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1.
Gerontologist ; 54(3): 409-22, 2014 Jun.
Article in English | MEDLINE | ID: mdl-23512770

ABSTRACT

OBJECTIVES: The UQDRIVE program, a group education and support program, was developed to meet the needs associated with driving cessation for older adults. The current study investigated the effect of the program on community mobility. DESIGN AND METHODS: A prospective, parallel, stratified randomized controlled trial was undertaken with a waitlist control group receiving current clinical practice (no intervention). Data were collected pre, post, and 3 months following the intervention. Participants were adults aged 60 years or older who had ceased driving or planned to cease driving within 12 months. RESULTS: A total of 131 participants were included in analyses (67 intervention, 64 control). Participating in the intervention was significantly associated with a higher number of episodes away from home per week at immediately postintervention (z = 2.56, p = .01). This was not significantly maintained at 3-month follow-up. Participation in the intervention also significantly predicted higher use of public transport at immediately postintervention (z = 2.12, p = .034), higher use of walking at immediately postintervention (z = 2.69, p = .007), increased aspects of community mobility self-efficacy (z = 3.81, p = .0001), and higher satisfaction with transport at 3-month follow-up (z = 2.07, p = .038). IMPLICATIONS: The program increased community mobility immediately postintervention and transport satisfaction at 3 months postintervention. Due to a high attrition rate, further research is required to clarify the long-term impact of the intervention.


Subject(s)
Adaptation, Psychological , Automobile Driving , Self-Help Groups , Humans , Middle Aged , Prospective Studies , Walking
2.
Aust Occup Ther J ; 59(5): 384-92, 2012 Oct.
Article in English | MEDLINE | ID: mdl-22998516

ABSTRACT

BACKGROUND/AIM: Driving cessation has been recognised as affecting the health and wellbeing of older people. Further exploration of the impact of driving status on time use, role participation and life satisfaction was required. METHODS: A cross-sectional survey of 234 older people (current drivers, retired drivers and people who have never driven) was employed. Time use in the previous week, role participation and life satisfaction were measured and compared between the groups, while controlling for sociodemographic variables (health status, activities of daily living and instrumental activities of daily living status, gender, age and living situation). RESULTS: When compared to current drivers, retired drivers had significantly lower life satisfaction (P = 0.01), fewer present roles (P < 0.0001) and were less likely to participate in volunteer (P = 0.005) and family member roles (P = 0.009). Retired drivers spent less time on social leisure (P = 0.002) and away from home (P = 0.0001), and more time in solitary leisure (P= 0.0001). Comparing the participation of retired drivers with those who had never driven indicated that retired drivers spent significantly less time in volunteer work (P = 0.009). CONCLUSIONS: The findings indicate that older non-drivers may require support for participation and wellbeing.


Subject(s)
Activities of Daily Living , Automobile Driving/psychology , Personal Satisfaction , Quality of Life/psychology , Social Behavior , Aged , Aged, 80 and over , Automobile Driving/statistics & numerical data , Cross-Sectional Studies , Health Status , Humans , Interviews as Topic , Leisure Activities , Logistic Models , Queensland , Time Factors , Transportation/methods
3.
Aust Occup Ther J ; 59(1): 79-88, 2012 Feb.
Article in English | MEDLINE | ID: mdl-22272886

ABSTRACT

BACKGROUND/AIMS: Community mobility is affected by an interruption to or cessation of driving following traumatic brain injury (TBI). This study aimed to examine loss of the driving role and to explore the outcomes associated with driving cessation from the perspectives of key people involved within the process: people with TBI, their family members and involved health professionals. METHODS: A qualitative methodology was used, employing semi-structured interviews with 15 individuals with TBI who had experienced driving cessation, 10 family members and 10 health professionals working with this population. RESULTS: This article focuses on two themes, each with three subthemes. Being stuck: needs related to driving cessation had subthemes: (i) an emotional time, (ii) being normal and (iii) participation without driving. The second theme, A better way: suggestions to improve outcomes had subthemes: (i) information, (ii) support and trying it out and (iii) their family member's roles and needs. CONCLUSIONS: Driving cessation following TBI is associated with emotional, identity, transport and participation-related needs. An ongoing, individualised approach involving information, support and practical experiences may improve outcomes of driving cessation for people with TBI and their family members.


