bluuebunny/crossref_metadata_2025 huggingface dataset:
Promoting continence in people with multiple sclerosis: A guide
Authors: Freeman Lynn
Published: May 2014

Many multiple sclerosis (MS) sufferers will experience difficulty with urinary continence at some time during the course of their disease. Although certain types of problems are common in this population, they are not exclusive. Identification of underlying bladder pathologies can prove difficult, resulting in delayed diagnosis and inappropriate treatments being carried out. Recent literature suggests using specialist continence teams; however, common pathologies can be compounded by associated functional deficits in mobility and dexterity as well as other problems, making patient management more difficult. The multidisciplinary team can play a valuable role alongside the specialist continence team.

This article describes the common bladder problems experienced by people with MS and gives practical advice on how health professionals can promote continence in this group.
Implementing a priority and waiting list system in an acute hospital setting
Authors: Lowe Deborah , Barber Lyndsey
Published: May 2014

This article outlines the development and review of the implementation of a process of prioritization and allocation of referrals to the occupational therapy team covering the medical wards in a 550-bed acute hospital in Swindon, UK. Before the implementation of the system, occupational therapists were ward aligned. Owing to the differing referral rates between wards, therapists experienced unequal caseloads. This created an inequitable service for patients, as some had to wait longer than others for assessment.

Because of the limited evidence base available, the system was developed based on practice rather than evidence. Local social services guidelines were adapted to establish levels of priority of referrals. Standards for length of wait for assessment were devised using existing criteria from the rapid assessment service, the previous system under which the occupational therapy service tried to see patients due for imminent discharge. Under the new system, referrals were prioritized daily and placed in a central folder. All occupational therapists on the medical wards assessed patients in order of priority, regardless of ward. At the time of the audit, 2–3 occupational therapists were responsible for the discharge planning role across the five medical wards and patients were transferred to another setting for rehabilitation if required.

The audit showed a high percentage adherence to the standards. Implementation of the system resulted in an equitable service for patients and more manageable, balanced caseloads for therapists.
A review of standing frame features and their impact on user acceptability
Authors: Daniels Nikki , Clift Maxine , Armstrong Julie , Gopsill Catherine , Pinnington Lorraine , Ward Chris
Published: May 2014

Over 70 standing frames are available in the UK. This equipment can be used by adults and children with a range of disabilities to help them achieve or maintain a standing posture. Variations exist between the styles of frames available and the features they offer. Factors such as positioning, comfort and personal acceptance can have a significant impact on duration and frequency of use. Practical issues, such as ease of use, adjustability, manoeuvrability and storage, can also affect the acceptance of such equipment.

To meet the diverse needs of different clinical groups and the changing needs of individuals, it is essential that appropriate features are selected. Awareness and knowledge of individual features and their appropriateness for user needs can help with successful frame selection and optimize the benefits of this intervention.

This article provides an overview of a selection of standing frame features and discusses their potential advantages and limitations in relation to the impact on user acceptability
A preview of the Independent Living London exhibition
Authors: Franklin Zoë
Published: May 2014

The homecare and rehabilitation exhibition, Independent Living, returns to London on September 21–22 and boasts a restructured seminar programme involving open floor debates.
Attitudes towards the diagnosis of Alzheimer's disease among carers and non-carers
Authors: Sullivan Karen , Muscat Tracey
Published: May 2014

This article provides some preliminary data on preferences among non-carer older adults regarding disclosure of Alzheimer's disease (AD) diagnosis, and compares these preferences to those of carers of people with AD (AD carers). Reasons underlying disclosure preference among carers and non-AD carers are investigated. The authors then explore the level of AD knowledge among carer and non-carer samples and investigate its relationship with disclosure preferences.

Participants were 20 elderly adults (aged 60–88 years) who were not caring for a relative with AD and 16 older adults (aged 51–79 years) who were caring for a relative with AD and who had attended a carer education programme. Participants completed a modified AD knowledge test and a test designed to measure the reasons for and against disclosure of an AD diagnosis.

AD knowledge among AD carers was significantly higher than that among non-carers. Views about disclosure of AD diagnoses did not differ between groups and generally, opinions were for disclosure. No significant differences were found when preferences for disclosure for oneself vs a significant other were compared. Similar reasons for disclosure were given by carers and non-carers, and included factors such as the person's right to know his or her diagnosis.
Context of change in community mental health occupational therapy: Part one
Authors: Harrison Deborah
Published: May 2014

Mental health services have experienced radical changes over the past 20 years. There has been a shift from institutional to community care and different professions have been brought together to work in teams. More recently, these teams have been aligned to geographical boundaries, not by profession, and have one manager from any professional background. The working relationships between the professional groups in the teams can be an area of difficulty and the individual clinician can experience role confusion and stress.

