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  • 1.
    Bruce, C. R.
    et al.
    Occupational Therapy, School of Allied Health, La Trobe University, Melbourne, VIC, Australia.
    Unsworth, Carolyn
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. Occupational Therapy, School of Allied Health, La Trobe University, Melbourne, VIC, Australia.
    Dillon, M. P.
    Prosthetics and Orthotics, School of Allied Health, La Trobe University, Melbourne, VIC, Australia.
    Tay, R.
    School of Business IT & Logistcs, RMIT University, Melbourne, VIC, Australia.
    Falkmer, Torbjörn
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. CHILD. School of Occupational Therapy and Social Work, Faculty of Health Sciences, Curtin University, Perth, WA, Australia.
    Bird, P.
    The Gosforth Clinic, Maroochydore QLD, Australia.
    Carey, L. M.
    Occupational Therapy, School of Allied Health, La Trobe University, Melbourne, VIC, Australia.
    Hazard perception skills of young drivers with Attention Deficit Hyperactivity Disorder (ADHD) can be improved with computer based driver training: An exploratory randomised controlled trial2017In: Accident Analysis and Prevention, ISSN 0001-4575, E-ISSN 1879-2057, Vol. 109, p. 70-77Article in journal (Refereed)
    Abstract [en]

    Background

    Young drivers with Attention Deficit Hyperactivity Disorder (ADHD) are at higher risk of road traffic injuries than their peers. Increased risk correlates with poor hazard perception skill. Few studies have investigated hazard perception training using computer technology with this group of drivers.

    Objectives

    *Determine the presence and magnitude of the between-group and within- subject change in hazard perception skills in young drivers with ADHD who receive Drive Smart training. *Determine whether training-facilitated change in hazard perception is maintained over time.

    Methods

    This was a feasibility study, randomised control trial conducted in Australia. The design included a delayed treatment for the control group. Twenty-five drivers with a diagnosis of ADHD were randomised to the Immediate Intervention or Delayed Intervention group.The Immediate Intervention group received a training session using a computer application entitled Drive Smart. The Delayed Intervention group watched a documentary video initially (control condition), followed by the Drive Smart computer training session. The participant’s hazard perception skill was measured using the Hazard Perception Test (HPT).

    Findings

    After adjusting for baseline scores, there was a significant betweengroup difference in post-intervention HPT change scores in favour of the Immediate Intervention group. The magnitude of the effect was large. There was no significant within-group delayed intervention effect. A significant maintenance effect was found at 6-week follow-up for the Immediate Intervention group.

    Conclusions

    The hazard perception skills of participants improved following training with large effect size and some maintenance of gain. A multimodal approach to training is indicated to facilitate maintenance. A full-scale trial is feasible.

  • 2.
    Bruce, C.
    et al.
    La Trobe University, Melbourne, Australia.
    Unsworth, Carolyn
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. La Trobe University, Melbourne, Australia.
    Dillon, M.
    La Trobe University, Melbourne, Australia.
    Tay, R.
    RMIT University, Melbourne, Australia.
    Falkmer, Torbjörn
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. CHILD. La Trobe University, Melbourne, Australia.
    Bird, P.
    The Gosforth Clinic, Maroochydore, Australia.
    Carey, L.
    La Trobe University, Melbourne, Australia.
    Hazard Perception Skills Of Young Drivers With Attention-Deficit Hyperactivity Disorder Can Be Improved With Computer-Based Training: A Feasibility Trial2017In: Australian and New Zealand journal of psychiatry (Print), ISSN 0004-8674, E-ISSN 1440-1614, Vol. 51, no Suppl. 1, p. 122-122Article in journal (Refereed)
    Abstract [en]

    Background: Young drivers with attention-deficit hyperactivity disorder (ADHD) are at higher risk of road traffic injuries than their peers. Increased risk correlates with poor hazard perception skill. Few studies have investigated hazard perception training using computer applications such as DriveSmart with this group of drivers.

