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Bassingthwaighte L, Gustafsson L, Molineux M. Lifespace and occupational participation following acquired brain injury during driving disruption: a mixed methods study. Disabil Rehabil 2024:1-15. [PMID: 38592071 DOI: 10.1080/09638288.2024.2338192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 03/28/2024] [Indexed: 04/10/2024]
Abstract
PURPOSE To examine the lifespace of participants referred for occupational therapy driving assessment following acquired brain injury, to understand how, why, where and with whom access and participation in community-based occupations is occurring during the period of driving disruption. MATERIALS AND METHODS The mixed methods, convergent research design utilised a travel diary and Lifespace Mobility Assessment-Composite quantitative elements and semi-structured interviews analysed qualitatively with an interpretive description lens. RESULTS Forty-eight participants (56.25% male) aged between 26 and 65 years, left home on average once/day, primarily to conduct instrumental activities of daily living, health management, and social participation community-based occupations. Most reported restricted lifespace (54.2%) requiring assistance to conduct community occupations (68.1%). Support was primarily provided by family members (80.3%). Analysis of semi-structured interviews (n = 15) created three themes that shaped participant occupational experience during driving disruption: (i) changes to occupational participation; (ii) reliance on others for community access and participation; and (iii) trying to move forward. CONCLUSION The period of driving disruption following the onset of acquired brain injury is a time of occupational disruption which restricts lifespace, changing how, why, where and with whom participation in community-based occupations occurs. Rehabilitation facilitating occupational adaptation process to enhance community access capacity is indicated.
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Affiliation(s)
- Louise Bassingthwaighte
- Discipline of Occupational Therapy, School of Health Sciences and Social Work, Griffith University, Brisbane, Australia
- Driving Assessment and Rehabilitation Service, Princess Alexandra Hospital, Brisbane, Australia
| | - Louise Gustafsson
- Discipline of Occupational Therapy, School of Health Sciences and Social Work, Griffith University, Brisbane, Australia
| | - Matthew Molineux
- Discipline of Occupational Therapy, School of Health Sciences and Social Work, Griffith University, Brisbane, Australia
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Marnane K, Gustafsson L, Liddle J, Molineux M. Interventions for Driving Disruption in Community Rehabilitation: A Chart Audit. Disabil Rehabil 2023; 45:4424-4430. [PMID: 36448310 DOI: 10.1080/09638288.2022.2152501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 11/22/2022] [Indexed: 12/02/2022]
Abstract
PURPOSE After injury or illness, a person's ability to drive may be impacted and they may experience a period of "driving disruption," a period during which they cannot drive although they have not permanently ceased driving. They may require additional information and supports from treating rehabilitation services; however, this process is less understood than others related to driving. MATERIALS AND METHODS This study aimed to document the prevalence of driving-related issues and the current practices of a community rehabilitation service, regarding driving interventions. An audit of 80 medical records was conducted in a multidisciplinary community rehabilitation service in Brisbane, Australia. RESULTS In total, 61% of clients were "driving-disrupted" on admission and 35% remained driving-disrupted on discharge. Majority of driving-disrupted clients had an acquired brain injury (ABI). Driving-related interventions were not routinely provided, with 29% receiving no information or supports. Clients with ABI more frequently received information; provision of psychosocial support and community access training was infrequent. CONCLUSIONS This study highlights that return to driving is a common issue and goal for people undergoing community rehabilitation, with the period of driving disruption extending beyond rehabilitation discharge. It also highlights gaps in community rehabilitation practice, and opportunities to better support these clients.IMPLICATIONS FOR REHABILITATIONMany clients of community rehabilitation services experience driving disruption, often beyond discharge.Driving disruption should be recognised and documented by community rehabilitation services.Current practices may not adequately address the practical and psychological needs of clients experiencing driving disruption.
