Defining dignity at the intersection of disability: a scoping review.

PURPOSE: This scoping literature review aimed to determine the definition of dignity in relation to disability. It also examined the extent to which inclusive research methods have been used to develop working definitions. MATERIALS AND METHODS: A comprehensive search was conducted in five electronic databases, using a modified framework by Arksey and O'Malley. Narrative synthesis and qualitative content analysis were employed to examine definitions of dignity and the use of inclusive research methods. RESULTS: 22 peer-reviewed studies were included. The majority of the studies were qualitative (72.72%) and examined various disability populations in diverse settings. Although 19 studies offered a definition of dignity, there was no clear consensus. Dignity was frequently defined from a utilitarian perspective, emphasising affordances and barriers. However, engagement with theoretical constructs was superficial and limited. Further, no studies mentioned the use of inclusive research methods. CONCLUSIONS: The absence of inclusive research methods hinders the development of a comprehensive definition of dignity that is accepted by and relevant to people with disability. Engaging with both theoretical and empirical perspectives of dignity is crucial to develop a meaningful and inclusive definition, which can inform interventions and policies that enhance dignity for people with disability across diverse settings and contexts.

The adoption of inclusive research methods in disability research should be a priority for rehabilitation researchers and clinicians to better shape research agendas, study design, and outcomes.The absence of inclusive research methods hinders the development of a comprehensive definition of dignity that is accepted by and relevant to people with disabilityThe findings emphasise the need to address dignity concerns within healthcare settings for people with disability.Rehabilitation practitioners can advocate for person-centered approaches, improved communication and increased accessibility to create dignified healthcare environments.Rehabilitation researchers and practitioners can play a pivotal role in advocating for social justice and equity by supporting policies and interventions that foster inclusive practices, dignity, and equitable opportunities for people with disability.

The Australian Traumatic Brain Injury Initiative: Single Data Dictionary to Predict Outcome for People With Moderate-Severe Traumatic Brain Injury.

In this series of eight articles, the Australian Traumatic Brain Injury Initiative (AUS-TBI) consortium describes the Australian approach used to select the common data elements collected acutely that have been shown to predict outcome following moderate-severe traumatic brain injury (TBI) across the lifespan. This article presents the unified single data dictionary, together with additional measures chosen to facilitate comparative effectiveness research and data linkage. Consultations with the AUS-TBI Lived Experience Expert Group provided insights on the merits and considerations regarding data elements for some of the study areas, as well as more general principles to guide the collection of data and the selection of meaningful measures. These are presented as a series of guiding principles and themes. The AUS-TBI Aboriginal and Torres Strait Islander Advisory Group identified a number of key points and considerations for the project approach specific to Aboriginal and Torres Strait Islander peoples, including key issues of data sovereignty and community involvement. These are outlined in the form of principles to guide selection of appropriate methodologies, data management, and governance. Implementation of the AUS-TBI approach aims to maximize ongoing data collection and linkage, to facilitate personalization of care and improved outcomes for people who experience moderate-severe TBI.

Dignity and the Importance of Acknowledgement of Personhood for People With Disability.

Exploring the intricate relationship between individual and collective experiences, this study explores dignity from the perspectives of people with disability. Using an extreme citizen science approach, we engaged people with disability as active partners in gathering data through qualitative surveys and focus groups. Framework Analysis was employed to ensure the validity of findings while privileging the voices of people with lived experience of disability. Dignity was contingent on the acknowledgement of personhood and the delivery of human rights. Our research identified five key aspects to maintain and protect dignity: (1) acknowledging personhood; (2) recognising people with disability as decision-makers of their lives; (3) realising the right to access information; (4) maintaining the right to privacy; and (5) eliminating or minimising barriers to accessibility and inclusion. Undignified experiences that resulted from a lack of acknowledgement negatively affected participants' wellbeing, and healthcare settings were identified as particularly challenging environments for dignity. These findings have significant implications for healthcare systems and services within an international and interdisciplinary context. They emphasise the need for adaptable, flexible services, co-designed with people with lived experience of disability. Addressing organisational constraints, resource limitations, and expectations is paramount to ensuring dignity is maintained through the acknowledgement of personhood and safeguarding of human rights.

