Community integration outcomes of people with spinal cord injury and multiple matched controls: A pilot study.

BACKGROUND/AIM: Australia's National Disability Insurance Scheme (NDIS) is designed to influence home, social and economic participation for Scheme participants. Given the major disability reform underway, this pilot study aimed to: (i) examine community integration outcomes of people with spinal cord injury (SCI); (ii) compare findings with multiple matched controls and (iii) consider findings within the context of Australia's NDIS. METHODS: Setting: Victoria, Australia. DESIGN: Matched analysis (people with and without SCI). INSTRUMENTATION: Community Integration Questionnaire (CIQ). PARTICIPANTS: n = 40 adults with SCI (M age = 52.8 years; 61% male; 77% traumatic SCI). ANALYSES: Matched analyses from each SCI subject aged <70 years (n = 31) with four CIQ normative data subjects (from n = 1927) was undertaken, with key demographic variables matched (age range, gender, living location and living situation). Risk of low CIQ score as a function of SCI was also examined using conditional Poisson regression. RESULTS: With key demographic variables held constant, small to medium effect sizes were found in favour of the normative sample, with statistically significant differences in home (ρ = 0.003) and productivity integration (ρ = 0.02). Relative risk of low home integration was significant in the SCI cohort (conditional RR (95% CI) = 3.1 (1.5-6.3), ρ = 0.001). Relative risk of low CIQ total, social integration and productivity scores did not reach significance. CONCLUSION: This cohort of SCI participants was less integrated into home and productive occupations than matched norms, holding implications for planning and allocation of supports to influence outcomes within an NDIS. Further research is necessary to understand community integration outcomes in larger matched samples.

Investigation of the self-reported health and health-related behaviours of Victorian mothers of school-aged children.

Lifestyle may influence many health-related issues currently facing Australian women. The extent to which women with school-aged children attend to their own health is unknown and the associations between health behaviours and health status requires investigation. This study aimed to investigate the prevalence of health behaviours (alcohol consumption, health-promoting activities) and their impact on self-reported health (weight, sleep quality, mental health) among mothers of school-aged children in Victoria. Mail-out survey design (n=263) including the Depression Anxiety Stress Scale (DASS) and Health Promoting Activities Scale was used to explore issues. The results indicated that substantial numbers of mothers reported moderate to extreme DASS scores: depression (n=45, 17%); anxiety (n=41, 15.6%); stress (n=57, 21.7%). The majority participated in physical activity less often than daily. High rates of daily alcohol use (20%) and poor sleep quality were reported. Nearly one-half (n=114, 46%) of the sample were overweight or obese and also reported poorer mental health than other women in the sample (P<0.001). Significant associations were detected between maternal weight, mental health and participation in health-promoting activities. The findings indicate that there is a need for increased health education and services for women with school-aged children. Direct services and population-based health promotion strategies may be required to address healthy lifestyle issues and educate mothers about the possible health legacy of poor health behaviours.

Secondary health conditions experienced by people with spinal cord injury within community living: implications for a National Disability Insurance Scheme.

BACKGROUND: Australia's National Disability Insurance Scheme (NDIS) provides supports for individuals, delivered through a personalised participant planning process, to influence choice and goal attainment. AIM: This study aimed to use both quantitative and qualitative methods to examine the impact of secondary health conditions on the experiences of people with spinal cord injury (SCI) who have returned to community living, in the context of Australia's National Disability Strategy and recently launched NDIS. Exploration of lived experience of health conditions following SCI utilising this mixed methods approach may offer important insights for effective planning within an NDIS. METHODS: A cross-sectional survey using the Spinal Cord Injury Secondary Conditions Scale (SCISCS), demographic questionnaire and in-depth interview was undertaken with 33 people with SCI living in the community. Demographic and SCISCS data were reported using descriptive statistics. Interviews were audio-taped, transcribed and analysed thematically. RESULTS: Participants were on average 58.5 years of age and 20 years post-injury. Five key themes emerged relating to (i) spasm and pain; (ii) sexual dysfunction; (iii) pressure areas; (iv) fatigue; and (v) the impact of secondary health conditions on life role participation and choice of supports and equipment. CONCLUSION: Secondary health conditions can significantly impact occupational participation following SCI. Appropriate intervention, including customised equipment and direct support, if delivered as part of an effective NDIS, may prevent or reduce the severity of these conditions and offer the potential to influence health and participation outcomes of people who have returned to community living.

