Early predictors of health-related quality of life outcomes at 12 months post-burn: ABLE study.

There remains a paucity of evidence on the early predictors of long-term Health-Related Quality of Life (HRQoL) outcomes post-burn in hospitalised adults. The overall aim of this study was to identify the factors (personal, environmental, burn injury and burn treatment factors) that may predict long-term HRQoL outcomes among adult survivors of hospitalised burn injuries at 12 months post-burn. A total of 274 participants, aged 18 years or over, admitted to a single state-wide burn centre with a burn injury were recruited. Injury and burn treatment information were collected from medical records or the hospital database and surveys collected demographic and social data. HRQoL outcome data were collected at 3-, 6- and 12-months using the 12-Item Short Form Survey (SF-12 v1) and Burns Specific Health Scale-Brief (BSHS-B). Personal, environmental, burn injury and burn treatment factors were also recorded at baseline. Analyses were performed using linear and logistic regression. Among 274 participants, 71.5 % (N=196) remained enrolled in the study at 12 months post-burn. The majority of participants reported HRQoL outcomes comparable with population norms and statistically significant improvements in generic (SF-12 v1) and condition-specific (BSHS-B) outcomes over time. However, for participants with poor HRQoL outcomes at 12-months post-burn, Univariable predictors included longer hospital length of stay, unemployment at the time of injury, a diagnosed pre-injury mental health condition, inadequate pre-burn social support, intentional injury, recreational drug use pre-injury and female gender. The early multivariable predictors of insufficient HRQoL outcomes were female gender, a previously diagnosed mental health condition, unemployment, inadequate social support, intentional injury, and prolonged hospital length of stay. These results suggest potential factors that could be used to screen and burns patients for psychosocial intervention and long-term follow up.

Clinical determinants for State-Trait Anxiety Inventory of the parents of children with respiratory problems.

BACKGROUNDS: Understanding factors associated with anxiety of parents/carers of children with respiratory problems is clinically important yet there is relative paucity of data. In 106 children seen in the respiratory clinic of a pediatric hospital, we evaluated (a) the determinants for parental anxiety and (b) whether the anxiety scores correlate with quality-of-life (QoL) scores in the subset with chronic cough. METHODS: We opportunistically re-analyzed data of our main study that examined the benefits of using spirometry for pediatric respiratory consultation where parents completed an anxiety questionnaire (State-Trait Anxiety Inventory, STAI) pre- and postconsultation. A subset (children with chronic cough) also completed the parent-proxy quality-of-life (PC-QoL) tool. We computed the association between clinical characteristics and anxiety scores using multivariable regression and between the two patient-reported outcome measures using Spearman's correlation. RESULTS: The majority of parents/carers were women (n = 89, 84%). Most children (mean age = 10.9 years, SD = 3.7 years) were previously seen at the clinic (n = 67, 63.2%). In multivariate regression, parental anxiety score was significantly associated with reported presence of cough [coefficient ß = 17.31 (95% confidence interval 9.62, 25.1)] and lower forced expiratory volume in first second (FEV1 )/forced vital capacity (FVC) [-3.88 (-7.05, -0.71)] at preconsultation, but associated with cough only [coefficient ß = 12.04 (5.24, 18.84)] at postconsultation, all p < .05. STAI strongly correlated with PC-QoL scores at pre- but only modestly at postconsultation (rs = -.63 and -.39, respectively, p < .05). CONCLUSION: Parental anxiety levels of children attending respiratory clinics are influenced by the presence of cough and low FEV1 /FVC of their child and are associated with poorer QoL. These highlight the need for on-going research to reduce parental anxiety focusing on cough and lung function indices.

The development of long-term osteoarthritis following anterior cruciate ligament injury: reconstruction vs no reconstruction.

