Psychosocial assessment of potential retinal prosthesis trial participants.

BACKGROUND: As the field of retinal prostheses advances, volunteers are required for device trials, and optimal participant recruitment is vital for intervention success. The aims of this study were: (i) to select tests that assess the psychosocial aspects of visual impairment and develop a psychosocial assessment protocol for persons who may be eligible for participation in retinal prostheses trials; (ii) to investigate correlations between these tests; and (iii) to determine associations between psychosocial factors and a person's interest in participating in a retinal prosthesis (bionic eye) trial. METHODS: Cross-sectional study of 72 adults with advanced retinal degeneration. Questionnaire assessments included personality, cognitive ability, social-support, self-efficacy, coping, optimism, depression, and quality of life (Impact of Vision Impairment Profile ([IVI], and Vision and Quality of Life Index [VisQoL]). Level of interest in a retinal prosthesis was also evaluated. RESULTS: All questionnaires were completed without floor or ceiling effects and with minimal respondent burden. Depression correlated with decreased quality of life (rho = -0.37 and 0.40, p < 0.001 for IVI and VisQoL, respectively). Together, depression, gender and vision-specific coping explained 35.2 per cent of variance in IVI quality of life (p < 0.001). Forty-nine per cent of participants were interested in a retinal prosthesis now and 77 per cent in the future. Although the personality trait of 'openness' was somewhat predictive of interest in retinal prostheses (odds ratio 0.78, 95% CI 0.62-0.97), neither severity of vision impairment nor any of the psychosocial measures were strong predictors. CONCLUSIONS: Several existing psychosocial questionnaires can be used for patients with advanced retinal degeneration and may be useful in exploring suitability for a retinal prosthesis or evaluating outcomes. However, the questionnaires used in this study were not good predictors of whether or not a person might be interested in a retinal prosthesis.

The experience of seeking, gaining and maintaining employment after traumatic spinal cord injury and the vocational pathways involved.

BACKGROUND: Vocational potential in people with spinal cord injury (SCI) are unrealised with rates of employment substantially lower than in the labour force participation of the general population and the pre-injury employment rates. OBJECTIVES: To understand the experience and pathway of people achieving employment outcome after traumatic spinal cord injury by; classifying participants into employment outcome groups of stable, unstable and without employment; identifying pre and post-injury pathways for participants in each group and, exploring the experiences of people of seeking, gaining and maintaining employment. METHODS: Thirty-one participants were interviewed. Mixed methods approach including interpretive phenomenological analysis and vocational pathway mapping of quantitative data. RESULTS: The most common pathway identified was from study and work pre-injury to stable employment post-injury. Four super-ordinate themes were identified from the interpretive phenomenological analysis; expectations of work, system impacts, worker identity and social supports. Implications for clinical practice include fostering cultural change, strategies for system navigation, promotion of worker identity and optimal use of social supports. CONCLUSIONS: The findings increase insight and understanding of the complex experience of employment after spinal cord injury. There is opportunity to guide experimental research, policy development and education concerning the complexity of the return to work experience and factors that influence pathways.

Comparison of an interactive CD-based and traditional instructor-led Basic Life Support skills training for nurses.

BACKGROUND: Basic Life Support (BLS) is a life-saving and fundamental skill in resuscitation. However, studies have reported limitations in BLS training outcomes for both health professional and lay populations, and noted the resource and time-intensive nature of traditional training approaches. PURPOSE: This exploratory study evaluated the effectiveness of an interactive CD-based BLS training programme that included unsupervised manikin practice compared with a traditional instructor-led BLS training programme involving demonstration and supervised practice. METHODS: A quasi-experimental post-test with follow-up design was used. The sample was comprised of two cohorts: Novice second-year undergraduate Nursing students (n=187) and Practising Nurses (n=107) in their first year of hospital employment. BLS skill outcomes were assessed at one week and again at eight weeks post training. FINDINGS: No statistically significant differences were found between the CD and traditional instructor-led BLS training methods in BLS skills of Novice and Practising Nurses at one week and eight weeks post training. However, there was a decrement in skill between one week and eight weeks post-training across both groups and an overall low level of competence. CONCLUSION: The failure to find a difference between the CD-based BLS programme with unsupervised manikin practice and a resource-intensive traditional instructor-led BLS training programme may indicate equivalence of the programmes or, even study design limitations. It is concerning that competence displayed by trainees from both groups was less than optimal and suggests the need for renewed efforts to develop and evaluate BLS training programmes which can achieve high rates of competence with acceptable skill retention over time.