Subject(s)
Adaptation, Psychological , Automobile Driving/psychology , Brain Injuries/psychology , Mental Competency/psychology , Physical Fitness/physiology , Residence Characteristics , Adult , Brain Injuries/complications , Female , Health Status , Humans , Male , Middle Aged , Qualitative Research , Stress, Psychological , Young Adult
4.
Int Psychogeriatr ; 24(5): 794-802, 2012 May.
Article in English | MEDLINE | ID: mdl-22217466

ABSTRACT

BACKGROUND: This study explored the transport and lifestyle issues of older retired and retiring drivers participating in the University of Queensland Driver Retirement Initiative (UQDRIVE), a group program to promote adjustment to driving cessation for retired and retiring older drivers. METHODS: A mixed method research design explored the impact of UQDRIVE on the transport and lifestyle issues of 55 participants who were of mean age 77.9 years and predominantly female (n = 40). The participants included retired (n = 32) and retiring (n = 23) drivers. Transport and lifestyle issues were identified using the Canadian Occupational Performance Measure and rated pre- and post-intervention. RESULTS: Paired t-tests demonstrated a statistically significant improvement in performance (t = 10.5, p < 0.001) and satisfaction (t = 9.9, p < 0.001) scores of individual issues. Qualitative content analysis identified three categories of issues including: protecting my lifestyle; a better understanding of transport options; and being prepared and feeling okay. CONCLUSIONS: Participation in UQDRIVE had a positive and significant effect on the issues of the participants. The results highlight that although all participants stated issues related predominantly to practical concerns, there were trends in the issues identified by the drivers and retired drivers that were consistent with their current phase of the driving cessation process.


Subject(s)
Automobile Driving/psychology , Life Style , Retirement/psychology , Transportation , Activities of Daily Living/psychology , Aged , Female , Health Services for the Aged , Humans , Male , Transportation/methods
5.
Disabil Rehabil ; 33(25-26): 2574-86, 2011.
Article in English | MEDLINE | ID: mdl-21671828

ABSTRACT

PURPOSE: The ability to drive safely is commonly affected by traumatic brain injury (TBI). Driving is a role and activity that is highly valued and also associated with successful community reintegration after TBI. Relatively little is understood about the processes of interruption to driving and potential return to driving that can be experienced by people with TBI and their family members (FMs). Exploring the way in which driving interruption, return to driving and permanent cessation of driving happen for people with TBI, their FMs and health professionals (HPs) who work with them can enable a fuller understanding of the experiences and needs and enhance the rehabilitation approaches in this situation. METHOD: A descriptive phenomenological approach was used to explore the experience with the aim of improving services for people with TBI. Semi-structured interviews about driving and driving cessation were conducted with 15 people with TBI, 10 FMs and 10 HPs who had experience in driving and driving cessation issues. RESULTS: The findings reveal experiences of the process of driving and driving cessation contextualised within experiences of the accident and treatment process. Participants identified key times of need in relation to driving: being told about driving restrictions, understanding driving restrictions, the 'on hold' period, and returning to driving. CONCLUSIONS: The processes surrounding driving and driving cessation after TBI are complex. Informational, support and practical needs differ at the different times. There are key times where people may need further support to improve rehabilitation outcomes. Rehabilitation approaches may particularly need to provide clear, consistent information about driving restrictions, and the process required for returning to driving. While recovery time appears necessary for allowing a safe return to driving, active support for continued involvement in the community using alternative transport may reduce the frustration and disengagement experienced by people in the 'on hold' period.


