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Background:Knowledge brokers in higher education are described as requiring a broad range of skills and characteristics, leading to both role conflict and ambiguity. Although existing studies report broad concepts regarding the role of knowledge brokers, the activities that they actually perform to broker knowledge are not systematically reported or impact evaluated. Aims and objectives:This paper aims to summarise the current literature on the role of knowledge brokers and describe this role in a higher education context. In an exploratory study, as two knowledge brokers we recorded our activities within a school of health in a large university setting using the Expert Recommendations for Implementation Change (ERIC) categories over a period of nine months. Using this report, we use the analogy of a musical to translate the role of knowledge broker. Considering the knowledge brokerage roles of musical director, set designer, choreographer, costume designer and sound and lighting, we discuss the impact of knowledge brokerage activities on actors relaying their knowledge story to an end-user audience. Knowledge brokers in the higher education context primarily perform activities in four areas: know your cast and crew; train your cast and crew; rehearse and review; and provide hands-on support. Key conclusions:Understanding the role of knowledge brokers may be enhanced by using the analogy of a musical. Due to the diverse nature of these roles, it is recommended that knowledge brokerage in higher education is performed in teams, where knowledge brokers can utilise different skill sets to facilitate their work.

Background:Universities are major producers of research evidence, and timely translation and uptake of evidence to sectors such as healthcare is imperative to inform best practice. Knowledge translation (KT) is complex and there is increasing awareness of the need for KT to facilitate evidence-informed changes, with grant funders increasingly requiring researchers to demonstrate KT and research impact. Despite this, there is little research about KT in university settings related to healthcare research. Aims and objectives:To evaluate the practice, attitudes, knowledge, confidence and perceived support needs in KT and communicating impact of university staff and higher degree research (HDR) students. Methods:We conducted a cross-sectional survey of 42 staff and 19 HDR students in a Health and Rehabilitation Sciences School in an Australian University setting. Descriptive and correlational quantitative analyses and qualitative content analysis of responses to open-ended questions was carried out. Findings:Participants regarded skills in KT and communicating impact as necessary for their work, and wanted support to build their capacity. Despite previous training for staff in some areas of KT and high levels of research experience of the staff in this sample, the level of knowledge, confidence and frequency of their KT practices was relatively low. Discussion and conclusion:There is a need to design and evaluate initiatives which aim to improve knowledge and skills, such as training and resources, as well as organisational structures that facilitate staff to plan and carry out KT activities concurrently with research production.

Prior to implementing new programmes or practices, it is essential to understand the context, barriers and enablers to support successful use. The tailored activity programme (TAP) is an evidence-based intervention provided by occupational therapists to support community-dwelling people living with dementia and their carers. The programme was developed in the United States, and although it is not currently available for routine use in Australia, its implementation would address the needs of many Australians with dementia and their carers.The aim of the study is to understand the perspectives of occupational therapists and their managers regarding barriers and enablers to the delivery and implementation of the TAP in Queensland, Australia.A qualitative descriptive methodology was employed. Semistructured interviews were undertaken with occupational therapists (n = 18) who work with community-dwelling people with dementia and their carers, and their managers (n = 10). Participants were recruited from a range of organisations across Queensland, and they were asked about potential barriers and enablers to implementing TAP. Interviews were recorded and transcribed verbatim. Data were mapped using framework analysis whilst remaining open to other themes.Themes were identified, and facilitating factors included the close alignment of TAP with occupational therapists' scope of practice; their acceptance of, and optimism about the programme and its perceived benefits including improved client outcomes; and an opportunity for occupational therapists to further develop their skills. Managerial support and carers' readiness and willingness to participate were also identified as important factors for success, whereas barriers were cost to clients and the capacity of the occupational therapy workforce to provide TAP.Occupational therapists and their managers expressed enthusiasm for TAP and awareness of its likely benefits, while also identifying barriers that will need to be addressed if implementation of the programme is to be successful in Australia.

Courses: Senior SeminarObjectives: (1) To provide graduating students a semester-long capstone experience where they can apply communication theories/skills in a professional context. (2) To create a capstone project that contributes to programmatic assessment.

Stroke survivors experience sensory impairments that significantly limit upper-limb functional use. Lack of clear research-based guidelines about their management exacerbates the uncertainty in occupational therapists' decision making to support these clients.This study explores occupational therapists' clinical decision making regarding upper-limb, post-stroke sensory impairments that can ultimately inform approaches to support therapists working with such clients.Twelve therapists participated in a qualitative descriptive study. Transcripts of semi-structured interviews were analyzed using content analysis.Three overarching categories were identified: deciding on the focus of interventions (describing intervention choices), it all depends (outlining factors considered when choosing interventions), and managing uncertainty in decision making (describing uncertainty and actions taken to resolve it).Providing training about post-stroke sensory impairment and decision making may improve therapists' decision making and ultimately improve client outcomes. Further research is needed to understand the impact of uncertainty on occupational therapy decision making and resulting care practices.