Predicting employment status at 2 years' postdischarge from spinal cord injury rehabilitation.

OBJECTIVES: This exploratory study examined the extent to which postinjury employment was predictable when patients were followed up 2 years' postdischarge from a specialist Spinal Cord Injury (SCI) Unit. PARTICIPANTS AND DESIGN: Seventy-two individuals with SCI for whom there were discharge Functional Independence Measure (FIM) scores, 60 complete sets of data were available for Discriminant Function Analysis. RESULTS: Using a combination of variables assessed prior to or shortly after discharge from rehabilitation, complemented by psychosocial variables assessed at the time of follow-up, moderate classification accuracy was achieved with respect to employment status at the 2-year follow-up period (72%), with the set of predictor variables being more accurate at predicting those subsequently in paid employment (83%) than those not (67%). CONCLUSIONS: The main implication of the study results is that nontraditional variables (i.e., variables other than injury and demographic variables), including, particularly, contextual environmental variables such as community integration, access to transport, and social support, are worthy of further research, especially because many of these are amenable to rehabilitation program interventions, and thus may facilitate the attainment of enhanced rates of postdischarge employment among those living with SCI.

Perceptions of participation: child patients with a disability in the doctor-parent-child partnership.

OBJECTIVE: To explore how the doctor-parent-child partnership is experienced and if the child patient is considered a contributor. METHODS: Qualitative methodology using semi-structured interviews with 33 participants (9 paediatricians, 14 parents, and 10 children aged 8-12 with cerebral palsy) from a paediatric teaching hospital in Victoria, Australia. RESULTS: Children were reported to participate in the doctor-parent-child partnership. The child was not perceived to be an 'equal' or 'regular' partner as there were reports of variability in the involvement between children, as well as variability in the progressive involvement of each child. Three categories emerged in relation to the child's position in the partnership: creating a space for the child's involvement; acknowledging the variability of child preferences to be involved; and negotiating the child's age and development. CONCLUSION: The doctor-parent-child partnership was perceived not necessarily to be dyadic, shared exclusively by the parent and paediatrician. Children were reported to contribute to the partnership, although there were limitations to the child's involvement. PRACTICE IMPLICATIONS: Previous understandings of partnership are not sufficient to explain the complexities involved in a doctor-parent-child partnership, and a social-model approach to care is highlighted as an important factor for enabling the development of a triadic partnership.

Employment status after spinal cord injury (1992-2005): a review with implications for interpretation, evaluation, further research, and clinical practice.

The purpose of this study is to review the research conducted on the topic of employment status after spinal cord injury that was published between 1992 and 2005. This study follows on from an earlier review that focused on papers published between 1976 and 1991. The current study extends the earlier review by reporting an aggregate employment rate for those at least 12 months postinjury, separating rates for those living in different geographical areas (i.e. North America, Europe, Australia, and Asia), and reporting rates at various times of postinjury (rates from a minimum of 1 year postinjury, through rates at a follow-up of more than 20 years postinjury). As was found in the earlier review, a diversity of employment rates was observed; however, this diversity was reduced when studies of similar design were compared. Results indicate that although it may take some time to be realized, there is significant vocational potential amongst those with spinal cord injury. On the basis of the results of the review, it was concluded that approximately 40% of working age people greater than 12 months postinjury are employed at the time of data collection, with this rate increasing as the postinjury time increases, peaking at 10-12 years postinjury. Significant differences in employment rates depending on the geographical location of the studied population were observed. Recommendations for further research are made and implications for service provision to individuals with disabling injuries are discussed.

Employment participation following spinal cord injury: relation to selected participant demographic, injury and psychological characteristics.

PURPOSE: To determine the relationship between selected demographic, injury and psychological characteristics and the extent of employment undertaken following spinal cord injury (SCI). METHOD: Data were collected from 289 persons with SCI who found employment post-injury. A survey was administered to patients of a specialist spinal cord injury unit located in South-Eastern Australia. A variety of demographic, injury and psychological variables were assessed for their relationship to the extent of employment undertaken following SCI. Extent of employment, was defined as time spent employed as a proportion of the time available for employment, and is hereafter referred to as "workrate." RESULTS: On average, participants reported having been employed for almost two-thirds of their available time. Study variables explained 22% (18% adjusted) of the variance in post-injury workrate. Individually, demographic and psychological variables, but not injury variables, were found to relate to the outcome measure. CONCLUSION: Using a novel measure of employment outcome, this study yielded findings consistent with other research using alternate employment measures. Results suggest that demographic and psychological variables are more related to this measure of employment participation than are injury variables. The addition of environmental variables may allow for the explanation of more variance in outcome.