PURPOSE: The high incidence of osteoarthritis (OA) in relatively young sportspeople following anterior cruciate ligament (ACL) reconstruction is concerning. Surgery is considered to reduce the development of OA compared to conservative management. This long-term study aimed to compare the incidence and severity of tibiofemoral OA (TFOA) and patellofemoral OA (PFOA) between reconstructed and non-reconstructed treatment groups and to determine which factors influence the development of OA. MATERIALS AND METHODS: Fifty-six ACL-reconstructed and 45 conservatively treated patients from a cohort of 330 were followed for 11 years (mean) post-injury. Twenty-nine patients had received a bone-patellar tendon-bone (B-PT-B) graft, and 27 had received a hamstring (semitendinosus/gracilis) tendon (HT) graft. Assessment included objective and subjective stability, quadriceps and hamstring strength and radiology. Chi-square analyses compared OA between reconstructed and non-reconstructed groups and between B-PT-B, HT and non-surgical groups. Further analysis assessed the relationship between OA and age, time post-injury, meniscal injury/meniscectomy, quadriceps strength, hamstring strength, objective and subjective stability and sporting activity. RESULTS: Forty-eight per cent reconstructed  and 53% non-reconstructed patients developed TFOA (p = 0.690). Thirty-six per cent reconstructed and 38% non-reconstructed patients developed PFOA (p = 0.831) with moderate PFOA occurring only in the non-reconstructed group. Close to significant differences (p = 0.075) were found comparing the severity of TFOA between groups with a higher incidence of moderate/severe OA in the non-reconstructed and B-PT-B groups. TFOA differed significantly between the B-PT-B and HT groups. The development of OA was related to age, time post-injury, meniscal injury/meniscectomy, quadriceps strength and subjective stability. CONCLUSIONS: There were no significant differences in OA incidence between reconstructed and non-reconstructed groups but fewer patients developed TFOA following HT grafting compared to B-PT-B grafting and to non-surgical treatment. Quadriceps weakness and meniscal injuries/meniscectomy, both potentially modifiable, were strongly associated with the development of TF and PFOA.

Children's Acute Cough-Specific Quality of Life: Revalidation and Development of a Short Form.

PURPOSE: Acute cough in children has a significant impact on the child and family. Relevant quality of life (QoL) instruments are essential for high-quality clinical research. This study aimed to (1) revalidate the 16-item Parent-proxy Children's Acute Cough-specific QoL questionnaire (PAC-QoL16) using a different dataset (i.e., different children), (2) confirm the minimally important difference (MID), and (3) develop and validate a short form. METHODS: Three datasets from two sources were utilized, comprising of 332 children with acute cough (< 2 weeks duration); the first dataset (n = 83, 54 boys; median age 2.04 years, IQR 1.08-4.06 years) was used for revalidation, the second dataset (n = 238, 141 boys; median age 2.17 years, IQR 1.21-4.21 years) was used to develop the short form, and the third dataset (n = 94, 62 boys; median age, 1.75 years, IQR 0.90-3.63 years) was used to confirm the short form. Psychometric properties were investigated. RESULTS: Six items were found to account for 96.4% of the variance in the PAC-QoL16. The PAC-QoL16 and short form (PAC-QoL6) scales correlated with cough scores (rs ≤ - 0.40, p < 0.001), were internally consistent (Cronbach α = 0.94 and 0.87, respectively) and demonstrated sensitivity to change over time. A MID of 0.71 to 1.11 is recommended. CONCLUSION: Both the PAC-QoL16 and newly developed short form (PAC-QoL6) are reliable and valid outcome measures that assess children's acute cough-specific QoL at a given time point, are easy to interpret and reflect changes over time. The new short form addresses the need for outcome measures to be as time effective as possible without loss of information.

Development and validation of a parent-proxy health-related quality of life survey for Australian First Nations children.