Subject(s)
Automobile Driving , Brain Injuries/rehabilitation , Occupational Therapy , Adaptation, Psychological , Adult , Automobile Driving/statistics & numerical data , Brain Injuries/psychology , Family , Female , Humans , Male , Middle Aged , Social Support , Young Adult
6.
Can J Occup Ther ; 78(2): 110-7, 2011 Apr.
Article in English | MEDLINE | ID: mdl-21560915

ABSTRACT

BACKGROUND: Driving cessation can lead to negative consequences, such as depression and reduced social activities. PURPOSE: The University of Queensland Driver Retirement Initiative (UQDRIVE) intensive support program is a six-week program to assist older people with driving cessation. METHODS: Fifty-five participants completed a survey of satisfaction with the program, including identification of the aspects of the program that were useful and they had applied in real life. FINDINGS: There was overall satisfaction with the program, and content analysis identified three areas that were highlighted as particularly useful: "Finding alternative means: transport and service options," "Planning with more wisdom: thinking about driving cessation," and "Being with people: sharing experiences with peers." IMPLICATIONS: These findings indicate that program participants were satisfied with the current UQDRIVE intensive support group program and found both the psychosocial supports and practical strategies to be useful in managing driving cessation.


Subject(s)
Adaptation, Psychological , Aging/psychology , Automobile Driving/psychology , Aged , Aged, 80 and over , Automobile Driving/education , Female , Health Status , Humans , Male , Personal Satisfaction , Program Evaluation , Queensland
7.
Work ; 38(2): 145-53, 2011.
Article in English | MEDLINE | ID: mdl-21297284

ABSTRACT

OBJECTIVE: The primary aim of the study was to explore the current practice of occupational therapists when assessing standing performance during Functional Capacity Evaluations (FCEs). METHODS: A semi-structured interview was conducted with occupational therapists and the participants were interviewed using both open and closed questions. PARTICIPANTS: A sample of occupational therapists (n=20) from Queensland, Australia were involved in a survey. They were all experienced in conducting FCEs. RESULTS: Ninety percent of the respondents used a distracting task during the assessment of standing with standardised and non-standardised nuts and bolts assembly tasks the most commonly used. Respondents reported using a mix of biophysical, physiological and psychophysical clinical observations to assess standing. The nuts and bolts assembly activities used by the respondents were rated to be of low interest in terms of engaging the client. CONCLUSIONS: It was identified there are minimal guidelines in the literature which focuses on assessment of standing in FCEs. Questions were raised regarding the adequacy of the use of nuts and bolts activities as a suitably distracting task in FCEs and further research is required on assessing standing in functional capacity evaluation including the use of suitably distracting activities.


Subject(s)
Occupational Therapy/methods , Posture/physiology , Work Capacity Evaluation , Female , Humans , Interviews as Topic , Male , Queensland
8.
Cochrane Database Syst Rev ; (9): CD006430, 2010 Sep 08.
Article in English | MEDLINE | ID: mdl-20824849

ABSTRACT

BACKGROUND: Cognitive impairment is a frequent consequence of stroke and can impact on a person's ability to perform everyday activities. There are a number of different intervention strategies that occupational therapists may use when working with people who have cognitive impairment post-stroke. OBJECTIVES: To determine whether occupational therapy improves functional performance of basic activities of daily living (ADL) and specific cognitive abilities in people who have cognitive impairment following a stroke. SEARCH STRATEGY: We searched the Cochrane Stroke Group Trials Register (last searched May 2009), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 1, 2009), MEDLINE (1966 to April 2009), EMBASE (1980 to April 2009), CINAHL (1982 to April 2009), PsycINFO (1840 to April 2009), PsycBITE, OTseeker and Dissertation Abstracts (the latest three were searched up to April 2009). In an effort to identify further published, unpublished, and ongoing trials, we also tracked relevant references through the cited reference search in Science Citation Index (SCI) and Social Science Citation Index (SSCI), reviewed the reference lists of relevant studies and reviews, handsearched relevant occupational therapy journals, and contacted key researchers in the area. SELECTION CRITERIA: Randomised and quasi-randomised controlled trials that evaluated an intervention focused on providing cognitive retraining to adults with clinically defined stroke and confirmed cognitive impairment. The intervention needed either to be provided by an occupational therapist or given under the supervision of an occupational therapist. DATA COLLECTION AND ANALYSIS: Two review authors independently examined the abstracts that might meet the inclusion criteria, assessed the quality and extracted data. We have presented results using mean differences. MAIN RESULTS: We included one trial with 33 participants in this review. We found no difference between groups for the two relevant outcomes that were measured: improvement in time judgement skills and improvement in basic ADLs on the Barthel Index. AUTHORS' CONCLUSIONS: The effectiveness of occupational therapy for cognitive impairment post-stroke remains unclear. The potential benefits of cognitive retraining delivered as part of occupational therapy on improving basic daily activity function or specific cognitive abilities, or both, of people who have had a stroke cannot be supported or refuted by the evidence included in this review. More research is required.


