Search

The article discusses maternity in early modern England through an analysis of the pamphlet "The Countesse of Lincolnes Nurserie" by Elizabeth Clinton, countess of Lincoln, England. Particular focus is given to the work's argument supporting maternal breastfeeding, as opposed to the use of a wet nurse. The developments in motherhood were largely informed by English Puritanism and the notion of women's salvation through raising children and subservience to patriarchy. Connections are also drawn between motherhood, early modern piety, and femininity.

The article discusses the evolving understanding of rehabilitation, emphasizing the need for a broader perspective that includes psychology, sociology, and other behavioral sciences. It challenges the biomedical approach and advocates for the biopsychosocial model of wellness. It recommends for a reevaluation of rehabilitation dogma and a shift towards a person-centered approach.

BACKGROUND: Intensity refers to the amount of effort or rate of work undertaken during exercise. People receiving rehabilitation after stroke frequently do not reach the moderate to high intensity exercise recommended to maximise gains. OBJECTIVE: To explore the factors that influence the acceptability of, and engagement with, a high intensity group-based exercise programme for people with stroke. METHODS: This qualitative descriptive study included 14 people with stroke who had completed a 12-week, high intensity group-based exercise rehabilitation programme. Semi-structured interviews were used to explore the acceptability of high intensity exercise and the barriers and facilitators to engagement. Interviews were recorded, transcribed and analysed using qualitative content analysis. RESULTS: The participants found high intensity exercise rehabilitation acceptable despite describing the exercise intensity as hard and reporting post-exercise fatigue. Participants accepted the fatigue as a normal response to exercise, and it did not appear to negatively influence engagement. The ease with which an individual engaged in high intensity exercise rehabilitation appeared to be mediated by inter-related factors, including: seeing progress, sourcing motivation, working hard, the people involved and the fit with the person and their life. Participants directly related the intensity of their effort to the gains that they made. CONCLUSIONS: In this study, people with stroke viewed training at higher intensities as a facilitator, not a barrier, to engagement in exercise rehabilitation. The findings may challenge assumptions about the influence of exercise intensity on engagement. [ABSTRACT FROM AUTHOR]

This article explores how Canadian nurses understood care for the elderly in the decades before geriatric/gerontological nursing emerged as a distinct subspeciality. Using articles, editorials, and advertisements published in the Canadian national nursing journal Canadian Nurse, this paper argues that from 1905 until the 1940s, Canadian nurses imagined care for the elderly as part of a wider paradigm of chronic and rehabilitative care, which integrated personal, domestic, scientific, and therapeutic practices. As the population of seniors grew after the Second World War, Canadian nurses joined other health professionals in defining old age as a distinct life phase best understood through the tools of scientific medicine. Embracing geriatric science held some advantages but also made it more difficult for nurses to sustain the integration of personal and scientific care. This article traces the historical shifts in how Canadian nurses approached care for the elderly and, in doing so, contributes to the larger project of making nurses’ work and knowledge visible. [ABSTRACT FROM AUTHOR]

Purpose: To test the feasibility and acceptability of an implementation intention strategy ( if-then plans) increasingly used in health psychology to bridge the goal intention-action gap in rehabilitation with people with neurological conditions who are experiencing difficulties with mobility. Methods: Twenty people with multiple sclerosis (MS) and stroke, randomised to an experimental and control group, set up to three mobility related goals with a physiotherapist. The experimental group also formulated if-then plans for every goal. Data collection: Focus groups and interviews with participants and therapists; Patient Activation Measure (PAM), 10-m walk test, Rivermead Mobility Index, self-efficacy, subjective health status, quality of life. Results: Qualitative data highlighted one main theme: Rehabilitation in context, encapsulating the usefulness of the if-then strategy in thinking about the patient in the context of complexity, the usefulness of home-based rehabilitation, and the perceived need for a few more sessions. Changes in walking speed were in the expected direction for both groups; PAM scores improved over 3 months in both groups. Conclusion: If-then plans were feasible and acceptable in bridging the goal intention-action gap in rehabilitation with people with MS and stroke, who are experiencing difficulties with mobility. This approach can now be adapted and trialled further in a definitive study. [ABSTRACT FROM AUTHOR]

Purpose: This article outlines our overall approach, qualitative work, and pilot testing to develop a tool to facilitate identification of level of support needs and assist in planning for vocational rehabilitation interventions. Methods: A set of foundation principles drawn from literature and previous critiques of work-ability assessment tools were used to guide a set of studies to develop a new tool. A review of the literature regarding factors that influence work-ability, qualitative interviews and focus groups with a range of stakeholders in the return-to-work process, and pilot testing in different settings were used to develop the Work-ability Support Scale (WSS) to a stage where it had face validity, usability and acceptability for a range of key stakeholders and was ready for further testing. Results: Qualitative work and pilot testing enhanced the proposed tool with a series of changes and refinements to the content, structure and scoring framework. The current version of the tool is presented. Inter-rater reliability is presented elsewhere. Conclusion: Core principles and stakeholders' views (injured or sick workers, employers, case managers and health professionals) support current tool design. Although further testing is required, the WSS appears to hold potential for use in the assessment of vocational rehabilitation needs. [ABSTRACT FROM AUTHOR]

