Virtual reality after stroke: Identifying important characteristics when designing experiences to improve engagement in upper limb rehabilitation.

Objective: Virtual reality (VR) has been used to improve upper limb function after stroke but there is little to guide product developers in building experiences that engage users in the sustained, repetitive training required. This research sought to understand the characteristics of VR scenarios best suited to engaging someone with a stroke during recovery to achieve therapeutic outcomes. Methods: Five creative immersive VR scenarios were designed by an experienced VR content creator containing unique combinations of VR characteristics. The usefulness of the scenarios was reviewed by expert clinicians experienced in stroke rehabilitation. Following this review, seven stroke survivors participated in each experience and reported on their engagement and motivation. Outcome measures were the User Satisfaction Evaluation Questionnaire and the modified Intrinsic Motivation Inventory. Semi-structured interviews were conducted with five participants following their immersive VR experience and analysed thematically. Results: Expert clinicians reported potential therapeutic value in the immersive VR scenarios by providing opportunities for repeated and graded practice of upper limb movements. Stroke survivors reported varied levels of enjoyment and engagement for each scenario. They recommended changes to the experiences, primarily relating to the tailoring of the scenarios to match varied upper limb capacities. Conclusion: This study highlights the characteristics of immersive VR scenarios that are important in sustaining motivation and providing high-repetition task-specific movement experiences. Differences in the experience and preferences of stroke participants regarding the characteristics of immersive VR experiences indicate that a variety of experiences are necessary to engage and sustain participation in an immersive VR-related therapy programme.

The use of practice evidence by Australian occupational therapists: Perspectives and actions.

INTRODUCTION: Evidence-based practice supports clinical decision-making by using multiple sources of evidence arising from research and practice. Research evidence develops through empirical study while practice evidence arises through clinical experience, client preferences, and the practice context. Although occupational therapists have embraced the paradigm of evidence-based practice, some studies have identified limits in the availability and use of research, which can lead to reliance on other forms of evidence. This study aimed to understand how Australian occupational therapists use practice evidence, manage potential bias, and enhance trustworthiness. Potential use of a critical appraisal tool for practice evidence was also explored. METHODS: A 42-item questionnaire was developed to address the study aims. It consisted of a 7-point Likert scale, ordinal and free text questions. Likert scales were collapsed into binary scales and analysed using SPSS. Ordinal data were graphed and free text responses were analysed using manifest content analysis. RESULTS: Most respondents (82%) indicated that practice evidence was an important informant of practice and is used alongside research evidence. Almost all respondents (98%) expressed confusion when reconciling discrepancies between research and practice evidence. There was general acknowledgement that practice evidence is prone to bias (82%), yet 92% were confident in trusting their own practice evidence. Most respondents (74.5%) undertook some measures to appraise practice evidence, and almost all respondents (90%) agreed they would refer to a critical appraisal tool that helped them evaluate practice evidence. CONCLUSION: Occupational therapists in this study routinely use practice evidence arising from their own experience, client perspectives, and their practice context to inform clinical decision-making. While they agreed that practice evidence was prone to bias and misinterpretation, they generally trusted their own practice evidence. Participants indicated they needed guidance to critically appraise their practice evidence and supported the development of a critical appraisal tool for this purpose.

Predictors of undergraduate occupational therapy students' academic performance during the Covid-19 pandemic: A hierarchical regression analysis.

BACKGROUND: The rapid switch to online learning in response to the Covid-19 pandemic affected occupational therapy students' education delivery. It is, therefore, important to investigate these impacts. AIMS/OBJECTIVES: This study investigated the potential predictors of academic performance in undergraduate occupational therapy students after moving to online or blended learning post-Covid-19. MATERIAL AND METHODS: A total of 208 students from three Australian universities completed a demographic questionnaire and the Distance Education Learning Environment Scale (DELES). Hierarchical linear regression analyses were completed to identify significant students' academic performance predictors. RESULTS: Hierarchical regression explained a cumulative total variance of 24.6% of students' academic performance. The following independent variables were significant predictors: DELES student autonomy (p = 0.033), number of hours per semester week dedicated to indirect online study (p = 0.003), number of hours per semester week dedicated to indirect offline study time (p = 0.034), gender (p = 0.005) and English as a first language (p = 0.045). CONCLUSIONS: The findings add to the knowledge base on the range of factors that have impacted occupational therapy students' academic performance during the Covid-19 pandemic. SIGNIFICANCE: The outcomes will assist faculty in developing supportive and pedagogically sound learning modes across online, hybrid and traditional forms of instruction within occupational therapy curricula.

Online Learning During the COVID-19 Pandemic: Comparing the Perceptions of Domestic and International Occupational Therapy Students.

PURPOSE: To investigate differences between domestic and international occupational therapy students in their perceptions and experiences of online learning during the COVID-19 pandemic. METHODS: Cross-sectional study of 151 occupational therapy students enrolled in the 4-year Bachelor of Occupational Therapy (Honours) courses at the University of Canberra and Monash University in Australia. Students completed the Student Engagement in the e-Learning Environment Scale (SELES) and the Distance Education Learning Environment Scale (DELES). Both instruments have established validity and reliability. ANOVA analysis with bootstrapping was completed to examine potential differences in domestic and international students' experiences and perceptions of online learning. RESULTS: Statistically significant differences were observed between domestic and international students' scores on the DELES Student Autonomy (p=0.001), Personal Relevance (p=0.001) and Student Interaction and Collaboration (p=0.037) subscales. CONCLUSION: International students experienced greater difficulties during online learning in relation to taking control of their own learning, connecting acquired knowledge with real-world settings, and forging collaborative and interactive working relationships with their peers. Academic, technological, and social support measures are recommended to strengthen students' self-directed learning skills, facilitate them to link what they have learned beyond online settings, and encourage active and collaborative engagement with peers and instructors.

