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• There was a high demand for ICU trained physiotherapists during the first wave of the COVID-19 pandemic. • Physiotherapists reported unwanted stress and were required to perform activities outside of their typical duties. • More robust physiotherapy guidelines for physiotherapy management of COVID-19 patients are required. • Varied techniques used in the management of patients with COVID-19 suggests that further evidence regarding the effectiveness and safety of these techniques is needed. Background Specific details pertaining to the clinical and other challenges faced by physiotherapists managing patients with COVID-19 during the pandemic are still largely unknown. Objectives To determine how physiotherapists clinically managed patients with COVID-19 in a hospital-based setting during the pandemic and to identify the personal and professional effects of working as a physiotherapist at this time. Methods Self-administered electronic cross-sectional survey. Participants included physiotherapists from around the world involved in the clinical management of patients with COVID-19. Results Of the 204 participants who returned the questionnaire, 39% worked as senior physiotherapists, 29% as consultant or specialist physiotherapists, 23% as general physiotherapists and 4% as graduate physiotherapists. Seventy-two percent of participants worked in the intensive care unit. The largest barrier to treating patients with COVID-19 was a lack of intensive care trained physiotherapists (70%). Eighty-three percent of participants reported performing activities outside of their typical work duties, including proning patients (55%), tutoring and advising other staff in the intensive care unit (55%) and adjusting or changing ventilator settings (52%). Almost all participants (90%) reported being aware of physiotherapy specific guidelines for treating patients with COVID-19, yet most participants performed techniques that were not recommended. Conclusions The experience of the pandemic highlighted the need for specialist training and availability of experienced cardiorespiratory physiotherapists to manage patients with COVID-19, specifically in intensive care. Furthermore, clear guidelines on the management of patients with COVID-19 should be established to ensure optimal management of patients and ensure the safety of physiotherapy staff. [ABSTRACT FROM AUTHOR]

Importance: Occupation-based interventions are used during inpatient rehabilitation, and group models may enhance intervention delivery. However, little is known about the impact of occupation-based groups on patient outcomes. Objective: To examine the effect of an occupation-based group on patient outcome measures of instrumental activities of daily living (IADL) skills over time and explore demographic differences among patients. Design: Longitudinal observational cohort study with four time points: preintervention, postintervention, 30-day follow-up, and 90-day follow-up. Setting: Tertiary hospital general rehabilitation ward. Participants: Inpatient adults age 18 or older recruited using consecutive sampling from those referred to the group. Intervention: The LifeSkills group, which focused on repetitive practice of meaningful occupation-based activities. Outcomes and Measures: Demographic data were obtained, and the Canadian Occupational Performance Measure (COPM), Goal Attainment Scaling, Lawton IADL scale, and a self-efficacy scale were administered at each data point. Results: Thirty people (21 women, 9 men; ages 35–91 yr) participated, with 5 lost to follow-up. A statistically significant increase in scores postintervention occurred on all measures and was also seen at 90-day follow-up for COPM occupational performance, satisfaction, and self-efficacy scores. Lawton IADL scale scores at follow-up were lower than those at preintervention and statistically significant. No significant differences were found for age and diagnosis. Conclusions and Relevance: Positive patient outcomes of goal achievement, occupational performance, satisfaction, and self-efficacy were seen at discharge, with evidence of sustainability over time. This could be a resource alternative for addressing skill retraining because people with different diagnoses and in different age groups benefited equally. What This Article Adds: Occupation-based group programs have encouraging application in general inpatient rehabilitation for addressing patient outcomes. This study highlights positive patient outcomes in measuring instrumental activities of daily living (IADL) skills over time after participation in occupation-based group programs. [ABSTRACT FROM AUTHOR]

