Experiences and perceptions of everyday decision-making in the lives of adults with intellectual disabilities, their care partners and direct care support workers.

Background: Decisional support is important to people with intellectual disabilities. This review explores: i) how everyday decision-making is perceived and/or experienced by adults with intellectual disability, their care partners and direct care support workers (DCSWs); ii) techniques/approaches used to support everyday decision-making; and iii) barriers/facilitators encountered. Method: PRISMA systematic review methodology using PsycInfo, PubMED, Web of Science, CINAHL and Scopus. Results: Eighty-one papers were included [qualitative (n = 69), quantitative (n = 7), mixed methods (n = 5)]. Adults with intellectual disability reported wanting to make decisions and needing support. Care partner support was affected by concerns about safety and decisional capacity. DCSWs reported difficulty balancing client decisions and care partner concerns when providing support. Supported Decision-Making (SDM) was identified as a key method of support. Barriers and facilitators were interconnected and impacted by stressors. Conclusion: This topic is under-researched and ill-defined. Supported decision-making is an increasingly popular approach whose application requires further exploration.

Impact of connected health interventions on psychological wellbeing and quality of life in patients with cancer: A systematic review and meta-analysis.

OBJECTIVE: Connected health technologies have the potential to improve access to cancer care and support and reduce costs. We aimed to assess the impacts of interventions delivered using connected health technologies on psychological and quality of life (QoL) outcomes in people living with and beyond cancer. METHODS: PUBMED, PsycINFO, Web of Science, and EMBASE were searched using terms relating to (i) cancer, (ii) connected health, and (iii) QoL/psychological wellbeing. Studies were included if they evaluated interventions using connected health technologies and assessed psychological and/or QoL outcomes for adults at any stage of cancer treatment or survivorship. RESULTS: Thirty-seven studies met the inclusion criteria with a total of 8956 participants. Connected health technologies included web-based applications (n = 24), smart applications (n = 12), and wearable devices (n = 1). Studies were heterogeneous in terms of intervention components. We identified five clusters: (i) Psychosocial support and rehabilitation, (ii) psychoeducation and information support, (iii) symptom monitoring, reporting and self-management, (iv) peer and social support, and (v) health coaching and physical activity training. Due to heterogeneity of outcome measures, the meta-analysis included only seven RCTs; pooled mean estimates showed connected health interventions were moderately effective in reducing symptoms of depression (SMD: -0.226, 95% CI -0.303/-0.149) and anxiety (SMD: -0.188, 95% CI: 0.279/-0.0963) compared with usual care. CONCLUSION: While the considerable heterogeneity observed highlights the need for more rigorous studies to improve reproducibility and efficiency, results suggest that connected health interventions have the potential to improve psychological wellbeing and QoL outcomes in people living with and beyond cancer.

Investigating the impact of self-management behaviours on quality of life and fear of recurrence in head and neck cancer survivors: A population-based survey.

OBJECTIVES: Emerging cancer-survivorship research suggests that self-management can lead to improved outcomes. However, research examining the impact of self-management behaviours on quality of life (QoL) and fear of recurrence (FoR) in cancer survivors is lacking. This study investigated the relationship between self-management behaviours and QoL and FoR following treatment for head and neck cancer (HNC). METHODS: Postal surveys were sent to 734 eligible HNC survivors (ICD10 C01-C14; C32) in the Republic of Ireland who were 12- to 60-months post diagnosis. QoL and FoR were measured using the Functional Assessment of Cancer Therapy (FACT-G and Head and Neck Cancer Subscale) measure and Fear of Relapse/Recurrence Scale, respectively. Seven self-management behaviours were measured using the Health Education Impact Questionnaire. RESULTS: Three hundred and ninety-five HNC survivors completed surveys (50.3% response rate). After controlling for sociodemographic and clinical characteristics, self-management behaviours accounted for 20% to 39.4% of the variance in QoL and FoR. Higher scores on positive and active engagement in life, constructive attitudes and approaches, and skill and technique acquisition were significantly associated with higher global QoL and lower FoR, whilst higher scores on positive and active engagement in life and constructive attitudes and approaches only were significantly associated with higher HNC-specific QoL. Additionally, lower scores on self-monitoring and insight were significantly associated with higher HNC-specific and global QoL and lower FoR. CONCLUSIONS: The findings highlight the potential utility of self-management interventions promoting active problem solving, positive self-talk, and skill acquisition amongst cancer survivors. However, increased self-monitoring may relate to negative outcomes in HNC, a finding that warrants further investigation.