Subject(s)
Activities of Daily Living , Cognition Disorders/rehabilitation , Occupational Therapy/methods , Stroke/complications , Adult , Cognition Disorders/etiology , Humans , Randomized Controlled Trials as Topic , Stroke Rehabilitation
9.
Aust Occup Ther J ; 57(3): 190-6, 2010 Jun.
Article in English | MEDLINE | ID: mdl-20854588

ABSTRACT

BACKGROUND: The literature promotes the use of a wide range of educational materials for teaching and training clients with chronic conditions such as stroke. Client education is a valuable tool used by occupational therapists to facilitate client and carer ability to manage the stroke-affected upper limb. The aim of this study was to identify what information was provided to clients and carers, how this information was delivered, when the information was delivered and the client factors that influenced the method of information provision. METHODS: Convenience and snowball sampling was used to recruit occupational therapists working in stroke. Twenty-eight participants completed the study questionnaire anonymously and their responses were summarised descriptively. RESULTS: There was a clinically important trend for carers to receive less information than clients. Written and/or verbal information was the favoured method for delivering information related to handling (57%), soft-tissue injury minimisation (46.4%) and oedema management (50%). Information was delivered with decreasing frequency from admission (86%) to discharge (64%). More than 90% of participants indicated that the client's cognitive ability, visual ability, level of communication, primary language and perceptual ability were considered prior to the delivery of information. DISCUSSION: Participants regularly conveyed information to clients and carers with respect to management of the stroke-affected upper limb. However, an increased emphasis on the development of practical self-management skills, awareness of the impact of personal factors and a timeline for information provision may prove useful.


Subject(s)
Caregivers/psychology , Occupational Therapy/methods , Patient Education as Topic , Professional-Patient Relations , Stroke Rehabilitation , Upper Extremity , Awareness , Female , Health Knowledge, Attitudes, Practice , Humans , Information Dissemination , Psychometrics , Self Care , Self Report , Stroke/psychology , Surveys and Questionnaires , Treatment Outcome
10.
Can J Aging ; 29(3): 435-44, 2010 Sep.
Article in English | MEDLINE | ID: mdl-20731892

ABSTRACT

This article presents the results of a study on the barriers and facilitators to bus use for people aged 60 or older. Two complementary methodologies, nominal group technique and focussed ethnography, were used to identify barriers and facilitators and rank their importance. Two sample sites from Queensland, Australia, were selected, with 227 people participating in the nominal group technique and 40 people participating in the focussed ethnography component. Seven priorities for age-friendly bus systems emerged from the data: vehicle entrance/exit; bus driver friendliness and helpfulness; timetables and scheduling of buses; bus stop locations; pedestrian infrastructure; information and training for older people; and bus routes and destinations. These findings will assist researchers, policy makers, and transport providers to set evidence-based strategic directions for creating age-friendly bus systems. Both methods provide complementary perspectives on bus usability, which could not be gained from either method alone.


Subject(s)
Aging , Motor Vehicles , Social Environment , Aged , Architectural Accessibility , Female , Focus Groups , Humans , Male , Middle Aged , Queensland , Sampling Studies , Social Behavior , Surveys and Questionnaires , Transportation
11.
Top Stroke Rehabil ; 17(2): 99-107, 2010.
Article in English | MEDLINE | ID: mdl-20542852