Further validation of the Health Promoting Activities Scale with mothers of typically developing children.

BACKGROUND/AIM: The Health Promoting Activities Scale (HPAS) measures the frequency that mothers participate in self-selected leisure activities that promote health and wellbeing. The scale was originally validated on mothers of school-aged children with disabilities, and the current article extends this research using a comparative sample of mothers of typically developing school-aged children. METHOD: Australian mothers (N = 263) completed a questionnaire containing the HPAS, a measure of depression, anxiety and stress (DASS-21) and questions concerning their weight, height, sleep quality and demographics. Statistical analysis assessed the underlying structure, internal consistency and construct validity of the HPAS. Inferential statistics were utilised to investigate the construct validity. RESULTS: Exploratory factor analysis supported the unidimensionality of the HPAS. It showed good internal consistency (Cronbach's alpha = 0.78). Significantly lower HPAS scores were recorded for women who were obese; had elevated levels of depression, anxiety and stress; had poor quality sleep or had heavy caring commitments. The mean HPAS score in this sample (M = 32.2) was significantly higher than was previously reported for women of children with a disability (M = 21.6: P < 0.001). CONCLUSIONS: Further psychometric evaluation of the HPAS continues to support the HPAS as a sound instrument that measures the frequency that women participate in meaningful occupation that is associated with differences in mental health and wellbeing and other health indicators.

An investigation into the role and meaning of occupation for people living with on-going health conditions.

BACKGROUND/AIM: In Australia and internationally, more people are developing on-going health conditions (chronic illnesses) in which their daily occupations are implicated in both the onset and management of the condition. This article investigates the role and meaning of occupation from a client-centred perspective. It presents one aspect of a broader study that aimed to inform occupation-based practice for people living with on-going health conditions. METHODS: This study used an emergent, mixed methods design. A total of 16 adult participants, with one or more on-going health conditions that impacted on their participation in occupations, were interviewed using two semi-structured interviews. Narrative data were analysed using grounded theory methods which included coding, memo-writing and constant comparison. A theoretical understanding, consisting of four categories and a core concept, was constructed through the data analysis. RESULTS: Occupation fulfils four distinct, but interrelated, roles for people living with on-going health conditions. Engaging in occupation can reveal, explain, manage and overcome on-going health conditions. The core concept, 'occupation empowers', integrates the different roles of occupation and reflects the meaning of occupation for people with on-going health conditions. CONCLUSIONS: This study contributes a theoretical understanding of the roles and meaning of occupation that is grounded in the experiences of people living with on-going health conditions. These findings extend our understanding of human occupation, and highlight the importance of narrative techniques to support occupation-based practice and empower people living with on-going illness.

Health status of people with work-related musculoskeletal disorders in return to work programs: a Malaysian study.

This study examined the health status of injured workers with musculoskeletal disorders enrolled in the Malaysian Return to Work (RTW) program. The 102 participants were categorized into three RTW groups: Off-work (n = 30, 29.4%), Re-entry (n = 44, 43.1%), and Maintenance (n = 28, 27.5%). Overall health status, as measured by the SF-36 version 2, of the workers exhibited below average compared to the internationally established normative population, with their physical health component summary rated lower than mental health. Across the different groups, significant differences were found in role-physical, vitality, bodily pain, general health, and mental health. However, the mean values of these variables were higher in the Maintenance group and were found significant. The current health status of injured workers at Off-work and Re-entry phases was significantly low and warranted to be improved by involving other health professionals such as occupational therapists, ergonomists, and psychologists.

Moving from aged care facilities to community-based accommodation: outcomes and environmental factors.

