Research capacity and culture among hand therapists in Australia: A cross-sectional survey.

BACKGROUND: Identifying the factors influencing engagement in research capacity and culture (RCC) in hand therapy practice is essential to inform strategies to support contributions to high-quality research and its implementation in clinical practice. However, the RCC of clinicians providing hand therapy services in Australia has not been investigated. PURPOSE: This study aimed to measure RCC among hand therapists in Australia to identify perceived barriers, motivators, and skills related to undertaking research. STUDY DESIGN: Cross-sectional survey. METHODS: All Australian Hand Therapy Association members were invited to complete the RCC tool, which includes three domains: i) individual, ii) professional group (team), and iii) organization. RESULTS: One hundred twenty-two therapists (13.6% response rate) completed the survey. Survey findings indicate that the RCC of hand therapists in Australia is relatively low across all RCC domains, with scores on these items being either moderate or low. The findings from this study suggest that the areas or skills that respondents felt most confident with were more closely aligned to the clinical skills required as evidence-based practitioners, compared to other skills more closely aligned with the clinician-researchers, such as data analysis or writing proposals. CONCLUSIONS: Hand therapists in Australia may not possess the research experience or skills required to confidently complete a range of research-related activities. Future support strategies should focus on improving hand therapist knowledge and confidence regarding common research tasks and provide funding and mentoring for additional hand therapist clinician-researcher roles.

Psychometric evaluation of the culturally adapted interprofessional socialisation and valuing scale (ISVS)-19 for health practitioners and students in Indonesia.

We aimed to develop a culturally appropriate psychometrically robust measure for assessing interprofessional socialization for health practitioners and students in Indonesia. The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) were used as guidelines. Our study was organized in three phases (a) translation, (b) cross-cultural validation by evaluating the content validity and internal structure of the translated instrument (i.e. structural validity, internal consistency reliability, and measurement invariances), and (c) hypotheses testing for construct validity. A total of 266 health practitioners and 206 students from various professional backgrounds participated. The Indonesian ISVS-19 was confirmed unidimensional. Content validity evaluation confirmed the inclusion of relevant, understandable items and was comprehensive. Factor analysis supported removal of two items. Configural, metric, and scalar tests confirmed the invariance of the 1-Factor 19-Items model in practitioner and student cohorts. Age was a differentiating factor in both cohorts; length of work was only significant for practitioners, and educational background was significant for students (80% of assumptions were accepted, fulfilling COSMIN requirement for construct validity). The Indonesian ISVS-19 has good psychometric properties regarding content validity, internal structure, and construct validity and, therefore, is a psychometrically robust measure for assessing interprofessional socialization for health practitioners and students in Indonesia.

An evaluation of intervention appropriateness from the perspective of parents: A peer-mediated, play-based intervention for children with ADHD.

INTRODUCTION: A peer-mediated, play-based intervention has been developed to address social participation challenges experienced by children with ADHD. To facilitate implementation into clinical practice, interventions should be evaluated for appropriateness to the end-user, as well as effectiveness. Previous research demonstrated the approach is effective for improving children's social play skills. This study aimed to evaluate the appropriateness of the intervention for children with ADHD and their families. METHODS: Parents of children with ADHD who participated in the play-based intervention were interviewed 1 month after completion. Parents were asked about their perspective of parent and children's experiences of the intervention, the perceived benefits for children and parents, the logistics of participating, and recommended adaptations to the intervention. Interviews were analysed thematically, and themes were mapped to the elements of the adopted definition of appropriateness to understand whether parents supported the appropriateness of the intervention for their families. CONSUMER AND COMMUNITY INVOLVEMENT: Consumers were not directly involved in the decisions made about this study. FINDINGS: One core theme, 'collaborative efforts', emerged from the data. Major themes comprising the core theme were 'on the same page', 'therapeutic relationship', and 'getting the job done'. Three sub-themes of 'engagement and motivation', 'the effort was worth it for the reward', and 'Rome wasn't built in a day' were nested within the major themes. CONCLUSION: Parents largely supported the appropriateness of the intervention, indicating it addressed an important goal for their child, participation was a positive experience, and they perceived the intervention to be beneficial. Future adaptions of the intervention are needed to increase its ecological validity and to generalise the strategies to other social environments and playmates, such as peers at school. PLAIN LANGUAGE SUMMARY: This study looked at an intervention that uses play with peers to help children with ADHD develop their play skills. The researchers wanted to know if parents thought the intervention was a good fit for their families and if it helped their children. Parents gave an interview a month after the intervention ended. They were asked about their thoughts on the intervention, how it helped their children and themselves, how easy it was to take part, and what changes could be made to make the intervention better. After analysing parents' answers, the researchers found parents mostly agreed that the intervention was a good fit. They said it helped their children to play with their peers, and they had a good time doing it. Parents thought the intervention was helpful, they liked that it was a joint effort between them and the occupational therapist, and they felt it was worth the effort. However, they also suggested some changes. They wanted the intervention to fit into other real-life social situations, such as school, so their children could use the skills they learned in other places. Overall, parents thought the intervention was helpful and suitable for their children and themselves, but some changes might make it more helpful.