Impact of information and deliberation on the consistency of preferences for prioritization in health care - evidence from discrete choice experiments undertaken alongside citizens' juries.

BACKGROUND: Public preferences are an important consideration for priority-setting. Critics suggest preferences of the public who are potentially naïve to the issue under consideration may lead to sub-optimal decisions. We assessed the impact of information and deliberation via a Citizens' Jury (CJ) or preference elicitation methods (Discrete Choice Experiment, DCE) on preferences for prioritizing access to bariatric surgery. METHODS: Preferences for seven prioritization criteria (e.g. obesity level, obesity-related comorbidities) were elicited from three groups who completed a DCE: (i) participants from two CJs (n = 28); (ii) controls who did not participate in the jury (n = 21); (iii) population sample (n = 1,994). Participants in the jury and control groups completed the DCE pre- and post-jury. DCE data were analyzed using multinomial logit models to derive "priority weights" for criteria for access to surgery. The rank order of criteria was compared across groups, time points and CJ recommendations. RESULTS: The extent to which the criteria were considered important were broadly consistent across groups and were similar to jury recommendations but with variation in the rank order. Preferences of jurors but not controls were more differentiated (that is, criteria were assigned a greater range of priority weights) after than before the jury. Juror preferences pre-jury were similar to that of the public but appeared to change during the course of the jury with greater priority given to a person with comorbidity. Conversely, controls appeared to give a lower priority to those with comorbidity and higher priority to treating very severe obesity after than before the jury. CONCLUSION: Being informed and undertaking deliberation had little impact on the criteria that were considered to be relevant for prioritizing access to bariatric surgery but may have a small impact on the relative importance of criteria. CJs may clarify underlying rationale but may not provide substantially different prioritization recommendations compared to a DCE.

Public preferences are an important consideration for priority-setting. However, some people worry that if the public doesn't know much about the issues, their opinions might not lead to the best decisions. To make these decisions, we used two different methods to get people's opinions: Deliberative methods and preference elicitation methods. Deliberative methods gather a small group of people and have them discuss an issue in detail, whereas preference elicitation methods seek opinions through surveying a large group of people.In this paper, we assessed the impact of information and deliberation via a deliberative method (Citizens' Jury, CJ) or a preference elicitation method (Discrete Choice Experiment, DCE) on preferences for prioritising access to bariatric surgery. We used data from two CJs and a DCE focussed on prioritising access to the surgery, to find out if the opinions of those in the CJs changed or stayed the same after they heard information from experts and discussed the topic.The results showed that the important criteria were rather similar across the groups, but the order of importance was a bit different. The people in CJs had more varied opinions after discussing it, while those who didn't discuss it had less varied opinions. The participants in CJs also prioritized those with other health problems more than they did at the beginning.This study helps us understand how different methods can be used to get the public's opinions on healthcare decisions.

A technology-focused service within a rehabilitation setting: exploring the experiences and current technology demands of people with disabilities.

PURPOSE: To understand and combat the challenges in taking up and implementing technology in rehabilitation settings, the HabITec Lab, a clinical service focused on technology, was piloted for 12-months within a tertiary hospital. This article reports on its preliminary impacts as a clinical service and on clients, including the types of assistive technology (AT) in demand. MATERIALS AND METHODS: Referral and administrative data from 25 individuals who attended the HabITec Lab were collated and analysed using descriptive statistics. For those who attended more than once (n = 12), goal attainment was assessed using the Modified Goal Attainment Measure (MGAM). Post-intervention semi-structured interviews were completed with participants to understand their experience at the HabITec Lab. Interviews were analysed using thematic analysis. RESULTS: Most attendees (92%) were undergoing inpatient rehabilitation following a spinal cord injury (SCI). The majority (73%) of goals related to improving entertainment and connection. All participants who completed the MGAM showed improved goal attainment following their HabITec Lab attendance. Qualitative data highlighted appreciation for the service and suggestions for its future. CONCLUSIONS: This study revealed a high level of demand for support to use AT amongst individuals with SCI, particularly consumer-grade smart devices that could assist communication. This finding may have been influenced by the impacts of the COVID-19 pandemic and frequent lockdowns during this period. This study indicated that the HabITec Lab was able to address important goals for attendees, but also illuminate a new future and trigger enthusiasm about future goals. Attendance was liberating, but resourcing barriers were frustrating.IMPLICATIONS FOR REHABILITATIONDedicated socio-technological spaces such as HabITec are an important way to provide access to expertise and develop consumer knowledge of technology not adequately addressed elsewhere in the rehabilitation continuum.Access to technological support for individuals in the inpatient setting facilitates access to technology in the present and capacity building to foster ongoing use of technology in the future.Dedicated socio-technological spaces should be adequately resourced, funded, staffed and promoted to ensure optimal outcomes.Access to Smart devices within the inpatient rehabilitation setting is critical for people with spinal cord injury to foster communication with family, friends and communities.

