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Introduction: Rural and remote communities face significant disadvantages accessing health services and have a high risk of poor health outcomes. Workforce challenges in these areas are multifaceted, with allied health professionals requiring broad skills and knowledge to provide vital services to local communities. To develop the expertise for rural and remote practice, the allied health rural generalist pathway (AHRGP) was introduced to develop and recognise specialist skills and knowledge required for rural and remote practice, however the experiences of professionals has not been explored. This study gained the experiences and perceptions of allied health professionals undertaking the pathway as well as their clinical supervisors, line managers, profession leads and consumer representatives. Methods: A qualitative study was undertaken drawing on pragmatic approaches across four research phases. This study was one component of a larger mixed methods study investigating the experience, impact and outcomes of the AHRGP across six regional Local Health Networks in South Australia (SA). Interviews, surveys and focus groups were conducted to explore the perceptions and experiences of participants. Data was analysed thematically across participant groups and research phases. Results: A total of 54 participants including 15 trainees, 13 line managers, nine clinical supervisors, six profession leads, four program managers and seven consumer representatives informed this study. Five themes were generated from the data; gaining broad skills and knowledge for rural practice, finding the time to manage the pathway, implementing learning into practice, the AHRGP impacts the whole team and confident, consistent, skilled allied health professionals positively impact consumers. Conclusion: The AHRGP is offering allied health professionals the opportunity to develop skills and knowledge for rural and remote practice. It is also having positive impacts on individuals' ability to manage complexity and solve problems. Findings indicated consumers and organisations benefited through the provision of more accessible, consistent, and high quality services provided by trainees. Trainees faced challenges finding the time to manage study and to implement learning into practice. Organisations would benefit from clearer support structures and resourcing to support the pathway into the future. Incentives and career advancement opportunities for graduates would strengthen the overall value of the AHRPG. [ABSTRACT FROM AUTHOR]

Introduction: The creation of age‐friendly home environments enables middle‐aged and older aged people to live independently at home while adapting to age‐related changes. Little is currently known about existing home hazards that may potentially hinder healthy older people as they age. Methods: Prospective cohort study of healthy adults who received an age‐friendly home environment assessment conducted by an occupational therapist. Adults aged 60 and over, without significant disability, living in homes within metropolitan Adelaide, South Australia were recruited through community advertising. Results: Sixty age‐friendly home environment assessments were conducted. Common areas where potential hazards were identified, and modifications recommended were bathrooms, toilets and backyards. Gardens were commonly identified as potentially requiring modifications in the future. Participants were more likely to consider moving to new housing if additional modifications were needed to their homes. Conclusion: Affordable and accessible age‐friendly housing is required to support an ageing population. Education on age‐friendly housing for healthy middle and older aged people is required enabling proactive planning rather than awaiting health crises. [ABSTRACT FROM AUTHOR]

Background: Participation in leisure activities is significantly impacted following acquired brain injury (ABI). Despite this being a common community rehabilitation goal, re-engagement with leisure activities following ABI is poorly addressed within Australian community rehabilitation services, which often cater to a mixed-diagnostic group of both ABI and non-ABI clients. Objectives: To evaluate the feasibility and effect of a leisure reintegration group programme within a community rehabilitation service. Method: A single-site, pre- and post-test feasibility study was conducted. Three cohorts of a semi-structured leisure group programme were offered, each conducted over eight sessions within 4 weeks. The Nottingham Leisure Questionnaire (NLQ) and Leisure Satisfaction Measure (LSM) were used as primary outcome measures. Measures of acceptability, including adherence, and a post-intervention participant survey were also completed. Results: Of the 14 consenting participants, 9 completed all outcome measures. Mean change score for the NLQ was −3.63 (p = 0.11) and the LSM 4.25 (p = 0.46). The programme was well attended (79%), acceptable for ABI and non-ABI participants and able to be implemented within an existing community rehabilitation service. Conclusion: Providing a leisure reintegration group programme met an identified need, developed client and carer capacity and could be delivered within a community rehabilitation service for clients with mixed diagnoses including ABI. A larger trial is warranted to examine the effectiveness and cost-effectiveness of this intervention for people with ABI. [ABSTRACT FROM AUTHOR]

Abstract Purpose Materials and Methods Results Conclusions \nIMPLICATIONS FOR REHABILITATION This study explored experiences of the management of challenging behaviours after traumatic brain injury (TBI) in the acute hospital setting from the perspectives of family members.A qualitative, interpretive phenomenological approach was adopted involving semi-structured interviews with 10 family members. Interviews were transcribed and analysed using thematic analysis, with Ecological Systems Theory applied as a guiding framework to discuss findings and implications for practice.Four primary themes were identified: 1) The hospital environment; 2) Hospital staffing; 3) Identifying and preventing triggers, and 4) Family support and information.This qualitative study highlights the need for further information, education, and support to families of patients with TBI in the acute setting. Further research investigating the implementation of best practice approaches for managing challenging behaviours practice in acute settings is needed to overcome the barriers of the hospital environment, inexperienced and inconsistent staffing, and difficulties identifying triggers within the acute hospital setting, experienced by families. Approaches for family involvement in behaviour management strategies, and facilitation of communication for people with TBI in the acute setting requires exploration. Families reported the hospital environment, inexperienced and inconsistent staffing, and difficulty identifying triggers were challenges in effectively managing challenging behaviours after traumatic brain injury (TBI) in the acute setting. Clinicians can support family involvement in preventative strategies with patients with TBI. Clinicians can enable quality of care by building rapport and providing compassionate care to patients with TBI. Families need more support and information during the acute stage of TBI in hospital settings. Families reported the hospital environment, inexperienced and inconsistent staffing, and difficulty identifying triggers were challenges in effectively managing challenging behaviours after traumatic brain injury (TBI) in the acute setting.Clinicians can support family involvement in preventative strategies with patients with TBI.Clinicians can enable quality of care by building rapport and providing compassionate care to patients with TBI.Families need more support and information during the acute stage of TBI in hospital settings. [ABSTRACT FROM AUTHOR]

Successful ageing-in-place is dependent on the design and features of the home. In some cases, home modifications or relocation may be required. Accessible, affordable, age-friendly housing for older adults is required to encourage forward planning. To understand the views of middle and older aged adults and individuals with older relatives, about home safety, ageing in place and housing accessibility. A qualitative descriptive approach, using reflexive thematic analysis was used. Data were gathered through semi-structured interviews with 16 participants, comprising eight middle- older aged people and eight individuals with older relatives. Seven themes were identified. Most participants accepted the ageing process and could recognise home environment hazards and potential future housing needs. Others were determined to remain independent at home and resistant to making future changes until necessary. Participants were interested in obtaining more information about how to improve home safety or services to support ageing-in-place. Most older adults are open to conversations about planning for ageing-in-place and would like further information on home safety and home modifications. Educational forums and tools (such as flyers or checklists) which assist older people to plan future housing needs are recommended. Many older people are living in homes that present hazards and limited accessibility as they age. Earlier planning could lead to home modifications which will improve the capacity to age in place. Action to provide earlier education is needed as the population ages and suitable housing for older people is limited. Decision-making around home safety among the ageing population can be compromised by lack of awareness, inadequate access to information and the sudden onset of age-related changes. An education guide or tool to support forward planning and housing decisions may improve early awareness among the ageing population. [ABSTRACT FROM AUTHOR]

