Study supports for rural mature-aged university health students: a Stakian multicase study.

BACKGROUND: The participation and success of university health students in rural areas is critical in addressing the maldistribution of the rural health workforces internationally. Particular attention to the experiences of mature-aged health students is needed to build a sustainable rural health workforce, given the higher proportions of mature-aged university students in rural, regional and remote areas compared with metropolitan areas and rural mature-aged students wanting to stay in their communities. However, little is known about the kinds of supports rural mature-aged students require to succeed with their studies. METHODS: Drawing on rural standpoint theory and using structural inequality as a retention lens, we explored the current and potential supports that rural mature-aged nursing and allied health students require to successfully participate and complete their pre-professional university course. A Stakian multicase study was undertaken with cases at three rural university campuses in Australia. The data collection was primarily qualitative, with semi-structured interviews, campus surveys and focus groups involving 36 participants (including students, academic and professional staff, and placement supervisors). RESULTS: This study found supports were provided formally and informally by the university, by the community and manifested by students. Several support gaps as well as potential supports to alleviate them were identified. These include formally acknowledging the mature-aged cohort and their diverse experiences and non-university commitments; fostering connections between mature-aged students; making university affordable; preparing mature-aged students for university; adapting course content and delivery; and restructuring placements for mature-aged students. CONCLUSIONS: We argue that rural mature-aged nursing and allied health students require supports that are age-specific, appropriate to the community context, and harness existing relational processes of rural university campus activity. Rural university campuses need to involve rural mature-aged students and other stakeholders relevant to each context in the process of identifying and implementing student supports for this cohort.

Telehealth-Delivered Allied Health Interventions: A Rapid Umbrella Review of Systematic Reviews.

Introduction: Telehealth is used by allied health professionals to deliver health care remotely. This umbrella review addressed the following questions: (1) What telehealth interventions have been implemented to deliver allied health care? (2) What are the reported clinical benefits, and challenges of the implementation of telehealth delivered allied health interventions? (3) What are the reported experiences of patients and clinicians? Methods: A rapid umbrella systematic review method was utilized. Following a search of five electronic databases, only systematic reviews reporting on telehealth-delivery allied health interventions published in the past 10 years were included. Reported outcomes included clinical effectiveness, implementation factors, and patient/clinician experiences. Methodological quality was established using the A MeaSurement Tool to Assess systematic Reviews 2. Results: After applying eligibility criteria to 571 studies, 26 studies were included. Findings indicate that telehealth-delivered allied health interventions may obtain similar clinical outcomes as compared with face-to-face appointments. Patients reported less stress and valued the reduced need to travel when telehealth was used. Patient satisfaction with telehealth delivered care was equal to face-to-face care, and no differences were noted in the capacity to build therapeutic alliance when using telehealth. Difficulties with technology use were reported by clinicians and patients. Clinicians were identified as needing increased time management skills. Cautious interpretation of findings is recommended due to the quality rating of low to critical low for the majority of individual reviews. Conclusions: Telehealth-delivered care might obtain similar clinical outcomes to face-to-face care; however, difficulties may arise during broad implementation. It is recommended that health services be strategic to overcome implementation barriers and provide targeted support to enable effective, equitable, and sustained allied health service delivery via telehealth.

Management of stable proximal interphalangeal joint volar plate injuries with figure-of-8 orthoses: A parallel-group randomized controlled trial.