Hand therapy role in return to work for patients with hand and upper limb conditions.

STUDY DESIGN: Electronic Web-based survey INTRODUCTION: Evidence supports the use of health-focused interventions combined with service coordination and work modification components to reduce the individual, community, and societal burden associated with acute and chronic musculoskeletal conditions. The levels of engagement, skill, and confidence of Australian hand therapists in assisting their patients to return to work (RTW) are currently unknown. PURPOSE OF THE STUDY: To identify current practices, skill, and the need for additional training in management of the RTW process from a sample of Australian hand therapists. METHODS: An electronic survey was sent to current members of the Australian Hand Therapy Association. Data collected included training and/or professional experience, caseload and/or workplace, scope of and barriers to vocational practice, and satisfaction with own contribution to the RTW process for patients. RESULTS: A total of 99 individual responses (12.4% of total membership) were included, with most indicating a limited role in the RTW process. Only 52.7% said they regularly monitored and adjusted their patients' RTW program. Most plans were informed by formal tests of underlying body structure and function components rather than the patient's ability to perform of a specific work role or task. Median satisfaction with the quality of RTW service they provided was 6 of 10, with 42% scoring ≤ 5 of 10, indicating considerable scope for improvement. CONCLUSIONS: Practice patterns are described for planning and monitoring RTW, and these did not always align with the evidence-base. Further exploration of clinician barriers to implementing RTW interventions is warranted, as is upskilling for those indicating a lack of confidence in this field.

Barriers and facilitating factors influencing implementation of occupational therapy home assessment recommendations: A mixed methods systematic review.

INTRODUCTION: Low implementation rates of occupational therapy home assessment recommendations have previously been reported. The objective was to identify and describe the barriers and facilitating factors that influence implementation of home assessment recommendations. METHODS: A mixed methods systematic review consisting of studies involving adults living in the community who received an occupational therapy home assessment was conducted. Seven databases were last searched in August 2021. Study quality was assessed using the Joanna Briggs Institute (JBI) critical appraisal tools (SUMARI) dependent on study design. Data synthesis followed the convergent integrated approach. Findings were mapped to the theoretical Capability Opportunity Motivation Behaviour (COM-B) model of health behaviour change. RESULTS: From 5,540 citations, 22 articles met the criteria for the systematic review. Implementation of occupational therapy home assessment recommendations ranged between 55% and 90%. Six synthesised findings were identified. Capability barriers included a patient's cognitive and physical ability. Motivation barriers included a perceived lack of need and stigma; patient reported decreased involvement and lack of choice. Opportunity barriers included limited family or carer involvement, carer stress, level of service provision available, including funding, therapy dosage and timing and environmental restrictions. Overall facilitators included patient-centred care, including choice and understanding need, individualised tailored recommendations, involvement of families and carers, provision of written record and strategies to support implementation. Results were limited by methodological weaknesses in identified studies and heterogeneity in the definition and measurement of implementation impacting on comparison. Specific intervention components were often poorly described. CONCLUSION: The theoretical model elucidates priority factors to address for promoting implementation of home assessment recommendations. Future high-quality research clearly defining intervention components is required to support short- and long-term implementation of recommendations in the home environment. Behaviour change techniques could be utilised to support home assessment practices in future research.

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

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

Parent-Mediated Intervention Training Delivered Remotely for Children With Autism Spectrum Disorder Living Outside of Urban Areas: Systematic Review.

