Challenges in the delivery of sex education for people with intellectual disabilities: A Chinese cultural-contextual analysis.

BACKGROUND: Staff members' views can have a significant impact on sexuality issues of people with intellectual disabilities. Research on the impact of sociocultural factors in this area in the Chinese context is sparse. METHODS: Semi-structured interviews were conducted with seven professionals (social worker, nurse, life skills trainer and manager) to explore their experiences of and attitudes towards the sexual needs of people with intellectual disabilities by applying interpretative phenomenological analysis. RESULTS: The study identified two major themes, each with two sub-themes: 1. Professional handling of the sexual needs of people with intellectual disabilities (sex education and intervention); 2. Barriers (incompatible approaches and parental resistance). Participants also experienced feelings of resignation facing the barriers they encountered. Collectivism and cultural view about sex are potentially the influencing factors. CONCLUSION: This study highlights the need to adopt an evidence-based sex education programme whose content and delivery should take account of cultural factors.

Potential occupational therapy scope of practice in the work-to-retirement transition in Australia.

INTRODUCTION: Retirement, being a major life event and a focus of healthy ageing in society, creates the opportunity for occupational therapists to support people transitioning from work to retirement. Little is known about the scope of practice of occupational therapy in the work-to-retirement transition. The aim of this study was to, in Australia, (1) explore the potential scope of practice and factors influencing the potential scope of practice of occupational therapy in the work-to-retirement transition and (2) map findings to occupational therapy theoretical frameworks to assist in articulating scope of practice. METHODS: A qualitative study (thematic analysis as an independent approach within a qualitative descriptive methodology) was undertaken using semi-structured interviews with Australian occupational therapists. FINDINGS: Australian occupational therapists (n = 14) were interviewed. Four themes were identified which related to the potential scope of occupational therapy practice in the work-to-retirement transition: finding meaningful occupation; modifying lifestyles and homes for better living; work engagement; and application of occupational therapy skills. Six themes were identified which related to contextual factors influencing the potential scope of occupational therapy practice in the work-to-retirement transition: right time; valuing our expertise; promoting occupation(al therapy); finding the money; life, work and retirement longevity; and social responsibility. CONCLUSION: The work-to-retirement transition can be incorporated into other practice areas or can be a unique practice area allowing for a more targeted service. The frameworks of who, what, when, and where and enablement skills assist in articulating occupational therapy scope of practice in the work-to-retirement transition. A number of contextual factors can be barriers and/or facilitators to occupational therapy practice. More clearly articulating occupational therapy practice in the work-to-retirement transition will enable the profession to promote their scope of practice assisting in obtaining professional and public recognition and overcoming barriers such as funding to enable provision of services within this area.

Current occupational therapy scope of practice in the work-to-retirement transition process: An Australian study.

BACKGROUND: Occupational therapists have skills to work with people considering or experiencing the transition from paid work to retirement. AIM: The aims were to explore: (1) occupational therapists' experiences and perceptions in working with people transitioning to retirement; (2) current scope of practice of occupational therapy in the work-to-retirement transition; and (3) factors influencing current scope of practice of occupational therapy in the work-to-retirement transition. METHODS: Qualitative semi-structured interviews with Australian occupational therapists were thematically analysed. RESULTS: Fourteen Australian occupational therapists were interviewed. Three overarching themes (12 sub themes) emerged: (1) occupational therapists' application of a contemporary occupational paradigm; (2) current approaches adopted by occupational therapists are add on, stylistic and talk based; and (3) contextual challenges and opportunities encountered by occupational therapists. CONCLUSION/SIGNIFICANCE: Occupational therapists use enablement skills (e.g. coach; collaborate) and consider various professional reasons (e.g. engagement in meaningful occupation; health responsibility) when addressing the transition from work to retirement. Overcoming barriers to service provision (e.g. funding; lack of role clarity) will facilitate a more comprehensive service provision to enable health and well-being of older adults.

Effects of functional task exercise on everyday problem-solving ability and functional status in older adults with mild cognitive impairment-a randomised controlled trial.

