A Systematic Review of Effective Interventions and Strategies to Support the Transition of Older Adults From Driving to Driving Retirement/Cessation.

Background and Objectives: In most western countries, older adults depend on private cars for transportation and do not proactively plan for driving cessation. The objective of this review was to examine current research studies outlining effective interventions and strategies to assist older adults during their transition from driver to driving retirement or cessation. Research Design and Methods: A search was completed across 9 databases using key words and MeSH terms for drivers, cessation of driving, and older adult drivers. Eligibility screening of 9,807 titles and abstracts, followed by a detailed screening of 206 papers, was completed using the Covidence platform. Twelve papers were selected for full-text screen and data extraction, comprising 3 papers with evidence-based intervention programs and 9 papers with evidence-informed strategies. Results: Three papers met the research criteria of a controlled study for programs that support and facilitate driving cessation for older adults. Nine additional studies were exploratory or descriptive, which outlined strategies that could support older drivers, their families, and/or healthcare professionals during this transition. Driving retirement programs/toolkits are also presented. Discussion and Implications: The driver retirement programs had promising results, but there were methodological weaknesses within the studies. Strategies extracted contributed to 6 themes: Reluctance and avoidance of the topic, multiple stakeholder involvement is important, taking proactive approach is critical, refocus the process away from assessment to proactive planning, collaborative approach to enable "ownership" of the decision is needed, and engage in planning alternative transportation should be the end result. Meeting the transportation needs of older adults will be essential to support aging in place, out-of-home mobility, and participation, particularly in developed countries where there is such a high dependency on private motor vehicles.

Comprehensive quality assessment for aphasia rehabilitation after stroke: protocol for a multicentre, mixed-methods study.

INTRODUCTION: People with aphasia following stroke experience disproportionally poor outcomes, yet there is no comprehensive approach to measuring the quality of aphasia services. The Meaningful Evaluation of Aphasia SeRvicES (MEASuRES) minimum dataset was developed in partnership with people with lived experience of aphasia, clinicians and researchers to address this gap. It comprises sociodemographic characteristics, quality indicators, treatment descriptors and outcome measurement instruments. We present a protocol to pilot the MEASuRES minimum dataset in clinical practice, describe the factors that hinder or support implementation and determine meaningful thresholds of clinical change for core outcome measurement instruments. METHODS AND ANALYSIS: This research aims to deliver a comprehensive quality assessment toolkit for poststroke aphasia services in four studies. A multicentre pilot study (study 1) will test the administration of the MEASuRES minimum dataset within five Australian health services. An embedded mixed-methods process evaluation (study 2) will evaluate the performance of the minimum dataset and explore its clinical applicability. A consensus study (study 3) will establish consumer-informed thresholds of meaningful change on core aphasia outcome constructs, which will then be used to establish minimal important change values for corresponding core outcome measurement instruments (study 4). ETHICS AND DISSEMINATION: Studies 1 and 2 have been registered with the Australian and New Zealand Clinical Trial Registry (ACTRN12623001313628). Ethics approval has been obtained from the Royal Brisbane and Women's Hospital (HREC/2023/MNHB/95293) and The University of Queensland (2022/HE001946 and 2023/HE001175). Study findings will be disseminated through peer-reviewed publications, conference presentations and engagement with relevant stakeholders including healthcare providers, policy-makers, stroke and rehabilitation audit and clinical quality registry custodians, consumer support organisations, and individuals with aphasia and their families.

Occupational Encounters: The Interpersonal Impact of Bus Drivers' Engagement With Disabled Passengers.