    Objectives: To: determine the magnitude of the between-group and within-subject change in hazard perception skills among young drivers with ADHD-exposed/delayed exposure to DriveSmart training and determine whether training-facilitated change in hazard perception is maintained over time.

    Methods: Australian feasibility study. Twenty-five drivers with a diagnosis of ADHD were randomized to the intervention or control group. Participants in the intervention group received a computer training session using DriveSmart, while the control group watched a documentary video. The design included a delayed treatment for the control group. The participants’ hazard perception skill was measured on the University of Queensland Hazard Perception Test (HPT) post training and at 6-week follow-up.

    Findings: After adjusting for baseline scores, there was a significant between-group difference (p = 0.023, partial η2 = 0.212) and a significant within-subject difference post intervention in the experimental group. There was no significant difference between post intervention and 6-week follow-up scores in the experimental group.

    Conclusions: The hazard perception skills of participants improved following training and were largely sustained. We found a large effect size consistent with one prior study. A full-scale trial is feasible.

  • 3.
    Fields, Sally M.
    et al.
    Occupational Therapy, School of Health, Medical and Applied Sciences, Central Queensland University, Melbourne, VIC, Australia.
    Unsworth, Carolyn
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. Occupational Therapy, School of Health, Medical and Applied Sciences, Central Queensland University, Melbourne, VIC, Australia.
    Revision of the Competency Standards for Occupational Therapy Driver Assessors: An overview of the evidence for the inclusion of cognitive and perceptual assessments within fitness-to-drive evaluations2017In: Australian Occupational Therapy Journal, ISSN 0045-0766, E-ISSN 1440-1630, Vol. 64, no 4, p. 328-339Article in journal (Refereed)
    Abstract [en]

    Background/aim: Determination of fitness-to-drive after illness or injury is a complex process typically requiring a comprehensive driving assessment, including off-road and on-road assessment components. The competency standards for occupational therapy driver assessors (Victoria, Australia) define the requirements for performance of a comprehensive driving assessment, and we are currently revising these. Assessment of cognitive and perceptual skills forms an important part of the off-road assessment. The aim of this systematic review of systematic reviews (known as an overview) is to identify what evidence exists for including assessment of cognitive and perceptual skills within fitness-to-drive evaluations to inform revision of the competency standards.

    Methods: Five electronic databases (MEDLINE, CINAHL, PsycINFO, The Cochrane Library, OT Seeker) were systematically searched. Systematic review articles were appraised by two authors for eligibility. Methodological quality was independently assessed using the AMSTAR tool. Narrative analysis was conducted to summarise the content of eligible reviews.

    Results: A total of 1228 results were retrieved. Fourteen reviews met the inclusion criteria. Reviews indicated that the components of cognition and perception most frequently identified as being predictive of fitness-to-drive were executive function (n = 13), processing speed (n = 12), visuospatial skills, attention, memory and mental flexibility (n = 11). Components less indicative were perception, concentration (n = 10), praxis (n = 9), language (n = 7) and neglect (n = 6).

    Conclusion: This overview of systematic reviews supports the inclusion of assessment of a range of cognitive and perceptual skills as key elements in a comprehensive driver assessment and therefore should be included in the revised competency standards for occupational therapy driver assessors. 

  • 4.
    Harries, Priscilla
    et al.
    Brunel University London, London, UK.
    Unsworth, Carolyn
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. Central Queensland University, Melbourne, Australia.
    Gokalp, Hulya
    Brunel University London, London, UK.
    Davies, Miranda
    Nuffield Trust, London, UK.
    Tomlinson, Christopher
    Imperial College London, London, UK.
    Harries, Luke
    University of Cambridge, Cambridge, UK.
    A randomised controlled trial to test the effectiveness of decision training on assessors' ability to determine optimal fitness-to-drive recommendations for older or disabled drivers.2018In: BMC Medical Education, ISSN 1472-6920, E-ISSN 1472-6920, Vol. 18, no 1, article id 27Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Driving licensing jurisdictions require detailed assessments of fitness-to-drive from occupational therapy driver assessors (OTDAs). We developed decision training based on the recommendations of expert OTDAs, to enhance novices' capacity to make optimal fitness-to-drive decisions. The aim of this research was to determine effectiveness of training on novice occupational therapists' ability to make fitness-to-drive decisions.

