Emma L. Friesen

Building research capacity in south-west Sydney through a Primary and Community Health Research Unit

The Primary and Community Health Research Unit was established in 2010 in south-west Sydney to build research capacity in primary and community health services and help generate evidence to underpin clinical activities. In 2011, six project teams participated in a 12-month researcher mentoring program, undertaking projects in quality improvement and service evaluation. Project teams were linked with academic mentors and participated in four research skill development workshops covering research design, research ethics, statistical analysis and academic writing. All project teams presented their work at two or more research conferences, and all are preparing manuscripts for publication in peer-reviewed journals. The Primary and Community Health Research Units approach to research capacity building in primary and community health services appears to be effective in supporting novice researchers to undertake research in their clinical settings. Sustainability is dependent on securing ongoing funding. Further analysis is needed to identify strengths and weaknesses of this approach.

Clinical assessment, design and performance testing of mobile shower commodes for adults with spinal cord injury: an exploratory review

Purpose: The purpose of this article is to explore evidence concerning clinical assessment, design and performance testing of mobile shower commodes used by adults with spinal cord injury (SCI). Method: Searches of electronic databases, conference proceedings and key journals were undertaken with no restriction on language or study design. Keywords included spinal cord injury, lesion, sanichair, sanitary chair, shower chair, bowel chair and commode. Results: A total of 20 publications were included in this review. Common approaches to clinical assessments were questionnaires and observational analysis to assess bowel care routines, function and skin integrity. Design features addressed access for bowel care, postural support, transfers, stability, use in wet environments and skin integrity. Objective performance measures addressed requirements for static stability, backward-sloping seat angles, arm supports and seat materials. Conclusions: Evidence reviewed was of low methodological quality and lacking in validated instruments to guide clinical practice. Further high-quality research is needed to identify bathing, showering and personal hygiene tasks affecting mobile shower commodes use and to develop validated clinical assessment tools. Performance testing to published standards is also needed. Implications for Rehabilitation Adults with spinal cord injury (SCI) use mobile shower commodes for functional activities including transferring, propelling, bowel care and showering, and the interactions between an adult with SCI, their mobile shower commode, and the physical environment are not well understood. Current mobile shower commode designs may not facilitate functional activities and may contribute to falls and development of pressure ulcers. Standardised and validated clinical assessment tools are needed to guide clinical practice, and should include questionnaires and observational analysis of functional activities performed in mobile shower commodes across all environments of use.

Use, performance and features of mobile shower commodes: perspectives of adults with spinal cord injury and expert clinicians

Abstract Purpose: The purpose of this article is to explore the use of Mobile Shower Commodes (MSCs) by adults with Spinal Cord Injury (SCI) and to understand how adults with SCI and expert clinicians identify and select MSC designs and features. Method: Semi-structured interviews were conducted with seven adults with SCI and eight expert clinical prescribers using semi-structured guides. Transcripts were analysed thematically using the Policy, Human, Activity, Assistance and Technology, and Environment (PHAATE) model as the underpinning theoretical framework. Results: Analysis of the interview transcripts revealed 3 themes and 12 sub-themes. The main themes were: (1) Activities, routines and interacting factors, (2) Features for functioning and (3) Getting it right. Substantial links existed between and across the themes and subthemes. Conclusions: The use of MSCs by adults with SCI is complex. MSC performance varies across activities, and during interactions between the user, the MSC, other assistive technologies, assistance and physical environments. Future studies should explore service delivery processes and develop validated clinical assessment instruments and outcome measures for MSC provision. Implications for Rehabilitation Mobile shower commode use is complex, involving nine distinct activities and three types of routines. Mobile shower commodes used by Australian adults with SCI are individualised to users and include customisations and custom-made components. Trialling individualised mobile shower commodes prior to funding is problematic and not reflected in assistive service delivery models. Validated clinical instruments for assessing and selecting mobile shower commode features are needed.

Development, Construction, and Content Validation of a Questionnaire to Test Mobile Shower Commode Usability

BACKGROUND Usability is an emerging domain of outcomes measurement in assistive technology provision. Currently, no questionnaires exist to test the usability of mobile shower commodes (MSCs) used by adults with spinal cord injury (SCI). OBJECTIVE To describe the development, construction, and initial content validation of an electronic questionnaire to test mobile shower commode usability for this population. METHODS The questionnaire was constructed using a mixed-methods approach in 5 phases: determining user preferences for the questionnaires format, developing an item bank of usability indicators from the literature and judgement of experts, constructing a preliminary questionnaire, assessing content validity with a panel of experts, and constructing the final questionnaire. RESULTS The electronic Mobile Shower Commode Assessment Tool Version 1.0 (eMAST 1.0) questionnaire tests MSC features and performance during activities identified using a mixed-methods approach and in consultation with users. It confirms that usability is complex and multidimensional. The final questionnaire contains 25 questions in 3 sections. The eMAST 1.0 demonstrates excellent content validity as determined by a small sample of expert clinicians. CONCLUSION The eMAST 1.0 tests usability of MSCs from the perspective of adults with SCI and may be used to solicit feedback during MSC design, assessment, prescription, and ongoing use. Further studies assessing the eMASTs psychometric properties, including studies with users of MSCs, are needed.

Assistive technology devices for toileting and showering used in spinal cord injury rehabilitation - a comment on terminology.