BACKGROUND: Volar plate injuries of the proximal interphalangeal (PIP) finger joint are common. Conservative treatment involves orthoses to limit hyperextension at the PIP joint yet allow movement of the joints to prevent joint stiffness and deformity. Custom-made dorsal blocking orthoses are recommended treatments. Previous research also supports the use of a figure-of-8 orthosis, although the comparative effectiveness of these orthoses is not currently known. PURPOSE: This study aimed to compare the figure-of-8 orthosis and dorsal blocking orthosis for changes in the range of movement, pain, and function following stable volar plate PIP joint injuries and to compare the number of hand therapy appointments required. STUDY DESIGN: A parallel-group pilot randomized controlled trial. This trial was registered with the Australian and New Zealand Clinical Trials Registry (Trial ID: CTRN12619000449134). METHODS: Participants aged 13-65 years were recruited from an outpatient hand therapy service and randomly assigned to experimental or control groups. The experimental group of 20 participants received a custom-made thermoplastic figure-of-8 orthosis limiting the extension to 15-20 degrees. The control group of 22 participants had a dorsal blocking orthosis, which was serially extended by 10 degrees weekly starting at 30 degrees flexion. Participants were blinded to their group allocation. Outcome measures included range of movement, edema, pain, function, and number of hand therapy appointments. Data collection was completed by the treating therapist who was not blinded to group assignment. Data analysis included a series of mixed-model analyses of variance to examine changes over time. RESULTS: Forty-two participants were recruited and had their data analyzed. No significant between-group differences were observed for DIP flexion, PIP flexion, pain, and function from baseline to follow-up. Both groups exhibited significant improvements in these outcomes over time (p < 0.001); effect sizes ranged from small to large (0.28-0.79). On average, the intervention group required 4 (±1.5) appointments compared to 6 (±1.5) in the control group over the same period representing a significant difference (p < 0.001). CONCLUSIONS: Both dorsal blocking and figure-of-8 orthoses provide similar outcomes. The use of a figure-of-8 orthosis, or a dorsal block orthosis fabricated in maximal comfortable extension depending on severity, could reduce the number of appointments and increase convenience for patients.

Enhancing occupational therapy service provision with military veterans through policy reform: Findings from a national survey.

INTRODUCTION: Almost half a million Australians have served with the Australian Defence Force. Given the high prevalence of physical and mental health conditions and complexity of civilian life adjustment after military service, high-quality occupational therapy services are critical. However, there is limited description of occupational therapy service provision to individuals funded by the Australian Department of Veterans' Affairs to inform government policy. The aim of this study was to describe the practice of Australian occupational therapists working with former service members and identify opportunities to enhance practice and policy. METHODS: A cross-sectional study using an online survey was conducted to collect information from occupational therapists providing services to Department of Veterans' Affairs clients. Frequency analyses were performed to describe quantitative data. Qualitative data were analysed using thematic analysis. No consumer or community involvement occurred. RESULTS: Participants included 123 Australian occupational therapists residing in metropolitan (47%), regional (28%) and rural/remote (23%) areas. Most occupational therapists (69%) had over 15 years of clinical experience and worked in private practice (87%). Common interventions included home modifications, equipment prescription and assistive technology (77%), goal-oriented rehabilitation (16%) and activities of daily living or function assessments and education (13%). Three themes describing practice issues were identified: (1) Service provision as rewarding yet underfunded, (2) Administrative complexity and lack of understanding of the occupational therapy role and (3) Need for specialist professional development opportunities. CONCLUSION: Australian occupational therapists are providing a range of services to Department of Veterans' Affairs clients although mostly relating to physical conditions. Occupational therapy practice with former Australian Defence Force members should be expanded to meet their diverse and complex needs. Further research and education are needed to support use of specialist knowledge and interventions. Advocacy by peak associations and policy reform are urgently required to ensure sustainable services, particularly in rural areas.

Professional care workforce: a rapid review of evidence supporting methods of recruitment, retention, safety, and education.

BACKGROUND: Across the care economy there are major shortages in the health and care workforce, as well as high rates of attrition and ill-defined career pathways. The aim of this study was to evaluate current evidence regarding methods to improve care worker recruitment, retention, safety, and education, for the professional care workforce. METHODS: A rapid review of comparative interventions designed to recruit, retain, educate and care for the professional workforce in the following sectors: disability, aged care, health, mental health, family and youth services, and early childhood education and care was conducted. Embase and MEDLINE databases were searched, and studies published between January 2015 and November 2022 were included. We used the Quality Assessment tool for Quantitative Studies and the PEDro tools to evaluate study quality. RESULTS: 5594 articles were initially screened and after applying the inclusion and exclusion criteria, 30 studies were included in the rapid review. Studies most frequently reported on the professional nursing, medical and allied health workforces. Some studies focused on the single domain of care worker education (n = 11) while most focused on multiple domains that combined education with recruitment strategies, retention strategies or a focus on worker safety. Study quality was comparatively low with a median PEDro score of 5/10, and 77% received a weak rating on the Quality Assessment tool for Quantitative Studies. Four new workforce strategies emerged; early career rural recruitment supports rural retention; workload management is essential for workforce well-being; learning must be contextually relevant; and there is a need to differentiate recruitment, retention, and education strategies for different professional health and care workforce categories as needs vary. CONCLUSIONS: Given the critical importance of recruiting and retaining a strong health and care workforce, there is an immediate need to develop a cohesive strategy to address workforce shortfalls. This paper presents initial evidence on different interventions to address this need, and to inform care workforce recruitment and retention. Rapid Review registration PROSPERO 2022 CRD42022371721 Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022371721.

