Search

Research training should facilitate effective researcher role development. While researcher roles require the performance of specialised knowledge and skill, they also require development of personal research identities within social contexts. Interaction with research peers can provide opportunities for reflective role development. Ad-hoc cohort-specific peer interventions are relatively common in research training, but these can lack standardisation and clear conceptual frameworks to underpin strategies. Peer Assisted Study Sessions (PASS) provide a structured approach to peer support for learning. As such, we aimed to develop, implement and evaluate a PASS program for research trainees. Participants (N = 21; (9 male, 12 female; exercise science n = 5, biomedical science n = 7, science n = 2, public health n = 4, nutrition n = 3) were post-bachelor honours students and PASS was provided on a weekly basis. Demographic, academic, and PASS data were collected from institutional records. Students completed standardised PASS satisfaction evaluations. Standard undergraduate PASS administrative, funding, and reporting strategies were successfully applied. Leader selection, training, and PASS resource development processes were adapted for the research training context. Attendance and student satisfaction was high as was timely completion of research related assessments. PASS has been shown to provide methodological consistency and a transparent conceptual framework to frame expectations about the process, leader and participant roles, and mechanisms to evaluate impact. PASS enables institutionally sanctioned but peer driven opportunities for social exchange wherein reflective interpretive approaches to research role development can be considered.

Objective. To provide an evidence-based description of how the occupational therapy profession operates in Saudi Arabia. Methods. A case study methodology set out an evidence-based description of occupational therapy in Saudi Arabia. Three procedures were used: (1) a structured narrative review of publications on occupational therapy in Saudi Arabia based on searches of seven healthcare databases; (2) an audit of "grey literature" about or referring to occupational therapy education, practice, research, or the profession in Saudi Arabia using Google Scholar, Google search, official documents and websites, and relevant global organisation such as the WFOT website and documents; and (3) consultation with occupational therapists to further discuss emerging evidence from peer-reviewed articles and grey literature about occupational therapy in Saudi Arabia. Data were collected in Arabic and English. Findings. Occupational therapy in Saudi Arabia is a rapidly growing and emerging profession primarily focused on rehabilitation practice. Between 2010 and 2019, seven academic organisations commenced bachelor's degree programmes. Occupational therapy services in Saudi Arabia are concentrated in city-based secondary and tertiary healthcare services targeting rehabilitation and disability support. The practice aims to promote the reduction in impairment and increase activity performance and participation in valued life roles. Despite the increasing demand for occupational therapy services, there needs to be more access to and availability of their services. Enhancement of the awareness of occupational therapy among the public and other healthcare professionals is needed. A consistent definition of occupational therapy in Saudi Arabia would strengthen the profession, along with a national scope of practice, practice guidelines, increased workforce and development, and professional education information. Conclusion. Occupational therapy in Saudi Arabia is growing regarding the size of the workforce and the number of programmes and services provided, thus contributing to the health and well-being of the population primarily through rehabilitation. Further development of the profession is necessary. [ABSTRACT FROM AUTHOR]

Background: Telerehabilitation is emerging in Saudi Arabia. This study investigated occupational therapy professionals’ perspectives on using telerehabilitation in their practice. Method: Data were collected through semi-structured phone interviews conducted with nine Saudi occupational therapists. A pragmatic qualitative evaluation approach was used. Findings: Experience and perceptions of participants regarding telerehabilitation were represented as follows: awareness and knowledge of telerehabilitation; how telerehabilitation increases occupational therapy availability and access in Saudi Arabia; telerehabilitation in the pandemic; telerehabilitation is preferred; suitability of telerehabilitation in Saudi Arabia; telerehabilitation care pathways; telerehabilitation readiness in Saudi Arabia; and telerehabilitation willingness by Saudi occupational therapists. Conclusion: Saudi occupational therapists have good knowledge and awareness of telerehabilitation, and some had used it during the pandemic. They showed positive attitudes and a willingness to use telerehabilitation if appropriate technology infrastructure, official policy standards and guidelines, training, data security, and financial resources could be provided to support implementation. [ABSTRACT FROM AUTHOR]

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 2-16y; Gross Motor Function Classification System levels I-V) 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. (Contains 3 tables and 1 figure.)

