Equine-assisted services for people living with dementia: a systematic review

BACKGROUND

Dementia has a significant impact on the social, physical, and psychological wellbeing of people living with dementia, their families and society. Animal-assisted interventions can have positive effects on the health and wellbeing of people living with dementia. Equine-assisted services are animal-assisted non-pharmacological interventions which have improved the health and wellbeing of diverse populations. The impact of participating in equine-assisted services on the health and wellbeing of people with dementia is unclear. A systematic review was conducted to synthesise evidence investigating the effects of participating in equine-assisted services on the health and wellbeing of people living with dementia.

DESIGN

Systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

METHODS

The databases CINAHL, EMBASE, MEDLINE, and Web of Science were searched for any research published prior to 14 June 2023. Peer-reviewed publications in the English language utilizing methods deriving quantitative and/or qualitative data were eligible. Methodological quality of included studies was assessed using the Mixed Methods Appraisal Tool. Findings from studies were synthesised using a deductive approach.

RESULTS

Of the 223 articles screened, six met the inclusion criteria: four quantitative and two qualitative studies. The six studies represent four separate equine interventions. Studies were of moderate to strong quality. Participants were people living with dementia (n = 44, mean age range 70-83 years), dementia care partners (n = 5, mean age 58), and equine-assisted services providers (n = 5). Interventions varied in duration, activities conducted, outcomes measured, and measurement tools used. Studies found a favourable impact of participating in equine-assisted services on the neuropsychiatric symptoms and quality of life of people living with dementia. Participating in equine-assisted services improved well-being, functional abilities, social participation, and communication, while also having a positive effect on social, emotional, and behavioural outcomes, and physical health.

CONCLUSIONS

The limited but high-quality literature investigating the impact of equine-assisted services among people living with dementia suggests that equine-assisted services can have a positive impact on the health and wellbeing of people living with dementia. Additional robust studies contributing to the evidence base are warranted; such studies can support the development of programs and further elucidate the impact of participation.

Exploring the relationship between loneliness and volunteering amongst Australian adults: a cross-sectional study

BACKGROUND

Alleviating loneliness and fostering social connections and a sense of belonging are essential for individuals' well-being in the aftermath of the COVID-19 pandemic. Volunteering has emerged as a potential strategy to prevent or alleviate loneliness among adults. To gain insights into factors that can reduce or protect against loneliness, it is important to consider multi-dimensional measures of loneliness and motivations to volunteer. This study aimed to understand which variables predict Australian volunteers' social, family, and romantic loneliness.

METHODS

From October 2021 to January 2022, a cross-sectional online survey was administered to a sample of Australian adults with volunteering experience. The survey collected demographic information and used validated measures to assess social, family, and romantic loneliness and volunteer motivation. Bivariate and multivariate analyses were conducted to examine the association between loneliness and motivations for volunteering.

RESULTS

Of the 1723 individuals who accessed the survey link, 160 participants completed the survey. The average age of respondents was 59.87 years (SD 12.3). The majority were female (77.5%), married or partnered (70.6%), and had ten or more years of volunteering experience (62.1%). Overall, participants reported low to moderate levels of loneliness across social (M = 12.1; SD = 5.3), family (M = 11.3; SD = 6.7), and romantic (M = 14.8; SD = 8.3) dimensions. Social motivation for volunteering was negatively associated with social and romantic loneliness, while enhancement and protective motivations were positively associated with family and romantic loneliness. Age and rurality were not significantly associated with any dimension of loneliness.

CONCLUSIONS

Loneliness is a multifaceted and intricate experience that impacts individuals socially and emotionally. This study's findings confirmed that having protective and enhancement motives to volunteer was associated with increased loneliness. Social motives to volunteer were associated with a tendency to have lower levels of loneliness, possibly due to the positive impact of building and maintaining social relationships through volunteering. Understanding these associations is necessary to ensure that volunteering activities align with each person's unique needs and motivations.

Comparing acute hospital outcomes for people with post-stroke aphasia who do and do not require an interpreter

BACKGROUND

People with communication differences are known to have poorer hospital outcomes than their peers. However, the combined impact of aphasia and cultural/linguistic differences on care and outcomes after stroke remains unknown.

OBJECTIVES

To investigate the association between cultural/linguistic differences, defined as those requiring an interpreter, and the provision of acute evidence-based stroke care and in-hospital outcomes for people with aphasia.

METHODS

Cross-sectional, observational data collected in the Stroke Foundation National Audit of Acute Services (2017, 2019, 2021) were used. Multivariable regression models compared evidence-based care and in-hospital outcomes (e.g., length of stay) by interpreter status. Models were adjusted for sex, hospital location, stroke type and severity, with clustering by hospital.

RESULTS

Among 3122 people with aphasia (median age 78, 49% female) from 126 hospitals, 193 (6%) required an interpreter (median age 78, 55% female). Compared to people with aphasia not requiring an interpreter, those requiring an interpreter had similar care access but less often had their mood assessed (OR 0.50, 95% CI 0.32, 0.76), were more likely to have physiotherapy assessments (96% vs 90% p = 0.011) and carer training (OR 4.83, 95% CI 1.70, 13.70), had a 2 day longer median length of stay (8 days vs 6 days, p = 0.003), and were less likely to be independent on discharge (OR 0.54, 95% CI 0.33, 0.89).

CONCLUSIONS

Some differences exist in the management and outcomes for people with post-stroke aphasia who require an interpreter. Further research to explore their needs and the practical issues underpinning their clinical care pathways is required.

