Carole James

Survey of Australian practitioners' provision of healthy lifestyle advice to clients who are obese

Obesity is a global issue, with healthcare practitioners increasingly involved in clinical interactions with people who are overweight or obese. These interactions are opportunities to provide evidence-based healthy lifestyle advice, and impact on public health. This study used a cross-sectional survey of Australian healthcare practitioners to investigate what influenced the provision of healthy lifestyle advice to obese and overweight clients. A modified theory of planned behavior was used to explore knowledge translation processes. Knowledge translation was linked to three factors: (i) a healthcare practitioners education and confidence in the currency of their knowledge; (ii) personal characteristics - whether they accepted that providing this advice was within their domain of practice; and (iii) the existence of organizational support structures, such as access to education, and best practice guidelines. To fulfill the potential role healthcare practitioners can play in the provision of evidence-based health promotion advice requires organizations to provide access to practice guidelines and to instill a belief in their workforce that this is a shared professional domain.

Occupational therapy and obesity: An integrative literature review

BACKGROUND/AIM Obesity is a significant public health concern globally. It is associated with poor physical health, mental health and subjective well-being and limitations on occupational participation. With its focus on the relationship between occupation, health and well-being, occupational therapy would appear to be well placed to address both the causes and consequences of obesity. The aim of this review was to explore the scope of the role of occupational therapy practice in this field and the supporting evidence base. METHODS Searches were conducted in four online databases and nine occupational therapy journals. Articles were included if they were theoretical, quantitative or qualitative research, explicitly related to occupational therapy and obesity, published in peer-reviewed journals, in English between 2002 and 2012. All research articles were critically reviewed and thematic analysis was conducted across all of the articles in the review. RESULTS Eight theoretical articles, 12 quantitative and two qualitative research studies were included. Only three were outcome studies. Thematic analysis identified four categories of focus of occupational therapy intervention: health promotion and prevention, increasing physical activity participation, modifying dietary intake and reducing the impact of obesity. Four categories of intervention strategies were also identified; assessment, modifying the environment, education and introducing and adapting occupations. CONCLUSION AND SIGNIFICANCE The findings of this review suggest a comprehensive role for occupational therapy in addressing obesity. However, the paucity of outcome studies mean that significantly more research is required to further define and provide a strong evidence base for occupational therapy practice in this emerging field.

The Return-To-Work Coordinator Role: Qualitative Insights for Nursing

Introduction Few studies have examined the role of RTW Coordination from the perspective of RTW Coordinator’s. Furthermore there is little health specific literature on returning injured nurses to work despite the critical workforce shortages of these professionals. The study aimed to examine barriers and facilitators identified by the RTW Coordinator to returning injured nurses to work and influences on specific health sector or geographic location. The study sought to gain insights into the professional backgrounds and everyday work practices of RTW Coordinators. Method Five focus groups were conducted in metropolitan and rural areas of NSW, Australia. Twenty-five RTW Coordinators from 14 different organisations participated in the study. The focus groups included participants representing different health sectors (aged, disability, public and private hospital and community health). Results The data analysis identified information pertaining to the qualifications and backgrounds of RTW Coordinators; the role of RTW Coordinators’ within organisational structures; a range of technical knowledge and personal qualities for RTW Coordination and important elements of the case management style used to facilitate RTW. Conclusions The findings identified a wide range of professional backgrounds that RTW Coordinators bring to the role and the impact of organisational structures on the ability to effectively undertake RTW responsibilities. The study found that interpersonal skills of RTW Coordinators may be more important to facilitate RTW than a healthcare background. A collaborative case management style was also highlighted and the difficulties associated with juggling conflicts of interest, multiple organisational roles and the emotional impact of the work.

