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Burden and preparedness amongst informal caregivers of adults with moderate to severe traumatic brain injury

- Lieshout, Kirsten, Oates, Joanne, Baker, Anne, Unsworth, Carolyn, Cameron, Ian, Schmidt, Julia, Lannin, Natasha

  • Authors: Lieshout, Kirsten , Oates, Joanne , Baker, Anne , Unsworth, Carolyn , Cameron, Ian , Schmidt, Julia , Lannin, Natasha
  • Date: 2020
  • Type: Text , Journal article
  • Relation: International Journal of Environmental Research and Public Health Vol. 17, no. 17 (2020), p. 1-12
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  • Description: 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. © 2020 by the authors. Licensee MDPI, Basel, Switzerland.
  • Description: Data collection for this project was supported by the NSW Lifetime Care and Support Scheme (now iCare Foundation). N.A.L. is supported by a Future Leader Fellowship (Award ID 102055) from the National Heart Foundation of Australia.

Clinical reasoning in occupational therapy practice

- Scanlan, Justin, Brentnall, Jennie, Unsworth, Carolyn

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

- Bryden, Gabrielle, Rockloff, Matthew, Browne, Matthew, Unsworth, Carolyn

  • Authors: Bryden, Gabrielle , Rockloff, Matthew , Browne, Matthew , Unsworth, Carolyn
  • Date: 2021
  • Type: Text , Journal article
  • Relation: Vaccine Vol. 39, no. 45 (2021), p. 6653-6659
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  • Description: 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. © 2021 Elsevier Ltd

Effect of navigation problems, assessment location, and a practice test on driving assessment performance for people with alzheimer's disease

- Unsworth, Carolyn, Russell, Kay, Lovell, Robin, Woodward, Michael, Browne, Matthew

  • Authors: Unsworth, Carolyn , Russell, Kay , Lovell, Robin , Woodward, Michael , Browne, Matthew
  • Date: 2019
  • Type: Text , Journal article
  • Relation: Journal of Alzheimer's Disease Vol. 67, no. 3 (2019), p. 1035-1043
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  • Description: Background: People with Alzheimer's disease may be required to undertake clinical and on-road assessments to determine fitness to drive. The manner in which on-road assessments are conducted with drivers who do and do not have navigational problems may affect the outcome. Objectives: Investigate the effect of 1) navigational difficulties, 2) location of assessment (un/familiar area) and assessment order, and 3) undertaking a second assessment (practice), on passing an on-road driving assessment. Methods: Forty-three drivers undertook an Occupational Therapy-Driver Assessment Off Road Assessment (OT-DORA) Battery which included the Drive Home Maze Test (DHMT). Participants with/without a history of navigational problems were randomly allocated into three groups: 1) Unfamiliar/then familiar area assessment; 2) Unfamiliar/unfamiliar; 3) familiar/unfamiliar. An on-road assessment protocol was used including over 100 expected behaviors at nominated points along the directed route. For familiar area assessments, the driver self-navigated from their home to shops and services. A pass/fail decision was made for each assessment. Results: A generalized linear mixed effects model showed neither location, nor practice affected passing the on-road assessment. Participants with navigational problems were six times less likely to pass regardless of route familiarity and direction method, and the DHMT was a significant negative predictor of passing. Conclusion: Drivers with Alzheimer's disease who have navigational problems and are slow to complete the DHMT are unlikely to pass an on-road assessment. However, navigation and maze completion skills may be a proxy for an underlying cognitive skill underpinning driving performance. © 2019 - IOS Press and the authors. All rights reserved.

