OBJECTIVESThe UQDRIVE program, a group education and support program, was developed to meet the needs associated with driving cessation for older adults. The current study investigated the effect of the program on community mobility.DESIGN AND METHODSA prospective, parallel, stratified randomized controlled trial was undertaken with a waitlist control group receiving current clinical practice (no intervention). Data were collected pre, post, and 3 months following the intervention. Participants were adults aged 60 years or older who had ceased driving or planned to cease driving within 12 months.RESULTSA total of 131 participants were included in analyses (67 intervention, 64 control). Participating in the intervention was significantly associated with a higher number of episodes away from home per week at immediately postintervention (z = 2.56, p = .01). This was not significantly maintained at 3-month follow-up. Participation in the intervention also significantly predicted higher use of public transport at immediately postintervention (z = 2.12, p = .034), higher use of walking at immediately postintervention (z = 2.69, p = .007), increased aspects of community mobility self-efficacy (z = 3.81, p = .0001), and higher satisfaction with transport at 3-month follow-up (z = 2.07, p = .038).IMPLICATIONSThe program increased community mobility immediately postintervention and transport satisfaction at 3 months postintervention. Due to a high attrition rate, further research is required to clarify the long-term impact of the intervention.

Investigators at the University of Queensland have been exploring time use as an outcome measure to capture the impact of ageing, health conditions (e.g. stroke), life transitions (e.g. driving cessation) and are now embarking on the exploration of the impact of Parkinson’s disease and deep brain stimulation on time use, participation and quality of life. The use of time of 195 older community dwelling Australians (aged 65 years and older) was investigated via face to face interviews using a time diary reflecting on the past week (Activity Configuration), role participation and life satisfaction.

Background: This study explored the transport and lifestyle issues of older retired and retiring drivers participating in the University of Queensland Driver Retirement Initiative (UQDRIVE), a group program to promote adjustment to driving cessation for retired and retiring older drivers.Methods: A mixed method research design explored the impact of UQDRIVE on the transport and lifestyle issues of 55 participants who were of mean age 77.9 years and predominantly female (n=40). The participants included retired (n=32) and retiring (n=23) drivers. Transport and lifestyle issues were identified using the Canadian Occupational Performance Measure and rated pre- and post-intervention.Results: Paired t-tests demonstrated a statistically significant improvement in performance (t=10.5, p < 0.001) and satisfaction (t=9.9, p < 0.001) scores of individual issues. Qualitative content analysis identified three categories of issues including: protecting my lifestyle; a better understanding of transport options; and being prepared and feeling okay.Conclusions: Participation in UQDRIVE had a positive and significant effect on the issues of the participants. The results highlight that although all participants stated issues related predominantly to practical concerns, there were trends in the issues identified by the drivers and retired drivers that were consistent with their current phase of the driving cessation process.

OBJECTIVE:The primary aim of the study was to explore the current practice of occupational therapists when assessing standing performance during Functional Capacity Evaluations (FCEs).METHODS:A semi-structured interview was conducted with occupational therapists and the participants were interviewed using both open and closed questions.PARTICIPANTS:A sample of occupational therapists (n=20) from Queensland, Australia were involved in a survey. They were all experienced in conducting FCEs.RESULTS:Ninety percent of the respondents used a distracting task during the assessment of standing with standardised and non-standardised nuts and bolts assembly tasks the most commonly used. Respondents reported using a mix of biophysical, physiological and psychophysical clinical observations to assess standing. The nuts and bolts assembly activities used by the respondents were rated to be of low interest in terms of engaging the client.CONCLUSIONS:It was identified there are minimal guidelines in the literature which focuses on assessment of standing in FCEs. Questions were raised regarding the adequacy of the use of nuts and bolts activities as a suitably distracting task in FCEs and further research is required on assessing standing in functional capacity evaluation including the use of suitably distracting activities.

