Predictors of resilience for people with spinal cord injury over two periods of COVID-19 social distancing restrictions: a 12-month longitudinal study using structural equation modelling.

BACKGROUND: The novel coronavirus (COVID-19) pandemic is disproportionately impacting the health of people with disability. Resilience has remained an important health promoting characteristic during periods of social distancing restrictions. Factors promoting resilience for people with disability under the context of the pandemic remains poorly understood. Studies have yet to investigate evidence-based factors that promote resilience over multiple periods of restrictions for people with disability. METHODS: A longitudinal study developed via a collaborative partnership between peer-support workers with lived experience of spinal cord injury (SCI) and university researchers was undertaken to fill knowledge gaps around factors promoting resilience for people with SCI during two periods of stringent social distancing restrictions within Victoria, Australia. Over 12-months, participants with SCI completed two surveys, towards the end of two lockdown periods. Evidence-based factors associated with resilience were measured. The Impact on Participation and Autonomy Questionnaire, the International SCI Quality of Life scale, and the 10-item Conor Davidson Resilience Scale, respectively measured autonomy and participation limitations, life satisfaction and psychological health, and resilience. A structural equation modelling (SEM) approach established factors directly and indirectly associated with resilience. RESULTS: A model with excellent fit was produced. During two extended lockdowns over the 12-month period, increased family role limitations and favourable psychological health were respectively, negatively (Lockdown 1 [n = 127]: ß = -.251, p < .01, Lockdown 2: ß = -.400, p < .01) and positively (Lockdown 1: ß = .601, p < .01, Lockdown 2 [n = 65]: ß = .430, p < .01) associated with resilience. Indirect negative associations between resilience and increased outdoor autonomy limitations (Lockdown 1: ß = -.195, p < .01, Lockdown 2: ß = -.255, p < .01) and social life limitations (Lockdown 1: ß = -.217, p < .01, Lockdown 2: ß = -.142, p < .05) existed, and these relationships were moderated by psychological health. CONCLUSIONS: Psychological health, and participation and autonomy are determinants of resilience during periods of crisis. Health and social care providers and public health departments should prioritise programs promoting these domains, to counter the negative impact of social distancing.

What happens post-lockdown for people with disability? Autonomy, quality of life, service access and health changes for people with spinal cord injury in Victoria, Australia after COVID-19 social distancing restrictions.

Social distancing restrictions are undoubtedly important for controlling the spread of COVID-19 however, they are also adversely impacting population health and health service access. It is important that priority populations with a disability which may already have adverse health, access to health services, and autonomy and participation compared to those without disability, are able to receive preventative health and social care during periods of restriction. The impact of social distancing restrictions on people with disability is not uniform nor well-understood. Research has been cross-sectional and considered data gathered during social distancing restrictions, or longitudinal, considering data gathered during a pre-pandemic baseline. This longitudinal study investigated the impact of lifting social distancing restrictions on priority domains for people with disability including autonomy and participation, access to health services, health issues and quality of life. People with spinal cord injury in Victoria, Australia (n = 71) completed a survey towards the end of social-distancing restrictions (T1) and 6-months post social distancing restrictions (T2). Non-parametric tests for significant differences confirmed that 6-months post-lifting social distancing restrictions participants experienced a significant increase in health conditions, a significant decrease in the number of inaccessible health services, and a significantly lower level of limitations across participation and autonomy, outdoor autonomy and work and education domains. QOL improved 6-months post lifting restrictions, however not to a significant level. The adverse health experienced by people with spinal cord injury after lifting restrictions may in part result from limited health service access and reduced participation during the time of restrictions. Clear definitions of what constitutes as essential care may ensure that eligible and required care remains received during lockdown or instances when service provision is compromised. Health and social care providers should be equipped with the knowledge of priority populations so that their support can be targeted to those most in need.

Access and engagement with places in the community, and the quality of life among people with spinal cord damage.