“I’m very visible but seldom seen” : consumer choice and use of mobility aids on public transport

- Unsworth, Carolyn, Rawat, Vijay, Sullivan, John, Tay, Richard, Naweed, Anjum, Gudimetla, Prasad

  • Authors: Unsworth, Carolyn , Rawat, Vijay , Sullivan, John , Tay, Richard , Naweed, Anjum , Gudimetla, Prasad
  • Date: 2019
  • Type: Text , Journal article
  • Relation: Disability and Rehabilitation: Assistive Technology Vol. 14, no. 2 (2019), p. 122-132
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  • Description: Purpose: The number of mobility aid users continues to rise as the population ages. While mobility aid users rely on public transport due to its affordability, evidence suggests access can be difficult. This study aims to describe people who use mobility aids to access public transport and the role of public transport access in influencing mobility aid choice. Methods: Sixty-seven mobility aid users participated in telephone surveys which predominantly used a structured quantitative format. Data were analysed descriptively and any additional comments were simply categorized. Results: Thirty-six participants were female (54%), with a total sample mean age of 58.15 years (SD = 14.46). Seventy-two percent lived in metropolitan areas, 48% lived alone, and the sample experienced a variety of conditions including spinal cord injury (37%) and arthritis (18%). Sixty-four percent of all respondents used two or more mobility aids including powered wheelchairs, scooters and walking frames. The most important features when choosing a mobility aid were reliability, turning ability and size. Fifty-two percent of all respondents strongly agreed that public transport is generally accessible. Conclusions: While work continues to ensure that public transport vehicles and stations are fully accessible, mobility aid users must manage current infrastructure and access a system which has been shown through this research to have many limitations. Mobility aid users, vendors and health professionals need to work together to identify mobility aids that fulfil needs, and are reliable and safe, so that mobility aid users are both “visible and seen” when accessing the public transport network.Implications for rehabilitation Some mobility aid users experience difficulties accessing and using public transport and further research is required to ensure the whole public transport network is fully accessible to people using mobility aids. Many people have more than one seated mobility aid, suggesting people can choose different aids for different purposes and environments. Health professionals may need to increase their involvement in assisting individuals to select and use mobility aids. © 2017, © 2017 Informa UK Limited, trading as Taylor & Francis Group.

A systematic review of evidence for fitness-to-drive among people with the mental health conditions of schizophrenia, stress/anxiety disorder, depression, personality disorder and obsessive compulsive disorder

- Unsworth, Carolyn, Baker, Anne, So, Man, Harries, Priscilla, O'Neill, Desmond

  • Authors: Unsworth, Carolyn , Baker, Anne , So, Man , Harries, Priscilla , O'Neill, Desmond
  • Date: 2017
  • Type: Text , Journal article
  • Relation: BMC Psychiatry Vol. 17, no. 1 (2017), p.
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  • Description: Background: Limited evidence exists regarding fitness-to-drive for people with the mental health conditions of schizophrenia, stress/anxiety disorder, depression, personality disorder and obsessive compulsive disorder (herein simply referred to as 'mental health conditions'). The aim of this paper was to systematically search and classify all published studies regarding driving for this population, and then critically appraise papers addressing assessment of fitness-to-drive where the focus was not on the impact of medication on driving. Methods: A systematic search of three databases (CINAHL, PSYCHINFO, EMBASE) was completed from inception to May 2016 to identify all articles on driving and mental health conditions. Papers meeting the eligibility criteria of including data relating to assessment of fitness-to-drive were critically appraised using the American Academy of Neurology and Centre for Evidence-Based Medicine protocols. Results: A total of 58 articles met the inclusion criteria of driving among people with mental health conditions studied, and of these, 16 contained data and an explicit focus on assessment of fitness-to-drive. Assessment of fitness-to-drive was reported in three ways: 1) factors impacting on the ability to drive safely among people with mental health conditions, 2) capability and perception of health professionals assessing fitness-to-drive of people with mental health conditions, and 3) crash rates. The level of evidence of the published studies was low due to the absence of controls, and the inability to pool data from different diagnostic groups. Evidence supporting fitness-to-drive is conflicting. Conclusions: There is a relatively small literature in the area of driving with mental health conditions, and the overall quality of studies examining fitness-to-drive is low. Large-scale longitudinal studies with age-matched controls are urgently needed in order to determine the effects of different conditions on fitness-to-drive. © 2017 The Author(s).