Design and implementation characteristics of research training for rural health professionals: a qualitative descriptive study.

BACKGROUND: Research capacity and capability of rural health professionals is essential to the delivery of evidence-based care and for informing strategies to address rural health inequities. Effective implementation of research education and training is fundamental to building rural health professional research capacity and capability. A lack of overarching guidance to inform the delivery of research education and training in rural health services can contribute to gaps in capacity-building approaches. The aim of this study was to identify characteristics of the design and implementation of current research training for rural health professionals in Victoria, Australia, to inform a future model for rural health professional research capacity and capability building. METHODS: A qualitative descriptive study was undertaken. Key informants, with extensive knowledge of research education and training in rural health services in Victoria, were invited to participate in semi-structured telephone interviews via snowballing recruitment methods. Interview transcripts were analysed inductively, with themes and codes mapped to the domains of the Consolidated Framework for Implementation Research. RESULTS: Of the 40 key informants approached, 20 agreed to participate including 11 regional health service managers, five rural health academics and four university managers. Participants suggested that research training varied in quality and relevance to rural health professionals. Training costs and lack of tailoring to the rural context were key barriers, whereas experiential learning and flexible modes of delivery enabled training uptake. Health service and government policies, structures, and processes both enabled or stifled implementation opportunities, with rural health professional networks from different regions offering capacity for research training development, and government departmental structures hampering training coordination. Tension between research activities and clinical practice, and health professional knowledge and beliefs, shaped the delivery of training programs. Strategically planned and evaluated research training programs and education via co-design with rural health professionals and use of research champions were strongly recommended by participants. CONCLUSIONS: To optimise research training for rural health professionals and increase the quality and quantity of relevant rural health research, a systematically planned, implemented, and resourced region-wide research training model is required.

Enhancing the quality of allied health clinical supervision in a regional setting: An action research study.

OBJECTIVE: To explore and describe strategies to enhance the implementation of an organisational clinical supervision framework and subsequently inform the development of a model of implementation of clinical supervision for allied health professionals in a regional health care setting. SETTING: A large regional health service in Victoria, providing hospital, rehabilitation, community, mental health and aged care services. PARTICIPANTS: Allied health managers employed at the health service were members of an action research group. DESIGN: This longitudinal study used an action research approach. The action research group informed the repeated cycles of planning, action and reflection. Data from recorded action research meetings were analysed using content analysis. RESULTS: The action research group met 11 times over a 5-year period informing four action research cycles. Six main themes relating to factors that enhanced the quality of clinical supervision emerged from the analysis of the action research group data: purpose and value of clinical supervision; clinical supervision characteristics; differences between disciplines; framework development; training and support and implementation of clinical supervision. CONCLUSION: The findings from this comprehensive longitudinal study provide evidence-based approaches to the implementation of allied health clinical supervision. The action research approach used ensures that the strategies described are realistic and sustainable. A model has been developed to inform the implementation of clinical supervision for allied health.

Effectiveness of allied health clinical supervision following the implementation of an organisational framework.