Background: Maintaining a health professional workforce in rural and remote areas poses a significant challenge internationally. A range of recruitment and retention strategies have had varying success and these are  generally developed from the collective experience of all health professions, rather than targeted to professional groups with differing educational and support contexts. This review explores, compares and synthesises the evidence examining the experience of early career rural and remote allied health professionals and doctors to better understand both the profession specific, and common factors that influence their experience.Methods: Qualitative studies that include early career allied health professionals' or doctors' experiences of working in rural or remote areas and the personal and professional factors that impact on this experience were considered. A systematic search was completed across five databases and three grey literature repositories to identify published and unpublished studies. Studies published since 2000 in English were considered. Studies were screened for inclusion and critically appraised by two independent reviewers. Data was extracted and assigned a level of credibility. Data synthesis adhered to the JBI meta-aggregative approach.Results: Of the 1408 identified articles, 30 papers were eligible for inclusion, with one rated as low in quality and all others moderate or high quality. A total of 23 categories, 334 findings and illustrations were aggregated into three synthesised findings for both professional groups including: making a difference through professional and organisational factors, working in rural areas can offer unique and rewarding opportunities for early career allied health professionals and doctors, and personal and community influences make a difference. A rich dataset was obtained and findings illustrate similarities including the need to consider personal factors, and differences, including discipline specific supervision for allied health professionals and local supervision for doctors.Conclusions: Strategies to enhance the experience of both allied health professionals and doctors in rural and remote areas include enabling career paths through structured training programs, hands on learning opportunities, quality supervision and community immersion.Systematic Review Registration Number: PROSPERO CRD42021223187. [ABSTRACT FROM AUTHOR]

Background: Maintaining a health professional workforce in rural and remote areas poses a significant challenge internationally. A range of recruitment and retention strategies have had varying success and these are generally developed from the collective experience of all health professions, rather than targeted to professional groups with differing educational and support contexts. This review explores, compares and synthesises the evidence examining the experience of early career rural and remote allied health professionals and doctors to better understand both the profession specific, and common factors that influence their experience. Methods: Qualitative studies that include early career allied health professionals' or doctors' experiences of working in rural or remote areas and the personal and professional factors that impact on this experience were considered. A systematic search was completed across five databases and three grey literature repositories to identify published and unpublished studies. Studies published since 2000 in English were considered. Studies were screened for inclusion and critically appraised by two independent reviewers. Data was extracted and assigned a level of credibility. Data synthesis adhered to the JBI meta-aggregative approach. Results: Of the 1408 identified articles, 30 papers were eligible for inclusion, with one rated as low in quality and all others moderate or high quality. A total of 23 categories, 334 findings and illustrations were aggregated into three synthesised findings for both professional groups including: making a difference through professional and organisational factors, working in rural areas can offer unique and rewarding opportunities for early career allied health professionals and doctors, and personal and community influences make a difference. A rich dataset was obtained and findings illustrate similarities including the need to consider personal factors, and differences, including discipline specific supervision for allied health professionals and local supervision for doctors. Conclusions: Strategies to enhance the experience of both allied health professionals and doctors in rural and remote areas include enabling career paths through structured training programs, hands on learning opportunities, quality supervision and community immersion. Systematic review registration number: PROSPERO CRD42021223187. [ABSTRACT FROM AUTHOR]

Objective: To synthesise the current best evidence on both pharmacological and non-pharmacological behaviour management interventions for adult patients in the acute hospital setting with traumatic brain injury (TBI) or post-traumatic amnesia (PTA). Data Sources: A comprehensive search of 10 electronic databases was completed. Study Selection: Systematic reviews (SRs) published in English before September 2018 were included. Initial search resulted in 4604 citations, 2916 for title and abstract screening with duplicates removed, and 2909 articles failed to meet the inclusion criteria leaving seven reviews for inclusion. Five reporting pharmacological management approaches, two reporting non-pharmacological management approaches, and one reporting both pharmacological and non-pharmacological management approaches. Data Extraction: Methodological quality was assessed independently by two reviewers using the Critical Appraisal Skills Programme Tool for SRs. Data were extracted from the studies based on the recommendations of the Joanna Briggs Institute (JBI) Methodology for JBI Umbrella Reviews. Data Synthesis: The SRs were of low-to-moderate quality overall. High-quality SRs were characterised by low numbers of studies and significant biases. The evidence relating to pharmacological interventions demonstrates low level and variable quality. The evidence relating to non-pharmacological interventions was limited and of low quality. Conclusions: The current evidence for the management of challenging behaviours in patients with acute TBI/PTA is generally equivocal, potentially reflecting the heterogeneity of patients with TBI and their clinical behaviours. More studies with rigorous methodologies are required to investigate the most suitable pharmacological and non-pharmacological behavioural interventions for the acute phase of TBI or PTA. [ABSTRACT FROM AUTHOR]

Background: Following traumatic brain and spinal cord injuries, maximising community participation leads to better physical and mental health outcomes. Objectives: To determine the effectiveness and health system resource use of a group intervention (CarFreeMe TI) on community participation in people with complex trauma injuries. Method: Randomised crossover trial of 54 participants, recruited from rehabilitation services in Adelaide, Australia. Inclusion criteria is a trauma injury, unable to return to full driving, aged over 18 years of age, adequate cognition/behavioural/communication abilities to participate in sessions and mobile. Exclusion criterion is living in setting where alternative transport is provided. Participants will be randomly assigned on a 1:1 allocation basis, to receiving Phase 1 CarFreeMe TI-group-based intervention or Phase 2 information related to transport options. Then, crossover to Phase 1 or 2 will occur. Primary outcome measure is community participation using a Global Positioning System. Secondary outcome measures include Community Mobility Self-efficacy Scale; CarFreeMe TI Transport Questionnaire, AQOL, EQ-5D-5L; Carer's Community Mobility Self-efficacy Scale and Modified Carer Strain Index for carers of participants. Outcome assessors will be blinded to group allocation. All analyses will be on an intention to treat basis with difference in community participation between the groups determined via a GLM ANOVA and the significance between groups on other measures using independent sample t -tests. It is hypothesised that the community mobility intervention (CarFreeMeTI) will result in increased community participation. Discussion: The results will provide proof of concept information on the feasibility and inform allocation of resources for people with complex trauma injuries. Trial registration: Australian and New Zealand Clinical Trials Register (ANZCTR): ACTRN12616001254482. [ABSTRACT FROM AUTHOR]