Background: Qualitative methods have at times been typified as interesting but of little value to clinical practice. However, questions exist that quantitative methods simply cannot address and this is certainly true of physiotherapy. Why do some patients engage with physiotherapy and some not? Why do some therapists achieve better outcomes than others? Are we measuring outcomes that matter to our patients? Why do some patients do well and others not? Objectives: This paper aimed to identify ways qualitative research can contribute practically to physiotherapy (and indeed other health professional practice). Major findings: The paper presents a framework of four key areas where qualitative research has demonstrated its place in physiotherapy relevant research (and has potential to do so more): as standalone research; to inform quantitative studies in the future; to augment concurrent quantitative research; and to inform the use or development of outcome measures. Data, as well as studies in progress, are described to demonstrate not only what these methods can provide, but how they can be operationalized. Conclusions: Any discipline dealing with complexity (as physiotherapy does in many contexts and many patient groups) is likely to find quantitative methods lacking at times. It should no longer be a debate around qualitative versus quantitative research but: what is the question that really matters and, what is the best way to address that question. [ABSTRACT FROM AUTHOR]

Purpose: It is often observed that different rehabilitation practitioners carrying out the same intervention can have a quite different impact on outcome. The relationship or connection between the practitioner and patient, referred to here as the therapeutic alliance (TA), is receiving growing attention as potentially contributing to the disparate response to treatment observed. In this paper, we discuss what we currently know about the TA in rehabilitation and its impact on engagement (and what do we not know) and consider the ramifications of not knowing. Key Messages: The TA is increasingly identified as an important determinant of engagement in, and health outcome following, rehabilitation. However, research identifying its core components is limited, with very little exploring howpractitioners might develop a more positive TA with patients. Further, what we do know/understand is limited by inadequate measurement tools. Research aiming to better understand the key ingredients of the TA that contribute to outcome and its role in rehabilitation is urgently required. Conclusions: Arguably, if we fail to advance knowledge in this field and seek answers to some of the questions we have raised, we may fail to tap into the true potential of the TA as a covariate of rehabilitation outcome. [ABSTRACT FROM AUTHOR]

Purpose. To explore the relationship that cognitive behavioural and other previously identified variables have with physical activity engagement in people with multiple sclerosis (MS). Methods. This study adopted a cross-sectional questionnaire design. Participants were 282 individuals with MS. Outcome measures included the Physical Activity Disability Survey -- Revised, Cognitive and Behavioural Responses to Symptoms Questionnaire, Barriers to Health Promoting Activities for Disabled Persons Scale, Multiple Sclerosis Self-efficacy Scale, Self-Efficacy for Chronic Diseases Scales and Chalder Fatigue Questionnaire. Results. Multivariable stepwise regression analyses found that greater self-efficacy, greater reported mental fatigue and lower number of perceived barriers to physical activity accounted for a significant proportion of variance in physical activity behaviour, over that accounted for by illness-related variables. Although fear-avoidance beliefs accounted for a significant proportion of variance in the initial analyses, its effect was explained by other factors in the final multivariable analyses. Conclusions. Self-efficacy, mental fatigue and perceived barriers to physical activity are potentially modifiable variables which could be incorporated into interventions designed to improve physical activity engagement. Future research should explore whether a measurement tool tailored to capture beliefs about physical activity identified by people with MS would better predict participation in physical activity. [ABSTRACT FROM AUTHOR]

Purpose. To explore the barriers and facilitators to engagement in physical activity from the perspective of people with multiple sclerosis (MS). Method. This study adopted a qualitative descriptive design, using semi-structured interviews. Participants were recruited through local MS Societies and one District Health Board as part of a larger study. Ten people with a definite diagnosis of MS were purposefully selected aiming for diversity on a range of characteristics. Results. A number of factors were identified that seemed to interact and work to tip the decisional balance regarding physical activity engagement for people with MS. The most prominent themes included beliefs about physical activity; related emotional responses; and the role of fatigue in the decision to take part in physical activity. One of the most striking findings was the apparent tension surrounding the decision to take part in physical activity which seemed to be related to the co-existence of conflicting beliefs. Conclusions. For people with MS, the decision to engage in physical activity (or not) is complex, fluid and individual; made more complex by the unpredictable nature of MS. Rehabilitation professionals attempting to engage people with MS in a physical activity programme should consider adopting an individualised approach to barrier management which takes into account personal beliefs and perceptions regarding physical activity engagement. [ABSTRACT FROM AUTHOR]

Objective: To determine the acceptability and clinical application of two recently developed goal-setting interventions (Goal Management Training and Identity Oriented Goal Training) in people with traumatic brain injury. Design: A three parallel group, randomized controlled pilot study. Setting: Inpatient and community rehabilitation facilities. Subjects: Thirty-four people with moderate to severe traumatic brain injury (Goal Management Training, n = 12; Identity Oriented Goal Training, n = 10; usual care, N = 12) and their rehabilitation clinicians. Interventions: For both Goal Management Training and Identity Oriented Goal Training participants met face to face with their key worker weekly over a period of 6-8 weeks, during which time the key worker worked to engage them in goal setting and goal performance using the strategy prescribed by their group allocation. Usual care was provided to the other participants. Main measures: Largely qualitative using observation, individual interviews and focus groups. Participants also completed a Goal Attainment Scale at baseline, post intervention and at three months follow-up. Results: Both approaches were acceptable to the majority of participants with many reporting improved mood and goal attainment. Clinicians found working in a different way with patients both challenging and rewarding, with both experimental approaches enhancing a focus on the person's own goals. Identity Oriented Goal Training seemed particularly helpful in engaging people in the goal-setting process while Goal Management Training appeared particularly helpful in providing a structured framework for error prevention in attempting goal performance. Conclusion: These theoretically informed approaches to goal setting showed promise but were time intensive and at times difficult for practitioners to utilize. [ABSTRACT FROM AUTHOR]