BACKGROUND: Clinical supervision makes an important contribution to high quality patient care and professional wellbeing for the allied health workforce. However, there is limited research examining the longitudinal implementation of clinical supervision for allied health. The aim of this study was to determine the effectiveness of clinical supervision for allied health at a regional health service and clinicians' perceptions of the implementation of an organisational clinical supervision framework. METHODS: A cross-sectional study was conducted as a phase of an overarching participatory action research study. The Manchester Clinical Supervision Scale (MCSS-26) tool was used to measure clinical supervision effectiveness with additional open-ended questions included to explore the implementation of the clinical supervision framework. MCSS-26 findings were compared with an initial administration of the MCSS-26 5 years earlier. MCSS-26 data (total scores, summed domain and sub-scale scores) were analysed descriptively and reported as mean and standard deviation values. Differences between groups were analysed with independent-samples t-test (t) and one-way between groups ANOVA. RESULTS: There were 125 responses to the survey (response rate 50%). The total MCSS-26 score was 78.5 (S.D. 14.5). The total MCSS-26 score was unchanged compared with the initial administration. There was a statistically significant difference in clinical supervision effectiveness between speech pathology and physiotherapy (F = 2.9, p = 0.03) and higher MCSS-26 scores for participants whose clinical supervisor was a senior clinician and those who chose their clinical supervisor. Seventy percent of participants perceived that the organisation's clinical supervision framework was useful and provided structure and consistent expectations for clinical supervision. CONCLUSIONS: Clinical supervision was effective for allied health in this regional setting and clinical supervision effectiveness was maintained over a 5 year period. The implementation of an organisational clinical supervision framework may have a positive effect on clinical supervision for some professions.

Community Health Programs Delivered Through Information and Communications Technology in High-Income Countries: Scoping Review.

BACKGROUND: The COVID-19 pandemic has required widespread and rapid adoption of information and communications technology (ICT) platforms by health professionals. Transitioning health programs from face-to-face to remote delivery using ICT platforms has introduced new challenges. OBJECTIVE: The objective of this review is to scope for ICT-delivered health programs implemented within the community health setting in high-income countries and rapidly disseminate findings to health professionals. METHODS: The Joanna Briggs Institute's scoping review methodology guided the review of the literature. RESULTS: The search retrieved 7110 unique citations. Each title and abstract was screened by at least two reviewers, resulting in 399 citations for full-text review. Of these 399 citations, 72 (18%) were included. An additional 27 citations were identified through reviewing the reference lists of the included studies, resulting in 99 citations. Citations examined 83 ICT-delivered programs from 19 high-income countries. Variations in program design, ICT platforms, research design, and outcomes were evident. CONCLUSIONS: Included programs and research were heterogeneous, addressing prevalent chronic diseases. Evidence was retrieved for the effectiveness of nurse and allied health ICT-delivered programs. Findings indicated that outcomes for participants receiving ICT-delivered programs, when compared with participants receiving in-person programs, were either equivalent or better. Gaps included a paucity of co-designed programs, qualitative research around group programs, programs for patients and carers, and evaluation of cost-effectiveness. During COVID-19 and beyond, health professionals in the community health setting are encouraged to build on existing knowledge and address evidence gaps by developing and evaluating innovative ICT-delivered programs in collaboration with consumers and carers.

Perceptions of rural high school teachers - on the frontline of youth suicide.

OBJECTIVE: This study aimed to investigate the perceptions and beliefs of rural high school teachers about student suicide completion in their school and their perceived self-efficacy in identification of suicidality in students (suicidal ideation, plans and behaviours). DESIGN: A cross-sectional survey methodology. SETTING: Gippsland and the Loddon Mallee regions of Victoria, Australia. PARTICIPANTS: Rural high school teachers. OUTCOME MEASURE: A survey that aimed to obtain participants' perceptions and self-reports about students who had died by suicide in their school within the last 5 years, their perceived self-efficacy in identifying suicidal students and barriers to helping students at risk. RESULTS: Two hundred and seventy-seven rural high school teachers participated and 86% reported that a student from their school had died by suicide within the last 5 years. Sixty-five per cent believed that more than one student had died by suicide and 70% perceived they were currently aware of students experiencing suicidality in their class. Receiving professional development about suicide and obtaining help from mental health clinicians predicted perceived self-efficacy in identification of suicidality in students. Participants perceived the barriers to help students at risk included insufficient numbers of school-based mental health professionals and community mental health services. CONCLUSIONS: Many rural high school teachers perceive they are at the front line of the youth suicide crisis due to unmet service need in youth mental ill health. Increased access to effective services immediately after teachers become aware of suicidality may assist in reducing youth suicide in rural areas.