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

- Lannin, Natasha, Galea, Claire, Coulter, Megan, Gruen, Russell, Jolliffe, Laura, Ownsworth, Tamara, Schmidt, Julia, Unsworth, Carolyn

  • Authors: Lannin, Natasha , Galea, Claire , Coulter, Megan , Gruen, Russell , Jolliffe, Laura , Ownsworth, Tamara , Schmidt, Julia , Unsworth, Carolyn
  • Date: 2021
  • Type: Text , Journal article
  • Relation: International journal for quality in health care : journal of the International Society for Quality in Health Care Vol. 33, no. 1 (2021), p.
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  • Description: 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 Author(s) 2021. Published by Oxford University Press on behalf of International Society for Quality in Health Care. All rights reserved.
  • Description: 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 Author(s) 2021. Published by Oxford University Press on behalf of International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Persistent symptoms and activity changes three months after mild traumatic brain injury

- Cooksley, Rebecca, Maguire, Emma, Lannin, Natasha, Unsworth, Carolyn, Farquhar, Michelle

  • Authors: Cooksley, Rebecca , Maguire, Emma , Lannin, Natasha , Unsworth, Carolyn , Farquhar, Michelle
  • Date: 2018
  • Type: Text , Journal article
  • Relation: Australian Occupational Therapy Journal Vol. 65, no. 3 (2018), p. 168-175
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  • Description: Background/aim: Approximately, 80% of traumatic brain injuries are considered mild in severity. Mild traumatic brain injury (mTBI) may cause temporary or persisting impairments that can adversely affect an individual's ability to participate in daily occupations and life roles. This study aimed to identify symptoms, factors predicting level of symptoms and functional and psycho-social outcomes for participants with mTBI three months following injury. Method: Patients discharged from the Emergency Department of a major metropolitan hospital with a diagnosis of mTBI were contacted by telephone three months after injury. An interview with two questionnaires was administered: The Concussion Symptom Inventory (CSI) Scale and the Rivermead Head Injury Follow-Up Questionnaire (RHIFUQ). Data obtained were used to determine the type and prevalence of post-concussion symptoms and their impact on activity change. Results: Sixty-three people with mTBI participated in the study. The majority of participants (81%) reported that all symptoms had resolved within the three-month time frame. Of those still experiencing symptoms, workplace fatigue (22%) and an inability to maintain previous workload/standards (17%) were reported. Conclusion: There is a small, but clinically significant, subgroup of patients who continue to experience symptoms three-month post-mTBI. Symptoms experienced beyond the expected three-month recovery timeframe have the potential to adversely affect an individual's ability to participate in daily occupation and return to work. © 2018 Occupational Therapy Australia. **Please note that there are multiple authors for this article therefore only the name of the first 5 including Federation University Australia affiliate “Carolyn Unsworthy” is provided in this record**

Anti-vaccination and pro-CAM attitudes both reflect magical beliefs about health

- Bryden, Gabrielle, Browne, Matthew, Rockloff, Matthew, Unsworth, Carolyn

  • Authors: Bryden, Gabrielle , Browne, Matthew , Rockloff, Matthew , Unsworth, Carolyn
  • Date: 2018
  • Type: Text , Journal article
  • Relation: Vaccine Vol. 36, no. 9 (2018), p. 1227-1234
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  • Description: We examined the relationship between complementary and alternative medicine (CAM) use and vaccination scepticism; and specifically whether a person's more general health-related worldview might explain this relationship. A cross-sectional online survey of adult Australians (N = 2697) included demographic, CAM, and vaccination measures, as well as the holistic and magical health belief scales (HHB, MHB). HHB emphasises links between mind and body health, and the impact of general ‘wellness’ on specific ailments or resistance to disease, whilst MHB specifically taps ontological confusions and cognitive errors about health. CAM and anti-vaccination were found to be linked primarily at the attitudinal level (r = −0.437). We did not find evidence that this was due to CAM practitioners influencing their clients. Applying a path-analytic approach, we found that individuals’ health worldview (HHB and MHB) accounted for a significant proportion (43.1%) of the covariance between CAM and vaccination attitudes. MHB was by far the strongest predictor of both CAM and vaccination attitudes in regressions including demographic predictors. We conclude that vaccination scepticism reflects part of a broader health worldview that discounts scientific knowledge in favour of magical or superstitious thinking. Therefore, persuasive messages reflecting this worldview may be more effective than fact-based campaigns in influencing vaccine sceptics. © 2017 Elsevier Ltd