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Affiliation(s)
- Kerry Marnane
- School of Health Sciences and Social Work, Griffith University, Brisbane, Australia
- Acquired Brain Injury Outreach Service, Princess Alexandra Hospital, Brisbane, Australia
| | - L Gustafsson
- School of Health Sciences and Social Work, Griffith University, Brisbane, Australia
| | - J Liddle
- School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia
| | - M Molineux
- School of Health Sciences and Social Work, Griffith University, Brisbane, Australia
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Waterworth S, Dakin M. Navigating the pathway to ceasing driving-A voyage of discovery. Int J Older People Nurs 2022; 17:e12473. [PMID: 35603642 PMCID: PMC9787459 DOI: 10.1111/opn.12473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 03/22/2022] [Accepted: 04/18/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Ceasing driving for older people is a life transition and can be associated with a sense of loss and decreased wellbeing. Nurses can play a key role in supporting the older person to manage the transitions, especially as the work involved in ceasing driving is often hidden. For example, finding alternative and accessible means of travel and maintaining mobility. Travel itself can be viewed as essential, for example attending health appointments and shopping. Discretionary travel may not be viewed as essential, but provides an important means of maintaining activity and social connection. METHOD A case study is presented of Mike's journey in ceasing driving. The concept of transition helps in co-creating with Mike his journey of discovery. Semi-structured interviews took place with Mike over a six-month period and a journey pathway created, which was subject to further iterations during subsequent interviews. RESULTS Ceasing driving involves a number of transitions encompassing a series of losses, managing uncertainty, problem-solving and learning new skills. Being able to access and adapt to maintain mobility and travel are influenced by structural and environmental barriers. CONCLUSION The World Health Organization's strategy to create age-friendly cities and communities is admirable. Like any other strategy this is a long-term plan, and in meantime action needs to happen to support older people in ceasing driving and creating a non-driving life and limit a decrease in well-being. Starting conversations on transitional travel planning is proposed, with nurses playing a central role in making this process happen.
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Affiliation(s)
- Susan Waterworth
- School of Nursing, Faculty of Medical and Health SciencesThe University of AucklandAucklandNew Zealand
| | - Mike Dakin
- School of Nursing, Faculty of Medical and Health SciencesThe University of AucklandAucklandNew Zealand
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George S, Barr C, Berndt A, Milte R, Nussio A, Adey-Wakeling Z, Liddle J. Effects of the CarFreeMe Traumatic Injuries, a Community Mobility Group Intervention, to Increase Community Participation for People With Traumatic Injuries: A Randomized Controlled Trial With Crossover. Front Neurol 2022; 13:821195. [PMID: 35847230 PMCID: PMC9283567 DOI: 10.3389/fneur.2022.821195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 05/20/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction After traumatic injuries community participation is a common goal, promoting wellbeing and independence. Community mobility and transportation influence an individual's independence in community participation. With the ability to drive safely often compromised after traumatic injuries, the adverse consequences of driving cessation include a loss of identity and reduced participation in chosen activities. In rehabilitation, individualized community mobility intervention is not routinely provided. The primary aim of this trial was to evaluate whether a group-based intervention, the CarFreeMe TI program was more effective than standard intervention, an information sheet of alternative transport, in improving community mobility for people following traumatic injuries. The secondary aim of this study was to evaluate the effect: types of transport used, transport satisfaction, community mobility self-efficacy, quality of life, goal satisfaction and performance, for people following traumatic injuries; and to undertake a preliminary assessment of the potential resource use associated with the intervention, and lessons for implementation. Design Prospective, pilot, randomized, blind observer, controlled trial with crossover. Participants Twenty individuals with traumatic injuries. Intervention Six-week group-based support and education program, the CarFreeMe TI delivered in community settings (intervention) and standard information related to transport options available (control). Primary Outcome Measures Community participation using a Global Positioning System device to record the location and number of outings from home. Secondary Outcome Measures CarFreeMe TI Transport Questionnaire, Community Mobility Self-efficacy Scale, quality of life measures, Modified Canadian Occupational Performance Measure for goals (importance and satisfaction), participant satisfaction survey results and researcher logs. Results Those who received the intervention were more likely to use public transport and transport services and had an improved quality of life, when compared to the control group. The intervention group also reported high levels of improvement in goal performance and satisfaction. Global Positioning System data collection was incomplete, with geolocation data unusable. There was no significant change in number/type of visits away from home. Conclusions A group-based community mobility education program promoted modes of active independent transport but did not impact on outings from home. Future research could include passive collection methods using a smartphone to record community participation. Clinical Trial Registration https://www.anzctr.org.au/, identifier: ACTRN12616001254482.