Introduction: This qualitative interpretive phenomenological study sought to understand the experiences of people using the SaeboFlex®, within an outpatient setting, following a stroke. Method: Five adults who had experienced a stroke and had received the SaeboFlex® from occupational therapists in one outpatient service within the previous 12 months were recruited using convenience sampling. Semi-structured interviews were conducted, recorded, transcribed verbatim, and analysed using Braun and Clarke's thematic analysis. Results: Three themes emerged from the data: (a) hope for upper limb recovery: 'you have got nothing to lose'; (b) the everyday experience of the SaeboFlex®: 'just keeping it in a routine'; (c) the self-reported outcomes: 'I can do more things you know ... but there haven't been any miracles'. Conclusion: The findings highlight the important role of hope in the recovery of people following a stroke, and that participants continue to use the device despite limited goal achievement. The reports of limited transfer of training into everyday occupations, either with or without the device, is something that should be carefully considered. The SaeboFlex® is a tool that is promoted for upper limb rehabilitation, but which has limited evidence of effectiveness and mixed client experiences. Further research is required. [ABSTRACT FROM AUTHOR]

Importance: Falls have a considerable physical and psychological impact on people with spinal cord injury (SCI). Occupational therapy practitioners require evidence to support the timely development of occupation-based programs that can be applied to fall prevention in daily life. Objective: To determine what is known about falls after SCI, including wheelchair users and people who are ambulatory, and to understand elements of fall prevention to be addressed by occupational therapy practitioners. We applied the Canadian Measure of Occupational Performance and Engagement to understand elements to be addressed in fall education and prevention with this population. Data Sources: We searched eight databases using the key words falls and spinal cord injury with no limit set on dates. Study Selection and Data Collection: Studies were included that reported on falls among adults with SCI and measured one or more of the following: incidence of falls, consequences of falls, contributing factors for falls, the person's experience of falls, and strategies to prevent falls. Findings: Thirty-five articles were included. The majority of the articles included information on the incidence (n = 20), consequences (n = 26), and contributing factors (n = 30) of falls. Two articles analyzed the person's experience of falls, and 1 study reviewed a fall prevention program for people with SCI specifically. Conclusions and Relevance: Research on participants' experience of falls and fall prevention programs used in spinal cord rehabilitation is extremely limited. Future research on the lived experience of falls for people with SCI is warranted. What This Article Adds: This review of evidence on falls after SCI highlights gaps in the current available evidence. [ABSTRACT FROM AUTHOR]

Introduction: The objective of this systematic review was to synthesise the evidence for cognitive strategy training to determine its effectiveness to improve performance of activities of daily living in an adult neurological population. Method: Medline, CINAHL, EMBASE, PSYCInfo, PsycBITE and Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews were searched until August 2019. Studies examining the effect of cognitive strategy training on functional performance were included. Population criteria included adults with non-progressive neurological conditions. External and internal validity of included studies was systematically evaluated using an appropriate methodological quality assessment for each study design. A content analysis was conducted of the methodologies used. Findings: Forty-one studies met the inclusion criteria and were appraised for content, 16 randomised or quasi-randomised trials were meta-analysed. Trial quality was generally 'good', Physiotherapy Evidence Database scale scores ranged from 3 to 8 (out of 10). For activity performance outcomes post-intervention, there was a significant benefit of cognitive strategy training over usual care (standardised mean difference 0.79, 95% confidence interval 0.49–1.09; P < 0.00001). Conclusion: More high-quality research is needed to strengthen the evidence base for cognitive strategy interventions to improve activity performance outcomes for adults with non-progressive neurological conditions. Systematic review registration: PROSPERO CRD42016033728 [ABSTRACT FROM AUTHOR]