ABSTRACT

PURPOSE: Cognitive impairment is a frequent consequence of stroke and can impact the ability of people who have had a stroke to perform everyday activities. There are a number of intervention strategies that various health professionals may use when working with people who have cognitive impairment post stroke. The purpose of this systematic review was to determine whether interventions for people with cognitive impairment after a stroke improve their functional performance of basic and/or instrumental activities of daily living (ADL). METHOD: Searches were performed in the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, PsycINFO, PsycBITE, OTseeker, and Dissertation Abstracts. Studies were eligible for inclusion if they were a randomised controlled trial or quasi-randomised controlled trial that evaluated an intervention that focused on providing cognitive retraining to adults with clinically defined stroke and confirmed cognitive impairment and measured functional ability, either basic or instrumental ADL, as either a primary or secondary outcome measure. RESULTS: Four studies, involving a total of 376 participants, were included in this review. There was no statistically significant difference between groups on basic ADL performance in any of the four studies or on instrumental ADL in the one study that measured this. CONCLUSION: There were not an adequate number of high quality trials to be able to make recommendations that support or refute the use of specific cognitive retraining interventions to improve functional outcomes following a stroke. More research is required before conclusions can be made about the effect of cognitive interventions on functional outcomes post stroke.


Subject(s)
Cognition Disorders/etiology , Cognition Disorders/rehabilitation , Cognitive Behavioral Therapy , Stroke Rehabilitation , Stroke/complications , Activities of Daily Living , Humans , Self Care
12.
Top Stroke Rehabil ; 17(2): 108-18, 2010.
Article in English | MEDLINE | ID: mdl-20542853

ABSTRACT

PURPOSE: Stroke survivors report multiple psychosocial issues after discharge and difficulties returning to meaningful roles and activities. This study explored the impact of an occupation-based group program on activity levels, well-being, and self-efficacy after discharge from inpatient rehabilitation. METHODS: This pilot study recruited participants from two hospital rehabilitation units. Both units provided individual therapy programs. Unit A provided an additional occupation-based group program. Behavioural mapping recorded participants' activity levels in hospital for one weekday and one weekend day. Outcome measures collected at recruitment, discharge, and/or 1 month after discharge included Modified Barthel Index, use of community supports, length of stay, Stroke Impact Scale, and Self- Efficacy Gauge. RESULTS: Participants from Unit A (n = 8) had a significantly longer length of stay than Unit B (n = 11) and spent significantly more time in occupational therapy (P = .01). Both participant groups were more inactive on the weekday compared to the weekend (P = .03). Participants in Unit A were more likely to report low levels of social participation and stroke recovery (P <.05) on the Stroke Impact Scale. CONCLUSION: There was no indication from the results of this study that an occupation-based group program had a positive effect on the measured outcomes.


Subject(s)
Occupational Therapy/methods , Physical Therapy Modalities , Stroke Rehabilitation , Aged , Female , Humans , Linear Models , Male , Patient Discharge/statistics & numerical data , Pilot Projects , Recovery of Function , Surveys and Questionnaires , Treatment Outcome
13.
Cochrane Database Syst Rev ; (6): CD006331, 2010 Jun 16.
Article in English | MEDLINE | ID: mdl-20556766

ABSTRACT

BACKGROUND: Sensory impairments significantly limit the ability to use the upper limb after stroke. However, little is known about the effects of interventions used to address such impairments. OBJECTIVES: To determine the effects of interventions that target upper limb sensory impairment after stroke. SEARCH STRATEGY: We searched the Cochrane Stroke Group Trials Register (last searched 8 October 2009), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2009, Issue 1), MEDLINE (1966 to January 2009), EMBASE (1980 to January 2009), and six further electronic databases to January 2009. We also handsearched relevant journals, contacted authors in the field, searched doctoral dissertation databases, checked reference lists, and completed citation tracking. SELECTION CRITERIA: Randomized controlled trials and controlled trials comparing interventions for sensory impairment after stroke with no treatment, conventional treatment, attention placebo or with other interventions for sensory impairment. DATA COLLECTION AND ANALYSIS: Two review authors selected studies, assessed quality and extracted data. We analyzed study data using mean differences and odds ratios as appropriate. The primary outcome we considered was sensory function and secondary outcomes examined included upper limb function, activities of daily living, impact of stroke and quality of life as well as adverse events. MAIN RESULTS: We included 13 studies, with a total 467 participants, testing a range of different interventions. Outcome measures included 36 measures of sensory impairment and 13 measures of upper limb function. All but two studies had unclear or high risk of bias. While there is insufficient evidence to reach conclusions about the effects of interventions included in this review, three studies provided preliminary evidence for the effects of some specific interventions, including mirror therapy for improving detection of light touch, pressure and temperature pain; a thermal stimulation intervention for improving rate of recovery of sensation; and intermittent pneumatic compression intervention for improving tactile and kinesthetic sensation. We could not perform meta-analysis due to a high degree of clinical heterogeneity in both interventions and outcomes. AUTHORS' CONCLUSIONS: Multiple interventions for upper limb sensory impairment after stroke are described but there is insufficient evidence to support or refute their effectiveness in improving sensory impairment, upper limb function, or participants' functional status and participation. There is a need for more well-designed, better reported studies of sensory rehabilitation.