Purpose. The ability to drive safely is commonly affected by traumatic brain injury (TBI). Driving is a role and activity that is highly valued and also associated with successful community reintegration after TBI. Relatively little is understood about the processes of interruption to driving and potential return to driving that can be experienced by people with TBI and their family members (FMs). Exploring the way in which driving interruption, return to driving and permanent cessation of driving happen for people with TBI, their FMs and health professionals (HPs) who work with them can enable a fuller understanding of the experiences and needs and enhance the rehabilitation approaches in this situation.Method. A descriptive phenomenological approach was used to explore the experience with the aim of improving services for people with TBI. Semi-structured interviews about driving and driving cessation were conducted with 15 people with TBI, 10 FMs and 10 HPs who had experience in driving and driving cessation issues.Results. The findings reveal experiences of the process of driving and driving cessation contextualised within experiences of the accident and treatment process. Participants identified key times of need in relation to driving: being told about driving restrictions, understanding driving restrictions, the 'on hold' period, and returning to driving.Conclusions. The processes surrounding driving and driving cessation after TBI are complex. Informational, support and practical needs differ at the different times. There are key times where people may need further support to improve rehabilitation outcomes. Rehabilitation approaches may particularly need to provide clear, consistent information about driving restrictions, and the process required for returning to driving. While recovery time appears necessary for allowing a safe return to driving, active support for continued involvement in the community using alternative transport may reduce the frustration and disengagement experienced by people in the 'on hold' period.

BACKGROUND/AIMS Community mobility is affected by an interruption to or cessation of driving following traumatic brain injury (TBI). This study aimed to examine loss of the driving role and to explore the outcomes associated with driving cessation from the perspectives of key people involved within the process: people with TBI, their family members and involved health professionals. METHODS A qualitative methodology was used, employing semi-structured interviews with 15 individuals with TBI who had experienced driving cessation, 10 family members and 10 health professionals working with this population. RESULTS This article focuses on two themes, each with three subthemes. Being stuck: needs related to driving cessation had subthemes: (i) an emotional time, (ii) being normal and (iii) participation without driving. The second theme, A better way: suggestions to improve outcomes had subthemes: (i) information, (ii) support and trying it out and (iii) their family member's roles and needs. CONCLUSIONS Driving cessation following TBI is associated with emotional, identity, transport and participation-related needs. An ongoing, individualised approach involving information, support and practical experiences may improve outcomes of driving cessation for people with TBI and their family members.

BACKGROUND/AIM:Driving cessation has been recognised as affecting the health and wellbeing of older people. Further exploration of the impact of driving status on time use, role participation and life satisfaction was required.METHODS:A cross-sectional survey of 234 older people (current drivers, retired drivers and people who have never driven) was employed. Time use in the previous week, role participation and life satisfaction were measured and compared between the groups, while controlling for sociodemographic variables (health status, activities of daily living and instrumental activities of daily living status, gender, age and living situation).RESULTS:When compared to current drivers, retired drivers had significantly lower life satisfaction (P = 0.01), fewer present roles (P < 0.0001) and were less likely to participate in volunteer (P = 0.005) and family member roles (P = 0.009). Retired drivers spent less time on social leisure (P = 0.002) and away from home (P = 0.0001), and more time in solitary leisure (P= 0.0001). Comparing the participation of retired drivers with those who had never driven indicated that retired drivers spent significantly less time in volunteer work (P = 0.009).CONCLUSIONS:The findings indicate that older non-drivers may require support for participation and wellbeing.

Background. Driving cessation can lead to negative consequences, such as depression and reduced social activities. Purpose. The University of Queensland Driver Retirement Initiative (UQDRIVE) intensive support program is a six-week program to assist older people with driving cessation. Methods. Fifty-five participants completed a survey of satisfaction with the program, including identification of the aspects of the program that were useful and they had applied in real life. Findings. There was overall satisfaction with the program, and content analysis identified three areas that were highlighted as particularly useful: “Finding alternative means: transport and service options,” “Planning with more wisdom: thinking about driving cessation,” and “Being with people: sharing experiences with peers.” Implications. These findings indicate that program participants were satisfied with the current UQDRIVE intensive support group program and found both the psychosocial supports and practical strategies to be useful in managing driving cessation.

Purpose: Cognitive impairment is a frequent consequence of stroke and can impact the ability of people who have had a stroke to perform everyday activities. There are a number of intervention strategies that various health professionals may use when working with people who have cognitive impairment post stroke. The purpose of this systematic review was to determine whether interventions for people with cognitive impairment after a stroke improve their functional performance of basic and/or instrumental activities of daily living (ADL). Method: Searches were performed in the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, PsycINFO, PsycBITE, OTseeker, and Dissertation Abstracts. Studies were eligible for inclusion if they were a randomised controlled trial or quasi-randomised controlled trial that evaluated an intervention that focused on providing cognitive retraining to adults with clinically defined stroke and confirmed cognitive impairment and measured functional ability, either basic or instrumental ADL, as either a primary or secondary outcome measure. Results: Four studies, involving a total of 376 participants, were included in this review. There was no statistically significant difference between groups on basic ADL performance in any of the four studies or on instrumental ADL in the one study that measured this. Conclusion: There were not an adequate number of high quality trials to be able to make recommendations that support or refute the use of specific cognitive retraining interventions to improve functional outcomes following a stroke. More research is required before conclusions can be made about the effect of cognitive interventions on functional outcomes post stroke.