Abstract Background Research into the prevalence of dishonest academic behaviours suggests that such behaviours may be extensive among international students in higher education. Objective To compare the academic integrity of domestic and international occupational therapy students and identify possible contributors to students' engagement in dishonest academic behaviours. Design A quantitative cross-sectional study using a survey containing several standardised scales was used to collect the data. Settings Five Australian universities. Participants 701 occupational therapy students. Methods Students completed a self-report questionnaire comprising demographic questions and six standardised scales: Academic Dishonesty Scale; Academic Dishonesty in the Classroom Setting Scale (ADCS); Academic Dishonesty in the Clinical/Practice Education Setting Scale; Moral Development Scale for Professionals; Academic Dishonesty Tendency Scale; and Perceived Academic Sources of Stress. One-way analysis of variance (ANOVA) was conducted to compare the scores of domestic and international students on academic dishonesty factors, moral development, and perceived sources of academic stress. Results Significant differences between domestic and international students were observed on age; grade point average; hours per week spent in paid work; moral practice; tendency towards cheating; tendency towards cheating in research assignments; pressures to perform; and self-perception. No significant differences were found on students' self-reported scores on academic dishonesty in academic classroom education contexts, fieldwork practice education settings or perceived stresses of workload and examinations and time restraints. Conclusions The reported incidences of dishonest academic behaviours in the classroom and fieldwork settings were low for all occupational therapy students, irrespective of origin and were comparable to findings from cohorts of other health professional students. However, concomitant with existing research, international students were found to have a greater tendency to engage in dishonest behaviours particularly on research assignments. This may be reflective the socio-cultural issues and external pressures that international students experience. Further study in this area is recommended. Highlights • Similarities and differences of self-reported academic integrity in domestic and international occupational therapy students were explored • Low incidences of dishonest academic behaviours across both domestic and international students were reported • There were significant differences between the two student groups on moral practice; and tendency towards cheating in research assignments • Results indicated that gaps exist in international students' knowledge of what constitutes academic integrity • There is a need for educators to be aware of the cultural stresses and external pressures experienced by international students [ABSTRACT FROM AUTHOR]

OBJECTIVE. This study examined the parallel-forms reliability of a web application (app) of the Activity Card Sort Australia for adults ages 18--64 and assessed its clinical utility. METHOD. Forty-eight participants completed the app and card versions of the tool within a 2- to 3-wk interval and provided feedback via a purpose-designed survey. Intraclass correlation analysis tested parallelforms reliability. RESULTS. The app demonstrated acceptable parallel-forms reliability for overall retained activity level (r5 .75, p < .001), the daily life domain (r 5 .77, p < .001), and the recreation and relaxation domain (r 5 .74, p < .001), but not for the physical activity domain (r 5 .59, p < .001). Clinical utility responses suggested good acceptance of both versions. CONCLUSION. The results suggest that further studies are required before the app version can be used for research or in clinical settings. [ABSTRACT FROM AUTHOR]

Introduction Measuring activity engagement using the Activity Card Sort Australia (18–64) supports occupational therapists and clients to identify goals for therapeutic interventions. The aim of this study was to investigate activity engagement for people aged 18 to 64 years with and without Parkinson’s disease. Method Thirty-two participants, 16 people with Parkinson’s disease (mean age 57.8) and 16 healthy adults (mean age 53.1), were required to sort 85 visual activity cards into one of five categories: ‘never done’, ‘do not do now’, ‘do now’, ‘do less now’ and ‘given up’. The retained activity values were calculated and compared using the Mann–Whitney U Test. Results The overall retained activity scores were not significantly different (p = .81); however, the group with Parkinson’s disease had higher retained scores in the physical activities domain (p = .04) Conclusion The preventative exercise regimes of people with Parkinson’s disease seems to influence activity engagement patterns. A more detailed understanding of activity engagement may further help form the basis of meaningful interventions. [ABSTRACT FROM AUTHOR]