OBJECTIVE: Within Australia, Aboriginal and Torres Strait Islander (First Nations) populations perceive health and well-being differently to non-Indigenous Australians. Existing health-related quality of life (HR-QoL) measurement tools do not account for these differences. The objective of this study was to develop and validate a culturally specific parent-proxy HR-QoL measurement tool for First Nations children. DESIGN: Scale development was informed by parents/carers of children with a chronic illness and an expert panel. The preliminary 39-item survey was reviewed (n=12) and tested (n=163) with parents/carers of First Nations children aged 0-12 years at baseline with comparative scales: the Kessler Psychological Distress Scale, generic HR-QoL (Paediatric QoL Inventory 4.0, PedsQL4.0) and Spence Children's Anxiety Scale, and repeated (n=46) 4 weeks later. Exploratory Factor Analysis was used for scale reduction. Reliability and validity were assessed by internal consistency, test-retest, and correlations with comparison scales. RESULTS: Items within our First Nations-Child Quality of Life (FirstNations-CQoL) were internally consistent with Cronbach's alpha coefficients of ≥0.7 (quality of life, 0.808; patient experience, 0.880; patient support, 0.768) and overall test-retest reliability was good (r=0.75; 95% CI 0.593 to 0.856). Convergent validity was observed with the PedsQL4.0 with Pearson's coefficients of r=0.681 (ages 2-4 years); r=0.651 (ages 5-12 years) and with the Kessler Psychological Distress scale (r=-0.513). Divergent validity against the Spence Anxiety Scale was not demonstrated. CONCLUSIONS: The FirstNations-CQoL scale was accepted by the participants, reliable and demonstrated convergent validity with comparison measures. This tool requires further evaluation to determine responsiveness, its minimal important difference and clinical utility.

Australian health professionals' perspectives of psychosocial adjustment to visible differences: A qualitative analysis of pediatric populations.

Living with a visible difference (e.g., disfigurement) can compromise a child's psychological wellbeing. Although some children can adjust well, others can develop a range of appearance-related issues such as social anxiety, low self-esteem, and body dissatisfaction. However, current research fails to confirm what factors contribute to appearance-related distress, and what factors buffer the consequences of living with a visible difference. Semi-structured qualitative interviews were conducted with 16 Australian specialist health professionals who care for children with visible differences. Interviews explored the type of appearance-related psychosocial concerns presented to a pediatric hospital, perspectives on the impact of appearance-related distress, as well as factors and processes that health professionals perceive influence adjustment. Data were subjected to inductive thematic analysis. Rich evidence was offered by health professionals, which demonstrated deep understanding of the psychological wellbeing of their patients. Three themes were identified: Mind, Body, and Soul; Stages of Life; and Individual Differences. Findings highlighted the complexity of appearance-related distress, with individual differences in adjustment, and the powerful impact it can have on a child's short and long-term psychosocial wellbeing. The importance of reaching consensus in the conceptualisation and measurement of psychological wellbeing is stressed, and key domains associated with adjustment are proposed.

Generalized joint hypermobility in siblings with anterior cruciate ligament injuries and matched unrelated healthy siblings.

BACKGROUND AND PURPOSE: Anterior cruciate ligament (ACL) ruptures are common knee injuries, and siblings of individuals with an ACL injury may be at higher risk of ACL injury. Generalized hypermobility may be a familial factor predisposing siblings to ACL injury and may also relate to faulty lower limb alignment. There is a need to determine whether the interaction between hypermobility, family history, and faulty alignment makes siblings with hypermobility at higher risk for ACL injury so that appropriate preventative measures can be taken. This study therefore aimed to (a) compare the prevalence of generalized hypermobility and faulty limb alignment in siblings with and without injury and (b) assess the relationship between generalized hypermobility and lower limb alignment. METHODS: In this case-controlled study, 24 siblings with ACL injuries from 10 families were matched with 24 healthy uninjured siblings from 10 unrelated families. Generalized hypermobility was assessed using Beighton's criteria. Chi-square analyses compared generalized hypermobility and lower limb alignment between siblings and sibling pairs with and without injuries. Spearman's rho was used to assess correlations between generalized hypermobility and lower limb alignment. RESULTS: There were significant differences between the number of injured and uninjured siblings demonstrating generalized hypermobility when tallied individually (p = .003) and in same-family sibling pairs (p = .019). Significant (or close) differences were found between siblings for knee hyperextension (p < .001), knee valgus (p = .01), and foot pronation (p = .002) and for sibling pairs sharing knee hyperextension (p < .001), knee valgus (p = .06), and foot pronation (p = .06). Generalized hypermobility correlated with knee hyperextension (rs = .722; p < .001), knee valgus (rs = .385; p = .007), and foot pronation (rs = .328; p = .023). CONCLUSIONS: Generalized hypermobility and faulty limb alignment occur significantly more frequently in injured than uninjured families. Screening for both features would assist in identifying at-risk siblings. Prevention programmes reduce ACL injuries by 50-70% and should target hypermobile siblings of the ACL injured.

