Development of a toolkit for educators of the wheelchair service provision process: the Seating and Mobility Academic Resource Toolkit (SMART).

BACKGROUND: Insufficient wheelchair training among rehabilitation professionals has been identified as an important factor that hinders access to appropriate wheelchair services. The aim of this study was to develop a toolkit to promote the integration of wheelchair education into academic curricula of rehabilitation programs. METHODS: A participatory action research design was carried out in three phases: (1) development of the Initial and Alpha Versions involving secondary analyses of surveys (n = 72), interviews (n = 14), and academic training partners meeting presentations (n = 16); (2) development of the Beta Version based on feedback from collaborators (n = 21); and (3) development of the Launch Version based on feedback from participants attending presentations of the Beta Version at conferences, symposiums, and webinars (n = 94). RESULTS: Over 100 individuals participated in reviews of the Seating and Mobility Academic Resource Toolkit (SMART). Initial development addressed modifiable factors that perpetuate insufficient wheelchair education in academic curricula (e.g., limited awareness, limited expertise). Internal feedback on the web-based Alpha Version resulted in modifications of appearance and multimedia, structure and design, and navigation. External feedback then led primarily to fine-tuning the navigation of SMART. Positive reviews were received from global wheelchair professionals (i.e., educators, researchers, clinicians). The Launch Version of the SMART (smart.wheelchairnetwork.org) provides a forum for sharing and accessing resources to inform the integration and enhancement of wheelchair content into university rehabilitation programs. CONCLUSIONS: As an open-source open-access online "living document," SMART has the potential to promote the integration of wheelchair service provision education into academic curricula of rehabilitation programs. Future studies will explore the ease of use and the effectiveness of the SMART.

Assessing the Quality and Readability of Web-Based Information on Otoplasty.

Introduction: As health care-related internet use expands, parents and patients considering otoplasty frequently turn to online resources for further information to aid their decision making. Objective: In online resources related to otoplasty, what is the quality of the information and how readable is it based on standardized tests? Methods: A web search was performed on the three major search engines, using search terms related to otoplasty. The top 20 results from each search engine were selected. The DISCERN instrument was applied to assess the quality of health information, whereas the Flesch-Kincaid readability tests were used to assess readability. Results: The mean DISCERN score was 28.7 out of a possible score of 80 (poor quality) and commercial bias was common. The Flesch-Kincaid readability test results were significantly higher than the average reading level for adults in the United Kingdom. On the largest search engine, there was a correlation between search engine ranking and both readability and quality. Conclusion: Online patient information resources on otoplasty are generally of poor quality and difficult to read for the average patient.

Exploring the inclusion of teaching and learning on assistive products in undergraduate curricula of health sciences faculties at three South African Universities.

BACKGROUND: Providers must be knowledgeable on policy, systems and products to provide a person centred service and prescribe the most appropriate assistive product for each user. AIM: This study aimed to determine to what extent teaching and learning on assistive products are included in undergraduate curricula of the Health science faculties at three universities in the Western Cape Province of South Africa. METHODS: Data were gathered through a cross sectional survey. Fifteen programmes were approached of whom eight participated. Information on teaching on assistive products was sourced from purposively identified key informants, through e-mail questionnaires. Descriptive analysis was done. RESULTS: A total of 104 assistive products were included in the eight programmes. Manual wheelchairs were the only product for which teaching was underscored by policy guidelines. Handheld mobility devices and wheelchairs were covered by five programmes. Teaching on assistive products for self-care, participation in domestic life, indoor and outdoor activities, employment and leisure was limited. Thirty seven products listed on the GATE List of 50 were taught by at least one of the programmes. Teaching and examination were theoretical in nature and occurred in professional silos. Clinical exposure was often incidental. For many products none of the four service delivery steps were covered. CONCLUSION: Assistive products were included in all the participating undergraduate programmes. The range of included products and the level of training were insufficient to prepare graduates to effectively address user's needs. Newly appointed graduates will require early in-service training to ensure appropriate assistive product service delivery.Implications for rehabilitationUndergraduate teaching on assistive products is provided in professional silos.Not all products on the GATE APL of 50 are included in under graduate teaching.Teaching does not always ensure a proficiency level that will support graduates to provide an independent AT service.

Integration of wheelchair service provision education: current situation, facilitators and barriers for academic rehabilitation programs worldwide.

