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A structured review using the PRISMA guidelines, MeSH keywords and eight health databases was conducted (1990 to March 2021). Telerehabilitation research evidence from the Middle East and North Africa region (MENA) was summarized. Twelve studies from Iran, Israel, Morocco, and Saudi Arabia met inclusion criteria; nearly all had been published within the past five years. Methodological quality was moderate to good in the four randomized controlled trials, five cohort-studies and three cross-section surveys. There were seven intervention studies in cardiovascular, musculoskeletal, neurology or burn rehabilitation and three patient perception and two practitioner perception studies. Narrative synthesis revealed content themes relating to rehabilitation availability and accessibility; patient/practitioner perceptions of telerehabilitation; telerehabilitation to augment traditional services; and barriers to telerehabilitation. Telerehabilitation practice in MENA has been demonstrated as feasible, acceptable to patients, and effective in practitioner-designed cohort specific programs. Practitioners are generally positive but lack experience and need training, enabling technological systems, and policy frameworks.

This study used a scoping review methodology to identify, collate and summarise published literature relating to people with disability in Libya. Most sources came from peak international agencies, some from humanitarian agency media releases, a few were Libyan government reports and very little from scholarly journals. Four themes summarize findings and provide a means to examine assumptions regarding people with disability in Libya: (1) scant data and information gaps are the norm; (2) disability is a medical problem to be managed; (3) acquisition context matters: conflict versus non-conflict disability; and (4) disability human rights – social model on paper but not yet in practice. Findings reveal gaps in knowledge, promising signs of change and areas for action. People with disability in Libya need: a stable and secure community; visibility in reporting, planning and evaluation of services that are inclusive in design and delivery; and measures, technical definitions and socio-cultural understandings of disability that value function, activity and participation in everyday life as much as medical conditions, impairments and expert treatment. These actions will help provide people with disability in Libya an opportunity to actively contribute in rebuilding their communities in a post-conflict future.

PURPOSE: The Disabilities of Arm, Shoulder and Hand (DASH) questionnaire is a patient reported outcome measure for evaluating upper limb function in people with musculoskeletal conditions. While the DASH has good psychometric properties when used with people with musculoskeletal conditions, it has not been tested with adults after stroke.METHODS: Data for n = 61 adults following stroke (aged 32-93 years, 44% male) were analyzed to test validity and reliability of the DASH for use with a stroke population. Data included demographic and clinical attributes, DASH scores (baseline and four weeks later) and Patient Rated Wrist Evaluation (PRWE) measures.RESULTS: Internal consistency was good (Cronbach alpha 0.92, SEM 6.65). Factor analysis and Rasch modeling suggested that the questionnaire comprised three subscales: pain, impact and function. Concurrent validity between the DASH and PRWE (Spearman's Rho rs = 0.41) was moderate. The scale was perceived by clinicians to be useful, quick and simple to administer. The DASH had low four-week test-retest reliability (ICC 0.56 [95% Cl 0.05-0.79]).CONCLUSIONS: The DASH is considered to have acceptable validity when used with adults following stroke. Test-retest reliability was low but further research is needed to establish whether this is a result of condition-related change or the stability of the measure. Implications for Rehabilitation The DASH questionnaire examines upper limb function in task performance and appears to be a useful tool, which is simple to administer in the clinical setting with adults following stroke. Upper limb function post stroke can be meaningfully assessed using the DASH as it has good internal consistency and moderate concurrent validity. Rasch analysis and factor analysis suggests that the tool appears to consist of three subscales: pain, impact and function. The total score of the DASH may be less meaningful than the totals of these subscales. The test-retest reliability of the DASH requires further research; over a four-week period DASH stability was poor in a group of people with moderate to severe upper limb impairment.