Applying bifactor modelling to improve the clinical interpretive values of Functional Independence Measure in adults with acquired brain injury.

Purpose: To apply a modern robust approach, bifactor modeling, to critically examine psychometric properties of Functional Independence Measure (FIM) in adults with acquired brain injury and to propose a solution to improve the clinical interpretive values of the FIM to inform policy and clinical practice.Methods: The data came from a state-wide specialist in-patient brain injury rehabilitation service in Queensland, Australia for adults with acquired brain injury and discharged between 2012 and 2017. The sample included 457 people. Three measurement models (unidimensional, correlated first-order and bifactor) for FIM were tested using confirmatory factor analysis with structural equation modeling. Then, model-based reliability and incremental validity were assessed.Results: The bifactor model best fit the data. When operationalized as latent factors under structural equation modeling framework, general care burden had a large predictive effect, while Motor and Cognitive showed medium and small predictive effects respectively on rehabilitation length of stay.Conclusions: The total score of FIM was a reliable measure of general care burden, while the subscale scores were not. A solution is to apply a bifactor modeling approach based on structural equation modeling to disentangle the unique variance attributable to Motor and Cognitive factors. In the structural equation modeling framework, the FIM demonstrated good incremental validity to inform policy and clinical practice.Implications for rehabilitationClinicians and researchers can confidently use FIM total score in adults with acquired brain injury.The current study proposed an alternative solution to the poor reliability of Motor and Cognitive scores, that is, by applying a bifactor modeling approach, the unique contributions of the Motor and Cognitive factors can be examined.The current study has demonstrated the strengths of bifactor modeling in the robust validation and interpretation of FIM to better inform clinical practice and policy decision-making.The current study has the potential to make an important contribution to enhance more equitable decision-making in the areas of national benchmarking of rehabilitation outcomes and other program eligibility criteria and funding allocation.

Opening a Pandora's Box that can't be salvaged: Health professionals' perceptions of appearance-related care in an Australian pediatric specialist hospital.

Many children and young people struggle adjusting to the psychosocial consequences (e.g., body dissatisfaction, social anxiety, and stigmatisation) of visible differences (or disfigurement). As appearance-affecting conditions often require specialist multidisciplinary team care, health professionals are in a unique position to offer psychosocial support and intervention. However, there is a dearth of literature on how appearance-related concerns are managed in pediatric hospital settings. Sixteen Australian specialist health professionals participated in semi-structured qualitative interviews to address this gap. Interviews explored current appearance-related psychosocial service provision, barriers in accessing appearance-related care, and perceptions of online platforms to deliver specialist support and intervention. Thematic analysis demonstrated four themes: We can do it better, Capability versus availability, Online generation, and Putting appearance on the agenda. This research highlighted the potential value of online platforms to increase accessibility to specialist appearance-related care, the need for more psychosocial resources to be integrated into appearance-related specialities, prioritising the development of low to medium appearance-related support and intervention, increasing the appearance-related knowledge of health professionals and families, and the need for more holistic approaches in routine care.

Survey of the perceptions of health practitioners regarding Functional Neurological Disorders in Australia.

Objectives of this study were to identify the knowledge and support needs for a wide range of health professions who come in contact with patients with Functional Neurological Disorders (FND) in Australia. Invitations to an anonymous online survey (36 items) were sent to health professionals (practicing in the fields of neurology, psychiatry, psychology, general practice, nursing and physiotherapy) who are involved in the care of patients suffering from FND. Potential participants were invited via professional and hospital databases, advertising in professional newsletters as well as direct emails. A total of 538 health professionals completed the questionnaire. Most participants did not feel well educated about FND with only 14% of General practitioners (GPs) reporting 'good' knowledge. Neurologists, GPs and nurses reported lower clinical interest and greater negative attitude towards FND than psychiatrists, psychologists and physiotherapists. Many health professionals do not feel confident discussing the possibility of a Functional Neurological Disorder with a patient. Seeing more patients per year was significantly correlated with greater knowledge (r = 0.54) and confidence diagnosing (r = 0.49) FND. It was also significantly related to confidence in discussing the diagnosis of FND with a patient (r = 0.44). These factors were not significantly related to years of practice. Although patients suffering from Functional Neurological Disorders are commonly seen by many health professionals in clinic practice, there is little training in this area and self-perceived knowledge in Australia is generally poor. There is, however, clear interest in this area and our findings suggest that improved teaching and education of health professionals about FND and its management could potentially have a significant impact towards better patient care.