Background: People with mild stroke comprise a significant proportion of the overall stroke population. Previously this population has been viewed as having limited impairments, receiving minimal services following hospital discharge. Recent findings demonstrate that the implications of mild stroke are more significant than originally comprehended, warranting further services. Objectives: To identify the evidence-base regarding services for people with mild stroke, post-acute hospital discharge, that target secondary prevention and/or changes following stroke. Methods: Scoping review utilizing the five-stage framework proposed by Arksey and O’Malley, with revisions by Levac, Colquhuon, and O’Brien. Framework stages included: identification of a research question and relevant studies, study selection, charting of data, and collating, summarizing, and reporting. A critical appraisal using theDowns and Black Checklistwas added to determine methodological quality of studies. The search strategy used six databases: Pubmed, Embase, PsycINFO, CINAHL, OTseeker, and Scopus, alongside a hand-search. Three researchers were involved in article selection and two in critical appraisal. Results: Twelve articles met inclusion criteria from 589 identified. A number of study methodologies were used to assess services, with varying methodological qualities. Studies were located within two major regions in the world. Five main approaches to service provision were identified: telehealth, exercise and education, Comprehensive Cardiac Rehabilitation, one-off visits and care-plan development, and community group programs. The majority of programs focused on secondary prevention and were aimed at an impairment level, with a mix of findings observed. Conclusion: Further development and assessment of services is warranted. Incorporation of the entire transition period, and research that is mild stroke and location-specific is advised. Attention to maximizing participation in daily life, secondary prevention, emotional well-being, and careful reporting is needed. [ABSTRACT FROM PUBLISHER]

Introduction Caregiving associated with driving disruption following an acquired brain injury is challenging and impacts on family members’ daily lives. However, little is known about the activities and meaning behind the occupation of a family member providing care during driving disruption. Method A prospective longitudinal design with a phenomenological approach was used as part of a larger study exploring family members’ needs and experiences. Forty-two semi-structured interviews were conducted with 15 family members over a 6-month period. Interviews were analysed using inductive thematic analysis. Results The occupational experiences related to caregiving during driving disruption emerged as a key finding. The meaning and activities comprising the caregiving occupation during driving disruption are captured in three themes: (1) More than just driving; (2) The invisible and undervalued care and (3) Being a therapist at home. Family members highlighted the challenges of managing broader and multiple responsibilities. Conclusion The lived experiences, perceived meaning and activities involved in the caregiver occupation during driving disruption extend beyond just transport provision. Family members require support for occupational engagement and satisfaction at this key time. Rehabilitation and support for the person after an acquired brain injury may also improve the occupational experiences of family members. [ABSTRACT FROM AUTHOR]

Introduction Home is a meaningful and important place and the transition to home from hospital is considered a significant point in recovery for people after stroke. Six dimensions of the home environment have previously been described as important for well-being and contributing to one's experience of home: the physical, social, personal, temporal, occupational and societal dimensions. The aim of this study was to understand the experience of home for people with stroke after discharge to home from hospital rehabilitation. Method A secondary template analysis applied the dimensions of home to semi-structured interviews that explored the transition to home experience for seven participants with stroke at 4–6 weeks post discharge. Results All six dimensions were present in the descriptions of returning to home from stroke rehabilitation. The social, personal and occupational dimensions appeared to be the most prominent and often centred on loss or change. Conclusion People returning home after a stroke enter a different home environment than the one they experienced prior to stroke, with changes experienced in all dimensions of home. Closer attention to the dimensions during discharge preparation may enhance the transition experience. [ABSTRACT FROM AUTHOR]

OBJECTIVE. We explored the efficacy of compression gloves in maintaining the benefits gained from compression bandaging of the stroke-affected upper limb. METHOD. Four participants completed a single-case (ABC) design study consisting of a baseline period (Phase A) and compression bandaging of the hand and upper limb (Phase B), followed by the application of a compression glove (Phase C). Edema was measured with circumferential tape at five specified points from the phalanx to the midforearm. All measurements were represented graphically for visual analysis, and celeration lines were calculated to indicate the degree of slope within each phase. RESULTS. Visual analysis indicated fluctuating edema volume during Phase A, decreasing edema volume during Phase B, and a mixed trend during Phase C. CONCLUSION. Compression gloves had mixed benefits in managing reductions in edema volume post-stroke. Further research may consider the material, sizing, and style of glove in the development of a maintenance strategy. [ABSTRACT FROM AUTHOR]