BackgroundBotulinum toxin A (BoNT-A) injections are increasingly used to treat muscle spasticity and are often complemented by adjunctive rehabilitation therapies; however, little is known about the effect of therapy after injection.PurposeThe aim of this study was to identify and summarize evidence on rehabilitation therapies used after BoNT-A injections to improve motor function in adults with neurological impairments.Data SourcesSearches were conducted in PubMed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL, National Research Register, metaRegistry of Controlled Trials, PEDro, and OTseeker.Study SelectionRandomized and quasi-randomized controlled trials were considered for inclusion. Participants with neurological impairments received BoNT-A to treat focal spasticity in limbs, with rehabilitation interventions provided to experimental groups only. Primary outcome measures were joint mobility, function of the affected limb, and spasticity. Eleven studies with 234 participants, most of whom had stroke, were included in the review.Data ExtractionTwo reviewers extracted study details and data.Data SynthesisMethodological quality was rated using the PEDro scale. Both fixed-effects and random-effects models were used to calculate effect size.ResultsStudies were of variable quality: 3 were poor (PEDro score 1 to 4), and 8 were moderate (PEDro score 6 to 7). No study investigated effects for longer than 24 weeks (6 months). Included trials presented 9 therapy types, including ergometer cycling, electrical stimulation, stretch (casting, splinting, taping, or manual or exercise-induced stretch), constraint-induced movement therapy, task-specific motor training, and exercise programs. Statistical findings suggest that combined therapy and BoNT-A is slightly more effective than BoNT-A alone.ConclusionEvidence relating to impact of adjunct therapy is available, but the heterogeneity of studies limits the opportunity to demonstrate overall impact. Researchers need to consider the benefits of greater consistency in study approaches and measures so that meaningful evaluations of overall adjunct therapy effects can be made.

Background Self-directed learning (SDL) is expected of health science graduates; it is thus a learning outcome in many pre-certification programs. Previous research identified age, gender, discipline and prior education as associated with variations in students’ self-directed learning readiness (SDLR). Studies in other fields also propose personality as influential. Method This study investigated relationships between SDLR and age, gender, discipline, previous education, and personality traits. The Self-Directed Learning Readiness Scale and the 50-item ‘big five’ personality trait inventory were administered to 584 first-year undergraduate students (n = 312 female) enrolled in a first-session undergraduate interprofessional health sciences subject. Results Students were from health promotion, health services management, therapeutic recreation, sports and exercise science, occupational therapy, physiotherapy, and podiatry. Four hundred and seven responses (n = 230 females) were complete. SDLR was significantly higher in females and students in occupational therapy and physiotherapy. SDLR increased with age and higher levels of previous education. It was also significantly associated with ‘big five’ personality trait scores. Regression analysis revealed 52.9% of variance was accounted for by personality factors, discipline and prior experience of tertiary education. Conclusion Demographic, discipline and personality factors are associated with SDLR in the first year of study. Teachers need to be alert to individual student variation in SDLR.

Background/aim The Western Neuro Sensory Stimulation Profile (WNSSP) is designed to measure disorders of consciousness in people with severe traumatic brain injury who are slow-to-recover. This study explores internal consistency reliability and concurrent validity of the WNSSP with function and two other consciousness measures. Method Retrospective chart audit of all severe traumatic brain injury patients admitted to a specialist neurological rehabilitation centre from January 2001 to December 2006 in a vegetative or minimally conscious state. Medical record of demographical, clinical and Glasgow Coma Scale (GCS) data were recorded. To be included in the study, patients needed admission and discharge WNSSP results; plus Functional Independence Measure™ (FIM™) and Rancho Los Amigos Scale (RLAS) scores. Results Of 37 potential participants, 33 had required WNSSP results (mean age 28 years; 27 male participants). Internal consistency reliability was very high (α = 0.933). Concurrent validity in relation to function was significant but weak at admission for FIM™ Total-scale but not subscales (rs = −0.146, P = 0.0424). At discharge, there was a modest relationship with FIM™ Motor-subscale (rs = 0.374; P = 0.045), and FIM™ Cognition-subscale (rs = 0.412; P = 0.026) scores, but not the FIM™ Total-scale. Concurrent validity in relation to the RLAS was strong at admission (rs = 0.693, P = 0.01) and discharge (rs = 0.788, P = 0.01). The WNSSP and GCS scores were not associated. Conclusion The WNSSP is sensitive to behavioural change in slow-to-recover patients with severe traumatic brain injury. It demonstrates very high internal consistency reliability, and positive evidence of concurrent validity with FIM™ and the RLAS providing detailed description of cognitive-sensory behaviour within RLAS-levels.