This article presents the results of a study on the barriers and facilitators to bus use for people aged 60 or older. Two complementary methodologies, nominal group technique and focussed ethnography, were used to identify barriers and facilitators and rank their importance. Two sample sites from Queensland, Australia, were selected, with 227 people participating in the nominal group technique and 40 people participating in the focussed ethnography component. Seven priorities for age-friendly bus systems emerged from the data: vehicle entrance/exit; bus driver friendliness and helpfulness; timetables and scheduling of buses; bus stop locations; pedestrian infrastructure; information and training for older people; and bus routes and destinations. These findings will assist researchers, policy makers, and transport providers to set evidence-based strategic directions for creating age-friendly bus systems. Both methods provide complementary perspectives on bus usability, which could not be gained from either method alone.

PURPOSE:Stroke survivors report multiple psychosocial issues after discharge and difficulties returning to meaningful roles and activities. This study explored the impact of an occupation-based group program on activity levels, well-being, and self-efficacy after discharge from inpatient rehabilitation.METHODS:This pilot study recruited participants from two hospital rehabilitation units. Both units provided individual therapy programs. Unit A provided an additional occupation-based group program. Behavioural mapping recorded participants' activity levels in hospital for one weekday and one weekend day. Outcome measures collected at recruitment, discharge, and/or 1 month after discharge included Modified Barthel Index, use of community supports, length of stay, Stroke Impact Scale, and Self- Efficacy Gauge.RESULTS:Participants from Unit A (n = 8) had a significantly longer length of stay than Unit B (n = 11) and spent significantly more time in occupational therapy (P = .01). Both participant groups were more inactive on the weekday compared to the weekend (P = .03). Participants in Unit A were more likely to report low levels of social participation and stroke recovery (P <.05) on the Stroke Impact Scale.CONCLUSION:There was no indication from the results of this study that an occupation-based group program had a positive effect on the measured outcomes.

BACKGROUNDSensory impairments significantly limit the ability to use the upper limb after stroke. However, little is known about the effects of interventions used to address such impairments.OBJECTIVESTo determine the effects of interventions that target upper limb sensory impairment after stroke.SEARCH STRATEGYWe searched the Cochrane Stroke Group Trials Register (last searched 8 October 2009), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2009, Issue 1), MEDLINE (1966 to January 2009), EMBASE (1980 to January 2009), and six further electronic databases to January 2009. We also handsearched relevant journals, contacted authors in the field, searched doctoral dissertation databases, checked reference lists, and completed citation tracking.SELECTION CRITERIARandomized controlled trials and controlled trials comparing interventions for sensory impairment after stroke with no treatment, conventional treatment, attention placebo or with other interventions for sensory impairment.DATA COLLECTION AND ANALYSISTwo review authors selected studies, assessed quality and extracted data. We analyzed study data using mean differences and odds ratios as appropriate. The primary outcome we considered was sensory function and secondary outcomes examined included upper limb function, activities of daily living, impact of stroke and quality of life as well as adverse events.MAIN RESULTSWe included 13 studies, with a total 467 participants, testing a range of different interventions. Outcome measures included 36 measures of sensory impairment and 13 measures of upper limb function. All but two studies had unclear or high risk of bias. While there is insufficient evidence to reach conclusions about the effects of interventions included in this review, three studies provided preliminary evidence for the effects of some specific interventions, including mirror therapy for improving detection of light touch, pressure and temperature pain; a thermal stimulation intervention for improving rate of recovery of sensation; and intermittent pneumatic compression intervention for improving tactile and kinesthetic sensation. We could not perform meta-analysis due to a high degree of clinical heterogeneity in both interventions and outcomes.AUTHORS' CONCLUSIONSMultiple interventions for upper limb sensory impairment after stroke are described but there is insufficient evidence to support or refute their effectiveness in improving sensory impairment, upper limb function, or participants' functional status and participation. There is a need for more well-designed, better reported studies of sensory rehabilitation.