OBJECTIVE: Nearly 3500 people under 60 years of age are living in residential aged care in Australia, a situation which is generally recognized as incompatible with optimum quality of life. The objective of the current study is to explore the transition experiences of young people with acquired brain injury who have lived in aged care facilities and moved into community-based settings. RESEARCH DESIGN: Grounded theory, qualitative design. METHODS AND PROCEDURES: Semi-structured interviews were conducted with seven individuals with very severe ABI, seven family caregivers and two disability support workers. Each interview was recorded and transcribed verbatim. RESULTS: Participants identified a range of positive outcomes that resulted from the transition from aged care settings to community living environments including increased independence in everyday activities, improved well-being and a greater degree of social inclusion. Participants also identified environmental factors that they deemed as crucial to facilitating positive outcomes. CONCLUSIONS: People with very severe ABI have the potential to increase their level of independence in community-based accommodation settings; a potential that is not fostered in most aged care environments. The findings inform the outcome variables and environmental factors that should be measured in studies of transition from aged care to the community.

Young people in aged care: progress of the current national program.

OBJECTIVE: The aim of this paper is to examine the progress and effect of the current 5-year $244 million National Young People in Residential Aged Care program on the reduction of young people in aged care. METHOD: Semi-structured telephone interviews with 20 service providers, 10 advocacy organisations and 6 public servants across Australia actively involved in the implementation of the program. RESULTS: The development of new accommodation options has been slow. The 5-year program aims to move 689 young people out of nursing homes; in the first 4 years of the initiative only 139 people had moved out. The lives of those who have been helped by the program have been enormously improved. CONCLUSIONS: This study highlights the challenges of achieving a long-term reduction in the number of young people in residential aged care, including the challenge of achieving systemic change to prevent new admissions. Implications. The accommodation options currently being developed for this target group will soon be at capacity. Without sustained investment in developing alternative accommodation options and resources to implement systemic change ~250 people under 50 are likely to continue to be admitted to aged care each year in Australia.

A secondary analysis to develop a scale for measuring unemployed workers' experiences of Australian employment services.

BACKGROUND: Research consistently shows that Australian employment services are failing those they are intended to serve. Based on findings in other human service areas, a valid and reliable instrument to measure unemployed workers' experiences may provide an opportunity for improvement in this sector. OBJECTIVE: To establish a basis for developing a suitable rating scale. METHODS: An exploratory factor analysis combined with qualitative cross check for face validity of an existing large survey of Australian unemployed workers. RESULTS: Six factors appear to be important elements of service delivery: (F1) useful and competent, (F2) client-centred, (F3) receptive to feedback, (F4) trustworthy, (F5) fair, and (F6) friendly. CONCLUSIONS: While each of these factors have been either described explicitly or referred to implicitly in previous studies, this study is the first to attempt to combine these factors and is a precursor to establishing a valid and reliable rating scale for use by unemployed workers in evaluating their employment service providers. At a time when Australia is exploring new approaches to employment services, such a scale using a robust set of factors may allow for the improvement of employment services and thus be held accountable to a significant stakeholder group whom they aim to serve -unemployed workers.

Occupational therapy entry-level education in Australia: which path(s) to take?

BACKGROUND/AIM: There has been an increase in the number of occupational therapy educational programmes offered in Australia over recent years. Although universities offer bachelor, masters and graduate-entry masters programmes, there is a push to consider phasing out occupational therapy bachelor degrees. The aim of this study was to identify advantages and disadvantages associated with current and future credentials needed for entry into the profession. METHODS: This article reviews current literature and other issues concerning entry-level occupational therapy education. RESULTS: The underlying issues are complex and require great consideration as a profession. CONCLUSION: As a profession we need to take charge of our destiny before governments, universities and other stakeholders/professions determine the basic level of entry for our profession.

'I know what I am doing': A grounded theory investigation into the activities and occupations of adults living with chronic conditions.

Background: A growing number of adults experience chronic conditions and related disability. However, a limited understanding of the activities and occupations of this population reduces the capacity of occupational therapists to deliver person-centred, occupation-based care.Aims: To investigate the activities and occupations of adults living with chronic conditions.Methods: Sixteen adults with multiple chronic conditions participated in two semi-structured interviews at their home or health center. Grounded theory methods were used to analyze data and construct a conceptual understanding of human occupation.Findings: Human occupation was conceptualized as doing activities and actions with meaning, in the context of one's life, health condition(s), and world. Three, two-dimensional categories of meaning were developed from the data: (i) connecting/reconnecting and disconnecting; (ii) caring and harming; and (iii) contributing and detracting.Conclusions: The findings present a complex, dynamic and multifaceted understanding of the activities and occupations of adults living with chronic conditions.Significance: This study demonstrates the value of exploring the experiences of actual or potential occupational therapy clients to refine the concept of human occupation. An in-depth knowledge of what people do is an essential foundation for person-centred, occupation-based practice.