Whether mundane or meaningful, interpersonal encounters are prerequisites for (and have a significant impact on) many occupations. This study sought to understand the interpersonal impact and occupational relevance of encounters, through exploring encounters between bus drivers and disabled passengers. The Person-Environment-Occupation-Performance (PEOP) Model was applied as part of a Framework Analysis, separately examining bus driver and disabled passenger data. The Interpersonal-Person-Environment-Occupation-Performance (I-PEOP) Model prototype was then developed to enable simultaneous exploration of the factors impacting such encounters. Application of the I-PEOP and PEOP Models found encounters between bus drivers and disabled passengers were pivotal to the exclusion or inclusion of disabled passengers in their communities. Understanding the occupational relevance of encounters, and the factors that determine their interpersonal impact, prompts occupational therapists to identify and address how intersectionality, power dynamics, occupational roles, and inter-perceptions impact an individual's community mobility and inclusion.

The Impact of Bus Drivers' Encounters With Disabled PassengersWherever we go, we meet people. We might smile at a baby in a pram, order coffee, or ask someone the time at the bus stop. These can be called "encounters," little moments with strangers. Sometimes these encounters may help or stop people from doing things they need or want to do, or from feeling included in their community. Researchers wanted to know more about encounters between bus drivers and disabled passengers. So, they asked bus drivers and disabled passengers questions about their encounters. The researchers then mapped out drivers' and passengers' answers to try to better understand their encounters using a "model" called the Interpersonal-Person-Environment-Occupation-Performance Model. This model helps people look at how their individual and shared experiences overlap. Encounters greatly impact people, so it would be good to learn more about them in the future.

Entrapment and extraction of wheelchairs at flange gaps with and without flange gap fillers at pedestrian railway crossings.

PURPOSE: Where pedestrian crossings meet rail tracks, a flange gap allows the train wheel flanges to pass. This gap can be hazardous for wheelchair users as castor wheels may become trapped. While compressible gap fillers can eliminate the flange gap, fillers are subject to wear, pose a derailment hazard to light rail vehicles and can strip grease from passing wheels. These issues could be mitigated by partially filling the flange gap with a compressible filler. The aim was to investigate the risk of entrapment and ease of extraction of wheelchair castors from flange gaps fully and partially filled with compressible fillers, and assess ride quality. MATERIALS AND METHODS: Entrapment risk and ease of extraction for four wheelchairs were tested at various crossing angles with flange gap fillers. Twelve wheelchair users tested ease of extraction and ride quality for partially and fully filled flange gaps. RESULTS: It was found that risk of entrapment is low if a standards-compliant crossing with open flange gaps is traversed in a straight line. However, castors can become trapped if the user alters direction to avoid an obstacle or if the crossing surface is uneven. Once trapped, castors are extremely difficult to remove without external assistance. CONCLUSIONS: Flange gap fillers that reduce the gap to 10 mm or less eliminate entrapment while retaining acceptable ride quality. Filling flange gaps or leaving a residual gap depth of less than 10 mm is the best option to eliminate risk of entrapment and ensure good ride quality for wheelchair users.IMPLICATIONS FOR REHABILITATIONRail crossings flange gaps pose an entrapment hazard for wheelchair usersPartial or complete flange gap fillers may reduce entrapment but require researchRehabilitation professionals need to educate wheelchair users on techniques to cross flange gaps safelyConsumers and health professionals can consult rail operators to partially fill flange gaps.

Initial validation of the powered mobility device autonomy residential screen (PoMoDARS).

BACKGROUND: The Powered Mobility Device Autonomy Residential Screen (PoMoDARS) is a new tool to enable clinicians to screen resident capacity and performance skills for powered mobility device (PMD) use in residential aged care settings. The PoMoDARS is context specific, time efficient and promotes resident autonomy and safety. AIMS: To (i) undertake initial face and content validation of the PoMoDARS, and (ii) use the research findings to make any modifications. METHODS: A mixed-methods study design, underpinned by Classical Test Theory. Eight clinicians completed 20 PoMoDARS screens and provided both quantitative and qualitative feedback on item importance and ease of use within a formal interview. RESULTS: Initial face and content validity of the PoMoDARS were supported, with small modifications made to item descriptors and instructions. CONCLUSIONS: The PoMoDARS has been developed for use in residential aged care settings to screen resident PMD use. While initial validation has been undertaken, further studies to determine the reliability of the tool and continue the validation process are required. SIGNIFICANCE: Older adults in residential aged care facilities benefit greatly from the autonomy gained through PMD use. The PoMoDARS promotes collaboration between occupational therapists, nurses, and the wider team to support residents and safe PMD use.

