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Purpose Low-grade glioma (LGG) patients may face health-related quality-of-life (HRQoL) impairments, due to the tumour, treatment and associated side-effects and prospects of progression. We systematically identified quantitative studies assessing HRQoL in adult LGG patients, for: aspects of HRQoL impacted; comparisons with non-cancer controls (NCC) and other groups; temporal trends; and factors associated with HRQoL. Methods MEDLINE, CINAHL, Embase, PubMed, and PsycINFO were systematically searched from inception to 14th September 2021. Following independent screening of titles and abstracts and full-texts, population and study characteristics, and HRQoL findings were abstracted from eligible papers, and quality appraised. Narrative synthesis was conducted. Results Twenty-nine papers reporting 22 studies (cross-sectional, n = 13; longitudinal, n = 9) were identified. Papers were largely good quality, though many excluded patients with cognitive and communication impairments. Comparators included high-grade gliomas (HGG) (n = 7); NCCs (n = 6) and other patient groups (n = 3). Nineteen factors, primarily treatment (n = 8), were examined for association with HRQoL. There was substantial heterogeneity in HRQoL instruments used, factors and aspects of HRQoL assessed and measurement timepoints. HRQoL, primarily cognitive functioning and fatigue, in adult LGG patients is poor, and worse than in NCCs, though better than in HGG patients. Over time, HRQoL remained low, but stable. Epilepsy/seizure burden was most consistently associated with worse HRQoL. Conclusion LGG patients experience wide-ranging HRQoL impairments. HRQoL in those with cognitive and communication impairments requires further investigation. These findings may help clinicians recognise current supportive care needs and inform types and timings of support needed, as well as inform future interventions.

Background: In a rapidly ageing population new and efficient ways of providing health and social support to older adults are required that not only preserve independence but also maintain quality of life and safety. Objective: The NEX project aims to develop an Internet of Things integrated system coupled with Artificial Intelligence to offer unobtrusive health and wellness monitoring to support older adults to live independently in their home environment. The primary objective of this study is to develop and evaluate the technical performance and user acceptability of “The NEX system”. The secondary objective is to apply machine learning algorithms to the data collected via the NEX system to identify and eventually predict changes in the routines of older adults in their own home environment. Methods: Mixed methods research (online survey and focus groups) was conducted with 426 participants including older adults (aged 60 and above), family caregivers, health care professionals and home care workers to inform the development of the NEX system (Phase 1). The primary outcome will be evaluated in two successive trials (the Friendly Trial (Phase 2) and the Action Research Cycle trial (Phase 3). The secondary objective will be explored in the Action Research trial (Phase 3). For the Friendly Trial, 7 older adult participants aged 60 years and above and living alone in their own homes for a 10-week period were enrolled in the trial. Thirty older adult participants aged 60 years and above and living alone in their own homes will be recruited for the Action Research trial for a 10-week period (Phase 3). Results: Phase 1 of the project (n=426) participants was completed in December 2020 and Phase 2 (n=7 participants for a 10-week pilot study) was completed in September 2021. The expected completion date for the third project phase (30 participants for 10-week usability study) is June 2022. Conclusions: The NEX project has considered the specific everyday needs of older adults and other stakeholders which have contributed to the design of the integrated system. The innovation of the NEX system lies in the use of IoT technologies and AI to identify and predict changes in the routines of older adults. The findings of this overall project will contribute to the e-Health research agenda focusing on the improvement of healthcare provision and patient support in home and community environments.