OBJECTIVES: This study aims to investigate the association between self-reported accessibility and engagement with health services and places in the community, and quality of life (QOL) for people with spinal cord damage (SCD). DESIGN: Cross-sectional survey. SETTING: Community. PARTICIPANTS: Two-hundred and sixty-six people with a SCD residing in Australia (Mage = 62.34, SDage = 15.95). OUTCOME MEASURE: The International Spinal Cord Injury Quality of Life Basic Data Set. RESULTS: Univariate regressions demonstrated that accessing a higher number of places in the community was significantly associated with favorable self-reported psychological health (ß = .160, P < .01), physical health (ß = .144, P < .01), overall well-being (ß = .206, P < .01), and QOL (ß = .187, P < .01). In contrast, reporting a higher number of inaccessible places was significantly associated with unfavorable self-reported psychological health (ß = -.171, P < .01), physical health (ß = -.270, P < .001), overall well-being (ß = -.238, P < .001), and QOL (ß = -.244, P < .001). Being older and living with injury or onset of damage longer were significantly associated with favorable scores across all outcomes (P < .01) except physical health. CONCLUSIONS: Community engagement can have a considerable impact on the self-reported health and QOL of people with SCD. Interventions aimed at increasing community engagement, particularly for people who have recently experienced SCD are warranted.

What Is the Impact of Engaging With Natural Environments Delivered Via Virtual Reality on the Psycho-emotional Health of People With Spinal Cord Injury Receiving Rehabilitation in Hospital? Findings From a Pilot Randomized Controlled Trial.

OBJECTIVES: This study investigated (1) the effect of engaging with 20-minute simulated natural environments delivered via virtual reality (VR) on current mood state and (2) the effect of engaging with multiple VR sessions over a period of a week on the depressive symptoms of people with a spinal cord injury (SCI). DESIGN: Randomized controlled trial design. SETTING: Spinal Cord Injury Rehabilitation Unit in Australia. PARTICIPANTS: Participants (N=24) were assigned to a group engaging in VR sessions during week 1 (group 1, n=10) or week 2 (group 2, n=14). INTERVENTIONS: The intervention week involved participation in up to three 20-minute VR sessions over 3 consecutive days. The control condition involved regular rehabilitation practice over a week. MAIN OUTCOME MEASURES: The Patient Health Questionnaire-8 (PHQ-8) was completed prior to the first week (T1), after the first week and prior to the second week (T2), and after the second week (T3). Current feeling states, including depressed/happy, anxious/relaxed, and not feeling good/feeling good, were rated immediately prior and after each VR session. RESULTS: Levels of happiness, relaxation, and feeling good were significantly higher subsequent to engaging with each VR session. Between-group differences in PHQ-8 scores were significantly greater for participants who experienced the intervention during the first week compared to participants within the control group: intervention participants had significant improvements in psycho-emotional health. Within-group PHQ-8 scores were reduced for each group subsequent to experiencing the intervention; however, differences were not significant. CONCLUSIONS: Engaging with simulated natural environments delivered via VR can favorably affect the psycho-emotional health of people with SCI receiving rehabilitation in hospital. Future research including larger samples and investigating the effect over a longer time period is required to confirm the findings presented.

General practitioner identification and retention for people with spinal cord damage: establishing factors to inform a general practitioner satisfaction measure.

People with spinal cord damage (SCD) report a high level of GP use. There is a dearth of research investigating factors that contribute to GP identification and retention for people with SCD. Furthermore, a GP satisfaction measure developed specifically for people with SCD is non-existent. This preliminary study sought to identify factors contributing to GP identification and retention. A total of 266 people with SCD primarily based in Queensland, Australia, completed a cross-sectional survey that aimed to fill these knowledge gaps. Descriptive statistics and correlational analyses clarified the factors contributing to GP identification and GP retention respectively. An exploratory factor analysis utilising the principal components analysis method clarified a set of items that could underpin key domains for a SCD-specific GP satisfaction measure. The findings confirm that knowledge about SCD, physically accessible services, and trust are seminal considerations aligned with GP identification and retention for people with SCD.

Surgeon's Preference in Total Knee Replacement: A Quantitative Examination of Attributes, Reasons for Alteration, and Barriers to Change.