This two-part study used focused ethnography to explore an occupational therapist's role in a community mental health team. It found that the occupational therapist was trying to develop her role both as a mental health worker and as an occupational therapist and that the context of organizational change was an important influence on these roles. This article describes the background literature, methodology and findings. Part two covers the data analysis, discussion and recommendations for further research and practice.
Driving to learn: Powered wheelchair training for those with cognitive disabilities
Authors: Nilsson Lisbeth M , Eklund Mona
Published: May 2014

The Driving to Learn project was an exploration of how those with significant cognitive disabilities could benefit from training in a joystick-operated powered wheelchair. This study focuses on a particular part of the wider Driving to Learn project, mainly looking at the relationship between characteristics connected to powered wheelchair-use and the trainees' success or failure in developing a consciousness of joystick-use.

Forty-five people, aged 12 months to 52 years, were included in the project one by one over a period of 12 years. Forty people from this group had profound cognitive disabilities and multivariate additional disabilities, the other five, aged below 2 years, were at high risk of developing this condition. Data sources consisted of video-recordings, field notes, and open interviews with trainers and others acquainted with the participants. The project had a grounded theory approach, using concomitant analysis and collection of data together with constant comparisons and repeated analyses' of changes in the participants' approaches and attitudes connected to powered wheelchairuse.

The findings showed that high predictability and usability of powered wheelchair-use, facilitated successful achievements in the earlier identified process of growing consciousness of joystick-use (Nilsson et al, 2006). The relevance of the gained knowledge and the implications for rehabilitation and occupational therapy practice are discussed.
Choosing a powered wheelchair: The options
Authors: Fernandes Tanya
Published: May 2014

Powered wheelchairs allow those with mobility problems to move around independently and participate in day-to-day activities, thus becoming active members of society.

This article will look at the importance of a thorough assessment of the user's needs in order to select the most appropriate piece of equipment to suit the individual's requirements.

There is a wide variety of powered wheelchairs on the market and this article will help those considering purchasing such equipment to navigate through the many choices and options available.
A waste of money and talent as junior physiotherapists face job crisis
Authors: Gray Phil
Published: May 2014

Recent surveys by the Chartered Society of Physiotherapy (CSP) have exposed a chronic shortage of jobs for newly qualified physiotherapy graduates seeking their first junior posts within the NHS. This is a scandalous waste of taxpayer money and physiotherapy talent, which will have a negative impact on patient care and further extend waiting times.
Participative service redesign using appreciative inquiry
Authors: Atkin Helen , Lawson Sally
Published: May 2014

Approaches to the development of strategy within the context of change vary in both style and success. A participatory approach to change provides everyone involved in the process with the opportunity to share their experience and knowledge, explore common values and create something they can have shared ownership of and responsibility for. The challenges to management are often around their perceived position of power, their need to control and plan the change process and the concept that ideas are best generated by experts.
A preview of the Naidex 2006 health-care exhibition
Authors: Franklin Zoë
Published: May 2014

The UK's homecare, disability and rehabilitation exhibition returns to the National Exhibition Centre in Birmingham from April 25–27. Naidex 2006 helps health-care professionals to keep in touch with the latest market innovations and developments in independent living and provides the ideal opportunity to meet with suppliers and manufacturers, as well as keeping up with best practice.
The effect of exercise training on balance in adult patients with post-stroke hemiplegia
Authors: Olawale OA , Ogunmakin OS
Published: May 2014

Stroke patients with balance problems are prone to falls. The objective of this study was to evaluate the effects of exercise training on balance and incidence of falls in adult patients with post-stroke hemiplegia. The study was conducted with 23patients with first episode, single stroke (14men, 9women; mean age=57.56±10.40years, range 43–78). Ten of the participants had right-sided hemiplegia and 13 had left-sided hemiplegia; mean time since stroke was 28.88±21.64months (range 3–60). The patients underwent balance-specific exercise training for 8weeks. Participants were assessed for balance before and after the intervention using the Berg Balance Scale (BBS). In addition, reports of falls among the patients were tracked for the period of intervention and compared with the history of falls in the 8weeks preceding the start of exercise training. Wilcoxon signed-rank test was used to evaluate the significance of the difference between the pre-training and post-training balance scores on the BBS, and to determine whether significant difference existed between the mean values of history of falls and incidence of falls (P<0.05).