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Affiliation(s)
- Stacey George
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
- Department of Occupational Therapy, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
- Department of Rehabilitation, Aged and Palliative Care Services, Flinders Medical Centre, Bedford Park, SA, Australia
| | - Christopher Barr
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Angela Berndt
- Department of Occupational Therapy, Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Rachel Milte
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Amy Nussio
- Department of Occupational Therapy, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Zoe Adey-Wakeling
- Department of Rehabilitation, Aged and Palliative Care Services, Flinders Medical Centre, Bedford Park, SA, Australia
- Department of Rehabilitation and Extended Care, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Jacki Liddle
- School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, QLD, Australia
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Pk Bernstein J, Milberg WP, McGlinchey RE, Fortier CB. Associations between Post-Traumatic stress disorder symptoms and automobile driving behaviors: A review of the literature. ACCIDENT; ANALYSIS AND PREVENTION 2022; 170:106648. [PMID: 35367898 PMCID: PMC9022601 DOI: 10.1016/j.aap.2022.106648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/28/2022] [Accepted: 03/25/2022] [Indexed: 06/03/2023]
Abstract
Human factors are responsible for most motor vehicle accidents that occur on the road. Recent work suggests that symptoms of posttraumatic stress disorder (PTSD) are linked to reduced driving safety, yet none have provided a comprehensive review of this small, emerging literature. The present review identified twenty-two studies reporting associations between PTSD and driving behaviors. Among these, longitudinal designs (k = 3) and studies using objective driving performance measures (e.g., simulators) (k = 2) were rare. Most studies (k = 18) relied on brief screener measures of PTSD status/symptoms or a prior chart diagnosis, while few used a standardized structured interview measure to determine PTSD status (k = 4), and only a small number of studies assessed PTSD symptom clusters (k = 7). PTSD was most frequently associated with increased rates of hostile driving behaviors (e.g., cutting off others), unintentional driving errors (e.g., lapses in attention) and negative thoughts and emotions experienced behind the wheel. Findings regarding risk of motor vehicle accident and driving-related legal issues were variable, however relatively few studies (k = 5) explored these constructs. Future directions are discussed, including the need for work focused on concurrent PTSD symptom/driving-related changes, more comprehensive PTSD and driving assessment, and consideration of the contributions of comorbid traumatic brain injury history and other neurological and psychiatric conditions on driving outcomes.
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Affiliation(s)
- John Pk Bernstein
- Translational Research Center for TBI and Stress Disorders (TRACTS) & Geriatric Research, Educational and Clinical Center (GRECC), VA Boston Healthcare System, Boston MA.
| | - William P Milberg
- Translational Research Center for TBI and Stress Disorders (TRACTS) & Geriatric Research, Educational and Clinical Center (GRECC), VA Boston Healthcare System, Boston MA; Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Regina E McGlinchey
- Translational Research Center for TBI and Stress Disorders (TRACTS) & Geriatric Research, Educational and Clinical Center (GRECC), VA Boston Healthcare System, Boston MA; Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Catherine B Fortier
- Translational Research Center for TBI and Stress Disorders (TRACTS) & Geriatric Research, Educational and Clinical Center (GRECC), VA Boston Healthcare System, Boston MA; Department of Psychiatry, Harvard Medical School, Boston, MA
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Adaptation of the CarFreeMe driver retirement intervention to provide driving cessation support to older people living with dementia. BRAIN IMPAIR 2020. [DOI: 10.1017/brimp.2020.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
AbstractObjective:Driving and stopping driving present challenging issues for older people living with memory problems and the family members supporting them. Changes to driving status impact the individual stopping driving and their family members. CarFreeMe is an existing, effective driving cessation program for older people that may be applicable to older people living with dementia. The purpose of this study was to adapt the program and explore feasibility and key stakeholder perspectives.Methods:The Medical Research Council guidelines for conducting research into complex interventions guided the development, acceptability and feasibility piloting. A multidisciplinary approach was taken, and key stakeholders were involved throughout the process. This included an adaptation process, followed by expert reference group feedback and case series pilot study.Results:The background research indicated that some key changes were required to meet the needs of people living with dementia. Aspects of the content, language, format and activities were adapted and an additional module was created for family members – whose involvement was identified as important. A more personalized, flexible approach was recommended. The expert reference group [psychologists (n = 2), occupational therapists (n = 3) and dementia behavior consultants (n = 2)] indicated the program was appropriate and needed, and made recommendations for feasibility. Pilot testing with three families indicated acceptability.Conclusion:A driving cessation program adapted for use with people living with dementia and their families required some changes to meet the needs and situations based on feedback from key stakeholders. Future studies will evaluate implementation outcomes across a range of settings.