Objective Informal caregivers of people with lung cancer often experience a substantial care burden and associated negative consequences due to the often-contracted course of the disease. The objective of this review was to systematically examine the evidence on the factors associated with lung cancer caregiver distress. Methods Five databases (MEDLINE, CINAHL, EMBASE, PsychINFO and Web of Science) were searched for studies investigating factors associated with distress amongst caregivers of people with lung cancer. Empirical studies published up to July 2020 were included if they measured distress using a valid and reliable measure and examined its association with at least one other factor, with a sample of 50 or more caregivers. Results Thirty publications describing 27 studies (16 cross-sectional; 6 prospective; 8 intervention) involving 3744 caregivers (primarily spouse or adult child) were included. A narrative synthesis of the findings is presented due to heterogeneity in study design, variables measured and analyses conducted. Patient variables associated with greater distress included: stage of cancer and quality of spousal relationship. Caregiver variables associated with higher distress included: social support, coping strategies and self-efficacy. Conclusions Several variables were associated with distress amongst lung cancer caregivers. Understanding these variables could inform the development of interventions that will enable caregivers to care effectively while maintaining their own well-being. Screening for distress among caregivers may identify those caregivers who would benefit from early intervention.

This study examined the relationship between sports commitment, outlined in the hierarchical Sport Commitment Model, and athlete burnout in men and women playing Gaelic games, for the first time. These athletes experience a number of unique challenges, including playing with numerous teams simultaneously, significant personal commitment despite their amateur status, and the societal and cultural importance of their sports. This study also involved piloting a novel commitment measure of ‘team importance’ for team-sport athletes. Two-hundred-and-one male and female Gaelic games players completed the Sports Commitment Questionnaire, team importance measure and Athlete Burnout Questionnaire. Hierarchical Multiple Regression analyses revealed a negative relationship between sport enjoyment, social support (emotional) and desire to excel and particular burnout components; a positive relationship between other priorities and personal investments and particular burnout components; and enthusiastic commitment was associated with lower burnout, while constrained commitment was linked to higher burnout. The team importance measure was also found to be a reliable and valid measure of sports commitment. These findings provide important insight into how sports commitment can contribute to, or guard against, burnout in male and female athletes.

Introduction Living with and beyond a diagnosis of a low- and intermediate- grade glioma (LIGG) can adversely impact many aspects of people’s lives and their quality of life (QoL). In people with chronic conditions, self- management can improve QoL. This is especially true if people are supported to self- manage. Supported self- management programmes have been developed for several cancers, but the unique challenges experienced by LIGG survivors mean these programmes may not be readily transferable to this group. The Ways Ahead study aims to address this gap by exploring the needs of LIGG survivors to develop a prototype for a supported self- management programme tailored to this group. Methods and analysis Ways Ahead will follow three sequential phases, underpinned by a systematic review of self- management interventions in cancer. In phase 1, qualitative methods will be used to explore and understand the issues faced by LIGG survivors, as well as the barriers and facilitators to self- management. Three sets of interviews will be conducted with LIGG survivors, their informal carers and professionals. Thematic analysis will be conducted with reference to the Theoretical Domains Framework and Normalisation Process Theory. Phase 2 will involve co- production workshops to generate ideas for the design of a supported self- management programme. Workshop outputs will be translated into a design specification for a prototype programme. Finally, phase 3 will involve a health economic assessment to examine the feasibility and benefits of incorporating the proposed programme into the current survivorship care pathway. This prototype will then be ready for testing in a subsequent trial. Ethics and dissemination The study has been reviewed and approved by an National Health Service Research Ethics Committee (REC ref: 20/WA/0118). The findings will be disseminated through peer- reviewed journals, conference presentations, broadcast media, the study website, The Brain Tumour Charity and stakeholder engagement activities.

ObjectiveHead & Neck Cancer (HNC) survivors encounter unique challenges following treatment. This study aimed to identify self-management strategies that HNC survivors use to overcome these post-treatment challenges.MethodsTwenty-seven individuals from four designated cancer centres in Ireland were interviewed about self-management strategies that helped them overcome challenges following HNC treatment. Interviews were audio-recorded, transcribed and analysed using directed content analysis.ResultsTwenty self-management strategy types (encompassing 77 specific strategies) were identified. The most frequently used self-management strategy types were Self-sustaining (used by 26 survivors), Self-motivating (n = 25) and Proactive problem solving (n = 25). The most frequently used specific strategies were adaptive approaches to ongoing physical consequences of HNC and its treatment (n = 24), customizing dietary practices (n = 24) and maintaining a positive outlook (n = 22).ConclusionsThe study identified strategies that helped HNC survivors to self-manage post-treatment challenges. This information could inform the design/development of self-management interventions tailored towards HNC survivors.

