Search

Implementation of evidence-informed rehabilitation of the upper limb is variable, and outcomes for stroke survivors are often suboptimal. We established a national partnership of clinicians, survivors of stroke, researchers, healthcare organizations, and policy makers to facilitate change. The objectives of this study are to increase access to best-evidence rehabilitation of the upper limb and improve outcomes for stroke survivors. This prospective pragmatic, knowledge translation study involves four new specialist therapy centers to deliver best-evidence upper-limb sensory rehabilitation (known as SENSe therapy) for survivors of stroke in the community. A knowledge-transfer intervention will be used to upskill therapists and guide implementation. Specialist centers will deliver SENSe therapy, an effective and recommended therapy, to stroke survivors in the community. Outcomes include number of successful deliveries of SENSe therapy by credentialled therapists; improved somatosensory function for stroke survivors; improved performance in self-selected activities, arm use, and quality of life; treatment fidelity and confidence to deliver therapy; and for future implementation, expert therapist effect and cost-effectiveness. In summary, we will determine the effect of a national partnership to increase access to evidence-based upper-limb sensory rehabilitation following stroke. If effective, this knowledge-transfer intervention could be used to optimize the delivery of other complex, evidence-based rehabilitation interventions.

OBJECTIVES: Somatosensory loss is common after stroke with one-in-two individuals affected. Although clinical practice guidelines recommend providing somatosensory rehabilitation, this impairment often remains unassessed and untreated. To address the gap between guideline recommendations and clinical practice, this study sought to understand the factors influencing delivery of evidence-based upper limb sensory rehabilitation after stroke. DESIGN: Qualitative study involving focus groups and interviews. Data analysis used an inductive approach (thematic analysis) and deductive analysis using implementation theory (the Theoretical Domains Framework and Normalisation Process Theory). SETTING: Eight healthcare organisations in metropolitan and regional areas of Victoria and New South Wales, Australia. PARTICIPANTS: Eighty-seven rehabilitation therapists (79% occupational therapists and 21% physiotherapists) were purposively sampled and participated in a knowledge translation study with staggered recruitment from 2014 to 2018. RESULTS: Three types of factors influenced therapists' delivery of upper limb somatosensory rehabilitation: individual ('The uncertain, unskilled therapist'), patient ('Patient understanding and priorities') and organisational ('System pressures and resources'). Deductive analysis using implementation theory identified key determinants of practice change, such as opportunities to consolidate new skills, the anticipated benefits of upskilling as a therapy team and the work anticipated by therapists to incorporate a new somatosensory rehabilitation approach. CONCLUSIONS: Occupational therapists and physiotherapists hold valuable insights towards practice change in somatosensory rehabilitation from the 'frontline'. Therapists experience barriers to change including a lack of knowledge and skills, lack of resources and organisational pressures. Facilitators for change were identified, including social support and therapists' perceived legitimacy in usi

This study developed a competition mechanism that is integrated into an industrysponsored project to enhance student motivation, engagement and learning achievement in a construction management under-graduate program. As part of the formative assessment exercises in a construction technology subject, students were tasked to propose an alternative precast concrete building solution for a four-storey car showroom that was originally designed to be constructed as an in-situ reinforced concrete structure. An industry partner was actively involved in establishing the scope of the project, provided all necessary documents, arranged site visits and introduced the range of precast concrete components that were available for use. A design engineer from the company was invited to present a lecture on the design and construction of precast concrete structures. Students also visited a project where these precast concrete elements were being erected. Students were assigned to work in pairs to develop an alternative precast design and propose a detailed construction plan for the client’s consideration. More importantly for this assignment, the industry partner offered cash prizes for the best solutions. An experiment was conducted to examine the effects of the competition by comparing the students’ performance in this competitive environment to another assignment in the same subject that did not offer any cash rewards. The results of a survey of the students indicated that many were more motivated, worked at a higher level and attained a more positive experience compared to a previous assignment that had no cash rewards. However, a small number of students reported that they were not influenced by the prize money and did not report any improvement in performance or learning. These findings indicate that individual learning preferences may influence the outcomes from competition mechanisms. This study will inform on future industry engagements with the construction management prog