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Frith J, James C, Hubbard I, Warren-Forward H. Australian health professionals' perceptions about the management of return to driving early after stroke: A mixed methods study. Top Stroke Rehabil 2020; 28:198-206. [PMID: 32787668 DOI: 10.1080/10749357.2020.1803570] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Stroke can affect a person's ability to drive a motor vehicle. In Australia, there is a 4-week restriction in driving after stroke and a 2-week restriction after transient ischemic attack. Concerns exist as to whether people discharged home from the acute setting receive education about these driving restrictions. OBJECTIVES This study sought to investigate health professionals' knowledge about, and responsibilities for patients return-to-driving (RTD) education after stroke and TIA. METHODS A cross-sectional online survey was designed and included questions about health professional demographic characteristics and knowledge and opinions of RTD guidelines. An open-ended question at the end of the survey enabled respondents to provide additional, free text information. Descriptive analyses were used to describe respondents' demography and characteristics. Chi-square analysis was used to compare responses across the different professional groups. Significance was tested using a p-value of 0.05. Data obtained from the free text question were analyzed through an inductive thematic approach. RESULTS A total of 455 health professionals responded to the survey, with 45% being occupational therapists. Only 22% of health professionals correctly selected the 4-week restriction period after stroke and 27% selected the 2-week restriction period for those with TIA. Occupational therapists were identified by 85% of respondents as the profession responsible for providing RTD education, followed by doctors (72%). Health professionals lack clarity in RTD guidelines and often defer the responsibility of managing RTD to others. CONCLUSIONS Education of health professionals in RTD guidelines is recommended to improve the processes of care after stroke.
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Affiliation(s)
- Janet Frith
- School of Health Sciences, Faculty of Health, University of Newcastle, Callaghan, Australia
| | - Carole James
- School of Health Sciences, Faculty of Health, University of Newcastle, Callaghan, Australia.,University of South Australia
| | - Isobel Hubbard
- School of Medicine and Public Health, Faculty of Health, University of Newcastle, Callaghan, Australia
| | - Helen Warren-Forward
- School of Health Sciences, Faculty of Health, University of Newcastle, Callaghan, Australia
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Oyesanya TO, Arulselvam K, Thompson N, Norelli J, Seel RT. Health, wellness, and safety concerns of persons with moderate-to-severe traumatic brain injury and their family caregivers: a qualitative content analysis. Disabil Rehabil 2019; 43:685-695. [PMID: 31298958 DOI: 10.1080/09638288.2019.1638456] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Persons with moderate-to-severe traumatic brain injury (TBI) face issues with health, wellness, and safety that affect their ability to independently manage their care, even for individuals who are ≥75% independent in activities of daily living. These issues often lead to increased family involvement in managing the person's condition after discharge home. PURPOSE We explored health, wellness, and safety concerns after discharge home from inpatient rehabilitation from the perspectives of persons with TBI who are ≥75% independent in activities of daily living and their family caregivers. MATERIALS AND METHODS We interviewed 27 persons with TBI and family caregivers and used conventional content analysis to analyse the data. RESULTS Seven themes related to health, wellness, and safety encompassed participants' experience. Health themes included: (1) attempting to manage medications and (2) navigating mental health difficulties. Wellness themes included: (1) working to stay physically active, (2) dealing with sleep and sleeplessness, and (3) adjusting to changing social relationships. Safety themes were: (1) addressing mobility challenges and (2) compensating for complications with cognitive functioning. CONCLUSIONS Findings can guide the development of tools, supports, and resources to promote health, wellness, and safety of persons with TBI as they recover after discharge home.Implications for rehabilitationFindings on numerous concerns related to health, wellness, and safety suggest the need for implementation or development and testing of tools, supports, and resources to promote health, wellness, and safety of persons with traumatic brain injury as they recover after discharge home.Our findings can be used to educate healthcare providers and increase awareness of the nuanced challenges patients and families face after discharge home.Findings can also be used by providers to educate patients and families on realistic expectations for life after discharge.
