flange gaps safelyConsumers and health professionals can consult rail operators to partially fill flange gaps.
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Affiliation(s)
- Kevin Farries
- School of Civil Environmental and Mining Engineering, University of Adelaide, Australia
| | - Matthew Baldock
- Centre for Automotive Safety Research, University of Adelaide, Australia
| | - James Thompson
- Centre for Automotive Safety Research, University of Adelaide, Australia
| | - Christopher Stokes
- Centre for Automotive Safety Research, University of Adelaide, Australia
| | - Carolyn A Unsworth
- Institute of Health and Wellbeing, Federation University, Australia
- Department of Rehabilitation, Jönköping University, Jönköping, Sweden
- Department of Neurosciences, Monash University, Clayton, Australia
- Department of Occupational Therapy, James Cook University, Townsville, Australia
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Dickson NC, Gohil AR, Unsworth CA. Initial validation of the powered mobility device autonomy residential screen (PoMoDARS). Scand J Occup Ther 2023:1-11. [PMID: 37995269 DOI: 10.1080/11038128.2023.2260834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 09/15/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND The Powered Mobility Device Autonomy Residential Screen (PoMoDARS) is a new tool to enable clinicians to screen resident capacity and performance skills for powered mobility device (PMD) use in residential aged care settings. The PoMoDARS is context specific, time efficient and promotes resident autonomy and safety. AIMS To (i) undertake initial face and content validation of the PoMoDARS, and (ii) use the research findings to make any modifications. METHODS A mixed-methods study design, underpinned by Classical Test Theory. Eight clinicians completed 20 PoMoDARS screens and provided both quantitative and qualitative feedback on item importance and ease of use within a formal interview. RESULTS Initial face and content validity of the PoMoDARS were supported, with small modifications made to item descriptors and instructions. CONCLUSIONS The PoMoDARS has been developed for use in residential aged care settings to screen resident PMD use. While initial validation has been undertaken, further studies to determine the reliability of the tool and continue the validation process are required. SIGNIFICANCE Older adults in residential aged care facilities benefit greatly from the autonomy gained through PMD use. The PoMoDARS promotes collaboration between occupational therapists, nurses, and the wider team to support residents and safe PMD use.
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Affiliation(s)
- Natalie C Dickson
- Institute of Health and Wellbeing, Federation University, Churchill, Australia
| | - Apeksha R Gohil
- Institute of Health and Wellbeing, Federation University, Churchill, Australia
- College of Healthcare Sciences, James Cook University, Townsville, Australia
| | - Carolyn A Unsworth
- Institute of Health and Wellbeing, Federation University, Churchill, Australia
- College of Healthcare Sciences, James Cook University, Townsville, Australia
- Department of Neurosciences, Monash University, Clayton, Australia
- Department of Occupational Therapy, Jönköping University, Jönköping, Sweden
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Unsworth CA, Timmer AJ. A Systematic Review of Wheelchair and Mobility Scooter Containment Systems Used Internationally on Public Transit Buses. Int J Environ Res Public Health 2023; 20:6952. [PMID: 37887690 PMCID: PMC10606695 DOI: 10.3390/ijerph20206952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/16/2023] [Accepted: 10/18/2023] [Indexed: 10/28/2023]
Abstract
Despite the daily need for people to travel on public transit buses using their wheeled mobility devices, relatively little information is available regarding the most efficacious, affordable, and independent approaches to assist passengers with keeping their mobility devices in the designated wheelchair access space. A systematic review was undertaken to summarize this literature, place it within a geographical and temporal context, appraise its quality, and establish common themes. Key academic and grey literature transportation databases and government websites searched from 1990 to May 2022 identified 33 documents, which were appraised using the Mixed Methods Appraisal Tool (MMAT) or the Authority, Accuracy, Coverage, Objectivity, Date, Significance (AACODS) tool. Overall, the documents included were of good quality. The literature retrieved focused on the development and testing of the active containment systems favored for use in North America with a contrastingly small examination of the effectiveness of passive or semi-passive containment systems. Almost no literature was retrieved in English from European researchers documenting the use or effectiveness of rearward-facing passive systems. While tip or slide events are relatively rare among mobility device users, the effective use of containment systems is vital to minimize these. Further research is required to support transport policy makers, operators, and bus drivers to identify and correctly implement optimal containment systems to promote safety for all passengers on public buses.
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Affiliation(s)
- Carolyn A. Unsworth
- Institute of Health and Wellbeing, Federation University, Churchill Campus, Churchill, VIC 3842, Australia;
- Department of Rehabilitation, Jönköping University, 55111 Jönköping, Sweden
- Department of Neurosciences, Monash University, Melbourne, VIC 3004, Australia
- Department of Occupational Therapy, James Cook University, Townsville City, QLD 4810, Australia
| | - Amanda J. Timmer
- Institute of Health and Wellbeing, Federation University, Churchill Campus, Churchill, VIC 3842, Australia;
- Ramsay Health Care, Donvale Rehabilitation Hospital, Donvale, VIC 3111, Australia
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Dickson NC, Gohil AR, Unsworth CA. Powered mobility device use in residential aged care: a retrospective audit of incidents and injuries. BMC Geriatr 2023; 23:363. [PMID: 37301972 PMCID: PMC10257823 DOI: 10.1186/s12877-023-04073-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 05/27/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Powered wheelchairs and motorised mobility scooters, collectively called powered mobility devices (PMD), are highly valued by older Australians, including those living in residential care, to facilitate personal and community mobility. The number of PMDs in residential aged care is expected to grow proportionally with that of the wider community, however, there is very little literature on supporting residents to use PMDs safely. Prior to developing such supports, it is important to understand the frequency and nature of any incidents experienced by residents whilst using a PMD. The aim of this study was to determine the number and characteristics of PMD use related incidents occurring in a group of residential aged care facilities in a single year in one state in Australia including incident type, severity, assessment, or training received and outcomes on follow-up for PMD users living in residential aged care. METHODS Analysis of secondary data, including documentation of PMD incidents and injuries for one aged care provider group over 12 months retrospectively. Follow-up data were gathered 9-12 months post incident to review and record the outcome for each PMD user. RESULTS No fatalities were recorded as a direct result of PMD use and 55 incidents, including collisions, tips, and falls, were attributed to 30 residents. Examination of demographics and incident characteristics found that 67% of residents who had incurred incidents were male, 67% were over 80 years of age, 97% had multiple diagnoses and 53% had not received training to use a PMD. Results from this study were extrapolated to project that 4,453 PMD use related incidents occur every year within Australian residential aged care facilities, with the potential for outcomes such as extended recovery, fatality, litigation, or loss of income. CONCLUSION This is the first time that detailed incident data on PMD use in residential aged care has been reviewed in an Australian context. Illuminating both the benefits and the potential risks of PMD use emphasizes the need to develop and improve support structures to promote safe PMD use in residential aged care.
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Affiliation(s)
- Natalie C Dickson
- Institute of Health and Wellbeing, Federation University, Gippsland Campus, PO Box 3191, Churchill, VIC, 3841, Australia
| | - Apeksha R Gohil
- Institute of Health and Wellbeing, Federation University, Gippsland Campus, PO Box 3191, Churchill, VIC, 3841, Australia
- College of Healthcare Sciences, James Cook University, Townsville, QLD, Australia
| | - Carolyn A Unsworth
- Institute of Health and Wellbeing, Federation University, Gippsland Campus, PO Box 3191, Churchill, VIC, 3841, Australia.
- College of Healthcare Sciences, James Cook University, Townsville, QLD, Australia.
- Department of Neurosciences, Monash University, Clayton, VIC, Australia.
- Department of Occupational Therapy, Jönköping University, Jönköping, Sweden.