Subject(s)
Recovery of Function , Somatosensory Disorders/rehabilitation , Stroke/complications , Upper Extremity , Adult , Humans , Outcome Assessment, Health Care , Randomized Controlled Trials as Topic , Somatosensory Disorders/etiology , Stroke Rehabilitation
14.
Work ; 33(3): 261-72, 2009.
Article in English | MEDLINE | ID: mdl-19759425

ABSTRACT

The continuation of older people in the paid workforce is regarded as beneficial for both the economy and older workers. While there have been attempts to encourage older people to continue working, little is understood about older workers' perspectives. This qualitative study explored the lived experiences and perceptions of paid workers aged 60 years and older with the aim of understanding why older people continue to work and the barriers and facilitators they encounter. Sixteen older Australians (eight males and eight females, mean age 67 years) who participated in paid employment for at least 12 hours per month were interviewed. Thematic analysis elicited themes of benefits of work, problems encountered at work and the ways in which older people respond to these challenges. Financial considerations, the desire to contribute and the absence of competing interests were reasons given for continuing involvement in work. Older workers identified stress, lack of support, physical demands and overemphasis on qualifications as barriers to their participation. Maintaining a healthy lifestyle, having a passion for work, and education were factors that participants identified as supporting continued work. These findings enhance the understanding of the experiences of older workers and may have implications for encouraging workforce participation of older people.


Subject(s)
Aging , Employment/psychology , Work/psychology , Adaptation, Psychological , Age Factors , Aged , Australia , Female , Humans , Interviews as Topic , Job Satisfaction , Male , Middle Aged , Motivation , Qualitative Research , Social Support
15.
Scand J Occup Ther ; 16(1): 3-12, 2009 Mar.
Article in English | MEDLINE | ID: mdl-18777441

ABSTRACT

The same reasons that prompt older people to give up driving can also result in difficulties with accessing public transport. Difficulties using public transport can limit older people's participation in society, thereby impacting negatively on their health. Focusing on public buses, this review explicates the link between bus usability and the health of older people and frames existing evidence on bus usability issues. The Person-Environment-Occupation (PEO) model offers a framework by which bus usability can be assessed. A combination of person-centred, environmental, and occupation-related factors, including bus design, service provision and performance, information, and the attitudes of staff and the community, impact on older people's ability to catch buses. More systematic research needs to take place in order to develop a comprehensive understanding of bus usability. Occupational therapy has a key role to play in conceptualizing, implementing, and evaluating improvements in bus usability for older people.


Subject(s)
Architectural Accessibility , Automobile Driving/psychology , Motor Vehicles , Social Behavior , Social Environment , Aged , Employment , Humans , Models, Biological , Models, Psychological
16.
Aust Occup Ther J ; 56(3): 177-88, 2009 Jun.
Article in English | MEDLINE | ID: mdl-20854511