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Affiliation(s)
- Tolu O Oyesanya
- Shepherd Center, Crawford Research Institute, Atlanta, GA, USA.,School of Nursing, Duke University, Durham, NC, USA
| | | | - Nicole Thompson
- Shepherd Center, Crawford Research Institute, Atlanta, GA, USA
| | - Jenna Norelli
- Shepherd Center, Crawford Research Institute, Atlanta, GA, USA
| | - Ronald T Seel
- Shepherd Center, Crawford Research Institute, Atlanta, GA, USA.,Department of Physical Medicine and Rehabilitation, Center for Rehabilitation Science and Engineering, VCU School of Medicine, Richmond, VA, USA
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Oyesanya TO, Thompson N, Arulselvam K, Seel RT. Technology and TBI: Perspectives of persons with TBI and their family caregivers on technology solutions to address health, wellness, and safety concerns. Assist Technol 2019; 33:190-200. [DOI: 10.1080/10400435.2019.1612798] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- Tolu O. Oyesanya
- Duke University School of Nursing, Durham, North Carolina, USA
- Shepherd Center, Crawford Research Institute, Atlanta, Georgia, USA
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, School of Medicine, Richmond, Virginia, USA
| | - Nicole Thompson
- Duke University School of Nursing, Durham, North Carolina, USA
- Shepherd Center, Crawford Research Institute, Atlanta, Georgia, USA
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, School of Medicine, Richmond, Virginia, USA
| | - Karthik Arulselvam
- Duke University School of Nursing, Durham, North Carolina, USA
- Shepherd Center, Crawford Research Institute, Atlanta, Georgia, USA
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, School of Medicine, Richmond, Virginia, USA
| | - Ronald T. Seel
- Duke University School of Nursing, Durham, North Carolina, USA
- Shepherd Center, Crawford Research Institute, Atlanta, Georgia, USA
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, School of Medicine, Richmond, Virginia, USA
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Scott T, Liddle J, Mitchell G, Beattie E, Pachana N. Implementation and evaluation of a driving cessation intervention to improve community mobility and wellbeing outcomes for people living with dementia: study protocol of the 'CarFreeMe' for people with dementia program. BMC Geriatr 2019; 19:66. [PMID: 30832581 PMCID: PMC6399961 DOI: 10.1186/s12877-019-1074-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 02/18/2019] [Indexed: 11/10/2022] Open
Abstract
Background Giving up driving is a pivotal life event and universal challenge for people living with dementia and their families, and a complex area of clinical practice for health professionals who monitor driving cessation. The best outcomes are for individuals to plan for and eventually cease driving, however with insufficient support programs in place, many avoid the issue until it is reaches a crisis point. This program of research investigates a comprehensive support- and education-based intervention targeted at people living with dementia and their care partners who are managing driving cessation. The primary aim of this research is to determine the effectiveness of the program through a cluster randomized controlled trial. Methods/design The intervention (CarFreeMe) is an intensive program delivered by a trained health professional that addresses practical and emotional needs relevant to driving cessation. The seven module program is person-centred, covering awareness raising, adjustment, and practical support that is individualized according to geographic location and the particular goals and preferences of participants. A cluster randomized controlled trial will evaluate the effectiveness of the program. Evaluation will take place pre-intervention, immediately following, and three months post-intervention. Clusters are randomized to either intervention or usual treatment. Participants within clusters will be recruited via primary and secondary care clinics, community agencies, service providers, local media, social media, support groups, and word of mouth. The primary outcome measure for persons with dementia and their care partners is lifespace, collected via (i) smartphone GPS technology and (ii) self-reported number of episodes away from home (during the past week). Secondary outcomes include safe alternative transport status, wellbeing, depression, anxiety, and self-efficacy, which will be collected from dyads. Caregiving strain will be collected from care partner/family member only. A process evaluation of the intervention will also be undertaken. Discussion There is an urgent need for therapeutic approaches to supporting people living with dementia and their families to negotiate the complex decision making involved in deciding to change their approach to driving. The driving cessation intervention may fill an important gap in service delivery to people living with dementia who are adjusting to life without driving. Trial registration Australian and New Zealand Clinical Trials Registry ACTRN12618000388213, 15 March 2018.
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Affiliation(s)
- Theresa Scott
- School of Psychology, The University of Queensland, St Lucia, Queensland, 4072, Australia.
| | - Jacki Liddle
- School of Information Technology and Electrical Engineering, The University of Queensland, St Lucia, Queensland, 4072, Australia
| | - Geoffrey Mitchell
- Primary Care Clinical Unit, Faculty of Medicine, The University of Queensland, RB&W Hospital, Herston, Queensland, 4006, Australia
| | - Elizabeth Beattie
- Dementia Centre for Research Collaboration, School of Nursing, Queensland University of Technology, Kelvin Grove, Queensland, 4059, Australia
| | - Nancy Pachana
- School of Psychology, The University of Queensland, St Lucia, Queensland, 4072, Australia
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Community Participation for People with Trauma Injuries: A Study Protocol of a Crossover Randomised Controlled Trial of the Effectiveness of a Community Mobility Group Intervention (CarFreeMe TI). BRAIN IMPAIR 2019. [DOI: 10.1017/brimp.2019.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background: Following traumatic brain and spinal cord injuries, maximising community participation leads to better physical and mental health outcomes.Objectives: To determine the effectiveness and health system resource use of a group intervention (CarFreeMe TI) on community participation in people with complex trauma injuries.Method: Randomised crossover trial of 54 participants, recruited from rehabilitation services in Adelaide, Australia. Inclusion criteria is a trauma injury, unable to return to full driving, aged over 18 years of age, adequate cognition/behavioural/communication abilities to participate in sessions and mobile. Exclusion criterion is living in setting where alternative transport is provided. Participants will be randomly assigned on a 1:1 allocation basis, to receiving Phase 1 CarFreeMe TI-group-based intervention or Phase 2 information related to transport options. Then, crossover to Phase 1 or 2 will occur. Primary outcome measure is community participation using a Global Positioning System. Secondary outcome measures include Community Mobility Self-efficacy Scale; CarFreeMe TI Transport Questionnaire, AQOL, EQ-5D-5L; Carer's Community Mobility Self-efficacy Scale and Modified Carer Strain Index for carers of participants. Outcome assessors will be blinded to group allocation. All analyses will be on an intention to treat basis with difference in community participation between the groups determined via a GLM ANOVA and the significance between groups on other measures using independent sample t-tests. It is hypothesised that the community mobility intervention (CarFreeMeTI) will result in increased community participation.Discussion: The results will provide proof of concept information on the feasibility and inform allocation of resources for people with complex trauma injuries.Trial registration: Australian and New Zealand Clinical Trials Register (ANZCTR): ACTRN12616001254482.
