Co-design is an increasingly prominent method for achieving disability-inclusive research. Co-design draws attention to the value of involving people with lived experience of disability in shaping research questions, methods, and outcomes, making it an ideal vehicle for inclusion. Yet, the rise in popularity of co-design in disability research has created challenges. Inconsistent definitions, misaligned practices, and inadequate reporting have undermined both the rigour of the method and its potential to generate meaningful and impactful outcomes. In this commentary, we argue that safeguarding the future of disability inclusive co-design requires a systemic shift towards accountability and transparency. We propose four urgent recommendations to enhance and maintain the integrity and impact of co-design: 1. Establish a shared language that distinguishes levels of participation, clarifies epistemic assumptions, and articulates underlying values. This is critical to ensure that co-design claims accurately reflect the nature of involvement. 2. Build capacity and capability for researchers and people with lived experience of disability. This includes in facilitation skills, ethical engagement, inclusive communication, and navigating power dynamics, to avoid tokenism and collaborate more effectively. 3. Develop a co-design-specific reporting framework to make relational, procedural, and decision-making processes more transparent. 4. Mandate better reporting of co-design practices by funders, journal editors, and institutions to ensure accountability and reportable rigour of co-design research with people with disability. Ultimately, co-design can either be a powerful tool for inclusive research or a hollow promise that perpetuates the exclusion it seeks to remedy. Adopting these recommendations for language, capacity, and standard, mandated reporting are essential steps for safeguarding the integrity of the method. It will also support more accountable, authentic, and impactful research that truly reflects the voices, priorities, and lived experiences of collaborators with disability. Co-design is a way of doing research where people with disability work with researchers to create, carry out, and share research. This method is now very popular. People with disability should have a say about how and what research is done. But the word “co-design” is sometimes used too often without really involving people with disability. In this paper, we talk about four important things that need to be improved to make co-design better. First, we need to use clear language, so everyone understands co-design and how it is different from other types of research. Second, everyone who does co-design research needs proper training and support to work together. Third, we need better ways to report what was done in each study, who was involved, how choices were made, and how people with disability were included. Fourth, research publications, funding agencies, and universities should ask for this reporting from researchers so that co-designed research can be trusted. By improving how co-design is done and reported, we can make sure it leads to more inclusive, fair, and helpful research that meets the needs of people with disability.

Co-design, a collaborative approach where end-users are actively involved in design processes, has gained traction in health communication. Its integration into health communication initiatives holds promise for amplifying the voices of people with disability. Despite this, its application remains inconsistent. This scoping literature review explores how people with disability are included, when and through what methods to co-design health communication interventions. Principles of importance are considered and identified. Thirty articles published between 2018 and 2023 were reviewed. The review identified a range of methods used in health communication initiatives, with people with disability engaging at different stages and in different ways. While co-design offers potential for improved health communication, challenges such as unpredictable outcomes, diversity of participant needs, and barriers to full engagement persist. Improved transparency and consistency in reporting co-design processes are recommended to enhance rigor and effectiveness of future initiatives.

BACKGROUND:Dance is a novel recreational activity that may improve psychosocial outcomes in inpatient neurological rehabilitation; however, adapted dance programs in neurological rehabilitation settings are still emerging. OBJECTIVE:This paper describes the co-design process undertaken to develop an adapted dance program for use in neurological rehabilitation. It also presents a study protocol aimed at evaluating the program's feasibility, acceptability, and preliminary efficacy in a subacute hospital setting. METHODS:A 3-phase co-design approach was used to develop the Dance as an Adjunct Therapy for Neurological Rehabilitation - Creative Enrichment for Recovery (DAN-CER) program and protocol, including knowledge seeking, seeking expert input, and refining. Information sources included a literature review, stakeholder meetings, workshops, and focus groups with clinicians and patients. This study has approval from two ethics committees (HREC/2023/QGC/99631 and GU 2023/813). RESULTS:We undertook 4 workshops with Queensland Ballet, and 2 focus groups were undertaken with staff and neuroscience ward patients. The resultant program was mapped to the Template for Intervention Description and Replication (TIDieR) checklist. A mixed methods design was selected to evaluate the program. Primary outcomes are the feasibility and acceptability of the adapted dance program with data on accrual and attendance collected weekly. Semistructured interviews with patients and staff were conducted postintervention. The secondary outcome is the efficacy of DAN-CER for improving well-being and affect, with impact on fatigue monitored. Adapted dance classes and data collection assessments began in late October 2024, and data collection was completed in late February 2025. At the time of manuscript submission, 14 participants had been recruited. Interviews have been transcribed, and preliminary coding is underway; findings are expected to be submitted for publication in December 2025. CONCLUSIONS:The rigor of the multiphase co-design process enabled the development of an adapted dance intervention capable of accommodating the physical, cognitive, and communication challenges of neurorehabilitation ward patients. The proposed mixed methods protocol will enable multidimensional evaluation of the adapted dance program. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID):DERR1-10.2196/69452.