Comprehensive Neuropsychological Assessment of Cognitive Functioning of Adults With Lower Limb Amputation in Rehabilitation.

OBJECTIVE: To establish a comprehensive profile of cognitive functioning in people engaged in lower limb amputation (LLA) rehabilitation. DESIGN: Cross-sectional study as part of a longitudinal prospective cohort. SETTING: A national tertiary rehabilitation hospital. PARTICIPANTS: Adult volunteer participants (N=87) referred for comprehensive rehabilitation for major LLA were sampled from 207 consecutive admissions. Participants with both vascular (n=69) and nonvascular (n=18) LLA etiologies were included. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Demographic and health information and a battery of standardized neuropsychological assessments. RESULTS: Compared to normative data, impairment was evident in overall cognitive functioning (P≤.003). Impairment was also evident in particular areas, including reasoning, psychomotor function, information processing, attention, memory, language/naming, visuospatial functions, and executive functions (all P≤.003 Holm-corrected). There were also higher frequencies of impaired functions across most aspects of functioning in this group compared with expected frequencies in normative data (P≤.003 Holm-corrected). There were no significant differences in cognitive functioning between participants of vascular and nonvascular LLA etiology. CONCLUSIONS: Findings support the need for cognitive screening at rehabilitation admission regardless of etiology. Administration of comprehensive neuropsychological assessment with a battery sensitive to vascular cognitive impairment is recommended in some cases to generate an accurate and precise understanding of relative strengths and weaknesses in cognitive functioning. Cognitive functioning is a potential intervention point for improvement of rehabilitation outcomes for those with LLA, and further research is warranted in this area.

Barriers to active self-management following treatment for head and neck cancer: Survivors' perspectives.

OBJECTIVE: Active self-management practices may help head and neck cancer (HNC) survivors to deal with challenges to their physical, functional, social, and psychological well-being presented by HNC and its treatment. This study investigates the factors perceived by HNC survivors to act as barriers to their active self-management following primary treatment. METHODS: In this qualitative study, 27 HNC survivors identified through 4 designated cancer centres in Ireland participated in face-to-face semistructured interviews. Interviews were audio-recorded, transcribed, and analysed using thematic analysis. RESULTS: Four themes (and associated subthemes) describing barriers to survivors' active self-management were identified: emotional barriers (eg, fear of recurrence), symptom-related barriers (eg, loss of taste), structural barriers (eg, access to appropriate health services), and self-evaluative barriers (eg, interpersonal self-evaluative concerns). CONCLUSIONS: This is the first study to describe HNC survivors' views about barriers to their active self-management after treatment. The findings have important implications for self-management research and intervention development concerning HNC survivorship.

Work Outcomes in Patients Who Stay at Work Despite Musculoskeletal Pain.