Efficacy of Multimodal Sensory Therapy in Adult Acquired Brain Injury: A Systematic Review

Adults who experience an acquired brain injury often experience disorders of consciousness, physical difficulties, and maladaptive behaviours. Multimodal sensory therapy may benefit brain injured patients, however the extent this therapy can facilitate rehabilitation is not well understood. This systematic review aimed to synthesize multimodal sensory therapy research for adults affected by acquired brain injury. PRISMA guidelines were followed and searches for work published up until July 2021 were undertaken in 5 databases, finding 1054 articles. 43 articles were included in the study. Results describe 29 studies related to coma following an acquired brain injury and 14 to no coma studies (mostly stroke). Multimodal sensory therapy was mostly used as a coma arousal technique following traumatic brain injury, finding positive effects. Multimodal sensory therapy was less applied in stroke, no coma rehabilitation, where most studies found improvement in somatosensory sensation and motor control in an affected limb. In several no coma studies, effects were maintained after several months. The most common senses stimulated in coma studies were audio (N = 30), tactile (N = 28), visual (N = 26), olfactory (N = 22), and gustatory (N = 17), while the most common senses stimulated in stroke, no coma studies were proprioception (N = 7), tactile (N = 8), and stereognosis (N = 4). Multimodal sensory therapy can be beneficial for patients, especially those in a minimally conscious state or attempting physical rehabilitation following stroke. Negative findings are infrequent in the current literature base. Multimodal sensory therapy appears to be a low-risk intervention with positive outcomes.

A systematic review of qualitative research exploring patient and health professional perspectives of breakthrough cancer pain

PURPOSE

Breakthrough cancer pain (BtCP) is a prevalent health issue which is difficult to manage. A plethora of quantitative research in this area exists. There is a paucity of research on the perspectives of health professionals and patients surrounding domains impacting effective treatment, including definitions of BtCP, treatment, and education opportunities. This review aims to identify and synthesize the extent of qualitative research exploring health professional and patient perspectives of BtCP.

METHODS

A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) approach was undertaken. The approach was registered with Prospero. MEDLINE, EMBASE, and Web of Science were searched for peer-reviewed literature published any date prior to May 19, 2022. Eligible sources must have considered health professional and/or patient perspectives of BtCP. A narrative synthesis approach was utilized.

RESULTS

Three sources met the review criteria. One source explored nurse perspectives, while two sources explored patient perspectives. Study quality was moderate to high. Overlapping themes across the three studies included communication, defining BtCP, impact of BtCP, management of BtCP, perceptions of BtCP, analgesia and pain relief, and training and professional development.

CONCLUSION

Given limited research investigating clinician and patient perspectives of BtCP, a rich understanding informed by exploratory qualitative methods around identification, best management strategies, professional development, and factors promoting and inhibiting best practice remains unclear. Further qualitative inquiry is warranted, and it is expected such research will inform BtCP clinical guidelines.

Predictors of resilience for people with spinal cord injury over two periods of COVID-19 social distancing restrictions: a 12-month longitudinal study using structural equation modelling

BACKGROUND

The novel coronavirus (COVID-19) pandemic is disproportionately impacting the health of people with disability. Resilience has remained an important health promoting characteristic during periods of social distancing restrictions. Factors promoting resilience for people with disability under the context of the pandemic remains poorly understood. Studies have yet to investigate evidence-based factors that promote resilience over multiple periods of restrictions for people with disability.

METHODS

A longitudinal study developed via a collaborative partnership between peer-support workers with lived experience of spinal cord injury (SCI) and university researchers was undertaken to fill knowledge gaps around factors promoting resilience for people with SCI during two periods of stringent social distancing restrictions within Victoria, Australia. Over 12-months, participants with SCI completed two surveys, towards the end of two lockdown periods. Evidence-based factors associated with resilience were measured. The Impact on Participation and Autonomy Questionnaire, the International SCI Quality of Life scale, and the 10-item Conor Davidson Resilience Scale, respectively measured autonomy and participation limitations, life satisfaction and psychological health, and resilience. A structural equation modelling (SEM) approach established factors directly and indirectly associated with resilience.

RESULTS

A model with excellent fit was produced. During two extended lockdowns over the 12-month period, increased family role limitations and favourable psychological health were respectively, negatively (Lockdown 1 [n = 127]: β = -.251, p < .01, Lockdown 2: β = -.400, p < .01) and positively (Lockdown 1: β = .601, p < .01, Lockdown 2 [n = 65]: β = .430, p < .01) associated with resilience. Indirect negative associations between resilience and increased outdoor autonomy limitations (Lockdown 1: β = -.195, p < .01, Lockdown 2: β = -.255, p < .01) and social life limitations (Lockdown 1: β = -.217, p < .01, Lockdown 2: β = -.142, p < .05) existed, and these relationships were moderated by psychological health.

CONCLUSIONS

Psychological health, and participation and autonomy are determinants of resilience during periods of crisis. Health and social care providers and public health departments should prioritise programs promoting these domains, to counter the negative impact of social distancing.

Advance care plans for vulnerable and disadvantaged adults: systematic review and narrative synthesis

BACKGROUND

Evidence suggests that there is a gap in advance care planning (ACP) completion between vulnerable and disadvantaged populations compared with the general population. This review seeks to identify tools, guidelines or frameworks that have been used to support ACP interventions with vulnerable and disadvantaged adult populations as well as their experiences and outcomes with them. The findings will inform practice in ACP programmes.

METHODS

A systematic search of six databases from 1 January 2010 to 30 March 2022 was conducted to identify original peer-reviewed research that used ACP interventions via tools, guidelines or frameworks with vulnerable and disadvantaged adult populations and reported qualitative findings. A narrative synthesis was conducted.

RESULTS

Eighteen studies met the inclusion criteria. Relatives, caregivers or substitute decision-makers were included in eight studies.