Unveiling the dark side of glucose-regulated protein 78 (GRP78) in cancers and other human pathology: a systematic review.

Glucose-Regulated Protein 78 (GRP78) is a chaperone protein that is predominantly expressed in the lumen of the endoplasmic reticulum. GRP78 plays a crucial role in protein folding by assisting in the assembly of misfolded proteins. Under cellular stress conditions, GRP78 can translocate to the cell surface (csGRP78) were it interacts with different ligands to initiate various intracellular pathways. The expression of csGRP78 has been associated with tumor initiation and progression of multiple cancer types. This review provides a comprehensive analysis of the existing evidence on the roles of GRP78 in various types of cancer and other human pathology. Additionally, the review discusses the current understanding of the mechanisms underlying GRP78's involvement in tumorigenesis and cancer advancement. Furthermore, we highlight recent innovative approaches employed in downregulating GRP78 expression in cancers as a potential therapeutic target.

Scoping review of return-to-work interventions for persons with traumatic brain injury.

PURPOSE: The study approach sought to understand which vocational rehabilitation (VR) strategies are available for individuals seeking return to work (RTW) following traumatic brain injury (TBI). Secondly, the review aimed to identify how these RTW interventions and outcomes are evaluated. MATERIALS AND METHODS: Using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) approach, the scoping review began by identifying relevant English language articles via PubMed, CINAHL, PsycINFO, and Embase databases for peer-reviewed journal articles published from January 2013 to September 2021. The review focused on identifying studies with a sample population of people with moderate to severe TBI. RESULTS: A total of 23 studies met the search criteria. For each included study, the following data were extracted: (a) country of origin, (b) sample size, (c) civilian or military sample population, (d) age, (e) participant gender, (f) RTW definition, (g) intervention approach, and (h) RTW outcome. The results were synthesized by placement into one of four categories as a function of the study's underlying methodological approach. CONCLUSIONS: The development of effective RTW approaches has largely been neglected in the rehabilitation literature for persons with TBI in civilian and military populations. Effective strategies do exist to help guide efforts to return this population to productive activity, including work.Implications for RehabilitationLack of productive engagement in work and school among persons with traumatic brain injury (TBI) presents a chronic challenge in rehabilitation systems internationally.Rehabilitation professionals should utilize multidisciplinary and integrated return-to-work (RTW) interventions given the varied areas of function that can result from TBI.Rehabilitation professionals should apply RTW interventions that promote on-site training and workplace integration.Given the idiosyncratic nature of TBI, RTW interventions should be tailored to meet the specific needs of the person seeking support.

Patients' experiences with rehabilitation care: a qualitative study to inform patient-centred outcomes.