Weight management including dietary and physical activity advice provided by Australian physiotherapists: a pilot cross-sectional survey

Abstract Physiotherapists may have an impact on obesity prevention and treatment by providing nutrition and physical activity advice to overweight or obese clients; yet little is known about physiotherapists’ beliefs and practices related to client weight management. The aim of this pilot study was to determine the practices, beliefs, attitudes and knowledge of physiotherapists regarding the provision of weight management advice to overweight or obese clients. Physiotherapists (n = 65) working in multiple practice settings completed a self-administered questionnaire. Logistic regression determined factors associated with the provision of dietary and physical activity advice for weight management. The majority of physiotherapists (n = 53 [81.5%]) believed providing weight management advice was within their scope of practice, yet only a minority had received training during their professional entry level education (n = 13 [20%]) or through professional development (n = 7 [11%]). Most physiotherapists (n = 55 [84.6%]) provided physical activity advice for weight management, but a minority (n = 27 [41.5%]) provided dietary advice. Having received training in weight management during their professional entry level education was associated with providing dietary advice (Odds ratio 8.8, 95% confidence interval 2.0–38.9, p = 0.004). Training in weight management may increase the likelihood of physiotherapists providing dietary advice, improving physiotherapists’ management of obesity.

Test-retest reliability of the manual handling component of the WorkHab functional capacity evaluation in healthy adults.

Purpose. The WorkHab Functional Capacity Evaluation (FCE) is one of many FCEs currently available and is widely used in the Australian workplace injury management and occupational rehabilitation arena. This study investigated the test–retest reliability of manual handling tasks within the WorkHab FCE in healthy adults. Method. A convenience sample of 25 healthy subjects, consisting of 19 women and 6 men with a mean age of 29 years (SD: 12.0) participated in this study. Two FCE sessions were held a week apart and subjects completed a floor to bench, bench to shoulder and bench to bench lift. Analysis of the outcomes of the FCE included descriptive analysis, intra-class correlations (ICC), kappa, percentage agreement and 95% limits of agreement where appropriate. Results. The ICCs for the three lifts show an excellent reliability (0.90–0.92), and a moderate reliability for the manual handling score (0.74). Further analysis of the components of the manual handling score found the percentage agreement was high for all components ranging from 72 to 92%; however, the kappa scores suggested poor to moderate reliability (range: −0.06 to 0.52). Internal consistency of the manual handling score was good (Cronbachs Alpha = 0.92) indicating this is a reliable scale. Conclusions. The ratings for the lifting components identified substantial levels of test–retest reliability for the lifting components of the WorkHab FCE in healthy adults.

Maintaining occupation-based practice in Australian mental health practice: A critical stance

Introduction This paper explores the way dominant discourses, and their associated practice knowledge dimensions, shape personal paradigms and occupation-based practice in mental health workplaces. Method Narrative inquiry methods and narrative thematic analysis was used to explore the career stories of nine occupational therapists who had worked in mental health practice for more than five years. Findings The main narrative themes to emerge were (i) living with the biomedical practice knowledge discourse, (ii) living with the psychological practice knowledge discourse and (iii) reflection as a strategy for maintaining occupation-based practice. These discourses created the need to reflect on practice and adopt strategies to avoid the marginalisation of occupational perspectives and occupation-based practice. The strategies used to cope with these discourses varied from acceptance and embracing of other discourses to resistance and rejection. Conclusion This paper demonstrates that in some mental health workplaces there is a danger that occupational perspectives and occupation-based practice can become marginalised. Making visible the different discourses in mental health practice allows occupational therapists to analyse, better understand, and live with the tensions in their professional lives. This requires professional support strategies to be in place to maintain occupation-based practices and retain practitioners in the workforce.