Aim: To investigate reliability of the Quality of Upper Extremity Skills Test (QUEST) scores for children with cerebral palsy (CP) aged 2-12 years. Method: Thirty-one QUESTs from 24 children with CP were rated once by two raters and twice by one rater. Internal consistency of total scores, inter- and intra-rater reliability findings for total, domain, and item scores were calculated. Results: Total scores inter-rater reliability, Intra-class Correlation Coefficient (ICC) was 0.86, and for intra-rater reliability, ICC was 0.96. Domains had high reliability (ICC greater than 0.80) within raters and between raters except for "grasp" (moderate at ICC = 0.67). Item inter-rater reliability was moderate or better for 80% of items; item intra-rater reliability was moderate or better for 87% of items. Total score internal consistency was high ([alpha] = 0.97). Implications: The QUEST has proven reliability for children with CP aged 18 months to 8 years. This study demonstrates strong reliability for children aged 2-12 years. (Contains 4 tables.)

Student death is an inevitable event in the long life of university communities. Although student death is uncommon, universities need to be able respond in a timely and appropriate way to bring the relationship with a deceased student to a dignified close. This article presents a review of factors previously identified in higher education and death studies literature to be useful inclusions in any university/college death response plan. It proposes that management frameworks underpin effective institutional responses to student death as they provide the organizational context for coherent multi-disciplinary action within complex policy, campus and departmental arrangements. The article reports on the development of a university death response plan that took a "structural" approach derived from the discipline of management, to the mobilizing, coordination and monitoring of resources relevant to student death in a multi-campus multi-disciplinary environment. (Contains 1 table.)

To identify the impact of upper limb spasticity on stroke survivors by linking their shared experience to the International Classification of Functioning, Disability, and Health (ICF). Ten community dwelling adults with a chronic stroke and spasticity, who had completed an upper limb rehabilitation trial participated in semi-structured interviews. Data were analysed using content analysis and linked to the ICF Comprehensive Core Set for stroke using standard linking rules. Four hundred and thirty-nine meaningful concepts eligible for linking were identified. The majority (n = 178) linked to Body Function, n = 137 to Activities and Participation, n = 115 to Environmental Factors, and n = 9 to Body Structures. Sixty-two of the 130 Comprehensive Core Set categories were used; an additional eight were required to fully represent experience. Stroke survivors with upper limb spasticity use words and discuss topics concentrated around mental functions, functions of the joints and bones, muscles and movements, carrying, moving and handling objects, support and relationships with immediate family and health professionals, products and technology, and health services. Half of the Comprehensive Core Set categories for stroke were relevant, but to adequately capture experience an additional eight were needed. The ICF category profile may be unique to our participants or may suggest further research is needed to determine if additions to core set categories are required. Our ICF mapping demonstrated that the Brief Core Set for stroke was not sufficient to capture the range of experience for stroke survivors with upper limb spasticity, instead the Comprehensive Core Set for stroke supplemented with eight clinical-cohort specific second-level-categories should be used. Our findings suggest that rehabilitation may better reflect lived experience if it focuses on Body Function (Chapters 1, 2, 4, 7), Activity and Participation (Chapters 1–9), and Environment (Chapters 1, 2, 3, 5) because Body Structure was rarely mentioned in this or previous post-stroke ICF mapping research. [ABSTRACT FROM AUTHOR]

Student death is an inevitable event in the long life of university communities. Although student death is uncommon, universities need to be able respond in a timely and appropriate way to bring the relationship with a deceased student to a dignified close. This article presents a review of factors previously identified in higher education and death studies literature to be useful inclusions in any university/college death response plan. It proposes that management frameworks underpin effective institutional responses to student death as they provide the organizational context for coherent multi-disciplinary action within complex policy, campus and departmental arrangements. The article reports on the development of a university death response plan that took a 'structural' approach derived from the discipline of management, to the mobilizing, coordination and monitoring of resources relevant to student death in a multi-campus multidisciplinary environment.