PURPOSE: To explore patients' experiences with rehabilitation, with a particular focus on outcomes that are perceived to be of value. MATERIALS AND METHODS: Semi structured interviews were conducted with adults who recently had rehabilitation for a chronic health condition in a hospital or community setting. Banja's definition of rehabilitation (personally fulfilling, socially meaningful and functionally effective) informed the enquiry and interpretation of the findings. Thematic analysis was used to categorise the data into codes and themes. RESULTS: 16 people (40-84 years, 69% male, n = 11) participated in individual telephone-interviews, describing their perspectives on what mattered to them about rehabilitation. The themes generated from the data suggested that participants focused on important social, functional and personal outcomes, but also required two fundamental features in their rehabilitation, namely a personalised and relational experience and a clear understanding of their own progress delivered in a way that is meaningful to them. CONCLUSIONS: People who undertake rehabilitation express diverse expectations when assessing their outcomes and progress, although common elements could be identified. Participants valued a number of key features about the delivery and evaluation of their rehabilitation. These features revolved around the personalisation of the process and having clarity about progress.Implications for rehabilitationRehabilitation therapists should encourage ongoing personalised discussions about progress to promote clear and shared understanding of what clients and therapists expect, alongside the use of current available measures.Rehabilitation therapists should consider providing opportunities for participants to self-reflect about their experiences and modify their goals based on personal progress and deeper understanding of their circumstances.Rehabilitation therapists should consider assessing the extent to which the individual feels satisfied with and capable of achieving these outcomes before departing from the rehabilitation service.Overall, rehabilitation teams should think about spending more time with the patient to prioritise and understand their individual goals and values.

The attention atlas virtual reality platform maps three-dimensional (3D) attention in unilateral spatial neglect patients: a protocol.

BACKGROUND: Deficits in visuospatial attention, known as neglect, are common following brain injury, but underdiagnosed and poorly treated, resulting in long-term cognitive disability. In clinical settings, neglect is often assessed using simple pen-and-paper tests. While convenient, these cannot characterise the full spectrum of neglect. This protocol reports a research programme that compares traditional neglect assessments with a novel virtual reality attention assessment platform: The Attention Atlas (AA). METHODS/DESIGN: The AA was codesigned by researchers and clinicians to meet the clinical need for improved neglect assessment. The AA uses a visual search paradigm to map the attended space in three dimensions and seeks to identify the optimal parameters that best distinguish neglect from non-neglect, and the spectrum of neglect, by providing near-time feedback to clinicians on system-level behavioural performance. A series of experiments will address procedural, scientific, patient, and clinical feasibility domains. RESULTS: Analyses focuses on descriptive measures of reaction time, accuracy data for target localisation, and histogram-based raycast attentional mapping analysis; which measures the individual's orientation in space, and inter- and intra-individual variation of visuospatial attention. We will compare neglect and control data using parametric between-subjects analyses. We present example individual-level results produced in near-time during visual search. CONCLUSIONS: The development and validation of the AA is part of a new generation of translational neuroscience that exploits the latest advances in technology and brain science, including technology repurposed from the consumer gaming market. This approach to rehabilitation has the potential for highly accurate, highly engaging, personalised care.

An undignified disaster reality for Australians with disability.

The United Nations Convention on the Rights of Persons with Disabilities and the Sendai Framework for Disaster Risk Management establish the importance of ensuring the equitable protection of human rights in disaster planning, relief, and recovery. However, internationally and within Australia, the reality is one of indignity, human rights violations, and corruption. Australia is living in a perpetual state of crisis, following 3years of environmental and health disaster events. Vulnerable Australian citizens, especially people with disability, are at a great risk of human rights violations and may have restricted access to resilience-building resources that would enable them to recover. Embedding dignity into disaster management and recovery can safeguard human rights and improve outcomes for people with disability.

The Dignity Project Framework: An extreme citizen science framework in occupational therapy and rehabilitation research.

INTRODUCTION: Engaging citizens and patients as research partners is receiving increasing emphasis across disciplines, because citizens are untapped resources for solving complex problems. Occupational therapists are engaging in inclusive research, but not always in equitable partnership. Moving beyond inclusive research to a dignified framework for research prioritises lived experience and human rights in health research. METHODS: Using nominal group technique over a series of three working group meetings, eight experts, including three with lived experience of disability and research, prioritised principles and steps for conducting dignified rehabilitation research in partnership with citizens with disability. FINDINGS: Embedding transparency, accessibility and inclusion, dignified language, and authenticity throughout research were integral to maintaining dignity and safety for citizens with disability engaged in research. The Dignity Project Framework encompasses five phases, namely, (1) vision, (2) uncover, (3) discuss, (4) critical reflection, and (5) change, which address the prominent criticisms of the disability community about research and embed the principles of importance into research practice. CONCLUSION: The framework builds on inclusive research frameworks to a human rights-based, dignified framework for extreme citizen science. Grounding disability in contemporary conceptualisations and providing a method for democratising knowledge production provide occupational therapists with a method for dignified partnership with citizens with disability.