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12
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Stepney M, Kirkpatrick S, Locock L, Prinjha S, Ryan S. A licence to drive? Neurological illness, loss and disruption. SOCIOLOGY OF HEALTH & ILLNESS 2018; 40:1186-1199. [PMID: 29790195 DOI: 10.1111/1467-9566.12754] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The sense of freedom and independence that being able to drive generates may be taken for granted by many until it is threatened by illness. Drawing on the 'mobility turn' in social sciences that emphasises the social and emotional significance of the car (Sheller and Urry , ), this article presents secondary analysis of narratives of driving and its significance across four neurological conditions (epilepsy, Parkinson's disease, transient ischaemic attack and motor neurone disease). Taking an interactionist approach we explore how the withdrawal of a driving licence can represent not just a practical and emotional loss of independence, but also loss of enjoyment; of a sense and feeling of 'normal' adulthood and social participation; and of an identity (in some cases gendered) of strength and power. Conversely the ability to keep driving can maintain an unbroken thread of narrative, for example enabling people with speech difficulties to feel and look normal behind the wheel. Moments of pleasure and normality illuminate the importance of examining the micro-strands of disruption illness can cause.
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Affiliation(s)
- Melissa Stepney
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Susan Kirkpatrick
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Louise Locock
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Suman Prinjha
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Sara Ryan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Saviola D, De Tanti A, Conforti J, Posteraro L, Manfredini A, Bagattini C, Basagni B. Safe return to driving following severe acquired brain injury: role of a short neuropsychological assessment. Eur J Phys Rehabil Med 2017; 54:717-723. [PMID: 29144107 DOI: 10.23736/s1973-9087.17.04905-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Driving is a complex ability requiring a broad range of motor, cognitive-behavioral and visual skills that may be impaired after severe acquired brain injury (sABI). Resumption of driving is perceived as a major need by patients, being closely linked to personal autonomy, work and social activities. AIM The objective of this study was to identify a short battery of neuropsychological tests with predictive value with regard to safe return to driving after sABI. DESIGN Observational study. SETTING Outpatient of a rehabilitation center for sABI. POPULATION A continuous series of 127 patients with stable sABI, well-reintegrated at a family and social level, dismissed since at least one year from the end of their intensive rehabilitation, enrolled between 2006 and 2014. METHODS Patients underwent an extensive battery of neuropsychological tests (pencil and paper and specific PC programs), aimed at assessing cognitive functions, in performance and verbal tasks. The results were analyzed in relation to their on-road performance during the driving test conducted by the office of the Italian Government Authority (success or failure of the test). RESULTS No correlations were found between demographic data, etiology, driving experience, verbal competence and the decision of the competent authority. Significant correlation was found between attention, executive functions, overall visual-spatial exploration and driving performance. CONCLUSIONS Both "pencil and paper" and computerized tests in the cognitive domains of attentive functions, and those involving performance with visual-spatial material, are significantly correlated with the driving test outcome, even if there is not enough evidence of the relative value of off-road compared to direct on-road tests. CLINICAL REHABILITATION IMPACT We propose a small neuropsychological battery of tests with normative data for Italian population, predictive with respect to the ability to drive safely. We recommend to use it as first screening before submitting patients to more demanding and risky on-road driving tests.
