OBJECTIVES:To measure disability and frailty and assess measurement properties of the HIV Disability Questionnaire (HDQ) in outer regional Australian people living with human immunodeficiency virus (HIV). METHODS:This cross-sectional, validity and reliability study included community-dwelling outer regional Australian adults with HIV. Participants completed the self-reported World Health Organization Disability Assessment Schedule 2.0 (WHODAS; scored 0-100), 5-Question Frail Scale (scored 0-5) and HDQ (scored 0-100). Median scores (Q1, Q3) for disability (WHODAS) and frailty (Frail Scale) were reported. HDQ validity was tested based on 16 a priori hypothesized relationships between WHODAS, Frail Scale and HDQ scores (threshold ≥75% confirmed), and HDQ internal consistency with Cronbach's alpha (acceptability threshold ≥ 0.70). Seven days after the initial completion, the HDQ was re-administered for test-retest reliability (intraclass correlation coefficient, acceptability threshold ≥ 0.75). RESULTS:Fifty participants were recruited, with a median age 55. Eighty-eight percent were male, and 38 participants completed the second HDQ. The median (Q1, Q3) scores were: WHODAS 9 (3,17), with domain scores ranging from 0 to 56. Pre-frailty (score 1-2) and Frailty (score 3-5) were present in 27% and 13% of participants, respectively. The HDQ demonstrated construct validity (81% hypotheses confirmed), internal consistency (Cronbach's alpha ≥ 0.79), except in the Episodic scale-Social inclusion domain (alpha = 0.34), and good test-retest reliability for all Presence and Severity domains (ICC range: 0.77-0.94). CONCLUSIONS:Disability, frailty and pre-frailty exist in this sample of outer regional Australians living with HIV. The HDQ showed acceptable construct validity, internal consistency and test-retest reliability to measure disability in this population. CLINICAL TRIAL REGISTRATION:Australian New Zealand Clinical Trials Registry (ACTRN12623000090617).

INTRODUCTION:The Living My Life Program was co-created with rural and remote stroke survivors by applying the Living My Life Framework as a lens on recovering. The aim of this study was to determine whether the Program stayed true to the lens when piloted and to refine the Program ahead of broader implementation. METHODS:A qualitative design integrating case study methods, narrative portraits, and features of constructivist grounded theory within an action research approach was used. Narrative portraits were crafted for five participants who piloted the individualised stroke recovery intervention and then analysed according to the categories of the Framework. CONSUMER AND COMMUNITY INVOLVEMENT:Four stroke survivors who piloted the Program contributed their experiences and reflections to craft the narratives, member-checked findings, provided feedback to refine the Program, and contributed as co-authors to disseminate findings. The fifth participant did not complete the Program; however, his contribution was acknowledged through a reflective narrative by the coach and cultural mentor. FINDINGS:Participants spoke about their unique experiences of the Program. Analysis confirmed the Program stayed true to the lens and illuminated further depth to the Framework. Conceptual (e.g., working out what works for me) and practical (e.g., options for measuring progress) refinements were incorporated iteratively. CONCLUSION:The Living My Life Program stayed true to the stroke survivors' lens on recovering. This suggests the Program can be used by health professionals to support stroke survivors to live their life as it evolves, while recovering their way, in their world. Stroke survivors' expertise needs to be prioritised when implementing the Program more broadly.

PURPOSE:To explore factors that influence community inclusion for adults with complex disabling conditions, from their perspective and that of their supports. METHODS AND MATERIALS:A scoping review was conducted in accordance with the Arksey and O'Malley approach. Studies were screened and selected using Covidence and reported using PRISMA. Cinahl, Medline, Emcare, and Scopus databases were searched until May 2025. Eligible studies were published in a peer-reviewed journal in the English language and described factors influencing community inclusion. Selected studies were mapped to components of the International Classification of Functioning, Disability and Health (ICF) framework through inductive synthesis and thematic analysis. RESULTS:A total of 4,088 records were screened. Across the 42 studies included in the final review, 67 factors (29 enablers and 38 barriers) influencing community inclusion were identified and mapped to the ICF. Enablers were most commonly mapped to Activities and Participation, while barriers were predominantly Environmental, encompassing physical, attitudinal and social factors. CONCLUSION:Community inclusion for people with complex disabling conditions is influenced by multiple, intersecting factors that extend beyond traditional markers of community integration. The findings reinforce the need for policy and practice approaches that explicitly prioritise fostering community inclusion outcomes across diverse community contexts.

