Factors impacting community living outcomes among former long-term nursing home residents using the interdependence-Human Activity Assistive Technology (i-HAAT) model

Despite an increased application of social theory in assistive technology (AT) outcomes research, there continues to be a gap in integrating AT conceptual models in research design, data analysis, and results interpretation. This paper merged two preexisting AT models, the Human Activity Assistive Technology model (HAAT) and the interdependence frame for AT into a novel framework, the interdependence-HAAT model (i-HAAT). This model was used to examine the outcomes of former long-term nursing home residents using AT. The model was also used as a framework to facilitate quantitative variable identification and categorization, emphasize the interconnectivity between domain variables, and explore the infrastructural supports necessary for the successful community reintegration of deinstitutionalized AT users. Meaningful integration of theory into practice is the essential next step in generating socially responsive research that addresses AT consumer needs and moves the field forward.

Development of clinical practice guidelines for allied health and nursing assessment and management of Duchenne muscular dystrophy

PURPOSE

To provide evidence-based guidance specific to allied health and nursing practice for the assessment and management of individuals with Duchenne muscular dystrophy (DMD).

MATERIALS AND METHODS

Thirteen key focus areas were identified in consultation with health professionals and consumer advocacy groups. A series of systematic literature reviews were conducted to identify assessment and management strategies for each key focus area. A consensus process using modified Delphi methodology, including an Australia-New Zealand expert consensus meeting, was conducted. Recommendations underwent consultative review with key groups before being finalised and prepared for dissemination.

RESULTS

This clinical practice guideline (CPG) generated 19 evidence-based recommendations, 117 consensus-based recommendations and five research recommendations across the 13 focus areas to inform allied health assessment and management of individuals with DMD.

CONCLUSIONS

The resulting recommendations can be used in conjunction with existing medical CPGs to improve, standardise and advocate for allied health and rehabilitation care in DMD. The process used here may be useful for the development of CPGs in other rare diseases.Implications for rehabilitationImplementation-ready evidence-based statements to guide clinical care of individuals with DMD are provided with the potential to improve participation, function in the community and quality of life.A model for developing best practice statements for other rare neurological diseases is described.Allied health and nursing health professionals should focus research efforts to generate quality evidence to support rehabilitation practice.

An integrated literature review of the current discourse around universal design in the built environment - is occupation the missing link?

PURPOSE

To synthesise current literature regarding applications of universal design (UD) to built environments that promote social participation, identify areas of agreement and areas requiring further attention and development. Occupations refer to personally meaningful activities, which people need, want or must do as part of their daily life.

MATERIALS AND METHODS

Recently published literature (January 2011-December 2017) relevant to UD and built environments, and pertaining to any discipline or professional area, were identified via a systematic search of databases in the EbscoHOST platform. The person-environment-occupation (PEO) model was chosen as a theoretical framework for the review, which included a sample of 33 peer reviewed journal articles.

RESULTS

The current discourse is driven more by description, discussion, and commentary than empirical approaches; although, a combination of quantitative, qualitative, and mixed methods approaches was employed. Much of the current discourse on UD and the built environment focuses on the person and the environment, with the occupations carried out in built environments and the interaction between these domains not referred to in much detail.

CONCLUSIONS

Including occupations, social participation, multi- and trans-disciplinary collaboration, and multicultural perspectives in the ongoing discourse around UD would enable the concept to reach its full potential as a medium for social justice. Implications for Rehabilitation The universal design (UD) process must account for the occupations that people perform in the built environment. Multi-disciplinary research and development, using multiple methods, is the most appropriate approach to investigate the application of UD to the built environment. Key areas of contention within the current discourse include meaningful inclusion of non-professional stakeholders, tensions between embracing and eliminating diversity and how professional education should be delivered.

Experiences and perceptions of facilitators of The WORKS

BACKGROUND

Some people who have a mental illness may require vocational rehabilitation and support to assist their participation in activity and employment. The WORKS is a vocational rehabilitation group intervention program, co-facilitated by Peer-Support Workers and Occupational Therapists. These facilitators provide support and guidance to people with a mental illness through practical activities and goal development.

OBJECTIVE

This study aimed to explore the lived experiences and perceptions of facilitators of The WORKS.

