Pat Dorsett

Health-related outcomes of people with spinal cord injury - a 10 year longitudinal study

Study Design: Longitudinal panel design over 10 years.Objectives: To describe the health outcomes for people with spinal cord injury and identify how indicators of health change over time.Setting: Queensland, Australia.Methods: A structured interview consisting of measures of perceived health, medical service utilization, hospitalization and pressure sore occurrence was administered on six occasions over 10 years after discharge from the hospital following the initial rehabilitation episode.Results: The majority of respondents were relatively healthy over the course of the 10-year study and required minimal medical interventions or hospitalization. There was however a group of up to 20% of respondents who required extensive medical intervention, including hospitalization and pressure sore management.Conclusion: The findings have significant implications for health-care policy and strategic planning for the ongoing management of spinal cord injury. A biopsychosocial approach combining patient education, cognitive behavioral interventions, screening and treatment for affective disorders and environmental interventions is recommended to facilitate optimal health outcomes for people with spinal cord injury over the long term.

Bridging the gap: Transitional rehabilitation services for people with spinal cord injury

Purpose : To review the current international rehabilitation and healthcare climate and describe a new model of service delivery aimed at enhancing the continuity of care for people with spinal cord injury (SCI). Method : An extensive literature review was undertaken and a new model of service delivery conceptualized and implemented in the Australian context of SCI rehabilitation. Results : This new model of service delivery aims to improve the rehabilitation continuum for people with SCI by reducing the time spent in hospital, increasing consumer control over the rehabilitation environment and enhancing community re-integration. The new model recognizes the changing nature of the healthcare system, the legislative frameworks within which rehabilitation services are provided and the increasing role of the consumer. Conclusions : Models of rehabilitation that address the need for shorter periods of hospitalization and attempt to improve client outcomes are integral to ensure sustainable rehabilitation services in the future.

Depression and adjustment after spinal cord injury: a three-year longitudinal study.

This article reports the prevalence and course of depressive symptomatology and adjustment scores in a sample of 46 individuals consecutively discharged from an Australian Spinal Cord Injury Unit over 3 years. The trend was for depressive symptomatology to increase immediately following discharge from hospital but to decrease significantly by 36 months post discharge. Self-rated adjustment scores were consistently high but the variation was not statistically significant over time. Repeated measures logistical regression analysis of determinants of depression revealed that two variables, overall self-rated adjustment (p = .002) and the presence of pressure sores (p = .002), were statistically significant determinants of depressive symptomatology in this group of people with spinal cord injury.

Developing core interprofessional competencies for community rehabilitation practitioners: findings from an Australian study

This study aimed to determine the core competencies that underpin the practice of community rehabilitation (CR) practitioners working in a single state in Australia. Using a recursive and consultative methodology designed to build consensus, CR professionals, trainers, educators, and researchers developed a preliminary set of core interprofessional competencies that were considered essential to their practice. Data were collected in four main stages that engaged practitioners and experts in the CR field in the process of identifying, defining, validating, and endorsing a set of competencies. The first stage involved focus groups with 50 senior practitioners in metropolitan, rural/remote, regional, and indigenous communities. The second and third stages involved expert panels consisting of 20 trainers/educators, senior leaders, and scholars who refined, defined and validated the competency areas and developed statements that reflected the data.These statements formed the basis of a survey that was distributed to all current CR practitioners based in this state for endorsement, 40 of whom responded. Ten competencies emerged from this process. Although there are limitations to the application of competencies, they will have significant implications for the future training of CR practitioners who can transcend professional boundaries.

Hospital Readmissions in the First Two Years After Initial Rehabilitation for Acute Spinal Cord Injury

A retrospective analysis of the incidence, length of stay (LOS), and reasons for rehospitalization in the first 2 years after discharge from an Australian spinal injuries unit was undertaken. Of the 68 participants, 31% were readmitted at least once. There were a total of 60 readmissions accounting for 598 bed days and with an average LOS of 10 days. Conditions related to spinal cord injury, such as pain, spinal surgery, and urological complications, accounted for 75% of readmissions and 81% of bed days. LOS data rather than counts of admission episodes may be more useful for designing community-based prevention programs.

Does spirituality facilitate adjustment and resilience among individuals and families after SCI

Abstract Purpose: The purpose of this scoping review was to investigate the role of spirituality in facilitating adjustment and resilience after spinal cord injury (SCI) for the individual with SCI and their family members. Method – data sources: Peer reviewed journals were identified using PsychInfo, MEDLINE, CINAHL, Embase and Sociological Abstracts search engines. Study selection: After duplicates were removed, 434 abstracts were screened applying inclusion and exclusion criteria. Data extraction: The selected 28 studies were reviewed in detail and grouped according to methodological approach. Results: Of the 28 studies relating to spirituality and related meaning-making constructs, 26 addressed the adjustment of the individual with SCI alone. Only two included family members as participants. Quantitative studies demonstrated that spirituality was positively associated with life satisfaction, quality of life, mental health and resilience. The utilisation of meaning-making and hope as coping strategies in the process of adjustment were highlighted within the qualitative studies. Clinical implications included recommendations that spirituality and meaning-making be incorporated in assessment and interventions during rehabilitation. The use of narratives and peer support was also suggested. Conclusions: Spirituality is an important factor in adjustment after SCI. Further research into the relationship between spirituality, family adjustment and resilience is needed. Implications for Rehabilitation Higher levels of spirituality were associated with improved quality of life, life satisfaction, mental health, and resilience for individuals affected by spinal cord injury. Health professionals can enhance the role that spirituality plays in spinal rehabilitation by incorporating the spiritual beliefs of individuals and their family members into assessment and intervention. By drawing upon meaning-making tools, such as narrative therapy, incorporating peer support, and assisting clients who report a decline in spirituality, health professionals can provide additional support to individuals and their family members as they adjust to changes after spinal cord injury.

