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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.

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 (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.Implications for rehabilitationOur 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.

Young adults who experience psychosis want to work but are less likely to be employed than their peers. Sixty two studies relating to young adults with psychosis and employment were reviewed following a systematic search of five databases: CINAHL, PsycINFO, MEDLINE, SCOPUS and EMBASE. Publication date ranged from 1973 to 2019 with > 70% between 2010 and 2019. Intervention was considered in 29 papers; critical appraisal revealed 90% of these had moderate to good methodological quality with only three RCTs. Of 11 intervention types “Early Intervention” and “Individual Placement and Support” were most common; both demonstrating positive impact on obtaining employment. The review identified minimal participant perspectives and great variability in: terminology used; the reporting of participant attributes; intervention characteristics and ways employment outcomes were measured. Employment processes identified were preparing for, seeking, obtaining, keeping and re-obtaining employment, with current research efforts focused on obtaining work. More focus is required on keeping and re-obtaining employment.

Objectives:Concerns exist over the long-term consequences of subclavian artery ligation in subclavian flap repair for coarctation of the aorta. We sought to analyse upper limb structural and functional performance in adults who have had surgery in childhood for coarctation of the aorta, using either subclavian flap repair or end to end aortic anastomosis.Methods:Two-group observational design using anatomical and upper limb functional performance measures. Purposive sampling from our specialist adult congenital heart disease database of patients who received subclavian flap repair or end to end anastomosis for coarctation of the aorta as children. Upper limb measurements were completed using MRI and blood flow velocity with ultrasound imaging. Bilateral standardised upper limb functional testing of assessment of strength, dexterity and a standardised self-report of upper limb disability was completed.Results:Eighteen right-handed patients, 9 with subclavian repair, (38 ± 12 years, 78% males) were studied. Age at repair was 4.7 ± 5.9 years; mean time from initial repair 32 ± 9 years. The subclavian group had a larger difference between right and left when compared the end to end anastomosis group in: lower arm muscle mass (94.5 ± 42.3 mls versus 37.8 ± 94.5 mls, p = 0.008), lower arm maximal cross-sectional area, (5.9 ± 2.8 cm2 versus 2.9 ± 2.6 cm2, p = 0.038) and grip strength (14.7 ± 8.3 lbs versus 5.9 ± 5.3 lbs, p = 0.016) There were no significant functional differences between groups.Conclusions:In adults with repaired coarctation of the aorta, those with subclavian flap repair had a greater right to left arm muscle mass and grip strength differential when compared to those with end to end anastomosis repair.

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 Falls after stroke trial (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

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.

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.

Background Academic and professional drivers have stimulated interest in self-directed learning of students in pre-certification health professional programs. Particular attention has focussed on factors which may influence a students' readiness for self-directed learning. Method A five stage structured scoping review of published literature was conducted to identify measures of self-directed learning readiness used with students in pre-certification health professional programs and those factors that have been investigated as potential determinants. Relevant articles were identified in six databases using key search terms and a search strategy. Two independent reviewers used criteria to cull irrelevant sources. Articles which met eligibility criteria were charted. Results The final analysis included 49 articles conducted in nursing, medicine, physiotherapy, pharmacy, occupational therapy and dentistry cohorts. Twenty-one potential determinants had been investigated with gender, year level, age program delivery and previous education level the most common. Self-directed learning readiness has been of interest globally, mostly in medicine and nursing, and studies have nearly exclusively used one of two instruments. Conclusion There is nascent evidence that age, year level and previous education level may have positive influence. These factors have in common the passing of time and may in fact be proxy for more encompassing developmental or social constructs. Further research is needed particularly in the allied health professions where there is limited research in very few disciplines. Studies in interprofessional contexts may be an efficient approach to increasing the knowledge base. Further work is also warranted to determine appropriate use of the two instruments across the range of health disciplines.

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.

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-FlexTM device had variable results on outcomes, with some positive trends seen in hand function, particularly dexterity.

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.

OBJECTIVE. The Western Neuro Sensory Stimulation Profile (WNSSP) presents a hierarchy of items suggestive of a sequence of recovery. The aim of this study was to understand the sequence of recovery of neurobehavioral function in patients with brain injury and determine whether this sequence was consistent with the WNSSP test item order. METHOD. We conducted a retrospective clinical chart audit of 37 adult inpatients (mean age = 29 yr; 31 men, 6 women) with a diagnosis of traumatic brain injury and a minimum of two medical record entries on the WNSSP. The sequence of recovery was statistically derived from the content and structure of the WNSSP. RESULTS. Our analysis did not support the current item ordering of the WNSSP as a function of the sequence of recovery from coma, with the exception of the Arousal/Attention subscale. CONCLUSION. WNSSP item performance suggested a sequence of recovery; clinicians may consider a revised item order that reflects this observed order.

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-FlexNine 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-FlexRecruitment 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-FlexThis pilot feasibility study showed that the use of assistive technology, specifically the Saebo-Flex

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: 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.

from the 22nd Stroke Society of Australasia Annual Scientific Meeting, 14-16 September 2011, Adelaide, Australia.

