Carol McKinstry

Functional Electrical Stimulation Improves Activity After Stroke: A Systematic Review With Meta-Analysis

OBJECTIVE To investigate the effect of functional electrical stimulation (FES) in improving activity and to investigate whether FES is more effective than training alone. DATA SOURCES Cochrane Central Register of Controlled Trials, Ovid Medline, EBSCO Cumulative Index to Nursing and Allied Health Literature, Ovid EMBASE, Physiotherapy Evidence Database (PEDro), and Occupational Therapy Systematic Evaluation of Effectiveness. STUDY SELECTION Randomized and controlled trials up to June 22, 2014, were included following predetermined search and selection criteria. DATA EXTRACTION Data extraction occurred by 2 people independently using a predetermined data collection form. Methodologic quality was assessed by 2 reviewers using the PEDro methodologic rating scale. Meta-analysis was conducted separately for the 2 research objectives. DATA SYNTHESIS Eighteen trials (19 comparisons) were eligible for inclusion in the review. FES had a moderate effect on activity (standardized mean difference [SMD], .40; 95% confidence interval [CI], .09-.72) compared with no or placebo intervention. FES had a moderate effect on activity (SMD, .56; 95% CI, .29-.92) compared with training alone. When subgroup analyses were performed, FES had a large effect on upper-limb activity (SMD, 0.69; 95% CI, 0.33-1.05) and a small effect on walking speed (mean difference, .08m/s; 95% CI, .02-.15) compared with control groups. CONCLUSIONS FES appears to moderately improve activity compared with both no intervention and training alone. These findings suggest that FES should be used in stroke rehabilitation to improve the ability to perform activities.

Scoping reviews in occupational therapy: The what, why, and how to

BACKGROUND/AIM Scoping reviews are a method of identifying, locating, analysing and summarising relevant empirical literature and research findings on a nominated topic. A description of scoping reviews is provided with examples that have been published in the occupational therapy and related literature and outline of the uses of scoping reviews for research and in evidence-based practice. METHODS Recent occupational therapy literature was searched to identify occupational therapy-related scoping reviews published in the refereed literature and to identify the methodologies used and topics covered. RESULTS A limited range of scoping reviews was located and a summary of their results is provided as examples of scoping reviews in the occupational therapy field. CONCLUSION The scoping review methodology is an efficient and effective approach for locating, analysing, summarising and presenting available literature and research findings on a particular topic. In comparison to a systematic review, it does not have the same high level of rigour, however does provide a general overview of the literature using a structured methodology to ensure consistency. The methodology of scoping reviews is effective for researchers where there is limited high level evidence available about a topic that would be required by a systematic review and provides an efficient way of identifying previous research and current knowledge gaps. Although there has been some scoping reviews published, it is predicted that there will be an increase in the future when the use of scoping reviews in occupational therapy is more fully realised and operationalised.

Perspectives of occupational therapists working in primary health promotion

BACKGROUND/AIM Given a global reorientation of health services towards upstream, or primary health promotion, there is a need to explore the role of occupational therapy in this area of practice. This study aimed to explore and describe the primary health promotion practice of community health workers with an occupational therapy background. The study highlights their practice working at a community or population (macro) level, rather than at the client service (micro) level, and explores related enablers and barriers to this practice. METHODS The study utilised the qualitative methodology of narrative enquiry. Five workers with an occupational therapy background were recruited from community health services within Victoria. Data were gathered via in-depth interviews. Individual participant interview data were ordered to form a narrative detailing each participants experience. These narratives were then analysed to generate themes representing important aspects of participants experiences. RESULTS Although some practitioners with an occupational therapy background perform primary health promotion, the findings indicate that a number of barriers deter occupational therapists from engaging in this type of practice, including lack of funding, preparation and limited understanding of the role of occupational therapy in health promotion. Enablers to engagement included undertaking further education, gaining clinical experience and establishing a professional identity. CONCLUSION This study provides insights into the experiences of occupational therapists who work at a macro rather than micro-level of practice, and emphasises some of the barriers and enablers to embracing the sorts of roles that are emerging as part of a changing health system.