SETTINGS

hospital outpatient clinics (N=7), community settings (N=7), nursing homes (N=2), prison (N=1) and hospital (N=1). A variety of ACP tools, guidelines or frameworks were identified; however, the facilitator's skills and approach in delivering the intervention appeared to be as important as the intervention itself. Participants indicated mixed experiences, some positive, some negative and four themes emerged: uncertainty, trust, culture and decision-making behaviour. The most common descriptors relating to these themes were prognosis uncertainty, poor end-of-life communication and the importance of building trust.

CONCLUSION

The findings indicate that ACP communication could be improved. ACP conversations should incorporate a holistic and personalised approach to optimise efficacy. Facilitators should be equipped with the necessary skills, tools and information needed to assist ACP decision-making.

The nature of inpatient rehabilitation for people with aphasia from culturally and linguistically diverse backgrounds: a scoping review

BACKGROUND

Due to language and cultural barriers, people with aphasia from culturally and linguistically diverse (CALD) backgrounds are at risk of disadvantage in their access to comprehensive care. They are at higher risk of poorer inpatient outcomes in addition to challenges in receiving appropriate aphasia assessment and intervention.

OBJECTIVES

This study aims to examine the extent and nature of what is known about the inpatient phase of aphasia rehabilitation for CALD stroke survivors and identify potential research gaps in the literature for investigation.

METHODS

A scoping review with systematic search was conducted in September 2020 following the PRISMA Scoping Review checklist. Five electronic databases were searched using a combination of terms pertaining to "aphasia," "inpatient care" and "CALD." Key variables were extracted from studies that met the inclusion criteria for analysis.

RESULTS

Eighteen studies were yielded. Data regarding the inpatient phase of care indicate that CALD people with aphasia do not always receive comprehensive assessment or intervention in all their languages that may impact their discharge destination and access to community services. Speech-language pathologists (SLPs) report numerous barriers to service provision for this population. No studies investigated the degree and nature of differences in outcomes between CALD and non-CALD stroke survivors with aphasia.

CONCLUSIONS

CALD stroke survivors with aphasia inconsistently access SLP services in hospital. Assessment is unlikely to be conducted in patient primary languages and therapy is usually provided in the language of SLPs. Further research is required to determine whether this impacts functional outcomes and health services.

Virtual reality to foster empathy in disability workers: A feasibility study during COVID-19

BACKGROUND

Empathy is a critical skill required by disability workers. Virtual reality may increase access to staff training to foster empathy.

METHOD

A mixed methods feasibility study investigated a custom-built virtual reality program, IMercyVE, which aimed to immerse a disability worker in a first-person perspective of having intellectual disability. Data were collected through online surveys (n = 9) completed before and after use of IMercyVE, and by videoconference focus groups (n = 6).

RESULTS

Qualitative findings included that IMercyVE delivered a novel experience for participants and a distinctive mode of learning that assisted participants to deepen their levels of empathy. Descriptive analyses of the surveys indicated that participants' empathy increased after engaging with IMercyVE.

CONCLUSIONS

IMercyVE has the potential to be offered as a remotely delivered and flexible staff training modality suitable for building empathy. Further research with a larger sample is warranted.

What happens post-lockdown for people with disability? Autonomy, quality of life, service access and health changes for people with spinal cord injury in Victoria, Australia after COVID-19 social distancing restrictions

Social distancing restrictions are undoubtedly important for controlling the spread of COVID-19 however, they are also adversely impacting population health and health service access. It is important that priority populations with a disability which may already have adverse health, access to health services, and autonomy and participation compared to those without disability, are able to receive preventative health and social care during periods of restriction. The impact of social distancing restrictions on people with disability is not uniform nor well-understood. Research has been cross-sectional and considered data gathered during social distancing restrictions, or longitudinal, considering data gathered during a pre-pandemic baseline. This longitudinal study investigated the impact of lifting social distancing restrictions on priority domains for people with disability including autonomy and participation, access to health services, health issues and quality of life. People with spinal cord injury in Victoria, Australia (n = 71) completed a survey towards the end of social-distancing restrictions (T1) and 6-months post social distancing restrictions (T2). Non-parametric tests for significant differences confirmed that 6-months post-lifting social distancing restrictions participants experienced a significant increase in health conditions, a significant decrease in the number of inaccessible health services, and a significantly lower level of limitations across participation and autonomy, outdoor autonomy and work and education domains. QOL improved 6-months post lifting restrictions, however not to a significant level. The adverse health experienced by people with spinal cord injury after lifting restrictions may in part result from limited health service access and reduced participation during the time of restrictions. Clear definitions of what constitutes as essential care may ensure that eligible and required care remains received during lockdown or instances when service provision is compromised. Health and social care providers should be equipped with the knowledge of priority populations so that their support can be targeted to those most in need.

Healthcare services for people with acquired disability in South-East Queensland, Australia: Assessing potential proximity and its association with service obstacles

This study described access potential in South-East Queensland, to healthcare services commonly used by people with acquired disability; and investigated the association between service proximity and perceived service obstacles. First, we described accessibility by conducting a spatial analysis to create maps of potential accessibility to health services in South-East Queensland. Queensland statistical area level 2 (SA2) locations were combined with the residential locations of participants from a longitudinal cohort study involving people with ABI and SCI. The locations of selected health services of interest were identified from Health Direct's National Health Service Directory. Travel times via motor vehicle were modelled with Robust Gaussian Stochastic Process, to smoothly interpolate between the sparse time-to-service observations. Probabilistic predicted values were generated from the model and were used to construct service accessibility maps of South-East Queensland. Disability population data were used to identify SA2s with relatively low service access but a high disability population. Second, we examined perceived service obstacles, by investigating the relationship between potential access to services and perceived service obstacles was examined using data from 63 people with ABI or SCI discharged from the specialist state-wide rehabilitation services, located in South-East Queensland. Obstacles to accessing service in relation to resource availability, transportation and finances were collected three-months after discharge, using the Service Obstacle Scale. Travel times to the closest health service were computed for each individual and were compared to their Service Obstacle Scale responses. Access potential was highly variable, particularly for allied health services. We identified several low-access, high-disability population areas. These hotpots of poor access were generally to the north and west of greater Brisbane. Longer travel times to allied health services were associated with 260% higher odds of agreeing that resource availability was an obstacle to accessing services. Policy makers should be concerned with the hotspots of poor access identified.