Purpose To assess self-reported work impacts and associations between psychosocial risk factors and work impairment amongst workers seeking care for musculoskeletal pain while continuing to work. Methods Patients were recruited from Musculoskeletal Assessment Clinics at 5 hospitals across Ireland. Participants completed questionnaires including assessments of work impairment (Work Productivity and Activity Impairment Questionnaire), work ability (single item from the Work Ability Index) and work performance (Work Role Functioning Questionnaire; WRFQ). Logistic and hierarchical regressions were conducted to analyse the relation between psychosocial variables and work outcomes. Results 155 participants (53.5% female; mean age = 46.50 years) who were working at the time of assessment completed the questionnaires. Absenteeism was low, yet 62.6% were classified as functioning poorly according to the WRFQ; 52.3% reported having poor work ability. Logistic regression analyses indicated that higher work role functioning was associated with higher pain self-efficacy (OR 1.51); better work ability was associated with older age (OR 1.063) and lower functional restriction (OR 0.93); greater absenteeism was associated with lower pain self-efficacy (OR 0.65) and poorer work expectancy (OR 1.18). Multiple regression analysis indicated that greater presenteeism was associated with higher pain intensity (ß = 0.259) and lower pain self-efficacy (ß = - 0.385). Conclusions While individuals continue to work with musculoskeletal pain, their work performance can be adversely affected. Interventions that target mutable factors, such as pain self-efficacy, may help reduce the likelihood of work impairment.

The effect of viewing fitness imagery on body dissatisfaction: sex and physical activity differences.

Exposure to cultural bodily ideals featuring thinness and muscularity can have deleterious effects on body satisfaction. The current study explores the effect of exposure to such imagery on body dissatisfaction and the influence of internalisation of cultural and athletic ideals. 188 (97 male) adults (18-25yrs; M = 20.97) were grouped according to a 2 × 2 × 2 mixed between-within subjects design (male/female; high/low physical activity; intervention/control). Participants were exposed to images of idealised physiques or neutral images. Internalisation-general, sex, physical activity levels, and Body Mass Index were associated with baseline levels of body dissatisfaction. Internalisation of cultural ideals appears to be an important factor for the prediction of body dissatisfaction. Exposure to idealised images resulted in increases in body dissatisfaction across all groups compared to controls. Neither sex nor physical activity levels buffer young adults from the negative effects of viewing images featuring idealised bodies.

Psychological variables associated with quality of life following primary treatment for head and neck cancer: a systematic review of the literature from 2004 to 2015.

OBJECTIVE: There has been a recent proliferation of research on quality of life (QoL) in head and neck cancer (HNC). The objective of this review was to systematically examine the evidence on psychological factors associated with QoL outcomes for HNC survivors in the post-treatment period published during 2004-2015. METHODS: Five databases were searched for studies investigating psychological factors associated with QoL in HNC survivors. Empirical studies published between January 2004 and June 2015 were included if they measured QoL as an outcome following treatment using a reliable and valid measure, examined its association with at least one psychological factor and included at least 50 HNC survivors. RESULTS: Twenty-four publications describing 19 studies (9 cross-sectional, 10 prospective) involving 2,263 HNC survivors were included. There was considerable heterogeneity in study design and diversity in measurement and analysis. Distress-related variables (depression, anxiety, distress) were most frequently investigated, and mostly reported negative associations with QoL outcomes. Associations were also observed between other psychological factors (e.g., coping, neuroticism and fear of recurrence) and QoL. CONCLUSIONS: Several psychological factors predict QoL among HNC survivors who have completed treatment. Routine screening and early interventions that target distress could improve HNC survivors' QoL following treatment. Longitudinal and population-based studies incorporating more systematic and standardised measurement approaches are needed to better understand relationships between psychological factors and QoL and to inform the development of intervention and supportive care strategies.Copyright © 2016 John Wiley & Sons, Ltd.

Self-management strategies used by head and neck cancer survivors following completion of primary treatment: A directed content analysis.