BACKGROUND:Clubfoot prevalence in the Aboriginal and Torres Strait Islander population (hereafter Indigenous population) is reportedly higher than globally. This study enumerates and describes the isolated (also 'idiopathic') clubfoot population in Australia's Northern Territory (NT), where 30% of the population is Indigenous. METHODS:In this retrospective study, medical records were searched to identify all cases in the NT born in 2009-22 inclusive. Birth prevalence was calculated by using established methods. Logistic regression estimated odds ratios (ORs) and 95% confidence intervals (CIs) comparing characteristics of Indigenous with non-Indigenous babies with clubfoot. RESULTS:The birth prevalence of isolated clubfoot (150 cases/53 591 births) was 2.80/1000 (95% CI: 2.35-3.25). For 109 Indigenous babies, the prevalence was five times higher (5.99, 95% CI: 4.87-7.12) than for non-Indigenous babies (1.16, 95% CI: 0.84-1.56) and three times higher in Indigenous males (4.11, 95% CI: 3.35-4.86) than females (1.42, 95% CI: 0.96-1.88). Among babies with clubfoot, Indigenous babies with clubfoot were more likely to be male (OR = 2.68; 95% CI: 1.22-5.90; P = 0.014), from remote or very remote localities (OR = 14.24; CI: 5.98-33.90; P < 0.001), and have younger mothers (OR = 13.88; 95% CI: 3.90-49.39; P < 0.001). CONCLUSION:The prevalence of isolated clubfoot in Australia's NT is higher than global estimates and other Australian reports, and disproportionately affects Indigenous babies. An Australian clubfoot register would be invaluable to improve the national understanding of prevalence patterns. Given the disproportionate prevalence in Indigenous babies, culturally responsive service provision, clinical outcomes, and experiences of their families warrant investigation.

IMPORTANCE:The minimum important difference (MID) for field walking tests aims to improve interpretation of outcomes, but the volume and heterogeneity of MIDs for these tests is challenging. We aimed to determine the MID for the 6-min walk distance (6MWD), incremental shuttle walk test (ISWT) and endurance shuttle walk test (ESWT) in adults with long-term conditions. METHODS:This systematic review included studies that generated a MID using an anchor-based approach in patients with long-term conditions for the 6MWD, ISWT or ESWT field walking tests. Studies were screened and data extracted by independent reviewers. Meta-analyses were performed using RevMan. RESULTS:42 studies were included in the analyses, involving n=13 949 participants. Of these, 12 studies involving exercise as an intervention were included in the meta-analyses to produce MIDs, presented as mean (95% confidence interval). The MID for the 6MWD was 25 m (24-26 m) for respiratory conditions, 23 m (8-37 m) for cardiac conditions and 37 m (26-49 m) for neurological/musculoskeletal conditions. The MID for the ISWT was 48 m (39-57 m) for respiratory conditions and 70 m (55-85 m) for cardiac conditions. The MID for ESWT in COPD was 159 s (94-224 s). The pooled MID across conditions within exercise interventions was 26 m (22-40 m) for the 6MWD and 53 m (44-62 m) for the ISWT, with reasonable heterogeneity (I2=48% and I2=47%, respectively). CONCLUSION:We propose new MIDs for exercise interventions using anchor-based methodology in long‑term conditions for the 6MWD, ISWT and ESWT. These can be used internationally for meta‑analyses where studies have used different field walking tests, to optimise trial sample size calculations, and for clinical service benchmarking.

Introduction This article presents an assessment of the mental health profile of women who were the subject of a suicide-related call to police or paramedics around the time of (i) pregnancy or (ii) surgical termination of pregnancy compared to (iii) other women of a similar age.Methods Findings are drawn from a population-wide linked dataset of approximately 70,000 individuals who were the subject of a suicide-related call to police or paramedics in Queensland, Australia. Mental health diagnoses were assessed based on the Diagnostic and Statistical Manual (fifth edition). Behavior, impairment, symptoms, and social functioning were assessed using Health of the Nation Outcome Scores (HoNOS).Results 32.7% of individuals had a record of one or more confirmed mental health diagnoses. The presence of a mental health diagnosis differed significantly across subgroups. Rates of clinically significant problems, as measured by HoNOS, differed significantly across groups for most items.Conclusion Findings present a complex picture of the relationship between mental health diagnosis, pregnancy or termination of pregnancy, and other stressors experienced around the time of a suicide-related contact with police or paramedics.