METHODS

The Integrating Theory, Evidence and Action (ITEA) method was used in this study, employing a phenomenological approach. Facilitators of The WORKS at a metropolitan Australian mental health service were purposively sampled, and four participated in semi-structured interviews. Data was transcribed verbatim and member checked, before being coded and analysed with reference to the Model of Human Occupation.

RESULTS

Five themes emerged from the data; Consumer Growth [Volition], Facilitator's Occupational Identity [Volition], Role of Facilitators [Habituation], Workload of Facilitators [Performance Capacity], and Adaptation of The WORKS Resources [Performance Capacity].

CONCLUSIONS

All participants perceived benefits related to The WORKS however discussed a co-facilitation power imbalance between facilitators. Therefore, more development is needed around the co-facilitation relationship between Occupational Therapists and Peer-Support Workers.

Instructional practices for evidence-based practice with pre-registration allied health students: a review of recent research and developments

The aim of this study is to update a previous review published in this journal on the effectiveness of teaching and assessment interventions for evidence based practice in health professions, and to determine the extent to which the five recommendations made from that review have been implemented. The Integrating Theory, Evidence and Action method was used to synthesise all published evidence from 2011 to 2015, which addressed instructional practices used for evidence based practice with pre-registration allied health students. Seventeen articles were found to meet the inclusion criteria, and were analysed for both their individual rigour and relationship to the five recommendations. The evidence reviewed in this study was diverse in both its geographical setting and the allied health disciplines represented. Most of the evidence used less rigorous methods, and the evidence base is generally exploratory in nature. To date, the five recommendations regarding instructional practices in this area have been implemented to varying degrees. Many current practices promote social negotiation, collaborative decision-making and collaborative learning, so the social constructivist approach is being adopted. However, the prior knowledge of students is not being assessed as a basis for scaffolding, communication of evidence based practice to varying audiences is rarely addressed and the role of clinicians in the learning of evidence based practice knowledge, skills, beliefs and attitudes remains limited.

The pan occupational paradigm: development and key concepts

BACKGROUND/AIM

Wilcock's Occupational Perspective of Health (OPH) aligns with the profession's re-discovery of its holistic, occupationally focused roots. Its dimensions of occupation-doing, being, becoming and belonging - resonate strongly with therapists on an intuitive, implicit level. However, its documented use in practice to date has been sparse, and several barriers to its implementation have been identified. The aim of this article is to present a renewal of the OPH - the Pan Occupational Paradigm (POP). Method of development: POP was developed using critical analysis, reflection and a comprehensive literature review. Each stage of development is described in detail, including the POP's inherent assumptions. Key concepts: POP retains the four dimensions of occupation, and shows their interdependent role within occupational entities (e.g. individuals, groups or communities). An entity can be approached by occupational therapy at any point and all the dimensions (either directly or indirectly) can be engaged. Occupational entities move along a continuum of wellbeing, and this movement can be in both positive and negative directions over a lifespan.

CONCLUSION AND SIGNIFICANCE

POP is a distillation of occupational therapy's unique way of knowing about occupation and the promotion of wellbeing. It is put forward as an updated paradigm for occupational therapy in the 21st century.

Occupational therapy in forensic psychiatry: Recent developments in our understandings (2007–2013)

Introduction

Occupational therapy in forensic settings has developed in recent decades, leading to an increasing amount of research being conducted in this field. There have been two previous attempts to provide overviews of this body of evidence and future directions for research; however, the rate of research has accelerated in recent years. This critical review addresses the following question: what evidence has been published about occupational therapy in forensic psychiatry over the past 7 years?

Method

A mixed methods approach was adopted, with four databases and a search engine consulted (OTDBase, CINAHL, AMED, PSYCHInfo, Google Scholar). The inclusion criteria were: (a) articles published in peer reviewed journals since 2007 and (b) authored by at least one occupational therapist. Twenty-five studies were identified for review, and the four dimensions of occupation – doing, being, becoming and belonging – were used to provide a theoretical context for the subsequent discussion.

Findings

The recent evidence base in forensic psychiatry focuses on doing and being, with fewer articles addressing becoming and belonging.

Conclusion

This review has identified increasing numbers of studies about forensic occupational therapy, which may reflect growth in both interest and the worldwide workforce.