Aim The aim of the study was to investigate the construct validity of the Quality of Upper Extremity Skills Test (QUEST) in children with cerebral palsy (CP). Method A total of 170 QUEST assessments from a convenience sample of 94 children with CP involved in clinical and research treatment programmes (54 males, 40 females; mean age 6y 10mo, SD 2y 11mo, range 216y; Gross Motor Function Classification System levels IV) were reviewed. Results The QUEST was not unidimensional; many items demonstrated poor fit when total scores were analysed; goodness of fit improved when domains were considered independently and limbs separately examined. QUEST items involving elbow flexion and/or forearm in pronation were easily achieved, thus reducing test sensitivity. Postures items in the grasp domain behaved erratically, with little total score relationship. Interpretation Calculating total scores is discouraged. Reporting QUEST results separately for domains and each limb is recommended. Posture items in the grasp domain had little relationship with total scores and it is recommended that they be removed from the test.

Aim Research funds for cerebral palsy are scarce and competition for them is strong. This study aimed to identify questions for future research that were agreed to be a high priority. Method An expert panel of consumers, researchers, and clinicians was assembled (n=127) and surveyed using a Delphi survey comprising three rounds. In round I, participants identified three important research topics. Three parallel surveys were constructed: (1) consumers; (2) intervention researchers and clinicians; and (3) aetiology and prevention researchers. In rounds II and III, participants rated priorities using a seven-point Likert scale. Questions reaching consensus were itemized and those not reaching consensus were discarded. Results Consumers identified questions in the themes of prevention/cure, quality of life/community participation, and service provision/intervention. Intervention researchers/clinicians identified questions in the themes of effective outcomes and effective research/services. Aetiology and prevention researchers identified questions in the themes of infection/inflammation, focus on timing, haematology, research tools, neuroregeneration, and genetics. Fifty per cent of the consumers’ priorities were also identified by professionals. Interpretation Research priorities change as evidence is established. Phase II of this project is to develop a web portal with international collaboration. As evidence builds for one research question, it will be added to the web portal and unanswered questions will become the priority.

This study critically explores the experience of one clinician who developed the practitioner-researcher role in a remote hospital.One occupational therapist working in rehabilitation who had never previously done or been trained for research but who completed and published a randomized controlled trial.Government hospital rehabilitation ward in remote northern Australia.Data from a reflective journal and project records were content analysed using a conceptual framework of the metropolitan practitioner-researcher experience.The participant's experience was similar to that of metropolitan practitioner-researchers as it was not just a matter of doing research, but rather one of role change from practitioner to researcher. The remote context created structural conditions that discouraged and hindered research and made the task of researcher role development challenging with high personal costs. Research deterrents included a lack of: Research-related infrastructure (such as information technology), research development policy, research accommodations in job descriptions, dedicated funding to support research time release and training, and research support networks. These deterrents were a consequence of the remote setting. Investment of substantial personal time, money and use of pro bono city research advisers was required to compensate for structural deterrents to ensure project completion.Researcher role development was central to project success, the remote context dominated role development processes and personal resources were needed to compensate for structural research deterrents

Occupational therapy home programs are a common approach used to provide interventions for children with cerebral palsy, but there is little evidence to demonstrate the effectiveness of such programs. This single-group pretest–posttest design pilot study evaluated the impact of an occupational therapy home program implemented with 20 children who had spastic hemiplegic cerebral palsy (ages 2–7 years, mean 3.8). We measured impact using Goal Attainment Scaling (GAS), the Pediatric Evaluation of Disability Inventory (PEDI), and the Quality of Upper Extremity Skills Test (QUEST). We measured participation amount through a parent self-report log. Significant changes following intervention occured in scores on the GAS, the PEDI Functional Skills and Caregiver Assistance Scales, and the QUEST, but has found no relationship between participation amount and outcome using the same measures. These promising results suggest that further investigation of the impact of occupational therapy home programs is warranted.

Background and Purpose— Splints are commonly applied to the wrist and hand to prevent and treat contracture after stroke. However, there have been few randomized trials of this intervention. We sought to determine whether wearing a hand splint, which positions the wrist in either a neutral or an extended position, reduces wrist contracture in adults with hemiplegia after stroke. Methods— Sixty-three adults who had experienced a stroke within the preceding 8 weeks participated. They were randomized to either a control group (routine therapy) or 1 of 2 intervention groups (routine therapy plus splint in either a neutral or an extended wrist position). Splints were worn overnight for, on average, between 9 and 12 hours, for 4 weeks. The primary outcome, measured by a blinded assessor, was extensibility of the wrist and long finger flexor muscles (angle of wrist extension at a standardized torque). Results— Neither splint appreciably increased extensibility of the wrist and long finger flexor muscles. After 4 weeks, the effect of neutral wrist splinting was to increase wrist extensibility by a mean of 1.4° (95% CI, −5.4° to 8.2°), and splinting the wrist in extension reduced wrist extensibility by a mean of 1.3° (95% CI, −4.9° to 2.4°) compared with the control condition. Conclusions— Splinting the wrist in either the neutral or extended wrist position for 4 weeks did not reduce wrist contracture after stroke. These findings suggest that the practice of routine wrist splinting soon after stroke should be discontinued.