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Fields SM, Unsworth CA, Harreveld B. Education leads to increased adherence to the 'Australian Competency Standards for Occupational Therapy Driver Assessors'. Scand J Occup Ther 2022:1-16. [PMID: 35704712 DOI: 10.1080/11038128.2022.2076735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Occupational therapy competency standards provide an evidence-base to inform clinical best practice, however it is not known whether education about competency standards will increase occupational therapists' adherence to their use. AIMS/OBJECTIVES To investigate if education about the 'Australian Competency Standards for Occupational Therapy Driver Assessors' leads to increased adherence to the competency standards in the clinical practice of occupational therapy driver assessors. MATERIALS AND METHODS A mixed methods multiple case study design was used to evaluate 5 occupational therapy driver assessors' adherence to the competency standards. An audit of 25 client files and interviews were conducted to evaluate practice against the competency standards prior to an education session, followed by an audit of a further 25 files, interview and feedback after education. RESULTS Qualitative and quantitative analyses suggest that education about the 'Australian Competency Standards for Occupational Therapy Driver Assessors' was associated with increased adherence to the competency standards in clinical practice. The results also support the use of competency standards in clinical practice. CONCLUSIONS AND SIGNIFICANCE Competency standards can be used to inform and guide clinical practice, and individualised education and feedback of practice against the competency standards can increase occupational therapists' adherence to these standards.
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Affiliation(s)
- Sally M Fields
- Occupational Therapy, Bond University, Robina, Australia.,Occupational Therapy, Federation University, Gippsland, Australia
| | - Carolyn A Unsworth
- Occupational Therapy, Federation University, Gippsland, Australia.,Monash University, Clayton, Australia.,Central Queensland University, Rockhampton, Australia
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Alderdice E, Wolfe D, Timmer AJ, Unsworth CA. Use of the AusTOMs-OT to record outcomes in an occupational therapy homeless service. Br J Occup Ther 2022. [DOI: 10.1177/03080226211067427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Occupational therapists provide services to homeless people internationally, yet relatively little research evidence underpins this practice. This study aimed to describe the process of selecting an outcome measure for use in a homeless occupational therapy service and demonstrate the changes experienced in the occupational performance of individuals participating in this service. Method The Glasgow homeless occupational therapy service staff reviewed eight outcome measures against six pre-determined criteria. The selected tool was then used to collect data pre and post an occupational therapy intervention with 58 participants. Data were analysed using descriptive statistics and Wilcoxon Signed Ranks Test to determine statistically significant change from admission to discharge in the different domains of the selected outcome measure. Results The AusTOMs-OT was implemented in daily practice and 70% of participants were discharged following achievement of therapy goals. Clients made clinically and statistically significant improvements over their admission as measured on AusTOMs-OT in areas such as Transfers, Self-Care and Domestic Life-Home, across the health domains of activity, participation and wellbeing. Conclusion AusTOMs-OT was successfully implemented and demonstrated that participants improved over their time with the service. This evidence can be used to support the effectiveness of occupational therapy services with people experiencing homelessness.
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Affiliation(s)
| | - Debra Wolfe
- Glasgow Homeless Occupational Therapy Service, Glasgow, UK
| | - Amanda J Timmer
- Ramsay Health Care-Donvale Rehabilitation Hospital, Donvale, VIC, Australia
| | - Carolyn A Unsworth
- Professor and Discipline Lead in Occupational Therapy, School of Health, Federation University, Churchill, VIC, Australia; and Adjunct Professor, Occupational Therapy, Central Queensland University, Adjunct Professor, Department of Neurosciences, Monash University, Clayton, VIC, Australia
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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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Affiliation(s)
| | - Carolyn A Unsworth
- Discipline of Occupational Therapy, School of Health, Federation University Churchill Campus, Victoria.,Department of Rehabilitation, Jönköping University, Jönköping, Sweden.,Central Clinical School, Monash University
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Fields SM, Unsworth CA, Harreveld B. The revision of competency standards for occupational therapy driver assessors in Australia: A mixed methods approach. Aust Occup Ther J 2021; 68:257-271. [PMID: 33604929 DOI: 10.1111/1440-1630.12722] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 12/23/2020] [Accepted: 01/10/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Competency standards outline the knowledge, skills, and attributes that are required for competent practice. This study describes the process followed to revise and validate the competency standards for occupational therapy driver assessors in order to guide clinical practice in this area of advanced occupational therapy practice. METHODS A mixed methods research approach was used in this study. In phase 1, three focus groups with driver assessors reviewed and suggested revisions to the competency standards for occupational therapy driver assessors. Phase 2 involved content validation with key stakeholders through a focus group with consumers, written feedback from Australian state, and territory driver licensing authorities, and a two-round Delphi process with Australian occupational therapy driver assessors. RESULTS Forty-nine occupational therapy driver assessors participated in the phase 1 focus groups. Deductive content analysis of the transcripts provided data to revise the competency standards. Inductive analysis provided an in-depth understanding of the participants' views and was interpreted through six categories and their underlying subcategories: purposes and benefits; jurisdictional variations and practice diversity; language use; defining competent practice; challenging systems and processes; and competency standards content. Forty-eight occupational therapy driver assessors participated in the Delphi process. In Round 1, only 1 of the 164 competency standards and practice behaviours rated did not achieve the pre-determined 70% consensus rate. In Round 2, all statements achieved consensus, with the overall average consensus level obtained across the Round 2 statements at 96.8%. CONCLUSION The revised Australian Competency Standards for Occupational Therapy Driver Assessors have been endorsed by Occupational Therapy Australia and released for clinical use. The methods described in this research provide a framework suitable for revision or development of competency standards in both other areas of occupational therapy practice and other health-care professions.
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Affiliation(s)
- Sally M Fields
- Central Queensland University, Rockhampton, Queensland, Australia.,Bond University, Gold Coast, Queensland, Australia
| | - Carolyn A Unsworth
- Federation University, Gippsland, Victoria, Australia.,Department of Rehabilitation, School of Health Sciences, Jönköping University, Jönköping, Sweden.,Monash University, Clayton, Victoria, Australia
| | - Bobby Harreveld
- Central Queensland University, Rockhampton, Queensland, Australia
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Lannin NA, Coulter M, Laver K, Hyett N, Ratcliffe J, Holland AE, Callaway L, English C, Bragge P, Hill S, Unsworth CA. Public perspectives on acquired brain injury rehabilitation and components of care: A Citizens' Jury. Health Expect 2020; 24:352-362. [PMID: 33264470 PMCID: PMC8077088 DOI: 10.1111/hex.13176] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/27/2020] [Accepted: 11/15/2020] [Indexed: 12/18/2022] Open
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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Affiliation(s)
- Natasha A Lannin
- Department of Neuroscience, Central Clinical School, Monash University, Clayton, Vic., Australia.,Occupational Therapy Department, Alfred Health, Melbourne, Vic., Australia
| | - Megan Coulter
- Occupational Therapy Department, Alfred Health, Melbourne, Vic., Australia
| | - Kate Laver
- Flinders University, Adelaide, SA, Australia
| | - Nerida Hyett
- La Trobe Rural Health School, La Trobe University, Melbourne, Vic., Australia
| | - Julie Ratcliffe
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Anne E Holland
- Central Clinical School, Monash University, Clayton, Vic., Australia.,Physiotherapy Department, Alfred Health, Melbourne, Vic., Australia
| | | | - Coralie English
- School of Health Sciences, Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Callaghan, NSW, Australia
| | - Peter Bragge
- BehaviourWorks Australia, Monash Sustainable Development Institute, Monash University, Clayton, Vic., Australia
| | - Sophie Hill
- Centre for Health Communication and Participation and School of Psychology and Public Health, La Trobe University, Melbourne, Vic., Australia
| | - Carolyn A Unsworth
- Department of Neuroscience, Central Clinical School, Monash University, Clayton, Vic., Australia.,School of Health, Federation University, Churchill, Vic., Australia.,Department of Rehabilitation, Jonkoping University, Jonkoping, Sweden
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Esparza J, Gudimetla P, De Silva S, Unsworth CA. An early warning system for diabetic automobile drivers with peripheral neuropathy. Disabil Rehabil Assist Technol 2019; 16:624-631. [PMID: 31703539 DOI: 10.1080/17483107.2019.1686076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE People with Type 2 diabetes exhibit peripheral neuropathy that results in the progressive loss of sensation in their feet. This may adversely affect their ability to drive as there is the potential for their foot to slip off the accelerator or brake pedals, with unwanted consequences including traffic accidents. This research aimed to develop a prototype for an adaptive haptic foot device for diabetic drivers experiencing peripheral neuropathy that can serve as an early warning system for foot slip during driving. METHODS A prototype system was designed in the laboratory which consisted of four force sensing resistors, four light emitting diodes and an eccentric rotating mass all connected and programmed through an Arduino Uno. The prototype was tested under controlled conditions and validated against recommended specifications. The system was then installed in a Ford Falcon GT 2005 and tested under controlled road conditions. RESULTS The results indicated that the haptic device was effective in sensing foot locations and providing instant audio and video feedback to the driver. CONCLUSION This research has successfully designed and fabricated a haptic feedback device that can be used as an early warning system for diabetic automobile drivers with peripheral neuropathy.IMPLICATIONS FOR REHABILITATIONA haptic foot prototype device capable of generating warning signals to diabetic drivers whose foot could slip off the brake or accelerator pedals has been developed.The prototype includes force sensing receivers integrated with eccentric rotating mass system, a haptic controller breakout board, and Arduino software.The system is very easy to use and provides highly reliable audio and visual feedback which are good alerting mechanisms for older automobile drivers.