'Learning in and out of lockdown': A comparison of two groups of undergraduate occupational therapy students' engagement in online-only and blended education approaches during the COVID-19 pandemic.

INTRODUCTION: In many countries, the COVID-19 pandemic resulted in sudden changes to the delivery of health professions education in response to local and national lockdowns. Within occupational therapy, university education programs traditionally delivered in face-to-face classroom, and clinical settings, the transition to online learning presented unique issues and challenges for faculty and students. This study compared the experiences and perceptions of learning in two groups of occupational therapy students during the pandemic: one group converted to online learning only and the other had a blended approach that combined face-to-face on-campus learning with some online lecture content delivery. METHODS: Two hundred and eight (n = 208) undergraduate occupational therapy students from three Australian universities completed an online self-report demographic questionnaire and two standardised instruments: the Student Engagement in the e-Learning Environment Scale and the Distance Education Learning Environment Scale. An independent-samples t test with bootstrapping was completed to examine differences in students' scores. RESULTS: Statistically significant differences were observed between the online and blended learning groups across a range of the SELES and DELES subscales. The strongest findings related to psychological motivation (p = 0.001), personal relevance (p = 0.001), interactions with instructors (p = 0.002), instructor support (p = 0.001), student interaction & collaboration (p = 0.001), and cognitive problem solving (p = 0.001). CONCLUSION: Occupational therapy students who transitioned to online-only learning experienced higher levels of motivation, interactions with instructors and peers, and self-directed learning than students who experienced a blended education delivery approach of face-to-face and online learning. The findings extend educators' understanding of the matrix of factors that have impacted students' education during COVID-19 and support the development of contemporary and pedagogically sound online and traditional modes of occupational therapy instruction. The results provide evidence of the importance of well-structured programs that facilitate active and flexible learning, provide meaningful and positive experiences, and promote initiatives safeguarding social and personal well-being. Further research in this area is recommended.

Attributes of excellence in practice educators: the perspectives of Australian occupational therapy students.

AIM: Occupational therapists frequently undertake the role of practice educator contributing to the development of the future workforce, however, little is known about how they effectively perform this role. This study aimed to elucidate students' perspectives on what makes an excellent practice educator. METHOD: Documentation for 124 Practice Excellence Commendations nominations by Queensland occupational therapy students for Queensland Occupational Therapy Fieldwork Collaborative awards between 2008 and 2011 were analysed. These were based on students' experiences on long block placements (five weeks or more) in their later years of undergraduate or masters' entry study. Written nominations addressing five selection criteria were de-identified and responses to each of these compiled. One independent coder and the two lead authors read the transcripts, identified coding categories and reached consensus regarding emerging themes using standard content and thematic analysis techniques. RESULTS: Providing the 'just right' challenge was the overarching theme that symbolised excellence in practice education from students' perspectives. Three themes emerged that enabled practice educators to provide student support needed to balance the challenges of learning on placement; (i) valuing a reciprocal relationship; (ii) facilitating learning opportunities and experiences; and (iii) encouraging autonomy and independence. CONCLUSION: Findings provided insights into student perceptions about how excellent practice educators facilitated their learning while on placement. These insights can be used to inform practice educators who wish to enhance their supervision skills. Future research should focus on how the attributes of practice educators positively influence student learning outcomes.

Clinical utility of the four-quadrant model of facilitated learning: perspectives of experienced occupational therapists.

BACKGROUND/AIMS: This study explored perspectives of experienced occupational therapists regarding teaching-learning approaches used during intervention. The aim was to ascertain the clinical utility of the Four-Quadrant Model of Facilitated Learning (4QM) (Greber, Ziviani, & Rodger, 2007a) by understanding how it might enhance clinical competency when applying teaching-learning modalities. METHODS: Mixed methods were used to ascertain the perspectives of two groups of therapists with seven or more years experience in either adult (n=8) or paediatric (n=7) practice. A pre-discussion questionnaire was used to prime participants for an initial focus group centred on understanding how participants used teaching-learning within occupational therapy intervention. Following a brief description of the 4QM, a further session explored the perspectives of participants regarding the 4QM as a means of conceptualising and planning teaching-learning interventions. RESULTS: Irrespective of practice area, therapists considered teaching-learning approaches core to their practice, without necessarily identifying a clear process to guide their implementation. Proficiency in teaching-learning was generally seen to be gained through trial and error. Participants identified potential clinical applications for the 4QM as a useful structure to support the application of teaching-learning interventions, speculating that it would be particularly useful for novice clinicians. CONCLUSIONS: Participants endorsed the 4QM as a useful integrating framework to support the development of professional competencies related to planning interventions that use a teaching-learning approach.

Increasing the occupational therapy mental health workforce through innovative practice education: a pilot project.

AIM: This paper describes the evaluation of a pilot trial of two innovative placement models in the area of mental health, namely role emerging and collaborative supervision. The Queensland Occupational Therapy Fieldwork Collaborative conducted this trial in response to workforce shortages in mental health. METHOD: Six occupational therapy students and eight practice educators were surveyed pre- and post-placements regarding implementation of these innovative models. RESULTS: Students participating in these placements reported that they were highly likely to work in mental health upon graduation, and practice educators were positive about undertaking innovative placements in future. An overview of the placement sites, trials, outcomes and limitations of this pilot trial is provided. CONCLUSION: Though limited by its small sample size, this pilot trial has demonstrated the potential of innovative placement models to provide valuable student learning experiences in mental health. The profession needs to develop expertise in the use of innovative placement models if students are to be adequately prepared to work with the mental health issues of the Australian community now and in the future.