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Unsworth, C. & Timmer, A. J. (2023). A Systematic Review of Wheelchair and Mobility Scooter Containment Systems Used Internationally on Public Transit Buses.. International Journal of Environmental Research and Public Health, 20(20), Article ID 6952.
Open this publication in new window or tab >>A Systematic Review of Wheelchair and Mobility Scooter Containment Systems Used Internationally on Public Transit Buses.
2023 (English)In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 20, no 20, article id 6952Article, review/survey (Refereed) Published
Abstract [en]

Despite the daily need for people to travel on public transit buses using their wheeled mobility devices, relatively little information is available regarding the most efficacious, affordable, and independent approaches to assist passengers with keeping their mobility devices in the designated wheelchair access space. A systematic review was undertaken to summarize this literature, place it within a geographical and temporal context, appraise its quality, and establish common themes. Key academic and grey literature transportation databases and government websites searched from 1990 to May 2022 identified 33 documents, which were appraised using the Mixed Methods Appraisal Tool (MMAT) or the Authority, Accuracy, Coverage, Objectivity, Date, Significance (AACODS) tool. Overall, the documents included were of good quality. The literature retrieved focused on the development and testing of the active containment systems favored for use in North America with a contrastingly small examination of the effectiveness of passive or semi-passive containment systems. Almost no literature was retrieved in English from European researchers documenting the use or effectiveness of rearward-facing passive systems. While tip or slide events are relatively rare among mobility device users, the effective use of containment systems is vital to minimize these. Further research is required to support transport policy makers, operators, and bus drivers to identify and correctly implement optimal containment systems to promote safety for all passengers on public buses.

Place, publisher, year, edition, pages
MDPI, 2023
Keywords
WTORS, disability, mobility device, occupational therapy, wheelchair tie-down and occupant restraint system
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:hj:diva-62812 (URN)10.3390/ijerph20206952 (DOI)37887690 (PubMedID)2-s2.0-85175050543 (Scopus ID)GOA;;913021 (Local ID)GOA;;913021 (Archive number)GOA;;913021 (OAI)
Available from: 2023-10-30 Created: 2023-10-30 Last updated: 2023-11-06Bibliographically approved
Das Neves, B., Unsworth, C. & Browning, C. (2023). 'Being treated like an actual person': attitudinal accessibility on the bus. Mobilities, 18, 425-444
Open this publication in new window or tab >>'Being treated like an actual person': attitudinal accessibility on the bus
2023 (English)In: Mobilities, ISSN 1745-0101, E-ISSN 1745-011X, Vol. 18, p. 425-444Article in journal (Refereed) Published
Abstract [en]

Whilst the essential nature of built environment accessibility has been well established in transport research, attitudinal, behavioural, and communication barriers experienced by transport users remain largely overlooked. Subtle and insidious, repetitive negative attitudes, behaviour, and communication can force disabled passengers out of the most affordable transport option available. Applying the Disability Justice Framework and a Mobility Justice approach, this study investigated disabled passengers' reported experience of bus driver attitudes, behaviours, and communication methods, and the impact of these encounters. A mixed methods cross-sectional survey and focus groups with disabled adults and support persons were conducted. An Advisory Working Group of transport accessibility advocates, all with lived experience, were engaged to oversee the study design. Participants reported that some bus drivers demonstrated ableist attitudes, discriminatory behaviour, and communication methods. Many passengers had reduced or stopped catching buses altogether due to these negative encounters, restricting their community mobility, which further impacted their quality of life. Participants' recommendations for drivers, operators, and transport authorities were thematically integrated into one statement, reinforcing the power of attitudinal access-'treat me like the person I am, who is valid; with a right to time, space and safety; listen to me, and prove you care'.