    METHODS: A double blind, parallel, randomised controlled trial was conducted to test the effectiveness of decision training on novices' fitness-to-drive recommendations. Both groups made recommendations on a series of 64 case scenarios with the intervention group receiving training after reviewing two thirds of the cases; the control group, at this same point, just received a message of encouragement to continue. Participants were occupational therapy students on UK and Australian pre-registration programmes who individually took part online, following the website instructions. The main outcome of training was the reduction in mean difference between novice and expert recommendations on the cases.

    RESULTS: Two hundred eighty-nine novices were randomised into intervention; 166 completed the trial (70 in intervention; 96 in control). No statistical differences in scores were found pre-training. Post training, the control group showed no significant change in recommendations compared to the experts (t(96) = -.69; p = .5), whereas the intervention group exhibited a significant change (t(69) = 6.89; p < 0.001). For the intervention group, the mean difference compared with the experts' recommendations reduced with 95% CI from -.13 to .09. Effect size calculated at the post-training demonstrated a moderate effect (d = .69, r = .32).

    CONCLUSIONS: Novices who received the decision training were able to change their recommendations whereas those who did not receive training did not. Those receiving training became more able to identify drivers who were not fit-to-drive, as measured against experts' decisions on the same cases. This research demonstrated that novice occupational therapists can be trained to make decisions more aligned to those of expert OTDAs. The decision training and cases have been launched as a free training resource at www.fitnesstodrive.com . This can be used by novice driver assessors to increase their skill to identify drivers who are, and are not fit-to-drive, potentially increasing international workforce capacity in this growing field of practice.

  • 5.
    Hilton, G.
    et al.
    Occupational Therapy Department, Central Queensland University, Royal Talbot Rehabilitation Centre, Melbourne, VIC, Australia.
    Unsworth, Carolyn A.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. Occupational Therapy Department, Central Queensland University, Royal Talbot Rehabilitation Centre, Melbourne, VIC, Australia.
    Murphy, G. C.
    School of Public Health, La Trobe University, Melbourne, VIC, Australia.
    Browne, M.
    Occupational Therapy Department, Central Queensland University, Royal Talbot Rehabilitation Centre, Melbourne, VIC, Australia.
    Olver, J.
    Victorian Spinal Cord Service, Austin Health, Melbourne, VIC, Australia.
    Longitudinal employment outcomes of an early intervention vocational rehabilitation service for people admitted to rehabilitation with a traumatic spinal cord injury2017In: Spinal Cord, ISSN 1362-4393, E-ISSN 1476-5624, Vol. 55, no 8, p. 743-752Article in journal (Refereed)
    Abstract [en]

    Study design: Longitudinal cohort design.

    Objectives: First, to explore the longitudinal outcomes for people who received early intervention vocational rehabilitation (EIVR); second, to examine the nature and extent of relationships between contextual factors and employment outcomes over time.

    Setting: Both inpatient and community-based clients of a Spinal Community Integration Service (SCIS).

    Methods: People of workforce age undergoing inpatient rehabilitation for traumatic spinal cord injury were invited to participate in EIVR as part of SCIS. Data were collected at the following three time points: Discharge and at 1 year and 2+ years post discharge. Measures included the spinal cord independence measure, hospital anxiety and depression scale, impact on participation and autonomy scale, numerical pain-rating scale and personal wellbeing index. A range of chi square, correlation and regression tests were undertaken to look for relationships between employment outcomes and demographic, emotional and physical characteristics.

    Results: Ninety-seven participants were recruited and 60 were available at the final time point where 33% (95% confidence interval (CI): 24-42%) had achieved an employment outcome. Greater social participation was strongly correlated with wellbeing (Ï =0.692), and reduced anxiety (Ï =â '0.522), depression (Ï =â '0.643) and pain (Ï =â '0.427) at the final time point. In a generalised linear mixed effect model, education status, relationship status and subjective wellbeing increased significantly the odds of being employed at the final time point. Tertiary education prior to injury was associated with eight times increased odds of being in employment at the final time point; being in a relationship at the time of injury was associated with increased odds of being in employment of more than 3.5; subjective wellbeing, while being the least powerful predictor was still associated with increased odds (1.8 times) of being employed at the final time point.