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Affiliation(s)
- Juan Esparza
- School of Engineering & Technology, CQUniversity, Bundaberg, Australia
| | - Prasad Gudimetla
- School of Engineering & Technology, CQUniversity, Bundaberg, Australia
| | - Shaminda De Silva
- School of Engineering & Technology, CQUniversity, Bundaberg, Australia
| | - Carolyn A Unsworth
- School of Health, Medical & Applied Sciences, CQUniversity, Melbourne, Australia
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Timmer AJ, Unsworth CA, Browne M. A randomized controlled trial protocol investigating effectiveness of an activity-pacing program for deconditioned older adults. Can J Occup Ther 2019; 86:136-147. [DOI: 10.1177/0008417419830374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. Acute hospitalization of older adults can lead to deconditioning and the need for rehabilitation to facilitate a return to home and previous lifestyle. An occupational therapy intervention to combat deconditioning is activity pacing, an active self-management strategy where individuals learn to modify how and when activities are completed with the aim of improving participation in occupation. Purpose. This study will examine the effectiveness of occupational therapy with activity pacing during rehabilitation for deconditioned older adults. Method. A randomized controlled trial is proposed with inclusion criteria of older adults, 65+ years old, living independently in the community prior to admission, with adequate cognition and language to participate in the intervention. Participation, health status, self-efficacy in daily activities, self-efficacy in activity pacing techniques, and symptom management (pain and fatigue) will be measured at admission, discharge, and 3 months postdischarge. Implications. Determining if an activity-pacing program is effective will provide occupational therapists with evidence to support service delivery.
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Unsworth CA, Russell K, Lovell R, Woodward M, Browne M. Effect of Navigation Problems, Assessment Location, and a Practice Test on Driving Assessment Performance for People with Alzheimer's Disease. J Alzheimers Dis 2019; 67:1035-1043. [PMID: 30776013 DOI: 10.3233/jad-181069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND People with Alzheimer's disease may be required to undertake clinical and on-road assessments to determine fitness to drive. The manner in which on-road assessments are conducted with drivers who do and do not have navigational problems may affect the outcome. OBJECTIVES Investigate the effect of 1) navigational difficulties, 2) location of assessment (un/familiar area) and assessment order, and 3) undertaking a second assessment (practice), on passing an on-road driving assessment. METHODS Forty-three drivers undertook an Occupational Therapy-Driver Assessment Off Road Assessment (OT-DORA) Battery which included the Drive Home Maze Test (DHMT). Participants with/without a history of navigational problems were randomly allocated into three groups: 1) Unfamiliar/then familiar area assessment; 2) Unfamiliar/unfamiliar; 3) familiar/unfamiliar. An on-road assessment protocol was used including over 100 expected behaviors at nominated points along the directed route. For familiar area assessments, the driver self-navigated from their home to shops and services. A pass/fail decision was made for each assessment. RESULTS A generalized linear mixed effects model showed neither location, nor practice affected passing the on-road assessment. Participants with navigational problems were six times less likely to pass regardless of route familiarity and direction method, and the DHMT was a significant negative predictor of passing. CONCLUSION Drivers with Alzheimer's disease who have navigational problems and are slow to complete the DHMT are unlikely to pass an on-road assessment. However, navigation and maze completion skills may be a proxy for an underlying cognitive skill underpinning driving performance.
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Affiliation(s)
- Carolyn A Unsworth
- School of Health, Medical and Applied Sciences, Central Queensland University, Melbourne, VIC, Australia
| | - Kay Russell
- Austin Health, Heidelberg West, VIC, Australia
| | - Robin Lovell
- Swinburne University of Technology, Melbourne, Australia
| | | | - Matthew Browne
- School of Health, Medical and Applied Sciences, Central Queensland University, Melbourne, VIC, Australia
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Townsend K, Unsworth CA. The inter‐rater reliability of the Powered Mobility Device Assessment Training Tool. Aust Occup Ther J 2019; 66:393-400. [DOI: 10.1111/1440-1630.12566] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2018] [Indexed: 11/28/2022]
Affiliation(s)
| | - Carolyn A. Unsworth
- Department of Occupational Therapy Central Queensland University Melbourne Victoria Australia
- Department of Rehabilitation Jönköping University Jönköping Sweden
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Timmer AJ, Unsworth CA, Browne M. Occupational therapy and activity pacing with hospital-associated deconditioned older adults: a randomised controlled trial. Disabil Rehabil 2019; 42:1727-1735. [PMID: 30653372 DOI: 10.1080/09638288.2018.1535630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: To examine the efficacy of an occupational therapy activity pacing intervention with deconditioned older adults in rehabilitation.Method: Randomised, single-blind controlled trial of deconditioned older adults admitted for rehabilitation following treatment of an acute medical condition, allocated to intervention [n = 51, males = 14, mean age = 80(8)] or control [n = 49, males = 12, mean age = 81(7)] group. The intervention group received individual and group activity pacing education with practice and application of techniques to daily activities and the home environment, while the control group received a typical occupational therapy program, which included brief activity pacing education. Outcomes included participation in daily living skills, health status (including pain and fatigue symptoms), self-efficacy in daily activities and activity pacing techniques using the Australian Therapy Outcome Measures-Occupational Therapy (AusTOMs-OT), Short Form-36 Health Survey (SF-36), Self-Efficacy Gauge and Activity Pacing Assessment.Results: No differences in groups at admission. Comparison at discharge and three months post discharge using 2 × 2 mixed ANOVA demonstrated small differences in only one scale of the activity limitation domain of the AusTOMs-OT. No significant differences were found in other scales or domains of the AusTOMs-OT, nor secondary outcome measures.Conclusion: Activity pacing in addition to typical occupational therapy during inpatient rehabilitation did not demonstrate benefits to participants in the management of their daily activities on returning home post hospitalisation.Implications for rehabilitationActivity pacing has been identified as one of the commonly used occupational therapy interventions utilised with deconditioned older adults in rehabilitation.An activity pacing intervention in conjunction with typical occupational therapy demonstrated no benefits for deconditioned older adults over typical occupational therapy which included basic education on this topic.Continuation of the activity pacing intervention into the outpatient setting may be of benefit to older adults and requires further investigation.