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Affiliation(s)
- Donatella Saviola
- Cardinal Ferrari Rehabilitation Center, S. Stefano Riabilitazione, Fontanellato, Parma, Italy
| | - Antonio De Tanti
- Cardinal Ferrari Rehabilitation Center, S. Stefano Riabilitazione, Fontanellato, Parma, Italy -
| | - Jessica Conforti
- Cardinal Ferrari Rehabilitation Center, S. Stefano Riabilitazione, Fontanellato, Parma, Italy
| | - Lucio Posteraro
- Unit of Specialistic Rehabilitation, Suzzara SpA Hospital, Mantua, Italy
| | - Alessia Manfredini
- Unit of Specialistic Rehabilitation, Suzzara SpA Hospital, Mantua, Italy
| | - Chiara Bagattini
- Department of Cognitive Neuroscience, IRCCS Centro San Giovanni di Dio, Fatebenefratelli, Brescia, Italy
| | - Benedetta Basagni
- Cardinal Ferrari Rehabilitation Center, S. Stefano Riabilitazione, Fontanellato, Parma, Italy
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14
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Lindsay S, Stoica A. A systematic review of factors affecting driving and public transportation among youth and young adults with acquired brain injury. Brain Inj 2017. [DOI: 10.1080/02699052.2017.1321140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Sally Lindsay
- Department of Occupational Science and Occupational Therapy, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, University of Toronto, Toronto, ON, Canada
| | - Andrei Stoica
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
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15
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Liang P, Fleming J, Gustafsson L, Griffin J, Liddle J. Family members' experiences of driving disruption after acquired brain injury. Brain Inj 2017; 31:517-525. [PMID: 28340304 DOI: 10.1080/02699052.2017.1283058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PRIMARY OBJECTIVE 1) To explore family members' lived experiences of driving disruption at early and later stages of the recovery continuum following acquired brain injury (ABI). 2) To describe health-related quality of life of family members of individuals with ABI who are experiencing driving disruption. RESEARCH DESIGN Mixed methods phenomenological research approach. METHODS AND PROCEDURES Semi-structured interviews and health-related quality of life questionnaires were conducted with 15 family members of individuals with ABI (early group: 1-12 months post-injury, n = 6; later group: >1 year post-injury, n = 9). RESULTS Two main themes were identified: Different for everyone: how driving disruption affects families, and Making it harder: context of driving disruption. The challenges of driving disruption were reported more frequently and with a more intense focus by family members who were caring for their relative for more than 1 year post-injury. This group also reported higher caregiver strain and poorer health-related quality of life. Reduced satisfaction with life, poor mental health and affected family functioning were reported by both groups. CONCLUSIONS Driving disruption impacts on family members and has long-lasting consequences. It is important for clinicians to work with family members to manage these challenges even years after ABI and consider individual contextual factors.
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Affiliation(s)
- Phyllis Liang
- a Division of Occupational Therapy, School of Health and Rehabilitation Sciences , The University of Queensland , Brisbane , Queensland , Australia
| | - Jennifer Fleming
- a Division of Occupational Therapy, School of Health and Rehabilitation Sciences , The University of Queensland , Brisbane , Queensland , Australia.,b Department of Occupational Therapy , Princess Alexandra Hospital , Brisbane , Queensland , Australia
| | - Louise Gustafsson
- a Division of Occupational Therapy, School of Health and Rehabilitation Sciences , The University of Queensland , Brisbane , Queensland , Australia
| | - Janelle Griffin
- b Department of Occupational Therapy , Princess Alexandra Hospital , Brisbane , Queensland , Australia
| | - Jacki Liddle
- c UQ Centre for Clinical Research , The University of Queensland , Brisbane , Queensland , Australia
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Frith J, Warren-Forward H, Hubbard I, James C. Shifting gears: An inpatient medical record audit and post-discharge survey of return-to-driving following stroke/transient ischaemic attack. Aust Occup Ther J 2017; 64:264-272. [DOI: 10.1111/1440-1630.12359] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Janet Frith
- School of Health Sciences; University of Newcastle; Callaghan New South Wales Australia
| | - Helen Warren-Forward
- School of Health Sciences; University of Newcastle; Callaghan New South Wales Australia
| | - Isobel Hubbard
- School of Medicine and Public Health; Faculty of Health; University of Newcastle; Callaghan New South Wales Australia
| | - Carole James
- School of Health Sciences; University of Newcastle; Callaghan New South Wales Australia
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17
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Liang P, Fleming J, Gustafsson L, Liddle J. Occupational experience of caregiving during driving disruption following an acquired brain injury. Br J Occup Ther 2016. [DOI: 10.1177/0308022616668359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Phyllis Liang
- Occupational Therapist, School of Health and Rehabilitation Sciences, Division of Occupational Therapy, The University of Queensland, Brisbane, Australia
| | - Jennifer Fleming
- Conjoint Associate Professor, School of Health and Rehabilitation Sciences, Division of Occupational Therapy, The University of Queensland, Brisbane, Australia
- Conjoint Associate Professor, Occupational Therapy Department, Princess Alexandra Hospital, Brisbane, Australia
| | - Louise Gustafsson