OBJECTIVE. This single-case study investigated the effectiveness of compression bandaging from the finger to the axilla in reducing poststroke edema in the upper limb. METHOD. Repeated circumferential measurements were recorded at five points along the participants' hand and forearm. Analysis of the data included the generation of graphs, celeration lines, and visual analysis. RESULTS. Five participants with edema (mean 38 days poststroke) were recruited to the study. Fluctuations in edema were observed in all three study phases, with an increasing to decreasing trend in edema between the baseline and intervention phases. There was no clear trend from the intervention to second baseline phase. CONCLUSION. Bandaging from the fingers to the axilla appears to be effective in reducing edema in the hand and forearm. However, return of edema after removal of the bandaging suggest that a greater understanding of underlying mechanisms and the appropriate intervention protocols is warranted. [ABSTRACT FROM AUTHOR]

Introduction: Older taxi drivers in Singapore face mandatory retirement at 73 years of age, often marked by the simultaneous loss of the worker and driver roles. The Driver Retirement Program was developed as an intervention to support this transition. Method: A pre- and post-experimental design was conducted with retired 73-year-old, male taxi drivers (n = 15) to investigate the hypotheses: (i) the Driver Retirement Program would increase activity participation (e.g. time use) and wellbeing (e.g. mood) outcomes at immediate post-intervention and (ii) maintain these changes at 3 months' follow-up. Non-parametric tests were used to compare changes between (i) pre- and post-intervention and (ii) 3 months follow-up to post-intervention. Participants' feedback on the Driver Retirement Program was obtained using a semi-structured questionnaire. Results: The Driver Retirement Program significantly improved mood, self-efficacy and satisfaction with individualised goals at post-intervention and maintained these changes at 3 months' follow-up. A significant decrease in time spent alone was found at follow-up compared with post-intervention. Participants rated high satisfaction with the Driver Retirement Program but also recommended a shorter programme without compulsory group sessions. Conclusion: The Driver Retirement Program was useful to support some aspects of work and driver retirement transition. Further work to enhance sensitivity to cultural and gender issues is indicated. [ABSTRACT FROM AUTHOR]

Introduction: Peer leaders are increasingly involved in health-related programmes due to the perceived benefits that they bring to the group process. This exploratory study examined the experiences of peer leaders in the University of Queensland Driver Retirement Initiative, an educational support group for older people undergoing driving cessation. Method: Semi-structured interviews were conducted with five peer leaders (two men, three women, age range: 67-81 years) regarding their role and involvement as a peer leader in the University of Queensland Driver Retirement Initiative programme as well as their positive and negative experiences. Results: Inductive thematic analysis revealed three themes: diversity of peer leaders, drawing on personal strengths and experiences, and taking the middle ground. Conclusion: This study revealed that peer leaders drew from their diverse range of personal resources and experiences to perform the role of peer leader, using varying approaches to perform the role successfully. The provision of broad guidelines in training allowed individual approaches to be developed and this contributed to a positive experience for peer leaders in the University of Queensland Driver Retirement Initiative. These findings have implications for the development of future peer-led driving cessation programmes and the selection of their peer leaders. [ABSTRACT FROM AUTHOR]

Background: Cognitive impairment is common and problematic post-stroke, yet vital information to understand early cognitive recovery is lacking. To examine early cognitive recovery, it is first necessary to establish the feasibility of repeat cognitive assessment during the acute post-stroke phase.Objective: To determine if serial computerised testing is feasible for cognitive assessment in an acute post-stroke phase, measured by assessment completion rates.Method: An observational cohort study recruited consecutive stroke patients admitted to an acute stroke unit within 48 hours of onset. Daily assessment with the Cambridge Neuropsychological Test Automated Battery (CANTAB) was performed for seven days, and single Montreal Cognitive Assessment (MoCA).Results: Seventy-one participants were recruited, mean age 74 years, with 67 completing daily testing. Participants had predominantly mild (85%; NIHSS ≤6), ischemic (90%) stroke, 32% demonstrated clinical delirium. The first day of testing, 76% of participants completed CANTAB batteries. Eighty-seven percent of participants completed MoCA a mean of 3.4 days post-stroke. The proportion of CANTAB batteries completed improved significantly from day 2 to day 3 post-stroke with test completion rates stabilizing ≥ 92% by day 4. Participants with incomplete CANTAB were older, with persisting delirium, and longer stay in acute care.Conclusion: Serial computerised cognitive assessments are feasible the first week post-stroke and provide a novel approach to measuring cognitive change for both clinical and research purposes. Maximum completion rates by day four have clinical implications for optimal timing of cognitive testing. [ABSTRACT FROM AUTHOR]