Primary objective: To investigate if patients with traumatic brain injury, who are discharged to the community before emergence from post-traumatic amnesia (PTA), experience more adverse outcomes than those discharged after emergence from PTA.Research design: A retrospective review of previously collected data and medical records.Methods and procedures: Occurrences of adverse events including hospital readmissions, disengagement from follow-up services, non-compliance with discharge precautions, support system breakdown or undue carer strain at the post-discharge clinic review were recorded. The Glasgow Outcome Scale – Extended (GOS-E) and Supervision Rating Scale (SRS) were completed, retrospectively. Twenty-seven patients discharged to the community, prior to emergence from PTA, were compared to 20 patients discharged within seven days of emergence from PTA.Main outcomes and results: Patients discharged prior to emergence from PTA did not experience an increase in adverse outcomes and showed a higher level of engagement in follow-up services (p= 0.015). There was no difference between groups in the improvements from discharge to clinic review on the GOS-E (p= 0.113) and SRS (p= 0.165).Conclusions: Patients can be discharged prior to emergence from PTA, if all other discharge criteria have been met, without an increase in adverse outcomes. [ABSTRACT FROM PUBLISHER]

Purpose: To assess the feasibility of a physiotherapy intervention using an interactive gaming program compared with conventional physiotherapy for hospitalised older people. Methods: Randomised controlled pilot study in a geriatric rehabilitation unit within an acute public hospital. Participants were randomly allocated to physiotherapy using an interactive gaming program ( n = 22) or conventional physiotherapy in a ward-based gym ( n = 22). Feasibility was assessed by comparing the effects of the intervention on clinical outcome measures (primary outcome: mobility as assessed by the Timed Up and Go test, secondary outcomes: safety, adherence levels, eligibility and consent rates). Results: Participants ( n = 44) had a mean age of 85 years (SD 4.5) and the majority (80%) were women. Univariable analyses showed no significant difference between groups following intervention. However, multivariable analyses suggested that participants using the interactive gaming program improved more on the Timed Up and Go test ( p = 0.048) than participants receiving conventional physiotherapy. There were no serious adverse events and high levels of adherence to therapy were evident in both groups. Only a small proportion of patients screened were recruited to the study. Conclusions: In this feasibility study, the use of a commercially available interactive gaming program by physiotherapists with older people in a hospital setting was safe and adherence levels were comparable with conventional therapy. Preliminary results suggest that further exploration of approaches using games as therapy for older people could include commonly used measures of balance and function. [ABSTRACT FROM AUTHOR]

Purpose: To describe a modification of the computer self efficacy scale for use in clinical settings and to report on the modified scale's reliability and construct validity. Methods: The computer self efficacy scale was modified to make it applicable for clinical settings (for use with older people or people with disabilities using everyday technologies). The modified scale was piloted, then tested with patients in an Australian inpatient rehabilitation setting ( n == 88) to determine the internal consistency using Cronbach's alpha coefficient. Construct validity was assessed by correlation of the scale with age and technology use. Factor analysis using principal components analysis was undertaken to identify important constructs within the scale. Results: The modified computer self efficacy scale demonstrated high internal consistency with a standardised alpha coefficient of 0.94. Two constructs within the scale were apparent; using the technology alone, and using the technology with the support of others. Scores on the scale were correlated with age and frequency of use of some technologies thereby supporting construct validity. Conclusions: The modified computer self efficacy scale has demonstrated reliability and construct validity for measuring the self efficacy of older people or people with disabilities when using everyday technologies. This tool has the potential to assist clinicians in identifying older patients who may be more open to using new technologies to maintain independence. [ABSTRACT FROM AUTHOR]

In this article the authors discuss the characteristics of virtual reality in stroke rehabilitation as a tool for occupational therapists. They state that virtual reality provides therapists an environment wherein they have better control of the setting, furnishes service offers of hospitals, and a cost-effective assessment and intervention. However, they argue that therapists must collaborate with engineering and game developers to develop advancement in the rehabilitation programmes.

The article discusses a study conducted to establish evidence for the viability of driving licensing policies and community mobility programmes on older adults' participation in leisure and social activities. Topics discussed include beneficial for older adults in reducing depression, increasing quality of life and care-givers acceptance, and influence of community mobility interventions.

Aim: This aim of this study was to determine the construct and predictive validity of the New South Wales Visual Recognition Slide Test (VRST) — a component of the occupational therapy off-road driving rehabilitation program designed to assess the abilities of speed of information processing and visual scanning. Methods and results: Twenty-six people with stroke were used to test construct validity, and 24 people with stroke were used to test predictive validity. Performance on the VRST was compared to scores on the Visual Scanning Analyser (VSA) and Response Time Measures (RTM) to determine construct validity. Predictive validity was examined by comparing VRST scores to the result on an on-road driving assessment. Results/conclusions: Results on the VRST was associated with on-road result, with it predicting those people recommended to pass or require lessons from their on-road evaluation. Scores from the VRST were associated with an inspection time component of the RTM, but not with the VSA, suggesting the VRST is an assessment of the identification phase of information processing but not of scanning or peripheral vision. The VSA, in particular the scanning task of field 5, was significantly related to the on-road result. These results indicate that the VRST is potentially a valid measure to use in the off-road driver rehabilitation program for people with stroke; however, validation is required on a larger population. The VSA should be further evaluated for consideration of inclusion in the driver rehabilitation program. [ABSTRACT FROM AUTHOR]

Objective: To describe the development of the Adelaide Driving Self-Efficacy Scale (ADSES) and to report on its reliability and validity. Methods: A set of 12 driving behaviours, developed through literature review, clinical experience and expert review, were rated for self-efficacy using a Likert scale. Internal consistency was investigated using a Cronbach's alpha coefficient and construct validity by comparing ADSES scores of stroke and non-stroke drivers. Criterion-related validity was examined by comparing ADSES scores with the result on a standardized on-road assessment. Setting: A rehabilitation hospital in Adelaide, South Australia. Participants: Staff from the hospital and stroke patients from the rehabilitation unit. Data from a non-stroke sample (n = 79) and stroke patients (n = 81) were used to test internal consistency and construct validity. A separate group of 45 people recommended for a driving assessment, of whom 34 were stroke patients, were used to test criterion validity. Results: Cronbach's alpha coefficient was 0.98, indicating high internal consistency. The non-stroke and stroke groups showed significant differences in ADSES scores (t(158) = 5.5, P < 0.05), demonstrating construct validity. Differences in ADSES scores for those participants who passed or failed the on-road assessment were significant for both the entire driving assessment group (t(43) = 3.2, P < 0.05) and the stroke subgroup (t(43) = 3.2, P < 0.05), indicating criterion validity. Conclusion: The ADSES has demonstrated internal consistency and construct validity with the stroke and non-stroke population. The scale demonstrated criterion validity in its relationship with outcome of an on-road driving assessment. It appears to be a reliable and valid measure of driving self-efficacy. [ABSTRACT FROM AUTHOR]

