Merrill Turpin

The Needs and Experiences Related to Driving Cessation for Older People

Older people may cease driving owing to health concerns, discomfort while driving, cancellation of their licence or financial reasons. Because driving is fundamental to the freedom and independence of older people, driving cessation can lead to depression, loss of roles and unsafe use of alternative transport. Little consideration has been given to the development of approaches to improve outcomes for retiring drivers. This study aimed to understand the experiences of driving cessation for older people to inform the design of interventions for retiring drivers. Qualitative methodology was used to explore the experiences of driving cessation from the perspective of nine retired drivers, three family members and six service providers. The retired drivers experienced challenges during three phases of driving cessation, in addition to discussing their driving history. The challenges were (1) a predecision phase – a balancing act and achieving awareness; (2) a decision phase – making the decision and owning the decision; and (3) a post-cessation phase – finding new ways and coming to terms. Interventions to facilitate the process of driving cessation may need to be designed according to the phase of driving cessation and the challenges that the person is experiencing and to be underpinned by behaviour change and life transition theories.

The meaning of leisure for children and young people with physical disabilities: a systematic evidence synthesis

Participation in leisure has known health benefits. Children and young people (CYP) with physical disabilities demonstrate reduced participation in leisure. To facilitate their meaningful participation, one must understand what leisure means to CYP. The aim of this study was to systematically synthesize evidence from qualitative studies on the meaning of leisure for CYP with physical disabilities.

A scoping review of rehabilitation interventions that reduce fatigue among adults with multiple sclerosis

Abstract Objective: To identify and summarize available research literature about rehabilitation interventions for multiple sclerosis (MS) fatigue management. Methods: Database searches (PubMed, EMBASE, CINAHL and PsychINFO) were conducted in October 2011 and last updated in July 2013. To be included, studies must have been published in a peer-reviewed scientific journal, written in English and included an intervention to manage MS fatigue. Effect size (ES) were calculated for the quantitative studies to estimate intervention effects, and major themes were summarized for the qualitative studies. Results: Thirty-eight studies were included in this review. A variety of exercise and behavior change interventions were prescribed to adults with MS. The two most common interventions were progressive resistive training and fatigue management programs. Three exercise intervention studies and nine behavior change intervention studies with quantitative data presented significant ES. Four studies with qualitative data supported the positive impact of certain exercise and behavior change interventions. Conclusions: This review identified a variety of exercise and behavior change interventions for MS fatigue management. While the findings may provide helpful information to inform practice, future researchers need to develop and evaluate knowledge translation strategies to facilitate the application of this evidence to daily practice to advance MS rehabilitation care. Implications for Rehabilitation Both exercise and behavior change interventions demonstrate some degree of effectiveness for managing MS fatigue. Effect sizes for exercise and behavior change interventions are similar, although the populations examined are different. Overall, evidence for exercise focuses on people who are less disabled, while evidence for behavior change interventions includes a broader population. Future researchers need to develop and evaluate knowledge translation strategies that facilitate application of evidence in daily practice in order to advance MS rehabilitation.

Living with Parental Multiple Sclerosis: Children's Experiences and Clinical Implications:

Background. Health professionals need to understand how chronic illness affects all family members. Purpose. This study explored the everyday experiences of children who have a parent with multiple sclerosis. Methods. Exploratory, semi-structured interviews were conducted with eight Queensland children, aged 7 to 14 years. Videotapes were transcribed verbatim and analysed inductively. Findings. Themes were labelled changing roles and responsibilities, emotional impact, and things that helped. Participants described taking on additional roles and responsibilities that restricted their participation in developmentally appropriate occupations, the emotional and practical impact of having aparent with MS and different methods they employed to cope with this impact. Implications. The findings emphasise the need for therapists to look beyond the diagnosed individual and see MS as a chronic illness affecting the whole family. Occupational therapists might assist parents and children to maintain their occupations through the provision of appropriate interventions and connection to referral networks.

Adjustment to loss of the driving role following traumatic brain injury: A qualitative exploration with key stakeholders

BACKGROUND/AIMS Community mobility is affected by an interruption to or cessation of driving following traumatic brain injury (TBI). This study aimed to examine loss of the driving role and to explore the outcomes associated with driving cessation from the perspectives of key people involved within the process: people with TBI, their family members and involved health professionals. METHODS A qualitative methodology was used, employing semi-structured interviews with 15 individuals with TBI who had experienced driving cessation, 10 family members and 10 health professionals working with this population. RESULTS This article focuses on two themes, each with three subthemes. Being stuck: needs related to driving cessation had subthemes: (i) an emotional time, (ii) being normal and (iii) participation without driving. The second theme, A better way: suggestions to improve outcomes had subthemes: (i) information, (ii) support and trying it out and (iii) their family members roles and needs. CONCLUSIONS Driving cessation following TBI is associated with emotional, identity, transport and participation-related needs. An ongoing, individualised approach involving information, support and practical experiences may improve outcomes of driving cessation for people with TBI and their family members.

Driving and driving cessation after traumatic brain injury: processes and key times of need.