The experience of attempting to return to work following spinal cord injury : a systematic review of the qualitative literature

- Hilton, Gillean, Unsworth, Carolyn, Murphy, Gregory

  • Authors: Hilton, Gillean , Unsworth, Carolyn , Murphy, Gregory
  • Date: 2018
  • Type: Text , Journal article , Review
  • Relation: Disability and Rehabilitation Vol. 40, no. 15 (2018), p. 1745-1753
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  • Description: Purpose: This review sought to answer the question “What are the barriers and facilitators influencing people’s experience of return to work following spinal cord injury?” Methods: Studies that met the selection criteria were identified, presented and critically appraised using National Institute for Health and Care Excellence guidelines. Thematic synthesis was completed with studies possessing strong methodological rigor. Synthesis and interpretation involved three stages; coding of primary data; development of descriptive themes reflective of the primary data; and establishment of analytical themes to answer the review question. Results: Data from nine papers were included in the thematic synthesis. Several descriptive themes and three analytical themes were drawn from the data to answer the research question. Analytical themes included: a matrix of personal and environmental factors exists requiring complex navigation in order to create possibilities and opportunities for postinjury employment; the process of seeking or gaining employment shares a reciprocal relationship with the temporal nature of adjustment to spinal cord injury; and there is an intrinsic need for occupational engagement through paid employment. Conclusions: Returning to or gaining employment after spinal cord injury is a fundamentally difficult experience for people. Multiple strategies are required to support the navigation of the process. There is, however, a need in people with spinal cord injury, to be a worker, and with that comes the inherent benefits of being employed. Implications for rehabilitation Returning to work should be a significant focus of spinal cord injury rehabilitation. Employment is both possible and health promoting following spinal cord injury. Multiple strategies are required to support people to navigate the return to work process. It is important to be cognizant of the individual motivations for being a worker and the complexity of the adjustment process. Spinal cord injury centers can provide a consistent and supportive framework and culture of positivity about employment after spinal cord injury. © 2017 Informa UK Limited, trading as Taylor & Francis Group.

A randomised controlled trial to test the effectiveness of decision training on assessors' ability to determine optimal fitness-to-drive recommendations for older or disabled drivers

- Harries, Priscilla, Unsworth, Carolyn, Gokalp, Hulya, Davies, Miranda, Tomlinson, Christopher, Harries, Luke

  • Authors: Harries, Priscilla , Unsworth, Carolyn , Gokalp, Hulya , Davies, Miranda , Tomlinson, Christopher , Harries, Luke
  • Date: 2018
  • Type: Text , Journal article
  • Relation: BMC Medical Education Vol. 18, no. 1 (2018), p.
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  • Description: Background: Driving licensing jurisdictions require detailed assessments of fitness-to-drive from occupational therapy driver assessors (OTDAs). We developed decision training based on the recommendations of expert OTDAs, to enhance novices' capacity to make optimal fitness-to-drive decisions. The aim of this research was to determine effectiveness of training on novice occupational therapists' ability to make fitness-to-drive decisions. Methods: A double blind, parallel, randomised controlled trial was conducted to test the effectiveness of decision training on novices' fitness-to-drive recommendations. Both groups made recommendations on a series of 64 case scenarios with the intervention group receiving training after reviewing two thirds of the cases; the control group, at this same point, just received a message of encouragement to continue. Participants were occupational therapy students on UK and Australian pre-registration programmes who individually took part online, following the website instructions. The main outcome of training was the reduction in mean difference between novice and expert recommendations on the cases. Results: Two hundred eighty-nine novices were randomised into intervention; 166 completed the trial (70 in intervention; 96 in control). No statistical differences in scores were found pre-training. Post training, the control group showed no significant change in recommendations compared to the experts (t(96) = -.69; p =.5), whereas the intervention group exhibited a significant change (t(69) = 6.89; p < 0.001). For the intervention group, the mean difference compared with the experts' recommendations reduced with 95% CI from -.13 to.09. Effect size calculated at the post-training demonstrated a moderate effect (d =.69, r =.32). Conclusions: Novices who received the decision training were able to change their recommendations whereas those who did not receive training did not. Those receiving training became more able to identify drivers who were not fit-to-drive, as measured against experts' decisions on the same cases. This research demonstrated that novice occupational therapists can be trained to make decisions more aligned to those of expert OTDAs. The decision training and cases have been launched as a free training resource at www.fitnesstodrive.com. This can be used by novice driver assessors to increase their skill to identify drivers who are, and are not fit-to-drive, potentially increasing international workforce capacity in this growing field of practice. © 2018 The Author(s).