Objective: There has been a recent proliferation of research on quality of life (QoL) in head and neck cancer (HNC). The objective of this review was to systematically examine the evidence on psychological factors associated with QoL outcomes for HNC survivors in the post‐treatment period published during 2004–2015. Methods: Five databases were searched for studies investigating psychological factors associated with QoL in HNC survivors. Empirical studies published between January 2004 and June 2015 were included if they measured QoL as an outcome following treatment using a reliable and valid measure, examined its association with at least one psychological factor and included at least 50 HNC survivors. Results: Twenty‐four publications describing 19 studies (9 cross‐sectional, 10 prospective) involving 2,263 HNC survivors were included. There was considerable heterogeneity in study design and diversity in measurement and analysis. Distress‐related variables (depression, anxiety, distress) were most frequently investigated, and mostly reported negative associations with QoL outcomes. Associations were also observed between other psychological factors (e.g., coping, neuroticism and fear of recurrence) and QoL. Conclusions: Several psychological factors predict QoL among HNC survivors who have completed treatment. Routine screening and early interventions that target distress could improve HNC survivors' QoL following treatment. Longitudinal and population‐based studies incorporating more systematic and standardised measurement approaches are needed to better understand relationships between psychological factors and QoL and to inform the development of intervention and supportive care strategies.

Background\ud Concerns have repeatedly been expressed about the quality of healthcare that people with learning disabilities receive in the NHS. Clinical audit can be an effective method for improving the quality of healthcare especially when existing standards are poor. This feasibility study for a national audit of learning disabilities examined the acceptability of data collection methods and the role that audit data could play in raising the standard of care provided. The audit team used these results to recommend how a future national audit should be conducted, including recommendations for standards, recruiting services, data collection methods, and helping services use audit data to improve the quality of care they provide. \ud Findings\ud Results of the study confirm that the quality of care for people with learning disabilities falls below recommended standards. Variation in practice across study sites suggests that it is possible to improve the quality of care people receive. \ud \ud Primary care standards in a national audit should address whether physical and mental health monitoring is adequate for people with learning disabilities. Based on stakeholder feedback, the audit should also collect information about interventions associated with these standards. Audit data should be reported to individual practices as well as at a commissioning level, to maximise engagement with quality improvement. \ud \ud A national audit of secondary care should include acute and mental health providers, as well as specialist learning disability services. Private providers commissioned for NHS patients should also be included within the audit’s remit. Standards in secondary care should be centred on physical and mental health monitoring, staff training, reasonable adjustments and delivery of person-centred care. There should be a core set of standards applying to all types of service, and a subset developed to audit priority issues specific to each service. Experience measures for staff, carers, and patients are necessary

To explore the goal-related strategies employed by people following lower limb amputation using a framework based on the dual-process model of adaptive self-regulation. Method: Semi-structured interviews were conducted with 30 individuals with a lower limb amputation. Results: Theoretical thematic analysis identified four broad assimilative/goal pursuit strategies; internal resource use, planning, technology use and help use. The most common strategies were maintaining a specific leisure activity (n =20), seeking instrumental help (n = 15), and determination (n = 15). Three broad categories of accommodative/goal adjustment strategies were also identified; interpersonal accommodation, managing limitations and meaning-making. The most common were accepting limitations (n = 18), emotional support from friends and family (n = 17) and adjusting goals to constraints (n = 16). There was also evidence of strategies that combined the use of accommodative and assimilative strategies, and the use of avoidant strategies. Conclusions: The findings point towards key assimilative/goal pursuit and accommodative/goal adjustment strategies that may be adaptive following lower limb amputation. The study highlights the potential usefulness of the dual-process model in understanding how individuals adapt to functional disability, while bringing to light issues warranting further explication within this framework.