A scoping review of the association between rural medical education and rural practice location

BackgroundInequitable distribution of the medical workforce is an international problem that undermines universal access to healthcare. Governments in many countries have invested in rural-focused medical education programs to increase the supply of rural doctors.MethodsUsing a structured five-step approach, a scoping review was conducted to map the existing evidence on the relationship between professional entry-level, pre-vocational medical education delivered in rural settings and rural workforce outcomes. Key search terms were developed, with database searches yielding 37 relevant articles. During data charting, a set of types of studies emerged, and we developed a typology to assist with article sorting and information structuring.ResultsMedical students attending a rural campus or spending time in a rural area are more likely to practise in non-metropolitan areas upon graduation than students studying at a city campus. In many cases, these positive findings could be confounded by students having a rural origin or being predisposed to want rural work. There is some evidence to suggest that the longer a person spends time as a medical student in a rural area, the more likely they are to work rurally following graduation. Overall, the articles located had limitations related to small sample size, inconsistent definition of rurality and lack of attention to controlling for variables that might influence rural practice decision, for example, rural background. Comparative data were lacking, and most studies were conducted by staff from the medical schools that were the focus of the research. There was no consideration given in any study found to the cost-effectiveness of entry-level medical education delivered in rural settings versus other ways of producing rural practitioners.ConclusionsGiven limitations, available evidence suggests that medical education in a rural location does increase the number of medical graduates that will work in a rural place. There are indications of a gradient effect where increased rural practice exposure during medical education leads to more rurally located graduates; however, robust studies are needed to verify this finding. Given the significant funding being directed to universities to increase graduates that will work rurally, appropriate future research is recommended.

Research capacity and culture of the Victorian public health allied health workforce is influenced by key research support staff and location

OBJECTIVE The aim of the present study was to identify and understand the self-rated research capacity and culture of the allied health workforce. METHODS. The present study was a cross-sectional survey. The Research Capacity and Culture tool was disseminated to all Victorian public health allied health departments. General demographic data were also collected, including the presence of an organisational allied health research lead. RESULTS Five hundred and twenty fully completed surveys were returned by participants; all allied health disciplines and all grades were represented. One hundred and eighty-six participants had an organisational allied health research lead and 432 were located in a metropolitan-based health service. There were significant differences (P < 0.05) within all organisational and team research skills between those with and without a research lead, together with those in different service locations (metropolitan vs non-metropolitan). Higher self-ratings in individual research skills (P < 0.05) were primarily associated with more senior and metropolitan-located clinicians. CONCLUSION The allied health workforce identifies as a group that is ready to build the evidence to support clinical practice yet requires a whole-systems approach to do so. The results of the present study suggest that the development of key people to build capacity at a higher organisational level has a flow-down effect on research capacity and culture.

Occupational therapy and circus: Potential partners in enhancing the health and well-being of today's youth

This paper describes and discusses the benefits of a project involving a community circus program developed for Victorian schools to assist in addressing students’ needs for life skills acquisition. A program logic model framework (CAOT, 1999), together with an occupational perspective, was used to develop an evaluation tool for Westside Circus’ ‘Circus in Schools’ program. The project was unique in that it introduced an occupational perspective to the evaluation of this innovative educational program. Although the project’s focus was primarily on program evaluation, it also demonstrated a connection between the core beliefs of community circus, education, occupational therapy, and health promotion. The occupational therapy profession can play a key role in education reform, which includes working in partnership with community organisations to develop innovative programs that meet the needs of young people. Educational and allied health professionals agree that effective teaching strategies which seek to promote overall health and well-being need to be implemented in schools to provide students with skills that will enable them to be healthy and positive contributors to society (Struthers, 2005). With an understanding of the dynamic interdependence of the person, occupation, and environment (CAOT, 1999), occupational therapists are equipped with skills that enable them to advise on educational program development, implementation and evaluation. Research conducted by the Victorian Curriculum and Assessment Authority (VCAA) led to the establishment of a framework, the ‘Victorian Essential Learning Standards’ (VELS) that aims to promote holistic education for young people (VCAA, 2005). The success of this educational reform requires a collaboration of disciplines to meet the complex needs of young people. Occupational therapists’ knowledge of program development, service delivery and evaluation can enable them to work in collaboration with community organisations, providing varied and innovative input into educational programs.