Purpose: An estimated 75 million people with disabilities need wheelchairs globally, of whom 5-15% have one. Access to an appropriate wheelchair requires rehabilitation professionals trained to provide wheelchair service. One aim of the International Society of Wheelchair Professionals (ISWP) is to promote and facilitate the integration of wheelchair service provision education into academic rehabilitation programs worldwide. To inform the development of integration strategies, the purpose of this study was to develop an in-depth global portrait of the wheelchair service provision education offered in academic rehabilitation programs, the process of its integration and the associated facilitators and barriers.Method: Semi-structured qualitative interviews were conducted with a purposive sample of 14 representatives from academic rehabilitation programs (i.e., occupational therapy, physical therapy, and prosthetics and orthotics) in 11 countries, including low, middle and upper resourced settings.Findings: Thematic data analyses identified three overarching themes. The first theme, "impact of context", portrays factors related to local population needs, governance and supply chain of equipment and service delivery. The second theme, "current and planned wheelchair education", describes the content, pedagogic approach, student evaluation and feedback process. The third theme, "integration process", details five states of this process.Conclusions: This study describes in-depth the wheelchair service provision education across academic rehabilitation programs and resource settings, illustrating the context-dependent nature of its integration. This understanding may assist the global community of educators in preparing future rehabilitation professionals to better serve wheelchair users. This work has informed the development of ISWP's Seating and Mobility Academic Resource Toolkit (http://smart.wheelchairnetwork.org/).Implications for RehabilitationThe Dynamics of Context-Dependent Integration of Wheelchair Service Provision Education in Curricula model, depicting the findings of this study, may help to inform key stakeholders (i.e., academic institutions, health care providers and policy makers) about potential barriers and facilitators to the implementation of adequate wheelchair service provision education in the curricula of academic rehabilitation program.Study findings may lead to creative strategies, such as the expansion of ISWP's Seating and Mobility Academic Resource Toolkit (SMART; http://smart.wheelchairnetwork.org/), that may enable academic rehabilitation programs to be a part of the solution to strengthening rehabilitation systems worldwide, through appropriately trained rehabilitation professionals in wheelchair service provision.

Opening the GATE: systems thinking from the global assistive technology alliance.

Purpose: This paper describes international actions to collaborate in the assistive technology (AT) arena and provides an update of programmes supporting AT globally. Methods: The World Health Organisation (WHO) identifies the severe global uneven distribution of resources, expertise and extensive unmet need for AT, as well the optimistic substantial capability for innovations and developments in appropriate and sustainable AT design, development and delivery. Systems thinking and market shaping are identified as means to address these challenges and leverage the ingenuity and expertise of AT stakeholders. Results: This paper is a 'call to action', showcasing emerging AT networks as exemplars of a distributed, but integrated mechanism for addressing AT needs globally, and describing the Global Alliance of Assistive Technology Organisations (GAATO) as a vehicle to facilitate this global networking. Conclusion: Partners in this Global Alliance aim to advance the field of assistive technology by promoting shared research, policy advocacy, educating people and organisations within and outside the field, teaching, training and knowledge transfer by pulling together broad-based membership organisations.Implications for RehabilitationCollegial, cross discipline and multi-stakeholder collaborations support assistive technology research and practice.Knowledge exchange within and across countries and regions is mutually beneficial.Self-organising assistive technology communities are emerging and supported by global movements such as WHO GATE and GAATO.

Establishing the need for clinical follow-up after emergency appendicectomy in the modern era: Retrospective case series of 145 patients.

INTRODUCTION: Emergency appendicectomy (EA) is a commonly performed operation, with an increasing number of EAs being performed as day-case. The aim of this study is to establish if there is a need for post-operative follow-up and if this could prevent adverse outcomes. METHODS: A retrospective analysis of patients who underwent EA at multiple centres over a six-month period was undertaken. They were contacted by telephone and a standardised questionnaire was used to ascertain post-operative outcomes, including duration of analgesia use, duration before return to normal daily activity (ADLs), surgical site infection rates (SSI) and rates of re-presentation to medical services. Patients were stratified into those who underwent laparoscopic versus open appendicectomy, smokers versus non-smokers, and body mass index (BMI). RESULTS: A total of 145 patients were included in the study. Patients undergoing open surgery (vs. laparoscopic surgery) required analgesia for significantly longer periods, with a significantly longer return to ADLs. Smokers, when compared to non-smokers experienced a significantly longer return to work/school; and significantly higher risk of SSI and re-presenting to accident & emergency; as did patients with a BMI >30 when compared to those with a BMI <30. CONCLUSION: Most patients do not need formal outpatient assessment after EA. However, there is clearly a subset of higher risk patients who may benefit from this - patients who are smokers or obese. They have prolonged recovery times, and are at greater risk of SSI. Earlier surgical outpatient follow-up of these patients could prevent adverse outcomes.