Place, publisher, year, edition, pages
Taylor & Francis, 2023
Keywords
Accessibility, attitudes, ableism, intersectionality, public transport
National Category
Transport Systems and Logistics
Identifiers
urn:nbn:se:hj:diva-58933 (URN)10.1080/17450101.2022.2126794 (DOI)000874743900001 ()2-s2.0-85141024192 (Scopus ID)HOA;intsam;842287 (Local ID)HOA;intsam;842287 (Archive number)HOA;intsam;842287 (OAI)
Available from: 2022-11-17 Created: 2022-11-17 Last updated: 2023-08-30Bibliographically approved
Farries, K., Baldock, M., Thompson, J., Stokes, C. & Unsworth, C. (2023). Entrapment and extraction of wheelchairs at flange gaps with and without flange gap fillers at pedestrian railway crossings. Disability and Rehabilitation: Assistive Technology
Open this publication in new window or tab >>Entrapment and extraction of wheelchairs at flange gaps with and without flange gap fillers at pedestrian railway crossings
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2023 (English)In: Disability and Rehabilitation: Assistive Technology, ISSN 1748-3107, E-ISSN 1748-3115Article in journal (Refereed) Epub ahead of print
Abstract [en]

PURPOSE: Where pedestrian crossings meet rail tracks, a flange gap allows the train wheel flanges to pass. This gap can be hazardous for wheelchair users as castor wheels may become trapped. While compressible gap fillers can eliminate the flange gap, fillers are subject to wear, pose a derailment hazard to light rail vehicles and can strip grease from passing wheels. These issues could be mitigated by partially filling the flange gap with a compressible filler. The aim was to investigate the risk of entrapment and ease of extraction of wheelchair castors from flange gaps fully and partially filled with compressible fillers, and assess ride quality.

MATERIALS AND METHODS: Entrapment risk and ease of extraction for four wheelchairs were tested at various crossing angles with flange gap fillers. Twelve wheelchair users tested ease of extraction and ride quality for partially and fully filled flange gaps.

RESULTS: It was found that risk of entrapment is low if a standards-compliant crossing with open flange gaps is traversed in a straight line. However, castors can become trapped if the user alters direction to avoid an obstacle or if the crossing surface is uneven. Once trapped, castors are extremely difficult to remove without external assistance.

CONCLUSIONS: Flange gap fillers that reduce the gap to 10 mm or less eliminate entrapment while retaining acceptable ride quality. Filling flange gaps or leaving a residual gap depth of less than 10 mm is the best option to eliminate risk of entrapment and ensure good ride quality for wheelchair users.IMPLICATIONS FOR REHABILITATIONRail crossings flange gaps pose an entrapment hazard for wheelchair usersPartial or complete flange gap fillers may reduce entrapment but require researchRehabilitation professionals need to educate wheelchair users on techniques to cross flange gaps safelyConsumers and health professionals can consult rail operators to partially fill flange gaps.

Place, publisher, year, edition, pages
Taylor & Francis, 2023
Keywords
Wheelchair, flange gap, mobility scooter, railway crossing, safety
National Category
Occupational Therapy
Identifiers
urn:nbn:se:hj:diva-63193 (URN)10.1080/17483107.2023.2296954 (DOI)001132784200001 ()38140983 (PubMedID)2-s2.0-85180432886 (Scopus ID)HOA;intsam;924276 (Local ID)HOA;intsam;924276 (Archive number)HOA;intsam;924276 (OAI)
Available from: 2024-01-04 Created: 2024-01-04 Last updated: 2024-01-12
Dickson, N. C., Gohil, A. R. & Unsworth, C. (2023). Initial validation of the powered mobility device autonomy residential screen (PoMoDARS). Scandinavian Journal of Occupational Therapy
Open this publication in new window or tab >>Initial validation of the powered mobility device autonomy residential screen (PoMoDARS)
2023 (English)In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014Article in journal (Refereed) Epub ahead of print
Abstract [en]

Background: The Powered Mobility Device Autonomy Residential Screen (PoMoDARS) is a new tool to enable clinicians to screen resident capacity and performance skills for powered mobility device (PMD) use in residential aged care settings. The PoMoDARS is context specific, time efficient and promotes resident autonomy and safety.

Aims: To (i) undertake initial face and content validation of the PoMoDARS, and (ii) use the research findings to make any modifications.