Objective: To perform a detailed psychometric analysis using both classical test theory and Rasch analysis of the three main scales of the Trinity Amputation and Prosthesis Experience Scales (TAPES) in people with a lower-limb amputation. Design: A sample of 498 persons who were prosthesis users with a lower-limb amputation was retrospectively studied, pooled from a number of studies undertaken across the United Kingdom and Ireland in the past decade in which the TAPES had been completed as part of a postal survey. Both factor analysis techniques and Rasch analysis were performed on TAPES data. Dimensionality, item fit to the model, response category performance, and internal construct validity were assessed. Category collapsing and item removal were considered to improve the questionnaire. Results: The analyses suggested to restructure the TAPES as follows: (a) three psychosocial adjustment subscales with a four-point rating scale (and a reworded item); (b) an activity restriction scale based on ten items with their original three-point rating scale; and (c) two satisfaction with the prosthesis subscales using a three-point rating scale. All scales and subscales showed acceptable internal consistency and ability to define a distinct hierarchy of persons along the measured construct. Conclusions: This study empirically identified a revised version of the TAPES (TAPES-R) with a simplified general structure and psychometrically suitable for assessing the complex experience of amputation and adjustment to a lower-limb prosthesis. Additional studies are needed to confirm and further explore its measurement properties in other samples, thereby adding clinical validity to the instrument.

The purpose of this study was to investigate sick children’s experiences of participation in consultation and decision-making within the healthcare setting.\ud The specific objectives were: to describe children’s experiences of consultation in the healthcare setting; to identify the factors that enhance children’s involvement in consultation and the decisionmaking process; to identify the factors that hinder children from involvement in consultation and the decisionmaking process; to explore strategies that will empower children to participate in their own healthcare decisions.

Research on assistive technology (AT) outcomes and impacts is lacking in higher education, despite the potential of AT to widen participation and improve students with disabilities (SWD) overall educational experience. A systematic review highlighted the need to examine AT and educational engagement more holistically, the effects of AT on psychosocial outcomes and the impact of AT on identity. This mixed methods study consisted of two phases; a cross sectional survey with SWD (n= 111), which explored the effects of AT on educational engagement and psychosocial outcomes, and a longitudinal qualitative research study consisting of two interviews with SWD (n=14), which explored the impact of AT in student and disability identities and if/how this changes over time. Those with met AT needs scored significantly higher than those with unmet AT needs on 4 educational engagement subscales, well-being and academic self-efficacy. AT use also had a positive psychosocial impact on competence, adaptability and self-esteem. Feeling valued was identified as the driver in the negotiation of identity change/continuity over time across three themes; feeling autonomous and competent, claiming disability and feeling like you belong. Also highlighted was the indirect impact of AT in feeling valued, the strategic use of AT in managing identities and how and why meanings attached to AT change over time. Overall, this thesis demonstrates the significance of meeting AT needs in promoting educational engagement and a positive mindset, the bi-directional relationship between AT and feeling valued, how AT can be considered both an identity threat and means of embracing and managing identity, and the integral role of AT as an enabler and instigator for involvement in collective spaces. This research has significant policy and AT provision implications and highlights the instrumental role of feeling valued in creating an environment where students are comfortable using their AT in higher education.