Background: Client-centered practice in stroke rehabilitation is strongly influenced by interprofessional team functioning and collaborative goal setting. The hospital context is problematic for client-centered practice and reduces the ability of the health care team and client with stroke to appreciate the impact of stroke on functioning within the home environment. Objective: The purpose of this study was to trial Stroke Rehabilitation Enhancing and Guiding Transition Home (STRENGTH), an approach to rehabilitation that provides clients, carers, and hospital-based therapists with weekly opportunities to develop goals and undertake therapy sessions in the home and community before hospital discharge. Methods: Nine participants, comprising 3 occupational therapists, 4 physiotherapists, and 2 speech pathologists, completed a custom-made survey and participated in a semi-structured focus group at the completion of the 6-month trial of STRENGTH. The survey and focus group questioned the participants on their experiences and impressions of STRENGTH. Results: Inductive thematic analysis of the focus group identified 2 themes: 'influences of context on team functioning' and 'experiences of the program.' The quantitative data supported the value of STRENGTH for team functioning and client outcomes. Conclusions: The findings provide an overall endorsement for STRENGTH from the therapists' perspectives and highlight the positive impact of environmental context on team functioning, collaborative goal setting, and ultimately client-centered practice. [ABSTRACT FROM AUTHOR]

OBJECTIVE. To explore the efficacy of low- and high-stretch compression bandaging for edema management in the stroke-affected upper limb. METHOD. A single-case, ABA-design study was conducted with 8 participants alternately allocated to receive low- or high-stretch bandaging. Edema was measured with circumferential tape at four specified points from the hand to the mid-forearm. All measurements were represented graphically for visual analysis, and celeration lines were calculated to indicate the degree of slope in each phase. RESULTS. Visual analysis indicated fluctuating edema volume in the first baseline phase, decreasing edema volume in the intervention phase, and increasing edema volume in the second baseline phase. The results did not clearly distinguish between the two bandaging groups. CONCLUSION. Compression bandaging may have benefits in the management of edema after stroke. Further research is required to identify factors contributing to the long-term maintenance of reductions gained after compression bandaging. [ABSTRACT FROM AUTHOR]

Purpose: Upper limb post-stroke sensory impairments have an impact on a significant number of stroke survivors. There is limited research in this area and it is unclear how occupational therapists are addressing sensory impairments in clinical practice. This study aimed to investigate the clinical practice patterns of occupational therapists, perceived barriers to providing interventions and information sources used when addressing upper limb post-stroke sensory impairments. Methods: A survey was sent to 500 randomly selected occupational therapists in the United States. Findings: The majority of the 145 respondents reported frequently assessing sensation, and half reported providing interventions for sensory impairments. Interventions primarily focused on providing passive sensory stimulation followed by compensatory strategies. Most therapists provided patient/caregiver education about safety. Therapists cited lack of knowledge and skills, patients' short length of stay and lack of time as barriers to utilizing interventions. Most therapists reported not being up to date with current research and requested continuing education to support practice. Conclusion: This survey established a profile of American occupational therapists' practice with people with upper limb post-stroke sensory impairments. Therapists have a need for information and training in all aspects of the management of upper limb post-stroke sensory impairment. Further research, evaluating the effectiveness of interventions and exploring therapists' clinical decision making when choosing interventions, is also needed. [ABSTRACT FROM AUTHOR]