Preferred Self-Administered Questionnaires to Assess Resilience, Optimism, Pain Acceptance, and Social Support in People with Pain: A Modified Delphi Study.

OBJECTIVES: The plethora of self-administered questionnaires to assess positive psychosocial factors complicates questionnaire selection. This study aimed to identify and reach consensus on the most suitable self-administered questionnaires to assess resilience, optimism, pain acceptance and social support in people with pain. DESIGN: A three-round modified Delphi study. PARTICIPANTS: Forty international experts. METHODS: In Round 1, the experts suggested questionnaires deemed appropriate to assess resilience, optimism, pain acceptance and/or social support. In Round 2, experts indicated whether they considered the suggested questionnaires to be suitable (Yes/No/Don't know) to assess these psychosocial factors, taking into consideration content, feasibility, personal experience and the measurement properties which we provided for each questionnaire. Questionnaires that were considered suitable by the majority of experts (≥60%) were retained for Round 3. In Round 3, the suitability of each questionnaire was rated on a 0-10 Likert scale. Consensus was reached if ≥75% of experts rated the questionnaire ≥7. RESULTS: From the 67 questionnaires suggested in Round 1, one questionnaire could be recommended per domain. For resilience: Pain Resilience Scale; for optimism: Revised Version of the Life Orientation Test; for pain acceptance: 8-item and Revised Versions of the Chronic Pain Acceptance Questionnaire; for social support: Emotional Support Item Bank of the PROMIS tool. Consensus for these questionnaires was also reached in a sensitivity analysis which excluded the ratings of experts involved in the development, translation and/or validation of relevant questionnaires. CONCLUSION: We advocate the use of these recommended questionnaires so data can be compared and pooled more easily.

The influence of personal factors, unmet need and service obstacles on the relationship between health service use and outcome after brain injury.

BACKGROUND: This exploratory study aimed to: (i) examine the relationship between health service use and quality of life, psychological wellbeing, global function and participation after discharge from brain injury inpatient rehabilitation, and (ii) determine the influence of personal factors, unmet need for services and service obstacles on the relationship between service use and these outcomes. METHODS: Using a prospective cohort design, 41 adults with acquired brain injury (median age = 46 years; 71% male; 61% severe traumatic injury) were followed for 6-months after discharge from specialist brain injury inpatient rehabilitation. Service use was continuously recorded and obtained through data linkage methods, focusing on the use of: outpatient medical services, outpatient nursing, outpatient allied health; medical acute services; incidents of re-hospitalization; and transitional rehabilitation service use. Outcome questionnaire measures were completed via telephone, at 6-months after discharge, and included: the EuroQol-5D; Depression Anxiety and Stress Scale, Mayo-Portland Adaptability Inventory and Sydney Psychosocial Reintegration Scale. Data were analyzed in a heterogeneous treatment effects framework, using Bayesian Additive Regression Trees. RESULTS: There was weak evidence that transitional rehabilitation service use was associated with better psychological wellbeing scores. The posterior probability of lower depression, anxiety and stress scores was .87, .81 and .86, respectively (average treatment effect). There was also weak evidence that re-hospitalization was associated with worse independent living skills scores. The posterior probability of worse scores was .87. However, most re-hospitalizations were due to unavoidable medical complications. We did not find that place of residence at discharge, marital status, unmet need, or service obstacles affected the relationship between service use and the studied outcomes. CONCLUSIONS: This study may highlight the importance of participation in transitional rehabilitation, in the 6-months after discharge from brain injury rehabilitation. Replication in a larger sample size is required to confirm these findings.

Practicing in a person-centred environment - self-help groups in psycho-social rehabilitation.