This study describes the self-reported driving behaviours of older South Australian drivers in a population survey (n = 3001). People over 65 years of age who drive were more likely to make adjustments to driving, reported lower confidence in driving and had less access to retraining, compared to those under 65. Of those reporting medical conditions (18.1%) people with visual impairment reported the most adjustments to driving, lowest confidence and high access to retraining. This is the first information on adjustments to driving made by South Australians as they age and suggests that interventions by occupational therapists directed at determining those most likely to stop driving, education regarding self-regulation and retraining options arc required. [ABSTRACT FROM AUTHOR]

The author reflects on the response of the occupational therapy profession in Australia to the COVID-19 pandemic in light of the Occupational Therapy Australia 29th National Conference and Exhibition. Topics discussed include the key role of health care personnel in the protection of the public during the pandemic, ability of occupational therapists to adopt innovative health care delivery, and the challenge facing the profession to promote human rights and support diversity.

Objective: It is widely understood that a key means of improving health systems and patient outcomes is through research – accessing, understanding, generating and applying research evidence-based practice. To promote more targeted and strategic research in Allied Health practice, this study sought to establish the principles, areas and priorities for clinical research as perceived by Allied Health leaders in the South Australian public health system. Methods: The study used a mixed-methods design (full, sequential and equal model). Participants were recruited from the South Australian Department of Health and Wellbeing employment lists for Allied Health senior leaders. Consenting participants attended face-to-face focus groups; after an overview presentation, they discussed the principles for Allied Health research, followed by areas and priorities for research. Summaries of the responses were themed descriptively and circulated electronically so participants could confirm the research areas and ascribe priority ratings, clinical populations and services. Results: A total of 28 people attended the stakeholder forum (5 online); 20 responded to the second-round electronic summary. Nine principles of research action were agreed. Fourteen research areas were identified and prioritised. There was a relatively consistent prioritisation of measuring Allied Health value, Allied Health workforce, hospital avoidance and closing the gap for Aboriginal and Torres Strait Islander peoples health outcomes – whether the individuals were thinking about their own service or the state as a whole. Conclusions: Allied Health leadership identified key principles and priorities for research to improve service delivery and patient outcomes. These priorities should generate further discussion and interest for novice and experienced researchers and leaders and can be used to inform granting and project plans. What is known about the topic? Allied Health are well equipped to engage in research but have limited capacity. What does this paper add? We have identified key priorities and principles to inform Allied Health research activity. What are the implications for practitioners? Practitioners, funders and other stakeholders can develop these identified principles and priorities to direct research time and resources for the most impact on health outcomes. [ABSTRACT FROM AUTHOR]

The article discusses a study that established the evidence for the link between physical activity and healthy ageing in longitudinal cohorts of community-based adults. Study highlights include the use of the Quality in Prognosis Studies tool in the quality assessment, the use of a random effect meta-analysis to calculate a pooled effect size and 95 percent confidence intervals, and an increase in the number of people aged over 65 in Australia.

A review of the article "Effectiveness of cognitive rehabilitation for people with multiple sclerosis: A meta-synthesis of patient perspectives" is presented.

The article discusses a study on the effectiveness of simulator-based occupational therapy driving intervention in reducing driving errors (DE) among returning combat veterans, which appeared in the volume 37 of the journal "OTJR: Occupation, Participation and Health." Topics mentioned include the causes of DE including polytrauma and post-traumatic stress disorder, and the study's limitations including the insufficiency of assessment duration for capturing DE in a usual driving route.

Clinical practice guideline (CPG) recommendations for the management of challenging behaviours after traumatic brain injury (TBI) in hospital and inpatient rehabilitation settings are sparse. This systematic review aims to identify and appraise CPGs, and report high-quality recommendations for challenging behaviours after TBI in hospital and rehabilitation settings. A three-step search strategy was conducted to identify CPGs that met inclusion criteria. Two reviewers independently scored the AGREE II domains. Guideline quality was assessed based on CPGs adequately addressing four out of the six AGREE II domains. Data extraction was performed with a compilation of high-quality CPG recommendations. Seven CPGs out of 408 identified records met the inclusion criteria. Two CPGs were deemed high-quality. High-quality CPG recommendations with the strongest supporting evidence include behaviour management plans; beta-blockers for the treatment of aggression; selective serotonin reuptake inhibitors for moderate agitation; adamantanes for impaired arousal/attention in agitation; specialised, multi-disciplinary TBI behaviour management services. This systematic review identified and appraised the quality of CPGs relating to the management of challenging behaviours after TBI in acute hospital and rehabilitation settings. Further research to rigorously evaluate TBI behaviour management programs, investigation of evidence-practice gaps, and implementation strategies for adopting CPG recommendations into practice is needed. Two clinical practice guidelines appraised as high-quality outline recommendations for the management of challenging behaviours after traumatic brain injury in hospital and inpatient rehabilitation settings. High-quality guideline recommendations with the strongest supporting evidence for non-pharmacological treatment include behaviour management plans considering precipitating factors, antecedents, and reinforcing events. High-quality guideline recommendations with the strongest supporting evidence for pharmacological management include beta blockers for aggression in traumatic brain injury. Few guidelines provide comprehensive detail on the implementation of recommendations into clinical care which may limit adoption [ABSTRACT FROM AUTHOR]

A review of the article “Effectiveness of occupation-based interventions to improve areas of occupation and social participation after stroke: An evidence-based review” by Wolf, T. J., Chuh, A., Floyd, T., McInnis, K. & Williams, E., which appeared in the previous issue of the journal is presented.

The author discusses the potential impact of inter-professional teamwork (IPT) in improving processes and outcomes in rehabilitation and chronic care settings. They mentions the areas to provide the clarity of IPT and where it can be targeted such as in an input, process and output model. Also stated the TeamSTEPPS, an evidence-based teamwork method introduced by clinical team to enhance patient outcomes.