A Systematic Review of Wheelchair and Mobility Scooter Containment Systems Used Internationally on Public Transit Buses.

Despite the daily need for people to travel on public transit buses using their wheeled mobility devices, relatively little information is available regarding the most efficacious, affordable, and independent approaches to assist passengers with keeping their mobility devices in the designated wheelchair access space. A systematic review was undertaken to summarize this literature, place it within a geographical and temporal context, appraise its quality, and establish common themes. Key academic and grey literature transportation databases and government websites searched from 1990 to May 2022 identified 33 documents, which were appraised using the Mixed Methods Appraisal Tool (MMAT) or the Authority, Accuracy, Coverage, Objectivity, Date, Significance (AACODS) tool. Overall, the documents included were of good quality. The literature retrieved focused on the development and testing of the active containment systems favored for use in North America with a contrastingly small examination of the effectiveness of passive or semi-passive containment systems. Almost no literature was retrieved in English from European researchers documenting the use or effectiveness of rearward-facing passive systems. While tip or slide events are relatively rare among mobility device users, the effective use of containment systems is vital to minimize these. Further research is required to support transport policy makers, operators, and bus drivers to identify and correctly implement optimal containment systems to promote safety for all passengers on public buses.

Powered mobility device use in residential aged care: a retrospective audit of incidents and injuries.

BACKGROUND: Powered wheelchairs and motorised mobility scooters, collectively called powered mobility devices (PMD), are highly valued by older Australians, including those living in residential care, to facilitate personal and community mobility. The number of PMDs in residential aged care is expected to grow proportionally with that of the wider community, however, there is very little literature on supporting residents to use PMDs safely. Prior to developing such supports, it is important to understand the frequency and nature of any incidents experienced by residents whilst using a PMD. The aim of this study was to determine the number and characteristics of PMD use related incidents occurring in a group of residential aged care facilities in a single year in one state in Australia including incident type, severity, assessment, or training received and outcomes on follow-up for PMD users living in residential aged care. METHODS: Analysis of secondary data, including documentation of PMD incidents and injuries for one aged care provider group over 12 months retrospectively. Follow-up data were gathered 9-12 months post incident to review and record the outcome for each PMD user. RESULTS: No fatalities were recorded as a direct result of PMD use and 55 incidents, including collisions, tips, and falls, were attributed to 30 residents. Examination of demographics and incident characteristics found that 67% of residents who had incurred incidents were male, 67% were over 80 years of age, 97% had multiple diagnoses and 53% had not received training to use a PMD. Results from this study were extrapolated to project that 4,453 PMD use related incidents occur every year within Australian residential aged care facilities, with the potential for outcomes such as extended recovery, fatality, litigation, or loss of income. CONCLUSION: This is the first time that detailed incident data on PMD use in residential aged care has been reviewed in an Australian context. Illuminating both the benefits and the potential risks of PMD use emphasizes the need to develop and improve support structures to promote safe PMD use in residential aged care.

Education leads to increased adherence to the 'Australian Competency Standards for Occupational Therapy Driver Assessors'.

BACKGROUND: Occupational therapy competency standards provide an evidence-base to inform clinical best practice, however it is not known whether education about competency standards will increase occupational therapists' adherence to their use. AIMS/OBJECTIVES: To investigate if education about the 'Australian Competency Standards for Occupational Therapy Driver Assessors' leads to increased adherence to the competency standards in the clinical practice of occupational therapy driver assessors. MATERIALS AND METHODS: A mixed methods multiple case study design was used to evaluate 5 occupational therapy driver assessors' adherence to the competency standards. An audit of 25 client files and interviews were conducted to evaluate practice against the competency standards prior to an education session, followed by an audit of a further 25 files, interview and feedback after education. RESULTS: Qualitative and quantitative analyses suggest that education about the 'Australian Competency Standards for Occupational Therapy Driver Assessors' was associated with increased adherence to the competency standards in clinical practice. The results also support the use of competency standards in clinical practice. CONCLUSIONS AND SIGNIFICANCE: Competency standards can be used to inform and guide clinical practice, and individualised education and feedback of practice against the competency standards can increase occupational therapists' adherence to these standards.