OBJECTIVE: To investigate the effect of functional task exercise on everyday problem-solving ability and functional status in older adults with mild cognitive impairment compared to single exercise or cognitive training and no treatment control. DESIGN: A single-blind, four-arm randomised controlled trial. SETTING: Out-patient clinic and community centre. PARTICIPANTS: Older adults with mild cognitive impairment aged ≥60 living in community. METHODS: Participants (N = 145) were randomised to 8-week functional task exercise (N = 34), cognitive training (N = 38), exercise training (N = 37), or wait-list control (N = 36) group. Outcomes measures: Neurobehavioral Cognitive Status Examination, Category Verbal Fluency Test, Trail Making Test, Problems in Everyday Living Test, Activities of Daily Living Questionnaire, Instrumental Activities of Daily Living Scale; Chair stand test, Berg Balance Scale, and Short Form-12 Health Survey were conducted at baseline, post-intervention and 5-months follow-up. RESULTS: Post-intervention results of ANCOVA revealed cognitive training improved everyday problem-solving (P = 0.012) and exercise training improved functional status (P = 0.003) compared to wait-list control. Functional task exercise group demonstrated highest improvement compared to cognitive training, exercise training and wait-list control groups in executive function (P range = 0.003-0.018); everyday problem-solving (P < 0.001); functional status (P range = <.001-0.002); and physical performance (P = 0.008) at post-intervention, with all remained significant at 5-month follow-up, and further significant improvement in mental well-being (P = 0.043). CONCLUSIONS: Functional task exercise could be an effective intervention to improve everyday problem-solving ability and functional status in older adults with mild cognitive impairment. The findings support combining cognitive and exercise intervention may give additive and even synergistic effects.

The experiences of work: Retirees' perspectives and the relationship to the role of occupational therapy in the work-to-retirement transition process.

BACKGROUND: Work experiences have the potential to influence retirement. Occupational therapists' understanding of the importance of engagement in occupation for active healthy ageing places them in a position to facilitate the work-to-retirement transition. OBJECTIVE: To describe the experience of work from retirees' perspectives to understand the influence of work on retirement and to discuss the role of occupational therapy in the work-to-retirement transition. METHODS: Semi-structured interviews with retirees were utilised. Thematic analysis identified themes and categories in relation to the experience of work. Categories were related to the Model of Human Occupation (MOHO). RESULTS: Eleven retirees were interviewed. Twelve categories relating to the experience of work were identified and were captured under three over-arching themes: Varied experiences and motivators; Intersection of work and life; and Impact of context. Categories collectively covered all MOHO concepts. Questions to guide therapeutic reasoning were developed to assist putting MOHO theory in to practice. CONCLUSIONS: Working experiences can be an influencing factor on retirement life. Occupational therapy could enable active healthy ageing through understanding the experience of work and how this can assist older workers to remain in the workforce, find a balance between work and other areas of life, and to choose retirement activities.

Pre-retirement job and the work-to-retirement occupational transition process in Australia: A review.

BACKGROUND: The transition from work to retirement is a complex process and unique experience with a relationship existing between work and retirement with implications for health in later life. This review explored the relationship between pre-retirement job and participation in the work-to-retirement transition process in Australia by exploring: (i) factors influencing retirement in relation to pre-retirement job; (ii) how jobs are classified; (iii) the effect of pre-retirement job (based on categories) on this occupational transition; and (iv) the potential role for occupational therapy in this occupational transition. METHOD: An integrative literature review was completed. PRISMA guidelines were used. Study designs were analysed for methodological quality using the National Health and Medical Research Council levels of evidence. Thematic analysis determined retirement factors which were used to compare differences between jobs. RESULTS: This review included 15 papers. There were two Level III-2, one Level III-3 and 13 Level IV studies. Factors influencing retirement related to the stages of work, preparation, transition and retired. White collar and blue collar was the most common job classification system. Although white collar and blue collar worker definitions utilised were inconsistent, differences between the two groups were still determined in all stages. CONCLUSION: Differences in the work-to-retirement transition process, based on pre-retirement job, are evident. Understanding differences by job groupings may assist occupational therapists to understand individualised needs during this occupational transition and subsequent tailoring of interventions (both individual and group based) to enable engagement in meaningful occupation in the work-to-retirement occupational transition to effect active healthy ageing.

