Search

This study describes the discharge destination, basic and instrumental activities of daily living (ADL), community reintegration and generic health status of people after stroke, and explored whether sociodemographic and clinical characteristics were associated with these outcomes. Participants were 51 people, with an initial stroke, admitted to an acute hospital and discharged to the community. Admission and discharge data were obtained by chart review. Follow-up status was determined by telephone interview using the Modified Barthel Index, the Assessment of Living Skills and Resources, the Reintegration to Normal Living Index, and the Short-Form Health Survey (SF-36). At follow up, 57% of participants were independent in basic ADL, 84% had a low risk of experiencing instrumental ADL difficulties, most had few concerns with community reintegration, and SF-36 physical functioning and vitality scores were lower than normative values. At follow up, poorer discharge basic ADL status was associated with poorer instrumental ADL and community reintegration status, and older participants had poorer instrumental ADL, community reintegration and physical functioning. Occupational therapists need to consider these outcomes when planning inpatient and post-discharge intervention for people after stroke. [ABSTRACT FROM AUTHOR]

Introduction: Despite the availability of stroke clinical practice guidelines and acceptance by therapists that guidelines contain 'best practice' recommendations, compliance remains low. While previous studies have explored barriers associated with implementing rehabilitation guidelines in general, it remains unknown if these barriers are applicable to upper limb rehabilitation specifically. To plan effective implementation activities, key motivators and barriers to use should be identified., Method: To investigate occupational and physiotherapists' perceptions of motivators and barriers to using upper limb clinical practice guideline recommendations in stroke rehabilitation, a mixed-method study was conducted. Using an online survey and semi-structured focus groups, physiotherapists and occupational therapists working in one of six stroke rehabilitation teams in Melbourne, Australia were invited to participate. Survey data were analysed using descriptive statistics, and thematic coding of free-text responses. Focus groups were transcribed, thematically coded and mapped against the Theoretical Domains Framework., Results: Forty-six participants completed the survey and 29 participated in the focus groups. Key motivators to use guideline recommendations included past experience with specific interventions, availability of required resources and an enabling workplace culture. Barriers included: limited training/skills in specific interventions, the complexity of intervention protocols, and beliefs about intervention effectiveness. Lack of accountability was highlighted and therapists perceived they are rarely checked for quality assurance purposes regarding guideline adherence., Conclusion: Therapists identified that both motivators and barriers to implementing best-practice upper limb rehabilitation occur largely at the levels of the individual and the environment. As such, intervention efforts should focus at both these levels to facilitate change., (© 2019 Occupational Therapy Australia.)

Background/aim: Scientific conferences provide a forum for clinicians, educators, students and researchers to share research findings. To be selected to present at a scientific conference, authors must submit a short abstract which is then rated on its scientific quality and professional merit and is accepted or rejected based on these ratings. Previous research has indicated that inter-rater variability can have a substantial impact on abstract selection decisions. For their 2015 conference, the Occupational Therapy Australia National Conference introduced a system to identify and adjust for inter-rater variability in the abstract ranking and selection process., Method: Ratings for 1340 abstracts submitted for the 2015 and 2017 conferences were analysed using many-faceted Rasch analysis to identify and adjust for inter-rater variability. Analyses of the construct validity of the abstract rating instrument and rater consistency were completed. To quantify the influence of inter-rater variability of abstract selection decisions, comparisons were made between decisions made using Rasch-calibrated measure scores and decisions that would have been made based purely on raw average scores derived from the abstract ratings., Results: Construct validity and measurement properties of the abstract rating tool were good to excellent (item fit MnSq scores ranged from 0.8 to 1.2; item reliability index = 1.0). Most raters (24 of 27, 89%) were consistent in their use of the rating instrument. When comparing abstract allocations under the two conditions, 25% of abstracts (n = 341) would have been allocated differently if inter-rater variability was not accounted for., Conclusion: This study demonstrates that, even with a strong abstract rating instrument and a small rater pool, inter-rater variability still exerts a substantial influence on abstract selection decisions. It is recommended that all occupational therapy conferences internationally, and scientific conferences more generally, adopt systems to identify and adjust for the impact of inter-rater variability in abstract selection processes., (© 2017 Occupational Therapy Australia.)