Difficulty re-establishing an organised and compelling sense of personal identity has increasingly been identified as a critical theme in outcome studies of individuals with severe traumatic brain injury (TBI) and a serious obstacle to active engagement in rehabilitation. There exists little empirical support for approaches to identity reconstruction that address common impairments associated with TBI. Similarly, there is as yet little empirical support for theoretically sound approaches to promoting engagement in goal setting for this population. This article has two purposes. First, theory and procedures associated with metaphoric identity mapping are discussed in relation to goal setting in TBI rehabilitation. Second, the results of a qualitative pilot study are presented. The study explored metaphoric identity mapping as a facilitator of personally meaningful goal setting with five individuals with significant disability many years after their injury. Drawing on principles of grounded theory, the investigators extracted data from semi-structured interviews with clients and clinicians, from focus groups with the clinicians, and from observation of client-clinician interaction. Analysis of the data yielded five general themes concerning the use of this approach: All clients and clinicians found identity mapping to be an acceptable process and also useful for deriving meaningful rehabilitation goals. Both clients and clinicians saw client-centred goals as important. Cognitive impairments posed obstacles to this goal-setting intervention and mandated creative compensations. And finally, identity-related goal setting appeared to require a “mind shift” for some clinicians and demanded clinical skills not uniformly distributed among rehabilitation professionals. [ABSTRACT FROM AUTHOR]

Stroke is a major cause of death and disability in many countries. Early access to the most appropriate medical treatment can improve health outcomes. Despite this, only 30–60% of people who experience a stroke seek medical help within the recommended 3-hour timeframe. This study used open-ended interviews to explore patients’ views on factors that influenced their decision to seek help at the time of stroke. Twenty participants were recruited from five centres: three hospitals, a community-based stroke support service and a primary healthcare service focused on providing health care for Maori. A qualitative methodology drawing on Grounded Theory informed data collection and analysis. Four main themes influenced the decision to seek help: making sense of symptoms, maintaining a sense of normality, presence and influence of another person and perception of medical services. Participants appeared to go through a process of recognition, interpretation and negotiation during their decision-making. Each of the four themes seemed to influence this process, either assisting or delaying help-seeking behaviour. The more time spent going through this process (or repeating each step), the longer the delay appeared to be. Our key findings which add to current help-seeking literature, include: (1) people tended to prioritise everyday commitments and responsibilities over their own health; (2) at times the presence and influence of another person contributed to delays in seeking help; and (3) people had different personal thresholds for when they perceived themselves to be ‘sick enough’ to seek medical help. [ABSTRACT FROM AUTHOR]

Objective: This pilot randomized controlled trial evaluated an assistant-led, community-based intervention to improve community mobility and participation after stroke, and examined the potential for independent community ambulation in people with subacute stroke who present with moderate gait deficit. Design: A multicentre, pilot randomized controlled trial. Setting: Three hospitals and three community settings in New Zealand. Subjects: Thirty post-acute, home-dwelling stroke survivors were randomly allocated to receive intervention in the community (n=14) or as hospital outpatients (n=16) twice a week for seven weeks. Interventions: The community intervention involved practice of functional gait activities in community environments relevant to each participant. Hospital-based physiotherapy was based upon a Motor Relearning approach. Main measures: The primary outcome measure was gait speed (m/min). Secondary outcomes included endurance (six-minute walk time), Activities-specific Confidence Balance Scale, and the Subjective Index of Physical and Social Outcomes measured at baseline, post intervention and six months. Results: Large gains in gait speed were obtained for participants in both groups: community group mean (SD) 16 (16.1) m/min; physiotherapy group mean (SD) 15.9 (16.1) m/min, maintained at six months. There were no significant differences between groups for primary and secondary outcomes after treatment (P=0.86 ANOVA) or at six months (P=0.83 ANOVA). Only 11 participants reported independent community ambulation. Levels of social integration were low to moderate. Conclusions: A community-based gait recovery programme appears a practicable alternative to routine physiotherapy, however independent community ambulation is a challenging rehabilitation goal. [ABSTRACT FROM AUTHOR]

Objective: To explore the test-retest reliability and construct validity of the standardized Physical Activity and Disability Survey (PADS) and its acceptability to people with multiple sclerosis. Design: Participants completed the PADS twice with seven days between repeated measures, while also wearing an Actical accelerometer. Semi-structured interview questions were used to explore the acceptability of the PADS. Subjects: Thirty participants were recruited from the Multiple Sclerosis Society of Auckland, New Zealand. Mean age of participants was 54 years (range 27–76). Main measures: Physical Activity and Disability Survey (PADS) and Actical accelerometer. Results: A wide range of standardized PADS scores were recorded at each time-point (ranges 6.7–83.3 and 6.7–87.4). While standardized PADS scores between time-points had a high intraclass correlation coefficient of 0.92 (95% confidence interval (CI) 0.88, 0.98), Bland-Altman 95% limits of agreement (-17.4, 17.4) were modest. Accelerometer activity counts were not accurately predicted by standardized PADS scores (wide 95% prediction intervals). Participants reported the PADS was easy to understand and complete, enabling them to give an accurate picture of their physical activity. Conclusions: The PADS appears to be a potentially appropriate measure of activity for people with multiple sclerosis, particularly in terms of the wide range of activities it covers and its ability to detect varying levels of physical activity. We suggest the test-retest reliability and validity of the PADS could be improved with some minor revisions. [ABSTRACT FROM AUTHOR]

Objective: Extending the role of allied health professionals has been promoted as a key component of developing a flexible health workforce. This review aimed to synthesize the evidence about the impact of these roles. Methods: A systematic review of extended scope of practice in five groups: paramedics, physiotherapists, occupational therapists, radiographers, and speech and language therapists. The nature and effect of these roles on patients, health professionals and health services were examined. An inclusive approach to searching was used to maximize potential sources of interest including multiple databases, 'grey' literature and subject area experts. An expanded Cochrane Collaboration method was used in view of the anticipated lack of randomized controlled trials and heterogeneity of designs. Papers were only excluded after the search stage for lack of relevance. Results: A total of 355 papers was identified as meeting relevance criteria and 21 studies progressed to full review and data extraction. The primary reason for exclusion from data extraction was that the study included neither qualitative nor quantitative data or because methodological flaws compromised data quality. It was not possible to evaluate any pooled effects as patient health outcomes were rarely considered. Conclusions: A range of extended practice roles for allied health professionals have been promoted and are being undertaken, but their health outcomes have rarely been evaluated. There is also little evidence as to how best to introduce such roles, or how best to educate, support and mentor these practitioners. [ABSTRACT FROM AUTHOR]