BACKGROUND: The reasons why surgeons prefer a particular total knee replacement (TKR) to other viable options with lower cost or lower revision risk remain uncertain. This study examined the concept of surgeon's preference in TKR; including the self-assigned utility of their preferred prosthesis, reasons to alter usual preference and barriers to permanently changing preference. METHODS: Using a multinational electronic survey, 347 TKR performing orthopedic surgeons were studied using anonymous mandatory responses, mutually exclusive closed options, multiple responses blocking, automatic stem randomization, Likert scale weighting, and an absence of neutral options. RESULTS: The highest rated of the 17 attributes were "reproducibility of outcome," "best functional outcome," and "better kinematics." The lowest rated were a "key-opinion leader or mentor uses it" and "new or innovative." "Lowest revision risk" ranked 10th, with 19.9% of surgeons stating it did not influence their preference. Cost did not influence 52.1% of surgeons and 33.7% agreed that their institution or system limited their preference. Surgeon's demographics and preferred prosthesis or technique altered some attribute ratings including surgical volume, country of practice, type of preferred implant; however, revision risk rating was not altered by any factor. Cost considerations altered rating of barriers to technique change. CONCLUSION: Understanding why surgeons prefer certain TKR prostheses or techniques to other viable alternatives is vital to reduce unwarranted variation. This study suggests that the self-assigned reasons driving surgeon's preferences, reasons for preference alteration, and barriers to change are multifactorial, diverse, and complex, with revision risk not being the highest rated attribute.

Preservice teachers' sources of information on mandatory reporting of child sexual abuse.

Teachers in many countries are mandated by law, professional codes, or education authorities to report child abuse and neglect, including child sexual abuse. However, teachers may not receive adequate preparation for such sensitive interventions, as preservice teacher education degrees provide very few or no compulsory courses on child protection and crucially related, lifelong health and well-being issues. So, where do preservice teachers source their information regarding the mandatory reporting of such abuse? This research examines preservice teachers' professional university education for their sources of information about mandatory reporting and child sexual abuse. A sample cohort of 56 final 4th-year university bachelor of education (primary school) student teachers in Australia identified the sources they used regarding 10 important aspects of child protection. The results suggest that most did not learn about mandatory reporting or child sexual abuse, and others cited sparse and sporadic public media as their primary information source. These findings, building on previous evidence about inadequate or nonexistent preservice mandatory intervention courses in primary teacher education, may guide the design of appropriate training responses enhancing educational professionals' knowledge, competencies, skills, and efficacies as mandatory reporters of child sexual abuse.

Child sexual abuse and mandatory reporting intervention preservice content preferred by student teachers.

The importance of preservice university teacher training about child sexual abuse and its mandatory reporting intervention is addressed in educational literature, although very little is known about student teachers' learning interests and preferences in this area. In this article, student teachers refer to students in university who are training to become teachers whose training includes teaching experiences in schools. This study examines the content about child sexual abuse and its intervention that student teachers believe they should learn. Results based on quantitative analyses show the relative importance of gender in determining responses to questions about university training and, to a lesser extent, the importance of a previous acquaintance with victims of sexual abuse, previous employment, and the length of the university course. Results based on qualitative data show that content knowledge preferred by elementary/primary and secondary school student teachers includes the teacher's role in mandatory reporting of child sexual abuse and signs, experiences, and responses to student disclosure. Student teachers prefer content examples of school professionals' responses and procedures after disclosure and prefer direct learning content from intervening school professionals. These outcomes could usefully guide teachers and educators who design intervention curricula on child sexual abuse for preservice teachers.

Dementia and its influence on quality of life and what it means to be valued: family members' perceptions.

This pragmatic, exploratory qualitative study, as part of a larger funded research project, sought to explore families' perspectives on what it means to value a person with dementia and how this value might influence the quality of life of people with dementia. In-depth interviews were conducted with 20 family members who used one long-term care service provider in Australia. Families described the factors influencing a positive quality of life for the person with dementia as being related to the environment and, in particular, to the resident's room, supportive staff and individualised care that valued the person's life experience. Family also reported a negative impact on quality of life when staff and the care facility neglected to provide an individualised approach. This study highlights the importance of demonstrating the value of the person with dementia, the family role and partnerships of care.

Factors influencing quality of life for people with dementia: a qualitative perspective.

OBJECTIVES: An exploration and understanding of quality of life (QOL) can help to enhance understanding and respect for people with dementia and assist in improving care and treatment of this population. This study sought to understand the factors that influence QOL for people living with dementia in long-term care (LTC), including an understanding of how they perceived they were valued. METHODS: In-depth interviews were conducted with 32 older people with dementia from one service provider and across four large care settings, in two Australian states. RESULTS: While these residents were either satisfied or dissatisfied with elements of their life, the factors influencing a positive QOL were related to their relationship with family and other people, and 'things' such as needing some control over their life and, more importantly, needing to contribute to their community. Participants reported feeling of little use and therefore of limited value to society. CONCLUSION: This study proposes a need to understand how relationships might be maintained and strengthened following a move into LTC and highlights the importance of control and its influence on feeling valued.