PurposeContemporary healthcare design often overlooks the environment as a resource for supporting patient well-being and rehabilitation, particularly in neurotrauma care. The prioritisation of safety and efficiency has created stressful spaces that negatively impact patient needs. This paper explores whether environmental enrichment can enhance rehabilitation outcomes for individuals recovering from neurotrauma. It also introduces the BEEhive laboratory, a multidisciplinary initiative integrating environmental enrichment principles into healthcare.MethodologyThis paper reviews literature on the role of environmental enrichment in neurotrauma rehabilitation, synthesising empirical evidence on its benefits, and highlighting its potential to improve various aspects of neurorehabilitation. The findings are applied to the BEEhive laboratory's objectives.ResultsEnvironmental enrichment is shown to stimulate neurogenesis, increase rehabilitation engagement, reduce disruptive behaviours and depressive symptoms, facilitate social relationships, improve cognitive functioning, reduce stress, and alleviate boredom. Despite these benefits, its application in neurotrauma rehabilitation remains underexplored. The BEEhive laboratory aims to address this gap through multidisciplinary collaboration, implementing strategies to enhance patient outcomes.ConclusionTo optimise rehabilitation outcomes, healthcare environments must holistically support well-being. Environmentally focused, sustainable interventions in neurotrauma care, exemplified by the BEEhive initiative, are crucial for bridging the gap between research and practice, fostering innovative approaches to neurotrauma rehabilitation

PURPOSE:Dignity in healthcare significantly impacts patient satisfaction and care personalisation. This study explores dignity from the perspectives of patients and staff in an inpatient rehabilitation unit, addressing the challenges of undignified care. MATERIALS AND METHODS:Using a Generative Co-design Framework for Healthcare Innovation, specifically reporting on the pre-design phase, semi-structured interviews were conducted with 18 patients and 20 staff members over approximately 5 months. Patient interviews occurred during hospitalisation and post-discharge. RESULTS:Dignity was experienced through interactions influenced by people, infrastructure, and policies. Participants defined dignity as being acknowledged and respected as people, or the acknowledgement of personhood. Positive dignified experiences were reported, but some patients reported undignified, but necessary care activities. Staff and patients highlighted the need for flexible, person-centred policies. Practices enhancing dignity included validating patient choices, respecting privacy, and ensuring informed decision-making. Despite some systemic challenges, staff showed a strong commitment to dignified care. CONCLUSIONS:Dignity is challenging to define. Rehabilitation units and health systems more broadly should cultivate more responsive care interfaces, through flexible, person-centred policies, prioritising and hiring staff with disability aware attitudes, and embedding dignity into the organisational culture.