- Head and Undergraduate Program Director in Occupational Therapy, School of Health and Rehabilitation Sciences, Division of Occupational Therapy, The University of Queensland, Brisbane, Australia
| | - Jacki Liddle
- Postdoctoral Research Fellow and Occupational Therapist, Asia-Pacific Centre for Neuromodulation, UQ Centre for Clinical Research and Queensland Brain Institute, The University of Queensland, Brisbane, Australia
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18
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Liang P, Gustafsson L, Liddle J, Fleming J. Family members' needs and experiences of driving disruption over time following an acquired brain injury: an evolving issue. Disabil Rehabil 2016; 39:1398-1407. [PMID: 27347745 DOI: 10.1080/09638288.2016.1196397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE Family members often assume the role of driver for individuals who are not driving post-acquired brain injury (ABI). Given that return to driving can be unpredictable and uncertain, the impact of driving disruption on family members may vary at different stages post-injury. This study aims to understand the needs and experiences of family members over time during driving disruption following an ABI. METHOD A qualitative prospective longitudinal research design was used with semi-structured interviews at recruitment to study, 3 and 6 months later. RESULTS Fourteen family members completed 41 interviews. The longitudinal data revealed four phases of driving disruption: (1) Wait and see, (2) Holding onto a quick fix, (3) No way out, and (4) Resolution and adjustment. The phases described a process of building tension and a need for support and resolution over time. CONCLUSIONS Holding onto a quick fix is a pivotal phase whereby supports, such as engagement in realistic goal setting, are essential to facilitate family members' resolution of driving disruption issues. Family members who see no way out might not actively seek help and these points to a need for long-term and regular follow-ups. Future research can explore ways to support family members at these key times. Implications for rehabilitation Health professionals need to facilitate the process of fostering hope in family members to set realistic expectations of return to driving and the duration of driving disruption. It is necessary to follow-up with family members even years after ABI as the issue of driving disruption could escalate to be a crisis and family members might not actively seek help. Health professionals can consider both practical support for facilitating transport and emotional support when addressing the issue of driving disruption with family members.
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Affiliation(s)
- Phyllis Liang
- a Division of Occupational Therapy, School of Health and Rehabilitation Sciences , The University of Queensland , Brisbane , Queensland , Australia
| | - Louise Gustafsson
- a Division of Occupational Therapy, School of Health and Rehabilitation Sciences , The University of Queensland , Brisbane , Queensland , Australia
| | - Jacki Liddle
- b Queensland Brain Institute, The University of Queensland , Brisbane , Queensland , Australia
| | - Jennifer Fleming
- a Division of Occupational Therapy, School of Health and Rehabilitation Sciences , The University of Queensland , Brisbane , Queensland , Australia.,c Occupational Therapy Department , Princess Alexandra Hospital , Brisbane , Queensland , Australia
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Liddle J, Gustafsson L, Mitchell G, Pachana NA. A Difficult Journey: Reflections on Driving and Driving Cessation From a Team of Clinical Researchers. THE GERONTOLOGIST 2016; 57:82-88. [PMID: 27102058 DOI: 10.1093/geront/gnw079] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 02/15/2016] [Indexed: 11/14/2022] Open
Abstract
Recognizing the clinical importance and safety and well-being implications for the population, a multidisciplinary team has been researching older drivers and driving cessation issues for more than 15 years. Using empirical approaches, the team has explored quality of life and participation outcomes related to driving and nondriving for older people and has developed interventions to improve outcomes after driving cessation. The team members represent occupational therapists, medical practitioners, and clinical and neuropsychologists. While building the evidence base for driving- and driving cessation-related clinical practice, the researchers have also had first-hand experiences of interruptions to their own or parents' driving; involvement of older family members in road crashes; and provision of support during family members' driving assessment and cessation. This has led to reflection on their understandings and re-evaluation and refocusing of their perspectives in driving cessation research. This work will share the narratives of the authors and note their developing perspectives and foci within research as well as their clinical practice. Personal reflections have indicated the far-reaching implications for older drivers and family members of involvement in road crashes: the potential for interruptions to driving as a time for support and future planning and the conflicting and difficult roles of family members within the driving cessation process. Overall the lived, personal experience of the authors has reinforced the complex nature of driving and changes to driving status for the driver and their support team and the need for further research and support.
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Affiliation(s)
- Jacki Liddle
- Asia Pacific Centre for Neuromodulation, Queensland Brain Institute,
| | | | | | - Nancy A Pachana
- School of Psychology, The University of Queensland, Brisbane, Australia
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