This research examined occupational therapists’ attitudes to Cultural Safety for Maori clients. The main research tool was a semi-structured qualitative research interview. A cross-case analysis method was used to determine the major recurring themes. Thirteen participants with varied occupational therapy training backgrounds were interviewed. Current Cultural Safety education is designed to challenge health professionals’ attitudes towards those culturally different from themselves. Results suggest that maturity and personal experiences had significant bearing on these attitudes. Implications for occupational therapy include implementing a policy that stipulates compulsory Cultural Safety education as part of professional development. Findings may have relevance for other countries where significant ethnic differentials in health service success exist, such as Australia. [ABSTRACT FROM AUTHOR]

Objective: To provide a practical guide on how to avoid the pitfalls of correlated correlation coefficients when comparing multiple instruments in rehabilitation research. Design: An observational study comparing a number of instruments measuring quality of life (QoL) compared with an external criterion. Subjects: Sixty-eight patients admitted to a rheumatology ward for intensive treatment of rheumatoid arthritis. Methods: Patients completed three new (QoL) instruments and an established instrument before and after intensive treatment for rheumatoid arthritis. Main outcome measures: Correlation coefficients together with their confidence intervals and a test for the difference between a set of correlated correlation coefficients for the change in the EuroQoL Quality of Life scale (EuroQoL), the World Health Organization Quality Of Life-Abbreviated version (WHOQoL-BREF) and the Quality of Life Profile (QLP) against the Stanford Health Assessment Questionnaire (HAQ). Results: Although the range of correlation between the new instruments and the external criterion was between -0.37 and -0.59 and suggested that one new instrument was far more responsive than the others,; an omnibus test for an overall difference could find no difference in responsiveness. Conclusions: It is conceptually simple to use correlation coefficients to assess the properties of multiple instruments measured on the same subjects to find a 'best' instrument. However, proper interpretation of results when correlated correlation coefficients are calculated is complex. We recommend analysis includes: (a) that simple plots of the pairs of analysed variables are shown, (b) that simple linear model-fitting statistics, e.g., the R -squared statistic, accompany the plots, (c) that confidence intervals are presented for correlation coefficients, (d) that an omnibus statistical test for the difference between correlated correlation coefficients is presented, and (e) that normal model assumptions are tested. [ABSTRACT FROM AUTHOR]

Objective: To determine whether health valuations, such as those used in economic evaluation, are affected by duration of a health condition. People with disabling health conditions tend to value health more highly than members of the general population, and one explanation for this is that over time their experience of living with a disabling illness changes the way in which they value health. If this is so, a relationship between the duration of an individual's disabling health condition and the valuation they assign to their health-state might reasonably be expected. Design: A postal survey using the EuroQoL (EQ-5D) instrument to collect descriptions and valuations for health from people who reported a diagnosis of either stroke or multiple sclerosis. Contact with participants was made through national support organizations and questionnaires were returned by mail. Results: Eight hundred and ninety-four people completed the survey. One hundred (11%) had one health-state indicating moderate problems in all five dimensions of the EQ-5D descriptive profile. For people with this health-state, analysis of covariance showed no relationship between valuation of health-state and time from onset of illness (F = 0.38, p = 0.54). This finding applied irrespective of the diagnosis, and for some other less frequently reported health-states. Conclusion: Clinical experience suggests that over time people adapt to longterm disability. However we found no evidence to support the proposition that higher health-state valuations by people with disabling conditions are explained by the actual duration of their condition. [ABSTRACT FROM AUTHOR]

The article focuses on the feminist reflection on working class history writing in Canada in the 1980s. It notes that studies in Canadian working class history increased due to the proliferation of research on working class women. The uneasy relationship between male workers and their union sisters is noticeable in studies examining women workers strikes and their roles within the union movement and working class political organizations. It points out that further research into the resistance of women working in secondary and tertiary sectors may challenge the existing class theory.

Background and Aims: Engagement is increasingly recognised as important for maximising rehabilitation outcome following stroke. However, engagement can be challenging when neurological impairment impacts a persons' ability to activate the regulatory processes necessary for engagement and in the context of a changed self. We explored engagement in stroke rehabilitation from the perspective of people with stroke with a primary focus on identifying key processes that appeared important to engagement in stroke rehabilitation. Design and Methods: This study drew on Interpretive Description methodology. Maximum variation and theoretical sampling were used to capture diversity in the sample and access a depth and breadth of perspectives. Data collection included semi-structured interviews with people with stroke (n = 19). Data were analysed through a collaborative and iterative process drawing on range of analytical tools including coding, memoing, diagramming and group discussions. Findings: Our findings highlight that engagement is a complex, nuanced, responsive, flexible and inherently two-way process. Developing connections appeared central to engagement with connections taking various forms. The most fundamental was the therapeutic connection between the person with stroke and their practitioner as it provided the foundation on which to build other connections. Connection was made possible through five collaborative processes: Knowing, Entrusting, Adapting, Investing and Reciprocating. Conclusions: Engagement is a social and relational process enabled through an inherently person-centred approach and active and ongoing reflexivity – highlighting the importance of a humanising approach to care where aspects of self, care and emotion are evident, for both the person with stroke and their practitioner. [ABSTRACT FROM AUTHOR]