University-affiliated student-led healthcare services have emerged to address challenges in securing quality clinical placements. As the benefits and challenges of student-led healthcare services emerge in recent literature, it is important to identify key measurement areas that will help stakeholders evaluate placements, allowing for standardisation, comparability, and quality improvement. This study aims to achieve consensus among key stakeholders on important areas of measurement for evaluating clinical placement performance in student-led healthcare services. A three-round modified Delphi study was conducted with 18 experts using purposive sampling to ensure diverse firsthand experience in clinical placements. Each round yielded quantitative (e.g. percentage of agreement) and qualitative (e.g. free text responses) data. Quantitative data were analysed to determine consensus with ≥70% agreement, and qualitative responses thematically analysed. Round one identified 47 areas of measurement for evaluating clinical placement. In rounds two and three, consensus was established on 44 areas of measurement related to four overarching themes: Learning Outcomes, Experience of Placement, Cost of Placement, and Research in Clinical Placement. The findings provide a solid foundation for evaluating clinical placements across various models, including student-led healthcare services, and offer valuable insights to guide future research into evaluating clinical placements.

OBJECTIVE:To review the quantitative outcome measures that have been used to evaluate community rehabilitation services delivered across rural and remote Australia. DESIGN:A scoping review was completed and reported using the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) extension for Scoping Reviews. METHODS:Peer-reviewed, original research published between January 2010-September 2023 was searched using MEDLINE, PubMed, EMBASE, CINAHL, Scopus, Cochrane database, Joanna Briggs Library, PsychINFO, Web of Science and Google Scholar. Studies were selected if they involved allied health outpatient, subacute or nonacute services for Australian rural or remote dwelling populations. Participants were required to have an underlying impairment. Face-to-face or telehealth delivery in a rural and remote location was included. Measures were identified and then mapped to the ICF domains of activity and participation, as well as quality of life. RESULTS:A total of 27 studies were included that yielded 40 different outcome measures of activity, participation and/or quality of life. Few measures, however, were used consistently across studies, and even fewer demonstrated a significant change across more than one study. Most studies evaluated single interventions, and few studies evaluated the service model as a whole. CONCLUSION:To ensure robust evaluation of community rehabilitation services in rural and remote Australia, a core data set and common framework for evaluation of community rehabilitation services is required. The evaluation framework must ensure consistency in measurement that reflects rural and remote service models and takes into account the environment in which services are delivered.

Introduction:One in six stroke survivors continue to experience arm and language disability at 3 months post-stroke. This study aims to identify which model(s) of integrated UPper limb and Language Impairment and Functional Training (UPLIFT) show promise for people 3 months to 24 months post-stroke. We hypothesise that at least one promising UPLIFT model of rehabilitation will be identified. Methods and analysis:This is an adaptive Phase IIa master protocol umbrella design that includes four simultaneous Bayesian Optimal Phase II studies to evaluate individual UPLIFT interventions against prespecified objective performance criteria. The intervention is upper limb and language training at 2 or 4 hours/day, 5 days/week for 4 weeks, delivered either in person (severe stratum) or via telerehabilitation (mild-moderate stratum). Up to 160 adult participants will be recruited across six metropolitan/regional university or healthcare hubs spanning five Australian states. Baseline and post-intervention assessments are blinded. A promising response is defined as a composite binary outcome combining indicators of promise of efficacy, safety and feasibility. For each UPLIFT intervention, the proportion of participants with a promising response will be monitored at three equally spaced, predefined interim stopping points and one final analysis point (n=40 participants/study). An intervention will be stopped if too few promising responses are observed. Ethics and dissemination:Ethical approval was obtained from The Royal Melbourne Human Research Ethics Committee. All participating sites obtained local governance approval. All recruited participants will provide informed consent. Trial results will be disseminated through peer-reviewed publications and presented at major stroke and rehabilitation conferences. Trial registration number:ACTRN12622000373774.

Objective To quantitatively describe therapists’ use of coaching with stroke survivors, in a hospital-based rehabilitation setting, to promote perseverance with longer-term practice. Design Prospective observational behavioural mapping study. Setting Rehabilitation unit of a regional public hospital in Queensland, Australia. Main measures A custom-designed behavioural mapping tool was used to collect rehabilitation session contextual data and therapists' use of coaching. Data were captured in 3-minute epochs for a maximum of 30 minutes. Data were analysed using descriptive statistics. Results Thirty-six rehabilitation sessions, including 34 participants (therapists n = 22, stroke survivors n = 12) were observed. Rehabilitation sessions were mostly inpatient ( n = 33, 91.7%), one-on-one ( n = 30, 83.3%), and conducted in the physiotherapy ( n = 160, 45.5%) or occupational therapy ( n = 155, 44.0%) gym. Strategies to promote perseverance were used in 76.7% ( n = 267) of observed epochs. The most frequently used strategy was monitoring the quality of practice and the least frequently used strategy was utilising a support person to facilitate practice. Conclusion Coaching that may promote perseverance with practice was regularly used by therapists during hospital-based rehabilitation sessions. Coaching that may enable longer-term perseverance beyond a therapist-dependent rehabilitation model was less commonly observed.