Barriers and enablers to aligning rehabilitation goals to patient life roles following acquired brain injury

- Sansonetti, Danielle, Nicks, Rebecca, Unsworth, Carolyn

  • Authors: Sansonetti, Danielle , Nicks, Rebecca , Unsworth, Carolyn
  • Date: 2018
  • Type: Text , Journal article
  • Relation: Australian Occupational Therapy Journal Vol. 65, no. 6 (2018), p. 512-522
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  • Description: Background/aim: Life roles are integral to occupational therapy practice. Goal setting is a method of establishing priorities to measure outcomes. While acquired brain injury can impact a person's ability to fulfil meaningful life roles, the alignment of goals set in rehabilitation to life roles, is unclear. This study aimed to (i) explore the alignment of goals with life roles for people with an acquired brain injury participating in inpatient rehabilitation; and (ii) identify barriers and enablers to life role discussions within a patient-directed goal setting framework. Method: A mixed-methods study was conducted on an inpatient rehabilitation unit in Victoria, Australia. Quantitative data were obtained from a retrospective file audit of randomly selected medical records. Qualitative data were collected through: a) interviews with patients and their families; and b) A focus group with occupational therapists. Thematic analysis of both audit data and narrative data was undertaken. Results: Thirty files were examined and demonstrated 33% alignment between goals and life roles. Four interviews were completed with patients, with a family member participating in two of these. Themes identified were: readiness, role concept, recovery concept and goal review. Five therapists attended the focus group. Themes identified were: Patient factors, goal review, expectations, role change and environment. Interview and focus group data identified that barriers to life role discussions included: lack of patient and family readiness, patients’ difficulty understanding role concept, focus on impairments and lack of family/ significant others support. Enablers included: having early conversations involving family, regular goal review and use of standardised tools. Conclusion: Goal setting in alignment with life roles is important in acquired brain injury rehabilitation, but may be limited. This process can be enhanced by including patients and their significant others in early goal setting conversations, along with regular goal review across the rehabilitation process. © 2018 Occupational Therapy Australia

Reliability of the Australian Therapy Outcome Measures for Occupational Therapy (AusTOMs-OT)

- Unsworth, Carolyn, Timmer, Amanda, Wales, Kylie

  • Authors: Unsworth, Carolyn , Timmer, Amanda , Wales, Kylie
  • Date: 2018
  • Type: Text , Journal article
  • Relation: Australian Occupational Therapy Journal Vol. 65, no. 5 (2018), p. 376-386
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  • Description: Background/aim: The delivery of evidence-based health care requires the routine adoption of outcome measures that are valid and reliable. The Australian Therapy Outcome Measures for Occupational Therapy (AusTOMs-OT) was developed in Australia to capture a global snapshot of status for any client, and has preliminary psychometric evidence to support use. Building on the psychometric evidence of the AusTOMs-OT will provide therapists and researchers with further information as to how best to apply the AusTOMs-OT in their field. This study reports on the reliability of the 12 AusTOMs-OT scales, which are each scored on the four domains of Impairment, Activity Limitation, Participation Restriction and Distress/Wellbeing. Methods: A total of 31 occupational therapists rated 12 written case studies on two occasions, separated by two weeks. Test–retest reliability, inter-rater reliability, intra-rater reliability (using intra-class correlation coefficients (ICCs)) and measurement error were calculated, in line with the COnsensus-based guidelines for the Selection of health Measurement Instruments (COSMIN). Results: The ICCs for inter-rater reliability for all domains for all scales ranged from 0.531 to 0.922 suggesting moderate to very high reliability. Therapist intra-rater reliability ranged from ICC 0.675 to 1.000, suggesting moderate to high consistency. The stability of the scales was demonstrated with test–retest ICCs coefficients ranging from 0.616 to 0.960. The measurement error was found to be below 0.5 point for all scales and domains except for Scale 1, Impairment (just over at 0.604) and similarly the error range for each scale was also all below 1 point except Scale 1, Impairment. Conclusion: The AusTOMs-OT scales possess moderate to very high reliability across the 12 scales. Occupational therapists can continue to use AusTOMs-OT with confidence with all clients to establish global outcomes and to build evidence to underpin practice. © 2018 Occupational Therapy Australia