Exercise training resulted in significant improvement in balance and non-significant reduction in incidence of falls of adult stroke patients. It was concluded that balance deficits should be addressed with individualized balance training programmes in order to reduce the incidence of falls in stroke patients.
Independent mobility for children with disabilities
Authors: Fernandes Tanya
Published: May 2014

It is essential that children with disabling conditions such as cerebral palsy or muscular dystrophy are helped to be independently mobile from an early age. If not, they can develop ‘learned helplessness’, where the child will become passive and dependent upon others, and will not grow and develop to his or her potential. Independent mobility can be achieved through the provision of customized vehicles such as wheelchairs or tricycles. The UK charity Whizz-Kidz provides this equipment, which is often not available through the NHS, to help children to ‘realize their true potential’.

This article aims to describe the different types of mobility equipment available to help children with disabilities to move around and develop their skills, and offers some examples of different products on the market.
A phenomenological study of patients' experiences of an orthopaedic preadmission clinic
Authors: Gillespie Beryl , Spalding Nicola J
Published: May 2014

Preadmission clinics are seen by healthcare professionals as an important part of patients' preoperative experience. Economic benefits, through reducing length of stay postoperatively, have been realized. Relatively little research exists which informs healthcare professionals of the patients view of such clinics. Such feedback from the patients has the potential to provide important evaluative data which can be used to inform future preadmission clinics.

This paper presents the findings from a small qualitative study conducted in a total hip replacement preadmission clinic in an independent hospital. Phenomenological interviews were undertaken with ten patients who attended a preadmission clinic.

The findings were used by the multidisciplinary team comprising of senior clinicians within the preadmission clinic, and a number of recommendations were made and implemented to improve the clinic. Further analysis of the data also led to the team appreciating the value of the clinic for boosting patients' confidence so that they could make informed choices about their care.
Response and completion rates for postal outcomes booklets in stroke rehabilitation
Authors: Murray Jenni , Forster Anne , Young John
Published: May 2014

This study aimed to assess the response and completion rates for patient and caregiver stroke outcome booklets administered by post. The study also investigated whether the inclusion of a sixty-item, multiple domain outcome measure; the stroke impact scale (SIS) in the booklets affected response and completion rates. A consumer group informed the development of two patient booklets: one with four outcomes (without the SIS) and one with five (including the SIS). A caregiver booklet comprising four outcomes was also prepared. The booklets were posted to the homes of 51 stroke patients and 33 caregivers.

The response rate was 84% and 79% for patients and their caregivers, respectively. Completion rates for individual outcomes were 85% and above for all outcomes except the EuroQol (79%) and the SIS (41%). For the EuroQol, 60% of uncompleted items were accounted for by one item: the selfrating health scale. Uncompleted items for the SIS were randomly distributed. The completion rate for patient booklets without the SIS was double that of booklets that included the SIS.

The patient and carer stroke outcomes booklets developed in this study produced high response and (excluding the SIS) high completion rates. The booklets may offer a standardized approach to postal-administered outcome measurement in stroke rehabilitation trials.
Multi-disciplinary perceptions of music therapy in complex neuro-rehabilitation
Authors: Magee Wendy L , Andrews Keith
Published: May 2014

Although there is growing evidence that music therapy has a significant role to play in rehabilitation of patients with complex neuro-disabilities, its provision in rehabilitation units varies widely internationally. Understanding the role it plays in therapeutic outcomes appears to be one of the barriers in developing music therapy service provision in the UK, where it remains under-resourced in rehabilitation units.

This paper reports on a retrospective study of referral patterns to an established music therapy service in a multidisciplinary (MDT) neuro-rehabilitation setting in England. Referrals over a 2-year period were analysed to examine the reasons for referral to music therapy both in terms of priority and frequency, as well as which members of the multidisciplinary team were referring.

The results indicate that where music therapy is integrated into MDT programmes it is perceived by the team to have a particular role in the rehabilitation of communication and emotional health needs.
Mind the gap: rethinking community neurological rehabilitation services
Authors: Jones Diana , Plant Rowena , Crawford Alison , Bearn Sue
Published: May 2014

Recognition that there was a lack of knowledge about what services existed for adults aged 18– 65 years with an acquired neurological condition in North Cumbria, and how they were accessed and co-ordinated, led to a project to identify community rehabilitation provision and explore potential service models. Interviews were undertaken with service providers, and focus groups, interviews and a questionnaire were undertaken with services users and carers.

The five areas of concern to emerge from a thematic analysis of the data related to service provision; respite care and day time occupation, transport and geography, co-ordination of services, and information. There were differences in perspectives and priorities. Having one point of contact for access to all services emerged as the preferred model, although this would not address the gaps in service provision.