Background: Community participation and physical activity are important for the health of older adults. This review aimed to identify studies which have measured physical activity and community participation in older adults using Global positioning systems. Materials and methods: This scoping review searched key databases using predetermined subject headings and keywords. Two independent reviewers selected studies based on a systematic procedure following current guidelines. Inclusion criteria for studies were: participants aged over 50 years living independently in the community that reported on physical activity and/or participation inclusive of physical and social activity, and including a quantitative measure of location. All searches were limited to English. The primary review question was; "What studies have monitored the location of physical activity in an older population?" with secondary enquiries investigating the types of global positioning system devices, barriers and facilitators for activity and community participation. Results: The search returned 3723 articles (following duplicate removal) and 45 met the inclusion criteria. Studies from 12 countries published over a 12-year period were included. Participants were mainly healthy (n = 23) followed by having a cognitive impairment (n = 10). There were 14 different global positioning system devices used, assessing a variety of outcomes (n = 24). Seventeen studies identified facilitators and barriers to participation and physical activity in an older population. The most common facilitators were safety, weather and access to multi-purpose facilities. The most common barriers were weather, safety, low income/high deprivation areas and use of motor vehicles. Conclusion: This scoping review identified a variety of locational monitoring of older people using global positioning devices. Global positioning systems are a valuable tool to obtain accurate activity locations of older people. There is a need for clear guidelines regarding the use of global positioning system devices and specified outcomes in primary research to enable comparison across studies. Physical activity and community participation are vital for healthy ageing. The environment can act as a facilitator or barrier to physical activity and community participation for older adults. Interventions need to target facilitators (weather, safety, facility access and social components) to maximize physical activity and community participation in older people. Interventions should be designed to reduce the barriers (weather, safety, low income and motor vehicle dependency) that prevent older adults from actively participating in their community. [ABSTRACT FROM AUTHOR]

Background: Challenging behaviours after traumatic brain injury (TBI) in the acute setting are associated with risk of harm to the patient and staff, delays in commencing rehabilitation and increased length of hospital stay. Few guidelines exist to inform practice in acute settings, and specialist services providing multi-disciplinary expertise for TBI behaviour management are predominantly based in subacute inpatient services. This study aims to investigate acute and subacute staff perspectives of barriers and enablers to effectively managing challenging behaviours after TBI in acute hospital settings. Methods: Qualitative focus groups were conducted with 28 staff (17 from acute setting, 11 from subacute setting) across two sites who had experience working with patients with TBI. Data were analysed using inductive-deductive reflexive thematic analysis. Data were applied to the constructs of the integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) framework to generate themes representing barriers and enablers to managing challenging behaviours after TBI in the acute hospital setting. Results: Four barriers and three enablers were identified. Barriers include (1) Difficulties with clinical decision making; (2) Concerns for risks to staff and patients; (3) Hospital environment; (4) Intensive resources are required. Enablers were (1) Experienced staff with practical skills; (2) Incorporating person-centred care; and (3) Supportive teams. Conclusion: These findings can inform pre-implementation planning for future improvements to TBI behaviour management in acute hospital settings. Difficulties with clinical decision making, concerns for risks of injury, the hospital environment and lack of resources are major challenges. Implementation strategies developed to address barriers will need to be trialled, with multi-disciplinary team approaches, and tailored to the acute setting. [ABSTRACT FROM AUTHOR]

The article presents a study which discusses systematic review and meta-analysis related to efficacy of cognitive prosthetic technology for peoples with memory impairment. Topics discussed include supporting technology use in improving everyday task performance requiring memory, inclusion of single case experiment designs (SCED) and group studies, and studies on patients with acquired brain injury (ABI). The study concludes that technology can improve performance on tasks requiring memory.

The article presents a study which examines the importance of multidisciplinary rehabilitation and fatigue management courses in improving function and participation in multiple sclerosis (MS) patients. The study reveals that MS patients can benefit from a program that focuses on improved functional performance and participation. It also shows the need to perform research studies on multidisciplinary rehabilitation programs and long-term outcomes related to intensity.

The authors discuss the study conducted to examine the re-admission rates and reduction in length of stay for older people with discharge planning. They mention that the systemic review of several databases including MEDLINE, Excerpta Medica Database (EMBASE), and CINAHL revealed that re-admission rates and hospital length of stay was reduced with discharge plan. They states that the review doesn't provide evidences of individual therapies effectiveness such as occupational therapy.

The article presents the authors' view on the study conducted by N. Korner-Bitensky and colleagues on the significant role of older driver retraining on improving on-road skills and knowledge. The authors comment that critical appraisal before implementing the clinical recommendations is needed to achieve quality of systematic reviews. The authors also claim that the grading in the study seems inconsistent and inaccuracies were observed in the quality reporting.

The article presents the authors' view on the study conducted by L. G. Kay and colleagues on the reliability of the DriveSafe and DriveAware tests. The authors comment that few methodological issues in the study such as the clients referred for a driving assessment, that could have influenced the findings and generalisation, The authors state that the findings on the reliability of DriveAware test is not convincing and a standard scoring procedures must be developed to gather strong evidence.

BACKGROUND: Homonymous hemianopia post-stroke reduces independence. OBJECTIVE: To compare the effectiveness of a standardised program versus current individualized therapy in patients with homonymous hemianopia. METHODS: Single-blind randomized controlled trial, 24 patients (54% male), mean age (65±4.3), mean time since stroke (51±52.3 days), recruited from rehabilitation and vision services in Adelaide, Australia. Participants were randomized to a combined standardized scanning and mobility program of 7 weeks, 3 times per week or to individualized therapy recommended by clinicians. Primary outcome was an assessment of scanning ability whilst walking. Secondary outcomes included measures of visual scanning, reading, and vision related quality of life (QOL). RESULTS: No significant differences were found between intervention groups for the primary outcome measure of scanning ability whilst walking at 7 weeks and at 3 months (P > 0.05). However, at 3 months significant differences were found for the QOL National Eye Institute Visual functioning Questionnaire (NEI VFQ25) total score (P = 0.03) and dependency sub-score (P = 0.03) measures. CONCLUSIONS: A standardized intervention of static scanning and mobility training improved QOL. Allocation of resources to visual rehabilitation services point towards the implementation of more mobility practice over a longer period of time. [ABSTRACT FROM AUTHOR]

Background: Infectious disease outbreaks disrupt inpatient clinical care and have an impact on staff and patients' ability to communicate with each other and with the wider community. Digital technology may offer opportunities for communication in the inpatient setting during infectious disease outbreaks. Aim: This scoping review aimed to investigate the use of digital technology in the inpatient setting to promote communication in the early stages of an infectious disease outbreak. Methods: There were three aspects to this scoping review: (1) a database search of Ovid MEDLINE (MEDLINE), Cumulative Index of Nursing and Allied Health Literature (CINAHL), Association for Computing Machinery Digital Library (ACM) and IEEE Xplore (IEEE) exploring peer-reviewed articles, (2) a gray literature search, and (3) a media search. Results: Results focused on the early stages of the COVID-19 pandemic. Thirty-eight peer-reviewed articles were extracted from the database search. There were three main areas of investigation: study characteristics, technology features, and benefits and barriers. Forty-four websites were searched for the gray literature search focusing on policy and guidance. Eighteen media articles were retrieved focusing on patients' use of technology and community involvement. Conclusion: Results demonstrate the diverse use of digital technology in the inpatient setting to facilitate communication during the early stages of the COVID-19 pandemic. However, the articles provide limited data to allow readers to fully understand and reproduce described actions. Furthermore, there was limited guidance to support clinicians to communicate using digital technology to create trusting therapeutic relationships. Areas for future development include standard reporting process for technology hardware, software, and content; and structured reporting and evaluation of the implementation of technologies. [ABSTRACT FROM AUTHOR]