Background: Provision of health information to people with aphasia is inadequate. Current practice in providing printed health education materials to people with aphasia does not routinely take into consideration their language and associated reading difficulties. Aims: This study aimed to investigate if people with aphasia can comprehend health information contained in printed health education materials and if the application of aphasia-friendly principles is effective in assisting them to comprehend health information. It was hypothesised that participants with aphasia would comprehend significantly more information from aphasia-friendly materials than from existing materials. Other aims included investigating if the effectiveness of the aphasia-friendly principles is related to aphasia severity, if people with aphasia are more confident in responding to health information questions after they have read the aphasia-friendly material, if they prefer to read the aphasia-friendly brochures, and if they prefer to read the brochure type that resulted in the greatest increase in their knowledge. Methods & Procedures: Twelve participants with mild to moderately severe aphasia were matched according to their reading abilities. A pre and post experimental design was employed with repeated measures ANOVA (p<.05) used to investigate the effectiveness of the aphasia-friendly principles. Outcomes & Results: While participants with aphasia comprehended health information from the existing printed education materials, participants comprehended 11.2% more information from materials that had an aphasia-friendly format. No significant correlation between aphasia severity and aphasia-friendly effectiveness was found. Participants were more confident in answering questions after they had read the aphasia-friendly brochures. A clear preference for aphasia-friendly brochures was not found and participants did not consistently select the brochure type that resulted in the greatest increase in their health knowledge. Conclusions: This preliminary investigation has found that aphasia-friendly material does assist people with aphasia to comprehend health information. The benefits of providing aphasia-friendly information have many clinical applications that extend beyond the provision of health information. The application of aphasia-friendly principles to all written materials could prove beneficial in removing some of the barriers people with aphasia face in trying to comprehend written materials. In addition, this research has highlighted that a greater understanding of people with aphasia's reactions to aphasia-friendly materials and also the social impact of providing aphasia-friendly information is required. Future research, that incorporates a qualitative research approach, will add valuable insight to these topics.

BACKGROUND:The literature promotes the use of a wide range of educational materials for teaching and training clients with chronic conditions such as stroke. Client education is a valuable tool used by occupational therapists to facilitate client and carer ability to manage the stroke-affected upper limb. The aim of this study was to identify what information was provided to clients and carers, how this information was delivered, when the information was delivered and the client factors that influenced the method of information provision.METHODS:Convenience and snowball sampling was used to recruit occupational therapists working in stroke. Twenty-eight participants completed the study questionnaire anonymously and their responses were summarised descriptively.RESULTS:There was a clinically important trend for carers to receive less information than clients. Written and/or verbal information was the favoured method for delivering information related to handling (57%), soft-tissue injury minimisation (46.4%) and oedema management (50%). Information was delivered with decreasing frequency from admission (86%) to discharge (64%). More than 90% of participants indicated that the client's cognitive ability, visual ability, level of communication, primary language and perceptual ability were considered prior to the delivery of information.DISCUSSION:Participants regularly conveyed information to clients and carers with respect to management of the stroke-affected upper limb. However, an increased emphasis on the development of practical self-management skills, awareness of the impact of personal factors and a timeline for information provision may prove useful.

The same reasons that prompt older people to give up driving can also result in difficulties with accessing public transport. Difficulties using public transport can limit older people's participation in society, thereby impacting negatively on their health. Focusing on public buses, this review explicates the link between bus usability and the health of older people and frames existing evidence on bus usability issues. The Person–Environment–Occupation (PEO) model offers a framework by which bus usability can be assessed. A combination of person-centred, environmental, and occupation-related factors, including bus design, service provision and performance, information, and the attitudes of staff and the community, impact on older people's ability to catch buses. More systematic research needs to take place in order to develop a comprehensive understanding of bus usability. Occupational therapy has a key role to play in conceptualizing, implementing, and evaluating improvements in bus usability for older people.