Effectiveness of interventions to reduce occupational stress among emergency department staff: a systematic review protocol.

REVIEW QUESTION: The aim of the review is to synthesize the best available evidence on interventions targeting occupational stress and burnout among emergency department (ED) staff. The specific review questions are.

Trauma-informed care in practice: Observed use of psychosocial care practices with children and families in a large pediatric hospital.

Hospitalization for illness or injury can be experienced by children and their families as traumatic, which can impede recovery and lead to ongoing problems. The provision of quality trauma-informed or psychosocial care by hospital staff may mitigate trauma-related problems; however, there is great variability in the use of psychosocial care practices. Most previous research is based on self-report data and focuses primarily on nurses and physicians. The current study aimed to investigate the use of psychosocial care practices among a range of staff in a large urban pediatric hospital, using observations and interviews. A coding matrix of practices and a set of interview questions were developed based on previous research. Participants included 18 direct care hospital staff and 10 patients. Trained observers observed 13 staff and 10 patients, and coded instances of psychosocial care; 17 staff participated in interviews. A large number of instances of psychosocial care were observed but there was substantial variability in overall use and the use of individual practices. Interviewed staff reported many benefits of psychosocial care for patients and staff, although there were some costs, including emotional fatigue. Contrary to current evidence, most staff reported they rely on visible triggers of distress or need before providing psychosocial care. Future research could investigate the optimal ratio of psychosocial to physical care practices, taking into account patient feedback and psychosocial and medical outcomes. To improve the consistency of psychosocial care, training could incorporate the practice examples documented here, include staff self-care, and encourage informal avenues of learning. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Nearly 90% participation in sports activity 12 years after non-surgical management for anterior cruciate ligament injury relates to physical outcome measures.

PURPOSE: Traditionally reconstructive surgery is recommended for patients planning to return to sport (RTS), especially to pivoting sports after anterior cruciate (ACL) rupture. Recent trends focus on delaying or avoiding surgery as some studies have found similar rates of RTS following both surgical and conservative management. This study aimed to establish long-term RTS levels in ACL-ruptured individuals treated conservatively, and to investigate the relationship between outcome measures and RTS, in particular, pivoting sports. METHOD: Fifty-five patients from a cohort of 132 ACL-deficient patients were followed-up for  12 (IQR 8,19) years post injury. Mean-aged 42 years, 22 patients were females and 33 males, 35 had meniscal injuries. Patients were treated with physiotherapy focussing on strength and dynamic stability training and not reconstructive surgery. Return to sport was measured on a 6-point scale. Outcome measures included: objective stability, subjective stability, quadriceps and hamstring strength. Spearman's rho and Chi-square tests were used to assess the relationship between RTS and outcome measures. RESULTS: Eighty-nine percent of ACL-deficient patients were currently participating in sport despite a 38% increase in anterior translation (p < 0.001) and a 7.5% loss of quadriceps strength (p = 0.004) compared to the contralateral side. Six patients (11%) did not RTS, ten (18%) returned to safe sports, five (9%) returned to running and 16 (29%) to non-strenuous sports involving limited twisting. Eighteen patients (33%) returned to pivoting sports, 12(22%) at recreational level and six (11%) at competitive level. The level of RTS was related to subjective stability (p = 0.002), and to quadriceps and hamstring strength of the injured leg (p < 0.001). Patients able to return to pivoting sports differed significantly from those not doing so in outcome measures including objective (p = 0.022) and subjective stability (p = 0.035), and quadriceps strength (p = 0.044). CONCLUSIONS: Eighty-nine percent of ACL-ruptured individuals treated conservatively lead an active sporting life. One-third returned to pivoting sports.  Overall RTS was related to subjective and objective stability and quadriceps and to a lesser extent hamstring strength. This finding reinforced the importance of dynamic stability training as an initial treatment option in most cases. LEVEL OF EVIDENCE: III.