Methods: A mixed-methods study design, underpinned by Classical Test Theory. Eight clinicians completed 20 PoMoDARS screens and provided both quantitative and qualitative feedback on item importance and ease of use within a formal interview.

Results: Initial face and content validity of the PoMoDARS were supported, with small modifications made to item descriptors and instructions.

Conclusions: The PoMoDARS has been developed for use in residential aged care settings to screen resident PMD use. While initial validation has been undertaken, further studies to determine the reliability of the tool and continue the validation process are required.

Significance: Older adults in residential aged care facilities benefit greatly from the autonomy gained through PMD use. The PoMoDARS promotes collaboration between occupational therapists, nurses, and the wider team to support residents and safe PMD use.

Place, publisher, year, edition, pages
Taylor & Francis, 2023
Keywords
Aged care, facility, motorised mobility scooter, nursing assessment, occupational therapy, older adult, power wheelchair, risk management, technology
National Category
Occupational Therapy
Identifiers
urn:nbn:se:hj:diva-62996 (URN)10.1080/11038128.2023.2260834 (DOI)001107781600001 ()37995269 (PubMedID)2-s2.0-85177560211 (Scopus ID)HOA;intsam;918955 (Local ID)HOA;intsam;918955 (Archive number)HOA;intsam;918955 (OAI)
Available from: 2023-12-05 Created: 2023-12-05 Last updated: 2023-12-15
Dickson, N. C., Gohil, A. R. & Unsworth, C. (2023). Powered mobility device use in residential aged care: a retrospective audit of incidents and injuries. BMC Geriatrics, 23(1), Article ID 363.
Open this publication in new window or tab >>Powered mobility device use in residential aged care: a retrospective audit of incidents and injuries
2023 (English)In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 23, no 1, article id 363Article in journal (Refereed) Published
Abstract [en]

BackgroundPowered wheelchairs and motorised mobility scooters, collectively called powered mobility devices (PMD), are highly valued by older Australians, including those living in residential care, to facilitate personal and community mobility. The number of PMDs in residential aged care is expected to grow proportionally with that of the wider community, however, there is very little literature on supporting residents to use PMDs safely. Prior to developing such supports, it is important to understand the frequency and nature of any incidents experienced by residents whilst using a PMD. The aim of this study was to determine the number and characteristics of PMD use related incidents occurring in a group of residential aged care facilities in a single year in one state in Australia including incident type, severity, assessment, or training received and outcomes on follow-up for PMD users living in residential aged care.MethodsAnalysis of secondary data, including documentation of PMD incidents and injuries for one aged care provider group over 12 months retrospectively. Follow-up data were gathered 9-12 months post incident to review and record the outcome for each PMD user.ResultsNo fatalities were recorded as a direct result of PMD use and 55 incidents, including collisions, tips, and falls, were attributed to 30 residents. Examination of demographics and incident characteristics found that 67% of residents who had incurred incidents were male, 67% were over 80 years of age, 97% had multiple diagnoses and 53% had not received training to use a PMD. Results from this study were extrapolated to project that 4,453 PMD use related incidents occur every year within Australian residential aged care facilities, with the potential for outcomes such as extended recovery, fatality, litigation, or loss of income.ConclusionThis is the first time that detailed incident data on PMD use in residential aged care has been reviewed in an Australian context. Illuminating both the benefits and the potential risks of PMD use emphasizes the need to develop and improve support structures to promote safe PMD use in residential aged care.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2023
Keywords
Powered wheelchair, Mobility scooter, Incidents, Injuries
National Category
Geriatrics
Identifiers
urn:nbn:se:hj:diva-61580 (URN)10.1186/s12877-023-04073-z (DOI)001002981100001 ()37301972 (PubMedID)2-s2.0-85163126734 (Scopus ID)GOA;;887701 (Local ID)GOA;;887701 (Archive number)GOA;;887701 (OAI)
Available from: 2023-06-26 Created: 2023-06-26 Last updated: 2023-08-14Bibliographically approved
McGregor, F. A. & Unsworth, C. (2022). Menstrual hygiene management strategies used by women who are blind or have low vision. Scandinavian Journal of Occupational Therapy, 29(7), 598-610
Open this publication in new window or tab >>Menstrual hygiene management strategies used by women who are blind or have low vision
2022 (English)In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 29, no 7, p. 598-610Article in journal (Refereed) Published
Abstract [en]

Background: Menstrual hygiene management is a global public health issue that requires local and individualized support to reduce activity limitations and enable safe, independent task performance for people with impaired body functions.