Integrated services and early intervention in the vocational rehabilitation of people with spinal cord injuries

Introduction:The design was a narrative review. The objective of the study was to investigate the potential for early vocational rehabilitation (VR) interventions for people with spinal cord injury (SCI) in overcoming barriers in returning to work, and to pinpoint factors contributing to effectiveness in early VR intervention for this population. The setting was at Queensland, Australia.Materials and methods:Synthesis of the findings of a literature search of online databases ProQuest and CINAHL, using keywords relating to the employment situation and VR of people with SCI. Themes were identified and analysed in accordance with the research objectives.Results:Despite increasing government commitment to the workforce and social participation of people with disabilities, Australians living with SCI have significantly diminished employment outcomes compared with the general population. Current VR approaches usually do not commence until some months post discharge, potentially missing a window of opportunity to preserve pre-existing employment or assist in vocational decision making. The review found that there are opportunities for enhancing VR service provision following SCI, namely integrating the VR programme within the primary rehabilitation team thus facilitating early VR intervention.Discussion:Emerging evidence shows promising results for early intervention in VR; however, questions remain regarding ideal intervention approaches, and it is clear that further empirical investigation is required to support the use of early intervention models post SCI. The study was sponsored by Motor Accident Insurance Commission (MAIC).

India Gateway Program: Transformational learning opportunities in an international context

Internationalisation is increasingly important in the social work curriculum. With globalisation and international resettlement, social workers require competencies to work locally with diverse populations as well as overseas. Study abroad experiences are used to enhance international content, cultural sensitivity and self-awareness in curricula. This article evaluates an Australian study tour focussing on students’ perspectives. Indications are that it was effective in enhancing cultural sensitivity, understanding of factors contributing to inequity, the lived experience of poverty, personal growth and professional identity. For students, it was a valued and transformational learning experience.

Moving forward on the journey: Spirituality and family resilience after spinal cord injury.

Purpose/Objective: The aim of this exploratory study was to consider how spirituality (encompassing meaning, hope and purpose), may facilitate family resilience after spinal cord injury (SCI) over time. Research Method/Design: A qualitative, longitudinal study design was adopted. Semistructured interviews were conducted with 10 family dyads (consisting of the individual with SCI and a nominated family member) on 2 occasions, 6 months apart. A thematic analysis was conducted. Results: Participants reported drawing upon a range of different sources of spirituality, including religious faith, the natural world, inner strength, and meaningful connectedness with others. These sources of spirituality were often tested in some way after the SCI. Meaning-making responses to these tests were linked with 3 key outcomes: gratitude, hope, and deeper connectedness with others, assisting families to move forward in their journey after SCI. Over time sources of spirituality did not change significantly; however, the intensity of spiritual experience lessened for some families. Conclusions: This study indicated that spirituality after SCI plays an important role for both the injured individual and their family members. Families draw upon a range of sources of spirituality, and these sources of spirituality may assist the family to move forward together after SCI. Further investigation of how health professionals can better address spirituality during spinal rehabilitation is warranted.

The role of spirituality in spinal cord injury (SCI) rehabilitation: exploring health professional perspectives

Study designDescriptive, qualitative study.ObjectivesTo explore the perspectives of health professionals (HPs) regarding the role of spirituality in spinal cord injury (SCI) rehabilitation.SettingSingle centre rehabilitation hospital, NSW, Australia.MethodsTwo focus groups (n = 12) were conducted with HPs (e.g., nursing, allied health, medical) working in SCI inpatient rehabilitation. A semi-structured interview was employed, consisting of questions about spirituality and its role in SCI rehabilitation. The groups were audio recorded and transcribed. An inductive thematic analysis was conducted.ResultsSix themes were identified from the focus group data: (i) the meaning of spirituality; (ii) spirituality as a help; (iii) spirituality as a hindrance; (iv) how spirituality is indirectly addressed in practice; (v) perceived barriers to incorporating spirituality into practice; (vi) how spirituality can be better integrated into practice. HPs recognised that spirituality played an important role in the adjustment of many individuals and their families after SCI. However, spirituality was not proactively addressed during SCI rehabilitation, and most often arose during informal interactions with clients. Spirituality, and specifically religious belief, was perceived to sometimes raise difficulties for clients and staff. The use of physical space and a review of rehabilitation processes were suggested by HPs as two ways spirituality could be better incorporated into practice.ConclusionsThe findings of this study reveal that spiritual needs of clients and their family members during SCI rehabilitation are important and could be better addressed. A range of initiatives are proposed, including staff training and the use of standardised spiritual assessment tools.