Pathways to increasing the use of psychosocial care with hospitalized children.

Trauma-informed care or psychosocial care can prevent or reduce the long-term impacts of hospitalization on children and their families, but few hospital staff members receive formal training in the optimal delivery of this care. This study aimed to (a) identify predictors of staff knowledge, confidence, use, and barriers regarding psychosocial care, and investigate whether these differed by profession; (b) identify pathways to increasing the use of psychosocial care; and (c) understand the association between psychosocial care and staff stress and burnout. Surveys were conducted with staff members (N = 180) within a large pediatric hospital. Questions were based on those used in similar research, and stress and burnout were assessed using the Professional Quality of Life scale. The study found that although all staff members reported using psychosocial care, only 27.2% had received training in these skills. There were no substantial differences in knowledge, confidence, and use of psychosocial care between different professions (medical, nursing, allied health, and administration staff), although nursing staff members reported a higher number of barriers to using psychosocial care. Training was indirectly associated with greater use via greater confidence and greater knowledge. Low confidence and a higher number of barriers were associated with staff burnout, and greater skill use and a higher number of barriers were associated with staff stress. Overall, these findings suggest that training that improves confidence and knowledge may support staff to deliver psychosocial care, with potential benefits for staff well-being. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Parent discipline in Thailand: Corporal punishment use and associations with myths and psychological outcomes.

A basic human right of all children is protection from physical punishment in all settings. Yet, corporal punishment remains common place within families, at home, at school, and elsewhere. In Thailand, cultural beliefs and values might preserve its use. This research sought to explore the use of corporal punishment in Thai homes. It also aimed to investigate young adult retrospective accounts of parent use of corporal punishment and their associations with psychological attributes and the acceptance of certain myths that might perpetuate its use. Two hundred and fifty young people (Mage = 20.26 years, SD = 1.19) recounted their parent's disciplining strategies related to when they were 10 years old. They also completed the Personality Assessment Questionnaire (Rohner, 1999), the Corporal Punishment Myth Scale (Kish & Newcombe, 2015) and responded as parents to a number of child misbehavior scenarios. Overall, 80.4% reported some instance of corporal punishment as a 10-year-old with lifetime prevalence at 85.5%. Receiving corporal punishment was related to poorer psychological outcomes as a young adult. Myths about corporal punishment significantly predicted the use of that discipline strategy in the scenarios. The results are discussed in relation to Thai cultural values and beliefs and the need to gather further evidence to support further policy and legislative changes.

Longitudinal study of quality of life among children with acute respiratory infection and cough.

PURPOSE: Acute respiratory infections (ARIs), and associated symptoms such as cough, are frequently experienced among children and impose a burden on families (e.g., use of medical resources and time off work/school). However, there are little data on changes in, and predictors of, quality of life (QoL) over the duration of an ARI with cough (ARIwC) episode. We therefore aimed to determine cough-specific QoL and identify its influencing factors among children with ARIwC, at the time of presentation to a pediatric emergency department (ED), and over the following 4 weeks. METHODS: Data from 283 children aged < 15 years were included in our analyses. We used the validated parent-proxy children's acute cough-specific QoL questionnaire (PAC-QoL) at each time-point. Linear regression and mixed effect modeling were used to identify factors influencing QoL at baseline and over the follow-up period. RESULTS: Median PAC-QoL at baseline was 2.7 (IQR 2.1-3.6) and significantly improved by Day-7 (4.9, IQR 3.8-6.1) and Day-14 (6.59, IQR 5.1-7.0), both p < 0.001. The improvements in median PAC-QoL between Days-14, -21, and -28 were not significant. Regression modeling identified that day-cough severity, night-cough severity, and financial concerns had the highest impact on both baseline, and follow-up, PAC-QoL scores. There were five additional independent significant factors at baseline and six at follow-up. CONCLUSIONS: Quality of life is considerably impaired at presentation to ED, but improves significantly by Days-7 and -14. As cough severity and financial concerns had the highest impact on QoL, effectively managing cough to reduce the clinical and financial burden on children and families is important.