Dementia significantly impacts on the individual's and caregiver's quality of life. The aim of this study was to describe Australian occupational therapy practice with people with dementia.A questionnaire was piloted and sent to occupational therapists in Australia working with people with dementia. Participants were recruited in one of three ways: (i) identified by OT AUSTRALIA as working in aged care; (ii) through dementia-specific facilities in Australia; or (iii) through occupational therapy aged care list serves. The questionnaire asked occupational therapists about referrals received, assessments and interventions used, perceived barriers to the delivery of interventions and perceived educational needs. Data were analysed descriptively and presented as frequencies and percentages.One hundred and thirty-four occupational therapists responded to this survey. Referrals were predominantly for environmental modification, home assessment or falls prevention and for assessment of activities of daily living. Therapists spent most of their time on assessment, with brief cognitive and functional assessments used most frequently. The most common interventions were environmental modification advice and prescription of assistive equipment. Lack of time was the most commonly reported barrier to the delivery of interventions with therapists also identifying concerns about staffing and role restrictions imposed by organisations. Therapists also identified that further training in this area would be useful.Therapists working in dementia care indicated that they are constrained in terms of time, staffing and organisational restrictions. Recommendations include enhanced training, further research into the most viable occupational therapy interventions, and advocating for improved funding, staffing and resources.

To evaluate the effectiveness of a semester-long multi-professional university course teaching evidence-based practice principles to allied health students in terms of changes in attitudes, confidence, and perceived and actual knowledge regarding evidence-based practice.This was a pre-post study of allied health students who completed a multi-professional university course that taught evidence-based practice skills and concepts. The course was run over a 13-week period (2 hours per week) and utilized didactic lectures, tutorial and workshop formats, and a hands-on database searching session. Participants completed a questionnaire which assessed their attitudes, confidence, and perceived and actual knowledge regarding evidence-based practice on the first and last day of the course.Ninety-one students participated in the study; however, complete data sets were available for only 59 participants. Attitudes towards evidence-based practice did not significantly improve; however, attitudes were already positive prior to undertaking the course. There was a statistically significant improvement in confidence with a mean increase of 9.02 [score range 6-30, 95% confidence interval (CI) 8.21, 9.82]. Perceived knowledge improved with a statistically significant mean increase of 14.15 (score range 5-25, 95% CI 12.55, 15.75) and there was a statistically significant mean increase in actual knowledge of 3.56 (score range 0-10, 95% CI 2.83, 4.29).Teaching evidence-based practice skills and concepts to allied health students within a multi-professional university curriculum improved confidence and perceived and actual knowledge regarding evidence-based practice. Further research is needed to determine if these changes result in long-term behaviour change once students graduate, and to consider optimal methods for multi- and interprofessional delivery of evidence-based practice training.