ABSTRACT

BACKGROUND/AIMS: This study investigated the time use, role participation and life satisfaction of older Australians (aged 65 years and older) who were 1-3 years post-stroke and living in the community. The results of this study were compared with a published study on the time use, role participation and life satisfaction of older Australians who had not experienced stroke. METHODS: Twenty-three participants with stroke (mean age 74.2 years, 69.6% men) were interviewed using measures of time use, role participation and life satisfaction. RESULTS: Participants with stroke spent most of their time in sleep (7.2 h/day), solitary leisure (7.0 h/day), social leisure (3.0 h/day), and basic activities of daily living (2.9 h/day). Compared to the sample without stroke, participants with stroke spent significantly less time in sleep, instrumental activities of daily living, and volunteer work, and significantly more time at home, with others, and engaged in solitary leisure. Similar to the sample without stroke, the most common roles for participants with stroke were family member, friend, and home maintainer. Participants with stroke engaged in fewer roles than participants without stroke. Unlike the sample without stroke, role loss was not correlated with life satisfaction for participants with stroke; however, having more roles was correlated with greater life satisfaction. CONCLUSION: Experiencing a stroke can affect the configuration of older people's time use and reduce their role participation. Facilitation of older people's role participation after stroke may enhance their life satisfaction.


Subject(s)
Activities of Daily Living , Leisure Activities , Social Support , Stroke Rehabilitation , Aged , Aged, 80 and over , Case-Control Studies , Female , Humans , Independent Living , Male , Middle Aged , Patient Satisfaction , Role
17.
Aust Occup Ther J ; 56(5): 324-31, 2009 Oct.
Article in English | MEDLINE | ID: mdl-20854538

ABSTRACT

BACKGROUND/AIM: Cognitive impairment is a common and often debilitating consequence of stroke. The current practice patterns of Australian occupational therapists who work in this area are not clearly known. The aim of this study was to investigate the theoretical approaches, assessments, interventions and research evidence used by Australian occupational therapists who work with patients who have cognitive impairment poststroke. METHODS: A self-administered, purpose-designed online survey was used. RESULTS: Survey responses were received from 102 occupational therapists. The client-centred approach was the most commonly used theoretical approach, with 81.3% and 72% using it often or all of the time with inpatients and outpatients, respectively. Assessments that were most frequently used were the Mini Mental State Examination (63.7% of participants), the Lowenstein Occupational Therapy Cognitive Assessment (45.1%), the Functional Independence Measure (57.8%, and the Assessment of Living Skills and Resources (10.0%). Interventions involving functional activities were used more frequently than compensatory techniques, such as diaries, alarms, or other electronic devices, and paper and pencil remedial exercises. Few (16%) participants used computer programs specifically designed for cognitive rehabilitation. Although 60.8% of the participants reported using research literature when making decisions about interventions, a higher percentage reported relying on their past experience (88.3%) and colleagues' opinions (77.4%). CONCLUSION: This study provides an insight into the current practices of Australian occupational therapists who work with people who have cognitive impairment after stroke. Client-centredness is emphasised in current practice; however, the use of research evidence to inform practice appears to be limited.


Subject(s)
Cognition Disorders/rehabilitation , Occupational Therapy/methods , Patient-Centered Care/methods , Stroke Rehabilitation , Adult , Australia , Cognition Disorders/etiology , Female , Health Care Surveys , Humans , Internet , Male , Middle Aged , Stroke/complications , Young Adult
18.
Aust Occup Ther J ; 56(5): 350-60, 2009 Oct.
Article in English | MEDLINE | ID: mdl-20854541

ABSTRACT

AIM: This study aimed to examine the effect of clinical factors including side of stroke, region of affected cerebral circulation, type of stroke and time since stroke, as well as age on the number and type of impairments of visual perception and praxis in patients following stroke. METHODS: Two hundred and eight participants with stroke were conveniently sampled from 12 hospitals in Brisbane and the Gold Coast. Background information was collected and each participant was assessed for impairments of visual perception and praxis using the Occupational Therapy Adult Perceptual Screening Test. RESULTS: Participants with left-hemisphere stroke were more likely to have impaired body scheme than participants with right-hemisphere stroke. Additionally, participants with right-hemisphere stroke were more likely to have unilateral neglect and impaired constructional skills than those with left-hemisphere stroke. There was a significant relationship between region of affected cerebral circulation and the occurrence of agnosia, unilateral neglect and constructional skill impairment. Moreover, the number of visual perceptual impairments experienced by participants was associated with the region of affected cerebral circulation. Increasing age was significantly related to the occurrence of constructional skill impairment and acalculia. CONCLUSIONS: Side of stroke, region of affected cerebral circulation and age affected the type of impairments of visual perception and praxis experienced by patients following stroke. Furthermore, region of affected cerebral circulation also influenced the number of impairments of visual perception and praxis in patients after stroke. The results have implications for more specific targeting of assessment and treatment practices following stroke.


