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
Description:
Occupational therapy driver assessment and rehabilitation is an advanced and complex area of practice. Users of this service require that occupational therapy driver assessors are, and remain, competent in their role. Competency standards support and inform occupational therapy driver assessment and rehabilitation practice, ensure standardisation of practice, and determine whether practice can be deemed competent. Competency standards for occupational therapy driver assessors in one Australian state, Victoria, were published in 1998 to provide a benchmark for service provision and guide training. Since then, occupational therapy driver assessor practice has undergone further developments and growth, including a significant increase in research evidence underpinning this advanced practice area. As a result, the competency standards required revision to reflect contemporary practice and enable their use and application across all Australian states and territories. The purpose of the research program reported in this thesis was to revise and validate the Australian Competency Standards for Occupational Therapy Driver Assessors and determine if education and practice using these standards led to increased adherence to their use in clinical practice. A sequential, exploratory, mixed methods design was used within a pragmatist research paradigm to revise and validate the competency standards for occupational therapy driver assessors from a national perspective. Four separate research studies were conducted. In the first study, an overview was undertaken to summarise the current evidence for including cognitive and perceptual assessments within fitness-to-drive evaluations, to inform the revision of the competency standards for occupational therapy driver assessors. The second study involved focus groups with Australian occupational therapy driver assessors and expert educators and identified the changes and revisions required to be made to the Victorian competency standards for occupational therapy driver assessors. Content themes and changes were extracted from the focus groups and combined with research evidence to draft the revised standards. The third study collected feedback from consumers and Australian driver licensing authorities to incorporate into the revised draft. This was followed by a two-round Delphi process with Australian occupational therapy driver assessors to achieve consensus and validate the Australian Competency Standards for Occupational Therapy Driver Assessors. A high level of consensus on the content of all competency standards and underlying practice behaviours was obtained in the final round. Finally, a mixed-methods multiple case-study methodology was adopted, and multiple forms of evidence were collected from file audits, semi-structured interviews and an individualised education session with occupational therapy driver assessors. This study demonstrated that, for this sample, occupational therapy driver assessors’ adherence to the Australian Competency Standards for Occupational Therapy Driver Assessors increased following an individually tailored education package about the standards. The research in this thesis has contributed to the evidence base for occupational therapy driver assessor practice. The Australian Competency Standards for Occupational Therapy Driver Assessors have been revised, validated and published, and the impact of an education package to increase adherence has been investigated. These competency standards: (i) assist occupational therapy driver assessors’ clinical practice, support occupational therapy registration and regulatory agencies to evaluate practice against a standard and (iii) provide universities with a framework to deliver postgraduate training in occupational therapy driver assessment and rehabilitation. Finally, this research has described a process that can be utilised in other areas of occupational therapy practice to develop and validate competency standards.
Description:
Occupational therapy driver assessment and rehabilitation is an advanced and complex area of practice. Users of this service require that occupational therapy driver assessors are, and remain, competent in their role. Competency standards support and inform occupational therapy driver assessment and rehabilitation practice, ensure standardisation of practice, and determine whether practice can be deemed competent. Competency standards for occupational therapy driver assessors in one Australian state, Victoria, were published in 1998 to provide a benchmark for service provision and guide training. Since then, occupational therapy driver assessor practice has undergone further developments and growth, including a significant increase in research evidence underpinning this advanced practice area. As a result, the competency standards required revision to reflect contemporary practice and enable their use and application across all Australian states and territories. The purpose of the research program reported in this thesis was to revise and validate the Australian Competency Standards for Occupational Therapy Driver Assessors and determine if education and practice using these standards led to increased adherence to their use in clinical practice. A sequential, exploratory, mixed methods design was used within a pragmatist research paradigm to revise and validate the competency standards for occupational therapy driver assessors from a national perspective. Four separate research studies were conducted. In the first study, an overview was undertaken to summarise the current evidence for including cognitive and perceptual assessments within fitness-to-drive evaluations, to inform the revision of the competency standards for occupational therapy driver assessors. The second study involved focus groups with Australian occupational therapy driver assessors and expert educators and identified the changes and revisions required to be made to the Victorian competency standards for occupational therapy driver assessors. Content themes and changes were extracted from the focus groups and combined with research evidence to draft the revised standards. The third study collected feedback from consumers and Australian driver licensing authorities to incorporate into the revised draft. This was followed by a two-round Delphi process with Australian occupational therapy driver assessors to achieve consensus and validate the Australian Competency Standards for Occupational Therapy Driver Assessors. A high level of consensus on the content of all competency standards and underlying practice behaviours was obtained in the final round. Finally, a mixed-methods multiple case-study methodology was adopted, and multiple forms of evidence were collected from file audits, semi-structured interviews and an individualised education session with occupational therapy driver assessors. This study demonstrated that, for this sample, occupational therapy driver assessors’ adherence to the Australian Competency Standards for Occupational Therapy Driver Assessors increased following an individually tailored education package about the standards. The research in this thesis has contributed to the evidence base for occupational therapy driver assessor practice. The Australian Competency Standards for Occupational Therapy Driver Assessors have been revised, validated and published, and the impact of an education package to increase adherence has been investigated. These competency standards: (i) assist occupational therapy driver assessors’ clinical practice, support occupational therapy registration and regulatory agencies to evaluate practice against a standard and (iii) provide universities with a framework to deliver postgraduate training in occupational therapy driver assessment and rehabilitation. Finally, this research has described a process that can be utilised in other areas of occupational therapy practice to develop and validate competency standards.
Description:
•Given the long-term recovery following BPI, consideration should be given to relevance of slow stream rehab and interdisciplinary care.•Consider upskilling or an interdisciplinary care model to assist hand therapists and the provision of pain management and psychological support.•Increased dissemination of resources to support hand therapists working with individuals following BPI and enhanced communication opportunities to develop networks both nationally and internationally. Traumatic, brachial plexus injuries (BPI) result represent a significant cost to the individual and society. Recovery involves multiple surgeries, takes years, and often results in permanent physical dysfunction. While the last couple of decades have seen advancements in surgical management, the BPI rehabilitation literature has not kept pace with these developments. We aim to explore the experience of public and privately employed hand therapists’ in delivering effective long-term rehabilitation services to inviduals with BPI in Australia. An interpretative qualitative study. Two focus groups were conducted with Australian hand therapists’ (n = 10). Data were analyzed using an inductive thematic approach. Three key themes were generated from the data. The first theme ‘Falling through the gaps: overlooked components of therapy for BPI’ captures participants’ thoughts on postinjury health care and rehabilitation services. The second ‘Developing a therapeutic alliance: underpinned by time and trust’ relates to the relationship building challenges and opportunities following trauma that will withstand the long-term recovery of individuals following BPI. The last theme, ‘Factors required for professional development: knowledge and support,’ considers the variation seen with these clients in relation to therapy needs and outcomes. The findings of this study highlight the need to better equip hand therapists’ skills and knowledge in responding to pain and psychological management post BPI. Our results reinforce the benefit of interdisciplinary models of care in the management of individuals with BPI.