Cancer-related fatigue: a survey of health practitioner knowledge and practice.

PurposeThis study aims to identify the current practices of health professionals in the assessment and treatment of cancer-related fatigue (CRF).MethodsHealth professionals working with oncology clients participated in an electronic survey distributed via professional associations and oncology societies.ResultsOne hundred twenty-nine professionals from nursing, medical, and allied health disciplines participated in an electronic survey. Overall, there was a perception that CRF was inadequately managed at some facilities. Routine fatigue screening processes in the workplace were reported by more than half of participants; however, less than one quarter used a clinical guideline or conducted in-depth CRF assessments. Awareness of interventions for CRF varied amongst participants with one quarter able to list five appropriate interventions for cancer-related fatigue. Access to services for managing fatigue was inconsistent across service types, with post-treatment triage a high priority for CRF in some organisations yet not others. Participants identified a need for improved guidelines, enhanced expertise and better access to services for people with CRF.ConclusionsThere is a need for further education in CRF management for a range of health disciplines in oncology and additional resources to facilitate translation of CRF guidelines into clinical practice.

Research culture in allied health: a systematic review

Research evidence is required to guide optimal allied health practice and inform policymakers in primary health care. Factors that influence a positive research culture are not fully understood, and nor is the impact of a positive research culture on allied health professionals. The aim of this systematic review was to identify factors that affect allied health research culture and capacity. An extensive search of 11 databases was conducted in June 2015. Studies were included if they were published in English, had full-text availability and reported research findings relating to allied health professions. Study quality was evaluated using the McMaster Critical Review Forms. Fifteen studies were eligible for inclusion. A meta-analysis was not performed because of heterogeneity between studies. Allied health professionals perceive that their individual research skills are lower in comparison to their teams and organisation. Motivators for conducting research for allied health professionals include developing skills, increasing job satisfaction and career advancement. Barriers include a lack of time, limited research skills and other work roles taking priority. Multilayered strategies, such as collaborations with external partners and developing research leadership positions, aimed at addressing barriers and enablers, are important to enhance allied health research culture and capacity.

Interventions for cancer‐related fatigue: a scoping review

Cancer-related fatigue (CRF) is common and can be distressing for some survivors. There is increasing interest in measuring levels of CRF, highlighting its impact on quality of life. This review describes the nature and scope of evidence relating to interventions for CRF. Scoping review methodology was used to identify studies, extract data, collate and summarise results. Data were collated according to cancer tumour streams, stage of illness and the types of trial interventions. A total of 447 trials and 37 systematic reviews met the inclusion criteria. Nine papers reported longitudinal results. Populations studied were predominantly of mixed cancer diagnoses and breast cancer. The most frequent interventions were exercise, pharmacological, psycho-education and mind-body interventions. Fatigue was identified as a primary outcome measure (OM) in 58% of studies, with 58 different fatigue measures reported. Emerging evidence exists for the effectiveness of fatigue interventions for some cancer types. More research on interventions with participants with the same cancer type and illness phase is needed. Measurement of severity and impact of CRF using fewer, robust OMs will permit comparisons across studies.

Youth mental ill health and secondary school completion in Australia: time to act

This paper reviews the evidence of youth mental ill health and its impact on secondary school educational attainment.