AIM: The increasing prevalence of chronic conditions and impairments in the population is putting new demands on health and rehabilitation services. Research on self-help groups suggest that participation in these groups might have a positive impact on people who are struggling with chronic illnesses or disabilities. In this study, we explore person-centred support in which participants in self-help groups are undergoing rehabilitation to develop their knowledge, skills and confidence necessary to handle life's challenges. METHOD: The design is exploratory, analysing data from informant interviews and focus groups (a total of 32 participants) using a Grounded Theory inspired approach to analyse. The participants were rehabilitation clients aged between 20 and 60 years; eight were men and twenty-six were women. RESULTS: Three main categories emerged as being important self-help processes that were likely to promote positive rehabilitation outcomes: (1) Learning and practicing safely, (2) A refuge from expectations, (3) Internal processes that accentuate the positives. CONCLUSION: Peer support delivered through the structured self-help environment can facilitate the development of new self-awareness, promote acceptance and adjustment, facilitate the establishment of new skills and enable transfer of learning to new environments, including the workplace.IMPLICATIONS FOR REHABILITATIONSelf-help groups may support the process of rehabilitation.Participating in self-help groups provides an enabling context for individuals to address challenges and limitations.Peer support delivered through the structured self-help environment can facilitate the development of new self-awareness, promote adjustment, and facilitate the establishment of new skills.Participating in peer led self-help groups can assist with the transfer of learning to new environments, including development of potential work capacity.

Does being psychologically resilient assist in optimising physical outcomes from a spinal cord injury? Findings from a systematic scoping review.

PURPOSE: To systematically search for current research on the role of resilience in the physical rehabilitation of SCI and describe the research to date. MATERIALS AND METHODS: The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) approach was used. Five databases were searched for papers published up to March 2020. The sample included adults who have sustained an SCI; outcomes included a physical rehabilitation outcome and a measure of psychological or personal resilience/resilience training. RESULTS: The initial search found 2074 studies. 12 studies were included. Six suggest positive effects of resilience on physical functioning/recovery, six report resilience as not affecting physical functioning/recovery. CONCLUSIONS: Resilience may positively affect physical outcomes; however, the relationship is under-researched and contrasting findings may be due to measurements and methods employed by research. Future research may distinguish between two sources of resilience following an SCI: prior resilient experiences, and resilience as a product of the injury. Individuals' past events that triggered resilient behaviour may be able to promote a resilient response to an SCI. Focussing on emotional coping may result in poorer outcomes than building a sense of control. Resilience training may affect psychosocial rehabilitation; it is difficult to establish if it would affect physical outcomes. A negative approach to an injury can have negative effects on functioning; when identifying patients for psychoeducational training, those with the presence of negative appraisals of their injury are most in need.IMPLICATIONS FOR REHABILITATIONResilience may positively affect physical outcomes; however, the relationship is under-researched.Individuals' past events that triggered resilient behaviour may be able to promote a resilient response to an SCI.Focussing on emotional coping may result in poorer outcomes than building a sense of control.When identifying patients for psychoeducational training, it may be those with the presence of negative appraisals of their injury that are most in need.

The impact of obstacles to health and rehabilitation services on functioning and disability: a prospective survey on the 12-months after discharge from specialist rehabilitation for acquired brain injury.

PURPOSE: Little is known about obstacles to health and rehabilitation services experienced by people with acquired brain injury (ABI) over time and what impact these have on recovery. This study utilised the International Classification of Functioning, Disability, and Health model to better understand the impact of service obstacles. The aims were: (1) describe and compare service obstacles reported in the 12-months post-discharge from inpatient rehabilitation; (2) examine service obstacles as a moderator of the relationship between functional impairment and activities and participation. MATERIALS AND METHODS: Prospective survey of 41 people who received ABI inpatient rehabilitation in Queensland, Australia. Validated self-report measures of service obstacles, functional impairment, and activities and participation were administered at 6- and 12-months post-discharge. RESULTS: Transportation was the highest-rated obstacle at 6-months post-discharge, and this decreased at 12-months. Dissatisfaction with treatment resources and financial obstacles were, on average, low-to-moderate and remained constant. Specifically, the moderation analyses showed that financial obstacles may exacerbate the negative impact of functional impairment on independent living skills. CONCLUSIONS: Our findings suggest that people living in Queensland, Australia, who experience financial obstacles to services after brain injury may be at risk of poorer recovery outcomes. Rehabilitation policy should consider prioritising individuals who experience financial obstacles to accessing services.IMPLICATIONS FOR REHABILITATIONIn Queensland, Australia, financial obstacles to accessing health services after brain injury may exacerbate the negative impact of functional impairment on independent living skills, in the first 12-months after hospital discharge.There may be a need to prioritize rehabilitation policy that targets individuals who experience financial obstacles to accessing health and rehabilitation services, after brain injury, irrespective of a health system's potential to enable access.