Introduction: This study explored factors influencing occupational therapists' clinical decision making when choosing to assess upper limb post-stroke sensory impairments (ULPSSI) and selecting interventions. Method: A survey of 187 American occupational therapists working with stroke survivors. Findings: Respondents most commonly assessed ULPSSI to determine the impact on occupational performance and guide interventions, and most commonly did not undertake assessment if clients either reported no impairments or were unable to participate in testing. Being unaware of interventions, believing motor interventions addressed ULPSSI and lack of time most commonly led to the decision not to use interventions for ULPSSI. Clients' cognitive status, severity of ULPSSI and time since stroke influenced therapists when choosing between compensatory or remedial approaches. Prior experience, effects seen when trialling interventions and consulting other therapists most commonly influenced specific intervention choice. Conclusion: Deciding to assess ULPSSI was influenced by theoretical knowledge and domain-specific clinical knowledge while decisions about interventions were largely influenced by the therapists' domain-specific clinical knowledge, clinical experience and by specific contextual factors such as time available for therapy. Respondents used both automatic and reflective or deliberate decision-making processes. Education on evidence-based interventions and strategies for decision making in areas of clinical uncertainty is warranted. [ABSTRACT FROM AUTHOR]

Introduction: Collaborative goal setting is an important part of the occupational therapy process in spinal cord injury rehabilitation. Little is known about the clinical utility of the Canadian Occupational Performance Measure (COPM) with this population, although it has potential advantages over informal methods of goal setting commonly used in a spinal injury unit (SIU). The aim of this study was to investigate the goal setting process and clinical utility of the COPM from the perspective of occupational therapists within a SIU. Method: A focus group was conducted with six occupational therapists working in a SIU to explore their experiences and use of goal setting and the COPM. Inductive thematic analysis identified key themes from their comments. Findings: Focus group themes were the impact of client adjustment and other factors, organisational and administrative factors, therapist skill level and experience requirements, benefits of the COPM and incorporating the COPM into practice. Conclusion: Formal goal setting was a concept that was identified as a priority by the participants; however, there were organisational, client and therapist related factors that were considered as both barriers and facilitators to formal goal setting and the use of the COPM in this setting. [ABSTRACT FROM AUTHOR]

Aim: A self-management approach to upper limb management following stroke has received little attention in the literature. The aim of the study was to investigate the impact of occupational therapists' and physiotherapists' standard practice on clients' and carers' self-management of upper limb recovery. Method: Fifteen clients, 7 carers, 11 occupational therapists and 7 physiotherapists were recruited. Therapists described five self-administered tasks they expected clients and carers were doing, using the Goal Attainment Scale (GAS). For each task, clients' and carers' performances were then evaluated using the GAS and their self-efficacy was rated on a 10-point Likert scale. A survey questionnaire investigated their perceptions of the training provided, with respect to a self-management approach. Results: At least a quarter of the self-administered tasks related to upper limb activity, strengthening and secondary prevention were performed below therapists' expectations. In contrast, mean self-efficacy ratings across these tasks were high (clients = 7.8-9.5, carers = 8.5-8.9). Seventy per cent of the self-management training strategies listed in the survey questionnaire were considered missing by more than 40% of carers. Conclusion: There is a need for therapy resources that enhance the content and delivery of self-management training related to upper limb management following stroke, particularly for carers. [ABSTRACT FROM AUTHOR]

Purpose: The Chedoke Arm and Hand Activity Inventory-9 (CAHAI-9) is an activity-based assessment developed to include relevant functional tasks and to be sensitive to clinically important changes in upper limb function. The aim of this study was to explore both therapists' and clients' views on the clinical utility of CAHAI-9 within 14 days of stroke. Method: Twenty-one occupational therapists actively working in stroke settings were recruited by convenience sampling from 8 hospitals and participated in semistructured focus groups. Five clients within 14 days of stroke were recruited by consecutive sampling from 1 metropolitan hospital and participated in structured individual interviews. The transcripts were analyzed thematically. Results: Six themes emerged from the focus groups and interviews: collecting information, decisions regarding client suitability, administration and scoring, organizational demands, raising awareness, and clients' perceptions of CAHAI-9 utility. All therapists agreed CAHAI-9 was suited for the stroke population and assisted identification of client abilities or difficulties within functional contexts. Opinions varied as to whether CAHAI-9 should be routinely administered with clients who had mild and severe upper limb deficits, but therapists agreed it was appropriate for clients with moderate deficits. Therapists made suggestions regarding refinement of the scoring and training to increase utility. All clients with stroke felt that the assessment provided reassurance regarding their recovery. Conclusion: The findings indicate that CAHAI-9 shows promise as an upper limb ability assessment for clients within 14 days of stroke. [ABSTRACT FROM AUTHOR]