Engaging patients with moderate to severe acquired brain injury in goal setting

- D’Cruz, Kate, Unsworth, Carolyn, Roberts, Karen, Morarty, Jacqui, Turner-Stokes, Lynne

  • Authors: D’Cruz, Kate , Unsworth, Carolyn , Roberts, Karen , Morarty, Jacqui , Turner-Stokes, Lynne
  • Date: 2016
  • Type: Text , Journal article
  • Relation: International Journal of Therapy and Rehabilitation Vol. 23, no. 1 (2016), p. 20-31
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  • Description: Background/Aims: An exploratory study of a novel approach to using the Goal Engagement Scale to examine patients’, families’ and health professionals’ perceptions of patient engagement in goal setting. Methods: This mixed methods study was conducted from September 2013 to April 2014 in both inpatient trauma and rehabilitation units at an Australian health care service. Participants were 22triads (patients with moderate to severe traumatic brain injury or stroke, their family member(s) and a treating health professional) participating in routine goal setting interviews. Goal setting interviews were audio recorded, transcribed and thematically analysed, drawing upon an iterative process of qualitative data analysis, while the Goal Engagement Scale scores were analysed descriptively, drawing comparison between triad participant findings. Findings: Perception of patient’s level of engagement in goal setting differed between health professionals, patients and families. Health professionals’ views dominated the goal setting process. Goal setting interview data revealed four main themes, highlighting the importance of reflective listening skills to build a trusting relationship with patients and families to support engagement in goal setting. Conclusions: The findings of this exploratory study both affirm the suitability of future research into goal setting engagement and provide clinically useful strategies to support engagement of patients and families in goal setting. © 2016 MA Healthcare Ltd. **Please note that there are multiple authors for this article therefore only the name of the first 5 including Federation University Australia affiliate “Carolyn Unsworth” is provided in this record**

Determining client cognitive status following mild traumatic brain injury

- Hobson, Elizabeth, Lannin, Natasha, Taylor, Amelia, Farquhar, Michelle, Morarty, Jacqui, Unsworth, Carolyn

  • Authors: Hobson, Elizabeth , Lannin, Natasha , Taylor, Amelia , Farquhar, Michelle , Morarty, Jacqui , Unsworth, Carolyn
  • Date: 2016
  • Type: Text , Journal article
  • Relation: Scandinavian Journal of Occupational Therapy Vol. 23, no. 2 (2016), p. 138-146
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  • Description: Background People with mild traumatic brain injury (mTBI) commonly experience cognitive impairments. Occupational therapists working in acute general hospitals in Australia routinely access client Glasgow Coma Scale (GCS) scores, and assess cognitive status using standardized tools and by observing basic activity of daily living (ADL) performance. However, limited evidence exists to identify the best assessment(s) to determine client cognitive status. Aim/objectives To determine whether cognitive status assessed by GCS score and the Cognistat are predictive of basic ADL performance among clients with mTBI in an acute general hospital and make inferences concerning the clinical utility of these assessment tools. Material and methods Retrospective analysis of medical record data on demographics, Cognistat, GCS, and modified Barthel Index (MBI) using descriptive statistics, chi-square tests and linear regression. Results Data analysis of 166 participants demonstrated that no associations exist between GCS and Cognistat scores, or Cognistat scores and MBI dependency level. The presence of co-morbid multi-trauma injuries and length of stay were the only variables that significantly predicted MBI dependency level. Conclusion and significance While the MBI scores are of value in identifying clients with difficulty in basic ADLs, Cognistat and GCS scores are of limited use in differentiating client levels of cognitive impairment and the authors caution against the routine administration of the Cognistat following mTBI. Further research is required to identify more suitable assessments for use with a mTBI population. © 2015 Taylor & Francis.