BACKGROUND: Parent training programs for families living outside of urban areas can be used to improve the social behavior and communication skills in children with autism spectrum disorder (ASD). However, no review has been conducted to investigate these programs. OBJECTIVE: The aim of this study was to (1) systematically review the existing evidence presented by studies on parent-mediated intervention training, delivered remotely for parents having children with ASD and living outside of urban areas; (2) provide an overview of current parent training interventions used with this population; (3) and provide an overview of the method of delivery of the parent training interventions used with this population. METHODS: Guided by the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement, we conducted a comprehensive review across 5 electronic databases (CINAHL, Embase, ERIC, PsycINFO, and Pubmed) on July 4, 2016, searching for studies investigating parent-mediated intervention training for families living outside of urban centers who have a child diagnosed with ASD. Two independent researchers reviewed the articles for inclusion, and assessment of methodological quality was based on the Kmet appraisal checklist. RESULTS: Seven studies met the eligibility criteria, including 2 prepost cohort studies, 3 multiple baseline studies, and 2 randomized controlled trials (RCTs). Interventions included mostly self-guided websites: with and without therapist assistance (n=6), with training videos, written training manuals, and videoconferencing. Post intervention, studies reported significant improvements (P<.05) in parent knowledge (n=4), parent intervention fidelity (n=6), and improvements in children's social behavior and communication skills (n=3). A high risk of bias existed within all of the studies because of a range of factors including small sample sizes, limited use of standardized outcome measures, and a lack of control groups to negate confounding factors. CONCLUSIONS: There is preliminary evidence that parent-mediated intervention training delivered remotely may improve parent knowledge, increase parent intervention fidelity, and improve the social behavior and communication skills for children with ASD. A low number of RCTs, difficulty in defining the locality of the population, and a paucity of standardized measures limit the generalization of the findings to the target population. Future studies should investigate the appropriateness and feasibility of the interventions, include RCTs to control for bias, and utilize standard outcome measures.

Patient specific methods for room-mounted x-ray imagers for monoscopic/stereoscopic prostate motion monitoring.

PURPOSE: To investigate the improvement of combined monoscopic/stereoscopic prostate motion monitoring with room-mounted dual x-ray systems by adopting patient specific methods. METHODS: The linac couch was used as a motion stage to simulate 40 highly dynamic real patient prostate trajectories. For each trajectory, 40 s pretreatment and 120 s treatment periods were extracted to represent a typical treatment fraction. Motion was monitored via continuous stereoscopic x-ray imaging of a single gold fiducial and images were retrospectively divided into periods of stereoscopic and monoscopic imaging to simulate periodic blocking of the room-mounted system by the gantry during arc-based therapy. The accuracy of the combined motion monitoring was assessed by comparison with the linac couch log files. To estimate 3-D marker position during monoscopic imaging, the use of population statistics was compared to both maximum likelihood estimation and stereoscopic localization based estimation of individualized prostate probability density functions (PDFs) from the pretreatment period. The inclusion of intrafraction updating was compared to pretreatment initialization alone. RESULTS: Combined mono/stereoscopic localization was successfully implemented. During the transitions from stereoscopic to monoscopic imaging, fiducial localization exhibits sharp discontinuities when population PDFs were employed. Patient specific PDFs successfully reduced the localization error when estimated from stereoscopic localizations, whereas maximum likelihood estimation (MLE) was too unstable in the room-mounted geometry. Intrafraction stereoscopic updating provided further increases in accuracy. Residual error tended to decrease throughout the treatment fraction, as the patient-specific PDFs became more refined. CONCLUSIONS: This is the first demonstration of toggled monoscopic/stereoscopic localization using room-mounted dual x-ray imagers, enabling continuous intrafraction motion monitoring for these systems. We showed that both pretreatment individualization and intrafraction updating should be used to provide the most accurate motion monitoring.

An evaluation of the psychometric properties of the Australian Collaborative Practice Assessment Tool.