Background: With the increasing age of the global population, key components of healthy ageing including community, physical, and social participation continue to gain traction. However, management of the COVID-19 pandemic aimed to protect older adults and reduce the spread of the virus, this restricted community participation and reduced the opportunities for social interaction. Methods: This mixed methods study investigates community dwelling older adults' community participation; physical activity and social interaction prior to, during, and following the COVID-19 lockdown in Adelaide, Australia. Twenty-six community dwelling older adults were monitored over three time-points between November 2018 and October 2020, with Global Positioning Systems, accelerometry and self-reported diaries. In addition, nineteen participants completed semi-structured interviews. Results: Community participation varied across the three time points, with significant reduction in the number of trips taken out-of-home (p = 0.021), social interactions (p = 0.001) and sleep quality (p = 0.008) during restrictions. Five themes were identified to explain personal experiences of community participation during restrictions: (1) Reframing of meaning, (2) Redefining to maintain activities, (3) Revision of risk, (4) Reflection and renewal and (5) Future planning. Conclusion: During COVID-19 the physical and social activities of community dwelling older adults changed. Services that support older adults to adapt their activities , considering their capacities and preferences, to facilitate community participation are required. [ABSTRACT FROM AUTHOR]

While a number of researchers have previously investigated the relationship between graph theory and quantum probability, the current work explores a new perspective. The approach of this paper is to begin with an arbitrary graph having no previously established relationship to quantum probability and to use that graph to construct a quantum probability space in which moments of quantum random variables reveal information about the graph's structure. Given an arbitrary finite graph and arbitrary odd integer m [?] 3, fermion annihilation operators are used to construct a family of quantum random variables whose mth moments correspond to the graph's m-cycles. The approach is then generalized to recover a graph's m-cycles for any integer m [?] 3 by defining nilpotent adjacency operators in terms of null-square generators of an infinite-dimensional Abelian algebra. It is shown that ordering the vertices of a simple graph induces a canonical decomposition Ps = Ps+ + Ps[?] on any nilpotent adjacency operator Ps. The work concludes with applications to Markov chains and random graphs. [ABSTRACT FROM AUTHOR]

Benefits of community participation and physical activity for the health and wellbeing of older adults are well documented. This review aims to answer the question; "How is community participation considered for older adults in the transition from hospital to home?" This scoping review searched key databases using subject headings and keywords. Two independent reviewers selected studies based on a systematic procedure. Inclusion criteria were adults aged ≥60 years, transitioning from hospital to home, reporting on community participation, inclusive of leisure activities, social activities, and physical activity. Of 2206 initial unique articles, 19 met inclusion criteria. Articles covered a range of diagnoses, most frequently stroke, hip replacement, or fracture. Numerous measures of community participation were reported, identifying "low" and "reduced" community participation in ten studies. Measures of physical activity, health-related quality of life, sleep quality, and loneliness were variable. Five studies reported interventions and four reported improved components of community participation. Numerous barriers to community participation were identified, with recommendations for future transition care services considered. There are considerable barriers to promoting community participation in transition care services for older people. Older adults need information to prepare for returning home from hospital and to regain valued leisure and social activities for health-related quality of life. Community participation is an important component of healthy ageing which health professionals should consider beyond discharge. Levels of mobility and endurance should be considered in terms of facilitating community participation for older adults. Transition care services should provide adequate information to prepare individuals expectations of returning home following hospital stay, whilst attempting to maintain valued leisure and social activities. [ABSTRACT FROM AUTHOR]

This study aimed to determine if implementing a clinically pragmatic behavior management approach for challenging behaviors during acute TBI reduces use of restraints, security incidences, acute length of stay admission and cost, thereby improving progress to rehabilitation. This pilot study involved a behavior management group (n = 27), compared with a historical control group (n = 74). The behavior management group received care following the implementation of a behavior management approach for challenging behaviors during acute TBI at two hospitals in South Australia. Fidelity results demonstrated high level of adherence to the implemented behavior management approach. The behavior management group had significant lower use of mechanical restraints (p = 0.03), and significantly lower acute admission costs (p = 0.034). Trends in lower pharmacological restraint usage, lower acute hospital length of stay and time from admission to rehabilitation acceptance were recorded. These pilot results contribute to improving quality of health care but methodological limitations make outcomes difficult to interpret as a direct result of the intervention. Future studies are required to investigate evidence-based behavior management interventions for acute TBI patients using more rigorous knowledge translation implementation designs. [ABSTRACT FROM AUTHOR]

Introduction: Driver‐trained occupational therapists are advanced practitioners who work with people to help maintain their independence and autonomy through driving. There is a lack of investigation of professional reasoning processes for why interventions are recommended by driver‐trained occupational therapists. This research project sought to explore the reasoning of driver‐trained occupational therapists when they plan, implement, and reflect on driver rehabilitation interventions. Methods: In‐depth semistructured interviews (n = 7) and one focus group (n = 5) were conducted with 12 experienced driver‐trained occupational therapists, comprising a wide range of experience, client populations, and licensing jurisdictions. Data were analysed using a modified template analysis approach. Results: Seven higher order modes that reflect professional reasoning theory and hierarchical models were evident in the work of the driver‐trained occupational therapists, with no new modes of reasoning emerging. Ethical reasoning regarding the balance of safety versus client independence was an overarching shared framework, with therapists mostly using interactive and conditional reasoning in practice. Twenty‐three second‐level themes were identified that exemplify how the reasoning modes operate in practice. Therapists described assessment activity even when solely asked about intervention, indicating the importance of assessment to intervention design. The full hierarchy of reasoning was evident during the rehabilitation phase. Conclusion: These findings elucidate the application of professional reasoning in advanced occupational therapy practices and could support driver‐trained occupational therapists in making driving rehabilitation recommendations if used in reflective practices. [ABSTRACT FROM AUTHOR]

Introduction: People with end‐of‐life care needs are seen in an increasingly diverse range of health and community settings. Opportunity for continued occupational participation is highly valued by people at the end of life. This scoping review sought to identify the priorities and preferences for participation at the end of life and to map findings using the model of human occupation. Methods: A search strategy informed by the research question was developed in collaboration with a research librarian. Data sources used were Ovid Medline(R), CINAHL, Ovid Emcare, Scopus, Web of Science and PsychInfo. Studies that focused on clinician perspectives, clinical care, grief and loss, did not clearly identify end‐stage diseases, <18 years and written in languages other than English were excluded. Findings Forty‐four studies were included with a total of 1,070 study participants. Inductively developed themes were mapped against the model of human occupation constructs of volition (personal causation, values, interests), habituation (habits of occupational performance and routine), performance capacity and the lived body within the physical, social and occupational environment. The majority of findings sat within the construct of volition, particularly around sense of personal capacity, self‐efficacy and values. At the end of life, people prioritise ongoing engagement in valued occupations even if participation is effortful. As disease progresses, opportunity to exert influence and control over this participation and engagement increases in importance. Personal causation plays an important role in the experience of occupational participation at this time. Conclusion: This review provides important insights into the occupational priorities of people at the end of life and the importance of supporting agency and volition at this time. The model of human occupation and its client‐centred focus offer a framework for a more robust examination of ways to enhance volitional capacity and enable occupational participation for people at the end of life. [ABSTRACT FROM AUTHOR]