BACKGROUND: Cognitive impairment is a frequent consequence of stroke and can impact on a person's ability to perform everyday activities. Occupational therapists use a range of interventions when working with people who have cognitive impairment poststroke. This is an update of a Cochrane Review published in 2010. OBJECTIVES: To assess the impact of occupational therapy on activities of daily living (ADL), both basic and instrumental, global cognitive function, and specific cognitive abilities in people who have cognitive impairment following a stroke. SEARCH METHODS: We searched the Cochrane Stroke Group Trials Register, CENTRAL, MEDLINE, Embase, four other databases (all last searched September 2020), trial registries, and reference lists. SELECTION CRITERIA: We included randomised and quasi‐randomised controlled trials that evaluated an intervention for adults with clinically defined stroke and confirmed cognitive impairment. The intervention needed either to be provided by an occupational therapist or considered within the scope of occupational therapy practice as defined in the review. We excluded studies focusing on apraxia or perceptual impairments or virtual reality interventions as these are covered by other Cochrane Reviews. The primary outcome was basic activities of daily living (BADL) such as dressing, feeding, and bathing. Secondary outcomes were instrumental ADL (IADL) (e.g. shopping and meal preparation), community integration and participation, global cognitive function and specific cognitive abilities (including attention, memory, executive function, or a combination of these), and subdomains of these abilities. We included both observed and self‐reported outcome measures. DATA COLLECTION AND ANALYSIS: Two review authors independently selected studies that met the inclusion criteria, extracted data, and assessed the certainty of the evidence. A third review author moderated disagreements if consensus was not reached. We contacted trial authors for additional information and data, where available. We assessed the certainty of key outcomes using GRADE. MAIN RESULTS: We included 24 trials from 11 countries involving 1142 (analysed) participants (two weeks to eight years since stroke onset). This update includes 23 new trials in addition to the one study included in the previous version. Most were parallel randomised controlled trials except for one cross‐over trial and one with a two‐by‐two factorial design. Most studies had sample sizes under 50 participants. Twenty studies involved a remediation approach to cognitive rehabilitation, particularly using computer‐based interventions. The other four involved a compensatory and adaptive approach. The length of interventions ranged from 10 days to 18 weeks, with a mean total length of 19 hours. Control groups mostly received usual rehabilitation or occupational therapy care, with a few receiving an attention control that was comparable to usual care; two had no intervention (i.e. a waiting list). Apart from high risk of performance bias for all but one of the studies, the risk of bias for other aspects was mostly low or unclear. For the primary outcome of BADL, meta‐analysis found a small effect on completion of the intervention with a mean difference (MD) of 2.26 on the Functional Independence Measure (FIM) (95% confidence interval (CI) 0.17 to 4.22; P = 0.03, I(2) = 0%; 6 studies, 336 participants; low‐certainty evidence). Therefore, on average, BADL improved by 2.26 points on the FIM that ranges from 18 (total assist) to 126 (complete independence). On follow‐up, there was insufficient evidence of an effect at three months (MD 10.00, 95% CI −0.54 to 20.55; P = 0.06, I(2) = 53%; 2 studies, 73 participants; low‐certainty evidence), but evidence of an effect at six months (MD 11.38, 95% CI 1.62 to 21.14, I(2) = 12%; 2 studies, 73 participants; low‐certainty evidence). These differences are below 22 points which is the established minimal clinically important difference (MCID) for the FIM for people with stroke. For IADL, the evidence is very uncertain about an effect (standardised mean difference (SMD) 0.94, 95% CI 0.41 to 1.47; P = 0.0005, I(2) = 98%; 2 studies, 88 participants). For community integration, we found insufficient evidence of an effect (SMD 0.09, 95% CI −0.35 to 0.54; P = 0.68, I(2) = 0%; 2 studies, 78 participants). There was an improvement of clinical importance in global cognitive functional performance after the intervention (SMD 0.35, 95% CI 0.16 to 0.54; P = 0.0004, I(2) = 0%; 9 studies, 432 participants; low‐certainty evidence), equating to 1.63 points on the Montreal Cognitive Assessment (MoCA) (95% CI 0.75 to 2.52), which exceeds the anchor‐based MCID of the MoCA for stroke rehabilitation patients of 1.22. We found some effect for attention overall (SMD −0.31, 95% CI −0.47 to −0.15; P = 0.0002, I(2) = 20%; 13 studies, 620 participants; low‐certainty evidence), equating to a difference of 17.31 seconds (95% CI 8.38 to 26.24), and for executive functional performance overall (SMD 0.49, 95% CI 0.31 to 0.66; P < 0.00001, I(2) = 74%; 11 studies, 550 participants; very low‐certainty evidence), equating to 1.41 points on the Frontal Assessment Battery (range: 0–18). Of the cognitive subdomains, we found evidence of effect of possible clinical importance, immediately after intervention, for sustained visual attention (moderate certainty) equating to 15.63 seconds, for working memory (low certainty) equating to 59.9 seconds, and thinking flexibly (low certainty), compared to control. AUTHORS' CONCLUSIONS: The effectiveness of occupational therapy for cognitive impairment poststroke remains unclear. Occupational therapy may result in little to no clinical difference in BADL immediately after intervention and at three and six months' follow‐up. Occupational therapy may slightly improve global cognitive performance of a clinically important difference immediately after intervention, likely improves sustained visual attention slightly, and may slightly increase working memory and flexible thinking after intervention. There is evidence of low or very low certainty or insufficient evidence for effect on other cognitive domains, IADL, and community integration and participation. Given the low certainty of much of the evidence in our review, more research is needed to support or refute the effectiveness of occupational therapy for cognitive impairment after stroke. Future trials need improved methodology to address issues including risk of bias and to better report the outcome measures and interventions used.

This is the protocol for a review and there is no abstract. The objectives are as follows: The primary aim is to determine which interventions for the stroke-affected shoulder effectively maintain soft-tissue length of the internal rotators. The secondary aim is to determine whether these interventions were effective in reducing pain and promoting recovery and function.

Research is essential for evidence-based practice yet many health professionals do not have enough time to find research. Studies relevant to occupational therapists can be particularly difficult to find. Most search engines are broad and return a large number of irrelevant articles. Occupational Therapy Systematic Evaluation of Evidence (OTseeker) is an occupational therapy database available at http://www.otseeker.com. Developed by Australian occupational therapists, the resource aims to increase access to research and support clinical decision making. This discipline-specific database contains pre-appraised information from a variety of sources and decreases the time required to locate best evidence.The aims of this paper are to: (i) describe how health librarians can use OTseeker to help allied health students, researchers and practitioners, particularly in occupational therapy, to find quality evidence; (ii) provide a teaching resource for health librarians based around the OTseeker evidence database; and (iii) highlight new features contained on the OTseeker database.A case study is provided which focuses on searching for evidence on the effectiveness of upper limb rehabilitation after stroke using OTseeker.This paper may increase the knowledge, skills and competencies of health librarians, helping them to access evidence-based databases, and educate other professionals.