PurposeAutistic youth with intellectual disability (ID) are underrepresented in transition research and services, particularly in programs that prioritize social inclusion, emotional wellbeing and autonomy. This study explores stakeholder experiences of Campus Life, an inclusive, postschool transition program designed specifically for autistic youth with ID.Design/methodology/approachThis qualitative study drew on multiple stakeholder perspectives. Accessible, visually supported surveys were completed by four autistic participants. Survey data from participants were analyzed descriptively to capture their priorities at program entry. In-depth interviews were conducted with six parents, and eight staff participated in focus groups or individual interviews. Reflexive thematic analysis was used to generate key themes across parent and staff data.FindingsParticipant surveys revealed interest in friendship and enjoyable activities, with more varied interest in work or further learning. Thematic analysis of parent and staff data generated four themes: (1) a supportive and structured environment, (2) growing into independence, (3) finding confidence in connection and (4) uncertain future access to a valued opportunity. Stakeholders perceived Campus Life as promoting psychological safety, social growth and autonomy in ways not commonly achieved through traditional employment-focused models.Originality/valueThis is one of the few studies to foreground the experiences of autistic youth with ID within a postschool transition program. It highlights the importance of holistic, person-centered supports that extend beyond employment to address broader developmental and social goals. The findings support rethinking what successful transition can look like for this population.

Significant others—family members, friends, and informal carers—play a vital yet underrecognised role in supporting people with disability in Australia. This study aimed to explore their lived experiences and identify systemic barriers impacting their well-being and caregiving capacity. A total of 188 significant others participated in a statewide survey, co-designed using inclusive research principles. Quantitative and qualitative data were collected and analysed collaboratively, using an a priori coding framework adapted to new themes. Four key findings were described: the joy and meaning found in caregiving; the overwhelming burden of navigating fragmented systems; the erosion of carer well-being due to financial, physical and emotional strain; and the urgent need for systemic support including respite and equitable access to services. Participants emphasised that caregiving itself was not inherently burdensome, rather, the lack of formal support and recognition creates unsustainable conditions. These findings highlight the critical role significant others play in sustaining Australia’s care economy and underscore the need for disability-inclusive policy reform. Strengthening support systems and embedding lived experience into reform and policy design are essential to ensuring the long-term sustainability of informal care and the rights and well-being of both carers and people with disability.

This article offers a more-than-human perspective on an equine assisted learning programme undertaken by marginalised young people attending a flexi-school in Australia. In contrast with therapist led equine programmes, our research examined horse assisted activities as a site of embodied learning. Paying attention to the affective dimension of horse-human relationality we explored how student and teacher narratives articulated learning in terms of affective pedagogies (being moved to learn differently). We discuss the theory-method tensions that arose through our shift from a mixed methods humanist design to a more-than-human analysis. Questioning the limitations of traditional humanist theories of attachment and individualised agency, we trace the agentic capacities afforded by the horse-human learning assemblage involving horses, volunteer coaches, young people, teachers, yards, grooming tools, etc. Our article contributes to explorations of more-than-human learning at the intersection of embodied movement, therapeutic interventions and informal education.

IntroductionEarly stakeholder engagement is critical to the successful development and translation of rehabilitation technologies, a pivotal step of which is usability testing with intended end-users. To this end, several methods employ end-user feedback to identify usability and implementation issues. However, the process of prioritizing identified issues seldom leverages the knowledge and expertise of the range of stakeholders who will ultimately affect the demand and supply of a device. This paper describes a novel method to prioritize end-user feedback using transdisciplinary stakeholder consultation and address it in subsequent product development. The proposed approach was demonstrated using a case study relating to the development of a novel technology for neural recovery after spinal cord injury.MethodFeedback from five individuals with chronic spinal cord injury was collected during two-hour usability evaluation sessions with a fully functional high-fidelity system prototype. A think-aloud and semi-structured interview protocol was used with each participant to identify usability and acceptability issues relating to the system in a 3-phase approach. Phase 1 involved extracting usability issues from think-aloud and semi-structured interview data. Phase 2 involved rating the usability issues based on their significance, technical feasibility, and implementation priority by relevant internal and external stakeholders. Finally, Phase 3 involved aggregating the usability issues according to design and implementation elements to facilitate solution generation, and these solutions were then raised as action tasks for future design iterations.ResultsSixty usability issues representing nine facets of usability were rated. Eighty percent of issues were rated to be of moderate to high significance, 83% were rated as being feasible to address, and 75% were rated as addressable using existing project resources. Fifty percent of the issues were rated to be a high priority for implementation. Evaluation of the grouped issues identified 21 tasks which were mapped to the product roadmap for integration into future design iterations.DiscussionThis paper presents a method for meaningful transdisciplinary stakeholder engagement in rehabilitation technology development that can extended to other projects. Alongside a worked example, we offer practical considerations for others seeking to co-develop rehabilitation technologies.