    Conclusions: EIVR shows promise in delivering similar return-to-work rates as those traditionally reported, but sooner. The dynamics around relationships, subjective wellbeing, social participation and employment outcomes require further exploration.

  • 6.
    Hilton, Gillean
    et al.
    Department of Occupational Therapy, Central Queensland University, Melbourne, Australia.
    Unsworth, Carolyn
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. Department of Occupational Therapy, Central Queensland University, Melbourne, Australia.
    Murphy, Gregory
    School of Public Health La Trobe University, Melbourne, Australia.
    The experience of attempting to return to work following spinal cord injury: a systematic review of the qualitative literature.2018In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 40, no 15, p. 1745-1753Article in journal (Refereed)
    Abstract [en]

    PURPOSE: This review sought to answer the question "What are the barriers and facilitators influencing people's experience of return to work following spinal cord injury?"

    METHODS: Studies that met the selection criteria were identified, presented and critically appraised using National Institute for Health and Care Excellence guidelines. Thematic synthesis was completed with studies possessing strong methodological rigor. Synthesis and interpretation involved three stages; coding of primary data; development of descriptive themes reflective of the primary data; and establishment of analytical themes to answer the review question.

    RESULTS: Data from nine papers were included in the thematic synthesis. Several descriptive themes and three analytical themes were drawn from the data to answer the research question. Analytical themes included: a matrix of personal and environmental factors exists requiring complex navigation in order to create possibilities and opportunities for postinjury employment; the process of seeking or gaining employment shares a reciprocal relationship with the temporal nature of adjustment to spinal cord injury; and there is an intrinsic need for occupational engagement through paid employment.

    CONCLUSIONS: Returning to or gaining employment after spinal cord injury is a fundamentally difficult experience for people. Multiple strategies are required to support the navigation of the process. There is, however, a need in people with spinal cord injury, to be a worker, and with that comes the inherent benefits of being employed. Implications for rehabilitation Returning to work should be a significant focus of spinal cord injury rehabilitation. Employment is both possible and health promoting following spinal cord injury. Multiple strategies are required to support people to navigate the return to work process. It is important to be cognizant of the individual motivations for being a worker and the complexity of the adjustment process. Spinal cord injury centers can provide a consistent and supportive framework and culture of positivity about employment after spinal cord injury.

  • 7.
    Hilton, Gillean
    et al.
    Central Queensland University, Melbourne, VIC, Australia.
    Unsworth, Carolyn
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. Central Queensland University, Melbourne, VIC, Australia.
    Stuckey, Ruth
    La Trobe University, Melbourne, VIC, Australia.
    Murphy, Gregory C
    La Trobe University, Melbourne, VIC, Australia.
    The experience of seeking, gaining and maintaining employment after traumatic spinal cord injury and the vocational pathways involved.2018In: Work: A journal of Prevention, Assessment and rehabilitation, ISSN 1051-9815, E-ISSN 1875-9270, Vol. 59, no 1, p. 67-84Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Vocational potential in people with spinal cord injury (SCI) are unrealised with rates of employment substantially lower than in the labour force participation of the general population and the pre-injury employment rates.

    OBJECTIVES: To understand the experience and pathway of people achieving employment outcome after traumatic spinal cord injury by; classifying participants into employment outcome groups of stable, unstable and without employment; identifying pre and post-injury pathways for participants in each group and, exploring the experiences of people of seeking, gaining and maintaining employment.

    METHODS: Thirty-one participants were interviewed. Mixed methods approach including interpretive phenomenological analysis and vocational pathway mapping of quantitative data.