What shapes research and research capacity building in rural health services? Context matters.

OBJECTIVE: To determine the contextual factors influencing research and research capacity building in rural health settings. DESIGN: Qualitative study using semi-structured telephone interviews to collect data regarding health professionals' research education and capacity building. Analysis involved inductive coding using Braun and Clark's thematic analysis; and deductive mapping to the Consolidated Framework for Implementation Research (CFIR). SETTING: Victorian rural health services and university campuses. PARTICIPANTS: Twenty senior rural health managers, academics and/or research coordinators. Participants had at least three years' experience in rural public health, health-related research or health education settings. MAIN OUTCOME MEASURES: Contextual factors influencing the operationalisation and prioritisation of research capacity building in rural health services. RESULTS: Findings reflected the CFIR domains and constructs: intervention characteristics (relative advantage); outer setting (cosmopolitanism, external policies and incentives); inner setting (implementation climate, readiness for implementation); characteristics of individuals (self-efficacy); and process (planning, engaging). Findings illustrated the implementation context and the complex contextual tensions, which either prevent or enhance research capacity building in rural health services. CONCLUSIONS: Realising the Australian Government's vision for improved health service provision and health outcomes in rural areas requires a strong culture of research and research capacity building in rural health services. Low levels of rural research funding, chronic workforce shortages and the tension between undertaking research and delivering health care, all significantly impact the operationalisation and prioritisation of research capacity building in rural health services. Effective policy and investment addressing these contextual factors is crucial for the success of research capacity building in rural health services.

Group clinical supervision for allied health professionals.

OBJECTIVE: To evaluate a group clinical supervision program for allied health professionals in a regional health service. DESIGN: This study used a mixed-methods design including a cross-sectional, quantitative survey of group clinical supervision participants and a focus group of facilitators. SETTING: A large regional health service in Victoria, providing hospital, community and mental health services. PARTICIPANTS: Allied health professionals and managers employed at the health service. INTERVENTIONS: Group clinical supervision, based on a critical reflection model, was implemented in 3 settings. MAIN OUTCOME MEASURE: The Clinical Supervision Evaluation Questionnaire was administered to group clinical supervision participants, with additional open-ended questions included. The Clinical Supervision Evaluation Questionnaire tool consists of 3 subscales relating to the purpose, process and impact of group clinical supervision. A focus group was used to capture the perspectives of group clinical supervision facilitators. RESULTS: Fifteen survey responses were received. The overall Clinical Supervision Evaluation Questionnaire score was 56.53 (standard deviation 7.66). Scores for the Process Subscale were higher than the Purpose and Impact subscales. Themes from the open-ended survey questions included the following: value of multiple perspectives, opportunities for reflection, peer support and group process and structure. Themes from group facilitators' focus group included the following: need for group clinical supervision, value of facilitator training and support, and sustainability. CONCLUSION: Group clinical supervision was perceived to be effective, enhancing reflection, learning and peer support. Organisational support, facilitator training, group structure and planning for sustainability were identified as critical factors for success. Interprofessional and cross-organisational models of group clinical supervision are strategies that could help address issues relating to access to quality clinical supervision for rural allied health professionals.

Building a rural workforce through identifying supports for rural, mature-aged nursing and allied health students: A systematic scoping review.

INTRODUCTION: There is a long-standing undersupply of nursing and allied health professionals in rural Australia. Rural, mature-aged people form an untapped section of rural communities that could help to address these workforce needs. There is little understanding of the supports required to assist rural, mature-aged nursing and allied health students to complete their studies and enter the rural health workforce. OBJECTIVE: To scope factors influencing rural, mature-aged nursing and allied health students' ability to access, participate, and succeed in higher education. DESIGN: A scoping review of the international rural nursing and allied health and education literature was undertaken. Five databases (CINAHL Complete, MEDLINE, Education Resources Information Center [ERIC], Embase, and Education Research Complete), key peer-reviewed journals, and Australian grey literature were searched. FINDINGS: Fourteen articles were included in the review. Ten studies described rural, mature-aged nursing and allied health student characteristics, 6 described barriers to students participating and succeeding in higher education, and 4 described student supports. DISCUSSION: This review found limited evidence to guide higher education providers in attracting, supporting and retaining rural, mature-aged nursing and allied health students. In particular, evidence of student supports is required beyond those manifested by students themselves or their family, to include offerings from university and government sources. CONCLUSION: Substantially more research attention is needed to understand the experiences of rural, mature-aged nursing and allied health students, and supports required for this cohort to access, participate and successfully complete higher education.