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There was considerable variability in access potential, which was generally greater for allied health than medical specialist services.

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We highlighted low-access high disability population areas, which were generally in outer suburbia.

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Poorer potential access to allied health services was associated with resource availability being rated as an service obstacle.

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We did not find any evidence that proximity to allied health services was associated with transportation or finance obstacles.

Access and engagement with places in the community, and the quality of life among people with spinal cord damage

OBJECTIVES

This study aims to investigate the association between self-reported accessibility and engagement with health services and places in the community, and quality of life (QOL) for people with spinal cord damage (SCD).

DESIGN

Cross-sectional survey.

SETTING

Community.

PARTICIPANTS

Two-hundred and sixty-six people with a SCD residing in Australia (M_age = 62.34, SD_age = 15.95).

OUTCOME MEASURE

The International Spinal Cord Injury Quality of Life Basic Data Set.

RESULTS

Univariate regressions demonstrated that accessing a higher number of places in the community was significantly associated with favorable self-reported psychological health (β = .160, P < .01), physical health (β = .144, P < .01), overall well-being (β = .206, P < .01), and QOL (β = .187, P < .01). In contrast, reporting a higher number of inaccessible places was significantly associated with unfavorable self-reported psychological health (β = -.171, P < .01), physical health (β = -.270, P < .001), overall well-being (β = -.238, P < .001), and QOL (β = -.244, P < .001). Being older and living with injury or onset of damage longer were significantly associated with favorable scores across all outcomes (P < .01) except physical health.

CONCLUSIONS

Community engagement can have a considerable impact on the self-reported health and QOL of people with SCD. Interventions aimed at increasing community engagement, particularly for people who have recently experienced SCD are warranted.

Evaluating an Inpatient Created Art Installation on Perceptions of the Physical Environment, Health Status, and Rehabilitation Motivation

OBJECTIVES

A methodology to assess the impact of involving end users in therapeutic activities to address the hospital physical environment is provided. The impact of participating in a recreational art creation program with the aim of developing an art installation on the immediate feelings of participants and their perception of the physical rehabilitation environment (PPRE) and motivation to participate in rehabilitation (MPR) is investigated.

BACKGROUND

Rehabilitation unit design has largely excluded the perspectives of end users with disability. Including their aesthetic design contributions moves beyond contemporary approaches where their perspectives are considered.

METHODS

A two-period, mixed-methods pre-post intervention design involving within and between group comparisons is proposed. During Period 1, program participants and nonparticipants completed admission (T1) and discharge (T2) surveys including PPRE and MPR measures developed by the authors. Surveys pre and post each art session were completed. The art installation will be implemented within unit corridors. Period 2 participants will complete a T1 survey and their physical environment perceptions compared to Period 1 participants.

RESULTS

Participating in the recreational art program significantly improved immediate levels of calmness, happiness, pain, and physical health. There is a positive relationship between environment perception and rehabilitation motivation.

CONCLUSIONS

People with disability should be actively involved in healthcare environment design. Arts-based programs have relevance to people with neurological injury as it promotes essential sensory stimulation. The methodology and findings can encourage further work which involves end users in the design of healthcare environments and evaluates the impact of their involvement.

Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study

BACKGROUND

Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications.

METHODS

We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC).

FINDINGS

In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]).

INTERPRETATION

In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required.

FUNDING

British Journal of Surgery Society.

COVID-19 test sites in Victoria approaching Stage 4 restrictions: evaluating the relationship between remoteness, travel time and population serviced

OBJECTIVE

In Australia, people residing remotely typically experience increased travel time to health services, and remote health services often have unfavourable population-to-provider ratios. The state of Victoria was treated as a case study and a spatial analysis investigated the impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) point-of-care-test (POCT) site location (Major City, Inner Regional or Outer Regional) on the mean travel time for closest residents and the number of closest residents.

METHODS

A network analysis established the travel time from every mesh block in Victoria to the closest POCT site. Inferential analyses investigated the impact of POCT site location on travel time and the number of closest residents.

RESULTS

Compared to urban locations, the mean travel time for closest residents to rural POCT sites was significantly higher, while rural POCT sites had significantly fewer residents to service.

CONCLUSIONS

Findings confirm Australian health service literature suggesting that rural regions have poorer proximate availability of health services, while also contrasting to literature indicating that Australian rural regions have fewer health services per capita. Implications for public health: Localities within outer regional Victoria are candidates for a localised response to reduce unnecessary travel. Employing innovative service models may improve health service access and use and reduce population-to-provider ratios in rural locations.

Application and utility of geographic information systems in pharmacy specific health research: A scoping review

BACKGROUND

Geographic Information Systems (GIS) are considered essential tools to analyze spatially referenced health data.

OBJECTIVES

The purpose of this scoping review is to describe how GIS is used in pharmacy specific health research.

METHODS

During July 2020, the following databases were searched: EMBASE, MEDLINE (PubMed), Web of Science and Scopus. The search strategy included terms relating to spatial analysis and pharmacy. Studies were considered eligible if they involved the use of GIS and focused on pharmacies. A narrative and tabular synthesis of the results was carried out, structured around the spatial analysis methods utilized across studies, as well as the characteristics of pharmacies evaluated in studies.

