Introduction: Passengers with disabilities report being driven past, denied bus access, inappropriately assisted, and rudely addressed by bus drivers. Bus drivers report their behaviour in encounters with passengers with disabilities is impacted by their limited understanding of their passengers' needs. This study aimed to create a bus driver training program targeting how bus drivers engage with passengers with disabilities. Methods: Drawing from co-design and inclusive research approaches, a team of seven researchers, transport advocates with lived experience of disability, and bus drivers, collaborated for 30 h over approximately twelve months to co-design a bus driver training program and evaluate the design process. Participant evaluations of the co-design process and resulting training program were completed. Results: Team evaluations indicated the co-design process was inclusive and collaborative, with key challenges including resource constraints and a hard-to-navigate university payment system. A 90-min online training program, and one-hundred-and-eighty-minute face-to-face training program, were developed using a slide-deck and role-play activities to support drivers when interacting with passengers with disabilities. Named the Better Transport Inclusivity for all Passengers (Better Trip) Training Program, the prototype is ready for small-scale implementation, revisions, and wider rollout. Conclusions: The Better Trip Training Program offers bus companies and the wider transport community the opportunity to increase their inclusion of people with disabilities. The co-design process ensured people with disabilities and bus drivers' needs were reflected in the final product. Further research is required to test and refine the newly developed training program.

IMPORTANCE: Driving is a complex occupation requiring the interplay of high-level cognitive, physical, sensory, and behavioral skills for safe performance. Occupational therapists need to routinely address driving with adults as an occupational performance area. Further research is needed to determine whether performance-based assessment tools can support occupational therapists in screening client driving potential.

OBJECTIVE: To conduct a pilot study to determine whether the Multiple Errands Test-Home Version (MET-Home), as a performance-based assessment, either alone or in combination with other assessments, should be further investigated for use by occupational therapists to screen clients' driving potential.

DESIGN: Cross-sectional pilot study.

SETTING: Private in-clinic and community setting, including participants' homes.

PARTICIPANTS: Convenience sampling recruited 28 participants through private occupational therapy driver assessors.

OUTCOMES AND MEASURES: Participants underwent a comprehensive in-clinic and behind-the-wheel assessment, as per standard practice, and three additional cognitive tests. Data were summarized with descriptive statistics, and univariate analyses were used to examine the relationships between cognitive assessment scores and driving outcomes.

RESULTS: The MET-Home, as a stand-alone tool and in combination with other cognitive assessment scores, was not associated with driving outcomes (pass-fail). However, participant self-assessment of their MET-Home performance was associated with driving outcomes (pass-fail; p = .014).

CONCLUSIONS AND RELEVANCE: Although our findings suggest that the MET-Home is unlikely to screen for driving potential, further research of performance-based assessment tool use by occupational therapists is needed to support identification of the optimal type and timing of client referral for comprehensive assessment. Plain-Language Summary: The Multiple Errands Test-Home Version (MET-Home) is commonly completed by occupational therapists. Although this pilot study revealed that MET-Home scores were not associated with driving outcomes, performance-based assessments such as the MET-Home have the potential to guide occupational therapists when screening clients to determine when further, comprehensive assessment is indicated.

BACKGROUND: Training occupational therapy students in manual skills such as goniometry typically requires intensive one on one student teacher interactions and repetitive practice to ensure competency. There is evidence that immersive virtual reality (IVR) supported embodied learning can improve confidence and performance of skills. Embodied learning refers to learner's experience of viewing a simulated body and its properties as if they were the learner's own biological body. The aim of this proof-of-concept study was to develop and examine the usability and establish preliminary efficacy of an Embodied Goniometric Occupational Therapy Training Program (EGOTTP) to teach occupational therapy students wrist goniometry.

METHODS: Following the generation of written scripts, we used a 360-degree camera to film and create the program, with 3- levels of detailed education for six wrist goniometry measures, flexion-extension, radial-ulnar deviation and pronation-supination. Five students rated their experience using EGOTTP on measures of usability and efficacy.

RESULTS: The EGOTTP was developed over a 1-month period, and the participants reported good to high levels of embodiment and engagement, and their ratings suggested that the EGOTTP was easy to use with the support of an educator.