Objective: To use secondary data from the Taking Charge after Stroke study to explore mechanisms for the positive effect of the Take Charge intervention on physical health, advanced activities of daily living and independence for people after acute stroke. Design: An open, parallel-group, randomised trial with two active and one control intervention and blinded outcome assessment. Setting: Community. Participants: Adults (n = 400) discharged to community, non-institutional living following acute stroke. Interventions: One, two, or zero sessions of the Take Charge intervention, a self-directed rehabilitation intervention which helps a person with stroke take charge of their own recovery. Measures: Twelve months after stroke: Mood (Patient Health Questionnaire-2, Mental Component Summary of the Short Form 36); 'ability to Take Charge' using a novel measure, the Autonomy-Mastery-Purpose-Connectedness (AMP-C) score; activation (Patient Activation Measure); body mass index (BMI), blood pressure (BP) and medication adherence (Medication Adherence Questionnaire). Results: Follow-up was near-complete (388/390 (99.5%)) of survivors at 12 months. Mean age (SD) was 72.0 (12.5) years. There were no significant differences in mood, activation, 'ability to Take Charge', medication adherence, BMI or BP by randomised group at 12 months. There was a significant positive association between baseline AMP-C scores and 12-month outcome for control participants (1.73 (95%CI 0.90 to 2.56)) but not for the Take Charge groups combined (0.34 (95%CI −0.17 to 0.85)). Conclusion: The mechanism by which Take Charge is effective remains uncertain. However, our findings support a hypothesis that baseline variability in motivation, mastery and connectedness may be modified by the Take Charge intervention. [ABSTRACT FROM AUTHOR]

The quality of the therapeutic alliance between a client and their clinician is thought to play an important role in healthcare but there is limited research about this concept in stroke rehabilitation. This study explored the core components of a therapeutic alliance and the factors perceived to impact on its development in a stroke rehabilitation unit. Interpretive description methodology was used to gather and synthesise participants' experiences of their therapeutic relationships. Ten individual client interviews and one clinician focus group were conducted. Data was were analysed using conventional content analysis. A therapeutic alliance appeared to consist of three overlapping core components: a personal connection, a professional collaboration, and family collaboration. Clients valued these components to different degrees and priorities could change over time. Alliance breakdowns were perceived to stem from a clinician's incorrect assumptions about their client's relationship preferences or lack of responsiveness to their needs. Recovery of the alliance seemed to depend on the strength of the pre-existing relationship and steps taken to repair it. Establishing and maintaining a therapeutic alliance appears to be an individualised and complex process. A clinician's ability to use their personal attributes therapeutically, and professional skills flexibly, appeared integral to relationship quality. Developing therapeutic relationships requires a person-centred and sometimes family/whānau-centred approach. The judicious use of self-disclosure may achieve emotional proximity and yet maintain professional boundaries. Maintaining relationship health requires a proactive approach to detect and manage relationship disruptions. [ABSTRACT FROM AUTHOR]

Enhancing student success has been increasingly a focus for universities. But the context has changed, with complex challenges including a global pandemic, rapid digital transitions and greater diversity with related inclusion needs. Creative thinking is essential to address what student success could (and arguably should) look like and be. In this article we utilize Appreciative Inquiry to rethink current knowledge and practice. We refer specifically to our context in Aotearoa New Zealand, where data shows that a change in approach is needed particularly for Māori students, Pacific students and other 'new' learners. We explore a different way of working and learning – 'mahitahi' – and argue that improving outcomes requires more than incremental or tactical shifts in action. We propose a re-imagining of diversity, inclusion and success for sustained transformation. Integrating Indigenous approaches to knowledge into innovative frameworks, adapting future-focused curriculum and creative practice pedagogy in the process, could benefit all students across disciplines. [ABSTRACT FROM AUTHOR]

Background and purpose: "Take Charge" is a novel, community-based self-directed rehabilitation intervention which helps a person with stroke take charge of their own recovery. In a previous randomized controlled trial, a single Take Charge session improved independence and health-related quality of life 12 months following stroke in Māori and Pacific New Zealanders. We tested the same intervention in three doses (zero, one, or two sessions) in a larger study and in a broader non-Māori and non-Pacific population with stroke. We aimed to confirm whether the Take Charge intervention improved quality of life at 12 months after stroke in a different population and whether two sessions were more effective than one. Methods: We randomized 400 people within 16 weeks of acute stroke who had been discharged to institution-free community living at seven centers in New Zealand to a single Take Charge session (TC1, n = 132), two Take Charge sessions six weeks apart (TC2, n = 138), or a control intervention (n = 130). Take Charge is a "talking therapy" that encourages a sense of purpose, autonomy, mastery, and connectedness with others. The primary outcome was the Physical Component Summary score of the Short Form 36 at 12 months following stroke comparing any Take Charge intervention to control. Results: Of the 400 people randomized (mean age 72.2 years, 58.5% male), 10 died and two withdrew from the study. The remaining 388 (97%) people were followed up at 12 months after stroke. Twelve months following stroke, participants in either of the TC groups (i.e. TC1 + TC2) scored 2.9 (95% confidence intervals (CI) 0.95 to 4.9, p = 0.004) points higher (better) than control on the Short Form 36 Physical Component Summary. This difference remained significant when adjusted for pre-specified baseline variables. There was a dose effect with Short Form 36 Physical Component Summary scores increasing by 1.9 points (95% CI 0.8 to 3.1, p < 0.001) for each extra Take Charge session received. Exposure to the Take Charge intervention was associated with reduced odds of being dependent (modified Rankin Scale 3 to 5) at 12 months (TC1 + TC2 12% versus control 19.5%, odds ratio 0.55, 95% CI 0.31 to 0.99, p = 0.045). Conclusions: Confirming the previous randomized controlled trial outcome, Take Charge—a low-cost, person-centered, self-directed rehabilitation intervention after stroke—improved health-related quality of life and independence. Clinical trial registration-URL: http://www.anzctr.org.au. Unique identifier: ACTRN12615001163594 [ABSTRACT FROM AUTHOR]