Background Spasticity in the upper limb is common after acquired brain impairment and may have a significant impact on the ability to perform meaningful daily activities. Traditionally, outcome measurement in spasticity rehabilitation has focused on impairment, however, improvements in impairments do not necessarily translate to improvements in an individual’s ability to perform activities or engage in life roles. There is an increasing need for outcome measures that capture change in activity performance and life participation. Methods/Design We will conduct a systematic review of the psychometric properties of instruments used to measure upper limb functional outcomes (activity performance and participation) in patients with spasticity. Assessments (n = 27) will be identified from a recently published systematic review of assessments that measure upper limb function in neurological rehabilitation for adults with focal spasticity, and a systematic review of each assessment will then be conducted. The databases MEDLINE, CINAHL and EMBASE will be searched from inception. Search strategies will include the name of the assessment and the COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) published search strategy for identifying studies of measurement properties. The methodological rigour of the testing of the psychometric quality of instruments will be undertaken using the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist. International Classification of Functioning, Disability and Health (ICF) definitions of impairment, activity and participation will be used for content analysis of items to determine the extent to which assessments are valid measures of activity performance and life participation. We will present a narrative synthesis on the psychometric properties and utility of all instruments and make recommendations for assessment selection in practice. Discussion This systematic review will present a narrative synthesis on the psychometric properties and utility of assessments used to evaluate function in adults with upper limb focal spasticity. Recommendations for assessment selection in practice will be made which will aid clinicians, managers and funding bodies to select an instrument fit for purpose. Importantly, appropriate assessment selection will provide a mechanism for capturing how applicable to everyday life the outcomes from individualised rehabilitation programs for the upper limb really are. Systematic review registration PROSPERO CRD42014013190 Electronic supplementary material The online version of this article (doi:10.1186/s13643-015-0076-5) contains supplementary material, which is available to authorized users.

The objective was to determine the effects of low-dose, high-concentration, dual localized botulinum toxin A (BTX-A) injections on upper limb movement quality and function. Study design was an evaluator-blinded, randomized, controlled trial. Forty-two children (31 males, 11 females; range 2-8y, mean 4y [SD 1.6]) with hemiplegic cerebral palsy (Gross Motor Function Classification System level I) participated. All received occupational therapy. The treatment group (n=21) received one injection series (mean muscles injected 6 [SD 1.05]; total dose 82-220 units, mean 139 [SD 37.48]; dilution 100 units/0.5ml). Primary outcome of Quality of Upper Extremity Skills Test (QUEST) at 6 months was not significant (p=0.318). Secondary outcomes were average treatment effects at 1, 3, and 6 months, which favoured the treatment group: QUEST (p

Social science research training is de-facto occupational socialisation to researcher-roles. To do research, trainees need to develop and demonstrate advanced scholarship that complies with disciplinary norms and perform tasks to pre-determined standards. Functionalist approaches to occupational socialization underpin the performative and standardised approach to research training common in universities. But there is more to research training than doing research. If truly successful, trainees will become researchers. They will take on the researcher-role and make it their own. Interpretive approaches to occupational socialization help illuminate intra-and inter-personal dimensions of role-taking and role-making, however this approach is rarely used to inform research training strategies. Occasional scholarship reveals ad-hoc application on interpretive approaches to research trainee experience (e.g., “the journey”) supervisor experience (e.g., “emotional burden of supervision”), research training methods such as peer-learning (e.g., informal or fabricated groups, research micro-climates), or research training pedagogy (e.g., collaborative learning, co-production). Recently, interpretive approaches have been used to inform career-planning strategies for PhD graduates (e.g., “Vitae”) but this is yet to systematically inform institutional strategies for research-training. To more effectively and efficiently facilitate researcher-role development, research training should consider occupational socialization as an organizing framework, and utilize performative and interpretive approaches to role development.