Factors predicting functional outcomes of cochlear implants in children.

This article reports the relationships between a large number of child- and family-related factors and children's functional outcomes, according to parental report, in the domains of spoken language communication, social skills and participation, academic achievement, and independence and identity, through a series of stepwise regression analyses. Parents of 247 children who had received cochlear implants in three eastern states of Australia completed a survey on their expectations and experiences of their children's outcomes with cochlear implants. A number of the independent variables were found to be associated, either positively or negatively, with children's outcomes. Implications for cochlear implant professionals, early intervention programmes, and educational authorities are discussed.

Using structural equation modeling to examine McCollough Effects (orientation-contingent color aftereffects): influence of dissociative experiences and age on illusory aftereffects.

Conventional accounts of the McCollough Effect (ME) have focused on strictly bottom-up processing accounts of the phenomenon, most commonly involving the fatiguing of orientation-selective neurons; although association-learning mechanisms have also gained acceptance. These lower order accounts do not take into account higher order variables related to key personality traits and/or associated cognitive control processes. This article reports the use of confirmatory factor analysis and follow-up structural equation style regressions that model MEs and also the part played by the personality trait of dissociation. After considering the relative impact of age and dissociative processes, the article concludes that trait dissociation is positively associated with reports of MEs.

Clinical utility of predictors of return-to-work outcome following work-related musculoskeletal injury.

INTRODUCTION: Clinical expertise is one source of evidence that is generally under-utilised in the development of an evidence-base in rehabilitation. The current study aimed to incorporate this valuable clinical expertise in determining the utility of multiple predictors of return-to-work outcome following injury. METHODS: Following systematic review of the rehabilitation literature and review, a total of 85 predictors were evaluated for clinical relevance by an expert panel of rehabilitation practitioners (n = 12). Each predictor was rated according the importance of the predictor in rehabilitation, its potential for modification and its classification into one of seven broad areas. In addition, practitioners were asked to provide a rationale as to why the predictor was important to rehabilitation. Analyses were conducted using inter-rater agreement statistics and text analysis. RESULTS: Predictors that were most commonly reviewed in the literature were not considered to be of greatest clinical utility, according to the current sample. From the total predictor set, only nine predictors were identified as clinically useful (i.e., both highly important and highly modifiable). Text analysis of the qualitative data revealed that these nine predictors highlighted the significance of time, context and engagement in rehabilitation practice. CONCLUSION: In the current study, predictors that were considered most clinically relevant were those that generally described workplace related processes. The findings confirmed the underlying supportive and collaborative processes that integrate predictors and account for their influence on outcome. Future rehabilitation efforts and indeed, individual outcomes, could benefit by incorporating these key predictors in targeted programs.

Resilience in the operating room: developing and testing of a resilience model.

AIM: This paper is a report of a study to examine the relation of perceived competence, collaboration, control, self-efficacy, hope, coping, age, experience, education and years of employment to resilience in operating room (OR) nurses. BACKGROUND: Resilience is viewed as a vital attribute for nurses because it augments adaptation in demanding and volatile clinical environments such as ORs. However, there has been little research into the utility of resilience as a means of dealing with workplace stress, and there is only limited understanding of variables that explain resilience in the context of nursing. METHOD: A correlational cross-sectional survey design was used. Of a national sample of 2860 Australian OR nurses, 1430 were selected by systematic random sampling and invited to complete a questionnaire in 2006. The instrument included scales measuring perceived competence, collaboration, control, self-efficacy, hope, coping and resilience, and gathered information about the demographic characteristics of respondents. RESULTS: Two regression models were used to develop a model of resilience. An initial model tested the hypothesis that a set of 12 explanatory variables contributed to resilience in OR nurses. Five variables (hope, self-efficacy, coping, control and competence) explained resilience at statistically significant levels. Age, experience, education and years of employment did not contribute to resilience at statistically significant levels. The final model explained 60% of the variance. In both models, the strongest explanatory variables were hope, self-efficacy and coping. CONCLUSION: Identification of explanatory variables that contribute to resilience in ORs may assist in implementing strategies that promote these behaviours, and thus retain nurses in this specialty.