Menstrual hygiene management strategies used by women who are blind or have low vision.

BACKGROUND: Menstrual hygiene management is a global public health issue that requires local and individualized support to reduce activity limitations and enable safe, independent task performance for people with impaired body functions. AIM: How do women with blindness or low vision self-manage their menstrual hygiene to promote independence, and what do they recommend occupational therapists incorporate in education for young women when working in this field? METHODS: Phenomenological design revealing lived experience expertise. Semi-structured interviews were conducted with six women who are blind or have low vision aged 16-70 in Australia. The resulting data transcripts were coded and analyzed thematically using the Person-Environment Occupation Performance Model as an organizing framework. RESULTS: Participants reported a range of personal (touch) and organizational strategies relying on environmental cues such as regular times for changing sanitary items, lining up pads using underwear seams and wearing dark clothing to disguise leaks. Participants suggested that group occupational therapy education sessions be used to promote self-management. CONCLUSIONS AND SIGNIFICANCE: The lived experience of women who successfully self-manage menstrual hygiene with blindness or low vision has generated evidence to inform the development of therapist-mediated interventions and resources that could be applied with women across a range of clinical populations.

Survey of Occupational Therapy Driver Assessors' Rehabilitation Interventions With Older Drivers.

The rehabilitation strategies used by occupational therapy driver assessors with older drivers with age-related decline or health conditions are not well understood. The objective of the study was to describe driver rehabilitation interventions used by Australian driver assessors, identify factors that guide rehabilitation choices, and identify barriers and facilitators encountered. An online survey was emailed to 300 driver assessors. Descriptive statistics were used to summarize and to rank order participant responses. A total of 148 respondents selected from a combined total of 655 interventions. The four most common rehabilitation methods were (a) graded driving (18%, n = 118), (b) practicing specific maneuvers (17.7%, n = 116), (c) using a modified vehicle (16.9%, n = 111), and (d) graded driving in local areas only (15.1%, n = 99). The most common barrier limiting driver rehabilitation was cost (M = 2.92, SD = 1.24). The most frequently used driver rehabilitation method was on-road training. Practice can be enhanced by collating and evaluating resources, and ensuring effective interventions are more accessible.

Injury by design: A thematic networks and system dynamics analysis of work-related musculoskeletal disorders in tram drivers.

Tram driving is a safety critical task where work-related musculoskeletal disorders (WRMSDs) and injuries are associated with interacting occupational design factors over time. These interactions then carry implications for workforce retention, public safety, workplace relations and supports. To better understand such interactions, this study used thematic networks and system dynamics (causal loop diagrams) analysis with the aim to unearth a global theme underscoring occurrence of WRMSDs, and describe the factors influencing the system dynamics of WRMSD occurrence in tram drivers. Building on earlier work focused on occupational participation, secondary analysis of driver interviews (n = 13) and driving observations (n = 11) produced thematic network and causal loop models of risk factors that highlighted an Injury by Design problem structure as a global theme. Research targeting organisational culture, human factors, and design standards is needed to minimise WRMSDs risk in tram drivers.

Effect of contamination and purity priming on attitudes to vaccination and other health interventions: A randomised controlled experiment.