Background/aim: When working with individuals following stroke or traumatic brain injury, an important role of the occupational therapist is to assess the impact of cognitive impairment on their ability to engage in occupations and resume important life roles. The aim of this study was to survey therapists' reasons for selection of and challenges with using various cognitive assessment approaches, across the continuum of care, when working with individuals following stroke and traumatic brain injury., Methods: A cross-sectional survey, completed via post or online, with responses from 209 Australian occupational therapists was conducted. Participants included clinicians working in acute, inpatient rehabilitation and community settings., Results: Occupational performance-based assessments were ranked as the most important assessment method, with 69% of participants reporting using these assessments for more than 75% of their clients with cognitive impairment. Participants identified the lack of quantitative data provided by these assessments as a frequent challenge. The identification of cognitive deficits was the highest ranked reason for using cognitive screens and batteries. Challenges identified with using cognitive screens and batteries included difficulty linking assessment results to occupational performance, and difficulty using results to generate intervention strategies. The majority of participants reported using a combined approach to assessment, and used screens and batteries to support findings of occupational performance-based assessments., Conclusions: Targeted efforts to further incorporate standardised occupational performance-based methods into clinical practice, research, and ongoing professional development is required to enhance occupational therapy services when working with individuals with cognitive impairment., (© 2013 Occupational Therapy Australia.)

Background/aim:   Networking, together with knowledge acquisition and resource sharing, are key components of occupational therapists' professional development. To enhance the connectedness and clinical support available to occupational therapists, OT AUSTRALIA Queensland developed an online community of practice (CoP). No research regarding the use of online CoPs by occupational therapists has been conducted. This study aimed to explore occupational therapists' perceptions of the benefits of, barriers to, and reasons for using or not using the online CoP., Methods:   Two focus groups were conducted, one with therapists who had used the CoP (n = 5) and the other with therapists who had not used it (n = 9). Participant responses to focus group questions informed the development of a survey asking therapists about their use of the CoP, its benefits and reasons for using/not using it, which was sent via email to all OT AUSTRALIA Queensland members., Results: Motivation to use the CoP, technology, workload management impacts, potential benefits and time considerations emerged as themes from the focus groups. Of the 55 survey respondents, 58.2% were aware of the CoP but only 32.7% had accessed it. Potential benefits of the CoP identified by participants included time efficiency, structural flexibility, networking capabilities and mentoring opportunities. Reasons for not accessing and/or participating in the CoP included access difficulties, usability difficulties, personal communication preferences and perceived irrelevance of available information., Conclusion: The findings of this study suggest that the CoP is still in the early stages of development; however, it has the potential to be further embraced by therapists if further promotion, training and minor usability modifications are undertaken., (© 2011 The Authors. Australian Occupational Therapy Journal © 2011 Occupational Therapy Australia.)

Background/aim: Cognitive impairment is a common and often debilitating consequence of stroke. The current practice patterns of Australian occupational therapists who work in this area are not clearly known. The aim of this study was to investigate the theoretical approaches, assessments, interventions and research evidence used by Australian occupational therapists who work with patients who have cognitive impairment poststroke., Methods: A self-administered, purpose-designed online survey was used., Results: Survey responses were received from 102 occupational therapists. The client-centred approach was the most commonly used theoretical approach, with 81.3% and 72% using it often or all of the time with inpatients and outpatients, respectively. Assessments that were most frequently used were the Mini Mental State Examination (63.7% of participants), the Lowenstein Occupational Therapy Cognitive Assessment (45.1%), the Functional Independence Measure (57.8%, and the Assessment of Living Skills and Resources (10.0%). Interventions involving functional activities were used more frequently than compensatory techniques, such as diaries, alarms, or other electronic devices, and paper and pencil remedial exercises. Few (16%) participants used computer programs specifically designed for cognitive rehabilitation. Although 60.8% of the participants reported using research literature when making decisions about interventions, a higher percentage reported relying on their past experience (88.3%) and colleagues' opinions (77.4%)., Conclusion: This study provides an insight into the current practices of Australian occupational therapists who work with people who have cognitive impairment after stroke. Client-centredness is emphasised in current practice; however, the use of research evidence to inform practice appears to be limited.