The use of electronic assistive technology for social networking by people with disability living in shared supported accommodation.

Background: This study aimed to examine use of electronic assistive technology for social networking by people with disability living in shared supported accommodation (SSA), and compare participants' Electronic Social Networking (ESN) integration with Australian ESN normative data.Method: Telephone surveys and the ESN subscale of the Community Integration Questionnaire-Revised (CIQ-R) were administered with SSA managers. Surveys gathered demographic data, and data on Internet access, technology use and ESN integration, of 91 people with disability who were identified technology users and living in SSA. Participant ESN data were then matched with existing CIQ-R ESN normative data (N = 359). Relative risk of reduced ESN integration was calculated.Results: This study identified that, despite access to mainstream technologies, people with disability living in SSA experience low ESN integration, and use ESN for social contact less than other Australians. This group were 210% more likely to report reduced ESN integration than the matched normative sample when key demographic variables were held constant.Conclusions: Factors related to disability, including high care and support needs and greater time spent completing essential activities of daily living (such as personal care), may explain the low electronic social networking integration for people with disability living in SSA identified in this study. Further research that examines factors that influence ESN access and use following disability is necessary to inform practice to bridge the digital divide that exists between this group and other Australians.

An occupational and rehabilitation perspective for institutional practice.

OBJECTIVE: The article aims to provide an occupational perspective on the lives of people with a serious mental illness who have committed a criminal offense and are incarcerated in a secure environment. PURPOSE: The article focuses on ways that institutions fail to meet occupational needs of such persons and the challenges for mental health and psychiatric rehabilitation professionals, including occupational therapists, in providing psychiatric rehabilitation to facilitate community integration and participation. The concepts of occupational deprivation, occupational imbalance, habits and occupational enrichment provide useful theoretical constructs underpinning practice endeavors. SOURCES USED: Ovid using Medline, PsychINFO, CINAHL, OTDBase, and ProQuest. CONCLUSIONS: There is a priority for research to validate tools to assess outcomes of occupations in secure settings, and the use of these tools to focus on which rehabilitation practices are correlated with establishing positive outcomes after release. Research evidence is also needed that demonstrates that occupational enrichment can result in observable and measurable outcomes that mitigate the negative effects of incarceration and support successful community re-entry of persons with mental illnesses who are offenders.

Electronic assistive technology use in Australian shared supported accommodation: rates and user characteristics.

Electronic assistive technologies (EATs) are fast becoming considered an essential component of everyday life. To date, there has been little research on the use of EAT by people living in shared supported accommodation (SSA), one of the major community-based housing options for people with disability (PwD) in Australia. This study aimed to (1) audit current EAT use by PwD living in SSA, (2) describe the impact of Internet access on EAT use, and (3) examine potential relationships between individual characteristics and EAT use. A customized survey administered with 32 house managers, representing 52 SSAs, gathered data on the EAT use of 254 people. Only 45.7% of residents used EAT, and devices available to the mainstream market were most frequently used. Access to home-based Internet was not a predictor of the number of devices in use. Disability type (congenital or acquired) was found to be significantly correlated with the number of devices in use, however, associations across a number of variables suggest complex mediational interactions. These findings provide an insight into the EAT use trends of PwD living in SSA, indicating that further work needs to be done to support the uptake and continued use of EAT by PwD Implications for Rehabilitation Further work needs to be done to promote the uptake and use of electronic assistive technology (EAT) by people with disability (PwD). Personal characteristics and experiences need to be considered in the prescription of EAT to PwD, as these may explain variations in use between individuals.

Evaluating the Use of Smart Home Technology by People With Brain Impairment: Protocol for a Single-Case Experimental Design.