OBJECTIVE: Head and neck cancer (HNC) survivors encounter unique challenges following treatment. This study aimed to identify self-management strategies that HNC survivors use to overcome these posttreatment challenges. METHODS: Twenty-seven individuals from 4 designated cancer centres in Ireland were interviewed about self-management strategies that helped them overcome challenges following HNC treatment. Interviews were audio-recorded, transcribed, and analysed using directed content analysis. RESULTS: Twenty self-management strategy types (encompassing 77 specific strategies) were identified. The most frequently used self-management strategy types were self-sustaining (used by 26 survivors), self-motivating (n = 25), and proactive problem solving (n = 25). The most frequently used specific strategies were adaptive approaches to ongoing physical consequences of HNC and its treatment (n = 24), customising dietary practices (n = 24), and maintaining a positive outlook (n = 22). CONCLUSIONS: The study identified strategies that helped HNC survivors to self-manage posttreatment challenges. This information could inform the design/development of self-management interventions tailored towards HNC survivors.

Early interventions to promote work participation in people with regional musculoskeletal pain: a systematic review and meta-analysis.

OBJECTIVES: To determine the effectiveness of early multidisciplinary interventions in promoting work participation and reducing work absence in adults with regional musculoskeletal pain. DATA SOURCES: Seven databases (CENTRAL, CINAHL, EMBASE, MEDLINE, Scopus, OT Seeker, PEDro; 1990 to December 2016) were searched for eligible studies. REVIEW METHODS: Trials were included if they reported on work-based outcomes for participants experiencing difficulties at work or ≤ three months' sick leave. Interventions had to include two or more elements of the biopsychosocial model delivered as a coordinated programme. Quality was assessed using the GRADE criteria. Results were analysed by hazard ratios for return to work data; continuous outcomes were analysed as standardised mean difference with 95% confidence intervals. RESULTS: A total of 20 randomized controlled trials, with 16,319 participants were included; the interventions were grouped according to their main components for meta-analyses. At 12-months follow-up, moderate quality evidence suggests that programmes involving a stepped care approach (four studies) were more effective than the comparisons in promoting return to work (hazard ratio (HR) 1.29 (95% confidence interval (CI) 1.03 to 1.61), p = 0.03), whereas case management (two studies) was not (HR 0.92 (95% CI 0.69 to 1.24), p = 0.59). Analyses suggested limited effectiveness in reducing sickness absences, in pain reduction or functional improvement across the intervention categories. CONCLUSION: There is uncertainty as to the effectiveness of early multicomponent interventions owing to the clinical heterogeneity and varying health and social insurance systems across the trials.

Management of diabetic foot disease and amputation in the Irish health system: a qualitative study of patients' attitudes and experiences with health services.

BACKGROUND: Diabetes is an increasingly prevalent chronic illness that places a huge burden on the individual, the health system and society. Patients with active foot disease and lower limb amputations due to diabetes have a significant amount of interaction with the health care services. The purpose of this study was to explore the attitudes and experiences of foot care services in Ireland among people with diabetes and active foot disease or lower limb amputations. METHODS: A purposive sample of individuals who had either active foot disease or a lower limb amputation as a result of diabetes were recruited from the Prosthetic, Orthotic and Limb Absence Rehabilitation (POLAR) Unit of an Irish hospital. One-to-one interviews were conducted in the POLAR unit using a semi-structured topic guide. Thematic analysis was used to identify, analyse and describe patterns within the data. RESULTS: Ten males participated in the study. Most participants expressed a need for emotional support alongside the medical management of their condition. There were substantial differences between participants with regard to the level of education and information they appeared to have received regarding their illness. There were also variations in levels of service received. Transport and medication costs were considered barriers. Having a medical card, which entitles the holder to free medical care, eased the burden of the patient's illness. A number of participants attributed some of the problems they faced with services to the health care system as a whole rather than health care professionals. CONCLUSION: Results suggest that rehabilitation services should place a strong focus on psychological as well as physical adjustment to active foot disease or lower limb amputations. The delivery of services needs to be standardised to ensure equal access to medical care and supplies among people with or at risk of lower extremity amputations. The wider social circumstances of patients should be taken into consideration by health care professionals to provide effective support while patients adjust to this potentially life changing complication. The patient's perspective should also be used to inform health service managers and health professionals on ways to improve services.