RESULTS

After a review of 6967 sources, 48 studies were included in this review. Twenty-nine studies were conducted in the United States (60.4%) and thirty-six focused on accessibility (75.0%; n = 36). Twenty-two studies investigated the relationship between sociodemographic aspects of the population and the accessibility and availability of pharmacies (45.8%). Twelve studies (25.0%) performed distance analysis and six studies (12.5%) performed geostatistical analysis. Community pharmacies were the setting evaluated most frequently, with over-the-counter selling products being the most evaluated pharmacy variable (13.3%; n = 6). Population density (58.3%; n = 28), income indicators (43.8%; n = 21) and minority community composition rates (41.7%; n = 20) were the most used population variables.

CONCLUSIONS

GIS have been increasingly used in pharmacy specific health research. Generally, research has sought to identify potential barriers to access and their effects on the population. Future research may benefit by utilizing robust spatial methods and applications across countries outside of the United States. Doing so could help to confirm the impact of sociodemographic characteristics on the availability and/or accessibility of pharmacies globally.

Does being psychologically resilient assist in optimising physical outcomes from a spinal cord injury? Findings from a systematic scoping review

PURPOSE

To systematically search for current research on the role of resilience in the physical rehabilitation of SCI and describe the research to date.

MATERIALS AND METHODS

The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) approach was used. Five databases were searched for papers published up to March 2020. The sample included adults who have sustained an SCI; outcomes included a physical rehabilitation outcome and a measure of psychological or personal resilience/resilience training.

RESULTS

The initial search found 2074 studies. 12 studies were included. Six suggest positive effects of resilience on physical functioning/recovery, six report resilience as not affecting physical functioning/recovery.

CONCLUSIONS

Resilience may positively affect physical outcomes; however, the relationship is under-researched and contrasting findings may be due to measurements and methods employed by research. Future research may distinguish between two sources of resilience following an SCI: prior resilient experiences, and resilience as a product of the injury. Individuals' past events that triggered resilient behaviour may be able to promote a resilient response to an SCI. Focussing on emotional coping may result in poorer outcomes than building a sense of control. Resilience training may affect psychosocial rehabilitation; it is difficult to establish if it would affect physical outcomes. A negative approach to an injury can have negative effects on functioning; when identifying patients for psychoeducational training, those with the presence of negative appraisals of their injury are most in need.IMPLICATIONS FOR REHABILITATIONResilience may positively affect physical outcomes; however, the relationship is under-researched.Individuals' past events that triggered resilient behaviour may be able to promote a resilient response to an SCI.Focussing on emotional coping may result in poorer outcomes than building a sense of control.When identifying patients for psychoeducational training, it may be those with the presence of negative appraisals of their injury that are most in need.

The Horse as a Therapist: Effects of an Equine Program Without "Therapy" on the Attention and Behavior of Youth Disengaged from Traditional School

Background: Equine-assisted therapy may promote positive behavior change in young people "at risk." However, it is not always clear what therapeutic content is involved and if a trained therapist is included. The therapeutic effects of the key part of the "therapy," the horse, are not understood. Objectives: To investigate the impact of an equine program without a therapist on attention and behavioral outcomes of young people "at risk." Design: A within subjects pre-post design. A small sample also completed a control period. Setting/location: A small riding center in a rural area of outer Brisbane, Australia. Subjects: Twelve- to 17-year olds (N = 50; 20 girls; mean age 13.88), attending nontraditional flexischool. Intervention: A 5-week program of 2-h long sessions of equine activities that did not include a trained therapist or specific therapeutic content. Outcome measures: Teacher-report measures of externalizing and internalizing behavior were reported before and after the program through the Behavioral Rating Inventory of Executive Function (BRIEF) and the Strength and Difficulties Questionnaire (SDQ). Results: A paired samples t test resulted in the statistically significant reduction of the BRIEF Global Executive Score between pre and post participation in the equine program (mean difference = -5.89), t(36) = -3.377, p = 0.002 and the SDQ Hyperactivity score (mean difference = -0.727), t(43) = -2.244, p = 0.030. Equine activities may reverse a trajectory of worsening problems. This may especially affect symptoms related to attention deficit hyperactivity disorder. Conclusion: Equine programs may offer an alternative method to reduce poor behavior and improve attention in young people. Benefits in attention may occur even without specific therapeutic content or therapist involvement. It is proposed that some of these benefits come directly from the horse and the interactions with the horse; others are contextual.

Pressure injuries, obesity and mental health concerns on admission to rehabilitation are associated with increased orthopaedic rehabilitation length of stay

OBJECTIVE

To investigate the association between a set of comprehensive factors across international literature and rehabilitation length of stay.

METHOD

A chart audit of 197 Australian hospital rehabilitation unit orthopaedic inpatients (2016-2018) was conducted. Items significantly associated with length of stay throughout univariate regressions were entered into a subsequent hierarchical multiple regression analysis, where variables were regressed against length of stay in two steps. Items which were relevant prior to admission to the rehabilitation unit, or immediately upon admission, were regressed against length of stay during the first step, while variables which emerged during admission were entered during the second step.

RESULTS

Having pressure injuries during rehabilitation (p < .001), limited compliance in rehabilitation programs (p = .007), mental health concerns on admission to rehabilitation (p = .007), being obese (p < .001), and having significant pain impacting function (p = .03) were all independently significantly associated with an increased length of stay. Higher Functional Independence Measure motor (p < .001) subscale scores on admission to rehabilitation were associated with decreased length of stay. A hierarchical multiple regression analysis found that pressure injuries during rehabilitation (p = .002), being obese (p = .04), having mental health concerns on admission to rehabilitation (p = .03), and Functional Independence Measure subscale scores on admission (p = .04) were significantly associated with length of stay.