Adolescents living with type 1 diabetes (T1D) begin to adopt a more collaborative approach to managing T1D with their parents before becoming independent in self-management. However, adolescents can encounter difficulties with T1D management and ambiguity in relation to the division of responsibilities for T1D management with their parents. This study aimed to explore: (1) how adolescents living with T1D experience self-management of T1D and share self-management responsibilities with parents and (2) the relationship between adolescent communication with parents about T1D self-management and demographic, clinical and psychosocial variables. A meta-synthesis of qualitative literature on child and adolescent experiences of self-management of T1D was conducted. The findings of the meta-synthesis indicated that balancing the demands of self-management with other aspects of life and sense of control over T1D are important for self-management of T1D. Following this a mixed methods study involving two phases was conducted; semi-structured interviews with adolescents aged 11 to 17 years (n = 28) and a cross-sectional survey with adolescents aged 11 to 17 years (n = 113). In interviews, adolescents highlighted their experiences of gaining independence in self-management in the overarching theme ‘Navigating increasing responsibility for self-management during adolescence: “it changed gradually… and I am almost fully doing it [self-managing] now”. The following themes contributed to the overarching theme: (1) Changing levels of involvement in self-management, (2) Talking about self-management with parents, (3) Taking ownership of self-management and (4) Environmental and contextual influences affecting self-management. The findings from the quantitative phase of this study indicated that parent-adolescent communication and T1D-specific family conflict are associated with T1D self-efficacy, division of family responsibility for T1D management, activation and self-management of T1D. However, the findings also indicated that T1D-specific family conflict and parent-adolescent communication are differentially related to distinct aspects of self-management and QOL. Overall, this study identified that parent-adolescent communication and family context characteristics relate to and contribute to self-management and T1D-specific QOL in adolescents living with T1D. This research identified what factors contribute to helping or hindering adolescent engagement with self-management of T1D and specifically that adolescents’ perceptions of their communication with their parents about T1D management are important. For the first time, the findings provide a nuanced understanding of adolescent perspectives on self-management of T1D and communication with parents about T1D self-management. Promoting self-efficacy through targeting communication strategies employed by adolescents and their parents may result in more optimal sharing of responsibilities, improved self-management and better QOL for adolescents living with T1D.

Objective To evaluate the accuracy of the depression subscale of the Hospital Anxiety and Depression Scale (HADS-D) to screen for major depression among people with physical health problems. Design Systematic review and individual participant data meta-analysis. Data sources Medline, Medline In-Process and Other Non-Indexed Citations, PsycInfo, and Web of Science (from inception to 25 October 2018). Review methods Eligible datasets included HADS-D scores and major depression status based on a validated diagnostic interview. Primary study data and study level data extracted from primary reports were combined. For HADS-D cut-off thresholds of 5-15, a bivariate random effects meta-analysis was used to estimate pooled sensitivity and specificity, separately, in studies that used semi-structured diagnostic interviews (eg, Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders), fully structured interviews (eg, Composite International Diagnostic Interview), and the Mini International Neuropsychiatric Interview. One stage meta-regression was used to examine whether accuracy was associated with reference standard categories and the characteristics of participants. Sensitivity analyses were done to assess whether including published results from studies that did not provide raw data influenced the results. Results Individual participant data were obtained from 101 of 168 eligible studies (60%; 25 574 participants (72% of eligible participants), 2549 with major depression). Combined sensitivity and specificity was maximised at a cut-off value of seven or higher for semi-structured interviews, fully structured interviews, and the Mini International Neuropsychiatric Interview. Among studies with a semi-structured interview (57 studies, 10 664 participants, 1048 with major depression), sensitivity and specificity were 0.82 (95% confidence interval 0.76 to 0.87) and 0.78 (0.74 to 0.81) for a cut-off value of seven or higher, 0.74 (0.68 to 0.79) and 0.84 (0.81 to 0.87) for a cut-off value of eight or higher, and 0.44 (0.38 to 0.51) and 0.95 (0.93 to 0.96) for a cut-off value of 11 or higher. Accuracy was similar across reference standards and subgroups and when published results from studies that did not contribute data were included. Conclusions When screening for major depression, a HADS-D cut-off value of seven or higher maximised combined sensitivity and specificity. A cut-off value of eight or higher generated similar combined sensitivity and specificity but was less sensitive and more specific. To identify medically ill patients with depression with the HADS-D, lower cut-off values could be used to avoid false negatives and higher cut-off values to reduce false positives and identify people with higher symptom levels. Fil: Wu, Yin. School Of Medicine; Canadá. Lady Davis Institute For Medical Research; Canadá Fil: Levis, Brooke. Keele University; Reino Unido Fil: Sun, Ying. Lady Davis Institute For Medical Research; Canadá Fil: He, Chen. Lady Davis Institute For Medical Research; Canadá Fil: Krishnan, Ankur. Lady Davis Institute For Medical Research; Canadá Fil: Neupane, Dipika. Lady Davis Institute For Medical Research; Canadá Fil: Bhandari, Parash Mani. Lady Davis Institute For Medical Research; Canadá Fil: Negeri, Zelalem. Université Mcgill; Canadá. Lady Davis Institute For Medical Research; Canadá Fil: Benedetti, Andrea. Centre Universitaire de Santé Mcgill; Canadá Fil: Thombs, Brett D.. Mcgill Faculty Of Medicine And Health Sciences; Canadá. Lady Davis Institute For Medical Research; Canadá Fil: Daray, Federico Manuel. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Farmacologia; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay; Argentina