Only 62% of BCC re-excisions contain residual tumour.[1] Alternative approaches (observation, topical therapy or targeted radiotherapy) may be used, making marker sutures of little benefit. Tullett I et al. i note marker sutures influenced re-excision in only a single case from a series of 663 BCC excisions using marker sutures.[2] Other patients with involved margins underwent observation or adjuvant radiotherapy rendering use of a marker suture pointless. Https://doi.org/10.1093/ced/llad083 Dear Editor, Excision and direct closure of cutaneous skin malignancies is a commonly performed surgical procedure. [Extracted from the article]

Background: Support-workers' performance and well-being are challenged by increasingly high workloads and poor working conditions, leading to high levels of occupational stress. Aims: To explore the experiences of work stress for support-workers in New Zealand residential facilities. Design: An Interpretive Descriptive study. Methods: Data from ten (n = 10) support-workers were collected between December 2013 and June 2014, using semi-structured in-depth face-to-face interviews. Thematic analysis was used to identify key themes that captured participant reports of their experiences. Results: Work stress was conceptualized by participants as being an everyday experience of having too much to deal with and feeling under constant pressure. It appeared to be a complex and fluid experience representing an inherent, dynamic tension between reasons to be a caregiver and the burden of caregiving. Participants highlighted a range of influencing factors (including lack of recognition, person and work context, and coping strategies), which may account for that fluidity. Conclusion: The findings extend current knowledge about support-workers' work stress by identifying the challenges relating to the lack of recognition of their role and expertize, the unintended consequences of person-centered care and the challenges faced by migrant support-workers. [ABSTRACT FROM AUTHOR]

The article discusses the contribution of qualitative research tom physiotherapy. It highlights the argument that quality of research is directly proportional with sample size. It states that large sample study may not be require due to huge cost involved and flaws in design. The article highlights that a research requires specific technical support and prior preparation. The article also discusses randomized clinical trials (RCTs) for determining effective intervention.

For some people, the word 'technology' in rehabilitation brings to mind equipment and assistive devices. For others - it is a brave new frontier where robotic advance means many of the functional consequences of impairment are/will be alleviated, and many roles health professionals and carers currently perform will disappear. Like most things in life, a simplistic interpretation in complexity rarely capture what is truly going on. This is certainly true for rehabilitation technologies where devices are clearly important for our clients and for our professions but, it is not just about gadgets - it is far more than that. Of the numerous definitions available, most have in common a notion of tools to apply knowledge to practical issues or, as noted in the Britannica Concise Encyclopaedia [1]: 'Whereas science is concerned with how and why things happen, technology focuses on making things happen'. [ABSTRACT FROM AUTHOR]

Abstract: Background: Engagement is commonly considered important in stroke rehabilitation, with some arguing it is essential for positive patient outcomes. An emerging body of research indicates the practitioner influences engagement through their ways of relating, communicating and working with the patient. People experiencing communication disability may face particular challenges with engagement as a practitioner's communication and interactional patterns may limit their ability to engage. Aims: To understand how rehabilitation practitioners worked to engage people experiencing communication disability throughout the course of rehabilitation. Methods & Procedures: A qualitative study using the Voice Centred Relational Approach. Longitudinal observational and interview data were gathered from 28 practitioners and three people experiencing communication disability in inpatient and community stroke rehabilitation services. Data were analyzed using the Listening Guide. Outcomes & Results: Engagement was a relational practice on the part of the rehabilitation practitioner. It was underpinned by a relational philosophy and characterized by three core processes: embedding relational work throughout rehabilitation; getting to know the patient and working in ways valued by the patient; and communicating using relational dialogue and supported conversation. Practitioners wove these together with their technical, disciplinary‐based work and rehabilitation tasks. Conclusions & Implications: Patient engagement was constructed through relationships and strongly influenced by the practitioners’ way of thinking about and enacting practice, challenging the idea that engagement is solely an intrinsic patient state and behaviour. The findings raise questions about which aspects of rehabilitation work and communication are most valuable when working to engage people experiencing communication disability. Viewing engagement as a relational practice and understanding the different ways this is enacted may support practitioners to reflect on their understandings of engagement, their patient's engagement, their ways of working, and the frames and philosophies that surround and influence their practice. [ABSTRACT FROM AUTHOR]

This editorial comments on a review in this issue of trials assessing the benefit of occupational therapy on the lives of people who have had a stroke. The review showed that occupational therapy targeted at daily living requirements was a big help for patients. The authors believe the study should have looked at other effects of occupational therapy such as ones that aim to improve involvement in activities but say the evidence that it helps so much in this area of rehabilitation is good news.

An introduction is presented in which the editor discusses various reports within the issue on topics including utility of population-based data in examining stroke incidence, guidelines for ideal stroke incidence and how to reduce these instances through secondary stroke prevention.

