The impact of a hand therapy workplace-based educational approach on the management of lateral elbow tendinopathy: A randomized controlled study.

BACKGROUND: Lateral elbow tendinopathy (LET) is one of the most prevalent work-related musculoskeletal conditions. Management strategies for LET rarely consider patients' work environments and have limited focus on education regarding occupational risk factors. Workplace-based rehabilitation has shown benefits in the return to work processes for injured workers with other health conditions, but no studies have investigated the impact of a workplace-based educational approach in the management of LET. PURPOSES: First, to identify the impact of an additional workplace-based educational intervention to standard hand therapy care on the outcomes of pain, grip strength, and function. Second, to identify the effectiveness of standard hand therapy on the same clinical outcomes. STUDY DESIGN: A randomized controlled trial. METHODS: Forty-nine participants were randomized to the control group (n = 25) or intervention group (n = 24). The control group received standard hand therapy for 12 weeks. The intervention group received standard hand therapy for the first 12 weeks plus an additional workplace-based educational intervention, "Working Hands-ED," delivered by a hand therapist. Pain levels for provocative tests, grip strength, and function were measured using a Numeric Rating Scale, Jamar Dynamometer, and the Patient-Rated Tennis Elbow Evaluation questionnaire at baseline, weeks 6 and 12. The Patient-Specific Functional Scale was also used for the intervention group. RESULTS: There were no statistical differences between both groups for all clinical outcomes by 12 weeks (P> .05). Pain levels for all provocative tests and Patient-Rated Tennis Elbow Evaluation scores statistically improved within both groups (P < .05), however with small effect sizes observed. The Patient-Specific Functional Scale scores statistically improved for the intervention group by 12 weeks (P < .05). CONCLUSION: The addition of a hand therapy workplace-based intervention did not result in superior clinical outcomes for pain, grip strength, and function. The study identified that a multimodal self-management approach used by hand therapists improved their patients' pain and function regardless of whether the education was given in the clinic or the workplace.

Managing work-related lateral elbow tendinopathy: Australian hand therapist's experiences with workplace-based interventions.

INTRODUCTION: Lateral elbow tendinopathy (LET) is one of the most prevalent work-related musculoskeletal conditions. Current treatments for LET focus mainly on the physiological symptoms of pain, grip strength, and function. Recently, a novel workplace-based hand therapy educational intervention, Working Hands-ED, was developed based on the Person-Environment-Occupation- Performance model, International Classification of Functioning, Disability and Health framework and the Australian Clinical Framework for the Delivery of Health Services. Combining a hand therapist's specialised knowledge and skills in upper limb rehabilitation with an approach that considers injured workers' occupations and work environments may provide a more holistic approach to managing work-related LET. To the best of our knowledge, no previous studies have investigated the experiences of hand therapists who perform workplace-based educational interventions for the management of LET. METHOD: An exploratory, descriptive qualitative design using semi-structured interviews was used with hand therapists who delivered the novel hand therapy intervention Working Hands-ED. FINDINGS: Ten occupational therapists working in hand therapy were interviewed. Three main themes and eight subthemes were identified from interview data: Person-centred approach, opportunity for therapists to provide enhanced service, and improved stakeholder engagement in the return-to-work process. Logistical challenges such as the costs and time spent away from the clinical setting were identified. CONCLUSION: All hand therapists reported delivering Working Hands-ED when managing work-related LET was a positive experience for them. They believed that the novel intervention could provide a more holistic approach to care that added value to their service delivery; however, there were some logistical factors to consider including the additional time and costs associated with the intervention.

From guidelines to practice: A retrospective clinical cohort study investigating implementation of the early detection guidelines for cerebral palsy in a state-wide early intervention service.

OBJECTIVES: To report on knowledge translation strategies and outcomes from the implementation of the early detection guidelines for cerebral palsy (CP) in a state-wide tertiary early intervention (EI) service and investigate the impact of social determinants on clinical services. DESIGN: Retrospective longitudinal cohort study. SETTING: The Western Australia tertiary paediatric EI service. PARTICIPANTS: EI clinicians, consumers and children using the EI service. OUTCOME MEASURES: Knowledge translation strategies including consumer perspectives, clinician training and Communities of Practice (CoP) guided implementation. We measured changes in referral number and age, delivery of early detection and intervention following the implementation of the guidelines. Exposure to adverse childhood experiences (ACEs), appointment non-attendance (DNA) rates, remoteness and socioeconomic quintiles were used to measure social determinants of health using negative binomial (Incidence Rate Ratios, IRR) and logistic regression (Odds Ratios, ORs). RESULTS: Ten consumers participated in Focus Groups, 100 clinicians were trained and 22 clinicians established a monthly CoP. Referrals increased fourfold to 511 children. Corrected gestational age at referral decreased from a median of 16.1 to 5.1 months (p<0.001) and at first appointment from 18.8 to 6.8 months (p<0.001). Children living in social disadvantage had the highest DNA risk (quintile 1 vs 5: IRR 2.2, 95% CI 1.1 to 4.6, p=0.037). Children exposed to ACEs had higher odds of living in social disadvantage (quintile 1 vs 5, OR=3.8, 95% CI 1.4 to 10.0, p=0.007). No significant association was found between remoteness and DNA rate or ACE score. CONCLUSIONS: Implementation strategies reduced referral age and improved the delivery of early detection assessments. Further investigation of the association between social disadvantage, DNA risk and ACE score is required in the development of a state-wide early detection network.