A review of occupational therapy's contribution to and involvement in the work-to-retirement transition process: An Australian perspective.

BACKGROUND: Retirement from paid work is an occupational transition, which can have a profound impact on a person's life. This review explored occupational therapy's contribution to and involvement in the work-to-retirement transition process in Australia. METHODS: An integrative literature review was undertaken using seven article repository databases. PRISMA guidelines informed searches. Articles were included if participants were Australian; researchers' discussed retirement from an occupational perspective or the scope of practice of occupational therapists; and publication was from 1994 to June 2015 in a peer-reviewed journal. Articles were critically appraised and thematic analysis explored: (i) occupational perspective, (ii) occupational therapy scope of practice, (iii) theory and (iv) retirement definitions. RESULTS: Eight articles met the review criteria. Three occupational perspective themes were identified: retirement intention influences, retirement preparation and retirement roles and activities. No articles on the current scope of practice of occupational therapy were found. Three articles discussed potential occupational therapy approaches. Three themes on what retirement is were identified: complete cessation, gradual transition and intermittent worker. Four theory themes were identified: occupational therapy, ageing, identity and work. CONCLUSION: Occupational therapy has the potential to be involved in improving health and well-being for people in the work-to-retirement transition process. It is suggested that future research explore not only people's experiences but also the approaches of occupational therapy in assisting people through this occupational transition. The use of theory to guide Australian occupational therapy practice on retirement should also be explored. The use of consistent retirement definitions will assist in understanding research.

Integration of occupation based intervention in hand injury rehabilitation: A Randomized Controlled Trial.

STUDY DESIGN: Randomized Controlled Trial (RCT). INTRODUCTION: Engagement in daily occupations and day to day activities helps to restore function in individuals with injured hands and provides a platform to practise selected occupations. PURPOSE: The purpose of this study was to investigate the effectiveness of a combination of Occupation Based Intervention (OBI) and Therapeutic Exercise (TE) compared to TE alone for the rehabilitation of hand injuries. METHOD: A single center RCT, parallel group was conducted at the Kuala Lumpur General Hospital (KLGH), Malaysia. Forty-six adult clients with hand injuries who consented to participate were randomly allocated to either the OBI + TE group or to the TE group. RESULTS: Following a ten week intervention program, statistical significance differences were found in DASH score (TE = 18.64 ± 14.84 vs OBI + TE = 9.50 ± 9.14, p = 0.02); total active motion (TE = 1035.85 ± 179.84 vs OBI + TE = 1203.65 ± 133.60, p = 0.01); neuropathic pain (TE = 2.90 ± 2.79 vs OBI + TE = 1.05 ± 2.01, p = 0.02); COPM performance (TE = 7.62 ± 2.03 vs OBI + TE = 9.53 ± 0.64, p < 0.001); and COPM satisfaction (TE = 7.60 ± 2.11 vs OBI + TE = 9.49 ± 0.76, p < 0.001) in favor of OBI + TE group. CONCLUSION: This study highlighted the integration of OBI into hand injury rehabilitation improved outcomes for clients.

Occupation-based intervention in hand injury rehabilitation: Experiences of occupational therapists in Malaysia.

INTRODUCTION: In a previous study consensus was sought from Malaysian occupational therapists of occupation-based intervention (OBI) that was perceived as a means and an end. Occupation as a means refers to occupational and purposeful tasks as a therapeutic agent while occupation as an end refers to occupation as an outcome of intervention. The purpose of this follow-up study was to describe the occupational therapists' experiences of providing OBI in hand injury rehabilitation in Malaysia. METHODS: Sixteen occupational therapists with more than five years of experience in hand rehabilitation were individually interviewed on their experiences of using OBI in practice. Data were thematically analysed using interpretative phenomenological analysis. RESULTS: Definition of "Occupation as a means", and "Occupation as an end" was broadened after data analysis of interviews to include two new themes: "Rewarding yet challenging" and "Making OBI a reality". Occupational therapists had positive experiences with OBI and perceived that occupation as a means and an end can be merged into a single therapy session when the occupational therapists use an occupation that is therapeutic. CONCLUSION: Although occupation as a means and as an end have different purposes, when the ultimate goal is to enhance the clients' maximum level of functioning both can be used for successful rehabilitation of hand injuries.