Exploring the intricate relationship between individual and collective experiences, this study explores dignity from the perspectives of people with disability. Using an extreme citizen science approach, we engaged people with disability as active partners in gathering data through qualitative surveys and focus groups. Framework Analysis was employed to ensure the validity of findings while privileging the voices of people with lived experience of disability. Dignity was contingent on the acknowledgement of personhood and the delivery of human rights. Our research identified five key aspects to maintain and protect dignity: (1) acknowledging personhood; (2) recognising people with disability as decision-makers of their lives; (3) realising the right to access information; (4) maintaining the right to privacy; and (5) eliminating or minimising barriers to accessibility and inclusion. Undignified experiences that resulted from a lack of acknowledgement negatively affected participants' wellbeing, and healthcare settings were identified as particularly challenging environments for dignity. These findings have significant implications for healthcare systems and services within an international and interdisciplinary context. They emphasise the need for adaptable, flexible services, co-designed with people with lived experience of disability. Addressing organisational constraints, resource limitations, and expectations is paramount to ensuring dignity is maintained through the acknowledgement of personhood and safeguarding of human rights.

In this series of eight articles, the Australian Traumatic Brain Injury Initiative (AUS-TBI) consortium describes the Australian approach used to select the common data elements collected acutely that have been shown to predict outcome following moderate-severe traumatic brain injury (TBI) across the lifespan. This article presents the unified single data dictionary, together with additional measures chosen to facilitate comparative effectiveness research and data linkage. Consultations with the AUS-TBI Lived Experience Expert Group provided insights on the merits and considerations regarding data elements for some of the study areas, as well as more general principles to guide the collection of data and the selection of meaningful measures. These are presented as a series of guiding principles and themes. The AUS-TBI Aboriginal and Torres Strait Islander Advisory Group identified a number of key points and considerations for the project approach specific to Aboriginal and Torres Strait Islander peoples, including key issues of data sovereignty and community involvement. These are outlined in the form of principles to guide selection of appropriate methodologies, data management, and governance. Implementation of the AUS-TBI approach aims to maximize ongoing data collection and linkage, to facilitate personalization of care and improved outcomes for people who experience moderate-severe TBI.

Points of interestPublic transport systems can play an important role in enabling, facilitating and sustaining dignity for people with disability.People with disability experience theoretical and practical gaps when using trains and buses.Gaps result from infrastructure, environment, information, and attitudinal barriers.Universal Design, access to accessible and inclusive information, and empathic attitudes help create dignified mobility experiences for people with disability when using buses and trains. When transport systems are accessible and inclusive, people with disability experience dignity. Alternatively, when personal mobility is constrained by physical, social and/or communication, barriers, people with disability experience exclusion and an increasing vulnerability to indignity. This study sought to qualitatively explore the role of trains and buses in an Australian city in supporting access, inclusion and dignified mobility experiences for people with disability. Twenty-six semi-structured interviews were conducted with participants with diverse visible and invisible disabilities and were analysed thematically using Framework Analysis. The findings highlight the complexities involved with navigating public transport systems while maintaining dignity for people with disability. Accessible and inclusive information, infrastructure, and interactions with staff ensured dignified mobility experiences. If any part of a journey was inaccessible, participants were vulnerable to indignity. Dignified mobility experiences represent a complex and dynamic interaction between personal experiences and preferences, impairment-specific requirements, transport infrastructure, interpersonal experiences, and information inclusivity.