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Affiliation(s)
- Amanda J Timmer
- School of Health Medical and Applied Sciences, Central Queensland University, Melbourne, Australia.,Ramsay Health Care, Donvale Rehabilitation Hospital, Donvale, Australia
| | - Carolyn A Unsworth
- School of Health Medical and Applied Sciences, Central Queensland University, Melbourne, Australia.,Department of Rehabilitation, Jönköping University, Jönköping, Sweden.,School of Allied Health, La Trobe University, Melbourne, Australia
| | - Matthew Browne
- School of Health Medical and Applied Sciences, Central Queensland University, Melbourne, Australia
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16
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Unsworth CA, Timmer A, Wales K. Reliability of the Australian Therapy Outcome Measures for Occupational Therapy (AusTOMs-OT). Aust Occup Ther J 2018; 65:376-386. [DOI: 10.1111/1440-1630.12476] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Carolyn A. Unsworth
- School of Health, Medical and Applied Sciences; Central Queensland University; Melbourne Vic. Australia
| | - Amanda Timmer
- Donvale Rehabilitation Hospital-Ramsay Health Care; Donvale Vic. Australia
- School of Health, Medical and Applied Sciences; Central Queensland University; Rockhampton City Qld Australia
| | - Kylie Wales
- School of Health Sciences; University of Newcastle; Callaghan NSW Australia
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17
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Cooksley R, Maguire E, Lannin NA, Unsworth CA, Farquhar M, Galea C, Mitra B, Schmidt J. Persistent symptoms and activity changes three months after mild traumatic brain injury. Aust Occup Ther J 2018; 65:168-175. [PMID: 29498077 DOI: 10.1111/1440-1630.12457] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND/AIM Approximately, 80% of traumatic brain injuries are considered mild in severity. Mild traumatic brain injury (mTBI) may cause temporary or persisting impairments that can adversely affect an individual's ability to participate in daily occupations and life roles. This study aimed to identify symptoms, factors predicting level of symptoms and functional and psycho-social outcomes for participants with mTBI three months following injury. METHOD Patients discharged from the Emergency Department of a major metropolitan hospital with a diagnosis of mTBI were contacted by telephone three months after injury. An interview with two questionnaires was administered: The Concussion Symptom Inventory (CSI) Scale and the Rivermead Head Injury Follow-Up Questionnaire (RHIFUQ). Data obtained were used to determine the type and prevalence of post-concussion symptoms and their impact on activity change. RESULTS Sixty-three people with mTBI participated in the study. The majority of participants (81%) reported that all symptoms had resolved within the three-month time frame. Of those still experiencing symptoms, workplace fatigue (22%) and an inability to maintain previous workload/standards (17%) were reported. CONCLUSION There is a small, but clinically significant, subgroup of patients who continue to experience symptoms three-month post-mTBI. Symptoms experienced beyond the expected three-month recovery timeframe have the potential to adversely affect an individual's ability to participate in daily occupation and return to work.
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Affiliation(s)
- Rebecca Cooksley
- Occupational Therapy, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | | | - Natasha A Lannin
- Occupational Therapy, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia.,Alfred Health, Melbourne, Victoria, Australia
| | - Carolyn A Unsworth
- Occupational Therapy, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia.,Occupational Therapy, School of Health, Medical and Applied Sciences, Central Queensland University, Melbourne, Victoria, Australia
| | | | - Claire Galea
- Cerebral Palsy Alliance, The University of Sydney, Sydney, New South Wales, Australia
| | - Biswadev Mitra
- Alfred Health, Melbourne, Victoria, Australia.,National Trauma Research Institute, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Julia Schmidt
- Occupational Therapy, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia.,Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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18
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Unsworth CA, Baker A, Lannin N, Harries P, Strahan J, Browne M. Predicting fitness-to-drive following stroke using the Occupational Therapy - Driver Off Road Assessment Battery. Disabil Rehabil 2018; 41:1797-1802. [PMID: 29488407 DOI: 10.1080/09638288.2018.1445784] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Introduction: It is difficult to determine if, or when, individuals with stroke are ready to undergo on-road fitness-to-drive assessment. The Occupational Therapy - Driver Off Road Assessment Battery was developed to determine client suitability to resume driving. The predictive validity of the Battery needs to be verified for people with stroke. Aim: Examine the predictive validity of the Occupational Therapy - Driver Off Road Assessment Battery for on-road performance among people with stroke. Method: Off-road data were collected from 148 people post stroke on the Battery and the outcome of their on-road assessment was recorded as: fit-to-drive or not fit-to-drive. Results: The majority of participants (76%) were able to resume driving. A classification and regression tree (CART) analysis using four subtests (three cognitive and one physical) from the Battery demonstrated an area under the curve (AUC) of 0.8311. Using a threshold of 0.5, the model correctly predicted 98/112 fit-to-drive (87.5%) and 26/36 people not fit-to-drive (72.2%). Conclusion: The three cognitive subtests from the Occupational Therapy - Driver Off Road Assessment Battery and potentially one of the physical tests have good predictive validity for client fitness-to-drive. These tests can be used to screen client suitability for proceeding to an on-road test following stroke. Implications for Rehabilitation: Following stroke, drivers should be counseled (including consideration of local legislation) concerning return to driving. The Occupational Therapy - Driver Off Road Assessment Battery can be used in the clinic to screen people for suitability to undertake on road assessment. Scores on four of the Occupational Therapy - Driver Off Road Assessment Battery subtests are predictive of resumption of driving following stroke.
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Affiliation(s)
- Carolyn A Unsworth
- a School of Health Medical and Applied Science , Central Queensland University , Bundaberg , Australia.,b School of Health Sciences , Jonkoping University , Jonkoping , Sweden.,c College of Science Health and Engineering , La Trobe University , Bundoora , Australia
| | - Anne Baker
- d Department of Occupational Therapy , Australian Catholic University , Melbourne , Australia
| | - Natasha Lannin
- c College of Science Health and Engineering , La Trobe University , Bundoora , Australia.,e Department of Occupational Therapy , Alfred Health , Melbourne , Australia.,f Rehabilitation Studies Unit , University of Sydney , Sydney , Australia
| | - Priscilla Harries
- g School of Health Sciences and Social Care , Brunel University London , London, UK
| | | | - Matthew Browne
- a School of Health Medical and Applied Science , Central Queensland University , Bundaberg , Australia
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Hilton G, Unsworth CA, Stuckey R, Murphy GC. The experience of seeking, gaining and maintaining employment after traumatic spinal cord injury and the vocational pathways involved. Work 2018; 59:67-84. [DOI: 10.3233/wor-172660] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Gillean Hilton
- Central Queensland University, Melbourne, VIC, Australia
- Austin Health, Melbourne, VIC, Australia
| | - Carolyn A. Unsworth
- Central Queensland University, Melbourne, VIC, Australia
- Jonkoping University, Jonkoping, Sweden
- Curtin University, Perth, WA, Australia
- La Trobe University, Melbourne, VIC, Australia
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20
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Bruce CR, Unsworth CA, Dillon MP, Tay R, Falkmer T, Bird P, Carey LM. Hazard perception skills of young drivers with Attention Deficit Hyperactivity Disorder (ADHD) can be improved with computer based driver training: An exploratory randomised controlled trial. Accid Anal Prev 2017; 109:70-77. [PMID: 29040873 DOI: 10.1016/j.aap.2017.10.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 06/05/2017] [Accepted: 10/03/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Young drivers with Attention Deficit Hyperactivity Disorder (ADHD) are at higher risk of road traffic injuries than their peers. Increased risk correlates with poor hazard perception skill. Few studies have investigated hazard perception training using computer technology with this group of drivers. OBJECTIVES *Determine the presence and magnitude of the between-group and within- subject change in hazard perception skills in young drivers with ADHD who receive Drive Smart training. *Determine whether training-facilitated change in hazard perception is maintained over time. METHODS This was a feasibility study, randomised control trial conducted in Australia. The design included a delayed treatment for the control group. Twenty-five drivers with a diagnosis of ADHD were randomised to the Immediate Intervention or Delayed Intervention group.The Immediate Intervention group received a training session using a computer application entitled Drive Smart. The Delayed Intervention group watched a documentary video initially (control condition), followed by the Drive Smart computer training session. The participant's hazard perception skill was measured using the Hazard Perception Test (HPT). FINDINGS After adjusting for baseline scores, there was a significant betweengroup difference in post-intervention HPT change scores in favour of the Immediate Intervention group. The magnitude of the effect was large. There was no significant within-group delayed intervention effect. A significant maintenance effect was found at 6-week follow-up for the Immediate Intervention group. CONCLUSIONS The hazard perception skills of participants improved following training with large effect size and some maintenance of gain. A multimodal approach to training is indicated to facilitate maintenance. A full-scale trial is feasible.