Neurological upper limb rehabilitation is influenced by a diverse range of factors within the practice environment. Clinical reasoning is the means by which occupational therapists make sense of such factors in order to make decisions that promote individual occupational goals. However, changes in neurological knowledge, the limited availability of research evidence and the need to maintain a focus on client-centred practice in rehabilitation settings are factors that contribute to clinical reasoning uncertainty. A protocol that aims to structure clinical decision making in the light of such diversity has been developed to guide upper limb rehabilitation after brain injury. As part of a larger study designed to determine the conceptual usefulness of the protocol, 11 expert occupational therapists were asked to describe the challenges that they faced in their practice. Four themes emerged from the focus group data, described in terms of (a) the complexity of domain-specific knowledge and the paucity of evidence for practice; (b) the diversity of upper limb presentation; (c) the need to balance client-centred practice and professional duty of care; and (d) uncertainty regarding clinical decision making. Although the data supported the participants' expertise, they nevertheless articulated a need for guidance in structuring the clinical reasoning and decision making underlying neurological upper limb rehabilitation. Various strategies are described that can be used to guide clinical reasoning, including research evidence, the differentiation of situations requiring the application of artistic or scientific knowledge, reflective and reflexive practice, and the application of system aids such as decision-making protocols.

This paper reports on the construct validity (scale design and convergent validity) and ecological validity of the Occupational Therapy Adult Perceptual Screening Test (OT-APST). The performance of 208 participants following stroke on the OT-APST and a reference tool (either the Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) or the LOTCA-Geriatric version (LOTCA-G)) was compared. The OT-APST performance of the stroke sample was compared with a healthy normative sample (n=356). The relationship between the OT-APST performance and the Functional Independence Measure (FIM™) score of the participants following stroke was also examined. Factor analysis and internal consistency results supported the scale design of the OT-APST. Significant correlations between the performance of the participants following stroke on the OT-APST and the reference tool supported the convergent validity of the OT-APST. The ability of the OT-APST to separate the two participant groups provided further evidence of its construct validity. Significant correlations between OT-APST and FIM™ scores supported the ecological validity of this tool. This study shows that the OT-APST is an ecologically valid tool with demonstrated construct validity in the assessment of visual perception.

Enhancement of quality of life is central to occupational therapy philosophy. The purpose of this study was to determine whether individuals with specific characteristics experience quality of life differently after angioplasty. Data on sociodemographic and psychosocial predictor variables were collected on 209 patients on the day before angioplasty. Data on the quality of life outcomes of functional capacity, life satisfaction, psychological well-being and return to work time were collected on 205 patients at a mean of 11 months after angioplasty. Multiple regression analyses revealed that previous exercise participation predicted functional capacity after angioplasty; social support, pre-angioplasty life satisfaction and pre-angioplasty psychological well-being predicted post-angioplasty life satisfaction; psychological well-being before angioplasty predicted psychological well-being after angioplasty; and having fewer dependents and a longer period of unemployment predicted return to work time. Consideration of individuals' social, psychological and employment status before angioplasty could assist occupational therapists in predicting prognosis and tailoring intervention to improve quality of life outcomes.

AIM This study aimed to examine the effect of clinical factors including side of stroke, region of affected cerebral circulation, type of stroke and time since stroke, as well as age on the number and type of impairments of visual perception and praxis in patients following stroke. METHODS Two hundred and eight participants with stroke were conveniently sampled from 12 hospitals in Brisbane and the Gold Coast. Background information was collected and each participant was assessed for impairments of visual perception and praxis using the Occupational Therapy Adult Perceptual Screening Test. RESULTS Participants with left-hemisphere stroke were more likely to have impaired body scheme than participants with right-hemisphere stroke. Additionally, participants with right-hemisphere stroke were more likely to have unilateral neglect and impaired constructional skills than those with left-hemisphere stroke. There was a significant relationship between region of affected cerebral circulation and the occurrence of agnosia, unilateral neglect and constructional skill impairment. Moreover, the number of visual perceptual impairments experienced by participants was associated with the region of affected cerebral circulation. Increasing age was significantly related to the occurrence of constructional skill impairment and acalculia. CONCLUSIONS Side of stroke, region of affected cerebral circulation and age affected the type of impairments of visual perception and praxis experienced by patients following stroke. Furthermore, region of affected cerebral circulation also influenced the number of impairments of visual perception and praxis in patients after stroke. The results have implications for more specific targeting of assessment and treatment practices following stroke.

Driving cessation has been recognised as having substantial negative impact on the health and wellbeing of older people. The University of Queensland Driver Retirement Initiative (UQDRIVE) program was developed to improve lifestyle and quality of life of older people facing driving cessation. Preliminary analyses of COPM scores indicate significant differences pre and post in perceived performance (mean difference=3.22 points; t=7.11; df=19; p<0.0001) and satisfaction with performance (mean difference=3.53 points; t=6.52; df=19; p<0.0001) scales. It appears this intervention enhances coping of older adults with the often daunting prospect of ceasing to drive; implications for clinical practice are provided.