Effects of functional tasks exercise on older adults with cognitive impairment at risk of Alzheimer's disease: a randomised controlled trial.

OBJECTIVE: the aim of this study was to compare the effects of a functional tasks exercise programme to a cognitive training programme in older adults with mild cognitive impairment. DESIGN: a single-blind randomised control trial with the intervention group compared with an active control group. SETTING: out-patient clinic. PARTICIPANTS: older adults with mild cognitive impairment (n = 83) aged 60 and older living in the community. METHODS: participants were randomised to either a functional task exercise group (n = 43) or an active cognitive training group (n = 40) for 10 weeks. All outcome measures were undertaken at baseline, post-intervention and 6-month follow-up using Neurobehavioral Cognitive Status Examination, Trail Making Test, Chinese Version Verbal Learning Test, Category Verbal Learning Test, Lawton Instrumental Activities of Daily Living Scale and Problems in Everyday Living Test. RESULTS: the functional task exercise group showed significant between-group differences in general cognitive functions, memory, executive function, functional status and everyday problem solving ability. The improvements were sustained over time at 6-month follow-up. CONCLUSION: a functional tasks exercise programme is feasible for improving cognitive functions and functional status of older adults with mild cognitive impairment. This may serve as a cost-effective adjunct to the existing interventions for populations with mild cognitive impairment. TRIAL REGISTRATION NUMBER: ACTRN12610001025022.

Effects of combined cognitive and exercise interventions on cognition in older adults with and without cognitive impairment: a systematic review.

Global concern on the potential impact of dementia is mounting. There are emerging calls for studies in older populations to investigate the potential benefits of combining cognitive and exercise interventions for cognitive functions. The purpose of this systematic review is to examine the efficacy of combined cognitive and exercise training in older adults with or without cognitive impairment and evaluate the methodological quality of the intervention studies. A systematic search of Cinahl, Medline, PsycINFO, ProQuest, EMBASE databases and the Cochrane Library was conducted. Manual searches of the reference list from the included papers and additional internet searches were also done. Eight studies were identified in this review, five of which included a cognitively impaired population and three studies included a cognitively healthy population. The results showed that combined cognitive and exercise training can be effective for improving the cognitive functions and functional status of older adults with and without cognitive impairment. However, limited evidence can be found in populations with cognitive impairment when the evaluation included an active control group comparison. Further well-designed studies are still needed to explore the potential benefits of this new intervention paradigm.

Translation and validation of Chinese version of the problems in everyday living (PEDL) test in patients with mild cognitive impairment.

BACKGROUND: Cognitive impairment places older adults at increased risk of functional decline, injuries, and hospitalization. Assessments to determine whether older persons are still capable of meeting the cognitive challenges of everyday living are crucial to ensure their safe and independent living in the community. The present study aims to translate and validate the Chinese version of the Problems in Everyday Living (PEDL) test for use in Chinese population with mild cognitive impairment (MCI). METHODS: The cultural relevancy and content validity of the Chinese version of PEDL (C-PEDL) was evaluated by a seven-member expert panel. Forty patients with MCI and 40 cognitively healthy participants were recruited to examine the psychometric properties of C-PEDL. RESULTS: Significant differences in the C-PEDL scores were found between the patients with MCI and the cognitively healthy controls in both educated (F = 9.96, p = 0.003) and illiterate (F = 10.43, p = 0.004) populations. The C-PEDL had excellent test-retest and inter-rater reliabilities, with intraclass correlation coefficient at 0.95 and 0.99 respectively. The internal consistency of C-PEDL was acceptable with Chronbach's α at 0.69. The C-PEDL had moderate correlation with the Mini-Mental State Examination (r = 0.45, p = 0.004) and the Category Verbal Fluency Test (r = 0.40, p = 0.012), and a moderate negative Spearman's correlation with the Global Deteriorating Scale (r = -0.42, p = 0.007). CONCLUSIONS: The C-PEDL is a valid and reliable test for assessing the everyday problem-solving ability in Chinese older population with MCI.