Goal pursuit and goal adjustment as predictors of disability and quality of life among individuals with a lower limb amputation: a prospective study.

OBJECTIVE: (1) To identify significant changes in disability and quality of life (QOL) across 3 time points (t1: admission to rehabilitation; t2: 6wk postdischarge; t3: 6mo postdischarge) in individuals with lower limb amputation, and (2) to examine whether goal pursuit and goal adjustment at t1 were predictive of these outcomes at t3. DESIGN: Prospective cohort study. SETTING: Inpatient rehabilitation. PARTICIPANTS: Consecutive sample of persons (N=64) aged ≥18 years with major lower limb amputation. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) and World Health Organization Quality of Life Scale Brief Version (WHOQOL-BREF). RESULTS: Mean WHODAS 2.0 scores were in the 95th percentile at each time point. Scores on the WHODAS 2.0 and the physical, psychological, and social relations domains of the WHOQOL-BREF remained stable across the study period. Environmental QOL scores decreased from t1 to t2 but returned to near-baseline levels between t2 and t3. Having a greater tendency toward goal pursuit at t1 was predictive of higher physical and psychological QOL at t3, whereas having a stronger disposition toward goal adjustment at t1 predicted lower disability and higher environmental QOL at t3. CONCLUSIONS: High levels of disability were experienced from admission to rehabilitation up to 6 months postdischarge. QOL in the physical, psychological, and social relations domains remained stable over the study period. Stronger goal pursuit and goal adjustment tendencies on admission predicted lower disability and higher QOL 6 months postdischarge.

Goal management tendencies predict trajectories of adjustment to lower limb amputation up to 15 months post rehabilitation discharge.

OBJECTIVES: To explore patterns of change in positive affect, general adjustment to lower-limb amputation, and self-reported disability from rehabilitation admission to 15 months postdischarge, and to examine whether goal pursuit and goal adjustment tendencies predict either initial status or rates of change in these outcomes, controlling for sociodemographic and clinical covariates. DESIGN: Prospective cohort study with 4 time points (t1: on admission; t2: 6wk postdischarge; t3: 6mo postdischarge; t4: 15mo postdischarge). SETTING: Inpatient rehabilitation. PARTICIPANTS: Consecutive sample (N=98) of persons aged ≥18 years with major lower-limb amputation. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Positive affect subscale of the Positive and Negative Affect Schedule; general adjustment subscale of the Trinity Amputation and Prosthesis Experience Scales-Revised; and World Health Organization Disability Assessment Schedule 2.0. RESULTS: Positive affect decreased from t1 to t4 for the overall sample, whereas general adjustment increased. Self-reported disability scores remained stable over this period. Stronger goal pursuit tendencies were associated with greater positive affect at t1, and stronger goal adjustment tendencies were associated with more favorable initial scores on each outcome examined. With regard to rates of change, stronger goal pursuit tendencies buffered against decreases in positive affect and promoted decreases in self-reported disability over time, whereas stronger goal adjustment tendencies enhanced increases in general adjustment to lower-limb amputation. CONCLUSIONS: Greater use of goal pursuit and goal adjustment strategies appears to promote more favorable adjustment to lower-limb amputation over time across a range of important rehabilitation outcomes.

A prospective study of the importance of life goal characteristics and goal adjustment capacities in longer term psychosocial adjustment to lower limb amputation.