OBJECTIVES: This study aimed to validate the Collaborative Practice Assessment Tool (CPAT) in the Australian setting and provide a quality instrument in terms of psychometric properties that can be used to measure interprofessional outcomes for both healthcare practitioners and students. The outcomes evaluated include the capacity to work in an interprofessional team, good interprofessional communication skills, leadership skills, ensuring clear division of tasks and roles in a team, effective conflict management, and being actively involved with patients and their families/communities in care. METHODS: The COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) taxonomy and standards were used as guides for evaluating the psychometric properties of the Australian CPAT, which include evaluations regarding instrument development requirements of sample target and size, content validity, internal structure (structural validity, internal consistency reliability and measurement invariance), and hypotheses testing. CPAT Australia was developed through two stages involving pilot studies and a validation study, both of which included healthcare practitioners and students as participants. A pilot study examined content validity regarding item relevance, item comprehensibility, and instrument comprehensiveness. The validation study was carried out to assess the internal structure of CPAT Australia for aspects of structural validity, internal consistency reliabilities, and configural, metric and scalar measurement invariance. The structural validity was explored using the following three steps: exploratory, confirmatory, and multi-group factor analysis. Construct validity was evaluated to confirm direct and indirect paths of assumptions based on a previously validated model. Data collected between August 2021 and May 2022. RESULTS: The content validity evaluation confirmed that all items were relevant, understandable and comprehensive for measuring interprofessional collaborative care in Australia. Three hundred ninety-nine participants contributed to the validation study (n=152 practitioners; n=247 students). The original instrument model of 8-Factor 56-Item was improved in the Australian CPAT. Two items, Item 27 (Physicians assume the ultimate responsibility) and Item 49 (Final decision rest with the physician), were consistently rejected and therefore discarded. The internal structure of the 7-Factor 54-Item solution was confirmed as a suitable model with fit indices meeting COSMIN standards for a good model in practitioner and student cohorts. Configural, metric and scalar invariances were confirmed, indicating the invariance of the instruments when used for the practitioner and student cohorts. The construct validity evaluation indicated that 81.3% of direct and indirect assumptions were accepted, fulfilling the COSMIN requirement of >75% of proposed assumptions being accepted. CONCLUSION: The Australian CPAT with a 7-factor 54-item solution was confirmed as a quality measure for assessing interprofessional education and collaborative practice for both healthcare practitioners and students in Australia with robust psychometric properties.

Assessing the research capacity and culture of allied health workforce in a national private healthcare organisation.

Objective We set out to provide a benchmark assessment of allied health professionals' research capacity and culture in a national private health care organisation, including identifying barriers and facilitators to staff participation in research. Methods All allied health professionals across 16 sites were invited to participate in an online survey, using the research capacity and culture tool from 9 May to 17 June 2022. Descriptive analysis of each demographic variable was expressed in frequencies and percentages. Differences between organisation, team and individual domains were analysed as ordinal data (scale 1-9), and a mean score and standard deviation were calculated. Results The survey was completed by 182 allied health professionals across 16 sites, with an estimated response rate of 12%. Overall results identified low levels of research support or skills at organisational and team levels and moderate levels of skills at an individual level. Respondents were motivated to participate in research 'to develop skills', for 'improved job satisfaction' and 'career advancement'. Major barriers to participation in research were 'lack of time', 'lack of resources' and 'other work roles taking priority'. Conclusion The current study fills a knowledge gap by reporting the research capacity and culture among allied health professionals in a national private healthcare organisation in Australia. This study suggests that allied health professionals in private healthcare organisations perceive less than adequate levels of support at the team and organisational levels compared to their public counterparts. However, the barriers and motivators to participate in research activities were consistent with public hospitals.

Laptop use and muscle activity in adult females: Ground sitting has lower muscular demand than using a chair.

BACKGROUND: With progressing technology in the portable computing field, laptops are now integral for work, home and social settings. Different working postures adopted by laptop users impose different loads on the relevant muscles, which can be associated with musculoskeletal discomfort in the various body regions. Some Arabic and Asian cultures adopted postures are not well investigated, particularly for the 20-30 years age-group. OBJECTIVE: This study compared muscle activity in the cervical spine, arm, and wrist among different laptop workstation setups. METHODS: In this cross-sectional study, 23 healthy female university students (age = 24.2±2.28 years, range 20-26 years) performed a standardized 10 minute typing task in four different laptop workstation setups: DESK, SOFA, GROUND sitting with back support, and laptop table (LAP-Tab). Differences between electromyography (EMG) muscle activity recorded in the trapezius (TR), cervical extensors (CE), deltoid (DEL), and wrist extensors (WE) were determined using one-way repeated ANOVA measures with a post-hoc Bonferroni test. RESULTS: Significantly higher muscle activity was observed respectively in the workstations of DESK > LAP-Tab > SOFA > GROUND. Significant differences were found between WE muscle activity and the three other muscle groups (p < 0.001). There was a significant interaction between workstations and muscle activity (F(9,264) = 3.81, p < 0.001, = 0.11), where the WE and DEL muscles showed respectively higher and lower muscle activity in all setups. CONCLUSION: Muscles showed variable activity in different workstations such that the GROUND workstation provided the minimum load, while the DESK workstation showed the maximum load on the measured muscle groups. These findings require further investigation in different cultural and gender specific groups.