Aim: To explore continuing professional development (CPD) resources and needs of Australian emergency department occupational therapists. Method: Australian websites and occupational therapy newsletters were searched to identify CPD resources/opportunities. Occupational therapists with recent clinical experience in Australian emergency departments were surveyed on strengths, weaknesses, opportunities and threats to their service, research information needs, supervision/mentor arrangements and quality assurance activity. Results: No Australian CPD opportunities were identified; 1.3% of the 2008 OT AUSTRALIA conference topics were emergency department specific. Forty-one Australian hospitals employed a total of 51 occupational therapists of whom 30 responded. Half were supervised by occupational therapists; 20 had occupational therapy mentors; 23 perceived that they were very independent; seven did quality assurance projects; 25 had unmet research needs; 27 thought their service was effective; and service strengths, weaknesses, opportunities and threats to service could be identified by most occupational therapists. Conclusion: Australian occupational therapists in emergency departments need specialised CPD opportunities. The information needs and strengths, weaknesses, opportunities and threats provide a CPD topic planning guide.

Therapists working in the outpatients service of a general hospital observed a problem regarding patient attendance at agreed appointment times. Valuable staff time was “lost” waiting for patients who failed to keep appointments. To develop policies and procedures about management of patient non-attendance a quality assurance study was conducted. This identified the extent of non-attendance, the reasons for this and the impact on the department. Of 192 appointments, 25 were non-attendances. Non-attendance was found to be a problem which occurred regularly, had an effect on staff job satisfaction and was a considerable financial cost to the department in terms of direct patient service delivery time lost. A number of methodological problems in the study are identified which limit the conclusions which can be drawn. These relate to data collection regarding the total outpatient service population which meant comparisons between attenders and non-attenders could not be made. On the basis of the information gained from the literature and the study a number of recommendations were made to decrease non-attendance. These include environmental changes to department waiting areas, the introduction of appointment reminder systems, waiting time policies, appointment negotiation procedures and a new protocol for dealing with non-attendance in the department.

The primary aim of this exploratory study was to explore how occupational therapy clinicians define ‘research’ in conceptual and operational terms. The secondary aim of this study was to identify observable and measurable indicators of research which could be used in structured instruments for further study of clinician research involvement. An opportunistic sample of 26 clinicians participated. A self report, open-ended question survey was used to explore clinician perspectives. Content analysis of data revealed a wide range of categories describing and explaining definitions of research, the way in which these definitions were formulated, and other factors associated with the term research such as the role of researcher, issues personally affecting clinicians and aspects of the environment. Recommendations for further research are made.

Meta-analysis is a statistical technique that can be used in occupational therapy research. This paper describes the features, advantages and disadvantages of the technique, and reviews the incidence of its use in occupational therapy literature. Recommendations are made regarding the use of meta-analysis in occupational therapy research.

Goal attainment scaling is a method to evaluate services based on the attainment of individual client or programme goals. This method was used to evaluate the effectiveness of a client-centred cognitive rehabilitation programme designed to teach compensatory strategies for planning daily activities. In this application, an 8-year-old boy long-term after traumatic brain injury and his family participated. The evaluation results revealed an overall goal attainment T-score of 68.70, indicating that the programme goal was attained above the expected level. The application of goal attainment scaling as an evaluation method for client-centred paediatric programmes is discussed.

The aim of this study was to investigate the quality of life of cancer patients receiving chemotherapy in terms of changes in activity patterns and overall psychological status. Activity patterns are central to the occupational therapy perspective. Twenty two subjects participated. Data was collected on random days from inpatients and outpatients, using a three-part questionnaire. A descriptive analysis was performed using frequency counts of the number of responses to questionnaire items. The results demonstrated that a majority of subjects had experienced a disruption in activity patterns since commencing chemotherapy treatment. Most subjects, however, expressed a positive outlook towards their life situations. These findings indicate that it is necessary to consider both extent of activity disruption and psychological well-being when assessing quality of life of cancer patients, in order to gain a comprehensive lifestyle analysis as a basis for planning appropriate occupational therapy intervention.

The present article profiles the development of a key professional group in Australia and New Zealand occupational therapy, the Australian New Zealand Council of Occupational Therapy Education (ANZCOTE). It identifies key issues of importance to this organization that can impact on the profession at large.

In this paper the authors present single system designs as a framework for the collecting, organising and analysing of information to evaluate programme impact. The steps involved in evaluation and research using single system designs are discussed and advantages and disadvantages of the design for occupational therapists are briefly presented. The authors conclude that single system designs are suitable for occupational therapists to use in research and clinical evaluation because of their flexibility and their emphasis on clinical significance.

“Paradigm” is a concept being increasingly used in occupational therapy literature as a tool to analyse theory, practice and occupational therapy's development. The philosophical assumptions inherent in this term are critically evaluated. This involves ambiguity, relativism and reflexivity of the concept as well as the rejection of scientific method and causality as a basis for research in occupational therapy. Implications for occupational therapy as a science are discussed.

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.