Implementation interventions to promote the uptake of evidence-based practices in stroke rehabilitation.

BACKGROUND: Rehabilitation based upon research evidence gives stroke survivors the best chance of recovery. There is substantial research to guide practice in stroke rehabilitation, yet uptake of evidence by healthcare professionals is typically slow and patients often do not receive evidence-based care. Implementation interventions are an important means to translate knowledge from research to practice and thus optimise the care and outcomes for stroke survivors. A synthesis of research evidence is required to guide the selection and use of implementation interventions in stroke rehabilitation. OBJECTIVES: To assess the effects of implementation interventions to promote the uptake of evidence-based practices (including clinical assessments and treatments recommended in evidence-based guidelines) in stroke rehabilitation and to assess the effects of implementation interventions tailored to address identified barriers to change compared to non-tailored interventions in stroke rehabilitation. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, and eight other databases to 17 October 2019. We searched OpenGrey, performed citation tracking and reference checking for included studies and contacted authors of included studies to obtain further information and identify potentially relevant studies. SELECTION CRITERIA: We included individual and cluster randomised trials, non-randomised trials, interrupted time series studies and controlled before-after studies comparing an implementation intervention to no intervention or to another implementation approach in stroke rehabilitation. Participants were qualified healthcare professionals working in stroke rehabilitation and the patients they cared for. Studies were considered for inclusion regardless of date, language or publication status. Main outcomes were healthcare professional adherence to recommended treatment, patient adherence to recommended treatment, patient health status and well-being, healthcare professional intention and satisfaction, resource use outcomes and adverse effects. DATA COLLECTION AND ANALYSIS: Two review authors independently selected studies for inclusion, extracted data, and assessed risk of bias and certainty of evidence using GRADE. The primary comparison was any implementation intervention compared to no intervention. MAIN RESULTS: Nine cluster randomised trials (12,428 patient participants) and three ongoing trials met our selection criteria. Five trials (8865 participants) compared an implementation intervention to no intervention, three trials (3150 participants) compared one implementation intervention to another implementation intervention, and one three-arm trial (413 participants) compared two different implementation interventions to no intervention. Eight trials investigated multifaceted interventions; educational meetings and educational materials were the most common components. Six trials described tailoring the intervention content to identified barriers to change. Two trials focused on evidence-based stroke rehabilitation in the acute setting, four focused on the subacute inpatient setting and three trials focused on stroke rehabilitation in the community setting. We are uncertain if implementation interventions improve healthcare professional adherence to evidence-based practice in stroke rehabilitation compared with no intervention as the certainty of the evidence was very low (risk ratio (RR) 1.19, 95% confidence interval (CI) 0.53 to 2.64; 2 trials, 39 clusters, 1455 patient participants; I2 = 0%). Low-certainty evidence indicates implementation interventions in stroke rehabilitation may lead to little or no difference in patient adherence to recommended treatment (number of recommended performed outdoor journeys adjusted mean difference (MD) 0.5, 95% CI -1.8 to 2.8; 1 trial, 21 clusters, 100 participants) and patient psychological well-being (standardised mean difference (SMD) -0.02, 95% CI -0.54 to 0.50; 2 trials, 65 clusters, 1273 participants; I2 = 0%) compared with no intervention. Moderate-certainty evidence indicates implementation interventions in stroke rehabilitation probably lead to little or no difference in patient health-related quality of life (MD 0.01, 95% CI -0.02 to 0.05; 2 trials, 65 clusters, 1242 participants; I2 = 0%) and activities of daily living (MD 0.29, 95% CI -0.16 to 0.73; 2 trials, 65 clusters, 1272 participants; I2 = 0%) compared with no intervention. No studies reported the effects of implementation interventions in stroke rehabilitation on healthcare professional intention to change behaviour or satisfaction. Five studies reported economic outcomes, with one study reporting cost-effectiveness of the implementation intervention. However, this was assessed at high risk of bias. The other four studies did not demonstrate the cost-effectiveness of interventions. Tailoring interventions to identified barriers did not alter results. We are uncertain of the effect of one implementation intervention versus another given the limited very low-certainty evidence. AUTHORS' CONCLUSIONS: We are uncertain if implementation interventions improve healthcare professional adherence to evidence-based practice in stroke rehabilitation compared with no intervention as the certainty of the evidence is very low.