OBJECTIVE: To explore the life goal characteristics and goal adjustment capacities of persons with lower limb amputation on admission to rehabilitation, and to examine their efficacy as predictors of psychosocial outcomes six months post discharge. DESIGN: Prospective, descriptive. SETTING: Two specialist inpatient rehabilitation facilities in Ireland. SUBJECTS: A consecutive sample of 64 patients with lower limb amputation. MAIN MEASURES: On admission to rehabilitation, life goal characteristics (goal importance, goal disturbance) were assessed using the Goal Facilitation Index and goal adjustment capacities (goal disengagement, goal re-engagement) were measured using the Goal Adjustment Scale. The Beck Depression Inventory-II and the Trinity Amputation and Prosthesis Experience Scales-Revised assessed depressive symptomatology and psychosocial adjustment to amputation at six months post discharge. RESULTS: The highest average importance ratings were assigned to goals associated with interpersonal relationships, independence and subjective well-being. Goals related to physical limitations and disruptions in daily activities received the highest hindrance ratings. Goal importance (ß = -0.33) and goal disengagement (ß = -0.29) on admission significantly predicted depressive symptomatology six months post discharge (P ≤ 0.05). Goal importance (ß = 0.32), goal disturbance (ß = -0.26), and goal re-engagement (ß = -0.21) on admission significantly predicted general adjustment to lower limb amputation at six months post discharge (P ≤ 0.05), while goal importance (ß = -0.32) and goal disturbance (ß = 0.30) significantly predicted social adjustment (P ≤ 0.05). CONCLUSIONS: Life goal characteristics and goal adjustment capacities on admission to rehabilitation predicted psychosocial outcomes six months post discharge among individuals with lower limb amputation.

Who uses connected health technologies after a cancer diagnosis? evidence from the US Health Information National Trends Survey.

PURPOSE: As the number of people living with and beyond cancer increases, connected health technologies offer promise to enhance access to care and support, while reducing costs. However, uptake of connected health technologies may vary depending on sociodemographic and health-related variables. This study aimed to investigate demographic and health predictors of connected health technology use among people living with and beyond cancer. METHODS: Cross-sectional data from the US Health Information National Trends Survey Version 5 Cycle 4 (H5c4) was used. Regression analysis was used to examine associations between sociodemographic factors and the use of connected health technologies. The sample was restricted to individuals who self-reported a cancer diagnosis or history of cancer. RESULTS: In this cycle, 626 respondents self-reported a cancer diagnosis, with 41.1% using connected health technologies (health and wellness apps and/or wearable devices). Most were female (58.9%) and white (82.5%); 43.4% had graduated college or higher education. One third (33.6%) had a household income of $75,000 or more. Respondents who were younger, have higher education, were living as married, had higher incomes, had higher self-rated health and had higher health-related self-efficacy were significantly more likely to use connected health technologies. There were no significant associations between gender, race, stratum, time since diagnosis, history of anxiety or depression, and use of connected health technologies among people living with and beyond cancer. CONCLUSIONS: Connected health technology use among people living with and beyond cancer is associated with sociodemographic factors. Future research should examine these demographic disparities as the use of connected health technologies in healthcare continues to gather momentum. IMPLICATIONS FOR CANCER SURVIVORS: The study underscores a disparity in connected heath technology usage among people living with and beyond cancer. There is a pressing need for research into adoption barriers and interventions to ensure equitable digital healthcare integration among this population, especially with the heightened adoption of technology post COVID-19 pandemic.

Assistive technologies, educational engagement and psychosocial outcomes among students with disabilities in higher education.

PURPOSE: Increasing numbers of students with disabilities are accessing higher education each year, yet little is known about their assistive technology (AT) needs and its influence on relevant outcomes. The aim of this study was to examine met/unmet AT needs on educational engagement, academic self-efficacy and well-being and the impact of AT use in the areas of competence, adaptability and self-esteem for students with disabilities in higher education in Ireland. METHODS: One hundred and eleven students with disabilities completed a cross-sectional online survey comprising the College Learning Effectiveness Inventory, the Student Course Engagement Questionnaire, the Self-Efficacy for Learning Form Abridged, the Psychosocial Impact of Assistive Devices Scale, and the Warwick-Edinburgh Mental Well-Being Scale. RESULTS: AT use was found to have a positive psychosocial impact in the areas of competence, adaptability and self-esteem. Those whose AT needs were fully met scored significantly higher on academic self-efficacy, well-being, and on 4 of the 10 educational engagement subscales compared to those who had unmet AT needs. Met/unmet AT needs were not predictive of educational engagement. CONCLUSION: These findings highlight the importance of AT from both educational engagement and psychosocial perspectives for students with a wide variety of disability diagnoses. The wide-reaching benefits of AT must be considered by governmental departments when making funding allocations to disability services within higher education institutions. Implications for rehabilitationStudents with disabilities can face many additional challenges within the higher education environment.Findings from this research show that access to appropriate assistive technology can support students' educational engagement, increase well-being and academic self-efficacy and have a positive impact in the areas of competence, adaptability and self-esteem.Disability and Assistive Technology Officers in higher education should be cognizant of both the educational and psychological benefits of assistive technology across diverse students with various disability diagnoses.Policy makers should consider the wide-reaching benefits of assistive technology when making funding allocations to higher education institutions.