Purpose. The ability to drive safely is commonly affected by traumatic brain injury (TBI). Driving is a role and activity that is highly valued and also associated with successful community reintegration after TBI. Relatively little is understood about the processes of interruption to driving and potential return to driving that can be experienced by people with TBI and their family members (FMs). Exploring the way in which driving interruption, return to driving and permanent cessation of driving happen for people with TBI, their FMs and health professionals (HPs) who work with them can enable a fuller understanding of the experiences and needs and enhance the rehabilitation approaches in this situation. Method. A descriptive phenomenological approach was used to explore the experience with the aim of improving services for people with TBI. Semi-structured interviews about driving and driving cessation were conducted with 15 people with TBI, 10 FMs and 10 HPs who had experience in driving and driving cessation issues. Results. The findings reveal experiences of the process of driving and driving cessation contextualised within experiences of the accident and treatment process. Participants identified key times of need in relation to driving: being told about driving restrictions, understanding driving restrictions, the ‘on hold’ period, and returning to driving. Conclusions. The processes surrounding driving and driving cessation after TBI are complex. Informational, support and practical needs differ at the different times. There are key times where people may need further support to improve rehabilitation outcomes. Rehabilitation approaches may particularly need to provide clear, consistent information about driving restrictions, and the process required for returning to driving. While recovery time appears necessary for allowing a safe return to driving, active support for continued involvement in the community using alternative transport may reduce the frustration and disengagement experienced by people in the ‘on hold’ period.

Establishing the Validity and Reliability of the Student Practice Evaluation Form–Revised (SPEF-R) in Occupational Therapy Practice Education: A Rasch Analysis

This study investigated construct validity and internal consistency of the Student Practice Evaluation Form–Revised Edition Package (SPEF-R) which evaluates students’ performance on practice education placements. The SPEF-R has 38 items covering eight domains, and each item is rated on a 5-point rating scale. Data from 125 students’ final placement evaluations in their final year study were analyzed using the Rasch measurement model. The SPEF-R exhibited satisfactory rating scale performance and unidimensionality across the eight domains, providing construct validity evidence. Only 2 items misfit Rasch model’s expectations (both related to students’ performance with client groups, which were often rated as not observed). Additionally, the internal consistency of each SPEF-R domain was found to be excellent (Cronbach’s α = .86 to .91) and all individual items had reasonable to excellent item-total correlation coefficients. The study results indicate that the SPEF-R can be used with confidence to evaluate students’ performance during placements, but continued validation and refinement are required.

Information Used by an Expert Paediatric Occupational Therapist When Making Clinical Decisions

Background. Occupational therapists use a range of types and sources of information when making clinical decisions. It is unclear how this information is integrated. Purpose. This paper describes an exploratory qualitative case study that identified the types and sources of information accessed by one experienced paediatric therapist and how this information was combined and prioritised when making clinical decisions. Methods. Data were collected using observations of therapy sessions, key informant interviews, and semi-structured interviews. Data were analysed the-matically. Findings. To inform clinical decisions, the participant prioritised information about each child in his or her context when making decisions. Other types of information from text books and journals, professional development activities and professional and personal experience, expanded her unique body of knowledge over time. Implications. Re-conceptualisation of how information use supports clinical decision making and expands a therapists unique body of knowledge over time can support client-centred practice in occupational therapy.

Chedoke Arm and Hand Activity Inventory-9 (CAHAI-9): perceived clinical utility within 14 days of stroke.

Abstract Purpose: The Chedoke Arm and Hand Activity Inventory-9 (CAHAI-9) is an activity-based assessment developed to include relevant functional tasks and to be sensitive to clinically important changes in upper limb function. The aim of this study was to explore both therapists’ and clients’ views on the clinical utility of CAHAI-9 within 14 days of stroke. Method: Twenty-one occupational therapists actively working in stroke settings were recruited by convenience sampling from 8 hospitals and participated in semistructured focus groups. Five clients within 14 days of stroke were recruited by consecutive sampling from 1 metropolitan hospital and participated in structured individual interviews. The transcripts were analyzed thematically. Results: Six themes emerged from the focus groups and interviews: collecting information, decisions regarding client suitability, administration and scoring, organizational demands, raising awareness, and clients’ perceptions of CAHAI-9 utility. All therapists agreed CAHAI-9 was suited for the stroke population and assisted identification of client abilities or difficulties within functional contexts. Opinions varied as to whether CAHAI-9 should be routinely administered with clients who had mild and severe upper limb deficits, but therapists agreed it was appropriate for clients with moderate deficits. Therapists made suggestions regarding refinement of the scoring and training to increase utility. All clients with stroke felt that the assessment provided reassurance regarding their recovery. Conclusion: The findings indicate that CAHAI-9 shows promise as an upper limb ability assessment for clients within 14 days of stroke.

The structural-personal interaction: Occupational deprivation and asylum seekers in Australia

ABSTRACT Asylum seekers experience occupational deprivation in the context of restrictive social structures while awaiting refugee visa-status determination. How do social structures of citizenship status and policy shape asylum seekers’ experiences? Asylum seekers’ experiences in Australia are examined using constructivist grounded theory. Field notes from 10 months of weekly participant observation, 11 formal interviews, 34 survey responses and four policy documents are combined to identify a substantive theory - the Structural-Personal Interaction (SPI). The SPI explains how occupational deprivation arises from an interaction between social structures and personal characteristics. Social structures of citizenship status and policy interact with asylum seekers’ personal characteristics, resulting in experiences of “having nothing to do”, a fundamental component of occupational deprivation. From the SPI, new insights regarding occupational deprivation emerge. Occupational deprivation can stem from an interaction between social structures and personal characteristics. While the SPI is a substantive theory and further research across a range of settings would be beneficial for its generalization, occupational deprivations structural roots and connections to human vulnerabilities and resilience are discernable when considered in light of the SPI. Strategies to address occupational deprivation might target changes to social structures as well as build on individual strengths and human diversity.