Abstract A review of assistive technologies, products and devices for toileting and showering identified at least 15 separate terms across all studies, with another two identified in subsequent studies. Terms are often used interchangeably, and are often not defined or described. Inconsistencies in terminology affect the quality of evidence available to policy makers, researchers and clinicians. Researchers are encouraged to provide clear definitions and descriptions of assistive technologies, products and devices for toileting and showering under investigation. Implications for Rehabilitation At least 17 different terms have been identified for assistive technologies, products and devices for toileting and showering. Inconsistencies in terminology make comparisons between studies difficult, and therefore affect the quality of evidence available to policy makers, researchers and clinicians. Providing clear definitions and descriptions of assistive technologies, products and devices for toileting and showering under investigation is encouraged.

Testing usability of Mobile Shower Commodes for adults with Spinal Cord Injury: research method and overview

This paper provides an overview of research to develop a new questionnaire testing mobile shower commode usability. It describes the methodology used to develop the questionnaire, and reports significant findings that have been published in peer-reviewed journals. Implications of the research and recommendations for further research on mobile shower commode usability are discussed.

Usability-for-one

This paper proposes usability-for-one as a new conceptual framework for understanding usability as it relates to Rehabilitation and Assistive Technology (R&AT). It argues that just as ergonomics for individual R&AT users is practiced as ergonomics-for-one, usability as it relates to individual R&AT users can be conceptualised as usability-for-one. The implications for R&AT service delivery and research are discussed.

Informing the Australian government on AT policies: ARATA’s experiences

Abstract This article describes the development and dissemination of an evidence-based Policy Statement and Background Papers by the Australian Rehabilitation and Assistive Technology Association (ARATA). An experienced project team was engaged to conduct literature reviews and member consultations, develop resources and implement a targeted advocacy strategy that included a policy launch and meetings with government officials. The Policy Statement and Background Papers have enabled ARATA to represent the views of Assistive Technology (AT) Practitioners in consultations around the National Disability Insurance Scheme and other AT-related inquiries. In ARATA’s experience, developing a policy statement and disseminating it through a targeted advocacy strategy is an effective way for a not-for-profit professional organisation to influence government policy. Implications for Rehabilitation AT practitioners must consider political factors in working towards effective policies to support their practice. To be effective at a systemic level, AT practitioners must develop political awareness and an understanding of the drivers of policy. This case study provides a blueprint for AT practitioners and organisations in tackling policy change.

Usability of mobile shower commodes for adults with spinal cord injury

Introduction This paper describes the usability of mobile shower commodes for adults with spinal cord injury, as measured by the new electronic Mobile Shower Commode Assessment Tool Version 1.0 (eMAST 1.0). Method A retrospective analysis of data collected for a cross-sectional validation study with adults aged 18 years or older, living with spinal cord injury, who use mobile shower commodes for toileting and/or showering (n = 32), was conducted. Usability was measured using the eMAST 1.0. Quantitative data were analysed using descriptive statistics. Qualitative data were analysed using directed content analysis. Results Overall usability on both the features and performance subscales was rated as high to very high. Ratings of very low to low usability were reported for portability/foldability/packability (41%, n = 13), mobile shower commode stability (25%, n = 8), positioning and repositioning (25%, n = 8), seat cushioning (25%, n = 8), and lower leg supports (22%, n = 7). Items receiving the highest number of qualitative comments included lower leg supports, seating, propelling and manoeuvring, cleaning and maintenance, and stability. Conclusion Results across the eMAST 1.0’s subscales showed high to very high usability. However, analysis of individual items and qualitative comments showed specific areas of reduced usability for individual users. Item-level responses and qualitative comments suggest research is urgently needed in the areas of stability, portability, durability, and seating. Studies exploring use of the eMAST 1.0 during initial provision, and after short- and long-term mobile shower commode use, are also needed.

An instrument to measure mobile shower commode usability: the eMAST 1.0

Purpose The purpose of this paper is to present a preliminary psychometric evaluation of the electronic mobile shower commode assessment tool (eMAST) 1.0. Design/methodology/approach A cross-sectional validation study was undertaken with 32 adults with spinal cord injury (SCI), aged 18 years or older, who use mobile shower commodes for toileting and/or showering. The eMAST 1.0, Quebec user evaluation of satisfaction with assistive technology, Version 2.0 (QUEST 2.0), and modified system usability scale (SUS) were administered online via SurveyMonkey. The eMAST 1.0 was re-administered approximately seven days later. Psychometric properties of internal consistency, test-retest reliability, and convergent validity were assessed. Findings As hypothesised, the eMAST 1.0 demonstrated strong internal consistency (Cronbach’s α=0.73, N=32); acceptable test-retest reliability (intra-class coefficient (3, 1)=0.75 (0.53-0.88, 95 per cent confidence interval) (n=27)); and strong, positive correlations with the QUEST 2.0’s devices subscale and modified SUS (Pearson’s correlation coefficients 0.70 and 0.63, respectively). Research limitations/implications The sample was not fully representative of Australian data in terms of gender, or state of residence, but was representative in terms of SCI level. Age data were not assessed. The sample size was small but adequate for a preliminary psychometric evaluation. Originality/value The preliminary psychometric evaluation indicates the eMAST 1.0 is a valid and reliable instrument that measures usability of MSCs for adults with SCI. It may be useful for exploring relationships between usability and satisfaction of MSCs.