Feeling valued: the interplay of assistive technology and identity.

PURPOSE: The aim of this study was to explore the impact of AT in identity for students with disabilities in higher education and if/how this changes over time. METHODS: Using a longitudinal qualitative research design, semi-structured interviews were conducted with students with disabilities (n = 13) in higher education in Ireland on two occasions during an academic year. A trajectory approach to longitudinal analysis was employed. This involved the use of matrices and identification of a through line for the study, which connects participant change over time. RESULTS: The through line identified was feeling valued, which was central in the negotiation of identity over time across three themes: feelings of autonomy and competence; claiming disability; and feeling like you belong as a student. AT impacted experiences across the three themes which subsequently promoted or undermined students' sense of value. Reciprocally, feeling valued influenced use and perceptions of AT. Factors specific to a higher education context were also identified which influenced meanings attached to AT over time. CONCLUSION: Creating an environment where students feel valued is key in promoting use of and positive perceptions of AT. This should form an integral part of AT and disability policy in higher education.

Assistive technology (AT) use can have significant implications for one's identityAT indirectly impacts on students with disabilities' sense of value through its influence on three areas of identity change/continuity; feelings of autonomy and competence, claiming disability and feeling like you belongFeeling valued was central to the negotiation of identity over time for students with disabilities in higher educationCreating an environment where students feel valued is integral to supporting students in their pursuit of a positive sense of identity and key in promoting use of and positive perceptions towards AT. This should form a central part of AT and disability policy in higher education.

Categorization and recommendations for outcome measures for lower limb absence by an expert panel.

BACKGROUND: Understanding the psychometric strengths and limitations of outcome measures for use with people with lower limb absence (LLA) is important for selecting measures suited to evaluating patient outcomes, answering clinical and research questions, and informing health care policy. The aim of this project was to review the current psychometric evidence on outcome measures in people with LLA to determine which measures should be included in a stakeholder consensus process. METHODS: An expert panel was assembled, and a 3-stage review process was used to categorize outcome measures identified in a systematic literature review into 3 distinct categories (recommended for measures with better than adequate psychometric properties; recommended with qualification; and unable to recommend). Panelists were asked to individually categorize measures based on results of a systematic review of identified measures' psychometric properties. Each measure's final categorization was based on ≥70% agreement by all panelists. RESULTS: No outcome measure attained the ≥70% consensus threshold needed to achieve a rating of "recommend." Hence, panelists suggested combining "recommend" and "recommend with qualifications" into a single category of "recommend with qualifications." Using this approach, consensus was reached for 59 of 60 measures. Consensus could not be reached on 1 outcome measure (socket comfort score). Thirty-six outcome measures were categorized as "unable to recommend" based on available evidence; however, 23 (12 patient-reported measures and 11 performance-based measures) demonstrated adequate psychometric properties in LLA samples and were thus rated as "recommend with qualification" by the expert panel. The panel of experts were able to recommend 23 measures for inclusion in the subsequent stakeholder review. A key strength of this process was bringing together international researchers with extensive experience in developing and/or using LLA outcome measures who could assist in identifying psychometrically sound measures to include in a subsequent stakeholder consensus process. CONCLUSION: The above categorizations represent the current state of psychometric evidence on outcome measures for people with LLA and hence may change over time as additional research becomes available. The results will be used to achieve wider consensus from clinicians, health policymakers, health clinic managers, researchers, and end users (i.e., individuals with LLA) on outcome measures for the International Society of Prosthetics and Orthotics lower limb Consensus Outcome Measures for Prosthetic and Amputation ServiceS.