Rationale: People with stroke experience falls at more than twice the rate of the general older population resulting in high fall-related injuries. However, there are currently no effective interventions that prevent falls after stroke. Aims: To determine the effect and cost-benefit of an innovative, home-based, tailored intervention to reduce falls after stroke. Sample size estimate: A total of 370 participants will be recruited in order to be able to detect a clinically important between-group difference of a 30% lower rate of falls with 80% power at a two-tailed significance level of 0.05. Methods and design: F alls a fter s troke t rial (FAST) is a multistate, Phase III randomized trial with concealed allocation, blinded assessment, and intention-to-treat analysis. Ambulatory stroke survivors within five years of stroke who have been discharged from formal rehabilitation to the community and who have no significant language impairment will be randomly allocated to receive habit-forming exercise, home safety, and community mobility training or usual care. Study outcomes: The primary outcome is the rate of falls over the previous 12 months. Secondary outcomes are the risk of falling (proportion of fallers), community participation, self-efficacy, balance, mobility, physical activity, depression, and health-related quality of life. Health care utilization will be collected retrospectively at baseline and prospectively to 6 and 12 months. Discussion: The results of FAST are anticipated to directly influence intervention for stroke survivors in the community. Trial Registration: ANZCTR 12619001114134 [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Introduction: This systematic review appraises the measurement quality of tools which assess activity and/or participation in adults with upper limb spasticity arising from neurological impairment, including methodological quality of the psychometric studies. Differences in the measurement quality of the tools for adults with a neurological impairment, but without upper limb spasticity, is also presented. Methods: 29 measurement tools identified in a published review were appraised in this systematic review. For each identified tool, we searched 3 databases (Medline, Embase, CINAHL) to identify psychometric studies completed with neurorehabilitation samples. Methodological quality of instrument evaluations was assessed with use of the Consensus-based Standards for the Selection of Health Status Measurement Instruments (COSMIN) checklist. Synthesis of ratings allowed an overall rating of the psychometric evidence for each measurement tool to be calculated. Results: 149 articles describing the development or evaluation of psychometric properties of 22 activity and/or participation measurement tools were included. Evidence specific to tool use for adults with spasticity was identified within only 15 of the 149 articles and provided evidence for 9 measurement tools only. Overall, COSMIN appraisal highlighted a lack of evidence of measurement quality. Synthesis of ratings demonstrated all measures had psychometric weaknesses or gaps in evidence (particularly for use of tools with adults with spasticity). Conclusions: The systematic search, appraisal and synthesis revealed that currently there is insufficient measurement quality evidence to recommend one tool over another. Notwithstanding this conclusion, newer tools specifically designed for use with people with neurological conditions who have upper limb spasticity, have emergent measurement properties that warrant further research. Systematic review registration: PROSPERO CRD42014013190. [ABSTRACT FROM AUTHOR]

The article informs about the periodical that covers occupational therapy. Topics include the dissemination of scholarship and evidence to substantiate, influence and shape policy and occupational therapy practice locally and globally; and preference of papers that use sound theoretical basis, methodological rigor with sufficient scope.