Despite the recognition that the National Service Framework for Long-term Conditions (Department of Health (DH), 2005b) has promoted service development for the target group, there is still a need to work towards greater coherence in service provision across a plurality of providers.
Integrating spirituality into mental health rehabilitation
Authors: Lloyd Chris , O’Connor Courtney
Published: May 2014

Spiritualty gives meaning to people's lives. In this article, the authors discuss how spirituality is defined in occupational therapy practice, how it enhances client-centred practice, and explore how spiritualty can be incorporated into mental health practice. The Psychospiritual frame of reference provides a definition of spirituality and a framework.

There is an emphasis on the spiritual dimension of connectedness, which is particularly salient for people with a severe mental illness living in community care units and undergoing the process of transition to community living.
An investigation of therapy student's perceptions of cultural awareness
Authors: Kale Swati , Swee Hong Chia
Published: May 2014

Cultural awareness is recognized as an essential skill for the effective practice of physiotherapy and occupational therapy. The aim of this study was to investigate the perceptions of cultural awareness of 274undergraduate physiotherapy and occupational therapy students.

A self administered questionnaire adapted and modified from Cheung et al (2002) was used. More than half of the students recognized the influence of cultural factors on the assessment and intervention process and the functional ability of the client. The majority of the students believed that the level of cultural awareness could be influenced by education (92%, 104/113) and placement experience (98%, 110/113). Students rated themselves to be ignorant or to having limited awareness of the sources of information and access to language translation services.

This study highlights the need to address the challenges of working in a multicultural society within the curriculum and equip the students with the skills required to work in a multicultural society.
Phase II cardiac rehabilitation improves quality of life in Iranian patients after CABG
Authors: Attarbashi Moghadam Behrooz , Reza Hadian Mohammad , Tavakol Kamran , Bagheri Hossein , Salarifar Mojtaba , Montazeri Ali , Jalaei Shohreh
Published: May 2014

The aim of this study was to determine the effects of a phase II cardiac rehabilitation programme on health-related quality of life (HRQoL) domains in cardiac patients following coronary artery bypass grafting (CABG). The study looked at post-CABG patients of Iranian origin who had been admitted to the Tehran Heart Center, Iran.

Forty-four patients aged between 40–60 years, participated in the programme, 4–5 weeks after CABG. The SF-36 Health Survey was used to assess the health-related quality of life (HRQoL) domains before and after the programme, and at 3-month follow-up. The data were then compared with corresponding values for 882 healthy Iranian individuals of similar ages from the general population.

The programme was safe and well-tolerated. The mean scores for all patients showed significant gains in all HRQoL domains, both at last exercise session and follow-up. Compared with mean scores at the last exercise session, the values at follow-up remained essentially unchanged in five domains. There were further significant gains in the mean scores for Role physical, Role Emotion and Bodily Pain at follow-up.

The results suggest that the programme produced significant short-term and long-term improvements in physical, mental and emotional aspects of the patients' quality of life in this patients Further research is needed to correlate the values of the SF-36 scores with clinical outcomes, and to investigate the mechanisms by which the programme is effective.
Reconfiguring evidence-based practice for occupational therapists
Authors: Reagon Carly , Bellin Wyn , Boniface Gail
Published: May 2014

Aims: Evidence-based practice is an approach to clinical decision making which combines the best available evidence with individual patient care. Debate as to what makes good evidence and how this should be applied in practice as well as ambiguity about the meaning of evidence-based practice and concern regarding its confl ict with other models of occupational therapy, have created uncertainty for occupational therapists attempting to become ‘evidence-based’. The aim of this study was to explore the meanings attributed to evidence-based practice by occupational therapists and to propose a defi nition and framework of evidence-based practice that refl ects participants’ perceptions.

Method: A mixed methodology qualitative design incorporating focus groups, in-depth interviews and observation was used to explore perceptions of evidence-based practice by occupational therapists at one setting in England.

Findings: The fi ndings indicate that evidence-based practice is typically associated with use of research but that this is only partially relevant to occupational therapy and the treatment of individuals. A defi nition of and framework for evidence-based occupational therapy which refl ects these fi ndings is presented.

Conclusion: Acknowledgement of a range of evidence, from research fi ndings to clients’ selfreports, corresponds with participants’ conception of clinical reasoning as a complex process that takes multiple factors into account. This, together with participants’ client-centred approach and emphasis on the human experience of health encounters, forms the basis of a reconfi guration of evidence-based occupational therapy.
Peer observation in professional development: Occupational therapists' perceptions
Authors: Davys Deborah , McKenna Jacqui , Tickle Ellen
Published: May 2014

Aims

Peer observation of practice is used to promote reflection and facilitate personal and professional development. However, there appears to be no published research on the use of peer observation by occupational therapists working in higher education. This action research project explored the perceptions of occupational therapy staff within a higher education setting towards the use of a peer observation of practice scheme.