    RESULTS: The most common pathway identified was from study and work pre-injury to stable employment post-injury. Four super-ordinate themes were identified from the interpretive phenomenological analysis; expectations of work, system impacts, worker identity and social supports. Implications for clinical practice include fostering cultural change, strategies for system navigation, promotion of worker identity and optimal use of social supports.

    CONCLUSIONS: The findings increase insight and understanding of the complex experience of employment after spinal cord injury. There is opportunity to guide experimental research, policy development and education concerning the complexity of the return to work experience and factors that influence pathways.

  • 8.
    Sansonetti, Danielle
    et al.
    Acquired Brain Injury Rehabilitation Centre, Caulfield Hospital, Melbourne, VIC, Australia.
    Nicks, Rebecca J.
    Occupational Therapy Department, Alfred Health, Melbourne, VIC, Australia.
    Unsworth, Carolyn
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. School of Health, Medical and Applied Science, Central Queensland University, QLD, Australia.
    Barriers and enablers to aligning rehabilitation goals to patient life roles following acquired brain injury2018In: Australian Occupational Therapy Journal, ISSN 0045-0766, E-ISSN 1440-1630, Vol. 65, no 6, p. 512-522Article in journal (Refereed)
    Abstract [en]

    Background/aim: Life roles are integral to occupational therapy practice. Goal setting is a method of establishing priorities to measure outcomes. While acquired brain injury can impact a person's ability to fulfil meaningful life roles, the alignment of goals set in rehabilitation to life roles, is unclear. This study aimed to (i) explore the alignment of goals with life roles for people with an acquired brain injury participating in inpatient rehabilitation; and (ii) identify barriers and enablers to life role discussions within a patient-directed goal setting framework.

    Method: A mixed-methods study was conducted on an inpatient rehabilitation unit in Victoria, Australia. Quantitative data were obtained from a retrospective file audit of randomly selected medical records. Qualitative data were collected through: a) interviews with patients and their families; and b) A focus group with occupational therapists. Thematic analysis of both audit data and narrative data was undertaken.

    Results: Thirty files were examined and demonstrated 33% alignment between goals and life roles. Four interviews were completed with patients, with a family member participating in two of these. Themes identified were: readiness, role concept, recovery concept and goal review. Five therapists attended the focus group. Themes identified were: Patient factors, goal review, expectations, role change and environment. Interview and focus group data identified that barriers to life role discussions included: lack of patient and family readiness, patients’ difficulty understanding role concept, focus on impairments and lack of family/ significant others support. Enablers included: having early conversations involving family, regular goal review and use of standardised tools.

    Conclusion: Goal setting in alignment with life roles is important in acquired brain injury rehabilitation, but may be limited. This process can be enhanced by including patients and their significant others in early goal setting conversations, along with regular goal review across the rehabilitation process. 

  • 9.
    Timmer, Amanda J.
    et al.
    School of Health Medical and Applied Sciences, Central Queensland University, Melbourne, Australia.
    Unsworth, Carolyn
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. School of Health Medical and Applied Sciences, Central Queensland University, Melbourne, Australia.
    Browne, Matthew
    School of Health Medical and Applied Sciences, Central Queensland University, Melbourne, Australia.
    Occupational therapy and activity pacing with hospital-associated deconditioned older adults: a randomised controlled trial2019In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, p. 1-9Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To examine the efficacy of an occupational therapy activity pacing intervention with deconditioned older adults in rehabilitation.

    METHOD: Randomised, single-blind controlled trial of deconditioned older adults admitted for rehabilitation following treatment of an acute medical condition, allocated to intervention [n = 51, males = 14, mean age = 80(8)] or control [n = 49, males = 12, mean age = 81(7)] group. The intervention group received individual and group activity pacing education with practice and application of techniques to daily activities and the home environment, while the control group received a typical occupational therapy program, which included brief activity pacing education. Outcomes included participation in daily living skills, health status (including pain and fatigue symptoms), self-efficacy in daily activities and activity pacing techniques using the Australian Therapy Outcome Measures-Occupational Therapy (AusTOMs-OT), Short Form-36 Health Survey (SF-36), Self-Efficacy Gauge and Activity Pacing Assessment.