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

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

Mindfulness-Based Approaches for Managing Stress, Anxiety and Depression for Health Students in Tertiary Education: a Scoping Review.

OBJECTIVES: High rates of depression, anxiety and stress are reported in tertiary health students. Mindfulness-based programs have been included in the training of health students to help them manage depression, anxiety and stress; however, to date, there has been no review of best practice implementation of mindfulness for health students. The aim of this review was to evaluate the outcomes of mindfulness-based practice for health students to inform best practice with this population. METHODS: A comprehensive search was conducted of three electronic databases (PsychINFO, Medline and Embase) guided by the five-step systematic process for conducting scoping reviews to investigate mindfulness-based intervention programs for students enrolled in a tertiary institution in a health-related course. RESULTS: Twenty-four papers met the eligibility criteria and were reviewed in detail. Findings suggested that mindfulness-based intervention approaches are useful in decreasing depression, anxiety and stress in health students; however, challenges exist in student engagement and retention. Generalization of results was limited by the heterogeneous population, intervention designs and delivery methods, as well as a lack of standardized outcome measures. CONCLUSION: The inclusion of mindfulness-based programs within tertiary curricula can be an effective approach to assist with managing depression, stress and anxiety in health students. Providing academic credit to students, improving translation of skills to working with future clients, and embedding mindfulness-based programs within the curriculum could improve engagement and retention. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s12671-021-01740-3.

Independent risk factors of carpal tunnel syndrome: Assessment of body mass index, hand, wrist and finger anthropometric measurements.

BACKGROUND: The most prevalent neuropathy in the upper extremity is carpal tunnel syndrome (CTS). A variety of related risk factors such as biomechanical exposures, body mass index (BMI), sex and hand shape are reported to be related to CTS. OBJECTIVE: We aimed to identify the role of BMI, hand, wrist and finger anthropometric dimensions in the development of CTS, and to compare these measured variables between control and CTS participants. METHODS: A cross-sectional, case control study (n = 240, CTS = 120, controls = 120) with participants recruited from a convenience sample diagnosed with CTS and referred for anthropometric measurements. The control participants were matched by age and sex. The body height, weight, hand width, hand length, wrist depth, wrist width, wrist circumference, and finger length were measured. Hand, wrist and finger indices, hand to height ratio, and BMI were calculated. Mean values of all dimensions were compared between cases and controls, and the role of independent risk factors were determined by logistic regression analysis. RESULTS: The mean BMI, age, weight, sex and height were not significant between the two groups. Among the measured dimensions and calculated indices the significantly different variables between two groups were the wrist width, wrist depth, wrist circumference, hand index, hand to height index, and wrist index. Regression analysis showed that the wrist index (ß=-1.7, p = 0.0001), wrist depth (ß=0.25, p = 0.0001) and wrist width (ß=0.21, p = 0.0001) were the strongest factors in CTS development in the sample. CONCLUSION: Wrist parameters have a strong role in predicting the development of CTS, while BMI was not confirmed as an independent risk factor.

Barriers and facilitators influencing adherence to occupational therapy home assessment recommendations: a mixed methods systematic review protocol.

OBJECTIVE: To identify and describe the barriers and facilitators that influence adherence to recommendations provided as part of an occupational therapy home assessment. INTRODUCTION: Home assessments, including environmental interventions, are commonly used by occupational therapists. Home assessment recommendations aim to support a patient's independence in their occupational roles and improve safety in the home. Research evaluating home assessments and adherence to recommended strategies is limited. However, low adherence has been associated with poorer outcomes including falls, deconditioning, and decreased function. This research aims to synthesize factors that influence adherence to home assessment recommendations. INCLUSION CRITERIA: This review will consider all qualitative and quantitative studies that report on adherence to recommendations provided during occupational therapy home assessments. Studies will include adults (>18) and/or their caregivers, who live in the community and receive an occupational therapy home assessment. METHODS: A mixed methods systematic review will be undertaken. Eight databases will be searched for studies published in English reporting on adherence following home assessments completed by occupational therapists published after January 2000. Study quality will be assessed using standardized JBI critical appraisal tools dependent on study design. Data extraction will be performed using a standardized tool, followed by data transformation. Data synthesis will follow the convergent integrated approach. All findings will be tabulated to explore factors that influence adherence. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42020159233.