Purpose: Stroke survivors report multiple psychosocial issues after discharge and difficulties returning to meaningful roles and activities. This study explored the impact of an occupation-based group program on activity levels, well-being, and self-efficacy after discharge from inpatient rehabilitation.Methods: This pilot study recruited participants from two hospital rehabilitation units. Both units provided individual therapy programs. Unit A provided an additional occupation-based group program. Behavioural mapping recorded participants' activity levels in hospital for one weekday and one weekend day. Outcome measures collected at recruitment, discharge, and/or 1 month after discharge included Modified Barthel Index, use of community supports, length of stay, Stroke Impact Scale, and Self- Efficacy Gauge.Results: Participants from Unit A (n = 8) had a significantly longer length of stay than Unit B (n = 11) and spent significantly more time in occupational therapy (P = .01). Both participant groups were more inactive on the weekday compared to the weekend (P = .03). Participants in Unit A were more likely to report low levels of social participation and stroke recovery (P <.05) on the Stroke Impact Scale.Conclusion: There was no indication from the results of this study that an occupation-based group program had a positive effect on the measured outcomes. [ABSTRACT FROM AUTHOR]

The clock drawing item in the Occupational Therapy Adult Perceptual Screening Test (OT-APST) screens for unilateral neglect and impairments in constructional skills. The purpose of this study was to re-evaluate the interrater reliability of the clock drawing item in the OT-APST following the addition of example clock drawings to the manual. This study also compared the interrater reliability for occupational therapy clinicians with that for final year occupational therapy students and examined clocks with poor interrater reliability for the individual scoring criteria. Sixteen occupational therapy students and 15 practising occupational therapists scored 50 clocks drawn by people with stroke, using the OT-APST clock drawing criteria. Interrater reliability was determined for each rater in comparison to the gold standard, using intraclass correlation (ICC) and kappa statistics. Student and clinician interrater reliability were compared using t-tests. The scoring of clocks with poor agreement was examined further in order to identify disparities. The student and clinician groups demonstrated excellent reliability for ICC (0.83 and 0.84 respectively) and moderate reliability for kappa statistics (0.58 and 0.59). The differences between the groups were not significant (p>0.05). Scoring disparities were seen in the formation of the circle or in the placement of the numbers. The results support reliable scoring for the clock drawing item in the OT-APST. [ABSTRACT FROM AUTHOR]

The aim of this paper was to review the psychometric properties and clinical utility of assessments of upper limb ability following stroke. Upper limb ability was defined as the use of the arm in meaningful activity. The database searches identified 13 assessments of upper limb ability. The inclusion criteria were (a) an evaluation of upper limb ability post-stroke, (b) a quantitative assessment yielding a numerical score, (c) able to be administered by an occupational therapist and (d) published information building on the results of a review in 2001. The assessments included were reviewed with respect to the ability measured, equipment required, evidence of reliability and validity, and advantages and disadvantages of use. Seven assessments satisfied the inclusion criteria. These assessments have undergone varying degrees of psychometric testing as outcome measures for upper limb recovery and all demonstrate at least adequate levels of reliability and validity. There is variation in the availability of instruction manuals and time commitments for test administration. All test items are generally available and inexpensive, enabling departments to set up the assessments with minimal financial outlay. The assessments described are regularly used in research and all demonstrate psychometric properties that suggest that they could be incorporated into clinical practice. Occupational therapists are encouraged to consider how they may include these assessments into their own clinical practice. An important step in this process may be further research into the clinical utility of these assessments. [ABSTRACT FROM AUTHOR]