PurposeAims to explain how application of organizational development (OD) can facilitate compliance with regulations imposed by an external government agency on university operations.Design/methodology/approachA total of 2,000 students and 150 staff were directly affected by the regulation, with the remaining university population potentially affected. The strategy utilized project management and change agent processes where analysis of the problem, design and implementation of interventions, and evaluation of intervention effect were carried out through a project working party with highly centralized leadership by senior management. There was regular progressive and summative evaluation of project goal attainment.FindingsUse of project management, change agents and centralized senior project leadership provided the practical means to support successful OD. OD worked well within the devolved, multi‐campus, multidisciplinary and organizationally complex environment of the university. OD proved to be an effective and efficient approach for large‐scale change in technical organizational sub‐systems, in particular structure and technology. By the end of the 18‐month intervention, no staff incidents had been reported, and of 2,000 students directly affected, only seven incidents had been identified and these were ultimately resolved by the project management group.Practical implicationsOD can be used effectively and efficiently to facilitate mandated change in multi‐site, multidisciplinary, large organizations. This case study demonstrated that project management, centralized leadership and the use of change agents were practical, efficient and effective within the OD framework.Originality/valueThis is the first study to describe and evaluate the use of OD to facilitate mandated change in universities in response to regulation.

This study used a Delphi survey method to identify research priorities of occupational therapists working in mental health. Twenty-two subjects were initially surveyed for their suggestions regarding research topics they thought were important. These 22 subjects represent a random sample of 12.4% of national OT-Australia membership of occupational therapists working in mental health. After three "rounds" of the Delphi methodology, consensus research priorities were obtained in six areas: research of value to clients (5 topics); research of value to occupational therapists working in mental health (4 topics); research related to providing community care for clients (2 topics); research that facilitates health promotion and disease prevention (6 topics); research that is of value to the profession of occupational therapy (6 topics); and research that is of value to occupational therapy education (4 topics). Implications for occupational therapy practice and re search are discussed.

Background Occupational therapists form a significant proportion of the allied health workforce in developed countries. Demand for occupational therapists in Australia is growing due to the rapidly expanding population of people living with chronic and complex conditions. Recent Australian government initiatives conducted through Health Workforce Australia have been implemented to enhance training opportunities to increase workforce supply. But increasing graduate numbers is only one part of a solution to matching workforce supply and demand. Another part that has had considerable attention in medicine but little in allied health, is where they want to work their practice preferences.

Background: functional assessment is an important component of the management of older adults in the emergency department (ED) as the function level has been identified as a predictor of adverse events including ED re-presentation. A systematic review (SR) of all functional assessments utilised in EDs has not been undertaken making assessment selection, on the basis of evidence, difficult for staff. Objective: this SR: (i) identified functional assessments that have been utilised in ED settings, (ii) examined what psychometric properties analysis has been completed and (iii) established recommendations for practice. Methods: electronic database searching was completed utilising key search terms. Articles were reviewed using pre-determined inclusion criteria. Each study was appraised using quality criteria for aspects of validity and reliability in addition to clinical utility, interpretability and responsiveness. Recommendations for practice were determined on the basis of the extent of psychometric data generated in ED settings and whether or not the assessment was specifically developed for ED use. Results: a total of 332 articles were identified of which 43 articles utilising 14 functional assessments were retained. Psychometric testing was scarce. Functional assessment has been reported internationally and only with older adults. Following appraisal four assessments [the Identification of Seniors at Risk (ISAR), Triage Risk Stratification Tool (TRST), Older Adult Resources and Services (OARS) and Functional Status Assessment of Seniors in Emergency Departments (FSAS-ED)] were recommended for practice with moderate reservations. Conclusion: the ISAR or TRST are suitable for fast screening, whereas the OARS or FSAS-ED are more suitable for a comprehensive understanding of functional performance. Further research is warranted and recommendations for ED assessment may change as more becomes known about psychometric properties and clinical applications of other assessments.

The aim of the study was to investigate the construct validity of the Quality of Upper Extremity Skills Test (QUEST) in children with cerebral palsy (CP).A total of 170 QUEST assessments from a convenience sample of 94 children with CP involved in clinical and research treatment programmes (54 males, 40 females; mean age 6y 10mo, SD 2y 11mo, range 2-16y; Gross Motor Function Classification System levels I-V) were reviewed.The QUEST was not unidimensional; many items demonstrated poor fit when total scores were analysed; goodness of fit improved when domains were considered independently and limbs separately examined. QUEST items involving elbow flexion and/or forearm in pronation were easily achieved, thus reducing test sensitivity. Postures items in the grasp domain behaved erratically, with little total score relationship.Calculating total scores is discouraged. Reporting QUEST results separately for domains and each limb is recommended. Posture items in the grasp domain had little relationship with total scores and it is recommended that they be removed from the test.

