Maori experiences of physical rehabilitation in Aotearoa New Zealand: a scoping review.

PURPOSE: The purpose of this review was to explore what is currently known about Maori experiences of physical rehabilitation services in Aotearoa New Zealand. METHODS: A scoping review was undertaken following steps described by the Joanna Briggs Institute. Databases and grey literature were searched for qualitative studies that included descriptions of Maori consumer experiences in their encounters with physical rehabilitation. Data relating to study characteristics were synthesised. Qualitative data were extracted and analysed using reflexive thematic analysis. RESULTS: Fourteen studies were included in this review. Four themes were generated that describe Maori experiences of rehabilitation. The first theme captures the expectations of receiving culturally unsafe care that become a reality for Maori during rehabilitation. The second theme describes whanau as crucial for navigating the culturally alien world of rehabilitation. The third theme offers solutions for the incorporation of culturally appropriate Maori practices. The final theme encompasses solutions for the provision of rehabilitation that empowers Maori. CONCLUSIONS: This scoping review highlights ongoing inequities experienced by Maori when engaging with rehabilitation services. Strategies for facilitating culturally safe rehabilitation for Maori have been proposed. It is essential that rehabilitation clinicians and policymakers implement culturally safe approaches to rehabilitation with a view to eliminating inequities in care provision and outcomes for Maori.

Maori experiences of physical rehabilitation are comparable to the negative experiences they have in other health contexts.Although there are pockets of optimism, the results of this scoping review indicate that the delivery of culturally safe rehabilitation is inconsistent in Aotearoa New Zealand.A whanau-centred approach to rehabilitation is key to recovery and healing for Maori.There are opportunities for clinicians to disrupt the culturally unsafe care experienced by Maori by facilitating rehabilitation that normalises Maori cultural practices and embeds Maori approaches to health and wellbeing.

Early Daily Activity: Development and description of an occupation-based intervention for surgically repaired distal radius Fractures.

OBJECTIVE: To describe the theoretical development and structure of an occupation-based intervention for people with a surgically repaired distal radius fracture. INTERVENTION DEVELOPMENT AND RATIONALE: The Early Daily Activity (EDA) intervention uses the performance of strategically selected daily activities as the primary rehabilitative strategy. Occupation-based interventions are recommended for hand injury rehabilitation but are often poorly described and lack explicit theoretical underpinnings. The EDA-intervention was developed from exploratory research that informed the theory and structure. The theoretical principles are that daily activity performance is (i) safe within defined parameters (ii) appropriately self-determined (iii) produces high ranges and amounts of therapeutic movement, and (iv) builds psychosocial competencies. INTERVENTION DESCRIPTION: The EDA-intervention is designed to be commenced within 2 weeks of surgery. There are three key components. The first is activity-specific education to emphasise the safety, benefits, and therapeutic actions of activity performance. A set of parameters for defining safe activities is described to support education. The second component is patient-therapist collaboration to select a range of daily activities that provide a 'just-right' challenge. Collaboration occurs at regular intervals throughout the rehabilitation period to incrementally increase the challenge of activities. The third component is performance of activities at-home targeted at improving range of movement and function. NEXT STEPS: The EDA-intervention can be used by hand therapists, but it has not yet undergone effectiveness evaluation. A planned study will explore clinician readiness to adopt the EDA-intervention, inform iterative changes to the protocol and the design of feasibility and effectiveness studies.

University Staff Insights on Interprofessional Education and Student-Led Clinic Opportunities at an Australian University.

Purpose: Organizational and university staff buy-in and advocacy are critical considerations in planning successful interprofessional education (IPE) initiatives in healthcare, such as interprofessional student-led clinics (SLCs). This study was designed with the purpose of gaining deeper insight into current views and perspectives of academic and professional staff at an Australian university, as a precursor to planning IPE and SLC activities. Methods: All academic and professional staff from within the School of Health Sciences were invited to participate in the study. In-depth-qualitative interviews were conducted with 16 staff to explore academic and professional staff perspectives on IPE and SLCs. Reflexive thematic analysis was used to analyse the data. Results: Findings are grouped within five themes that incorporate broad perspectives on the tensions and possibilities of IPE and establishment of SLCs: Academic and professional staff commitment; Better/smarter IPE; Student-led clinic potential; Vision and innovation; and Strategy and resourcing. The themes reflect the high value placed on IPE by academic and professional staff and incorporate innovative ideas on how to prepare students for a rapidly changing and evolving healthcare environment. A reticence towards standard models of university based SLCs was expressed. Conclusion: Academic and professional staff insights suggest university leaders need to develop a greater strategic focus on improving IPE. Effective engagement with staff is required to support IPE planning and implementation. If considering implementation of SLCs, contemporary fit-for-purpose models should be explored such as partnerships with primary healthcare providers, community wellness facilities, and hospital clinics rather than traditional university-based clinics.