The objective of this experiment is to assess whether priming for contamination and purity causes a change in attitudes to health interventions, including vaccination, and complementary and alternative medicines (CAMs). An online priming experiment was conducted with four between-subject experimental conditions including photos of: 1) biological contamination, 2) chemical contamination, 3) pure environments, such as pristine landscapes, and 4) hazard signs/icons indicating physical threats. Two control conditions included photos of neutral scenes and neutral icons, whereby experimental groups were compared against the related control groups (photograph for conditions 1-3 and neutral icons for condition 4). Subjects were randomly assigned to one of the six conditions, and after exposure to the images they were asked to rate 10 conventional and alternative health interventions for effectiveness and safety, as well being assessed for disgust sensitivity using the reduced-item DPSS-R [10]. A total of 642 adults completed the experiment. Exposure to primes did not cause a differential change in ratings of health interventions. Nevertheless, higher levels of sensitivity to disgust were associated with lower ratings of the effectiveness of MMR vaccination, tetanus injection, antibiotics, and surgery; and higher levels of sensitivity to disgust were associated with higher ratings of effectiveness of vitamins/minerals. In conclusion, this online experiment did not find an experimental effect of priming for contamination and purity on subjects' ratings of the safety and effectiveness of conventional and alternative health interventions. This indicates that attitudes to these health interventions are not influenced by a temporary increase in the salience of feelings of contamination or purity. However, individual differences in disgust sensitivity are related to their attitudes to vaccination and CAM interventions.

Fitness to drive practices among non-driver trained occupational therapists in an Australian community-based rehabilitation setting.

INTRODUCTION: Driving is a valued occupation given the independence and freedom it provides. Safe driving performance can be impacted by medical conditions, change in functional status and ageing processes. Occupational therapy driver assessors (OTDAs) provide invaluable driving recommendations; however, this requires specialist training for the therapist and is costly for clients. The number of OTDAs is not expected to meet the growing demand for expert services in this area, and little is known about the practices that non- OTDAs use to assist clients with returning to driving. The aims of this study were to investigate the practices of non-OTDAs in a community-based rehabilitation setting in Australia with respect to knowledge, confidence and skills in assessments, recommendations and outcomes for clients as part of the return to driving process. METHODS: A descriptive study including medical record audits between April and September 2019 and staff surveys were completed at a large metropolitan community-based rehabilitation facility. Descriptive statistics and thematic analysis were used to summarise data. RESULTS: A total of 102 client medical records were audited, and 13 clinician surveys were completed. Medical record audits identified that return to driving was not consistently addressed by occupational therapists. Clinician surveys outlined a lack of knowledge and confidence of return to driving processes and available assessment tools to guide this process. CONCLUSION: All occupational therapists have an ethical obligation to address driving as an activity of daily living; however, non-OTDAs report that they are not equipped for this role. This may negatively impact on driver safety, independence and overall health and well-being of clients in community-based rehabilitation. Further research is indicated to develop evidence-based driving resources to support best practice of non-OTDAs.

Feasibility of modifying the hospital environment to reduce the length of amnesia after traumatic brain injury: a pilot randomized controlled trial.

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

The revision of competency standards for occupational therapy driver assessors in Australia: A mixed methods approach.

INTRODUCTION: Competency standards outline the knowledge, skills, and attributes that are required for competent practice. This study describes the process followed to revise and validate the competency standards for occupational therapy driver assessors in order to guide clinical practice in this area of advanced occupational therapy practice. METHODS: A mixed methods research approach was used in this study. In phase 1, three focus groups with driver assessors reviewed and suggested revisions to the competency standards for occupational therapy driver assessors. Phase 2 involved content validation with key stakeholders through a focus group with consumers, written feedback from Australian state, and territory driver licensing authorities, and a two-round Delphi process with Australian occupational therapy driver assessors. RESULTS: Forty-nine occupational therapy driver assessors participated in the phase 1 focus groups. Deductive content analysis of the transcripts provided data to revise the competency standards. Inductive analysis provided an in-depth understanding of the participants' views and was interpreted through six categories and their underlying subcategories: purposes and benefits; jurisdictional variations and practice diversity; language use; defining competent practice; challenging systems and processes; and competency standards content. Forty-eight occupational therapy driver assessors participated in the Delphi process. In Round 1, only 1 of the 164 competency standards and practice behaviours rated did not achieve the pre-determined 70% consensus rate. In Round 2, all statements achieved consensus, with the overall average consensus level obtained across the Round 2 statements at 96.8%. CONCLUSION: The revised Australian Competency Standards for Occupational Therapy Driver Assessors have been endorsed by Occupational Therapy Australia and released for clinical use. The methods described in this research provide a framework suitable for revision or development of competency standards in both other areas of occupational therapy practice and other health-care professions.