Background/aim: The Action Research Arm Test (ARAT) measures upper limb activity limitations in people with acquired brain injuries. Evidence relating to the use of this test in neurorehabilitation is scattered. This review identifies, rates and synthesises evidence on the original 1981 ARAT use within neurorehabilitation. Psychometric properties are reviewed, including specific examination of participants with upper limb spasticity. Methods: Systematic review of published articles describing psychometric properties and/or use of the original version of the ARAT in neurorehabilitation. COnsensus‐based Standards for the selection of health Measurement INstruments (COSMIN) search strategy, reporting and methodological checklist with criterion‐based appraisal of quality criteria for good measurement properties were applied. A best evidence synthesis for each psychometric property was completed. Results: In 28 included studies, participants had suffered a stroke or traumatic brain injury, with 46% >6 months post‐injury. Six studies identified participants with upper limb spasticity. Methodological quality of psychometric properties ranged from poor to excellent. Best evidence synthesis determined moderate positive evidence for using the ARAT with people without limb spasticity: intra‐rater reliability (ICC 0.71 (95% CI 0.53–0.89) to 0.99 (95% CI 0.98, 0.99)); responsiveness (ROC curve 0.72–0.88, SRM 0.89); and regarding construct validity, it is a valid measure of activity limitation. Limited evidence for psychometric properties of the ARAT were found when used with people with upper limb spasticity for construct validity and responsiveness (ES 0.55–0.78). Gaps in evidence were found for inter and test–retest reliability, measurement error, content validity, structural validity, floor and ceiling effects. Conclusions: The ARAT is an appropriate measure of activity limitation post‐stroke and should be considered for use with people with TBI; evidence for people with upper limb spasticity is limited. Gaps and mixed limited to moderate evidence for psychometric properties in neurorehabilitation mean further research is required. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background/aim Assistive technologies have the potential to increase the amount of movement practice provided during inpatient stroke rehabilitation. The primary aim of this study was to investigate the feasibility of using the Saebo-Flex™ device in a subacute stroke setting to increase task-specific practice for people with little or no active hand movement. The secondary aim was to collect preliminary data comparing hand/upper limb function between a control group that received usual rehabilitation and an intervention group that used, in addition, the Saebo-Flex™ device. Methods Nine inpatients (mean three months (median six weeks) post-stroke) participated in this feasibility study conducted in an Australian rehabilitation setting, using a randomised pre-test and post-test design with concealed allocation and blinded outcome assessment. In addition to usual rehabilitation, the intervention group received eight weeks of daily motor training using the Saebo-Flex™ device. The control group received usual rehabilitation (task-specific motor training) only. Participants were assessed at baseline (pre-randomisation) and at the end of the eight-week study period. Feasibility was assessed with respect to ease of recruitment, application of the device, compliance with the treatment programme and safety. Secondary outcome measures included the Motor Assessment Scale (upper limb items), Box and Block Test, grip strength and the Stroke Impact Scale. Results Recruitment to the study was very slow because of the low number of patients with little or no active hand movement. Otherwise, the study was feasible in terms of being able to apply the Saebo-Flex™ device and compliance with the treatment programme. There were no adverse events, and a greater amount of upper limb rehabilitation was provided to the intervention group. While there were trends in favour of the intervention group, particularly for dexterity, no between-group differences were seen for any of the secondary outcomes. Conclusions This pilot feasibility study showed that the use of assistive technology, specifically the Saebo-Flex™ device, could be successfully used in a sample of stroke patients with little or no active hand movement. However, recruitment to the trial was very slow. The use of the Saebo-Flex TM device had variable results on outcomes, with some positive trends seen in hand function, particularly dexterity. [ABSTRACT FROM AUTHOR]