Aim: How do women with blindness or low vision self-manage their menstrual hygiene to promote independence, and what do they recommend occupational therapists incorporate in education for young women when working in this field?

Methods: Phenomenological design revealing lived experience expertise. Semi-structured interviews were conducted with six women who are blind or have low vision aged 16–70 in Australia. The resulting data transcripts were coded and analyzed thematically using the Person-Environment Occupation Performance Model as an organizing framework.

Results: Participants reported a range of personal (touch) and organizational strategies relying on environmental cues such as regular times for changing sanitary items, lining up pads using underwear seams and wearing dark clothing to disguise leaks. Participants suggested that group occupational therapy education sessions be used to promote self-management.

Conclusions and significance: The lived experience of women who successfully self-manage menstrual hygiene with blindness or low vision has generated evidence to inform the development of therapist-mediated interventions and resources that could be applied with women across a range of clinical populations.

Place, publisher, year, edition, pages
Taylor & Francis, 2022
Keywords
disability, low vision, Menstrual health, menstruation, self-care, vision impaired
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:hj:diva-54250 (URN)10.1080/11038128.2021.1954995 (DOI)000681124500001 ()34347580 (PubMedID)2-s2.0-85111846694 (Scopus ID);intsam;1585263 (Local ID);intsam;1585263 (Archive number);intsam;1585263 (OAI)
Available from: 2021-08-16 Created: 2021-08-16 Last updated: 2022-12-11Bibliographically approved
Unsworth, C., Baker, A., Morton-Kehle, D. & Darzins, S. (2022). Survey of Occupational Therapy Driver Assessors’ Rehabilitation Interventions With Older Drivers. OTJR (Thorofare, N.J.), 42(2), 115-126
Open this publication in new window or tab >>Survey of Occupational Therapy Driver Assessors’ Rehabilitation Interventions With Older Drivers
2022 (English)In: OTJR (Thorofare, N.J.), ISSN 1539-4492, E-ISSN 1938-2383, Vol. 42, no 2, p. 115-126Article in journal (Refereed) Published
Abstract [en]

The rehabilitation strategies used by occupational therapy driver assessors with older drivers with age-related decline or health conditions are not well understood. The objective of the study was to describe driver rehabilitation interventions used by Australian driver assessors, identify factors that guide rehabilitation choices, and identify barriers and facilitators encountered. An online survey was emailed to 300 driver assessors. Descriptive statistics were used to summarize and to rank order participant responses. A total of 148 respondents selected from a combined total of 655 interventions. The four most common rehabilitation methods were (a) graded driving (18%, n = 118), (b) practicing specific maneuvers (17.7%, n = 116), (c) using a modified vehicle (16.9%, n = 111), and (d) graded driving in local areas only (15.1%, n = 99). The most common barrier limiting driver rehabilitation was cost (M = 2.92, SD = 1.24). The most frequently used driver rehabilitation method was on-road training. Practice can be enhanced by collating and evaluating resources, and ensuring effective interventions are more accessible.

