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Background: Reorientation programmes have been an important component of neurotrauma rehabilitation for adults who suffer from post-traumatic amnesia (PTA) after traumatic brain injury (TBI); however, research testing the efficacy of acute programmes is limited., Objective: This study aimed to determine if it is feasible to provide a standardized environmental reorientation programme to adults suffering from PTA after TBI in an acute care hospital setting, and whether it is likely to be beneficial., Methods: We conducted a randomized controlled trial with concealed allocation and intention-to-treat analysis. A total of 40 participants suffering from PTA after TBI were included. The control group received usual care; the experimental group received usual care plus a standardized orientation programme inclusive of environmental cues. The primary outcome measure was time to emergence from PTA measured by the Westmead PTA Scale, assessed daily from hospital admission or on regaining consciousness., Results: Adherence to the orientation programme was high, and there were no study-related adverse responses to the environmental orientation programme. Although there were no statistically significant between-group differences in time to emergence, the median time to emergence was shorter for those who received the standardized reorientation programme (9.0 (6.4-11.6) versus 13.0 (4.5-21.5) days). Multivariate analysis showed that the Glasgow Coma Scale (GCS) at scene (P = 0.041) and GCS at arrival at hospital (P = 0.0001) were significant factors contributing to the longer length of PTA., Conclusion: Providing an orientation programme in acute care is feasible for adults suffering from PTA after TBI. A future efficacy trial would require 216 participants to detect a between-group difference of 5 days with an alpha of 0.05 and a power of 80%., (© The Author(s) 2021. Published by Oxford University Press on behalf of International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

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

Construct validity of instruments, tests, and scales can be examined using the Rasch Measurement Model (RMM) during their initial construction and validation, or after they have been published. The aim of this study was to examine the construct validity of the Test of Visual-Motor Skills-Revised (TVMS-R) by applying the RMM to evaluate its scalability, dimensionality, differential item functioning, and hierarchical ordering. The participants included 400 children aged 5 to 12 years, recruited from six schools in the Melbourne metropolitan area, Victoria, Australia. Children completed the TVMS-R under the supervision of an occupational therapist. Overall, 39 out of 142 of the TVMS-R scale scoring accuracy classification criteria items exhibited poor measurement properties. As nearly one-third of the scoring classification criteria items were found to be problematic, the TVMS-R in its current form is not recommended for clinical use, as it is not consistent with the clinical demands expected of an instrument used to evaluate the visual motor integration skills of children.

Objective: The purpose of this research was to examine the perceptions of older persons with stroke concerning the discharge housing decisions made during their rehabilitation program. The research explored clients' locus of control, their perceptions of the role of the rehabilitation team and their family in the decision, and their perceptions of their activities of daily living skills., Method: Sixty-two subjects with stroke completed four measures: (a) the Functional Independence Measure (FIM), (b) a housing information questionnaire, (c) a semistructured interview, and (d) the Bialer Locus of Control Scale. Rehabilitation team members also completed the FIM and housing information questionnaire for each subject. These instruments were used to collect data relating to clients' perceptions of their functional status, discharge from the hospital, housing options available, and locus of control., Results: Despite the team or family opinions on discharge housing, subjects saw housing decisions as primarily their own. The majority of subjects were reluctant to consider alternatives to returning home, even though they have self-care deficits and frequently reported that the presence of a spouse and family members were important to support their return home. Subjects generally seemed unaware of the influence of team and family opinions and the impact of their functional status on their discharge housing. Subjects' locus of control seemed unrelated to satisfaction with the discharge decision process., Conclusion: Clients who have had a stroke could use assistance to determine housing that is appropriate for their living skills. Discussions with clinicians concerning accommodation options may lead to a smoother transition from the hospital to longer term housing for clients after stroke.