Public perspectives on acquired brain injury rehabilitation and components of care : a citizens' jury

- Lannin, Natasha, Coulter, Megan, Laver, Kate, Hyett, Nerida, Unsworth, Carolyn

  • Authors: Lannin, Natasha , Coulter, Megan , Laver, Kate , Hyett, Nerida , Unsworth, Carolyn
  • Date: 2021
  • Type: Text , Journal article
  • Relation: Health Expectations Vol. 24, no. 2 (Apr 2021), p. 352-362
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  • Description: 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.

A systematic review of professional reasoning literature in occupational therapy

- Unsworth, Carolyn, Baker, Anne

  • Authors: Unsworth, Carolyn , Baker, Anne
  • Date: 2016
  • Type: Text , Journal article , Review
  • Relation: British Journal of Occupational Therapy Vol. 79, no. 1 (2016), p. 5-16
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  • Description: Introduction: Over the past 33 years, theoretical and empirical articles have been published on professional reasoning in occupational therapy. This systematic review sought to answer two questions: (1) What is the nature and volume of professional reasoning literature; and (2) What do we know about the development of professional reasoning in students through literature exploring novice and expert differences? Method: A systematic review of the peer-reviewed literature with narrative and critical analysis. Findings: A total of 140 articles were classified into six topic areas: what is professional reasoning, ethics and moral reasoning?, methods of studying professional reasoning, novice-expert differences, professional reasoning of assistants, and advancing specific fields of practice using professional reasoning. Of these, 68% included analysis of data, and the remainder were discussions. Fourteen articles examining novice-expert differences were critiqued but only eight were rated as strong. Research findings prompt the need for reflection, extended fieldwork, and development of protocols to facilitate reasoning. Conclusion: This is the first systematic review of the professional reasoning literature, and provides a foundation for more detailed critiques of specific topics to be undertaken. While research strengths have been identified, gaps include the use of standardised measures of professional reasoning and identification of educational approaches that promote professional reasoning. © The Author(s) 2015.

Determining fitness to drive among drivers with alzheimer's disease or cognitive decline

- Unsworth, Carolyn, Chan, Siew-Pang

  • Authors: Unsworth, Carolyn , Chan, Siew-Pang
  • Date: 2016
  • Type: Text , Journal article
  • Relation: British Journal of Occupational Therapy Vol. 79, no. 2 (2016), p. 102-110
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  • Description: Introduction: Fitness to drive skills progressively deteriorate following a diagnosis of Alzheimer's disease/cognitive decline. Occupational therapists require standardised assessments to help them make recommendations to clients and licensing authorities regarding client fitness to drive. This research aimed to determine whether drivers in the early stages of Alzheimer's disease/cognitive decline can drive safely, and if this could be predicted using the occupational therapy - driver off-road assessment battery (OT-DORA Battery). Method: Drivers with Alzheimer's disease/cognitive decline were assessed by one of nine driver assessors over 18 months. Client data were collected on the OT-DORA Battery and following on-road assessment; the outcome was recorded as pass, pass with conditions, or fail. Results: A total of 63 clients were assessed, and n = 40 (63.5%) were passed as fit to drive, of whom 33(83%) had at least one condition placed on their licence. Client age and scores on four subtests of the OT-DORA Battery were predictive of outcome. Conclusion: A diagnosis of Alzheimer's disease/cognitive decline should not automatically preclude driving. Scores on four of the subtests from the OT-DORA Battery may be used to help determine whether a client is fit to drive or not fit to drive, or whether a client should be referred for specialist occupational therapy driver assessment. © The Author(s) 2015.