Reliability of the bipolar form of the profile of mood states using an alternative test protocol.

The bipolar version of Profile of Mood States was completed by 124 participants (58 women and 66 men, M age 26.5, SD=3.9 yr.) on two occasions--once when the measure was self-administered according to that test protocol and once when POMS-BI items were projected onto a screen with participants being asked to provide oral responses to items. Data from both modes of administration provided similar support for the internal consistency of the measure (alpha values ranged from .78 to .90).

Agricultural workers' return to work following spinal cord injury: a comparison with other industry workers.

PURPOSE: To investigate the impact of spinal cord injury on employment outcomes as experienced by agricultural workers in comparison with persons employed in other industries. Because of the challenges associated with working in many of the agricultural industries, it was anticipated that agricultural workers would achieve inferior return-to-work outcomes. METHOD: Survey of all employed persons who experienced a traumatic spinal cord injury in southeastern Australia between 1990 and 1996 (inclusive). RESULTS: Contrary to expectation, agricultural workers had a significantly higher rate of return to work (61.7% vs. 41.1%). However, an investigation into the hours spent working and agricultural workers' satisfaction with their employment activities, indicated that most were underemployed and had the potential to achieve even better outcomes. CONCLUSION: Results indicate that more can be done to help injured agricultural workers achieve their employment potential.

Explaining labor force status following spinal cord injury: the contribution of psychological variables.

OBJECTIVE: To investigate the relative influence of demographic, injury and psychological characteristics on the labor force status of people living with spinal cord injury. DESIGN: Cross-sectional survey. SUBJECTS: 459 persons who had experienced a traumatic spinal cord injury. All participants were patients of 1 of 2 specialist spinal cord injury services located in south-eastern Australia. METHODS: A survey, administered on average of 11.2 years after their injury, was used to collect the data. The study's main outcome measure was labor force status at the time of survey. Of those invited to participate in the study, 73% agreed to do so. RESULTS: Demographic, injury and psychological variables were found to explain 30% of the variance in the employment criterion: "in the labor force" vs "not in the labor force". Psychological variables contributed significantly to the separation of the 2 labor force groups. CONCLUSION: The inclusion of the selected psychological variables has advanced the understanding of the factors related to return to work following spinal cord injury, however this understanding is still not complete. Future efforts in this field would likely benefit from the inclusion of additional psychological characteristics, as well as environmental factors.

A social psychology approach to measuring vocational rehabilitation intervention effectiveness.

It is rare for rehabilitation researchers to report substantial relationships between functional capacity and vocational rehabilitation achievements. The reason for this is that there are many other factors that also impact on the return-to-work outcomes people achieve. A solution to the problem of having to take into consideration the effects of multiple factors when evaluating intervention effectiveness is to focus more directly on cognitions and behaviors that have been theoretically and empirically linked with a satisfactory return to work. The aim of this paper is to explore and describe a measure of rehabilitation effectiveness based in cognitive-behavioral theory. Rather than the measurement of employment per se, the described measure is focused on the efforts individuals make in relation to achieving their desired outcome. To test the effectiveness, acceptability, and utility of the approach, the measure was trialed with 170 people with a spinal cord injury. This preliminary work has revealed that participants found the measure acceptable and gave detailed responses in regards to: their satisfaction with their vocational status; what it is they would prefer to be doing; and what it is that they are doing to achieve their aims. Study findings suggest that while the approach is likely to require further development, focusing on process variables holds promise as an evaluation approach when assessing the success of vocational rehabilitation intervention effectiveness.

Measure of beliefs about improvements in mood associated with exercise.

Changes in mood following exercise are well documented; however, one particular limitation of research examining mood changes associated with exercise is that studies have not controlled for a possible expectancy effect. Given the difficulty associated with utilising a placebo control group in exercise settings and that no current questionnaires are available to measure beliefs concerning mood improvements during and after exercise, the present studies aimed to develop a suitable instrument for assessing these beliefs. In the first of these studies, 220 regular runners were respondents in developing the new scale. A logical approach to test construction, as proposed by Hase and Goldberg in 1967, produced two scales of acceptable reliability: a five-item subscale to measure beliefs concerning mood improvements during running (Cronbach alpha=.77) and a two-item subscale to measure beliefs about mood improvements following running (Cronbach alpha=.86). A second study, which involved the administration of these scales to 50 regular runners after a 60-min. treadmill run, indicated there were moderate associations between scores on these measures and mood changes during and after the run.