Background: Epilepsy is one of the most common neurological conditions occurring in childhood. However, the consequences of epilepsy extend beyond seizures to include psychosocial effects interfering with the child’s social experiences, quality of life (QOL), and family relations. One particular challenge children living with epilepsy (CWE) and their parents face is the presence, or fear, of societal epilepsy-related stigma, which can sometimes limit family discussions about epilepsy. However, little is known about epilepsy-related dialogue between CWE and their parents. Aims: This study aims to explore CWE’s and parents’ experiences of talking about epilepsy together, and the relationship between epilepsy-related communication and a number of demographic, clinical and psychosocial variables. Methods: A systematic review of available evidence relating to epilepsy-related communication in families living with childhood epilepsy was conducted. Following this, a sequential exploratory mixed-method design was employed involving two phases; 1) qualitative interviews with 29 CWE and 33 parents, and 2) cross sectional surveys completed by 47 CWE and 72 parents. Results: Integrative findings revealed that CWE and their parents experience many challenges and facilitators to dialoguing about epilepsy, including; condition visibility, epilepsy-related knowledge, fear of causing worry, quest for normalcy, CWE desire for autonomy and parent’s desire to protect, and epilepsy-related attitudes. Closed epilepsy-related communication was associated with poorer psychosocial outcomes for CWE and their parents, including; greater perceived-stigma, poorer illness-attitudes, negative self-perceptions, less social support, and poorer QOL. Conversely, open epilepsy-related communication was associated with positive psychosocial wellbeing. Conclusions: This study contributes significantly to the under-researched area of parent-child epilepsy-related communication. The findings provide valuable information surrounding the contextual factors influencing CWE and parents epilepsy-related dialogue, and the impact of this communication on CWE’s and parents’ wellbeing. Family-based communication interventions should endeavour to increase epilepsy-related knowledge and CWE autonomy in order to enhance effective parent-child dialogue about epilepsy.

Client engagement in psychotherapy can be defined as intense involvement with the therapy tasks and materials, and presence with the therapist and the self. Client engagement is deemed important in determining the success of the psychotherapeutic process and outcome (Hubble, Duncan and Miller 1999). Client engagement has been investigated most often in the context of its intersection with other client related factors in psychotherapy such as attendance, accessibility, agreement on and completion of the tasks of therapy, or the mutual process of the therapeutic alliance (Tetley et al. 2011; Dew and Bickman 2005). Little is known about clients’ experiences of engagement in psychotherapy and the key issues for clients therein. In this Interpretative Phenomenological Analysis (IPA) study, individual interviews were conducted with five clients who attended psychotherapy in a mental health setting with therapists of varied experience and therapeutic orientations. The transcribed interviews were analysed using the analytic method described by Smith, Flowers and Larkin (2009). The study highlights the complex, evolving and dynamic nature of engagement. It particularly illuminates the profound sense of risk of self-annihilation, through death of the physical self or destruction of the psyche that participants grappled with as they navigated a number of key interconnected dilemmas inherent in engaging in psychotherapy. The study contributes to the field by informing practice concerns such as therapeutic impasse, informed consent and drop-out. It also informs client response to mental health treatment in general in relation to issues such as treatment compliance and decision making. Additionally, the study has implications for training, policy and future research.