    RESULTS: No differences in groups at admission. Comparison at discharge and three months post discharge using 2 × 2 mixed ANOVA demonstrated small differences in only one scale of the activity limitation domain of the AusTOMs-OT. No significant differences were found in other scales or domains of the AusTOMs-OT, nor secondary outcome measures.

    CONCLUSION: Activity pacing in addition to typical occupational therapy during inpatient rehabilitation did not demonstrate benefits to participants in the management of their daily activities on returning home post hospitalisation. Implications for rehabilitation Activity pacing has been identified as one of the commonly used occupational therapy interventions utilised with deconditioned older adults in rehabilitation. An activity pacing intervention in conjunction with typical occupational therapy demonstrated no benefits for deconditioned older adults over typical occupational therapy which included basic education on this topic. Continuation of the activity pacing intervention into the outpatient setting may be of benefit to older adults and requires further investigation.

  • 10.
    Townsend, K.
    et al.
    Austin Health.
    Unsworth, Carolyn
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. Central Queensland University, Melbourne, Victoria, Australia.
    The inter-rater reliability of the Powered Mobility Device Assessment Training Tool2019In: Australian Occupational Therapy Journal, ISSN 0045-0766, E-ISSN 1440-1630, Vol. 66, no 3, p. 393-400Article in journal (Refereed)
    Abstract [en]

    Introduction:

    The prescription of powered mobility devices for clients is an important role for occupational therapists. However, the skill of may powered mobility device users to drive their devices remains unknown and clients are provided with only brief education on their use. Few assessments exist to guide mobility device use assessment, and none of these incorporate the training clients need. The aim of this paper was to investigate the inter-rater reliability of a new assessment and training tool called the Powered Mobility Device Assessment Training Tool (PoMoDATT).

    Method:

    The PoMoDATT comprises an initial interview and then Part A- cognitive skills, Part B physical and psychosocial skills and Part C driving skills and behaviours. The assessment outcome is a profile of the client's physical, cognitive and psychosocial skills related to powered mobility device use. The driving assessments of 24 powered mobility device users were video-recorded, and four experienced occupational therapists scored the clients on the 26 items of Part C of the PoMoDATT.

    Results:

    Following clarification of three items which included re-scoring and data re-analysis, the inter-rater reliability for the PoMoDATT Part C items ranged from ICC (2, 1) 0.641 to 0.938 suggesting moderate to excellent agreement.

    Conclusions:

    The PoMoDATT Part C has demonstrated adequate inter-rater reliability to support its use by occupational therapists to assess powered mobility device user's capacities and abilities and to highlight ongoing training needs.

  • 11.
    Unsworth, Carolyn
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. School of Health, Medical and Applied Sciences, Central Queensland University, Australia.
    Analysing and interpreting outcomes data to support evidence-based practice using the example of AusTOMs-OT2017In: British Journal of Occupational Therapy, Vol. 80, no 10, p. 631-637Article in journal (Refereed)
    Abstract [en]

    Statement of context: Occupational therapists working with clients who have neurological impairments routinely collect outcomes data. However, data cannot inform practice unless it is routinely reviewed. The aim of this paper was to show how outcomes data collected on the Australian Therapy Outcome Measures – Occupational Therapy scale were analysed and interpreted. Although the example pertains to clients with neurological problems, the approach can be applied to all areas of practice.

    Critical reflection on practice: When outcomes data are routinely analysed and findings reviewed, occupational therapists have an increased understanding of practice strengths and limitations.

    Implications for practice: Incorporating analysis and interpretation of outcomes data for clients with neurological problems into practice contributes evidence to support therapy and ensures clinicians retain control of their data. 