Research funds for cerebral palsy are scarce and competition for them is strong. This study aimed to identify questions for future research that were agreed to be a high priority.An expert panel of consumers, researchers, and clinicians was assembled (n=127) and surveyed using a Delphi survey comprising three rounds. In round I, participants identified three important research topics. Three parallel surveys were constructed: (1) consumers; (2) intervention researchers and clinicians; and (3) aetiology and prevention researchers. In rounds II and III, participants rated priorities using a seven-point Likert scale. Questions reaching consensus were itemized and those not reaching consensus were discarded.Consumers identified questions in the themes of prevention/cure, quality of life/community participation, and service provision/intervention. Intervention researchers/clinicians identified questions in the themes of effective outcomes and effective research/services. Aetiology and prevention researchers identified questions in the themes of infection/inflammation, focus on timing, haematology, research tools, neuroregeneration, and genetics. Fifty per cent of the consumers' priorities were also identified by professionals.Research priorities change as evidence is established. Phase II of this project is to develop a web portal with international collaboration. As evidence builds for one research question, it will be added to the web portal and unanswered questions will become the priority.

Response: The letter by Marossezky et al takes issue with the design of our recent randomized trial of splinting early after stroke,1 suggesting that our findings failed to show that “routine splinting soon after stroke should be discontinued.” They believe that we did not define “contracture.” We take this opportunity to clarify that we use the term contracture to refer to a reduction in the slack length or compliance of the relaxed muscle.2 Clinically, contracture manifests as a loss of range of motion or an increased resistance to passive movement.3 Much of our article refers to muscle extensibility to make clear …

The efficacy of repeated botulinum toxin A (BTX-A) injections in two and three dose regimes, together with occupational therapy, on upper limb movement and function, was studied using an evaluator blinded, randomized, controlled two-group trial. Forty-two children (31 males, 11 females; range 2-8 y, mean 4 y [SD 1 y 7 mo]) with hemiplegic cerebral palsy (Gross Motor Function Classification System Level I) longitudinally participated for 30 months, with the first 6 months reported earlier (Lowe et al. 2006). The BTX-A group (n=21) received three injections (0, 6, and 18 mo), while the delayed group had two (6 and 18 mo; dose 0.5-2.1 units/kg, mean 1.5 [SD 0.18]; dilution 100 units/0.5 ml). At 30 months, no difference existed between groups on any standardized measures. First and second injections showed significant treatment effect sizes, on Quality of Upper Extremity Skills Test (5.5 p=0.01: 4.5 p=0.03); parent Goal Attainment Scaling (GAS; 3.5 p=0.02: 3.9 p=0.01; therapist GAS 7.8 p=0.00: 4.0 p=0.03); Canadian Occupational Performance Measure (performance 0.4 p=0.05: 0.4 p=0.02; satisfaction 0.4 p=0.05: 0.37 p=0.08); and Pediatric Evaluation of Disability Inventory functional skills (1.8 p=0.00: 2.3 p=0.04). BTX-A was not linked to adverse events, suggesting repeated upper limb injections in children with hemiplegia receiving occupational therapy were safe and effective for improvement of movement and function.

Response: Manigandan and Charles make 3 criticisms of our randomized trial of splinting the wrist after stroke.1 In our opinion those criticisms do not survive close scrutiny. We respond to each in turn. The literature on mechanisms of contracture (which we and others have reviewed)2–4 provides little guidance as to when and how splinting should be applied. It is not implausible that, if splinting had beneficial effects, the magnitude of those effects might depend on when the splinting was first applied, but we see no reason to expect qualitatively different effects of splinting applied 4 weeks after stroke (the mean in our study) or sooner after stroke. Our data support …

Response: Dr Shah makes 5 criticisms of our randomized trial of splinting the wrist after stroke.1 We respond to each in turn. Randomization was based on the diagnosis and time from onset, not the degree of spasticity : The randomization schedule in our trial was unrestricted; it was not, as Dr Shah suggests, “based on the diagnosis [or] time from onset.” Dr Shah insists that randomization “should be based on the degree of spasticity.” Presumably, he means that we should have stratified allocation by spasticity, but he does not provide a coherent justification for that assertion. There is no methodological imperative to stratify …