CONCLUSION

It is imperative that clinical programs and interventions promoting mental health outcomes, and addressing the distinct needs of obese inpatients, are delivered in the rehabilitation context.

Noninvasive three-state sleep-wake staging in mice using electric field sensors

STUDY OBJECTIVE

Validate a novel method for sleep-wake staging in mice using noninvasive electric field (EF) sensors.

METHODS

Mice were implanted with electroencephalogram (EEG) and electromyogram (EMG) electrodes and housed individually. Noninvasive EF sensors were attached to the exterior of each chamber to record respiration and other movement simultaneously with EEG, EMG, and video. A sleep-wake scoring method based on EF sensor data was developed with reference to EEG/EMG and then validated by three expert scorers. Additionally, novice scorers without sleep-wake scoring experience were self-trained to score sleep using only the EF sensor data, and results were compared to those from expert scorers. Lastly, ability to capture three-state sleep-wake staging with EF sensors attached to traditional mouse home-cages was tested.

RESULTS

EF sensors quantified wake, rapid eye movement (REM) sleep, and non-REM sleep with high agreement (>93%) and comparable inter- and intra-scorer error as EEG/EMG. Novice scorers successfully learned sleep-wake scoring using only EF sensor data and scoring criteria, and achieved high agreement with expert scorers (>91%). When applied to traditional home-cages, EF sensors enabled classification of three-state (wake, NREM and REM) sleep-wake independent of EEG/EMG.

CONCLUSIONS

EF sensors score three-state sleep-wake architecture with high agreement to conventional EEG/EMG sleep-wake scoring 1) without invasive surgery, 2) from outside the home-cage, and 3) and without requiring specialized training or equipment. EF sensors provide an alternative method to assess rodent sleep for animal models and research laboratories in which EEG/EMG is not possible or where noninvasive approaches are preferred.

Which Melbourne Metropolitan Areas Are Vulnerable to COVID-19 Based on Age, Disability, and Access to Health Services? Using Spatial Analysis to Identify Service Gaps and Inform Delivery

Aging adults (65+) with disability are especially vulnerable to coronavirus disease 2019 (COVID-19), and on contracting, they are a cohort most likely to require palliative care. Therefore, it is very important that health services-particularly health services providing palliative care-are proximately available. Treating the Melbourne metropolitan area as a case study, a spatial analysis was conducted to clarify priority areas with a significantly high percentage and number of aging adults (65+) with disability and high barriers to accessing primary health services. Afterward, travel times from priority areas to palliative medicine and hospital services were calculated. The geographic dispersion of areas with people vulnerable to COVID-19 with poor access to palliative care and health services is clarified. Unique methods of health service delivery are required to ensure that vulnerable populations in underserviced metropolitan areas receive prompt and adequate care. The spatial methodology used can be implemented in different contexts to support evidence-based COVID-19 and pandemic palliative care service decisions.

Which Melbourne Metropolitan Areas Are Vulnerable to COVID-19 Based on Age, Disability, and Access to Health Services? Using Spatial Analysis to Identify Service Gaps and Inform Delivery

Aging adults (65+) with disability are especially vulnerable to coronavirus disease 2019 (COVID-19), and on contracting, they are a cohort most likely to require palliative care. Therefore, it is very important that health services-particularly health services providing palliative care-are proximately available. Treating the Melbourne metropolitan area as a case study, a spatial analysis was conducted to clarify priority areas with a significantly high percentage and number of aging adults (65+) with disability and high barriers to accessing primary health services. Afterward, travel times from priority areas to palliative medicine and hospital services were calculated. The geographic dispersion of areas with people vulnerable to COVID-19 with poor access to palliative care and health services is clarified. Unique methods of health service delivery are required to ensure that vulnerable populations in underserviced metropolitan areas receive prompt and adequate care. The spatial methodology used can be implemented in different contexts to support evidence-based COVID-19 and pandemic palliative care service decisions.

General practitioner identification and retention for people with spinal cord damage: establishing factors to inform a general practitioner satisfaction measure

People with spinal cord damage (SCD) report a high level of GP use. There is a dearth of research investigating factors that contribute to GP identification and retention for people with SCD. Furthermore, a GP satisfaction measure developed specifically for people with SCD is non-existent. This preliminary study sought to identify factors contributing to GP identification and retention. A total of 266 people with SCD primarily based in Queensland, Australia, completed a cross-sectional survey that aimed to fill these knowledge gaps. Descriptive statistics and correlational analyses clarified the factors contributing to GP identification and GP retention respectively. An exploratory factor analysis utilising the principal components analysis method clarified a set of items that could underpin key domains for a SCD-specific GP satisfaction measure. The findings confirm that knowledge about SCD, physically accessible services, and trust are seminal considerations aligned with GP identification and retention for people with SCD.

A171 MAGNETIC RESONANCE IMAGING IN CHILDREN WITH EARLY ONSET INFLAMMATORY BOWEL DISEASE- A RETROSPECTIVE COHORT STUDY

Background

Magnetic Resonance (MR) Imaging is the preferred imaging method in Inflammatory Bowel Disease (IBD) patients to investigate for small bowel disease. There are challenges in performing MR imaging in Early Onset IBD (EO-IBD) patients, and in particular in children with Very Early Onset IBD (VEO-IBD). These children often need a general anaesthetic which exposes them to adverse effects and preclude conventional luminal distention influencing the quality of the test. Therefore, the utility of MR imaging in this age group is questionable.

Aims

To assess the quality of MRI studies in VEO-IBD and EO-IBD patients and to compare the utility of this test between the two groups.

Methods

We retrospectively identified and reviewed IBD patients diagnosed under 10 years of age, between January 1999 and December 2011, from the British Columbia Children’s Hospital (BCCH) GI Division IBD database. Patients’ first diagnostic MRI results were recorded. Disease location and severity were documented according to the Paris classification.