Accurate, timely wound assessment and documentation is fundamental to nursing practice. A 2005 retrospective chart audit (N = 54) at a rural, 238-bed tertiary care facility in Northeastern Pennsylvania (average daily census 175 to 180) found that complete wound assessment documentation (including measurements) was lacking in 59% of patient charts. The purpose of this quality improvement initiative, led by the Wound Ostomy Continence Nurse (WOCN), was to evaluate and improve nursing assessment and documentation of impaired skin (pressure ulcers, skin tears, open surgical wounds, diabetic ulcers, and venous stasis ulcers). A review of the literature confirmed the importance of consistency, which led to the hospital-wide implementation of education programs and "Measurement Monday." Using AHCPR guidelines of care for pressure ulcers and beginning in January 2006 all wounds were assessed and measured every Monday and the proportion of incomplete charts declined to 38%. Following addition of a wound documentation tool in 2007, the proportion of incomplete records was 14.8%. This quality improvement initiative improved the quality and consistency of wound assessment/measurement and documentation.

Intestinal lymphangiectasia is an uncommon condition that can present diagnostic difficulties. It may be primary or secondary. Treatment of the condition involves management of the effects of lymphangiectasia and also management of the underlying cause (in cases of secondary lymphangiectasia). Patients are usually unwell, requiring multiple investigations, often developing complications and needing considerable in-patient hospital stays. Management is frequently by a multidisciplinary team of health professionals. The following case illustrates all of the above, together with learning points and a general discussion of lymphangiectasia diagnosis and management including the underlying cause in this case. John, a 9-year-old boy, saw his GP several times with a three-month history of cramping lower abdominal pain, diarrhoea, tiredness, difficulty sleeping and weight loss. He had been passing loose stools 6–8 times a day but without blood or mucus. His weight was 27 kg and height 132 cm, both close to the 25th centile. He looked tired and miserable but general examination was otherwise normal. His GP considered gastrointestinal pathology and requested a full blood count, urea and electrolytes, liver and thyroid function tests, plasma viscosity, and endomysial antibodies, all of which were normal. Nevertheless, in view of the recurrent visits to the surgery with persistent symptoms, a referral was made to a consultant paediatrician. However, in the meantime, a concerned school medical officer arranged an urgent appointment with the paediatric gastroenterologist. Five months after the onset of the illness, diarrhoea and malaise continued to be prominent symptoms, to the extent that John had now stopped attending school. There was no family history of bowel disease. A grandfather had recently died from pancreatic carcinoma. On examination John was strikingly thin and weak, with proximal muscle wasting. His weight was 22.8 kg. There were no other abnormal findings on clinical examination and in particular no lymphadenopathy …

Online databases can support the implementation of evidence-based practice by providing easy access to research. OTseeker (http://www.otseeker.com), an electronic evidence database, was introduced in 2003 to assist occupational therapists to locate and interpret research.This study explored Australian occupational therapists' use and perceptions of OTseeker and its impact on their knowledge and practice.A postal survey questionnaire was distributed to two samples: (i) a proportionate random sample of 400 occupational therapists from all states and territories of Australia, and (ii) a random sample of occupational therapists working in 95 facilities in two Australian states (Queensland and New South Wales).The questionnaire was completed by 213 participants. While most participants (85.9%) had heard of OTseeker, only 103 (56.6%) had accessed it, with lack of time being the main reason for non-use. Of the 103 participants who had accessed OTseeker, 68.9% had done so infrequently, 63.1% agreed that it had increased their knowledge and 13.6% had changed their practice after accessing information on OTseeker.Despite OTseeker being developed to provide occupational therapists with easy access to research, lack of time was the main reason why over half of the participants in this study had not accessed it. This exploratory research suggests, however, that there is potential for the database to influence occupational therapists' knowledge and practice about treatment efficacy through access to the research literature.

Unlike most readers of this special issue, I have been both a consumer and provider of rehabilitation services. A retinal hemorrhage that occurred when I was in my late twenties signaled the beginning of delayed-onset retinopathy of prematurity–a condition that has been further complicated since that time. In this article, I offer a glimpse of what living with low vision is like by describing activities in my own life and accommodations I have made. My hope is that therapists will learn more about the realities of living with low vision and will seek our additional information that they will incorporate into their practice.