An evaluation of wrist and forearm movement during purposeful activities and range of movement exercises after surgical repair of a distal radius fracture: A randomized crossover study.

PURPOSE: Following surgical repair of distal radius fractures, range of movement (ROM) exercises are the primary approach for restoring movement during early rehabilitation. Specified purposeful activities can also be used, but the movement produced by activities is not well-understood. The study aimed to evaluate and compare movement during purposeful activity and ROM exercises METHODS: Thirty-five adults with a surgically repaired distal radius facture undertook two 10-minutes interventions: purposeful activity (PA) and active ROM exercises (AE), separated by a 60 minute washout, in random order. Data collection occurred during a single session on the same day. Electrogoniometry was used to measure time-accumulated position (TAP), a global metric of movement range and amount, maximum active end range, movement repetitions, excursions >75% of available ROM, and active time. Data were analyzed using linear mixed and generalized linear mixed regression models. RESULTS: Purposeful activities selected were predominantly household or food preparation. TAP was significantly higher during AE than PA: -1878 [-2388, -1367], p ≤.001, for wrist extension/flexion. PA produced significantly greater movement repetitions for wrist extension/flexion and deviation, excursions beyond 75% of available ROM, and active time, than AE. During PA the wrist was extending/flexing a mean of 97% [92, 101], of the time, compared with 43% [40, 47], during AE. There were no significant differences in maximum end range for wrist extension between PA, 33.7° [29.8, 37.5] and AE, 34.5° [30.7, 38.4], or for ulnar deviation. CONCLUSIONS: ROM exercises produced higher volumes of sustained joint position than purposeful activity but activities, selected for importance and challenge, produced significantly higher volumes of continuous, repetitious motion in equivalent ranges of movement as exercise repetitions. The study challenges therapists to consider the rehabilitative potential of movement produced by activity for restoring movement and function in the early postoperative weeks.

"The more I do, the more I can do": perspectives on how performing daily activities and occupations influences recovery after surgical repair of a distal radius fracture.

PURPOSE: The study aimed to explore perceptions and experiences about how engaging in daily activities and occupations influenced recovery in the first eight weeks after surgical treatment of a distal radius fracture. METHODS: Twenty-one adults completed an online activity and exercise log then participated in a semi-structured interview between weeks 6 and 8 postoperatively. Interviews were transcribed and analysed using reflexive thematic analysis. RESULTS: Daily activities and occupations were highly influential in facilitating recovery of movement and function of the operated limb. Five themes provided an understanding of how occupation operated to promote recovery. Occupation was (i) a primary driver of the rehabilitative process, providing an impetus for recovery, (ii) offered ready-to-hand challenges for opportunistic, automatic movement, (iii) invited intentional use of the affected wrist, (iv) habituated the wrist to movement through repetition and confidence-building, and (iv) drew on psychosocial resources to enable reengagement with life activities and roles. CONCLUSIONS: Incorporating the performance of graded, modified activities during the early weeks of rehabilitation creates opportunities for wrist movement, enhances wellbeing, and assists in the habituation of wrist movement. Activities and occupations can be used as a therapeutic strategy to promote recovery from surgical treatment of a distal radius fracture.Implications for rehabilitationRehabilitation after surgical repair of distal radius fractures has traditionally focused on exercise routines.Daily activities and occupations can also be used to promote wrist movement and function during the early weeks of rehabilitation.Occupation is a naturally occurring source of wrist movement, motivation, and wellbeing that can be harnessed for therapeutic advantage after surgical repair of distal radius fractures.Therapists can collaborate with patients to select and modify daily activities and occupations to incorporate into early postoperative therapy programmes.

Influence of Purposeful Activities on Upper Extremity Motor Performance: A Systematic Review.

Following upper extremity injury, exercise-approaches are commonly used to address motor impairments. Occupation-based approaches are also used but less widely promoted and their mechanisms of action not well-understood. Movement performed during purposeful activities and occupations may yield better motor performance than during nonpurposeful tasks. This review investigated the influence of engagement in purposeful activities and occupations on upper extremity motor performance in healthy and musculoskeletal populations. Databases were searched for studies in healthy or upper extremity musculoskeletal-injured adults that compared motor performance during purposeful activities against nonpurposeful movements. Twenty-one studies of moderate quality, conducted predominantly in healthy populations, were included. Upper extremity movement quantity and quality were enhanced when performed during purposeful conditions. Purposeful activities have potential to be used following injury to enhance movement and address motor impairments to a greater extent than is currently promoted. Research in musculoskeletal populations is required.