A systematic review of public transport accessibility for people using mobility devices.

PURPOSE: Being able to access public transport is vital for mobility device users as this is an affordable way of maintaining community connections and participating in activities that promote quality of life. This systematic review investigated literature on public transport access for people using mobility devices, excluding transit restraint and securement literature. MATERIALS AND METHODS: A systematic review of the peer-reviewed literature in English from 1995 to 2019, with critical appraisal and narrative synthesis. RESULTS: Twenty-six articles were identified, including 14 studies investigating user experiences, seven examining bus formats and floor layouts, and five focusing on bus ramp incidents and optimal design. Studies were generally observational and descriptive, with 12 including analysis of video data. CONCLUSION: This is the first systematic review of literature related to the accessibility of public transport for people using mobility devices. Topics such as ramp access have been relatively well-researched, as have the experiences of users. However, many gaps remain and there is a need for research to; address the barriers identified through user experiences, discern the best access to stations and stops, as well as floor formats for people to ingress, manoeuvre and egress from a variety of transport modes, and promote universal design principles in the transport sector. Rehabilitation professionals can use the findings of this review to advocate for, and support people using mobility devices to successfully negotiate public transport.Implications for RehabilitationAccessible public transport is vital to enable people using mobility devices to remain connected in their communities.Despite increased international awareness and adoption of accessibility features by the public transport sector to improve getting to a stop, ingress, manoeuvrability within and egress from conveyances, access for people using wheeled mobility devices cannot be assumed.When prescribing new wheeled mobility devices with clients, rehabilitation professionals and users need to consider public transport access and the suitability of different devices for this purpose.Rehabilitation professionals can undertake skills training with people using wheeled mobility devices to test out access prior to independent travel on public transport and develop strategies to overcome any barriers.

An early warning system for diabetic automobile drivers with peripheral neuropathy.

PURPOSE: People with Type 2 diabetes exhibit peripheral neuropathy that results in the progressive loss of sensation in their feet. This may adversely affect their ability to drive as there is the potential for their foot to slip off the accelerator or brake pedals, with unwanted consequences including traffic accidents. This research aimed to develop a prototype for an adaptive haptic foot device for diabetic drivers experiencing peripheral neuropathy that can serve as an early warning system for foot slip during driving. METHODS: A prototype system was designed in the laboratory which consisted of four force sensing resistors, four light emitting diodes and an eccentric rotating mass all connected and programmed through an Arduino Uno. The prototype was tested under controlled conditions and validated against recommended specifications. The system was then installed in a Ford Falcon GT 2005 and tested under controlled road conditions. RESULTS: The results indicated that the haptic device was effective in sensing foot locations and providing instant audio and video feedback to the driver. CONCLUSION: This research has successfully designed and fabricated a haptic feedback device that can be used as an early warning system for diabetic automobile drivers with peripheral neuropathy.IMPLICATIONS FOR REHABILITATIONA haptic foot prototype device capable of generating warning signals to diabetic drivers whose foot could slip off the brake or accelerator pedals has been developed.The prototype includes force sensing receivers integrated with eccentric rotating mass system, a haptic controller breakout board, and Arduino software.The system is very easy to use and provides highly reliable audio and visual feedback which are good alerting mechanisms for older automobile drivers.

Public perspectives on acquired brain injury rehabilitation and components of care: A Citizens' Jury.

