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Arts on Prescription at Home (AoP@Home) involves a professional artist visiting a person with dementia and their informal carer(s) in their own home to engage them in participatory art making. While there is evidence for the use of these programs, more work is needed to facilitate effective implementation. This study explored contextual barriers and enablers to implementation of AoP@Home within a real‐world community aged care service. Two remote focus groups were conducted at a community aged care provider in Sydney, Australia. Key stakeholders (n= 14) were recruited, representing: people with dementia, informal (family) carers, AoP artists, service referrers and community service managers. Focus group transcripts were analysed using qualitative content analysis and mapped onto the Consolidated Framework for Implementation Research (CFIR). Outcomes were reviewed against the Expert Recommendations for Implementing Change (ERIC) strategy compilation to inform development of a tailored implementation strategy. Four overarching themes described the range of barriers and enablers to AoP@Home implementation: (1) “I don't know enough about it” (awareness and engagement within the sector), (2) artists delivering programs, (3) awareness and engagement of people impacted by dementia, (4) practicalities of implementation. All five domains of the CFIR were represented across the four themes. The ERIC compilation provided a list of practical strategies for implementation of AoP@Home. The implementation of psychosocial interventions for people living with dementia within a community aged care service is complex and multifactorial. So what?:Organisations planning implementation should consider conducting their own pre‐implementation analysis to identify context‐specific strategies.

Introduction Facilitating engagement in meaningful occupations underpins occupational therapy intervention. Occupation-based practice, while linked to improved professional identity and job satisfaction for occupational therapists, is challenging to implement, particularly in hospital settings. This study aimed to explore occupational therapists’ perceptions of their role, and facilitators and challenges to implementing occupation-based practice in neurology.Method This qualitative descriptive study included semi-structured interviews with seven occupational therapists working in Australian acute/sub-acute neurology settings.Findings Three themes identified: Conceptualisation versus implementation of occupation-based practice; Use of occupation-based practice impacts role satisfaction; Promoting the profession. Participants described using occupations in their practice as important, however, reported that the challenges of the neurology environment hindered their ability to carry out occupation-based practice.Conclusion This study provides insights into occupational therapist’s perceptions regarding occupation-based practice in neurology settings, finding there is a need for occupational therapists to promote their role and use of occupations in neurology settings, and that occupation-based practice impacts job satisfaction. The study highlights occupational therapists working in neurology settings would benefit from a number of approaches including student interprofessional activities, potential buddy system for new graduates and experienced clinicians, and increased support by the profession to maintain their identity as occupation-based specialists.

Introduction Acute care readmissions of older people are an ongoing concern in many countries. Occupational therapists are well positioned to play a significant role in contributing to improved outcomes and fewer readmissions following discharge from acute hospitals, yet there is a lack of empirical evidence to support this claim.Methods This study used a retrospective clinical audit of secondary hospital data to investigate and describe the time spent on occupational therapy, and the range of occupational therapy and other allied health services provided to older people admitted to acute care, in one Australian health care service.Results Occupational therapists conducted numerous assessments and interventions to support patients and to prepare them for safe discharge home. Occupational therapy was significantly associated with length of stay. Readmission was not related directly or significantly to time spent in occupational therapy or any other factor included in this study. However, of the people who received occupational therapy, there was a higher percentage readmitted when they had more services already in place on admission and when they lived alone.Conclusions This study provides preliminary evidence regarding the contact time and range of occupational therapy assessments and interventions provided to older people in the acute hospital setting.