  • 12.
    Unsworth, Carolyn
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. School of Health, Medical and Applied Sciences, CQ University, Melbourne, VIC, Australia .
    Review papers: Getting the best occupational therapy evidence into practice2017In: British Journal of Occupational Therapy, ISSN 0308-0226, E-ISSN 1477-6006, Vol. 80, no 3, p. 143-144Article in journal (Other (popular science, discussion, etc.))
  • 13.
    Unsworth, Carolyn
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. School of Health Medical and Applied Science, Central Queensland University, Bundaberg, Australia.
    Baker, Anne
    Department of Occupational Therapy, Australian Catholic University, Melbourne, Australia.
    Lannin, Natasha
    College of Science Health and Engineering, La Trobe University, Bundoora, Australia.
    Harries, Priscilla
    School of Health Sciences and Social Care, Brunel University London, London, UK.
    Strahan, Janene
    Sunshine Hospital, Melbourne, Australia.
    Browne, Matthew
    School of Health Medical and Applied Science, Central Queensland University, Bundaberg, Australia.
    Predicting fitness-to-drive following stroke using the Occupational Therapy - Driver Off Road Assessment Battery2019In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 41, no 15, p. 1797-1802Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: It is difficult to determine if, or when, individuals with stroke are ready to undergo on-road fitness-to-drive assessment. The Occupational Therapy - Driver Off Road Assessment Battery was developed to determine client suitability to resume driving. The predictive validity of the Battery needs to be verified for people with stroke.

    AIM: Examine the predictive validity of the Occupational Therapy - Driver Off Road Assessment Battery for on-road performance among people with stroke.

    METHOD: Off-road data were collected from 148 people post stroke on the Battery and the outcome of their on-road assessment was recorded as: fit-to-drive or not fit-to-drive.

    RESULTS: The majority of participants (76%) were able to resume driving. A classification and regression tree (CART) analysis using four subtests (three cognitive and one physical) from the Battery demonstrated an area under the curve (AUC) of 0.8311. Using a threshold of 0.5, the model correctly predicted 98/112 fit-to-drive (87.5%) and 26/36 people not fit-to-drive (72.2%).

    CONCLUSION: The three cognitive subtests from the Occupational Therapy - Driver Off Road Assessment Battery and potentially one of the physical tests have good predictive validity for client fitness-to-drive. These tests can be used to screen client suitability for proceeding to an on-road test following stroke. Implications for Rehabilitation: Following stroke, drivers should be counseled (including consideration of local legislation) concerning return to driving. The Occupational Therapy - Driver Off Road Assessment Battery can be used in the clinic to screen people for suitability to undertake on road assessment. Scores on four of the Occupational Therapy - Driver Off Road Assessment Battery subtests are predictive of resumption of driving following stroke.

  • 14.
    Unsworth, Carolyn
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. School of Health Medical and Applied Sciences, Central Queensland University, Melbourne, Australia.
    Timmer, Amanda J.
    School of Health Medical and Applied Sciences, Central Queensland University, Melbourne, Australia.
    Browne, Matthew
    School of Health Medical and Applied Sciences, Central Queensland University, Melbourne, Australia.
    A randomized controlled trial protocol investigating effectiveness of an activity-pacing program for deconditioned older adults2019In: Canadian Journal of Occupational Therapy / Revue Canadienne d`Ergotèrapie, ISSN 0008-4174, Vol. 86, no 2, p. 136-147Article in journal (Refereed)
    Abstract [en]

    Background

    Acute hospitalization of older adults can lead to deconditioning and the need for rehabilitation to facilitate a return to home and previous lifestyle. An occupational therapy intervention to combat deconditioning is activity pacing, an active self-management strategy where individuals learn to modify how and when activities are completed with the aim of improving participation in occupation.

    Purpose

    This study will examine the effectiveness of occupational therapy with activity pacing during rehabilitation for deconditioned older adults.

    Method

    A randomized controlled trial is proposed with inclusion criteria of older adults, 65+ years old, living independently in the community prior to admission, with adequate cognition and language to participate in the intervention. Participation, health status, self-efficacy in daily activities, self-efficacy in activity pacing techniques, and symptom management (pain and fatigue) will be measured at admission, discharge, and 3 months postdischarge.

    Implications 

    Determining if an activity-pacing program is effective will provide occupational therapists with evidence to support service delivery.

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