Subject(s)
Apraxias/diagnosis , Functional Laterality/physiology , Occupational Therapy/methods , Stroke/complications , Vision Disorders/diagnosis , Adult , Age Factors , Aged , Apraxias/etiology , Female , Humans , Logistic Models , Male , Middle Aged , Queensland , Stroke/pathology , Stroke/physiopathology , Vision Disorders/etiology
19.
Top Stroke Rehabil ; 15(4): 295-306, 2008.
Article in English | MEDLINE | ID: mdl-18782734

ABSTRACT

PURPOSE: Information provision is an integral part of poststroke care, and there is a need to identify how to provide it most effectively. Intervention details, such as content, delivery style, format, and timing, are infrequently reported in the literature. This project describes in detail the provision of information to clients with stroke and their carers by community services in Brisbane, Australia, and compares these to current recommendations in the literature. METHOD: Fifty-seven metropolitan-based community services were surveyed regarding the content, delivery style, format, and timing of information available to clients with stroke and their carers, using a telephone-administered questionnaire designed for this study. RESULTS: Services provided information using a range of formats and delivery styles. The most frequently provided topics were information on services and benefits available and practical management strategies. Less than 75% of services provided written information to most of their clients and/or carers. Less than 40% of services considered client and carer input when designing written information materials. CONCLUSION: Community services surveyed in this study demonstrated congruency with some, but not all, of the current content, format, and delivery style recommendations in the literature. Areas for improvement are discussed.


Subject(s)
Community Health Services , Patient Education as Topic/organization & administration , Stroke Rehabilitation , Australia , Guideline Adherence/statistics & numerical data , Humans , Patient Education as Topic/statistics & numerical data , Practice Guidelines as Topic , Practice Patterns, Physicians'/statistics & numerical data , Stroke/psychology , Surveys and Questionnaires , Teaching Materials
20.
Top Stroke Rehabil ; 15(4): 341-50, 2008.
Article in English | MEDLINE | ID: mdl-18782737

ABSTRACT

PURPOSE: To analyse the stroke content in OTseeker in terms of the quantity of the research evidence, the quality of the randomised controlled trials (RCTs), and the types of interventions and outcome measures used. METHOD: A survey of stroke-related content in the OTseeker database was conducted in 2007. The year of publication and intervention categories used in each stroke-related RCT and systematic review (SR) were recorded. The internal validity of RCTs using the PEDro scale (partitioned) and the outcome measures used were also recorded. RESULTS: Of the 4,369 articles indexed on OTseeker, 452 (10.3%) related to stroke were conducted between 1979 and 2006. The five most frequently studied intervention categories were movement training (43.2%), models of service delivery (31.2%), physical modalities/orthotics/splinting (30.1%), exercise/stretching/strength training (19.5%), and skill acquisition/training (9.3%). Random allocation (96.1%) was the most frequently satisfied internal validity criterion and therapist blinding (3.1%) was least often satisfied. The five most frequently used outcome measurement categories were basic and extended activities of daily living (70.1%), hand and upper limb function (56.1%), walking/gait (44.1%), movement/motor function (32.7%), and quality of life/general overall health (27.9%). CONCLUSION: The stroke-related content on OTseeker is useful for allied health professionals. This study highlights a need for better definitions of interventions and consensus about the best outcome measures. Few interventions or outcome measures were participation focused.


Subject(s)
Bibliometrics , Databases, Factual , Evidence-Based Medicine , Occupational Therapy/statistics & numerical data , Stroke Rehabilitation , Humans , Outcome Assessment, Health Care , Randomized Controlled Trials as Topic , Reproducibility of Results
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