Methods

All colleagues within a directorate of occupational therapy were invited to complete a questionnaire. Additionally, fi ve staff were invited to take part in semi-structured interviews and core themes were identifi ed following thematic analysis, typifi ed by grounded theory.

Findings

Staff used a range of methods to support professional development, including peer observation. Key themes identifi ed were the concept that peer observation has both positive and negative connotations, that feedback must be carefully managed, that the relationship between observed and observer is important and that staff want clear ground rules for peer observation schemes.

Conclusions

Findings indicated the need for further research into peer observation and how such a scheme could be formally implemented.
Approaching in the right spirit: Spirituality and hope in recovery from mental health problems
Authors: Bassett Hazel , Lloyd Chris , Tse Samson
Published: May 2014

Aims

Research indicates that having an active spiritual or religious life and sense of hope is highly protective against a wide range of problems throughout the life cycle. However, the two important domains of spirituality and hope have received limited coverage in mental health rehabilitation literature. Therefore the authors sought to discuss the role of spirituality and hope for people with mental health problems, and propose a process for practice which uses these concepts.

Methods

A discussion on the role of spirituality and hope in mental health rehabilitation is presented. The authors explore how spirituality has been defi ned in the literature, and its role in recovery from illness. The concept of hope in relation to spirituality and mental illness is discussed. Finally the authors propose how rehabilitation practitioners can apply these concepts in practice, in both assessment and interventions.

Findings and conclusions

This article highlights the importance of including spirituality and hope in assessment and treatment in order to move towards a recovery-orientated health-care service. The role of hope in assisting practitioners to be sensitive to the spiritual needs of clients is demonstrated.
Social inclusion and valued roles: A supportive framework
Authors: Davys Deborah , Tickle Ellen
Published: May 2014

Aims

Social inclusion is important to an individual's health, quality of life and sense of wellbeing. In today's society, there is an understanding that it is the social, economic and cultural barriers encountered by people with impairments that cause disability. Health-care professionals are wellplaced to identify these barriers and the potential for supporting the development of valued roles for their clients, to engender social inclusion.

Methods

This article examines the concepts of social exclusion, social inclusion and their relevance to health, wellbeing and valued social roles. The theory of social role valorization—;which was developed initially to support and sustain socially valued roles for those who are, or are at risk of, being devalued within society—;is discussed and the criticism of this theory is explored. A framework based on this theory is then presented. This framework incorporates these principles and can be used by health professionals across a range of practice settings as a legitimate starting point from which to support the acquisition of socially valued roles, which are integral to inclusion.

Conclusions

Supporting the development and maintenance of valued roles is an intrinsic role for all health-care professionals, and it is hoped that this framework to assist the acquisition of valued social roles may be implemented in therapy and rehabilitation settings. Further exploration of the practical implementation of this framework is suggested.
Survey research: Process and limitations
Authors: Coughlan Michael , Cronin Patricia , Ryan Frances
Published: May 2014

Background

Survey research is a non-experimental research approach used to gather information about the incidence and distribution of, and the relationships that exist between, variables in a pre-determined population. Its uses include the gathering of data related to attitudes, behaviours and the incidence of events. For most modern researchers sample surveys are more cost effective and easier to undertake than population surveys when gathering information; however, this increases the risk of both representation and measurement errors.

Contents

There are a number of different forms of survey research; however, they all share common steps and common limitations. This article discusses these steps with a view to highlighting some of the common difficulties.

Conclusions

In the modern era, pressures on time and cost have led population census to, generally, be replaced by sample surveys. Newer survey methods of data collection may also help in reducing cost, but still have limitations. Researchers need to be aware of the potential errors that can occur with surveys, in order to reduce the risk in those areas that they can control.
Emotional support for stroke survivors: Share Your Story Group
Authors: Gurr Birgit
Published: May 2014

Aims

This article discusses the implementation and evaluation of a psychosocial group for stroke survivors in the acute phase of rehabilitation. Participants were encouraged to share thoughts and feelings about the impact of their stroke, progress in rehabilitation, and views on the future. It was hoped that this intervention would help patients' emotional adjustment to difficulties following stroke. The evaluation aimed to discover how successful the group was in achieving this.