Study design: Qualitative study using semi-structured interviews. Objectives: To describe and compare models of service delivery intended to support community integration in the immediate period following inpatient rehabilitation for SCI, and describe the characteristics of these models or approaches. Setting: Spinal services from multiple international countries Methods: Semi-structured interviews were completed with 12 participants from a convenience sample of ten spinal services from developed economies. Interviews were audio-recorded, transcribed verbatim and thematically analysed. Results: Three themes were identified, and are described with supporting quotations. These are: Theme One—Models of service delivery (sub-themes: staffing, peer mentors, facilitating community integration during inpatient rehabilitation; Theme Two—Services provided (sub-themes: telehealth, vocational services, groups); Theme Three—Facilitating self-efficacy and self-management. Conclusions: A variety of models aimed at supporting community integration in the immediate period following inpatient rehabilitation for SCI were found. Multi-disciplinary staffing and involvement of peer mentors was common to all services. The importance of vocational rehabilitation was acknowledged by all participants, although the approaches taken to this varied. Telehealth has the potential to assist in self-management, particularly for patients who live a long distance from the spinal unit or are confined to the home for health reasons, and could be further developed. Although service models are greatly influenced by the funding context, the findings from this study can be used to inform service planning in this area.

Scoping review. The objective of this study is to report on the extent, range and nature of the research evaluating peer-led interventions following spinal cord injury, and to categorize and report information according to study design, peer role, intervention type and intended outcomes. Arksey and O’Malley’s methodological framework for conducting scoping reviews was used. Original research studies of a peer-led intervention published between 2010 and present were included. CINAHL Plus, Ovid MEDLINE and PsycINFO were searched using key terms, in addition to citation checks. Data were extracted against a previously published consolidated typology. Significant heterogeneity in studies (n= 21) existed in aims and methods. Two studies reported on randomized controlled trials with relatively robust sample sizes and qualitative methodology was common. Peer role was frequently described as ‘peer support’, but there was variation in the description and duration of the interventions, complicating the categorization process. The majority of interventions were conducted one to one (n= 15). Studies most commonly aimed to address community integration (n= 15) and health self-management outcomes (n= 10). A small number of studies were eligible for review, although increasingly with rigorous designs. The nature of the peer mentor and mentee experiences were explored, and the interaction between the two, offering rich insights to the value of lived experience. Further work refining typology describing intervention type, peer roles and outcomes would facilitate replication of programmes and study designs, enabling statistical synthesis and potentially strengthening the credibility of peers as a viable resource in in-patient and community settings.

Philosophers and bioethicists are typically sceptical about invocations of dignity in ethical debates. Many believe that dignity is essentially devoid of meaning: either a mere rhetorical gesture used in the absence of good argument or a faddish term for existing values like autonomy and respect. On the other hand, the patient experience of dignity is a substantial area of research in healthcare fields like nursing and palliative care. In this paper, it is argued that philosophers have much to learn from the concrete patient experiences described in healthcare literature. Dignity is conferred on people when they are treated as having equal status, something the sick and frail are often denied in healthcare settings. The importance of equal status as a unique value has been forcefully argued and widely recognised in political philosophy in the last 15 years. This paper brings medical ethics up to date with philosophical discussion about the value of equal status by developing an equal status conception of dignity.

Introduction The number of people with non-traumatic spinal cord injury is rising in developed countries such as Australia and Great Britain. People with non-traumatic spinal cord have different gender, injury and age-related profiles compared to those with traumatically acquired spinal cord injury; therefore, their lived experience is likely to be different. However, the specific issues and challenges that this group faces have not been well investigated.Method Semi-structured in-depth interviews were conducted with 17 adults with non-traumatic spinal cord injury. Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis.Findings The factors that influenced the social and community participation of people with non-traumatic spinal cord injury were grouped into three broad areas: person factors, factors in the physical and institutional environment, and factors in the social or cultural environment.Conclusion The findings from this study inform the understanding of occupational therapists regarding the social and community participation of people with non-traumatic spinal cord injury and how this can be facilitated. Assisting people with non-traumatic spinal cord injury to participate in meaningful social and community-based activities is important to maximise their quality of life.