Learned pacing for adults with chronic pain: A randomised controlled trial feasibility study.

INTRODUCTION: Chronic pain can significantly impact on an individual's occupational performance and quality of life. Pacing is a pain management strategy regularly used in occupational therapy practice; however, evidence for its effectiveness has not been established. OBJECTIVES: To determine the feasibility of a future randomised controlled trial to investigate the effectiveness of a learned pacing intervention on occupational performance and satisfaction for adults with chronic pain. METHODS: A randomised controlled trial feasibility study was conducted with participants randomly assigned to a learned pacing intervention or a waitlist control group. The primary outcome measure was the Canadian Occupational Performance Measure. RESULTS: One hundred and twenty-eight people were screened for eligibility over 36 weeks, with 74 people invited to participate. Twelve were randomly assigned, eight to the learned pacing group and four to the control group. Those receiving the learned pacing intervention had clinically important changes in occupational performance and occupational satisfaction. Participants in the waitlist control group also had clinically important changes in occupational satisfaction. The method design was deemed feasible; however, several improvements would increase the rate of participant recruitment and reduce attrition. Recruitment from multiple sites is required to obtain an adequate sample size of 60. CONCLUSION: Undertaking a future randomised controlled trial is feasible and warranted to establish the effectiveness of a learned pacing intervention on occupational performance and satisfaction for adults with chronic pain.

Reflective practice facilitation within occupational therapy supervision processes: A mixed method study.

INTRODUCTION: Supervisors of occupational therapists play a key role facilitating reflective practice with their supervisees. Through reflective practice, supervisees can optimise their skills in professional reasoning and decision making. The aim of this study was to describe to what degree reflective practice is facilitated within occupational therapy supervision processes. METHODS: A mixed methods study design was used, collecting data via online surveys and focus groups. Quantitative data were initially analysed using descriptive statistics. Qualitative and quantitative data were then thematically analysed to identify hindering and enabling mechanisms to reflective practice facilitation. RESULTS: Eighteen supervisees and 17 supervising occupational therapists completed the surveys and 14 supervisors participated in a focus group. Half of the supervisees reported that reflective practice was facilitated through supervision only "rarely" or "sometimes." A hindering mechanism to reflective practice facilitation was the awareness of reflective practice models. Enabling mechanisms for reflective practice facilitation included understanding the benefits of reflective practice; recognising the attributes of a reflective practice practitioner; setting up an optimal supervision environment; and flexibly facilitating reflective practice. CONCLUSION: Findings suggest that reflective practice is not always regularly facilitated through supervision. This may limit opportunities for supervisees to optimise the development of their professional reasoning and clinical skills in the early stages of their careers.

A profile of Australian occupational therapy academic workforce job satisfaction.