Methods

Participants' emotional functioning was measured using the Hospital Anxiety and Depression Scale (HADS) (Zigmond and Snaith, 1983), and showed no significant changes in mood following the group. A trend towards improvement in mood was indicated by the reduction of mean HADS scores at the end of the intervention. Participants' contributions during the group sessions were recorded on flipcharts. Participants were asked to rate, on a 10-point Likert-rating item, how helpful for recovery they found the group.

Findings

The categorization of participants' contributions revealed eight themes in their attitude to stroke problems. While the evaluation did not show that the group caused a significant improvement in participants' moods, the majority reported on the 10-point Likert-rating item that the group was helpful for the recovery process (average score 7).

Conclusions

A longer intervention with larger numbers of participants would be necessary to assess whether the group could improve mood. However, even with this brief trial, participants found it very helpful, and the group leaders reported that they gained a better understanding of participants' individual ways of dealing with difficulties, and that this intervention contributed to improved team working.
The concerns of older women during inpatient rehabilitation after fractured neck of femur
Authors: Colleen Wykes , Pryor Julie , Jeeawody Basseer
Published: May 2014

Aims

There have been many studies conducted on the impact of fractured neck of femur on older women, but they have not focused specifically on the psychosocial impact of this injury on the lives of previously independent older women. This pilot study aimed to explore the impact of fractured neck of femur on the lives of previously independent women, and identify their concerns when participating in inpatient rehabilitation following their fracture.

Methods

Semi-structured interviews were undertaken with five women hospitalized for rehabilitation following fractured neck of femur. Qualitative description within the constructivist paradigm and using thematic analysis was used to analyse the transcripts.

Findings

All of the five women experienced loss of control as a distressing consequence of fractured neck of femur. Their primary concerns were about the behaviour of others, what was happening to them, the impact of their injury on others and their other health issues.

Conclusions

Loss of control is a major issue for older women who fracture a femur. In addition, during rehabilitation they are concerned about a range of issues, some of which seem to have the potential to be ameliorated by thoughtful staff-initiated interactions. Identification of what concerns patients can help staff know where to focus their input as they guide and support patients on their rehabilitation journeys. Further research is required to guide and refine the development of effective staff-initiated interactions.
UK research governance developments: Opportunities for therapy research?
Authors: Pettican Anna R , Bostock Jennifer L
Published: May 2014

Background

Evidence-based practice requires that all therapists are consumers of research, which means they must read, appraise and where appropriate apply, research findings to their practice. Indeed, their contribution has been described at three levels: as research consumers, research participants and as proactive researchers.

Content

This article presents five key recent UK research governance developments, illustrated with case examples, which are relevant to therapists across all three of these levels. In particular the article focuses on exploring the opportunities that such developments could potentially provide as the therapy professions strive to increase their research capacities.

Conclusions

All therapists are urged to stay abreast of the research governance developments, in order to effectively exploit the opportunities and advantages they may provide.
Staff in-service training on post-stroke psychological and communication issues
Authors: Ross Sarah , Barton Jane , Read Jennifer
Published: May 2014

Aims

This article describes the development, content and evaluation to date of an in-service, interdisciplinary training programme on psychological and communication problems after stroke. The training is open to all staff but is particularly focused towards qualified and unqualified nursing staff and therapy assistants who work in acute stroke care and rehabilitation both in hospital and community settings.

Content

The programme, developed by the authors whose backgrounds include speech and language therapy, occupational therapy, and clinical psychology, aims for all staff to develop an integrated, patient-centred approach to care, and addresses issues such as improving the patient and carer experience of rehabilitation, as well as reducing the negative psychosocial consequences of stroke. Service users are involved in delivering the training. Informal evaluation highlighted improvements for trained staff in knowledge and perceived confidence in the recognition and basic management of communication, cognitive and emotional problems after stroke.

Conclusions

Limitations in evaluation in terms of design, methodology and data are acknowledged, however, preliminary findings highlight the benefits of this programme in holistic stroke care delivery. Suggestions are made regarding future more empirically rigorous research into longer-term effects of the training both for staff and patient outcomes.
Normative values for the high-level mobility assessment tool (HiMAT)
Authors: Williams GP , Rosie J , Denisenko S , Taylor D
Published: May 2014

Aims

The high-level mobility assessment tool (HiMAT) was originally developed to quantify the physical ability of young people with TBI. The aims of this study were to determine the retest reliability and normative HiMAT values for young healthy adults. Known HiMAT normative scores may facilitate clinical decision making and goal setting in independently mobile people with traumatic brain injury as they provide a target for re-attaining pre-injury mobility levels

Methods

One hundred and three people, aged 18-25 years, were recruited. A sub-group of 59 participants completed repeat testing to investigate test-retest reliability.

