Louise Gustafsson

Time use, role participation and life satisfaction of older people: impact of driving status.

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.

A programme of static positional stretches does not reduce hemiplegic shoulder pain or maintain shoulder range of motion -a randomized controlled trial

Objective: To evaluate the effectiveness of a programme of static positional stretches and positioning of the stroke-affected shoulder for maintaining shoulder external rotation and decreasing hemiplegic shoulder pain. Design: Randomized controlled trial with pretest and posttest design. Setting: Inpatient rehabilitation unit. Subjects: Thirty-two participants (17 treatment, 15 comparison) with a first time stroke who were admitted for rehabilitation. Interventions: Treatment participants completed a programme of static positional stretches of the stroke-affected shoulder twice daily and positioned the stroke affected upper limb in an armrest support at all other times when seated. Main measures: The main outcome measures were pain-free range of motion into external rotation, pain in the stroke-affected shoulder at rest and with movement, motor recovery and functional independence. Results: All participants demonstrated a significant loss of external rotation (P=0.005) with no significant group differences. All participants demonstrated a significant improvement in motor recovery (P<0.01) and functional independence (P<0.01) with no significant group differences. There were no significant effects for pain. The comparison group recorded a decrease in mean pain reported with movement from admission to discharge, and the treatment group recorded an increase. Conclusions: Participation in the management programme did not result in improved outcomes. The results of this study do not support the application of the programme of static positional stretches to maintain range of motion in the shoulder. The effect of increasing pain for the treatment group requires further investigation.

Comparison of time use, role participation and life satisfaction of older people after stroke with a sample without stroke

BACKGROUND/AIMS  This study investigated the time use, role participation and life satisfaction of older Australians (aged 65 years and older) who were 1-3 years post-stroke and living in the community. The results of this study were compared with a published study on the time use, role participation and life satisfaction of older Australians who had not experienced stroke. METHODS  Twenty-three participants with stroke (mean age 74.2 years, 69.6% men) were interviewed using measures of time use, role participation and life satisfaction. RESULTS  Participants with stroke spent most of their time in sleep (7.2 h/day), solitary leisure (7.0 h/day), social leisure (3.0 h/day), and basic activities of daily living (2.9 h/day). Compared to the sample without stroke, participants with stroke spent significantly less time in sleep, instrumental activities of daily living, and volunteer work, and significantly more time at home, with others, and engaged in solitary leisure. Similar to the sample without stroke, the most common roles for participants with stroke were family member, friend, and home maintainer. Participants with stroke engaged in fewer roles than participants without stroke. Unlike the sample without stroke, role loss was not correlated with life satisfaction for participants with stroke; however, having more roles was correlated with greater life satisfaction. CONCLUSION Experiencing a stroke can affect the configuration of older peoples time use and reduce their role participation. Facilitation of older peoples role participation after stroke may enhance their life satisfaction.

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.

Client and carer experience of transition home from inpatient stroke rehabilitation

Purpose: The purpose of this qualitative study was to enhance our understanding of the transition experience for clients with stroke and their carers during discharge and the first month at home. Method: Semi-structured interviews were conducted with five clients with stroke and their carers (n = 5) at 1 month after discharge from stroke rehabilitation. Questioning in the interviews explored preparation for and the experience of the transition. Inductive thematic analysis was completed with the client and carer interviews and the resultant themes were compared. Basic demographic data were collected to allow description of the participants. Results: Five clients and five carers were interviewed 1 month after discharge to home. The analysis of the client interviews yielded three themes including: rehabilitation was okay, it’s a struggle, and supports and assistance. The carer interviews also yielded three themes including: the purpose of rehabilitation, life is different now, and looking to the future. Conclusions: The clients and the carers all spoke of the positive aspects of rehabilitation but raised concerns about the limited ability to undertake daily tasks regularly and develop personalised routines in preparation for discharge. The daily routines at home were disrupted with clients taking longer to complete daily activities and carers juggling caring responsibilities with their own lifestyle. Overall, the results suggest that there is a need for stroke rehabilitation services to better prepare the clients and carers for transition to home. Implications for Rehabilitation Stroke rehabilitation should offer more opportunities for clients to participate regularly in meaningful activities in the hospital environment. It is beneficial to consider transition from the perspectives of the client and carer as a working unit. Alternate models of service delivery that increase outreach to the home environment may be beneficial.