Evaluation of rehabilitation outcomes following acquired disability should include participation in social and community life. Evidence is needed to guide clinical practice to ensure that it is client-centered; therefore, findings from studies that report on social and community participation following spinal cord injury (SCI) need to be reviewed and synthesized. The objectives of this critical literature review are to examine the available evidence on social and community participation following SCI and to examine the factors that influence that participation. The barriers and facilitators will be identified and described in terms of the contextual factors – personal or environmental, as outlined by the International Classification of Functioning, Disability and Health. An additional objective is to appraise the quality of the evidence examined. A systematic literature search was completed in the databases OVID MEDLINE, AMED, CINAHL PLUS, PSYCHINFO, and hand searches were carried out. Quantitative, qualitative, and mixed methods studies were included. Twenty-three studies fulfilled the inclusion criteria: 17 quantitative, five qualitative, and one mixed methods. In general, studies were of low methodological quality, and no intervention studies were identified. The terms participation, social participation, and community participation were used interchangeably often without clarification of meaning. Adequate personal care assistance, appropriate social support, having adequate specialized equipment, and appropriate occupational therapy input were found to facilitate social and community participation, whereas problems with transport, inaccessibility of the natural and built environment, issues with healthcare services and rehabilitation providers, and pain were identified as barriers. In-depth investigation into what aspects of social and community participation are important to those living with SCI is needed so that client-focused solutions and interventions can be identified and developed, aimed at creating and promoting opportunities for social and community participation.

Distributive justice decision making tends to require a trade off between different valued outcomes. The present study tracked computer mouse cursor movements in a forced-choice paradigm to examine for tension between different parameters of distributive justice during the decision-making process. Participants chose between set meal distributions, to third parties, that maximised either equality (the evenness of the distribution) or efficiency (the total number of meals distributed). Across different formulations of these dilemmas, responding was consistent with the notion that individuals tend to base decisions in part on the magnitude of these parameters. In addition, dilemmas associated with inconsistent responding across the sample tended to elicit the greatest spatial deviation of the cursor, potentially reflecting dilemma difficulty. One interpretation of these results is that individuals value equality and efficiency in such a way that moral dilemmas are resolved by comparing the perceived value of these qualitatively different parameters, consistent with a value pluralistic framework of decision making. A post-hoc analysis indicated that individuals also incorporated sufficiency concerns during distributive justice decision making. The results are discussed in relation to political philosophy.

Introduction: Meaningful time use provides an indicator of quality of life and is a key area of interest to occupational therapists. Spinal cord injury is a prevalent and catastrophic acquired neurological impairment, which occurs most commonly in early adulthood. Spinal cord injury has been found to have little impact on life expectancy, but has a profound influence on productivity and participation. Understanding how people with spinal cord injury use their time is imperative if rehabilitation and quality of life outcomes are to be influenced.Method: A systematic review was completed and relevant studies located. These studies were then rated to discern their level of evidence.Results: A total of four published articles, from two studies, were found that fitted the inclusion criteria. All published studies were cross-sectional surveys. The level of evidence provided in these studies is relatively low.Conclusion: There has been limited research completed in the area of time use following spinal cord injury. There is a need for high quality evidence to inform occupational therapists about how people with spinal cord injury spend their time and how satisfied they are with the occupations in which they engage.

If it is so obvious that international participants should share in the spoils of research profits, why isn’t it equally obvious that participants who share nationality with the researchers should do so as well? I argue that if one believes that some form of benefit-sharing is morally obligatory in research conducted in developing countries, it is very hard to escape the conclusion that it should at least in some circumstances be thought equally obligatory in research conducted within the borders of developed countries. I show that untenable assumptions about solidarity and altruism within developed countries are relied upon to deny fair treatment to research participants in developed countries — treatment that would be considered exploitative if meted out to citizens in developing countries.

Nurses from occupational health care settings around the world, interpreting the theme “Communication, Health Care, and the Community,” presented papers at the First International Conference on Occupational Health Nursing in Edinburgh, Scotland in October, 1986. In keeping with AAOHN's commitment to an international perspective, this article is Part I of a five part series of articles that will be printed in the AAOHN JOURNAL. Next month, Part II of the series will feature, “Traditional and Modern Medicine in Worker Health Care.”