A twelve-month follow-up of an information communication technology delivered intervention for children with autism spectrum disorder living in regional Australia.

This study investigated the long-term follow-up of an information communication techonology based intervention, the Therapeutic Outcomes By You application, for children with autism spectrum disorder living in regional Australia. Fifteen participants who completed a three-month randomised controlled trial of the Therapeutic Outcomes By You were assessed at least 12 months post-intervention to determine the maintenance or continued improvement of their language and social communication skills. Findings demonstrate the receptive language, social skills, pragmatic language and playfulness of children with autism spectrum disorder improved during the three-month intervention period and were maintained at least 12 months after ceasing the Therapeutic Outcomes By You app intervention.

A Randomised Controlled Trial of an Information Communication Technology Delivered Intervention for Children with Autism Spectrum Disorder Living in Regional Australia.

This exploratory randomised controlled trial tested the effectiveness of a tablet-based information communication technology early intervention application to augment existing therapy with the aim of improving visual motor, imitation, language and social skills in young children with ASD who reside in regional areas. Fifty-nine participants were recruited and randomised to either a therapy-as-usual group or intervention group. With the exception of the expressive language subscale on the Mullen Scales of Early Learning, no significant between-group differences were recorded for visual motor, imitation, receptive language and social skills of participants between baseline and post-intervention. When all participants were pooled and measured over time, improvements were shown in receptive and pragmatic language and social skills; these gains were maintained, thus suggesting skill acquisition.

Appropriateness of the TOBY Application, an iPad Intervention for Children with Autism Spectrum Disorder: A Thematic Approach.

This study aimed to explore the appropriateness of an ICT intervention, the Therapeutic Outcomes by You application (TOBY app), from the perspectives of the parents. Parental experiences of twenty-four parents of a child with ASD who had participated in a three-month trial using the TOBY app were collected using semi-structured interviews. Thematic analysis was conducted and themes were mapped against an appropriateness framework. Collectively, parents felt the TOBY app was relevant and important to them and their children's needs, while expressing partial support of the TOBY app as: a positive experience for them and their children, beneficial for them and their children, a socially and ecological valid intervention, and an intervention that supported change and continuation in the skills learnt.

Factors associated with stress in families of children with autism spectrum disorder.

PURPOSE: The purpose of this study was to identify key factors associated with severe stress in families raising a child with autism spectrum disorder (ASD). METHODS: Questionnaires were mailed to families with one or more children with a diagnosis of ASD. Data from 543 surveys were analyzed using univariate and multivariate logistic regression. RESULTS: Forty-four percent (n = 241) of the caregivers reported severe family stress related to raising a child with ASD. Severe family stress was associated with (1) reduced ability to socialize; (2) not having accessed individual therapy; (3) negative co-parent relationships; and (4) high out of pockets costs due to the child's ASD. The specific ASD diagnosis, comorbid conditions, socio-demographic variables, and social support were not associated with severe family stress. CONCLUSION: The findings of the current study highlight the importance of a systemic approach to family stress, whereby individual, family, and ecological factors are investigated.

Developing Agentic Learners for 21st Century Practice: A Pedagogic Approach in Occupational Therapy.

In this paper, an approach to teaching occupational therapy students how to create orthoses, whilst at the same time developing higher-order critical thinking, reflective, and clinical reasoning skills is described. The scaffolded nature of the learning activities, incorporating Kolb's reflective learning cycle, was used to support students' capacity for clinical reasoning and better prepare them for clinical placement. The peer-assessment element was also designed to support the experiential learning by allowing students to test their evaluation of hand orthoses, compare their assessment with an expert's, and identify areas for improvement. Students who demonstrated higher grades for the written reflection assessment showed better agreement with the experts (smaller bias, p<0.01). This study concluded there was a correlation between students' capacity for reflective thinking and the development of clinical reasoning. Furthermore, the reflective writing exercise encouraged students to generalise their skills beyond the classroom. The approach and findings of this study are relevant to a range of allied health professions through providing a process to support the development of higher-order critical thinking, reflection, and reasoning skills. Furthermore, the study provides an evidence base to demonstrate that higher reflective skill capacity and critical thinking are crucial to creating agentic learners.