Purpose: This study looked at the influences on the return to work (RTW) in the first 2 years for people severely injured in the 22 February 2011 Christchurch earthquake.Method: We used a constructivist grounded theory approach using semi-structured interviews to collect data from 14 people injured in the earthquake.Results: Analysis elicited three themes that appeared to influence the process of RTW following the Christchurch earthquake.Living the earthquake experience, the individual’s experiences of the earthquake and how their injury framed their expectations;rebuilding normality, the desire of the participants to return to life as it was; whiledealing with the secondary effects of the earthquakeincludes the earthquake specific effects which were both barriers and facilitators to returning to work.Conclusion: The consequences of the earthquake impacted on experience, process and outcome of RTW for those injured in the Christchurch Earthquake. Work and RTW appeared key tools to enhance recovery after serious injury following the earthquake.Implications for RehabilitationThe altered physical, social and economic environment must be considered when working on the return to work (RTW) of individuals with earthquake injuries.Providing tangible emotional and social support so injured earthquake survivors feel safe in their workplace may facilitate RTW.Engaging early with employers may assist the RTW of injured earthquake survivors. [ABSTRACT FROM AUTHOR]

This article synthesized evidence for the validity and reliability of the Strengths and Difficulties Questionnaire in children aged 3–5 years. A systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidelines was carried out. Study quality was rated using the Consensus-based Standards for the Selection of Health Measurement Instruments. In total, 41 studies were included (56 manuscripts). Two studies examined content and cultural validity, revealing issues with some questions. Six studies discussed language validations with changes to some wording recommended. There was good evidence for discriminative validity (Area Under the Curve ≥ 0.80), convergent validity (weighted average correlation coefficients ≥ 0.50, except for the Prosocial scale), and the 5-factor structural validity. There was limited support for discriminant validity. Sensitivity was below 70% and specificity above 70% in most studies that examined this. Internal consistency of the total difficulty scale was good (weighted average Chronbach’s alpha parents’ and teachers’ version 0.79 and 0.82) but weaker for other subscales (weighted average parents’ and teachers’ range 0.49–0.69 and 0.69–0.83). Inter-rater reliability between parents was moderate (correlation coefficients range 0.42–0.64) and between teachers strong (range 0.59–0.81). Cross-informant consistency was weak to moderate (weighted average correlation coefficients range 0.25–0.45). Test-retest reliability was mostly inadequate. In conclusion, the lack of evidence for cultural validity, criterion validity and test-retest reliability should be addressed given wide-spread implementation of the tool in routine clinical practice. The moderate level of consistency between different informants indicate that an assessment of a pre-schooler should not rely on a single informant. [ABSTRACT FROM AUTHOR]

Objective: To undertake an economic analysis of the Take Charge intervention as part of the Taking Charge after Stroke (TaCAS) study. Design: An open, parallel-group, randomised trial comparing active and control interventions with blinded outcome assessment Setting: Community. Participants: Adults (n = 400) discharged to community, non-institutional living following acute stroke. Interventions: The Take Charge intervention, a strengths based, self-directed rehabilitation intervention, in two doses (one or two sessions), and a control intervention (no Take Charge sessions). Measures: The cost per quality-adjusted life year (QALY) saved for the period between randomisation (always post hospital discharge) and 12 months following acute stroke. QALYs were calculated from the EuroQol-5D-5L. Costs of stroke-related and non-health care were obtained by questionnaire, hospital records and the New Zealand Ministry of Health. Results: One-year post hospital discharge cost of care was mean (95% CI) $US4706 (3758–6014) for the Take Charge intervention group and $6118 (4350–8005) for control, mean (95% CI) difference $ −1412 (−3553 to +729). Health utility scores were mean (95% CI) 0.75 (0.73–0.77) for Take Charge and 0.71 (0.67–0.75) for control, mean (95% CI) difference 0.04 (0.0–0.08). Cost per QALY gained for the Take Charge intervention was $US −35,296 (=£ −25,524, € −30,019). Sensitivity analyses confirm Take Charge is cost-effective, even at a very low willingness-to-pay threshold. With a threshold of $US5000 per QALY, the probability that Take Charge is cost-effective is 99%. Conclusion: Take Charge is cost-effective and probably cost saving. [ABSTRACT FROM AUTHOR]

Understanding personal experiences of real-world walking for stroke survivors could assist clinicians to tailor interventions to their clients' specific needs. We explored the research questions: "What does real-world walking mean to people after stroke and how do they think it can be better?" Using an Interpretive Descriptive methodology, we purposively sampled eight stroke survivors who reported difficulty walking in the real-world. We sought diversity on key participant characteristics. Participants were interviewed using a semi-structured guide. Data were analysed with thematic analysis. Many found real-world walking, particularly in the outdoors, created opportunities for freedom from dependence and a visible step by step progress, which generated hope for future recovery. Conversely, when participants did not experience sufficient progress, they expressed negative emotions. Participants strove to overcome challenges to their walking goals using everyday routines, planning skills, and confidence building experiences to motivate themselves. They also drew on, and extended, social resources highlighting the relational aspects of real-world walking. Walking in their real-world provided a meaningful, desirable, but challenging goal for participants that required significant emotional effort. Successful progress in real-world walking builds confidence and hope and can contribute to psychological wellbeing by providing opportunities for successful mastery and social connectedness. Real-world settings can be unpredictable which makes walking in the real-world after stroke demanding. Positive experiences of walking in the real-world can provide significant psychological benefits to stroke survivors. Many survivors need to carefully concentrate on the act of walking in outdoor settings. Pre-planning routes, confidence-building experiences and developing daily routines may help patients overcome these challenges. [ABSTRACT FROM AUTHOR]

Purpose: Goal setting and patient-centredness are considered fundamental concepts in rehabilitation. However, the best way to involve patients in setting goals remains unclear. The purpose of this study was to explore patient experiences of goal setting in post-acute stroke rehabilitation to further understanding of its application to practice. Method: Thematic analysis was used to analyse interview transcripts from 10 stroke survivors, recruited from 4 rehabilitation units as part of a pilot study investigating the effects of a structured means of eliciting patient-centred goals in post-acute stroke rehabilitation. Results: Three key themes emerged: (1) 'A Day by Day Momentum', comprising subordinate themes of 'Unpredictability' and 'Natural Progression' in which daily progress forwards was seen as an integral part of rehabilitation; (2) 'Battle versus Alliance' in which issues of struggle versus support influenced participants' advancement; and (3) 'The Special Things', consisting of subordinate themes of 'What Makes Me 'Me'' and 'Symbolic Achievements' concerning issues defining individuals and their rehabilitation experiences. Conclusions: Patients' discourse around goal setting can differ from the discourse conventionally used by clinicians when describing 'best practice' in rehabilitation goal setting. Understanding patients' non-conventional views of goals may assist in supporting and motivating them, thus providing drive for their rehabilitation. [ABSTRACT FROM AUTHOR]