Lower limb amputation is a life-changing event that can cause significant disruptions in many important areas of existence. Although a substantial minority of individuals suffer from emotional difficulties following this procedure, most adapt successfully to the losses and limitations incurred, with some achieving positive change and growth as a result. According to self-regulation theory, the physical, social and psychological upheaval caused by amputation is likely to disturb progress towards goal attainment, which may leave individuals vulnerable to negative psychosocial outcomes if they do not regulate their goals in response to these challenges. The aim of the present study was to examine the relationships between goal disturbance, tenacious goal pursuit (TGP), flexible goal adjustment (FGA), and various positive and negative psychosocial outcomes (participation, positive and negative affect, quality of life, psychosocial adjustment to amputation, depressive symptomatology) in a sample of 98 individuals with lower limb amputations, and to investigate whether these self-regulatory constructs predicted psychosocial outcomes in this population after controlling for sociodemographic/clinical variables, optimism, and perceived social support. Participants completed self-report questionnaires on admission to an inpatient prosthetic rehabilitation programme (T1), six weeks post-discharge (T2), and six months post-discharge (T3). Baseline assessments of the self-regulatory constructs together contributed significantly to the prediction of several psychosocial outcomes at each time point. Higher levels of goal disturbance predicted poorer outcomes at T1, whereas TGP and FGA were predictive of enhanced outcomes at each study time point. These findings indicate the utility of self-regulation theory as an organising framework for research on psychosocial adjustment to amputation. TGP and FGA may help in identifying individuals at risk for long-term adjustment difficulties following limb loss, and represent important targets for interventions to promote adjustment in this patient group.

The aim of this research is to explore what constitutes success following upper limb absence (ULA), and to reach consensus on which areas are important to consider in the rehabilitation of an individual following ULA. Following a review of the literature on ULA, two case studies using the repertory grid technique (RGT) was undertaken with two prosthesis users in order to understand the unique requirements that upper limb prosthetic users may have. Following this, eleven interviews were conducted with Rehabilitation Professionals (RP’s). Two focus groups were also conducted with a total of seven individuals with ULA and one to one interviews with four additional individuals were used to supplement these focus groups. These qualitative studies were conducted in order to determine prominent factors of importance following ULA from both perspectives. All data were analysed using thematic analysis. This study culminated in a Delphi study in order to reach consensus regarding what is considered successful outcomes in three key areas: ‘Prosthesis use’, Activities and Participation’ and ‘Self image’ where there is currently little knowledge or agreement in the literature. The Delphi also aimed to identify the salient factors that are important for RP’s to take into consideration following ULA. The RGT produced a unique profile of preferences regarding prosthetic technologies for each participant. The qualitative analyses with RP’s and individuals with ULA produced common themes such as ‘Prosthesis Use’, Activities and Participation’, ‘Psychological factors’, ‘Physical factors’, ‘Social factors’, ‘Satisfaction with the prosthesis’ and ‘Satisfaction with the service’. However, the emphasis within these themes differed amongst RP’s and individuals with ULA. Consensus was reached in several areas following the Delphi study, which revealed core factors and items to consider. This study identified what RP’s and individuals with ULA believe constitutes success in three key areas and identified the most important factors that RP’s should consider in the rehabilitation setting. These factors will provide a guide for RP’s in assessing the progress of individuals with ULA and identifying the important areas to target in rehabilitation.