CONCLUSION: IVR training programs such as this one hold promise for teaching manual skill acquisition such as goniometry. As IVR technologies become more affordable and widespread, this approach could complement other strategies used to teach goniometry skills to students.

Introduction: While a small number of occupational therapists have additional training as driver assessors, all occupational therapists have a duty of care to address driving as an occupation. This study aimed to develop a resource to support Australian non-driver trained occupational therapists in daily practice to address driving with clients who may require on-road assessment due to a health concern.

Method: A literature review and comprehensive process for the development of a driving clinical decision pathway was followed using four phases. A virtual nominal group technique was used to investigate the content validity of the driving clinical decision pathway. Purposive sampling was used to recruit two groups of occupational therapists to participate in a virtual nominal group technique.

Results: A driving clinical decision pathway was developed with five key sections. The 11 participants attended 1 of 2 virtual nominal group technique for 120 minutes each, where 100% consensus was achieved with both groups relating to the content validity of the clinical decision pathway content, and ease of use.

Conclusion: Driving is a meaningful goal for all adults who have health-related challenges. A comprehensive driving clinical decision pathway has been developed and made available that supports Australian non-driver trained occupational therapists to address driving as an occupation that maintains individuals' independence and public safety.

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.

BackgroundFew evidence-based resources exist to support generalist occupational therapists address driving in practice. This pilot study aimed to evaluate whether a driving clinical decision pathway can assist generalist occupational therapists to address driving with clients.MethodsUsing a before (Timepoint-1) and after (Timepoint-2) design, data were collected at a multi-site outpatient community rehabilitation service. Medical record audits documenting how driving was addressed in practice and descriptive surveys of therapist's perceptions of pathway use were collected at Timepoints 1 and 2. A driving clinical decision pathway was implemented over 6 months. Descriptive statistics and content analysis were used to analyse and compare data over time.ResultsTimepoint-1 data from 102 client medical records, and 13 clinician surveys were compared against Timepoint-2 data from 144 records and 8 surveys. Following implementation of the pathway, the number of assessments used by generalist occupational therapists increased three-fold, to inform driving process recommendations which increased two-fold. Clinicians' self-reported knowledge, skills and confidence also increased two-fold.ConclusionA comprehensive driving clinical decision pathway provided clinicians with increased structure and support to guide practice change and promote role fulfilment in addressing return to driving with adults following a change in health status.

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.

Whether mundane or meaningful, interpersonal encounters are prerequisites for (and have a significant impact on) many occupations. This study sought to understand the interpersonal impact and occupational relevance of encounters, through exploring encounters between bus drivers and disabled passengers. The Person-Environment-Occupation-Performance (PEOP) Model was applied as part of a Framework Analysis, separately examining bus driver and disabled passenger data. The Interpersonal-Person-Environment-Occupation-Performance (I-PEOP) Model prototype was then developed to enable simultaneous exploration of the factors impacting such encounters. Application of the I-PEOP and PEOP Models found encounters between bus drivers and disabled passengers were pivotal to the exclusion or inclusion of disabled passengers in their communities. Understanding the occupational relevance of encounters, and the factors that determine their interpersonal impact, prompts occupational therapists to identify and address how intersectionality, power dynamics, occupational roles, and inter-perceptions impact an individual's community mobility and inclusion.

Plain Language Summary:

The Impact of Bus Drivers' Encounters With Disabled Passengers

Wherever we go, we meet people. We might smile at a baby in a pram, order coffee, or ask someone the time at the bus stop. These can be called "encounters," little moments with strangers. Sometimes these encounters may help or stop people from doing things they need or want to do, or from feeling included in their community. Researchers wanted to know more about encounters between bus drivers and disabled passengers. So, they asked bus drivers and disabled passengers questions about their encounters. The researchers then mapped out drivers' and passengers' answers to try to better understand their encounters using a "model" called the Interpersonal-Person-Environment-Occupation-Performance Model. This model helps people look at how their individual and shared experiences overlap. Encounters greatly impact people, so it would be good to learn more about them in the future.

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.