Discourse analysis following the work of Michel Foucault has become a valuable methodology in the critical analysis of a broad range of topics relating to health. However, it can be a daunting task, in that there seems to be both a huge number of possible approaches to carrying out this type of project, and an abundance of different, often conflicting, opinions about what counts as ‘Foucauldian’. This article takes the position that methodological design should be informed by ongoing discussion and applied as appropriate to a particular area of inquiry. The discussion given offers an interpretation and application of Foucault’s methodological principles, integrating a reading of Foucault with applications of his work by other authors, showing how this is then applied to interrogate the practice of vocational rehabilitation. It is intended as a contribution to methodological discussion in this area, offering an interpretation of various methodological elements described by Foucault, alongside specific application of these aspects. [ABSTRACT FROM PUBLISHER]

International policy has emphasized the development of interprofessional education (IPE) to reinforce interprofessional practice. This study explored the extent to which IPE initiatives in the UK are based on sound theoretical frameworks. Findings from semi-structured interviews with lead IPE curriculum developers at eight higher education institutions are presented which identified curriculum developers' developmental approaches to IPE. The findings reveal a notable lack of explicit theoretical basis for models of IPE. In many cases, senior managers determined the institutional approach to IPE which academic staff then needed to deliver. Curriculum developers reported adopting a largely practical approach to IPE curriculum development. However, questioning that focused on learning and teaching methods revealed that a range of learning theories was used implicitly. The significance of these findings is discussed with recommendations to inform future curriculum development of IPE initiatives. [ABSTRACT FROM AUTHOR]

This article examines 110 reported incidents from an online survey of 26 women from each of the eight universities in New Zealand. They responded to questions asking them to describe times when work and non-work situations have helped or hindered their advancement in university leadership roles. Five key themes, incorporating a range of factors, emerged as making a difference to advancement as leaders. These themes are: work relationships; university environment; invisible rules; proactivity; and personal circumstances. This research is part of the L-SHIP (Leadership- Supporting Higher Intent & Practice) project and has two main aims. First, to identify factors in universities that help and hinder women’s advancement as leaders, as reported by women; second, to provide useful evidence to underpin the development of programmes supporting women’s advancement in university leadership roles. This research is a first step in the development of the L-SHIP Toolkit for good practice in leadership development in higher education. [ABSTRACT FROM AUTHOR]

Abstract: Knowledge of the position of one’s limbs is an essential component of daily function and relies on complex interactions of sensorimotor body schema-related information. Those with Complex Regional Pain Syndrome (CRPS) express difficulty in knowing where their affected limb is positioned. The aim of this study was to determine the degree to which experimental data supported the reported difficulty in limb position sense. A controlled experimental design was used to measure upper limb position accuracy amongst those with CRPS of one arm. Position accuracy was individually measured in both arms and compared to a known target position. Video captured each of 36 trials (half with arm in full view and half with vision obscured). The error in degrees between actual and known targets was determined using video analysis software. The Brief Pain Inventory measured pain. A subjective mental image representation of both upper limbs was documented. The CRPS group had moderate pain intensity and were significantly less accurate in positioning both the affected and unaffected limbs compared to controls (p <0.001). Position accuracy of the CRPS affected limb significantly improved with vision (8.3° in view, 10.7° not in view). Subjective mental representations of the affected limb were visualised as distorted. Evidence of bilateral arm positioning impairments in unilateral arm CRPS suggests that central mechanisms are involved. Cortical reorganisation in regions associated with the body schema (i.e. primary somatosensory and parietal cortices) is proposed as an explanation. The exact relationship between pain and limb position deficits requires further exploration. [Copyright &y& Elsevier]

Objective: To revise the Physical Activity Disability Scale (PADS) and to explore the acceptability and test--retest reliability of the revised measure, the PADS-R, in people with multiple sclerosis. Design: This study was conducted over three phases: (1) PADS-R questionnaire development including modification to the original PADS, field testing and refinement; (2) PADS-R scoring; (3) PADS-R acceptability and reliability assessment, where participants completed the PADS-R twice over the telephone, three days apart, and then answered a series of semi-structured questions on the instrument's acceptability. Subjects: Participants were recruited from the local Multiple Sclerosis Society, Stroke Foundation and Auckland District Health Board depending on the purpose of each phase: (1) PADS-R questionnaire development (n=30, multiple sclerosis); (2) PADS-R scoring (n=293, multiple sclerosis; and n=83, stroke); and (3) PADS-R acceptability and reliability assessment (n=29, multiple sclerosis). Main measures: Physical Activity Disability Scale-Revised (PADS-R) Results: The PADS-R took approximately 20 minutes to administer and most (n=25; 86%) participants reported it to be easy to understand and complete. All participants reported that it enabled them to give an accurate picture of their physical activities. In terms of test--retest reliability, the intraclass correlation coefficient was high (0.87 (95% confidence intervals (CI) 0.78, 0.96)), but the 95% limits of agreement were wide (1.13). When observations which potentially represented important changes in activity were excluded, these limits narrowed considerably (0.89). Conclusions: The PADS-R appears to be a conceptually and psychometrically sound measure of physical activity for people with chronic neurological conditions. [ABSTRACT FROM AUTHOR]