Results

124 patients were included in the cohort, 54 VEO-IBD and 70 EO-IBD patients (See Table 1). Median age at diagnosis was 6.46 (IQR 3.94–8.71), 65.32% males and 43.54% were diagnosed with Crohn’s disease. Overall, 52 patients underwent MRI, 17 (31.48%) in the VEO-IBD group and 35 (50%) in the EO-IBD group; median time from diagnosis to MRI was 3.02 years (IQR 1.08–5.83) for VEO-IBD and 0.44 years (IQR 0.07–1.58) for EO-IBD (p&lt;0.001). In the EO-IBD group there was a significantly higher percentage of patients with MRI findings than in the VEO-IBD group, 23 (67.31%) and 5 (29.41%) respectively (p=0.014). Only one patient in the VEO-IBD group had a disease characteristic identified by MR imaging that could not be diagnosed by endoscopy (small bowel disease).

Conclusions

The diagnostic yield of MRI in children with VEO-IBD appears to be quite limited but requires further study.

Funding Agencies

None

Assessing emotional and social health using photographs: An innovative research method for rural studies and its applicability in a care-farming program for youth

A framework for assessing photographs for the emotional and social health of young people (SHAPE) is described and tested, within the context of a rural program. Two independent raters assessed the photographs of participants. To assess inter-rater reliability, Cohen' K and Kendall's W were calculated. The two reviewers' assessments of photographs were in agreement. The assessment of emotional/behavioural display showed 82% agreement. Agreement between reviewers' judgements of proxemics (W = .866), interaction (W = .722), engagement (W = .932) and overall impression (W = .804) were all significant (p < .005). The method yielded results indicating that participants found gardening immediately engaging but their approach to equines exhibited a change from fascination to confidence during the program. The visual-diary method is a useful and sensitive method for research: where resources are limited; to complement traditional measures; for use with people who lack appropriate verbal communication or literacy skills to complete questionnaires; young children; other underrepresented groups.

Using the natural environment to address the psychosocial impact of neurological disability: A systematic review

Engaging with the natural environment contributes to favourable psychosocial health outcomes. A systematic review of research published before June 2017 was conducted to establish how engaging with natural environments impact the psychosocial health of people with a neurological disability. Identified studies included populations with dementia (n=14), brain injury (n=2), and stroke (n=2). Evidence suggests that engaging with gardens, and gardening, can favourably impact the emotional and social health of people with dementia and, an explanatory theoretical model is proposed. Considerable research gaps exist and further research investigating the psychosocial impact of engaging with natural environments for people with different neurological conditions (for example spinal cord injury or stroke) is warranted.

Perspectives of self-direction: a systematic review of key areas contributing to service users' engagement and choice-making in self-directed disability services and supports

Self-directed disability support policies aim to encourage greater choice and control for service users in terms of the health and social care they receive. The proliferation of self-directed disability support policies throughout the developed world has resulted in a growing amount of research exploring the outcomes for service users, and their families and carers. Our understanding of the issues faced by people with disabilities, particularly how they make health and social care decisions and the key areas that determine their engagement with service providers within a self-directed environment is limited. A synthesis of research is timely and can provide knowledge for service users and health and social care support providers to ensure their successful participation. A systematic review guided by the PRISMA approach explored (i) the key areas determining service users' engagement with self-directed disability services and supports, and (ii) how service users make informed decisions about providers. In October 2014 and April 2016, three databases - MEDLINE, CINAHL and Web of Science - were searched for research and review articles. Eighteen sources met the search criteria. Findings were mapped into either: key areas determining service user engagement, or service users' informed decision-making. Findings concerning key areas determining engagement fell into three themes - personal responsibility for budgeting, personalised approaches, and a cultural shift in practice and delivery among service providers. Findings about decision-making yielded two themes - supporting informed decision-making and inhibiting informed decision-making. Literature suggests that self-directed models of care may provide service users with increased control over the services that they receive. Increased control for some service users and their families requires independent external decision-making support, particularly around the domains of budgeting, planning and hiring. Future research must continue to investigate the perspectives of service users pertaining to their engagement, as their participation is central to the effectiveness of the approach.

Violence against children in Afghanistan: Concerns and opportunities for positive change

Violence against children (VAC) in Afghanistan is a serious issue in the context of many decades of conflict and poverty. To date, limited studies have explored the extent of VAC in Afghanistan and the settings where VAC takes place. To understand (i) the extent of VAC, (ii) settings where VAC takes place, (iii) parental forms of VAC and (iv) regional differences, an interview administered cross-sectional survey was employed among a community sample of 145 children and 104 parents living within Kabul, Torkham, and Jalalabad. Demographic information was collected as well as items from the International Child Abuse Screening Tool (ICAST-CH). In this study, 71% of children reported experiencing physical violence is some form in the past year. Home was the most likely location of violence. The overwhelming majority of parents reported using physical violence as a discipline method. Parents who attained higher levels of education and had more skilled occupations used violence less as a discipline method. However, consistent with international research, children cited their parents as their preferred source of support in situations of violence. Interestingly, parents did not see violent forms of discipline as more effective than non-violent strategies. The results offer a disturbing yet 'on the ground' insight into VAC in Afghanistan from the experience of children and parents. The results have important implications for programming design and provide a focus for stopping and preventing VAC in Afghanistan and similar contexts.

Thermoelectric properties of Ag-doped CuS nanocomposites synthesized by a facile polyol method

Single crystalline hexagonal nanodisks (NDs) of covellite CuS and temperature dependent thermoelectric figure of merit of Ag-doped CuS nanocomposites.