Place, publisher, year, edition, pages
Sage Publications, 2022
Keywords
aging, driving, occupational therapy, rehabilitation, adult, article, female, human, human experiment, major clinical study, male
National Category
Occupational Therapy
Identifiers
urn:nbn:se:hj:diva-54941 (URN)10.1177/15394492211050634 (DOI)000708500400001 ()34643144 (PubMedID)2-s2.0-85117119824 (Scopus ID);intsam;1605729 (Local ID);intsam;1605729 (Archive number);intsam;1605729 (OAI)
Available from: 2021-10-25 Created: 2021-10-25 Last updated: 2022-04-08Bibliographically approved
Unsworth, C., Baker, A., Brito, S., Das Neves, B., Dickson, N., Gohil, A., . . . Timmer, A. (2022). Views of American and Australian mobility device users and ambulant bus users regarding occupant restraint systems on public buses. Journal of Transport and Health, 25, Article ID 101380.
Open this publication in new window or tab >>Views of American and Australian mobility device users and ambulant bus users regarding occupant restraint systems on public buses
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2022 (English)In: Journal of Transport and Health, ISSN 2214-1405, E-ISSN 2214-1405, Vol. 25, article id 101380Article in journal (Refereed) Published
Abstract [en]

Introduction: With an ageing population, increasing numbers of people are using mobility devices, such as wheelchairs or scooters, whilst travelling on public route buses. The regulations and availability of active (wheelchair tie down and occupant restraint systems or WTORS) and passive (rearward facing) mobility device restraint systems on buses varies between countries. To date few studies have investigated passenger feedback on the use of restraint systems. This study aimed to gather feedback about WTORS on buses from passengers where these are in use (United States) and not in routine use (Australia) to guide decisions on their introduction. Methods: A prospective study using a purpose-designed electronic survey. Participants, predominantly recruited by Qualtrics, comprised two groups; mobility device and ambulant bus users in two countries; Australia and the United States (US). Results: The 448 participants rated the top two most important factors when deciding if buses should have WTORS as safety and comfort. Ninety-two percent of respondents believed people using mobility devices should use a WTORS which was rated 7.66/10 (SD1.97) as effective to prevent injuries to self or others. Only a minority of participants (13.2%) had ever slid or fallen from their mobility device, or seen a person slide or fall (13.6%) while on a bus with no differences between countries despite WTORS not being in use in Australia. Respondents reported it was OK to delay a journey an average of 5.52 (SD 2.89) minutes to secure/release a restraint system, which compares favourably to literature-reported real time of one to 4 min. Conclusions: Although WTORS were widely perceived by participants as important for safety, questions concerning their effectiveness to prevent slide or tip remain. Prior to the introduction of any securement system in Australia, the effectiveness of passive occupant containment systems to prevent slide or tip also warrants investigation.

Place, publisher, year, edition, pages
Elsevier, 2022
Keywords
Buggies, Community mobility, Mobility scooters, Transportation, Wheelchairs
National Category
Transport Systems and Logistics
Identifiers
urn:nbn:se:hj:diva-56549 (URN)10.1016/j.jth.2022.101380 (DOI)2-s2.0-85129943119 (Scopus ID)
Available from: 2022-05-24 Created: 2022-05-24 Last updated: 2022-05-24Bibliographically approved
Lannin, N. A., Coulter, M., Laver, K., Hyett, N., Ratcliffe, J., Holland, A. E., . . . Unsworth, C. (2021). Public perspectives on acquired brain injury rehabilitation and components of care: A Citizens’ Jury. Health Expectations, 24(2), 352-362
Open this publication in new window or tab >>Public perspectives on acquired brain injury rehabilitation and components of care: A Citizens’ Jury
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2021 (English)In: Health Expectations, ISSN 1369-6513, E-ISSN 1369-7625, Vol. 24, no 2, p. 352-362Article in journal (Refereed) Published
Abstract [en]

Background: Brain injury rehabilitation is an expensive and long-term endeavour. Very little published information or debate has underpinned policy for service delivery in Australia. Within the context of finite health budgets and the challenges associated with providing optimal care to persons with brain injuries, members of the public were asked ‘What considerations are important to include in a model of care of brain injury rehabilitation?’.

Methods: Qualitative study using the Citizen Jury method of participatory research. Twelve adult jurors from the community and seven witnesses participated including a health services funding model expert, peak body representative with lived experience of brain injury, carer of a person with a brain injury, and brain injury rehabilitation specialists. Witnesses were cross-examined by jurors over two days.