INTRODUCTION: There has been an increase in the number of Australian occupational therapy education programmes and student enrolment numbers in existing programmes, whereas there is a perceived current and predicted future workforce shortage of qualified university academics. The aim of the study was to map the current Australian occupational therapy academic workforce and investigate the group's job satisfaction. METHODS: The research was a cross-sectional online survey of Australian occupational therapy academics employed part-time or full-time in fixed or ongoing positions. The survey included the Job Satisfaction Survey. Quantitative data were analysed using descriptive statistics, Spearman rho correlations, and linear and multi-linear regressions. RESULTS: Responses were received from 120 participants who met inclusion criteria, with 89% of the sample being women, 83% employed in ongoing positions and 61% employed full-time. Over half had a PhD or professional doctorate and similarly, over half were employed in lecturer or level B positions. One quarter of respondents were in teaching-only positions and 58% were in combined teaching and research positions. Nearly half were over 46 years of age. Respondents reported that they were satisfied with supervision, the nature of the work, and co-workers; however, were dissatisfied with operating conditions and were ambivalent about pay, contingent rewards, opportunities for promotion, communication, and fringe benefits. Most participants were motivated by teaching students but reported unrealistic workload requirements as their greatest challenge. CONCLUSION: The Australian occupational therapy academic workforce is relatively stable with most in ongoing positions; however, there are fewer in senior positions. The majority of respondents were in lecturer or level B positions, with lowest levels of satisfaction, particularly those who had been at this level longer. Workload expectations and lack of opportunities for promotion contributed to marked job dissatisfaction. Workforce planning, including recruitment and retention strategies, is needed to address predicted increased demands.

Applying a digital literacy framework and mapping tool to an occupational therapy curriculum.

INTRODUCTION: Amidst claims that rapid technological changes in health far outstrip the capabilities of the health workforce, digital literacy is featured in occupational therapy competency standards. However, little attention have been given to the development of digital literacy in entry-level occupational therapy programmes and the preparation of graduates for digital health. There is a lack of guidance on how universities can demonstrate digital literacy development in occupational therapy students. The aim of this study was to test the usefulness of a digital literacy framework and mapping tool in identifying opportunities for students to develop digital literacy within an entry-level occupational therapy programme. METHODS: Intrinsic case study design was used to test the usefulness of the digital literacy framework and mapping tool. The framework and tool were applied to the curriculum of a large entry-level Australian occupational therapy programme. RESULTS: Through the process of mapping, key insights were developed on how digital literacy was embedded across the occupational therapy curricula. Limited attention was given to the development of student digital literacy in the early years of the programme. In later years, more opportunities were available to develop digital literacy at basic and intermediate levels. Across the programme, there was limited evidence of the development of advanced digital literacy. CONCLUSIONS: The framework and mapping tool were useful in broadening understanding of the concept of digital literacy beyond information communication technologies. The framework and tool can assist those designing or refining occupational therapy curricula to operationalise the notion of digital literacy for practice, and prompt discussion and debate on digital literacy and requirements for students, graduates and occupational therapists in an ever-changing complex health environment.

Effectiveness of Pacing as a Learned Strategy for People With Chronic Pain: A Systematic Review.

IMPORTANCE: Pacing is a key pain management strategy used by occupational therapy practitioners when working with people with chronic pain. However, there is a paucity of evidence and a lack of consensus regarding the effectiveness of pacing as a pain management strategy for people with chronic pain. OBJECTIVE: To evaluate the evidence for the effectiveness of pacing as a learned strategy for people with chronic pain. DATA SOURCES: Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used to undertake a systematic review. Six databases were searched in March 2016 for randomized controlled trials (RCTs). Combinations of keywords and MeSH terms were used as search terms. STUDY SELECTION AND DATA COLLECTION: We sought intervention studies that included participants using pacing as a strategy. Studies were assessed for eligibility on the basis of predetermined criteria. Of the 2,820 articles located, 7 RCTs met inclusion criteria. FINDINGS: Pacing does not reduce the severity of pain or alter psychological traits; however, it can assist in lessening joint stiffness and the interference of fatigue and in decreasing the variability of physical activity. CONCLUSIONS AND RELEVANCE: Current evidence supports the delivery of a learned pacing intervention to reduce the interference of fatigue, reduce joint stiffness, and decrease physical activity variability but does not support the use of learned pacing to reduce pain severity. Future research should investigate the effectiveness of pacing as a pain management strategy within the International Classification of Functioning, Disability and Health domains of activity and participation. WHAT THIS ARTICLE ADDS: This systematic review examines existing research on pacing as a learned intervention strategy. The findings will support the clinical reasoning of occupational therapy practitioners, to determine when a learned pacing strategy is indicated, and considerations for how it may be delivered.