Nominal group technique for individuals with cognitive disability: a systematic review

RATIONALE

Considering the perspectives of individuals with cognitive disability is important for their participation in their self-directed health care. The nominal group technique (NGT) has been identified as a method to gather opinions of people with cognitive disability; however, a synthesis of methodological considerations to undertake when employing the approach among people with cognitive disability is non-existent.

METHOD

A systematic review guided by the preferred reporting items for systematic review and meta-analysis protocols was undertaken. Five databases (CINAHL, ISI Web of Science, ProQuest Social Science Journals, Scopus, and MEDLINE) were searched for peer-reviewed literature published before September 2016. Methodological considerations pertaining to the four stages of the NGT- generating ideas, recording ideas, clarification, and ranking - were extracted from each study.

RESULTS

Nine publications contributing to eight studies were included. Methodological considerations focused on (i) the number of participants within discussion groups, (ii) research question introduction, (iii) support individuals and accessible methods, (iv) ranking, and (v) researcher training and counselling services.

CONCLUSIONS

The use of the NGT to gain the health care perspectives of adults with cognitive disability is promising. Conducting nominal group techniques informed by the methodological considerations identified within this review can work towards ensuring that the health care perspectives of people with cognitive disability are considered. Implications for rehabilitation The emergent policy move towards self-directed health care for people with disability requires that the health care perspectives of people with disability are considered. Effective consultation and discussion techniques are essential to gain the health care perspectives of people with cognitive disability. After undertaking methodological considerations, the NGT can be an effective approach towards gaining the health care perspectives of people with cognitive disability.

Evidence for Using Farm Care Practices to Improve Attachment Outcomes in Foster Children: A Systematic Review

Anecdotal evidence suggests that care farming practices have the potential to provide positive outcomes for young people in foster-care and residential care environments. A systematic review (searching; CINAHL, Web of Knowledge, PsychInfo) was conducted to explore how participation in care farming initiatives impacts attachment in children in foster-care and what aspects of care farming initiatives provides positive attachment outcomes. The systematic review did not identify any research publication in care farming and foster-care. Therefore, it is imperative that practitioners realise that the evidence is lacking when using these types of interventions and keep a close account of the benefit and harms that may be encountered during the interaction processes.

Study protocol: developing a decision system for inclusive housing: applying a systematic, mixed-method quasi-experimental design

BACKGROUND

Identifying the housing preferences of people with complex disabilities is a much needed, but under-developed area of practice and scholarship. Despite the recognition that housing is a social determinant of health and quality of life, there is an absence of empirical methodologies that can practically and systematically involve consumers in this complex service delivery and housing design market. A rigorous process for making effective and consistent development decisions is needed to ensure resources are used effectively and the needs of consumers with complex disability are properly met.

METHODS/DESIGN

This 3-year project aims to identify how the public and private housing market in Australia can better respond to the needs of people with complex disabilities whilst simultaneously achieving key corporate objectives. First, using the Customer Relationship Management framework, qualitative (Nominal Group Technique) and quantitative (Discrete Choice Experiment) methods will be used to quantify the housing preferences of consumers and their carers. A systematic mixed-method, quasi-experimental design will then be used to quantify the development priorities of other key stakeholders (e.g., architects, developers, Government housing services etc.) in relation to inclusive housing for people with complex disabilities. Stakeholders randomly assigned to Group 1 (experimental group) will participate in a series of focus groups employing Analytical Hierarchical Process (AHP) methodology. Stakeholders randomly assigned to Group 2 (control group) will participate in focus groups employing existing decision making processes to inclusive housing development (e.g., Risk, Opportunity, Cost, Benefit considerations). Using comparative stakeholder analysis, this research design will enable the AHP methodology (a proposed tool to guide inclusive housing development decisions) to be tested.

DISCUSSION

It is anticipated that the findings of this study will enable stakeholders to incorporate consumer housing preferences into commercial decisions. Housing designers and developers will benefit from the creation of a parsimonious set of consumer-led housing preferences by which to make informed investments in future housing and contribute to future housing policy. The research design has not been applied in the Australian research context or elsewhere, and will provide a much needed blueprint for market investment to develop viable, consumer directed inclusive housing options for people with complex disability.

They [do more than] Interrupt Us from Sadness: Exploring the impact of participatory music making on social determinants of health and wellbeing for refugees in Australia

This paper reports on the outcomes of an exploratory narrative study on the impact of participatory music making on social determinants of health (SDOH) and wellbeing for refugees in Brisbane, Australia. A key component of this exploratory research was to map health and wellbeing outcomes of music participation using an existing SDOH framework developed by researchers in the field of health promotion (Schulz & Northridge, 2004). This paper maps reported health and wellbeing outcomes for five refugee and asylum seeker members of a participatory Brisbane-based music initiative, the Scattered People, along an SDOH continuum ranging from individual level through to macro level fundamental determinants of health.While most themes emerging from this study corresponded to distinct categories in the Schulz and Northridge SDOH framework, three key aspects, which were critical to the achievement of wellbeing for participants, did not fit any of the pre-defined categories. These were: cultural expression, music making, and consolidation of personal and social identity. The importance of those themes to participants suggests that music and wellbeing studies involving culturally diverse groups and from a SDOH perspective may need to consider broader, more relevant concepts. The paper provides recommendations for future interdisciplinary research in this field. 

Playgroups offering health and well-being support for families: a systematic review

This systematic review explores the health and well-being outcomes that families experience as a result of their participation in playgroups that provide health and well-being services. A systematic review of peer-reviewed literature resulted in 12 articles for inclusion. A meta-synthesis method, using reciprocal translation, was implemented to synthesize findings. Findings suggest that programs support children's social development, transition to school, and overall health. For parents, programs provide targeted social and health support, and knowledge sharing and learning opportunities. Future research in this area will benefit from participatory research approaches and exploring how universal approaches to program provision benefit families.