Findings

Retest reliability measured using intraclass correlation coefficients was high (ICC (2,1)=0.88, 95% CI 0.82-0.92) with low typical error (0.95; 95% CI 0.85-1.09). The results of the Friedman test indicated that there was no significant difference between HiMAT test scores across the three time points for males, x2 (2, n=28)=4.04, P=0.13, or females, x2 (2, n=30)=4.52, P=0.11 indicating no practice effect had occurred. Males scored significantly higher than females. The median HiMAT score for males was 54/54 (inter-quartile range 53–54) and the 5th percentile was 50. For females, the median HiMAT score was 51/54 (inter-quartile range 48–53) and the 5th percentile was 44. A ceiling effect was evident for males as 52.1% achieved the maximum score.

Conclusions

The HiMAT has high retest reliability in the normal population and is susceptible to a ceiling effect for males, but not for females. Normative data provided in this study may aid clinicians to establish patient goals relative to the expected normal performance on this measure.
Exploring lived experience: principles and practice of phenomenological research
Authors: Finlay Linda
Published: May 2014

Background

Phenomenology has been increasingly used in therapy and rehabilitation research. While some confusion exists about the nature of the phenomenological project, the desire to understand the lived experience of illness and/or wellbeing is evident.

Content

This article outlines current theory and practice of phenomenological research applied to health care. I explain the basic ideas underpinning phenomenological research such as the lifeworld and the use of bracketing. With its diverse philosophical heritage, phenomenological research has evolved into a range of approaches including first person accounts, descriptive phenomenology and hermeneutic phenomenology. These are discussed using a range of examples.

Conclusions

Studies which focus on subjective experience without attending to the ‘phenomenological attitude’ and/or underpinning philosophical theory are probably best considered phenomenologically-inspired rather than phenomenology per se. The special contribution and strength of phenomenology is the way it can capture the richness, poignancy, resonance and ambiguity of lived experience, allowing readers to see the worlds of others in new and deeper ways.
Predicting behaviour to reduce stroke risk in at-risk populations: the role of beliefs
Authors: Sullivan Karen A , White Katherine M , Young Ross McD , Scott Clinton
Published: May 2014

Aims

Changing behaviour to reduce stroke risk is a difficult prospect made particularly complex because of psychological factors. This study examined predictors of intentions and behaviours to reduce stroke risk in a sample of at-risk individuals, seeking to find how knowledge and health beliefs influenced both intention and actual behaviour to reduce stroke risk.

Methods

A repeated measures design was used to assess behavioural intentions at time 1 (T1) and subsequent behaviour (T2). One hundred and twenty six respondents completed an online survey at T1, and behavioural follow-up data were collected from approximately 70 participants 1 month later. Predictors were stroke knowledge, demographic variables, and beliefs about stroke that were derived from an expanded health belief model. Dependent measures were: exercise and weight loss, and intention to engage in these behaviours to reduce stroke risk.

Findings

Multiple hierarchical regression analyses showed that, for exercise and weight loss respectively, different health beliefs predicted intention to control stroke risk. The most important exercise-related health beliefs were benefits, susceptibility, and self-efficacy; for weight loss, the most important beliefs were barriers, and to a lesser degree, susceptibility and subjective norm.

Conclusions

Health beliefs may play an important role in stroke prevention, particularly beliefs about susceptibility because these emerged for both behaviours. Stroke education and prevention programmes that selectively target the health beliefs relevant to specific behaviours may prove most efficacious.
Driving assessment for older taxi drivers in Singapore
Authors: Chan Mei Leng , Gustafsson Louise , Liddle Jacki
Published: May 2014

Aims

Licensing authorities in different countries differ in their approaches to the use of age based licensing, medical fitness and driving assessments. This article describes a new licensing policy introduced in Singapore in 2006 whereby driving assessment by occupational therapists became a critical stage in the licensing process for older taxi drivers. Preliminary data on the older taxi drivers are presented. Implications for future studies and clinical intervention are discussed.

Methods

Information was gained from the Land Transport Authority of Singapore on current taxi drivers, the projected number of taxi drivers aged 70 years who were eligible to renew their licences in 2008, 2009, 2010, and any data on accidents, demerit points and complaints against taxi drivers. Information about the 70 year old taxi drivers that had undergone the functional driving assessment program in 2006 and 2007 was gained from the Department of Occupational Therapy. This information was analysed.

Findings

There was a very high pass rate - 98% of those aged 70 or over who took the test, passed.