BACKGROUND: Brain injury rehabilitation is an expensive and long-term endeavour. Very little published information or debate has underpinned policy for service delivery in Australia. Within the context of finite health budgets and the challenges associated with providing optimal care to persons with brain injuries, members of the public were asked 'What considerations are important to include in a model of care of brain injury rehabilitation?' METHODS: Qualitative study using the Citizen Jury method of participatory research. Twelve adult jurors from the community and seven witnesses participated including a health services funding model expert, peak body representative with lived experience of brain injury, carer of a person with a brain injury, and brain injury rehabilitation specialists. Witnesses were cross-examined by jurors over two days. RESULTS: Key themes related to the need for a model of rehabilitation to: be consumer-focused and supporting the retention of hope; be long-term; provide equitable access to services irrespective of funding source; be inclusive of family; provide advocacy; raise public awareness; and be delivered by experts in a suitable environment. A set of eight recommendations were made. CONCLUSION: Instigating the recommendations made requires careful consideration of the need for new models of care with flexible services; family involvement; recruitment and retention of highly skilled staff; and providing consumer-focused services that prepare individuals and their carers for the long term. PATIENT AND PUBLIC CONTRIBUTION: As jury members, the public deliberated information provided by expert witnesses (including a person with a head injury) and wrote the key recommendations.

Burden and Preparedness amongst Informal Caregivers of Adults with Moderate to Severe Traumatic Brain Injury.

This study examined the patterns of informal (unpaid) caregiving provided to people after moderate to severe traumatic brain injury (TBI), explore the self-reported burden and preparedness for the caregiving role, and identify factors predictive of caregiver burden and preparedness. A cross-sectional cohort design was used. Informal caregivers completed the Demand and Difficulty subscales of the Caregiving Burden Scale; and the Mutuality, Preparedness, and Global Strain subscales of the Family Care Inventory. Chi-square tests and logistic regression were used to examine the relationships between caregiver and care recipient variables and preparedness for caregiving. Twenty-nine informal caregivers who reported data on themselves and people with a moderate to severe TBI were recruited (referred to as a dyad). Most caregivers were female (n = 21, 72%), lived with the care recipient (n = 20, 69%), and reported high levels of burden on both scales. While most caregivers (n = 21, 72%) felt "pretty well" or "very well" prepared for caregiving, they were least prepared to get help or information from the health system, and to deal with the stress of caregiving. No significant relationships or predictors for caregiver burden or preparedness were identified. While caregivers reported the provision of care as both highly difficult and demanding, further research is required to better understand the reasons for the variability in caregiver experience, and ultimately how to best prepare caregivers for this long-term role.

Maze test score time adjustments when using nondominant hand in fitness-to-drive assessments.

Drivers with medical conditions may need to demonstrate their fitness by participating in clinical and on-road assessments. Scores from the clinic-based occupational therapy-drive home maze test (OT-DHMT) can contribute to fitness-to-drive recommendations. The OT-DHMT is a short, timed test that has previously been shown to be valid and reliable, and norms are available for completion with a driver's dominant hand. Following stroke or trauma, many drivers need to complete assessments and resume driving using their nondominant hand. The validity of a person's OT-DHMT score when completed with a nondominant hand is unknown. This study investigated if a person's OT-DHMT score time requires adjustment when completed with a nondominant hand. The OT-DHMT was administered with a convenience sample of 148 community-dwelling participants, aged 21-81 years (M = 48.6, SD = 19.38) using both their dominant and nondominant hands, in a random order. OT-DHMT score times were significantly faster when using dominant (M = 15.73) compared with nondominant (M = 17.64) hand, d = 1.91 [confidence interval (CI) 1.13, 2.69], t = 4.84, P < 0.01. Employing a generalized weighted least squares regression model indicated that multiplying a driver's nondominant hand time by 0.833 s for drivers aged ≤60, and by 0.929 s for drivers aged 61+ can approximate dominant hand completion times. The OT-DHMT has been validated for use with people using their nondominant hand. Time adjustments are required for people using their nondominant hand when completing the OT-DHMT, and a larger adjustment is required for people aged ≤60 reinforcing previous findings that younger people have faster OT-DHMT completion times.