Identifying Suitable Cognitive Assessments for Children and Adolescents with Acquired Brain Injury for use by Occupational Therapists in Acute and Subacute Hospital Contexts: A Scoping Review.

AIM: To appraise the literature evaluating psychometric properties and clinical utility of cognitive assessments available for use by occupational therapists in acute and subacute hospital contexts with children aged 4-18 years diagnosed with an acquired brain injury. METHODS: Scoping review. Assessments and associated studies were evaluated for their methodologic quality using the COnsensus-based standard for the Selection of health Measurement INstruments (COSMIN) strategy. RESULTS: Forty-one studies evaluated 49 different assessments and reported on assessment psychometrics (n = 40), clinical utility (n = 1) and five reported on both. Fourteen assessments with the strongest psychometric properties and clinical utility were shortlisted. CONCLUSION: A gold standard assessment was not identified. Instead, a shortlist of functional, performance-based, technology-based, and self-report assessments were identified as relevant for the setting and population, but requiring further investigation. Future development of a cognitive assessment in partnership with therapists working in tertiary pediatric settings will ensure optimal clinical utility and validity.

Does the Integration of Telehealth into Occupational Therapy Practice Impact Clinical Outcomes for Hand and Upper Limb Rehabilitation? A Matched Case Control Study.

Health services are capitalizing on the rise of telehealth and seeking to develop sustainable models incorporating telehealth into standard care. Further research is required to explore the service and clinical outcomes of telehealth in occupational therapy hand and upper limb practice. This research utilized a case-control study to explore the feasibility and clinical outcomes of case matched patients who received a telehealth hybrid model versus traditional in-person care. One hundred and two patients were recruited (n=51 in the controls and cases) with a mean age of 45 years. Telehealth was not inferior to standard care with no significant increase in therapy time (p=0.441) or length of referral (p=0.047). There was no difference in clinical adverse events (p=0.741). Patients who received telehealth had significantly less withdrawals from the service (p = 0.031). Patient and therapist satisfaction were high, supporting the ongoing use and continued implementation of telehealth in occupational therapy.

An observational cohort study to determine the impact of research capacity building strategies implemented in an Australian metropolitan hospital occupational therapy department.

INTRODUCTION: Research capacity building enhances the abilities of individuals and is critical within health systems for quality patient care and promotes a culture of excellence within the occupational therapy profession. A research capacity building toolkit was proposed identifying strategies to support allied health professionals to undertake research. This study evaluated participant-reported outcomes of research capacity building toolkit implementation in an occupational therapy department. METHODS: An observational pre-post-cohort study at a tertiary hospital with volunteer occupational therapists using the standardised Research Capacity in Context Tool (RCCT) and an author-designed quality improvement (QI) survey was employed. The RCCT measures research capacity and culture at organisation, team and individual levels. Semi-structured interviews were used to elicit reflections regarding participant experience. RESULTS: All levels of the toolkit were implemented successfully. The response rate was 59% (n = 36) at baseline and 49.1% (n = 26) at follow-up. Eighty-five percent of participants held direct clinical roles. Nine clinicians participated in the interviews. There were significant improvements in the estimate mean for the organisation (6.51 [2019] compared with 8.13 [2020], p = <0.001) and the team (5.52 [2019] compared with 7.15 [2020], p = 0.001). The individual level did not significantly change with an estimate mean of 4.20 in 2019 increasing slightly to 4.84 in 2020 (p = 0.128). This was supported by the QI survey where improvements were noted in the department but not at an individual level. The qualitative findings verified the components of the toolkit including 'supporting clinicians in research', 'working together', 'valuing research for excellence' and reflected the importance of 'individual attributes'. CONCLUSION: The toolkit supported the implementation of specific strategies to enhance research capacity and culture. Improvements within the organisation and team were evident; however, these were not seen at an individual level. Further research about the contribution of individual-related factors and processes to the building of research capacity is required.