Background/aim Home visits, used by occupational therapists to facilitate independence and enhance safety, are effective but costly and time consuming. This research aims to establish the level of agreement in equipment prescribed by occupational therapists using: digital photographs only, and using home visits and digital photographs, respectively. Method Quasi-experimental methodological design conducted in private dwellings in the community in Adelaide with rehabilitation patients and their family members. The equipment recommended by occupational therapists for the toilet and bathroom using similar methods (both digital photographs from previous data; n = 5) was compared with equipment recommended using different methods (conventional home visits vs. digital photographs; n = 14). Results Percent agreement for equipment prescribed between groups, that is digital only and home visit/photography, respectively, were: 72.5/83.9% for toilet; 87.4/88.3% for bathroom and 83/87% for toilet and bathroom. Variability of agreement in the equipment prescribed showed that some items of equipment were incongruently prescribed, by both methods for toilet and bathroom areas. Conclusion Using digital photographs taken by family members, patient information, and an equipment list is a reliable method of making accurate equipment prescriptions in the toilet and bathroom areas. To enhance accuracy, in-depth patient information via face-to-face interview and measurements of physical environment should be included. [ABSTRACT FROM AUTHOR]

Purpose: It is acknowledged in the literature that the physical and cognitive effects of the degenerative neurological condition of multiple sclerosis can impact upon driver safety. The aim of this study was to identify the experiences and needs of people with multiple sclerosis in relation to driver assessment and rehabilitation. Methods: Focus group discussions were conducted with people with multiple sclerosis (MS) who were: currently driving; no longer licensed or no longer driving and health professionals. Results: The four themes that emerged from the data were: (1) from self-management to formal assessment - a journey of uncertainty and emotional dilemmas; (2) lost independence with grieving and adjustment by self and family; (3) alternative transport is challenging and unsatisfactory; (4) gaps in information and services exist. Conclusions: The results of this study highlight the need for ongoing support in relation to driving for people with MS, ranging from support for self-management, driving assessment and retraining, and preparation for loss of license. Standardised information needs to be developed and health professionals and licensing authorities require knowledge and skills to ensure driver assessment and rehabilitation processes and resources can better meet the needs of people with MS. [ABSTRACT FROM AUTHOR]

Aim: To explore what the obstacles are that deter patients from continuing stroke rehabilitation after discharge from hospital in Singapore. Methods: In this qualitative study, individual semi-structured telephone interviews were undertaken and analysed using inductive thematic analysis. Thirty one stroke patients, who had been discharged from the hospital after inpatient rehabilitation (mean age=66.46 years, mean duration postdischarge= 95.82 days), were interviewed. Results: Five themes were identified as obstacles to post-discharge stroke rehabilitation including: the means to access rehabilitative services; lapse in discharge coordination; family members’ views and actions; discrepancies in expectation; and the perception that rehabilitation is simple. Participants indicated a need for timely and appropriate information, delivered according to their individualised needs. Conclusion: Study findings revealed that the absence of a smooth transition through the continuum of stroke care and not having a common understanding of rehabilitation accounts for the lack of adherence to therapy recommendations. The results suggest that clinicians need to be more aware of their role in providing well-coordinated information about therapy. The study also highlighted the need to review the goal-setting processes that guide the course of rehabilitation. Goals should be more patient-centred to reduce the discrepancies in expectations of rehabilitation. There needs to be a greater involvement of carers in discharge planning to minimise the dissatisfaction in care arrangements and information delivery. [ABSTRACT FROM AUTHOR]

Aim: To explore what the obstacles are that deter patients from continuing stroke rehabilitation after discharge from hospital in Singapore. Methods: In this qualitative study, individual semi-structured telephone interviews were undertaken and analysed using inductive thematic analysis. Thirty one stroke patients, who had been discharged from the hospital after inpatient rehabilitation (mean age=66.46 years, mean duration postdischarge= 95.82 days), were interviewed. Results: Five themes were identified as obstacles to post-discharge stroke rehabilitation including: the means to access rehabilitative services; lapse in discharge coordination; family members’ views and actions; discrepancies in expectation; and the perception that rehabilitation is simple. Participants indicated a need for timely and appropriate information, delivered according to their individualised needs. Conclusion: Study findings revealed that the absence of a smooth transition through the continuum of stroke care and not having a common understanding of rehabilitation accounts for the lack of adherence to therapy recommendations. The results suggest that clinicians need to be more aware of their role in providing well-coordinated information about therapy. The study also highlighted the need to review the goal-setting processes that guide the course of rehabilitation. Goals should be more patient-centred to reduce the discrepancies in expectations of rehabilitation. There needs to be a greater involvement of carers in discharge planning to minimise the dissatisfaction in care arrangements and information delivery. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: To investigate the relative importance of a number of key factors that influence older people in the decision to relinquish their driver's licence. Method: A discrete choice experiment (DCE) was administered as an online survey to Australian adults, 65 years plus (N =114) who drive, recruited from an online panel. The survey was composed of three main sections. (A) The Adelaide Driving Self Efficacy Scale to assess confidence in driving. The scale is generated from individual's responses about confidence in their driving ability in various situations. (B) The DCE in which respondents were presented with a series of hypothetical binary choice situations and asked to indicate in which situation they would be more likely to relinquish their driving licence. (C) Socio-demographic and health status questions. A conditional logit regression model was adopted to analyse the DCE data. Results: Older people would be more likely to relinquish their driver's licence due to advanced age, low confidence in driving ability and in situations where their local doctor advises them to cease driving. Other transport options availability and the cost of public transport were not found to be influential to this decision. Conclusions: Factors pertaining to the individual themselves including advanced old age and low confidence in driving ability may be more influential than environmental factors such as availability of other transport options and the cost of public transport in an older person's decision to relinquish their driving licence. [Copyright &y& Elsevier]