Conclusions

The high pass rate needs further exploration. Future research can explore the cost effectiveness of the licensing and driving assessment systems in terms of accident rates, the validity of on road tests and useful predictive off road tests.
Behaviour of the muscle-tendon unit during static stretching following unloading
Authors: Kanazawa Hiroshi , Urabe Yukio , Shirakawa Taizan
Published: May 2014

Aims

To determine the amount of displacement in the muscle-tendon unit of the medial head of the human gastrocnemius muscle during static stretching, after a period of non-weight-bearing following injury.

Methods

Twenty female patients with a unilateral lower leg injury participated in this study (N = 13 following ankle fracture-dislocation; N = 7 following fracture of the tibiofibula). The difference in displacement of the junction of the fascicle and the deep aponeurosis junction (DA) at ¼ proximal height of the lower leg and that of the myotendinous junction (MTJ) between the injured and uninjured leg was measured using ultrasonograms and analyzed by two way analysis of variance for repeated measures and paired t-tests

Findings

Initially, DA displacement was larger, and MTJ displacement was smaller, in the injured compared with the uninjured leg. After treatment, DA and MTJ displacements in the injured leg approached levels of the uninjured leg. At all time points, DA and MTJ displaced distally during the first three minutes of stretching in both legs (P < 0.01).

Conclusions

Following a non-weight-bearing period, fascicles and tendon may be excessively extended. Recovery of the muscle tendon complex might be accelerated by applying exercises aimed at attaining increased extensibility of the aponeurotic tissue.
Ethnography: a suitable approach for providing an inside perspective on the everyday lives of health professionals
Authors: Thomson Di
Published: May 2014

Di Thomson

Background: This article provides a rationale for the use of ethnography, using an inside perspective on the everyday lives of health professionals as an example. Gaining such a perspective occurs through a researcher's firsthand experience of ‘being there’ for an extended period of time. By observing health professionals at work, and their social interactions, it is possible to gain an understanding of their experiences and the meanings they ascribed to these experiences.

Contents: The article describes the key methods of data collection - participant observation and interviewing - along with the ongoing process of analysis. Issues related to the challenge of gaining access, the insider/outsider status of the researcher and the ethical issues involved in carrying out ethnographic research are also addressed.

Conclusions: It is argued that ethnography is a useful methodology in healthcare research because it captures a holistic understanding of the social and cultural world of health professionals.
Use of technology to enhance student self evaluation and the value of feedback on teaching
Authors: Corrigan Rosemary , Hardham Greg
Published: May 2014

Background: Assessment using case based practical exams that require demonstration of clinical practice skills and articulation of clinical reasoning is commonly used in undergraduate allied health and nursing professions. However, the student often struggles in understanding and evaluating their performance of practical skills in preparation for summative practical assessment tasks. The fear of attempting and completing practical tasks does not contribute to learning. Any means of encouraging self evaluation, refection and facilitating learning that is driven by the learner and not the assessor will contribute to the performance of the student in the short term and the practitioner in the future.

Aims: This project used a mixed-methodological approach to explore the use of audio-visual technology to enhance 61 undergraduate physiotherapy students' practice of self evaluation and then sought to explore and understand the student experience of the activity and the teacher feedback provided.

Findings: Themes relating to the students concerns, strengths and levels of self-confidence were identified. Refection on the student feedback provided and the implications for teaching are also discussed.
Scapula and humeral movement patterns and their relationship with pain: a preliminary investigation
Authors: Hardwick Dustin D , Lang Catherine E
Published: May 2014

Dustin D Hardwick, Catherine E Lang

Aims: Altered movement patterns may contribute to this shoulder pain following stroke. This article describes a study examining scapular and humeral movement patterns in people with hemiparetic shoulder pain (HSP), exploring the relationship between pain and these movement patterns.

Methods: Kinematic data from nine participants with HSP and twelve matched controls were collected as they performed scapular plane shoulder elevation. Correlation analyses were used to examine relationships between participants’ ratings of pain and kinematic data.

Findings: The HSP group had decreased humeral external rotation compared to the control group. Despite a trend toward decreased scapular upward rotation, there was considerable variation in scapular upward rotation movement patterns across the participants with HSP. Scapular tilt was not different between groups. There was an inverse relationship between pain and scapular upward rotation, indicating that those with more pain had less scapular upward rotation.

Conclusions: People with HSP demonstrated scapular and humeral movement patterns that differed from controls, where some of the altered movement patterns were related to reported pain levels. Rehabilitation management of people with HSP may be improved by careful assessment of scapulohumeral movement patterns and treatments aimed at normalizing these patterns.