How prepared is Australian occupational therapy to decolonise its practice?

INTRODUCTION: Being culturally secure, respectful and responsive can mean occupational therapists can contribute to improving the health and wellbeing of Aboriginal and Torres Strait Islander peoples. New culturally responsive accreditation and competency standards provide an opportunity to decolonise the profession to enhance the cultural capabilities of graduates. The purpose of this study was to explore how well-prepared Australian occupational therapy courses are to implement the new standards. METHODS: The principles of participatory action research were applied. An initial survey with occupational therapy academic staff was used to inform questions for semi-structured interviews. Semi-structured interviews were conducted with 10 occupational therapy academics and occupational therapy accreditors. Interview data were thematically analysed. FINDINGS: The four themes identified from the interviews were: occupational therapy profession drivers, effective leadership, community and Elder involvement, and course design and delivery. CONCLUSION: The new accreditation and competency standards are a promising step forward for the profession. However, the profession needs to be better prepared to decolonise Australian occupational therapy. A positive and culturally secure way forward is to engage Elders and other community members in learning experiences to build student, academic and practicing occupational therapist's cultural capability. Non-Aboriginal and Torres Strait Islander leadership at all levels of the profession and within universities is crucial to establishing trusting, reciprocal relationships to support deep knowledge exchange. These relationships lay the foundation to build cultural capabilities and decolonise processes in the profession.

Investigating mechanisms for recruiting and retaining volunteers: The role of habit strength and planning in volunteering engagement.

Volunteering rates in high-income countries are declining. Most research into understanding volunteering engagement has focused on conscious processes (e.g., motives), with little exploration of non-conscious antecedents of volunteering engagement. Adopting a new line of investigation, this research used temporal self-regulation theory to investigate the influence of both rational and automatic processes on volunteering engagement. Two related studies using different methodologies were conducted to investigate the influence of intention, planning, and habit strength on volunteering engagement. In both studies, intention and habit strength were significant predictors of volunteering engagement, with planning only significantly predicting volunteering engagement in Study 1. It was also found, in Study 2, that habit strength moderated the intention-behavior relationship. These findings highlight that both rational and automatic processes play a part in volunteering engagement and have implications for recruiting and retaining volunteers.

A randomized pilot study on self-management in head and neck lymphedema.

BACKGROUND: The purpose of this pilot trial was to determine the feasibility of a self-managed lymphedema randomized control trial to test the effectiveness of a head and neck-specific exercise protocol. METHODS: Nine participants were randomized to receive usual treatment provided by an Australian metropolitan teaching hospital (n = 4) or usual treatment with an added head and neck exercise regime (n = 5). Feasibility was assessed through ease of recruitment, adherence, and safety. Lymphedema reduction and quality of life (QOL) data were assessed at baseline (0 week) and follow-up (6 weeks). RESULTS: The study was feasible in terms of safety and participant retention. However, a slow recruitment rate and low adherence may impact future trials. There were no significant differences in lymphedema reduction or QOL between groups. CONCLUSION: This pilot feasibility study demonstrated that a self-management trial can be implemented, however, modifications will be required due to the slow recruitment and poor adherence rates. LEVEL OF EVIDENCE: 1b: Individualized randomized control trial.

Motivations for volunteering time with older adults: A qualitative study.

Improved health, wellbeing and quality of life are associated with older adults living well at home. Enabling older adults to remain at home requires organisations to consider different workforce models to support these initiatives. Volunteers are often used by organisations providing such services. However, given the changing nature of the volunteer industry, volunteer recruitment and retention practices must be better understood. This study sought to understand individuals' motivations to volunteer in aged care home support. Eighteen volunteers were recruited from not-for-profit aged support organisations in Perth, Western Australia. Semi-structured interviews were conducted, and five themes were thematically interpreted: What's Important to Me?, Learning and Growth, Somewhere to Belong, Meet Me in the Middle, and Not Just a Number. Fulfilling volunteers' desires for interest, social connection, self-growth, recognition, and support appeared conducive to positive volunteering experiences. These findings may suggest avenues to capture and retain volunteers in aged care home support.

Associations between meeting sleep, physical activity or screen time behaviour guidelines and academic performance in Australian school children.