Stroke management: updated recommendations for treatment along the care continuum

The Australian Clinical Guidelines for Stroke Management 2010 represents an update of the Clinical Guidelines for Stroke Rehabilitation and Recovery (2005) and the Clinical Guidelines for Acute Stroke Management (2007). For the first time, they cover the whole spectrum of stroke, from public awareness and prehospital response to stroke unit and stroke management strategies, acute treatment, secondary prevention, rehabilitation and community care. The guidelines also include recommendations on transient ischaemic attack. The most significant changes to previous guideline recommendations include the extension of the stroke thrombolysis window from 3 to 4.5 h and the change from positive to negative recommendations for the use of thigh‐length antithrombotic stockings for deep venous thrombosis prevention and the routine use of prolonged positioning for contracture management.

Participation in leisure activities during brain injury rehabilitation.

Primary objective: To describe and compare pre- and post-injury leisure activities of individuals receiving brain injury rehabilitation and explore levels of leisure participation and satisfaction. Research design: Cross-sectional descriptive study incorporating a survey of current and past leisure activities. Methods and procedures: Questionnaires were completed by 40 individuals with an acquired brain injury receiving inpatient or outpatient rehabilitation. Measures: Shortened Version of the Nottingham Leisure Questionnaire and Changes in Leisure Questionnaire (developed for this study). Results: Leisure participation declined following injury, particularly in social leisure activities. Pre-injury activities with high rates of discontinued or decreased participation were driving, going to pubs and parties, do-it-yourself activities and attending sports events. Inpatient participants generally attributed decreased participation to the hospital environment, whereas outpatient participants reported this predominantly as a result of disability. Post-injury levels of perceived leisure satisfaction were significantly lower for the inpatient group compared to pre-injury, but not for the outpatient group. Uptake of some new leisure activities was reported post-injury, however not at the rate to which participation declined. Conclusions: Leisure participation decreases during brain injury rehabilitation compared to pre-injury levels. Re-engagement in relevant, age-appropriate leisure activities needs to be addressed during rehabilitation to improve participation in this domain.

Effect of a Group Intervention to Promote Older Adults’ Adjustment to Driving Cessation on Community Mobility: A Randomized Controlled Trial

OBJECTIVES The 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 METHODS A 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. RESULTS A 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). IMPLICATIONS The 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.

Understanding the dimensions of home that impact on home modification decision making

BACKGROUND/AIM The home environment is a multidimensional and personally meaningful place, and the complexity of this environment often impacts on the home modification process and outcomes. Home modifications can appear as a straightforward solution to safety and occupational performance concerns; nevertheless, clients sometimes reject modifications or are unsatisfied with the completed works. To understand this phenomenon, this study aimed to determine what aspects of the home environment impact home modification decision making. METHOD In this qualitative descriptive study, 42 in-depth interviews using a semi-structured questionnaire were undertaken and analysed using a template analysis. The interviews explored the experience of the home modification process, including concerns and the decisions made about the modifications. FINDINGS Four dimensions of the home environment were commonly found to affect decision making namely, the personal, societal, physical and temporal dimensions of home as well as social and occupational dimensions. CONCLUSIONS An understanding of the dimensions of home that impact decision making provides occupational therapists with a greater appreciation of the experience of home and allows them to enhance the effectiveness and acceptance of home modifications.

Is there a role for meaningful activity in stroke rehabilitation

Abstract 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.