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Affiliation(s)
- C R Bruce
- Occupational Therapy, School of Allied Health, La Trobe University, Melbourne, VIC, 3086, Australia.
| | - C A Unsworth
- Occupational Therapy, School of Allied Health, La Trobe University, Melbourne, VIC, 3086, Australia; Occupational Therapy, School of Health, Medical and Applied Sciences, CQUniversity, 120 Spencer St, Melbourne, VIC 3000, Australia; Jönköping University, Gjuterigatan 5, Box 1026, 551 11, Jönköping, Sweden; School of Occupational Therapy and Social Work, Faculty of Health Sciences, Curtin University, GPO Box U1987, Perth, WA 6845, Australia.
| | - M P Dillon
- Prosthetics and Orthotics, School of Allied Health, La Trobe University, Melbourne, VIC, 3086, Australia.
| | - R Tay
- School of Business IT & Logistcs, RMIT University, Melbourne, VIC 3000 Australia.
| | - T Falkmer
- School of Occupational Therapy and Social Work, Faculty of Health Sciences, Curtin University, GPO Box U1987, Perth, WA 6845, Australia; Rehabilitation Medicine Unit, Department of Medicine and Health Sciences (IMH), Faculty of Health Sciences, Linköping University & Pain and Rehabilitation Centre, SE-581 83, Linköping, Sweden.
| | - P Bird
- The Gosforth Clinic, PO Box 680, Maroochydore QLD 4558, Australia.
| | - L M Carey
- Occupational Therapy, School of Allied Health, La Trobe University, Melbourne, VIC, 3086, Australia; The Florey Institute of Neuroscience and Mental Health, Neurorehabilitation and Recovery, 245 Burgundy Street, Heidelberg, Melbourne, VIC 3084, Australia.
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Unsworth CA, Rawat V, Sullivan J, Tay R, Naweed A, Gudimetla P. "I'm very visible but seldom seen": consumer choice and use of mobility aids on public transport. Disabil Rehabil Assist Technol 2017; 14:122-132. [PMID: 29183207 DOI: 10.1080/17483107.2017.1407829] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE The number of mobility aid users continues to rise as the population ages. While mobility aid users rely on public transport due to its affordability, evidence suggests access can be difficult. This study aims to describe people who use mobility aids to access public transport and the role of public transport access in influencing mobility aid choice. METHODS Sixty-seven mobility aid users participated in telephone surveys which predominantly used a structured quantitative format. Data were analysed descriptively and any additional comments were simply categorized. RESULTS Thirty-six participants were female (54%), with a total sample mean age of 58.15 years (SD = 14.46). Seventy-two percent lived in metropolitan areas, 48% lived alone, and the sample experienced a variety of conditions including spinal cord injury (37%) and arthritis (18%). Sixty-four percent of all respondents used two or more mobility aids including powered wheelchairs, scooters and walking frames. The most important features when choosing a mobility aid were reliability, turning ability and size. Fifty-two percent of all respondents strongly agreed that public transport is generally accessible. CONCLUSIONS While work continues to ensure that public transport vehicles and stations are fully accessible, mobility aid users must manage current infrastructure and access a system which has been shown through this research to have many limitations. Mobility aid users, vendors and health professionals need to work together to identify mobility aids that fulfil needs, and are reliable and safe, so that mobility aid users are both "visible and seen" when accessing the public transport network. Implications for rehabilitation Some mobility aid users experience difficulties accessing and using public transport and further research is required to ensure the whole public transport network is fully accessible to people using mobility aids. Many people have more than one seated mobility aid, suggesting people can choose different aids for different purposes and environments. Health professionals may need to increase their involvement in assisting individuals to select and use mobility aids.
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Affiliation(s)
- Carolyn A Unsworth
- a Department of Exercise and Health Sciences, Central Queensland University , Melbourne , Australia
| | - Vijay Rawat
- a Department of Exercise and Health Sciences, Central Queensland University , Melbourne , Australia
| | - John Sullivan
- b Department of Physiotherapy, University of Otago , Dunedin , New Zealand
| | - Richard Tay
- c Royal Melbourne Institute of Technology , Melbourne , Australia
| | - Anjum Naweed
- d Appleton Institute, Central Queensland University , Adelaide , Australia
| | - Prasad Gudimetla
- e Engineering, Central Queensland University , Bundaberg , Australia
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Unsworth CA, Baker AM, So MH, Harries P, O’Neill D. A systematic review of evidence for fitness-to-drive among people with the mental health conditions of schizophrenia, stress/anxiety disorder, depression, personality disorder and obsessive compulsive disorder. BMC Psychiatry 2017; 17:318. [PMID: 28859696 PMCID: PMC5579945 DOI: 10.1186/s12888-017-1481-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Accepted: 08/22/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Limited evidence exists regarding fitness-to-drive for people with the mental health conditions of schizophrenia, stress/anxiety disorder, depression, personality disorder and obsessive compulsive disorder (herein simply referred to as 'mental health conditions'). The aim of this paper was to systematically search and classify all published studies regarding driving for this population, and then critically appraise papers addressing assessment of fitness-to-drive where the focus was not on the impact of medication on driving. METHODS A systematic search of three databases (CINAHL, PSYCHINFO, EMBASE) was completed from inception to May 2016 to identify all articles on driving and mental health conditions. Papers meeting the eligibility criteria of including data relating to assessment of fitness-to-drive were critically appraised using the American Academy of Neurology and Centre for Evidence-Based Medicine protocols. RESULTS A total of 58 articles met the inclusion criteria of driving among people with mental health conditions studied, and of these, 16 contained data and an explicit focus on assessment of fitness-to-drive. Assessment of fitness-to-drive was reported in three ways: 1) factors impacting on the ability to drive safely among people with mental health conditions, 2) capability and perception of health professionals assessing fitness-to-drive of people with mental health conditions, and 3) crash rates. The level of evidence of the published studies was low due to the absence of controls, and the inability to pool data from different diagnostic groups. Evidence supporting fitness-to-drive is conflicting. CONCLUSIONS There is a relatively small literature in the area of driving with mental health conditions, and the overall quality of studies examining fitness-to-drive is low. Large-scale longitudinal studies with age-matched controls are urgently needed in order to determine the effects of different conditions on fitness-to-drive.
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Affiliation(s)
- Carolyn A. Unsworth
- 0000 0001 2193 0854grid.1023.0Central Queensland University, Melbourne, Australia
| | - Anne M. Baker
- 0000 0001 2194 1270grid.411958.0Australian Catholic University, Melbourne, Australia
| | - Man H. So
- 0000 0001 2193 0854grid.1023.0Central Queensland University, Melbourne, Australia
| | | | - Desmond O’Neill
- 0000 0004 1936 9705grid.8217.cTrinity College, Dublin, Republic of Ireland
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Abstract
Statement of context Occupational therapists working with clients who have neurological impairments routinely collect outcomes data. However, data cannot inform practice unless it is routinely reviewed. The aim of this paper was to show how outcomes data collected on the Australian Therapy Outcome Measures – Occupational Therapy scale were analysed and interpreted. Although the example pertains to clients with neurological problems, the approach can be applied to all areas of practice. Critical reflection on practice When outcomes data are routinely analysed and findings reviewed, occupational therapists have an increased understanding of practice strengths and limitations. Implications for practice Incorporating analysis and interpretation of outcomes data for clients with neurological problems into practice contributes evidence to support therapy and ensures clinicians retain control of their data.