BACKGROUND: Current guidelines suggest too little sleep, too little physical activity, and too much sedentary time are associated with poor health outcomes. These behaviours may also influence academic performance in school children. The primary purpose of this study was to examine the relationships between sleep, physical activity, or sedentary behaviours and academic performance in a school with a well-developed and integrated technology use and well-being program. METHODS: This was a cross-sectional survey of students (n = 934, Grades 5-12) in an Australian school with a bring-your-own device (tablet or laptop computer) policy. Students reported sleep, physical activity, and sedentary (screen and non-screen) behaviours. Academic performance was obtained from school records. Linear regressions were used to test the association between behaviours and academic performance outcomes. RESULTS: Seventy-four percent of students met sleep guidelines (9 to 11 h for children 5-13 years and 8 to 10 h for 14-17 year olds), 21% met physical activity guidelines (60 min of moderate-to-vigorous physical activity every day), and 15% met screen time guidelines (no more than 2 h recreational screen time per day); only 2% met all three. There were no associations between meeting sleep guidelines and academic performance; however later weekend bedtimes were associated with poorer academic performance (- 3.4 points on the Average Academic Index, 95%CI: - 5.0, - 1.7, p < .001). There were no associations between meeting physical activity guidelines and academic performance. Meeting screen guidelines was associated with higher Average Academic Index (5.8, 95%CI: 3.6, 8.0, p < .001), Maths 7.9, 95%CI: 4.1, 11.6, p < .001) and English scores (3.8, 95%CI: 1.8, 5.8, p < .001) and higher time in sedentary behaviours was associated with poorer academic performance, including total sedentary behaviours in hrs/day (5.8 points on Average Academic Index, 95%CI: 3.6, 8.0, p < .001. Meeting at least two of the three behaviour guidelines was associated with better academic performance. CONCLUSIONS: Sleep and sedentary behaviours were linked to academic performance. School communities should emphasize comprehensive wellness strategies to address multiple behaviours to maximize student health and academic success.

Understanding occupational engagement for individuals with bariatric needs: The perspectives of Australian Occupational Therapists.

INTRODUCTION: Over the last 20 years, the number of individuals affected by obesity in Australia has increased by 56%. The impact of excessive weight gain results in a wide range of physical, psychological and social difficulties, with resultant changes to occupational performance and engagement. For some people within this population, a further consequence of this increasing weight gain contributes to additional difficulties, with the individual being considered to be "bariatric". For these people, resultant changes include decreased capacity to engage in self-care activities, leisure occupations and productive roles, creating significant difficulties in undertaking important life roles. This phenomenological study aimed to understand the occupational engagement of individuals with bariatric needs, and to identify potential opportunities to support the engagement and participation of these individuals from the perspectives of Australian occupational therapists. METHODS: Qualitative data were collected from 11 semi-structured interviews with occupational therapists from a variety of practice settings. RESULTS: Thematic analysis identified four central themes (a) Occupational engagement was significantly impacted by a lack of suitable resources and availability of daily living equipment; (b) Health and well-being were impacted by a disruption in meaningful occupational engagement; (c) Occupational roles were limited due to poor occupational identity and perceptions of not belonging within the community; (d) Occupational therapists do have a varied role when working with individuals with bariatric needs. CONCLUSION: Occupational therapists engaged in this study indicated that people with bariatric needs were significantly impacted by many complex issues as a result of their health condition, often contributing to poor health and decreased well-being. Occupational therapists are well-placed to engage with individuals with bariatric needs across many care contexts and must take up potential opportunities to provide services targeted towards the increased engagement and participation of these individuals, with resultant improvements to health and well-being.

iPad applications that required a range of motor skills promoted motor coordination in children commencing primary school.

BACKGROUND/AIM: Children are reported to spend less time engaged in outdoor activity and object-related play than in the past. The increased use and mobility of technology, and the ease of use of tablet devices are some of the factors that have contributed to these changes. Concern has been raised that the use of such screen and surface devices in very young children is reducing their fine motor skill development. We examined the effectiveness of iPad applications that required specific motor skills designed to improve fine motor skills. METHOD: We conducted a two-group non-randomised controlled trial with two pre-primary classrooms (53 children; 5-6 years) in an Australian co-educational school, using a pre- and post-test design. The effectiveness of 30 minutes daily use of specific iPad applications for 9 weeks was compared with a control class. Children completed the Beery Developmental Test of Visual Motor Integration (VMI) and observation checklist, the Shore Handwriting Screen, and self-care items from the Hawaii Early Learning Profile. RESULTS: On post testing, the experimental group made a statistically and clinically significant improvement on the VMI motor coordination standard scores with a moderate clinical effect size (P < 0.001; d = 0.67). Children's occupational performance in daily tasks also improved. CONCLUSION: Preliminary evidence was gained for using the iPad, with these motor skill-specific applications as an intervention in occupational therapy practice and as part of at home or school play.