Indonesian provisional clinical psychologists' knowledge, attitudes, and behaviours towards complementary-alternative medicine (CAM).

Sixty provisional clinical psychologists in Indonesia were emailed to seek their participation in an online-questionnaire that reflected: CAM knowledge, attitudes CAM, and CAM behaviours. Of the 60 participants approached, 44 with majority of female (95%) completed the questionnaire. The mean age of participants was 25 years. Overall, participants reported low knowledge of CAM and attitudes towards CAM were positive. While 73% reported having recommended CAM to their clients, only 39% had ever made referral. Most of the participants (98%) had used CAM personally but just over half (59%) had ever used it in clinical practice. It was found that knowledge and attitudes towards CAM did not predict CAM recommendation, personal use, nor professional use among the participants. However, CAM knowledge was found to predict CAM referrals. It is assumed that positive attitudes towards CAM integration among participants has been conflicted with their concern for CAM safety.

Evaluation of complementary-alternative medicine (CAM) questionnaire development for Indonesian clinical psychologists: A pilot study.

This study aimed to evaluate questionnaire development to measure the knowledge of Complementary-Alternative Medicine (CAM), attitudes towards CAM, CAM experiences, and CAM educational needs of clinical psychologists in Indonesia. A 26-item questionnaire was developed through an extensive literature search. Data was obtained from provisional psychologists from the Master of Professional Clinical Psychology programs at two established public universities in urban areas of Indonesia. To validate the questionnaire, panel reviews by executive members of the Indonesian Clinical Psychology Association (ICPA), experts in health psychology, and experts in public health and CAM provided their professional judgements. The self-reporting questionnaire consisted of four scales including: knowledge of CAM (6 items), attitudes towards CAM (10 items), CAM experiences (4 items), and CAM educational needs (6 items). All scales, except CAM Experiences, were assessed on a 7-point Likert scale. Sixty provisional psychologists were eligible to complete the questionnaire with a response rate of 73% (N=44). The results showed that the CAM questionnaire was reliable (Cronbach's coefficient alpha range=0.62-0.96; item-total correlation range=0.14-0.92) and demonstrated content validity. Following further psychometric evaluation, the CAM questionnaire may provide the evidence-based information to inform the education and practice of Indonesian clinical psychologists.

Factors influencing psychological, social and health outcomes after major burn injuries in adults: cohort study protocol.

INTRODUCTION: The goal of burn care is that 'the quality of the outcome must be worth the pain of survival'. More research is needed to understand how best to deliver care for patients with burns to achieve this aim. Loss of independence, function as well as loss of income for patients with burns and carers cause a significant burden at both individual and societal levels. Much is being done to advance knowledge in the clinical care field; however, there has been a paucity of research exploring psychosocial outcomes. This paper describes the study background and methods, as implemented in an Australian cohort study of psychosocial outcomes after major burn injuries. METHODS AND ANALYSIS: In this inception cohort study, a target sample of 230 participants, aged 18 years or over, admitted to a single statewide burns centre with a burn injury are identified by hospital staff for inclusion. Baseline survey data are collected either in person or by telephone within 28 days of the injury and participants then followed up with telephone interviews at 3, 6 and 12 months postburn. Injury and burns treatment information is collected from medical records. Social support is measured as a predictor variable using the Multidimensional Scale of Perceived Social Support. Outcome data are collected via standardised measures in the domains of Quality of Life (SF-12, EQ-5D, BSHS-B), depression (PHQ-9), post-traumatic stress disorder (PCL-C, PAS), community integration (CIQ-R) and Quality-Adjusted Life Years (EQ-5D). Additional survey questions measure life satisfaction, return to work and public services utilisation at 12 months postinjury. Data analysis methods will include analysis of variance, Pearson correlation and hierarchical multiple regression analyses. ETHICS AND DISSEMINATION: Hospital-based and University of Queensland Human Research Ethics Committees have approved the protocol. Results from the study will be disseminated at national and international conferences, in peer-reviewed journals and in a doctoral thesis. TRIAL REGISTRATION NUMBER: Australia New Zealand Clinical Trials Registry (ACTRN12616000828426). Retrospectively registered on 23 June 2016; pre-results.