Background/aim Understanding the differences in preferences of patients and occupational therapists for the way in which rehabilitation services are provided is important. In particular, it is unknown whether new approaches to rehabilitation such as high intensity therapy and virtual reality programs are more or less acceptable than traditional approaches. Methods A discrete choice experiment was conducted to assess and compare the acceptability of these new approaches, relative to other characteristics of the rehabilitation program. The study included patients participating in a stroke or medical rehabilitation program (n = 100), occupational therapists (n = 23) and other clinicians (n = 91) working in rehabilitation settings at three hospitals in South Australia. Data were analysed using a conditional (fixed-effects) logistic regression model. Results The model coefficient attached to very high intensity therapy programs (defined as six hours per day) was negative and highly statistically significant for both patients and therapists indicating aversion for this option. In addition, other rehabilitation clinicians and patients were strongly averse to the use of virtual reality programs (as evidenced by the negative and highly statistically significant coefficient attached to this attribute for both groups) relative to occupational therapists. Conclusion The comparison of the views of patients, occupational therapists and other rehabilitation clinicians revealed some differences. All participants (patients and clinicians) showed an inclination for programs that resulted in the best recovery. However, patients expressed stronger preferences than clinicians for traditional therapy approaches. As a group, occupational therapists were most likely to accept approaches such as virtual reality suggesting changes away from traditional delivery methods will be more readily integrated into practice. [ABSTRACT FROM AUTHOR]

There is a gap in the evidence on telerehabilitation (TR) for people with fragility fractures. It is unclear whether this group with recent falls who are often frail with cognitive changes will accept tele-rehabilitation and functional gains can be achieved using this approach. Prospective observational study of consecutive patients admitted with femoral or pelvic fracture to a hospital-based home rehabilitation service (HRS) between January and November 2017. Using tablets, multidisciplinary rehabilitation was provided via videoconferencing and use of exercise apps. Patients chose a face-to-face visit or TR. Information on demographic characteristics, functional levels, the total number of therapy sessions, TR episodes, reasons for non-acceptance of TR, and patient-reported experience using TR was collected. Fifty-two patients with hip and pelvic fractures were admitted to the HRS and 35 (67.3%) received TR. Patients who did not accept TR were older, frailer and more likely to be female than those who received TR. Of the 17 who did not receive TR, 6 were deemed unsuitable by staff due to hearing, vision or cognitive problems and 3 refused. The TR group achieved acceptable functional gains. In the TR group on average, participants had 13.63 (± 7.29) home visits however they only elected to have 3.43 (± 2.48) sessions delivered via TR. TR was acceptable to a subset of hip fracture patients but face-to-face was the preferred mode of delivery. More research is needed to understand patients' preferences and beliefs, and the influence of clinician attitudes on uptake of TR. [ABSTRACT FROM AUTHOR]

Background: With the advancing age of the population, and increasing demands on healthcare services, community participation has become an important consideration for healthy ageing. Low levels of community participation have been linked to increased mortality and social isolation. The extent to which community participation has been measured objectively in older adults remains scarce. This study aims to describe where and how older adults participate in the community and determine the feasibility of measurement methods for community participation.Methods: This observational cross-sectional study obtained data from 46 community dwelling older adults. A combination of Global Positioning Systems (GPS), accelerometry, and self-reported diaries were used over a 7-day monitoring period. Feasibility of methods were determined by calculating the loss of GPS data, questionnaires, and comparison of self-reported locations with GPS co-ordinates. Relationships between community participation, physical activity, social interactions, health related quality of life, sleep quality and loneliness were explored.Results: Older adults took a median (IQR) of 15 (9.25-18.75) trips out of home over the 7-day monitoring period, most frequently visiting commercial and recreational locations. In-home activities were mainly sedentary in nature, with out of home activities dependent on location type. Self-reported and GPS measures of trips out of home and the locations visited were significantly correlated (self-report 15.7 (5.6) GPS 14.4 (5.8) (r = 0.94)). Significant correlations between both the number of trips taken from home, with social interactions (r = 0.62) and the minutes of moderate to vigorous physical activity (MVPA) (r = 0.43) were observed. Daily MVPA was higher in participants who visited local walk/greenspaces (r = 0.48).Conclusion: Participants performed more activities with social interactions out of home and visited commercial locations most frequently. The combination of GPS, accelerometry and self-report methods provided a detailed picture of community participation for older adults. Further research is required with older adults of varying health status to generalise the relationships between community participation, location and physical activity.Trial Registration: Ethical approval was gained from the Flinders University Social and Behavioural Research Ethics Committee (protocol no. 8176). [ABSTRACT FROM AUTHOR]

Purpose: Driving is often a rehabilitation goal of people with acquired disability, and vehicle modifications are typically required to facilitate this outcome. Though there have been several survey studies on vehicle modifications for people with disability, there has been no qualitative work on understanding people with disabilities' experiences of being a modified vehicle driver. Method: An interpretative phenomenological approach was used to understand the lived experiences of drivers with disability. Semi-structured interviews were conducted (n = 8) with drivers who used a variety of vehicle modifications from simple to highly complex. Using NVivo, Stage 1 of the coding involved case by case analysis and Stage 2 cross case analysis to identify themes that best captured drivers' experiences. Results: Four core themes were identified: knowing vs. challenging limitations, making complex driving considerations, considering undesired alternative transportation options, and responding emotionally to temporary vehicle loss. The Person-Environment-Occupation model was used as an orientating framework to discuss findings. Conclusions: This explorative small scale study highlights that less than full utilisation of modified vehicles is not a result of driver choice, but rather a complex interface between drivers' physical and psychological limitations, and physical environments that do not support the needs of drivers with disability. The development of resources that identify environmental factors in public spaces (e.g., number and location of parking for people with disability, steps, slopes, ticket machines and their height and location) could support the driving choices of people with disabilities. It is important to assess psychological limitations of driving as well as physical limitations. Driving goals and driving capacity across different locations requires periodic review post-rehabilitation. More advocacy for improving community accessibility is required. [ABSTRACT FROM AUTHOR]

Introduction: Returning to driving is often a goal for people with acquired disabilities. Vehicle modifications make it possible for people with both acquired and lifelong disabilities to drive yet can be costly. There has been no financial evaluation of vehicle modifications in Australia or internationally. Methods: A social return on investment analysis of vehicle modifications was undertaken. Primary data were collected via qualitative interviews with consumers and other stakeholders (e.g. driver‐trained occupational therapists, rehabilitation physicians, driving instructors, vehicle modifiers) (n = 23). Secondary data were collected from literature searches and used to identify suitable financial proxies and make estimations of the proportion of drivers with vehicle modifications experiencing each outcome. A co‐investment model was adopted to estimate social return on investment and payback period for funder and consumer. Five scenarios were developed to illustrate social return for low‐cost modifications (Scenario 1) through to high‐cost modifications (Scenario 5). Results: Social return on investment ratios was positive for funder and consumer investment in all five scenarios. Social return on investment calculations based on co‐investment ranged from $17.32 for every $1 invested (Scenario 1) to $2.78 for every $1 invested (Scenario 5). Consumers' payback periods were between 5.4 and 7.1 months, and funders between 3.5 weeks and 2 years 8.4 months. Conclusion: Vehicle modifications represent sound investments for both funders and consumers. Given the short payback periods, funders should reconsider age restrictions on vehicles considered suitable for modifications, especially for low‐ to medium‐cost modifications. [ABSTRACT FROM AUTHOR]