Mobile technology dominates school children's IT use in an advantaged school community and is associated with musculoskeletal and visual symptoms.

This paper describes the contemporary use of information technology devices by children in a socio-educationally advantaged school. A sample of 924 children (50% girls) from grades 5 to 12 (ages 10-19 years) completed an online survey in class. Total daily technology use was high and similar for girls (mean 219 (SD 148) mins/day) and boys (207 (142), p=.186). Tablet computer was the dominant device used in grades 5-9, with laptop computer the dominant device in grades 10-12. Patterns of exposure were influenced by gender, device, grade and purpose of use interactions. For example, girls used mobile phones more than boys for social purposes for grades 10 and 11, but not grade 12. Whilst children's attitudes to technology use were positive, musculoskeletal and visual symptoms were commonly reported. Hours/day tablet and phone use was related to neck/shoulder discomfort (OR = 1.07; 1.13) and visual symptoms (OR = 1.10; 1.07). Practitioner Summary: Technology use by children appears to be quite different now to a decade ago. This paper describes contemporary school children's use of various devices for various purposes. The survey of >900 children found high technology use, dominated by new mobile technologies, and associations with musculoskeletal and visual symptoms.

A socioeconomic related 'digital divide' exists in how, not if, young people use computers.

Government initiatives have tried to ensure uniform computer access for young people; however a divide related to socioeconomic status (SES) may still exist in the nature of information technology (IT) use. This study aimed to investigate this relationship in 1,351 Western Australian children between 6 and 17 years of age. All participants had computer access at school and 98.9% at home. Neighbourhood SES was related to computer use, IT activities, playing musical instruments, and participating in vigorous physical activity. Participants from higher SES neighbourhoods were more exposed to school computers, reading, playing musical instruments, and vigorous physical activity. Participants from lower SES neighbourhoods were more exposed to TV, electronic games, mobile phones, and non-academic computer activities at home. These patterns may impact future economic, academic, and health outcomes. Better insight into neighbourhood SES influences will assist in understanding and managing the impact of computer use on young people's health and development.

Children, computer exposure and musculoskeletal outcomes: the development of pathway models for school and home computer-related musculoskeletal outcomes.

Children's computer use is rapidly growing, together with reports of related musculoskeletal outcomes. Models and theories of adult-related risk factors demonstrate multivariate risk factors associated with computer use. Children's use of computers is different from adult's computer use at work. This study developed and tested a child-specific model demonstrating multivariate relationships between musculoskeletal outcomes, computer exposure and child factors. Using pathway modelling, factors such as gender, age, television exposure, computer anxiety, sustained attention (flow), socio-economic status and somatic complaints (headache and stomach pain) were found to have effects on children's reports of musculoskeletal symptoms. The potential for children's computer exposure to follow a dose-response relationship was also evident. Developing a child-related model can assist in understanding risk factors for children's computer use and support the development of recommendations to encourage children to use this valuable resource in educational, recreational and communication environments in a safe and productive manner. PRACTITIONER SUMMARY: Computer use is an important part of children's school and home life. Application of this developed model, that encapsulates related risk factors, enables practitioners, researchers, teachers and parents to develop strategies that assist young people to use information technology for school, home and leisure in a safe and productive manner.

Promoting healthy computer use among middle school students: a pilot school-based health promotion program.

BACKGROUND: Introduction of notebook computers in many schools has become integral to learning. This has increased students' screen-based exposure and the potential risks to physical and visual health. Unhealthy computing behaviours include frequent and long durations of exposure; awkward postures due to inappropriate furniture and workstation layout, and ignoring computer-related discomfort. OBJECTIVE: Describe the framework for a planned school-based health promotion program to encourage healthy computing behaviours among middle school students. METHODS: This planned program uses a community- based participatory research approach. Students in Year 7 in 2011 at a co-educational middle school, their parents, and teachers have been recruited. Baseline data was collected on students' knowledge of computer ergonomics, current notebook exposure, and attitudes towards healthy computing behaviours; and teachers' and self-perceived competence to promote healthy notebook use among students, and what education they wanted. The health promotion program is being developed by an inter-professional team in collaboration with students, teachers and parents to embed concepts of ergonomics education in relevant school activities and school culture. End of year changes in reported and observed student computing behaviours will be used to determine the effectiveness of the program. SIGNIFICANCE: Building a body of evidence regarding physical health benefits to students from this school-based ergonomics program can guide policy development on the healthy use of computers within children's educational environments.