Context: Little is known about Libyan disability and rehabilitation services. Objectives: To describe workforce characteristics of the only functioning disability rehabilitation service in 2012 Libya. This was the Benghazi Rehabilitation and Handicap Center. The focus of the case study was the physical disability services including amputee care. Method: Organizational case study involving site visit, self-report workforce survey, and review of relevant policy, government and peak agency reports relevant to disability services. Results: The case study revealed that disability regulations in Libya focussed on social security entitlements and impairment focussed treatment. Community based rehabilitation or initiatives for social inclusion and participation were scant, creating problems for people requiring long term rehabilitation in the community. The center workforce continued to function in spite of conflict and in difficult circumstances. While expatriate staff left in the 2011 conflict, local staff retention was high. These workers were mono-lingual, had longevity of tenure, and a lack of qualification mobility. Some such as therapists and prosthetic technicians, had highly specialised skills requiring center facilities. The case study revealed: escalating patient demand; bed-block; and problems in supplies, capital and equipment maintenance. There were opportunities to increase capacity through: clinical and administrative staff training; development of inpatient facilities for women; discharge options for long-term male inpatients; and coordinated information systems. Of 232 eligible, n=72 staff, who participated in the survey (mean age was 39.4 years; n=40 males). Most therapists/ prosthetic technicians were male; most nurses/ administrative workers were female (p=.0001). The most common qualification across occupations was secondary school; 28.2% had intermediate secondary and 22.5% university degrees as their highest qualification. A third had been employed at the centre >20 years, >10 years and <10 years respectively. 42% worked as part of a team. Conclusion: The study provides an insight into issues affecting disability services and revealed areas for future post-conflict workforce development and opportunities for disability service capacity building particularly in relation to coordinated information systems, qualification upgrades, in-service training, and development of inpatient discharge options including community based rehabilitation and supported accommodation. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background/aim To describe Australian physiotherapy and occupational therapy practice for patients who receive upper-limb Botulinum Toxin-A (BoNT-A). Method Anonymous online survey asking about practice experience. Convenience sample of 128 BoNT-A experienced occupational therapists and physiotherapists. Results The primary work setting was multidisciplinary inpatient or outpatient rehabilitation services where therapists had automatic referral to BoNT-A patients. Patients expected BoNT-A to improve functional movement, reduce hypertonicity, increase passive range, reduce pain, improve appearance and hand hygiene. Most patients were injected in multidisciplinary public hospital clinics and had median 2 pre-injection (range 0-30) and 8 post-injection (range 0-50) therapy sessions. Biceps, flexor digitorum profundus/superficialis and brachoradialis were most frequently injected. Injectors used therapist assessment information to select sites 68% of the time; only 44% of services had assessment protocols. Standardised therapy assessments examined motor performance, pain and function in that order of frequency. The greater the awareness and perceived relevance of an assessment the more often therapists used it. All therapists set goals, most collaboratively, and these mirrored patient expectations. The most common treatments were stretch, task-specific functional training, strength training and home programmes. Conclusion While trends in Australian assessment, goals and treatment practice were observed, greater consistency could be achieved if therapy practice guidelines existed. The gap is exacerbated by the absence of Australian BoNT-A organisation and process of care spasticity management guidelines. This creates an environment where practice variability is inevitable. Recommendations to improve local service quality are made. [ABSTRACT FROM AUTHOR]

BACKROUND: Botulinum 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. PURPOSE: The 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 SOURCES: Searches were conducted in PubMed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL, National Research Register, metaRegistry of Controlled Trials, PEDro, and OTseeker. STUDY SELECTION: Randomized 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 EXTRACTION: Two reviewers extracted study details and data. DATA SYNTHESIS: Methodological quality was rated using the PEDro scale. Both fixed-effects and random-effects models were used to calculate effect size. RESULTS: Studies 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. CONCLUSION: Evidence 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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Aim: To investigate reliability of the Quality of Upper Extremity Skills Test (QUEST) scores for children with cerebral palsy (CP) aged 2-12 years. Method: Thirty-one QUESTs from 24 children with CP were rated once by two raters and twice by one rater. Internal consistency of total scores, inter- and intra-rater reliability findings for total, domain, and item scores were calculated. Results: Total scores inter-rater reliability, Intra-class Correlation Coefficient (ICC) was 0.86, and for intra-rater reliability, ICC was 0.96. Domains had high reliability (ICC > 0.80) within raters and between raters except for grasp (moderate at ICC == 0.67). Item inter-rater reliability was moderate or better for 80%% of items; item intra-rater reliability was moderate or better for 87%% of items. Total score internal consistency was high (α == 0.97). Implications: The QUEST has proven reliability for children with CP aged 18 months to 8 years. This study demonstrates strong reliability for children aged 2-12 years. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Focuses on the necessity for occupational therapy practitioners to incorporate evidence-based practice into professional role in Australia. Strategies for continuing professional development; Development of institutional requirements for evidence-based practice; Use of local clinical guidelines; Reasons for the low levels of research involvement.

Australia currently uses the World Federation of Occupational Therapists’ guidelines and standards for the professional accreditation of occupational therapy educational programmes. The case for developing Australian accreditation standards and guidelines is presented. [ABSTRACT FROM AUTHOR]

Focuses on the development of a key professional group in Australia and New Zealand occupational therapy, the Australian New Zealand Council of Occupational Therapy Education. Historical background of the organization; Key issues of importance to the organization.