Development and initial testing of functional task exercise on older adults with cognitive impairment at risk of Alzheimer's disease--FcTSim programme--a feasibility study.

The purpose of this study was to illustrate the development of a new functional task-based exercise programme and initially test its feasibility as well as effectiveness for older adults with mild cognitive impairment (MCI). This study used a single-group repeated-measures design. A total of 11 patients (mean age 71.8 years) were recruited to participate in a structured functional task exercise programme for 10 weeks. All outcome measures were undertaken at baseline, post-intervention and post-3-month follow-up using the Neurobehavioral Cognitive Status Examination (NCSE), Verbal Fluency Test (VFT), Chinese Version Verbal Learning Test (CVVLT), Lawton Instrumental Activities of Daily Living Scale (Lawton IADL) and Problems in Everyday Living test (PEDL). Data were analysed using a repeated-measures analysis of variance. Cohen's d effect size was used to assess the practical significant effects. The participants showed significant improvement in NCSE composite score, VFT, CVVLT total free recall, CVVLT 10-minute delayed free recall, Lawton IADL and PEDL. Results of this study demonstrate that the newly designed functional task exercise programme, which uses simulated tasks, is feasible and beneficial to cognitive functions and functional status of older persons with MCI. The findings of the current study further reinforce occupational therapy practitioners' understanding that "occupation" is a "means" and an "end". Further study with a larger population is needed to draw more definitive conclusions.

Measures of everyday competence in older adults with cognitive impairment: a systematic review.

BACKGROUND: The issue of safety of the cognitively impaired elderly people living alone has been continuously raised. Traditional psychometric measures of cognitive abilities may not adequately reflect older adults' functioning in a real everyday context. OBJECTIVES: To conduct a systematic review on instruments available for evaluating the everyday problem-solving or everyday competence of the elderly with cognitive impairment and to critically review the measurement properties of the identified instruments. METHODS: We searched the databases such as Cinahl, Medline, PsycINFO, AARP Ageline, ProQuest and the Cochrane Library for the time period between January 1995 and December 2010. Reference lists of the included papers were also manually searched. RESULTS: Five instruments were included. All the instruments focused their framework on Instrumental Activities of Daily Living (IADL) domains which meet well with suggestions from other studies on the importance of IADL in determining an elderly individual's capability to live independently in the community. No available instruments for the moderate to severe impairment group were identified under this review. CONCLUSIONS: Few existing instruments to assess the ability of everyday problem-solving of the elderly with cognitive impairment can be identified in the literature. Further research validating them against functional, real-world outcomes is needed.

Death preparation among the ethnic Chinese well-elderly in Singapore: an exploratory study.

Death preparation is an important process as it can help the elderly to achieve ego integrity at the last stage of their lives. This study aims to explore how the ethnic Chinese elderly in Singapore approach issues related to death and dying, and to identify factors that influence death preparation. Descriptive surveys with semi-structured interview questions were used. Eight ethnic Chinese older adults, recruited through purposive sampling, were interviewed. Additionally, 4 adults with a deceased parent were also interviewed to validate and complement the earlier identified themes. Results show that the current generation of Chinese elderly in Singapore do not seem to be averse to talking about issues related to death, and those who find it unnecessary to prepare for death seem to be associated with, among other factors, lesser financial assets and a strong belief in filial piety. With increasing affluence and dissolving traditions, it will be beneficial to draw the attention of the current generation of mature adults on early preparation at the final stage of the lifespan.

Understanding the complex interplay between tourism, disability and environmental contexts.

PURPOSE: To explore and describe the complex issues and factors related to participation in tourism as perceived by people with disabilities in Hong Kong. METHOD: Naturalistic inquiry using key informant interviews and focus groups with 86 people with disabilities. Interviews were transcribed, translated and coded to develop themes and relationships. Triangulation of three investigators from different backgrounds occurred. RESULTS: The Process of Becoming Travel Active emerged as a six-stage process, intricately related to the personal/disability context and the environmental/travel context. Personal and environmental factors contribute to the six-stage model explaining the complex interplay between tourism, disability and environmental context. CONCLUSION: Understanding the complexity provides insight into ways to increase active participation in tourism. Health, tourism and disability sectors have a role to play in the development of accessible tourism.