BACKGROUND: Smart home technologies are emerging as a useful component of support delivery for people with brain impairment. To promote their successful uptake and sustained use, focus on technology support services, including training, is required. OBJECTIVE: The objective of this paper is to present a systematic smart home technology training approach for people with brain impairment. In addition, the paper outlines a multiple-baseline, single-case experimental design methodology to evaluate training effectiveness. METHODS: Adult participants experiencing acquired brain impairment who can provide consent to participate and who live in housing where smart home technology is available will be recruited. Target behaviors will be identified in consultation with each participant based on his or her personal goals for technology use. Target behaviors may include participant knowledge of the number and type of technology functions available, frequency of smart home technology use, and number of function types used. Usage data will be gathered via log-on smart home technology servers. A smart technology digital training package will also be developed and left on a nominated device (smartphone, tablet) with each participant to use during the trial and posttrial, as desired. Measures of the target behavior will be taken throughout the baseline, intervention, and postintervention phases to provide the evidence of impact of the training on the target behaviors and ascertain whether utilization rates are sustained over time. In addition, trial results will be analyzed using structured visual analysis, supplemented with statistical analysis appropriate to single-case methodology. RESULTS: While ascertaining the effectiveness of this training protocol, study results will offer new insights into technology-related training approaches for people with brain impairment. Preliminary data collection has been commenced at one supported housing site, with further scoping work continuing to recruit participants from additional sites. CONCLUSIONS: Evaluation evidence will assist in planning for the smart technology set-up as well as training and support services necessary to accompany the provision of new devices and systems. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR1-10.2196/10451.

People under 60 living in aged care facilities in Victoria.

OBJECTIVE: To describe the characteristics of people under 60 years of age living in residential aged care in Victoria and to examine the occupational participation of younger residents in aged care facilities by measuring their social contact, participation in recreation and community access. METHODS: A survey was sent to the Directors of Nursing at all 803 Commonwealth Department of Health and Aged Care registered aged care facilities in Victoria. RESULTS: The survey had a 78% response rate and information was provided about the characteristics of 330 people under 60 years with high clinical needs residing in aged care facilities. This sample was extremely isolated from peers, with 44% receiving a visit from a friend less often than once per year. Sixteen per cent of residents participated in a recreation activity less than once per month and 21% went outside less than once per month. Of the sample, 34% almost never participated in any community-based activities such as shopping, leisure or visiting friends and family. CONCLUSION: Over one third of younger people in aged care are effectively excluded from life in our community. Most younger residents are socially isolated and have limited opportunities for recreation. Placement of younger people in aged care facilities is inappropriate, and alternative care models and settings are required.

An Exploration of the Use of a Sensory Room in a Forensic Mental Health Setting: Staff and Patient Perspectives.

Despite the increased use of sensory rooms, there is little published evidence related to their benefits. The purpose of this study was to explore staff and patient perspectives of the use of a sensory room in an Australian forensic mental health setting. Staff and patients on a forensic hospital unit were recruited for this study. Focus group data was obtained from the perspective of the healthcare staff. A sensory assessment identified patients' sensory preferences. The details of the patients sensory room use and stress experienced before and after using the sensory room were recorded. The results showed a mean decrease in stress that was attributed to the use of the sensory room. Stress reducing benefits of sensory room use may improve a patient's experience within a forensic mental health facility while applying a recovery approach. As a limitation of the study, patient stress was rated on an un-validated scale. Further research is needed for greater insight and evidence in evaluating the use of sensory rooms in forensic mental health settings in reducing stress. Copyright © 2016 John Wiley & Sons, Ltd.

Multimorbidity and the process of living with ongoing illness.

OBJECTIVES: Living with two or more health conditions, or multimorbidity, is associated with higher rates of disability and lower quality of life. To overcome the challenges associated with multimorbidity, person-centred health care is essential. However, to provide person-centred health care, health professionals first need to understand how people with multiple health conditions experience their illness. METHODS: Sixteen adult participants, with one or more health conditions, were recruited from hospital outpatient and community health services and interviewed twice. Qualitative data from interview transcripts and field notes were inductively analysed using constructivist grounded theory and life chart methods. FINDINGS: 'Living with ongoing illness' describes a process involving four interrelated experiences. Participants described, 'recognising something is not right,' 'working out what is wrong,' 'getting things under control' and 'getting on with life.' A case example is used to illustrate and compare the process across a participant's first and subsequent health conditions. DISCUSSION: Participants with different health conditions shared similar illness experiences. Yet, the process of living with ongoing illness was unique and differed according to participants' health conditions and life context. By understanding the experiences, needs, and priorities of people with multimorbidity, health professionals can provide timely and relevant health care.