OBJECTIVE. To evaluate factors associated with randomized controlled trial patient recruitment by therapists. METHOD. Survey of 18 (of a possible 26) therapists who had agreed to recruit patients for a randomized controlled trial (78% response rate). RESULTS. Sixteen respondents had enrolled at least one patient. The site at which the therapist worked neither influenced the likelihood that a therapist would contact the researcher nor influenced the recruitment rate. Seventeen respondents reported that they contacted the researcher to discuss one or more of their patients for potential inclusion in the trial. Factors reported by therapists as reasons why they did not recommend the trial to eligible patients were not specific to study inclusion or exclusion criteria, rather were linked to personal judgments about patient suitability for the study. Regression analysis indicated that being enrolled or having completed master’s level postgraduate studies, and choosing not to refer patients because of concern for their poor medical prognosis were the only factors that significantly influenced recruitment rate (p < 0.001). CONCLUSION. Recruitment practices vary amongst therapists. Selection of therapists with postgraduate qualifications as recruiters may be an effective way to enhance recruitment rate.

The aim of this study was to explore the effect of rater training on interrater reliability, internal consistency, standard error of measurement, and rater familiarity for the Melbourne Assessment of Unilateral Upper Limb Function. Twenty-four participants (raters) were randomly assigned to either 'trained' (n=12) or 'untrained' (n=12) interventions; they then scored the same nine video recordings of children completing the instrument. The age range of the children was 5 years 5 months to 12 years; there were six males, three females, all with spastic cerebral palsy (five with quadriparesis and four with hemiparesis); Gross Motor Function Classification System levels were I (n=3), II (n=3), III (n=1), and IV (n=2). All participants were novice occupational therapists and had no previous experience of using the instrument. A significant difference in perceived test familiarity was found after scoring but not before: trained raters scored higher. A significant difference in total scores for all cases was found and in eight of 16 individual item total raw scores. Again, trained raters scored higher. Interrater reliability was high in both groups, except item 6 (untrained). Internal consistency was high in both groups, except items 6 and 9 (untrained). We conclude that training for novice users increases familiarity and results in raters' perceiving higher levels of performance in some items. The Melbourne Assessment has high reliability even for novice users.

Poster presented at Health Services Research: Evidence-based practice, 1-3 July 2014, London, United Kingdom.

Over the last 20 years Australia has seen a huge growth in new occupational therapy programs. Each new program is an historic event that changes occupational therapy’s national profile. Each new course raises expectations. Governments fund universities expecting a civic and economic return on public investment through teaching, community engagement and research. Universities expect occupational therapy academic staff to fulfil this institutional obligation and bring a return on staffing and infrastructure costs. Students expect their employability, life and career opportunities will be enhanced. The profession expects the program will be high quality and will add to occupational therapy’s esteem. Clients and the community expect ethical, safe and competent graduates will help them.

Background Fifteen years ago in Health Services Research (1999) qualitative research methods were argued to be useful and valid. Since that time qualitative research methods have gained increasing legitimacy however qualitative research papers remain underrepresented in high impact health journals [1]. The rigour of qualitative methods and their relevance in policy evaluation and development is, however, a continuing debate. On the one hand, qualitative inquiry methods bring the complexity of health service policy impacts to the fore; they provide policy makers with perspectives from the people services aim to support. On the other hand, the variability of qualitative approaches can lead to questions around validity and utility of findings. Narrative inquiry is one qualitative approach which, like others, has no prescribed method. Yet it is a method gaining increasing popularity in social science, clinical and health services research. This paper makes the methodological case for narrative inquiry in health services research and recommends techniques.

Background Health services provide clinical training to medical, allied health and nursing staff. Ensuring the quality and quantity of this training is critical to workforce supply. Health Workforce Australia (HWA) has funded initiatives to enhance clinical training quality and the availability of clinical training placements. The quantity and quality of clinical placements must be increased. While there are many strategies to improve quantity and many strategies claim to enhance quality, there is an absence of agreed measures to evaluate placement quality. A standardised, comprehensive and widely applicable measure of clinical education placement quality is required. This study describes the challenges involved in constructing a systematic review search strategy.