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Affiliation(s)
- Carolyn A Unsworth
- Professor, School of Health, Medical and Applied Sciences, Central Queensland University, Australia
- Adjunct Professor, La Trobe University, Melbourne, Australia
- Adjunct Professor, Curtin University, Perth, Australia
- Adjunct Professor, Jönköping University, Sweden
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Fields SM, Unsworth CA. Revision of the Competency Standards for Occupational Therapy Driver Assessors: An overview of the evidence for the inclusion of cognitive and perceptual assessments within fitness-to-drive evaluations. Aust Occup Ther J 2017; 64:328-339. [DOI: 10.1111/1440-1630.12379] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2017] [Indexed: 01/08/2023]
Affiliation(s)
- Sally M. Fields
- Occupational Therapy; School of Health; Medical and Applied Sciences; Central Queensland University; Melbourne Victoria Australia
- Faculty of Health Sciences and Medicine; Bond University; Gold Coast Queensland Australia
| | - Carolyn A. Unsworth
- Occupational Therapy; School of Health; Medical and Applied Sciences; Central Queensland University; Melbourne Victoria Australia
- Department of Rehabilitation; School of Health Sciences; Jönköping University; Jönköping Sweden
- Faculty of Health Sciences; Curtin University; Bentley Western Australia Australia
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Hilton G, Unsworth CA, Murphy GC, Browne M, Olver J. Longitudinal employment outcomes of an early intervention vocational rehabilitation service for people admitted to rehabilitation with a traumatic spinal cord injury. Spinal Cord 2017; 55:743-752. [DOI: 10.1038/sc.2017.24] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Revised: 02/02/2017] [Accepted: 02/07/2017] [Indexed: 11/09/2022]
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Abstract
Very little is known about the differences between novice and expert clinical reasoning in community health practice. This article presents the findings of a study of the clinical reasoning of five expert and five novice community health occupational therapists (CHOTs) during the conducting of home visits. A head-mounted video camera was used to record the visits, followed by the participants reporting their clinical reasoning verbally using a video-assisted debriefing method. The transcripts from these verbal reports were analysed quantitatively and qualitatively. The quantitative results demonstrated many differences between experts and novices in terms of the amounts and types of clinical reasoning used. For example, the novices used more procedural reasoning whereas the experts used more conditional reasoning and mixes of different reasoning types. The qualitative results demonstrated that the experts used a free-flowing conversational approach when reasoning during home visits whereas the novices depended on external structures such as assessment forms to guide the process. Given their experience and familiarity with the process, the experts were confident and clear in their reasoning whereas the novices were more awkward and self-conscious. The experts handled sensitive issues whereas the novices seemed to avoid them. The study findings may provide insights for student and novice therapists concerning expert CHOTs' practice and promote reflection in general on the attainment of expertise in clinical practice.
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Abstract
Using both clinical reasoning data and literature from the past 20 years, this paper sought to examine the relationship between client-centred practice and clinical reasoning, to explore the concept of pragmatic reasoning and to present a diagrammatic conceptualisation of our knowledge of clinical reasoning in occupational therapy. The clinical reasoning literature published between 1982 and 2001 was reviewed and this information was combined with the findings from a study which used a head-mounted video camera to collect data and then explore the clinical reasoning of 13 experienced occupational therapists. The data were collected and analysed within a focused ethnographic framework. The findings showed that clinical reasoning occurred in the context of client-centred practice, but that a reciprocal relationship appeared to exist between client-centred practice and interactive reasoning. It also appeared that pragmatic reasoning was related only to the therapist's practice context and that all forms of reasoning were influenced by the therapist's worldview. A diagram was developed to depict this current understanding of the modes of clinical reasoning. While clinical reasoning has been described as the guiding force in a therapeutic practice, we are only just beginning to understand the nature of reasoning and reflection and how clinicians think. Further research is required to build and test the emerging theory of clinical reasoning in occupational therapy.
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Abstract
It appears that the focus of occupational therapy on function has moved away from the concept to centre on assessments. Conceptual debate concerning function has been muted and lost in the technicalities of the measurement process and measurement theory. Numerous reviews of functional assessments have recently appeared in the occupational therapy literature.1–5 Current discussions appear to be driven by technical issues, such as the demonstration of the reliability and validity of specific measures, rather than the extent to which the design and structure of the measures form the most appropriate conceptualisation of function. A re-centring of this issue towards conceptual discussions and away from measurement technicalities is highly desirable. The purpose of this article is to review the ways function is currently perceived and to raise many of the questions that the profession must debate and resolve regarding this issue.
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Affiliation(s)
- Carolyn A Unsworth
- Carolyn Unsworth, BAppSc(OccTher), PhD Student, Department of Behavioural Health Sciences, La Trobe University, Bundoora 3083, Australia
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Unsworth CA, Duncombe D. A Comparison of Client Outcomes from Two Acute Care Neurological Services Using Self-Care Data from the Australian Therapy Outcome Measures for Occupational Therapy (AusTOMs - OT). Br J Occup Ther 2016. [DOI: 10.1177/030802260506801007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The 12 scales in the Australian Therapy Outcome Measures for Occupational Therapy (AusTOMs-OT) have been previously reported as offering therapists a simple and quick outcome measure for use in all practice areas. This short report describes and compares outcomes for a sample of 82 clients with neurological problems from two acute care hospitals who were rated on the AusTOMs-OT Self-care scale. It was found that client outcomes were comparable at the two facilities, although one site had a higher number of occupational therapy contacts and a greater number of clients showed a reduction in their level of impairment. The findings of this study suggest that AusTOMs-OT can be used by services to compare client outcomes. Ultimately, AusTOMs-OT could be used to establish clinical benchmarks against which services could make comparisons.
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Abstract
In order to conduct occupational therapy services that are evidence based, studies are urgently required which demonstrate the effectiveness of interventions offered. This paper presents the findings of a study undertaken to determine occupational therapy outcomes for clients with stroke during inpatient rehabilitation. The participants were 43 clients with stroke and four occupational therapists. Therapy outcomes for personal activities of daily living were measured using the Functional Independence Measure (Adult FIMSM); instrumental activities of daily living were measured using the Assessment of Living Skills and Resources (ALSAR); and quality of life was measured using the Quality of Life Index (Q-L Index) and a semi-structured interview. The semi-structured interview was also used to understand clients' perceptions of the outcome of their participation in occupational therapy. The data were collected at client admission, discharge and 3 months' follow-up. The results indicated that the clients believed that their ability to perform activities of daily living (Adult FIMSM t (38) = −7.80, p = 0.000, and ALSAR t (35) = 4.82, p = 0.000) and their quality of life (Q-L Index t (39) = −7.23, p = 0.000) improved over the course of their inpatient rehabilitation. The therapists also rated the clients as improving during their rehabilitation in relation to activities of daily living (Adult FIMSM t (42) = −9.71, p = 0.000, and ALSAR t (40) = 7.75, p = 0.000) and quality of life (Q-L Index t (39) = −11.20, p = 0.000). Many of the clients interviewed attributed these gains to participation in the occupational therapy programme. In conclusion, this study demonstrated that a triangulated approach to data collection and analysis was useful in providing evidence that occupational therapy, as part of comprehensive rehabilitation, made a difference to the lives of many of the clients studied.
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Unsworth CA. Measuring Outcomes using the Australian Therapy Outcome Measures for Occupational Therapy (AusTOMs-OT): Data Description and Tool Sensitivity. Br J Occup Ther 2016. [DOI: 10.1177/030802260506800804] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Although there is increasing demand for greater accountability from occupational therapists for the outcomes of their practice, there are few quick, simple and psychometrically sound tools available to measure these outcomes. This paper reports on the first data collection exercise using a new outcome measure, the Australian Therapy Outcome Measures for Occupational Therapy (AusTOMs-OT). The aims of this paper are to present the scales, describe the data set and examine whether the scales are sufficiently sensitive to detect change over time in client status. Data were collected with 466 clients at 12 metropolitan and rural health care facilities using the 12 AusTOM-OT scales, which rate the client in relation to the four domains of Impairment, Activity limitation, Participation restriction and Distress/wellbeing. The findings indicated that the most frequently used scales were Self-care, Upper limb use, Transfers and Functional walking and mobility, and that all scales were successful in demonstrating statistically significant client change over time. The AusTOMs-OT can be used to document client outcomes in relation to four important practice domains and thus be of value in research and quality assurance activities seeking to provide evidence that occupational therapy does make a difference to the lives of clients.