Button battery (BB) exposures are common in children and can have devastating consequences. We reviewed current evidence on the complications associated with BB exposure and identified predictors of outcomes using individual patient-level data. We carried out a systematic review and pooled analysis by searching MEDLINE, Embase, and Scopus up to May 19, 2023. Included studies describe complications following BB exposures in children (aged < 18 years). Odds ratios (ORs) were calculated using binary logistic regression to measure associations between predictive factors and different outcomes. Two-hundred seventeen studies (439 children) were included. The median age at presentation was 1.75 [interquartile range (IQR) 1.00–3.00] years and 399 (90.9

Background: Previous studies have focused on demographic factors that might predict non-completion of pulmonary rehabilitation (PR). We aimed to identify key modifiable factors that promote completion of PR. Methods: A mixed methods survey was offered to participants completing a discharge assessment following PR. Descriptive statistics and inductive thematic analysis were used to analyse the survey responses, with investigator triangulation. Results: 62 of 187 (33%) patients attending a PR discharge assessment between November 2022 and April 2023 returned the anonymised survey. Desire to improve health and wellbeing was the main reason for both initially committing to a course and for continuing with PR past transient thoughts of leaving. The positive impact of staff was the second most common reason. The enjoyment of the PR programme, being held accountable to attend classes, and the importance of other group members were other key themes identified. Conclusions: In conclusion, our findings suggest PR services need to implement strategies which ensure regular promotion and reinforcement of the health benefits of PR as well as implementation of PR modalities which best monopolise on the positive impact skilled staff have on motivating patients to complete PR.

BackgroundClubfoot management according to the Ponseti method, including 4-5 years of bilateral foot abduction bracing to prevent relapse, is widely accepted as gold standard. Adherence to bracing is often low, despite non-adherence being associated with poor outcomes.ObjectivesThis systematic scoping review aimed to identify and synthesize factors associated with brace adherence and non-adherence in the Ponseti method, to identify strategies shown to improve adherence, and to provide a clinically meaningful synthesis of available evidence.MethodsThis scoping review utilized systematic search and formal guidance on conduct and reporting. Medline, SCOPUS, Informit, EmCare, CINAHL, and PEDro databases were searched for peer-reviewed primary research reporting factors associated with brace adherence or non-adherence during Ponseti management. Factors were identified, then grouped using inductive then deductive methods and reported in a narrative synthesis.ResultsA total of 413 studies were identified and 42 were included in the review: 31 quantitative and 11 qualitative, generally of low quality. Meta-analysis was not feasible. Factors associated with non-adherence were identified more often than with adherence, and findings for both were inconsistent. Fifty-three factors were investigated, with conflicting findings common. No studies evaluating strategies to improve brace adherence were identified.ConclusionsAvailable evidence does not indicate that any one factor or set of factors is consistently associated with adherence or non-adherence to bracing in Ponseti clubfoot management, and so clinically meaningful factors are proposed. Adequately powered longitudinal studies of adherence to bracing are required. Mixed methods approaches would help to inform and evaluate strategies to improve adherence, particularly those routinely recommended in clinical practice.

INTRODUCTION:First Nations Peoples consistently demonstrate strength and resilience in navigating systemic health care inequities. Acknowledging racism as a health determinant underscores the urgent need for a counterforce-cultural safety. Indigenous Allied Health Australia (IAHA) contends that with cultural responsiveness, the health workforce can take action to create a culturally safe environment. OBJECTIVE:To explore features of culturally responsive occupational therapy (OT) practice when providing a service with First Nations People and examine alignment of those features with the IAHA Cultural Responsiveness in Action Framework. DESIGN:A systematic scoping review was undertaken using CINAHL, Emcare, MEDLINE, PsychInfo and Scopus databases. Examples of culturally responsive OT practice with First Nations Peoples were mapped to the six IAHA Framework capabilities and confirmed by First Nations co-authors. FINDINGS:OT practice with First Nations Peoples aligned with the six capabilities to varying degrees. The importance of OTs establishing relationships with First Nations People, applying self-reflection to uncover cultural biases, and addressing limitations of the profession's Western foundations was evident. DISCUSSION:Recognising the interrelatedness of the six capabilities, the absence of some may result in a culturally unsafe experience for First Nations People. OTs must acknowledge the leadership of First Nations Peoples by privileging their voices and consider how established practices may reinforce oppressive systems. CONCLUSION:To ensure a culturally safe environment for First Nations People, the OT profession must respect the leadership of First Nations Peoples and address the limitations of the profession's Western foundations to uphold the profession's core value of client-centred care.