Indigenous procurement policies encourage the construction sector to provide new training, employment and business opportunities for Indigenous people suffering from economic and social disadvantage. However, the success of these policies is often distorted by the failure of policy evaluations to account for Indigenous perceptions of social value. Since these often differ markedly from non-Indigenous values, this can distort the allocation of funds to Indigenous communities and exacerbate the marginalisation of the communities these policies are meant to help. Drawing on theories of community-based research, this methodological paper seeks to reconceptualise approaches to measuring Indigenous social value in an Indigenous social procurement policy context. Working in partnership with a peak body for Aboriginal business in Australia, we have co-designed a novel approach to Indigenous social impact research that recognises the legitimacy of Indigenous perspectives when investigating the social value Indigenous procurement policies create. We argue that culturally appropriate focus groups (yarning discussion groups) are appropriate in Indigenous social impact research because they prioritise Indigenous people’s experiences of Indigenous procurement policies, rather than focusing on simplistic policy targets. As a method that promotes community involvement in social impact research to define how social value is perceived, yarning discussion groups have significant implications for future research seeking to represent Indigeonus perspectives of social value. It is concluded the approach developed here can be operationalised in the field to better understand the nature of Indigenous social value and the impact created by Indigenous procurement policies in Australia and other countries with disadvantaged Indigenous populations.

In countries like Australia, Canada and South Africa with large Indigenous populations, governments are increasingly turning to social procurement to solve entrenched social problems like Indigenous disadvantage. Social procurement works by leveraging construction and infrastructure spending to encourage construction firms to give back to the communities in which they build. It does this through new partnerships with governments, not-for-profits and social benefit organisations like Indigenous enterprises, which deliver construction products and services in ways that, benefit Indigenous communities. However, the success of social procurement policies is typically judged from an outsider's perspective, ignoring Indigenous notions of value: the intended beneficiaries whose lives social procurement is aimed at improving. Mobilising strain theory and undertaking a critical literature review to conceptualise social procurement in a new way, this paper explores the proposition that current methods of assessing the success of Indigenous social procurement. It finds that policies are culturally insensitive and fail to articulate adequately their social impact on the communities they are designed to benefit, presenting an overly optimistic view of success that does not align with Indigenous perspectives of social value. We also argue that the project-based nature of construction appears to conflict with Indigenous notions of social value by undertaking temporary endeavours that lack local knowledge. The paper concludes by presenting a new conceptual framework of cultural counterfactuals that will allow future policy social impact assessments to represent better the views of Indigenous people in the social procurement policy debate.

Sustainable transition of the built environment con struction industry is challenging the existing construction practices and business models. This article presents a framework for understanding and facilitating sustainable transition in the built environment. The framework was developed through a four years innovation project based on theories on sectorial and business model i nnovation and ten detailed case studies of different types of companies and their experimentation with different management and sustainability concepts. The framework interprets the construction industry as a collection of three generic domains - the Project, Product and Service domain - with widely different markets, companies, business models and regulation. Besides identifying the characteristics of the different domains, the findings show that these domains are interdependent, but largely live their own lives with internal agendas. Furthermore, it is shown that the domains are subject to more or less consciously coordinated innovation activities. The research concludes that the three-domain-model represents a promising framework for understanding and facilitating sustainable transition of the construction industry and built environment.

Buildings are essential for securing a sustainable society, and the Scandinavian building sector is viewed upon globally as the one to lead the way. This paper investigates in which directions sustainable building in Scandinavia is likely to move and outlines a number of areas where sustainable in novations are necessary for supporting this movement. The focus on innovations as essential support for the sustainable transition of the building sector derives from the Multi-Level Perspective, which has been applied to this study as a framework for understanding sustainable transitions of socio-technical systems. The findin gs are based on twelve expert interviews with key persons from central companies, research institutions and associations in Denmark, Norway and Sweden. The experts identify five directions for sustainable building in Scandinavia and list a number of innovations that will support the movement of the sector in these directions. These paths to the future for sustainable building seem remarkable clear and manageable, and the paper discusses the risk of the experts being too optimistic in the ir assessment of the sustainable transition of the Scandinavian building sector.