Inter- and intra-rater reliability of the manual handling component of the WorkHab Functional Capacity Evaluation

The WorkHab Functional Capacity Evaluation (FCE) is widely used in Australian workplace injury management and occupational rehabilitation arenas; however, there is a lack of published literature regarding its reliability and validity. Purpose. This study investigated the intra- and inter-rater reliability of the manual handling component of this FCE. Method. A DVD was produced containing footage of the manual handling components of the WorkHab conducted with four injured workers. Therapist raters (n  ==  17) who were trained and accredited in use of the WorkHab FCE scored these components and 14 raters re-evaluated them after approximately 2 weeks. Ratings were compared using intraclass correlation coefficients (ICCs), paired sample t-tests (intra-rater), chi-squared (inter-rater) and percentage agreement. Results. Intra-rater agreement was high with ICCs for the manual handling components and manual handling score showing excellent reliability (0.94–0.98) and good reliability for identification of the safe maximal lift (ICC: 0.81). Overall inter-rater agreement ranged from good to excellent for the manual handling components and safe maximal lift determination (ICC  >  0.9). Agreement for safe maximal lift identification was good. Conclusions. Ratings demonstrated substantial levels of intra-rater and inter-rater reliability for the lifting components of the WorkHab FCEs.

Fishy Tales: Experiences of the Occupation of Keeping Fish as Pets

Pet ownership is an occupation that has benefits for human health and wellbeing. However, research on pet ownership mainly addresses the benefits of interactive pets, such as dogs and cats. Some individuals are unable to participate in the occupation of interactive pet ownership and, therefore, may be deprived of the benefits that pets can bring to their lives. This research used a qualitative, phenomenological methodology to explore the ownership of fish as pets. Data were collected using in-depth semi-structured interviews and were analysed inductively. Nine participants were interviewed and the following themes were identified from the data collected: the reasons for owning fish as pets; the fish environment; caring for fish; and the benefits of owning fish as pets. It was discovered that pet fish ownership is a meaningful occupation that provides purpose and enjoyment in life. The findings of this study suggest that pet fish may be an alternative to interactive pets, and one that therapists can recommend to clients who wish to own a pet.

Functional Capacity Evaluation Research: Report from the Second International Functional Capacity Evaluation Research Meeting

Introduction Functional capacity evaluations are an important component of many occupational rehabilitation programs and can play a role in facilitating reintegration to work thus improving health and disability outcomes. The field of functional capacity evaluation (FCE) research has continued to develop over recent years, with growing evidence on the reliability, validity and clinical utility of FCE within different patient and healthy worker groups. The second International FCE Research Conference was held in Toronto, Canada on October 2nd 2014 adjacent to the 2014 Work Disability Prevention Integration conference. This paper describes the outcomes of the conference. Report Fifty-four participants from nine countries attended the conference where eleven research projects and three workshops were presented. The conference provided an opportunity to discuss FCE practice, present new research and provide a forum for discourse around the issues pertinent to FCE use. Conference presentations covered aspects of FCE use including the ICF–FCE interface, aspects of reliability and validity, consideration of specific injury populations, comparisons of FCE components and a lively debate on the merits of ‘Man versus Machine’ in FCE’s. Future directions Researchers, clinicians, and other professionals in the FCE area have a common desire to improve the content and quality of FCE research and to collaborate to further develop research across systems, cultures and countries.

Returning to driving after stroke: A systematic review of adherence to guidelines and legislation

Introduction This systematic review aimed to determine whether stroke survivors routinely received return-to-driving education in the acute hospital setting prior to discharge home; and if education was provided, were the restrictions in driving guidelines adhered to. Method A systematic search was conducted of PubMed, Medline, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsychINFO, Web of Science, Scopus, Pedro and OTseeker databases for original research reporting findings on the adherence to return-to-driving legislation and clinical guidelines after stroke, and return-to-driving behaviours in stroke survivors up to 1 month post stroke. Results Three studies met the inclusion criteria and reported on a combined total of 252 stroke survivors living in the United Kingdom. Forty-eight per cent of stroke survivors received education on the 1 month driving restriction. A total of 61.4% of participants waited 1 month prior to returning to driving. Conclusion This review found that there is limited literature available on the management of return to driving following acute stroke but there is evidence that education may not be routinely provided in the acute hospital setting and that many stroke survivors could be returning to driving within the 1 month restriction.