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Unsworth CA, Harries PA. Special Issue: Driving and community mobility (II) – interventions to enable driving. Br J Occup Ther 2015. [DOI: 10.1177/0308022614566859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Carolyn A Unsworth
- Professor of Occupational Therapy, Central Queensland University, Australia
| | - Priscilla A Harries
- Head of Department for Clinical Sciences, Department for Clinical Sciences, Brunel University, UK
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Baker A, Unsworth CA, Lannin NA. Fitness-to-drive after mild traumatic brain injury: mapping the time trajectory of recovery in the acute stages post injury. Accid Anal Prev 2015; 79:50-55. [PMID: 25797386 DOI: 10.1016/j.aap.2015.03.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 02/08/2015] [Accepted: 03/11/2015] [Indexed: 06/04/2023]
Abstract
INTRODUCTION Little is known about the trajectory of recovery in fitness-to-drive after mild traumatic brain injury (mTBI). This means that health-care professionals have limited evidence on which to base recommendations to this cohort about driving. OBJECTIVE To determine fitness-to-drive status of patients with a mTBI at 24h and two weeks post injury, and to summarise issues reported by this cohort about return to driving. METHOD Quasi-experimental case-control design. Two groups of participants were recruited: patients with a mTBI (n=60) and a control group with orthopaedic injuries (n=60). Both groups were assessed at 24h post injury on assessments of fitness-to-drive. Follow-up occurred at two weeks post injury to establish driver status. MAIN MEASURES Mini mental state examination, occupational therapy-drive home maze test (OT-DHMT), Road Law Road Craft Test, University of Queensland-Hazard Perception Test, and demographic/interview form collected at 24h and at two weeks. RESULTS At the 24h assessment, only the OT-DHMT showed a difference in scores between the two groups, with mTBI participants being significantly slower to complete the test (p=0.01). At the two week follow-up, only 26 of the 60 mTBI participants had returned to driving. Injury severity combined with scores from the 24h assessment predicted 31% of the variance in time taken to return to driving. Delayed return to driving was reported due to: "not feeling 100% right" (n=14, 23%), headaches and pain (n=12, 20%), and dizziness (n=5, 8%). CONCLUSION This research supports existing guidelines which suggest that patients with a mTBI should not to drive for 24h; however, further research is required to map factors which facilitate timely return to driving.
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Affiliation(s)
- Anne Baker
- Institute for Safety, Compensation and Recovery Research, Monash University, Melbourne, Australia
| | - Carolyn A Unsworth
- Faculty of Health Sciences, La Trobe University, Victoria, Australia; Department of Occupational Therapy, Central Queensland University, Victoria, Australia; Department of Rehabilitation, School of Health Sciences, Jönköping University, Sweden; Department of Occupational Therapy, Curtin University, Perth, Australia
| | - Natasha A Lannin
- Faculty of Health Sciences, La Trobe University, Victoria, Australia; Department of Occupational Therapy, Alfred Health, Victoria, Australia; Rehabilitation Studies Unit, Sydney Medical School, The University of Sydney, Australia.
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Bruce C, Unsworth CA, Tay R, Dillon MP. Development and validation of the Occupational Therapy Risk Propensity Test (OT-RiPT) for drivers with disability. Scand J Occup Ther 2015; 22:147-52. [DOI: 10.3109/11038128.2014.992952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Affiliation(s)
- Priscilla A Harries
- Head of Department for Clinical Sciences, Brunel University London, Uxbridge, UK
| | - Carolyn A Unsworth
- Professor of Occupational Therapy, Central Queensland University, Melbourne, Australia
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Baker A, Unsworth CA, Lannin NA. Determining fitness to drive: A systematic review of the methods and assessments used after mild traumatic brain injury. Br J Occup Ther 2015. [DOI: 10.1177/0308022614562405] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Introduction Limited evidence is available to support knowledge of the time-frame and capacity for fitness to drive after mild traumatic brain injury. The aim of this systematic review was to identify what methods and assessments are, or could be used to determine fitness to drive for this population. Method We undertook a systematic search of six electronic databases. Two authors rated all studies for methodological content and quality, and standardised data were extracted. Narrative analysis was conducted to understand the content of eligible studies. Findings A total of 2022 articles were retrieved; seven articles met the inclusion criteria. Self-reported questionnaires, non-standardised assessments, questionnaires completed by next-of-kin, and simulator tests were the primary methods used to determine fitness to drive. Only one assessment has been used to aid recommendations about fitness to drive in the acute hospital setting. Six additional standardised assessments were identified that have the potential to predict fitness to drive in this population group; however, these assessments require further psychometric testing prior to use. Conclusion While a variety of methods and assessments are currently used, there is little research evidence to suggest when individuals are able to return to driving after mild traumatic brain injury. Research is urgently required to determine a consistent and standardised approach to assessing fitness to drive following mild traumatic brain injury.
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Affiliation(s)
- Anne Baker
- Doctoral Candidate, La Trobe University, Bundoora, Victoria, Australia
| | - Carolyn A Unsworth
- Professor, La Trobe University, Bundoora, Victoria, Australia
- Professor, Jönköping University, Jönköping, Sweden
- Professor, Curtin University, Bentley, Perth, Australia
- Professor, Central Queensland University, Melbourne, Victoria, Australia
| | - Natasha A Lannin
- Associate Professor, La Trobe University, Bundoora, Victoria, Australia
- Associate Professor, Alfred Health, Prahran, Victoria, Australia
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Timmer AJ, Unsworth CA, Taylor NF. Occupational therapy inpatient rehabilitation interventions with deconditioned older adults following an acute hospital admission: A Delphi study. Aust Occup Ther J 2015; 62:41-9. [DOI: 10.1111/1440-1630.12169] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Amanda J. Timmer
- School of Allied Health; La Trobe University; Melbourne Australia
- Donvale Rehabilitation Hospital; Ramsay Health Care; Donvale Victoria Australia
| | - Carolyn A. Unsworth
- School of Allied Health; La Trobe University; Melbourne Australia
- School of Health Sciences; Department of Rehabilitation; Jönköping University; Jönköping Sweden
- School of Occupational Therapy and Social Work; Curtin University; Perth Australia
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Unsworth CA. Using the Australian Therapy Outcome Measures for Occupational Therapy (AusTOMs-OT) to Measure Outcomes for Clients Following Stroke. Top Stroke Rehabil 2015; 15:351-64. [DOI: 10.1310/tsr1504-351] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Unsworth CA, Baker A. Driver rehabilitation: a systematic review of the types and effectiveness of interventions used by occupational therapists to improve on-road fitness-to-drive. Accid Anal Prev 2014; 71:106-114. [PMID: 24906164 DOI: 10.1016/j.aap.2014.04.017] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 03/31/2014] [Accepted: 04/23/2014] [Indexed: 06/03/2023]
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 OTDBase) 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.