Implementation of a pan-European ecosystem and an interoperable platform for Smart and Healthy Ageing in Europe: An Innovation Action research protocol.

As life expectancy continues to increase in most EU Member States, smart technologies can help enable older people to continue living at home, despite the challenges accompanying the ageing process. The Innovation Action (IA) SHAPES 'Smart and Healthy Ageing through People Engaging in Supportive Systems' funded by the EU under the Horizon 2020 Research and Innovation Programme (grant agreement number 857159) attends to these topics to support active and healthy ageing and the wellbeing of older adults. This protocol article outlines the SHAPES project's objectives and aims, methods, structure, and expected outcomes. SHAPES seeks to build, pilot, and deploy a large-scale, EU-standardised interoperable, and scalable open platform. The platform will facilitate the integration of a broad range of technological, organisational, clinical, educational, and social solutions. SHAPES emphasises that the home is much more than a house-space; it entails a sense of belonging, a place and a purpose in the community. SHAPES creates an ecosystem - a network of relevant users and stakeholders - who will work together to scale-up smart solutions. Furthermore, SHAPES will create a marketplace seeking to connect demand and supply across the home, health and care services. Finally, SHAPES will produce a set of recommendations to support key stakeholders seeking to integrate smart technologies in their care systems to mediate care delivery. Throughout, SHAPES adopts a multidisciplinary research approach to establish an empirical basis to guide the development of the platform. This includes long-term ethnographic research and a large-scale pan-European campaign to pilot the platform and its digital solutions within the context of seven distinct pilot themes. The project will thereby address the challenges of ageing societies in Europe and facilitate the integration of community-based health and social care. SHAPES will thus be a key driver for the transformation of healthcare and social care services across Europe.

The impact of assistive technology use for students with disabilities in higher education: a systematic review.

PURPOSE: This systematic review examines the impact of assistive technology (AT) on educational and psychosocial outcomes for students with disabilities (SWDs) in higher education. MATERIALS AND METHODS: Qualitative, quantitative and mixed method studies were identified through systematic searches of five databases: PsycINFO, PubMed, CINAHL, ERIC and Web of Science (Social Science Citation Index). The search was conducted in January 2018. Thematic synthesis was carried out to collate findings across papers and the methodological quality of included papers was assessed using a Mixed Methods Appraisal Tool (MMAT). RESULTS: Twenty-six papers were included for analysis. Four analytic themes were identified; "AT as an enabler of academic engagement"; "barriers to effective AT use can hinder academic engagement"; "the transformative possibilities of AT from a psychological perspective"; and "AT as an enabler of participation". CONCLUSIONS: This systematic review identifies that AT can promote educational, psychological and social benefits for SWD. However, AT users and AT officers must be aware of certain factors, such as inadequate AT training, inadequacies of devices, availability of external support and the challenge of negotiating multiple information sources, can hinder effective AT use and thus restrict engagement in the higher education environment. Future AT practices should focus on harnessing the potential of mainstream devices as AT for all students, thus facilitating inclusion and reducing stigma.IMPLICATIONS FOR REHABILITATIONStudents with disabilities face academic, psychological and social challenges within the higher education environment.Assistive technology (AT) use can enable academic engagement and social participation and be transformative from a psychological perspective.Disability support staff in higher education should ensure that the AT needs of students with disabilities are met in order to enhance the educational experience.Harnessing the potential of mainstream devices as AT for all students will facilitate inclusion and reduce stigma.