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.

The Horse as a Therapist: Effects of an Equine Program Without "Therapy" on the Attention and Behavior of Youth Disengaged from Traditional School.

Background: Equine-assisted therapy may promote positive behavior change in young people "at risk." However, it is not always clear what therapeutic content is involved and if a trained therapist is included. The therapeutic effects of the key part of the "therapy," the horse, are not understood. Objectives: To investigate the impact of an equine program without a therapist on attention and behavioral outcomes of young people "at risk." Design: A within subjects pre-post design. A small sample also completed a control period. Setting/location: A small riding center in a rural area of outer Brisbane, Australia. Subjects: Twelve- to 17-year olds (N = 50; 20 girls; mean age 13.88), attending nontraditional flexischool. Intervention: A 5-week program of 2-h long sessions of equine activities that did not include a trained therapist or specific therapeutic content. Outcome measures: Teacher-report measures of externalizing and internalizing behavior were reported before and after the program through the Behavioral Rating Inventory of Executive Function (BRIEF) and the Strength and Difficulties Questionnaire (SDQ). Results: A paired samples t test resulted in the statistically significant reduction of the BRIEF Global Executive Score between pre and post participation in the equine program (mean difference = -5.89), t(36) = -3.377, p = 0.002 and the SDQ Hyperactivity score (mean difference = -0.727), t(43) = -2.244, p = 0.030. Equine activities may reverse a trajectory of worsening problems. This may especially affect symptoms related to attention deficit hyperactivity disorder. Conclusion: Equine programs may offer an alternative method to reduce poor behavior and improve attention in young people. Benefits in attention may occur even without specific therapeutic content or therapist involvement. It is proposed that some of these benefits come directly from the horse and the interactions with the horse; others are contextual.

Immediate and Long-Term Implications of the COVID-19 Pandemic for People With Disabilities.

Some people with disabilities may have greater risk of contracting COVID-19 or experiencing worse outcomes if infected. Although COVID-19 is a genuine threat for people with disabilities, they also fear decisions that might limit lifesaving treatment should they contract the virus.During a pandemic, health systems must manage excess demand for treatment, and governments must enact heavy restrictions on their citizens to prevent transmission. Both actions can have a negative impact on people with disabilities.Ironically, the sociotechnical advances prompted by this pandemic could also revolutionize quality of life and participation for people with disabilities. Preparation for future disasters requires careful consideration.

"She'll be right, mate!": do Australians take their health for granted?

INTRODUCTION Health consciousness highlights the readiness of individuals to undertake health actions and take responsibility for their health and the health of others. AIM To examine the health consciousness of Australians and its association with health status, health-care utilisation and sociodemographic factors. METHODS This quantitative cross-sectional study was a part of a larger project aiming to engage the general public in health-care decision-making. Adults from Queensland and South Australia (n=1529) were recruited to participate by a panel company. The questionnaire included the Health Consciousness Scale (HCS), health status, health-care utilisation, sociodemographic and socioeconomic variables. RESULTS The health consciousness of Australians was relatively low (mean score=21), compared to other international administrations of the HCS, and further investigations revealed that more health-conscious people tended to live in South Australia, be female and single, experience poorer physical and mental health and were more frequent users of health-care services. DISCUSSION The general approach to health in this sample of the Australian public may reflect 'here and now' concerns. It appears that an attitude of 'she'll be right, mate' prevails until a change in an individual's health status or their exposure to the health system demands otherwise. These findings need to be investigated further to see if they are confirmed by others and to clarify the implications for primary health programmes in Australia in redressing the public's apparent apathy.