Results: Key themes related to the need for a model of rehabilitation to: be consumer-focused and supporting the retention of hope; be long-term; provide equitable access to services irrespective of funding source; be inclusive of family; provide advocacy; raise public awareness; and be delivered by experts in a suitable environment. A set of eight recommendations were made.

Conclusion: Instigating the recommendations made requires careful consideration of the need for new models of care with flexible services; family involvement; recruitment and retention of highly skilled staff; and providing consumer-focused services that prepare individuals and their carers for the long term.

Patient and public contribution: As jury members, the public deliberated information provided by expert witnesses (including a person with a head injury) and wrote the key recommendations.

Place, publisher, year, edition, pages
John Wiley & Sons, 2021
Keywords
consumer participation, decision making, deliberative methods, health policy, traumatic brain injury
National Category
Occupational Therapy
Identifiers
urn:nbn:se:hj:diva-51151 (URN)10.1111/hex.13176 (DOI)000594888200001 ()33264470 (PubMedID)2-s2.0-85096968545 (Scopus ID)GOA;intsam;1507331 (Local ID)GOA;intsam;1507331 (Archive number)GOA;intsam;1507331 (OAI)
Available from: 2020-12-07 Created: 2020-12-07 Last updated: 2021-12-12Bibliographically approved
Fields, S. M., Unsworth, C. & Harreveld, B. (2021). The revision of competency standards for occupational therapy driver assessors in Australia: A mixed methods approach. Australian Occupational Therapy Journal, 68(3), 257-271
Open this publication in new window or tab >>The revision of competency standards for occupational therapy driver assessors in Australia: A mixed methods approach
2021 (English)In: Australian Occupational Therapy Journal, ISSN 0045-0766, E-ISSN 1440-1630, Vol. 68, no 3, p. 257-271Article in journal (Refereed) Published
Abstract [en]

Introduction: Competency standards outline the knowledge, skills, and attributes that are required for competent practice. This study describes the process followed to revise and validate the competency standards for occupational therapy driver assessors in order to guide clinical practice in this area of advanced occupational therapy practice.

Methods: A mixed methods research approach was used in this study. In phase 1, three focus groups with driver assessors reviewed and suggested revisions to the competency standards for occupational therapy driver assessors. Phase 2 involved content validation with key stakeholders through a focus group with consumers, written feedback from Australian state, and territory driver licensing authorities, and a two-round Delphi process with Australian occupational therapy driver assessors.

Results: Forty-nine occupational therapy driver assessors participated in the phase 1 focus groups. Deductive content analysis of the transcripts provided data to revise the competency standards. Inductive analysis provided an in-depth understanding of the participants’ views and was interpreted through six categories and their underlying subcategories: purposes and benefits; jurisdictional variations and practice diversity; language use; defining competent practice; challenging systems and processes; and competency standards content. Forty-eight occupational therapy driver assessors participated in the Delphi process. In Round 1, only 1 of the 164 competency standards and practice behaviours rated did not achieve the pre-determined 70% consensus rate. In Round 2, all statements achieved consensus, with the overall average consensus level obtained across the Round 2 statements at 96.8%.

Conclusion: The revised Australian Competency Standards for Occupational Therapy Driver Assessors have been endorsed by Occupational Therapy Australia and released for clinical use. The methods described in this research provide a framework suitable for revision or development of competency standards in both other areas of occupational therapy practice and other health-care professions.

Place, publisher, year, edition, pages
John Wiley & Sons, 2021
Keywords
automobile driving, competency standards, Delphi technique, focus group, occupational therapy, professional competence, standard of care
National Category
Occupational Therapy
Identifiers
urn:nbn:se:hj:diva-51969 (URN)10.1111/1440-1630.12722 (DOI)000619305400001 ()33604929 (PubMedID)2-s2.0-85100980409 (Scopus ID);intsam;1532101 (Local ID);intsam;1532101 (Archive number);intsam;1532101 (OAI)
Available from: 2021-03-01 Created: 2021-03-01 Last updated: 2021-12-13Bibliographically approved
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Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-6430-2823

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