PURPOSE:This scoping literature review aimed to determine the definition of dignity in relation to disability. It also examined the extent to which inclusive research methods have been used to develop working definitions. MATERIALS AND METHODS:A comprehensive search was conducted in five electronic databases, using a modified framework by Arksey and O'Malley. Narrative synthesis and qualitative content analysis were employed to examine definitions of dignity and the use of inclusive research methods. RESULTS:22 peer-reviewed studies were included. The majority of the studies were qualitative (72.72%) and examined various disability populations in diverse settings. Although 19 studies offered a definition of dignity, there was no clear consensus. Dignity was frequently defined from a utilitarian perspective, emphasising affordances and barriers. However, engagement with theoretical constructs was superficial and limited. Further, no studies mentioned the use of inclusive research methods. CONCLUSIONS:The absence of inclusive research methods hinders the development of a comprehensive definition of dignity that is accepted by and relevant to people with disability. Engaging with both theoretical and empirical perspectives of dignity is crucial to develop a meaningful and inclusive definition, which can inform interventions and policies that enhance dignity for people with disability across diverse settings and contexts.

PURPOSE:Both demand and need for assistive technology (AT) are growing worldwide. However, ensuring an optimal fit between the person and AT is complex. With health professionals often being the "gatekeeper" to AT, it is imperative to understand their experiences of AT. This study was positioned within a sociotechnical space known as "HabITec", which aims to bring together potential AT users with health professionals and technology developers to enhance the technology-person fit. The current paper reports on health professionals' experiences of the HabITec Lab (THL), the physical manifestation of HabITec that was piloted in a tertiary hospital for 12-months. MATERIALS AND METHODS:The study used a qualitative descriptive approach to explore the experiences of nine health professionals who referred patients to the lab. RESULTS:Four major themes were identified together with suggestions for the future of THL and HabITec. The themes focused on 1) Balancing service and independence; 2) Capitalising on possibilities and connections; 3) Negotiating multiple mismatches; and 4) Fitting it all together in a coherent service. CONCLUSIONS:It was clear that health professionals who referred patients to THL identified a range of benefits associated with it, but barriers to its effectiveness were identified and concerns were raised over health professionals becoming too reliant on the lab. For THL to be sustainably implemented, it appears that a policy-level shift is needed to enable its appropriate resourcing.

This article explores how gender and disability inequity is addressed in research, policy and organisational strategies that shape the Australian sporting landscape. By examining the most current annual reports and strategic plans of 31 national sport organisations, national disabled sport organisations, peak bodies, and government agencies, we identify the implications of siloed thinking that considers gender and disability to be separate forms of diversity. Our analysis outlines the limitations of organisational strategies, specific plans and even participation data for women with disability. We argue that an understanding of the nuanced experiences of women with disability is needed to inform policies and practices that advance equitable sport provision, making visible what women's disabled bodies can do and become through sport.

PURPOSE:To understand and combat the challenges in taking up and implementing technology in rehabilitation settings, the HabITec Lab, a clinical service focused on technology, was piloted for 12-months within a tertiary hospital. This article reports on its preliminary impacts as a clinical service and on clients, including the types of assistive technology (AT) in demand. MATERIALS AND METHODS:Referral and administrative data from 25 individuals who attended the HabITec Lab were collated and analysed using descriptive statistics. For those who attended more than once (n = 12), goal attainment was assessed using the Modified Goal Attainment Measure (MGAM). Post-intervention semi-structured interviews were completed with participants to understand their experience at the HabITec Lab. Interviews were analysed using thematic analysis. RESULTS:Most attendees (92%) were undergoing inpatient rehabilitation following a spinal cord injury (SCI). The majority (73%) of goals related to improving entertainment and connection. All participants who completed the MGAM showed improved goal attainment following their HabITec Lab attendance. Qualitative data highlighted appreciation for the service and suggestions for its future. CONCLUSIONS:This study revealed a high level of demand for support to use AT amongst individuals with SCI, particularly consumer-grade smart devices that could assist communication. This finding may have been influenced by the impacts of the COVID-19 pandemic and frequent lockdowns during this period. This study indicated that the HabITec Lab was able to address important goals for attendees, but also illuminate a new future and trigger enthusiasm about future goals. Attendance was liberating, but resourcing barriers were frustrating.