Search

Introduction: Driving is a valued occupation given the independence and freedom it provides. Safe driving performance can be impacted by medical conditions, change in functional status and ageing processes. Occupational therapy driver assessors (OTDAs) provide invaluable driving recommendations; however, this requires specialist training for the therapist and is costly for clients. The number of OTDAs is not expected to meet the growing demand for expert services in this area, and little is known about the practices that non- OTDAs use to assist clients with returning to driving. The aims of this study were to investigate the practices of non-OTDAs in a community-based rehabilitation setting in Australia with respect to knowledge, confidence and skills in assessments, recommendations and outcomes for clients as part of the return to driving process., Methods: A descriptive study including medical record audits between April and September 2019 and staff surveys were completed at a large metropolitan community-based rehabilitation facility. Descriptive statistics and thematic analysis were used to summarise data., Results: A total of 102 client medical records were audited, and 13 clinician surveys were completed. Medical record audits identified that return to driving was not consistently addressed by occupational therapists. Clinician surveys outlined a lack of knowledge and confidence of return to driving processes and available assessment tools to guide this process., Conclusion: All occupational therapists have an ethical obligation to address driving as an activity of daily living; however, non-OTDAs report that they are not equipped for this role. This may negatively impact on driver safety, independence and overall health and well-being of clients in community-based rehabilitation. Further research is indicated to develop evidence-based driving resources to support best practice of non-OTDAs., (© 2021 Occupational Therapy Australia.)

Background/aim: Life roles are integral to occupational therapy practice. Goal setting is a method of establishing priorities to measure outcomes. While acquired brain injury can impact a person's ability to fulfil meaningful life roles, the alignment of goals set in rehabilitation to life roles, is unclear. This study aimed to (i) explore the alignment of goals with life roles for people with an acquired brain injury participating in inpatient rehabilitation; and (ii) identify barriers and enablers to life role discussions within a patient-directed goal setting framework., Method: A mixed-methods study was conducted on an inpatient rehabilitation unit in Victoria, Australia. Quantitative data were obtained from a retrospective file audit of randomly selected medical records. Qualitative data were collected through: a) interviews with patients and their families; and b) A focus group with occupational therapists. Thematic analysis of both audit data and narrative data was undertaken., Results: Thirty files were examined and demonstrated 33% alignment between goals and life roles. Four interviews were completed with patients, with a family member participating in two of these. Themes identified were: readiness, role concept, recovery concept and goal review. Five therapists attended the focus group. Themes identified were: Patient factors, goal review, expectations, role change and environment. Interview and focus group data identified that barriers to life role discussions included: lack of patient and family readiness, patients' difficulty understanding role concept, focus on impairments and lack of family/ significant others support. Enablers included: having early conversations involving family, regular goal review and use of standardised tools., Conclusion: Goal setting in alignment with life roles is important in acquired brain injury rehabilitation, but may be limited. This process can be enhanced by including patients and their significant others in early goal setting conversations, along with regular goal review across the rehabilitation process., (© 2018 Occupational Therapy Australia.)

Background: One method of evaluating the construct validity of instruments is the Rasch Measurement Model (RMM), an increasingly popular method used for test construction and validation., Aim: The aim was to examine the construct validity of the Developmental Test of Visual-Motor Integration 5th Edition (VMI) by applying the RMM to evaluate its scalability, dimensionality, differential item functioning and hierarchical ordering., Method: The participants were 400 children aged 5 to 12 years, recruited from six schools in Melbourne, Victoria, who completed the VMI under the supervision of an occupational therapist. VMI items 1, 2 and 3 were excluded from the Rasch analysis since all of the children achieved a perfect score on these items., Results: None of the items exhibited RMM misfit due to goodness-of-fit mean square (MnSq) infit statistics and standardised z (ZStd) scores being outside the specified acceptable range. VMI item 9 (copied circle) exhibited differential item functioning based on gender. In relation to hierarchical ordering of items, several were found to have similar logit difficulty values. For example, VMI items 26, 27 and 29; items 18, 22 and 24; and items 4, 5 and 11 were found to have the same level of challenge. As well, the VMI scale item logit measure order did not match that presented in the VMI test manual., Conclusion: Theoretically, the VMI items are developmentally ordered; however, this ordering was not mirrored by the item logit difficulty scores obtained. This has scoring implications, where scoring a respondent's VMI test booklet is terminated after three consecutive items are not passed. Clinicians should also be aware that item 9 may exhibit bias related to gender.