Assistive technology products: a position paper from the first global research, innovation, and education on assistive technology (GREAT) summit.

This paper is based on work from the Global Research, Innovation, and Education on Assistive Technology (GREAT) Summit that was coordinated by WHO's Global Cooperation on Assistive Technology (GATE). The purpose of this paper is to describe the needs and opportunities embedded in the assistive product lifecycle as well as issues relating to the various stages of assistive product mobilization worldwide. The paper discusses assistive technology product terminology and the dangers of focusing on products outside the context and rolling out products without a plan. Additionally, the paper reviews concepts and issues around technology transfer, particularly in relation to meeting global needs and among countries with limited resources. Several opportunities are highlighted including technology advancement and the world nearing a state of readiness through a developing capacity of nations across the world to successfully adopt and support the assistive technology products and applications. The paper is optimistic about the future of assistive technology products reaching the people that can use it the most and the excitement across large and small nations in increasing their own capacities for implementing assistive technology. This is expressed as hope in future students as they innovate and in modern engineering that will enable assistive technology to pervade all corners of current and potential marketplaces. Importantly, the paper poses numerous topics where discussions are just superficially opened. The hope is that a set of sequels will follow to continue this critical dialog. Implications for Rehabilitation Successful assistive technology product interventions are complex and include much more than the simple selection of the right product. Assistive technology product use is highly context sensitive in terms of an individual user's environment. The development of assistive technology products is tricky as it must be contextually sensitive to the development environment and market as well. As a field we have much to study and develop around assistive technology product interventions from a global perspective.

A rare case of umbilical metastasis after delayed transverse rectus abdominis myocutaneous flap reconstruction for invasive breast cancer.

A 46-year-old female presented with an inflamed and painful umbilicus. Past medical history included breast cancer, followed by metastatic sternal cancer two years after the initial breast cancer diagnosis.The painful umbilicus was confirmed metastasis from a primary breast cancer she had treated eleven years previously.Metastases to the umbilicus are rare, and are usually gastrointestinal in origin. To our knowledge this is the first report of a metastasis from any primary cancer to the umbilicus after transverse rectus abdominis myocutaneous flap (TRAM). Any lesion at any stage after treatment for breast cancer should be viewed with suspicion of recurrence and investigated and treated appropriately.

Wheelchair service provision education in academia.

BACKGROUND: An estimated 70 million people with disabilities need wheelchairs. To address this global crisis, the World Health Organization (WHO) proposed an eight-step wheelchair service provision model to ensure service quality regardless of resource setting. The International Society of Wheelchair Professionals (ISWP) aims to facilitate the integration of the WHO eight-step model into professional rehabilitation programmes. OBJECTIVE: To develop an enhanced understanding of the current wheelchair service provision education provided in professional rehabilitation programmes worldwide. METHODS: In a cross-sectional design, an online survey was distributed to ISWP contacts of educational institutions. Quantitative responses were analysed through summary statistics and qualitative answers were analysed by content analyses. When relevant, educational institutions were stratified into resource settings. RESULTS: Seventy-two representatives of educational institutions in 21 countries completed the survey. Wheelchair content was taught in 79% of represented institutions, of which 75% of respondents reported using original course material, 10% of respondents used WHO Wheelchair Service Training Packages and 15% of respondents used other available resources. The majority of educational institutions teaching with their own wheelchair-related course material taught ≤ 20 hours. Fourteen of the 15 respondents without wheelchair education, expressed an interest in integrating wheelchair education into their academic curricula. CONCLUSION: The majority of the educational institutions teach wheelchair education; however, there is great variability in what and how it is taught and evaluated. The results demonstrate the need for more in-depth investigation regarding the integration process of wheelchair education in educational institutions, with the ultimate goal of improving wheelchair service provision worldwide.

Cochlear implantation: An assessment of quality and readability of web-based information aimed at patients.

OBJECTIVES: Patients should have access to high-quality health information websites on which to base their decision-making. There are concerns regarding the accuracy and quality of some health websites. We aimed to objectively measure website quality related to cochlear implantation. METHODS: Selected patient-information websites were scored, depending on how highly they ranked on search engines and if they were ranked on more than one of the search engines used. The top 40 websites from three major search engines were analysed. The quality of each website was scored using the DISCERN tool and the readability was scored using the Flesch-Kincaid reading ease and the Gunning-Fog index. RESULTS: The average Flesch-Kincaid score was 49.7, giving an average reading age of a 15-17 years old, and the average Gunning-fog score was 13.1, which equals that of an 18 years old. CONCLUSION: Internet-based information regarding cochlear implantation is of varied quality and is written above the expected reading level of an average person.