Hazard perception skills of young drivers with Attention Deficit Hyperactivity Disorder (ADHD) can be improved with computer based driver training : an exploratory randomised controlled trial

- Bruce, C., Unsworth, Carolyn, Dillon, M., Tay, R., Falkmer, T., Bird, P., Carey, L.

  • Authors: Bruce, C. , Unsworth, Carolyn , Dillon, M. , Tay, R. , Falkmer, T. , Bird, P. , Carey, L.
  • Date: 2017
  • Type: Text , Journal article
  • Relation: Accident Analysis and Prevention Vol. 109, no. (2017), p. 70-77
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  • Description: Background: Young drivers with Attention Deficit Hyperactivity Disorder (ADHD) are at higher risk of road traffic injuries than their peers. Increased risk correlates with poor hazard perception skill. Few studies have investigated hazard perception training using computer technology with this group of drivers. Objectives: *Determine the presence and magnitude of the between-group and within- subject change in hazard perception skills in young drivers with ADHD who receive Drive Smart training. *Determine whether training-facilitated change in hazard perception is maintained over time. Methods: This was a feasibility study, randomised control trial conducted in Australia. The design included a delayed treatment for the control group. Twenty-five drivers with a diagnosis of ADHD were randomised to the Immediate Intervention or Delayed Intervention group.The Immediate Intervention group received a training session using a computer application entitled Drive Smart. The Delayed Intervention group watched a documentary video initially (control condition), followed by the Drive Smart computer training session. The participant's hazard perception skill was measured using the Hazard Perception Test (HPT). Findings: After adjusting for baseline scores, there was a significant betweengroup difference in post-intervention HPT change scores in favour of the Immediate Intervention group. The magnitude of the effect was large. There was no significant within-group delayed intervention effect. A significant maintenance effect was found at 6-week follow-up for the Immediate Intervention group. Conclusions: The hazard perception skills of participants improved following training with large effect size and some maintenance of gain. A multimodal approach to training is indicated to facilitate maintenance. A full-scale trial is feasible. © 2017 Elsevier Ltd

Revision of the competency standards for occupational therapy driver assessors : an overview of the evidence for the inclusion of cognitive and perceptual assessments within fitness-to-drive evaluations

- Fields, Sally, Unsworth, Carolyn

  • Authors: Fields, Sally , Unsworth, Carolyn
  • Date: 2017
  • Type: Text , Journal article , Review
  • Relation: Australian Occupational Therapy Journal Vol. 64, no. 4 (2017), p. 328-339
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  • Description: Background/aim: Determination of fitness-to-drive after illness or injury is a complex process typically requiring a comprehensive driving assessment, including off-road and on-road assessment components. The competency standards for occupational therapy driver assessors (Victoria, Australia) define the requirements for performance of a comprehensive driving assessment, and we are currently revising these. Assessment of cognitive and perceptual skills forms an important part of the off-road assessment. The aim of this systematic review of systematic reviews (known as an overview) is to identify what evidence exists for including assessment of cognitive and perceptual skills within fitness-to-drive evaluations to inform revision of the competency standards. Methods: Five electronic databases (MEDLINE, CINAHL, PsycINFO, The Cochrane Library, OT Seeker) were systematically searched. Systematic review articles were appraised by two authors for eligibility. Methodological quality was independently assessed using the AMSTAR tool. Narrative analysis was conducted to summarise the content of eligible reviews. Results: A total of 1228 results were retrieved. Fourteen reviews met the inclusion criteria. Reviews indicated that the components of cognition and perception most frequently identified as being predictive of fitness-to-drive were executive function (n = 13), processing speed (n = 12), visuospatial skills, attention, memory and mental flexibility (n = 11). Components less indicative were perception, concentration (n = 10), praxis (n = 9), language (n = 7) and neglect (n = 6). Conclusion: This overview of systematic reviews supports the inclusion of assessment of a range of cognitive and perceptual skills as key elements in a comprehensive driver assessment and therefore should be included in the revised competency standards for occupational therapy driver assessors. © 2017 Occupational Therapy Australia