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Affiliation(s)
- Carolyn A Unsworth
- Faculty of Health Sciences, La Trobe University, Melbourne 3086, VIC, Australia; Department of Rehabilitation, School of Health Sciences, Jönköping University, Jönköping, Sweden.
| | - Anne Baker
- Faculty of Health Sciences, La Trobe University, Melbourne 3086, VIC, Australia
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Timmer AJ, Unsworth CA, Taylor NF. Rehabilitation interventions with deconditioned older adults following an acute hospital admission: a systematic review. Clin Rehabil 2014; 28:1078-86. [PMID: 24844238 DOI: 10.1177/0269215514530998] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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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Affiliation(s)
- Amanda J Timmer
- School of Allied Health, La Trobe University, Melbourne, Victoria, Australia Donvale Rehabilitation Hospital, Ramsay Healthcare, Donvale, Victoria, Australia
| | - Carolyn A Unsworth
- School of Allied Health, La Trobe University, Melbourne, Victoria, Australia School of Health Sciences, Department of Rehabilitation, Jönköping University, Sweden
| | - Nicholas F Taylor
- School of Allied Health, La Trobe University, Melbourne, Victoria, Australia
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Abu-Awad Y, Unsworth CA, Coulson M, Sarigiannis M. Using the Australian Therapy Outcome Measures for Occupational Therapy (AusTOMs-OT) to Measure Client Participation Outcomes. Br J Occup Ther 2014. [DOI: 10.4276/030802214x13916969446958] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Introduction: Measuring change in clients' ‘participation’, and being able to attribute this change to occupational therapy intervention, is important in the quest to provide evidence to support practice. The Australian Therapy Outcome Measures for Occupational Therapy is an outcome measure that has four domains, one of which is concerned with measuring client participation. An occupational therapy service wanted to determine if client level of participation was improving, as measured by the Australian Therapy Outcome Measures for Occupational Therapy. Method: Data were collected between 2009 and 2012 from three home-based therapy services, using the Australian Therapy Outcome Measures for Occupational Therapy. Data were divided into diagnostic cohorts, and then exploratory data analysis techniques and paired t-tests were performed. Findings: Data from 506 participants were analysed and clients in all diagnostic groups made statistically (p < .05) significant improvements over time in relation to their participation. Conclusion: Most clients in this study improved or maintained their level of participation between admission and discharge, with few clients deteriorating, when measured on the Australian Therapy Outcome Measures for Occupational Therapy scales. These results suggest the home-based therapy service was meeting its goal, and further supports the responsiveness of the Australian Therapy Outcome Measures for Occupational Therapy to detect change in clients' participation status over time. Randomized control trials are needed to determine whether improvements in participation are due to engaging in the occupational therapy program.
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Affiliation(s)
- Yasar Abu-Awad
- Post-professional Master's Student, La Trobe University — Occupational Therapy, Melbourne, Victoria, Australia
| | - Carolyn A Unsworth
- Professor, La Trobe University — Occupational Therapy, Melbourne, Victoria, Australia
| | - Melissa Coulson
- Research Assistant, La Trobe University — Occupational Therapy, Melbourne, Victoria, Australia
| | - Mary Sarigiannis
- Occupational Therapy Manager, Aged and Chronic Care Rehabilitation Service, Sydney Local Health District, Sydney, New South Wales, Australia
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Chaffey L, Unsworth CA, Fossey E. Relationship between intuition and emotional intelligence in occupational therapists in mental health practice. Am J Occup Ther 2013; 66:88-96. [PMID: 22389943 DOI: 10.5014/ajot.2012.001693] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Clinical reasoning studies have acknowledged tacit aspects of practice, and recent research suggests that clinical reasoning contains intuition informed by tacit knowledge. Intuition also appears to be influenced by awareness and understanding of emotions. This study investigated the relationship between intuition and emotional intelligence among occupational therapists in mental health practice. METHOD We mailed a survey containing measures of cognitive style and of use of emotional competencies at work and demographic questions to 400 members of the national occupational therapy association; 134 occupational therapists responded. RESULTS A moderate relationship was found between intuitive cognitive style and emotional intelligence. Experienced therapists scored higher on the use of emotional competencies at work and reported a preference for an intuitive cognitive style to a greater extent than novices. CONCLUSION This study represents the first attempt to explore occupational therapists' preferred cognitive style and self-reported emotional intelligence. Findings suggest that exploring emotions through reflective practice could enhance intuitive aspects of clinical reasoning.
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Affiliation(s)
- Lisa Chaffey
- School of Health, Medicine, Nursing and Behavioural Science, Deakin University, Geelong, Victoria 3216, Australia.
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Affiliation(s)
- Priscilla A Harries
- Senior Lecturer and Divisional Research Lead, School of Health Sciences and Social Care, Brunel University, London
| | - Carolyn A Unsworth
- Professor of Occupational Therapy, Department of Occupational Therapy, Faculty of Health Sciences, La Trobe University, Australia and Adjunct Professor of Occupational Therapy, Department of Rehabilitation, School of Health Sciences, Jönköping University, Sweden
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Harries PA, Unsworth CA. Special Issue — Driving and Community Mobility. Br J Occup Ther 2013. [DOI: 10.1177/030802261307600703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Fristedt S, Elgmark Andersson E, Unsworth CA. The inter-rater and test–retest reliability of the Self-care and Transfer scales, and intra-rater reliability of all scales of the Swedish Translation of the Australian Therapy Outcome Measures for Occupational Therapy (AusTOMs-OT-S). Scand J Occup Ther 2013; 20:182-9. [DOI: 10.3109/11038128.2013.777940] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Krishnasamy C, Unsworth CA, Howie L. Exploring the mobility preferences and perceived difficulties in using transport and driving with a sample of healthy and outpatient older adults in Singapore. Aust Occup Ther J 2012; 60:129-37. [DOI: 10.1111/1440-1630.12020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2012] [Indexed: 11/30/2022]
Affiliation(s)
| | | | - Linsey Howie
- Department of Occupational Therapy, La Trobe University, Melbourne; Victoria; Australia
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Unsworth CA, Baker A, Taitz C, Chan SP, Pallant JF, Russell KJ, Odell M. Development of a standardised Occupational Therapy--Driver Off-Road Assessment Battery to assess older and/or functionally impaired drivers. Aust Occup Ther J 2011; 59:23-36. [PMID: 22272880 DOI: 10.1111/j.1440-1630.2011.00979.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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 off-road driving capacity of clients.
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Affiliation(s)
- Carolyn A Unsworth
- Department of Occupational Therapy, La Trobe University, Melbourne, Australia.
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Unsworth CA, Pallant JF, Russell K, Odell M, Coulson M. Interrater Reliability of the Road Law and Road Craft Test as Part of the OT-DORA Battery for Off-Road Driver Assessment. Br J Occup Ther 2011. [DOI: 10.4276/030802211x13125646370960] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background: The Occupational Therapy Driver Off Road Assessment (OT-DORA) Battery is in development as a comprehensive off-road evaluation of fitness to drive. Although several psychometric properties of the Road Law and Road Craft Test (RLRCT) have been previously studied, interrater reliability must also be established to include this test in the battery. Aim: The aim of the study was to determine the interrater reliability of the RLRCT. Method: Three occupational therapy driver assessors independently scored 20 client responses on the 14-item RLRCT. Results: The interrater reliability for all items, except item 6, was found to be between 0.57 and 1.00. The scoring instructions for item 6 were revised and the interrater reliability rose from 0.42 to 0.77. Conclusion: The RLRCT has been found to be reliable when administered by different raters and is thus suitable for inclusion in the OT-DORA Battery. Ongoing research to confirm the psychometric properties of the RLRCT is required.
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Affiliation(s)
- Carolyn A Unsworth
- Associate Professor, Department of Occupational Therapy, La Trobe University, Bundoora, Victoria, Australia; Adjunct Professor, School of Health Sciences, Jönköping University, Jönköping, Sweden; and Visiting Professor, Faculty of Health and Social Care, London South Bank University, London, UK
| | - Julie F Pallant
- Associate Professor, Rural Health Academic Centre, University of Melbourne, Shepparton, Victoria, Australia
| | - Kay Russell
- Senior Occupational Therapist, Austin Health Heidelberg Repatriation Hospital, Melbourne, Victoria, Australia
| | - Morris Odell
- Medical Adviser toVicRoads, Victorian Institute of Forensic Medicine, Monash University, Melbourne, Victoria, Australia
| | - Melissa Coulson
- Research Assistant, Department of Occupational Therapy, La Trobe University, Bundoora, Victoria, Australia
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Affiliation(s)
- Carolyn A Unsworth
- Associate Professor, Department of Occupational Therapy, La Trobe University, Australia
- Adjunct Professor, School of Health Sciences, Jönköping University, Jönköping, Sweden
- Visiting Professor, Faculty of Health and Social Care, London South Bank University, London
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