Tammy Aplin

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.

Understanding home modifications impact on clients and their family's experience of home: a qualitative study

BACKGROUND/AIM Home modifications aim to enhance safety and occupational performance in the home. However, given the complexity and unique meaning of the home, they can impact aspects other than function. This qualitative descriptive study aimed to explore the impact of home modifications on clients and their familys experience of home. METHODS Home modification clients and their family and carers participated in 42 in-depth interviews which were analysed using a template analysis. FINDINGS Home modifications impacted positively and negatively on five dimensions of the home environment, the personal, occupational, physical, temporal and social dimension. The outcomes of the modifications and the home modification process were influenced by three themes, workmanship, consultation or involvement in decision-making, and the societal dimension of the home environment. CONCLUSIONS The negative outcomes and poor consultation experiences suggest the need for occupational therapists to understand their clients personal experience of home and to comprehensively follow-up and evaluate these following home modifications.

Tracking down a solution: exploring the acceptability and value of wearable GPS devices for older persons, individuals with a disability and their support persons

Abstract Purpose: To explore the acceptability and value of three wearable GPS devices for older persons and individuals with a disability and safety concerns when accessing the community. Methods: This pilot study explored six wearers’ and their support persons’ experience of using three different wearable GPS devices (a pendant, watch, and mini GPS phone), each for a two-week period. Results: Participants identified safety as the main value of using a wearable GPS device. The acceptability and value of these devices was strongly influenced by device features, ease of use, cost, appearance, the reliability of the GPS coordinates, the wearer’s health condition and the users familiarity with technology. Overall, participants indicated that they preferred the pendant. Conclusions: Wearable GPS devices are potentially useful in providing individuals who have safety concerns with reassurance and access to assistance as required. To ensure successful utilization, future device design and device selection should consider the user’s familiarity with technology and their health condition. This study also revealed that not all wearable GPS devices provide continuous location tracking. It is therefore critical to ensure that the device’s location tracking functions address the wearer’s requirements and reason for using the device. Implications for Rehabilitation The acceptability and usability of wearable GPS devices is strongly influenced by the device features, ease of use, cost, appearance, the reliability of the device to provide accurate and timely GPS coordinates, as well as the health condition of the wearer and their familiarity with technology. Wearable GPS devices need to be simple to use and support and training is essential to ensure they are successfully utilized. Not all wearable GPS devices provide continuous location tracking and accuracy of location is impacted by line of sight to satellites. Therefore, care needs to be taken when choosing a suitable device, to ensure that the device’s location tracking features are based on the wearer’s requirements and value behind using the device.

Understanding the dimensions of home for people returning home post stroke rehabilitation

Introduction Home is a meaningful and important place and the transition to home from hospital is considered a significant point in recovery for people after stroke. Six dimensions of the home environment have previously been described as important for well-being and contributing to ones experience of home: the physical, social, personal, temporal, occupational and societal dimensions. The aim of this study was to understand the experience of home for people with stroke after discharge to home from hospital rehabilitation. Method A secondary template analysis applied the dimensions of home to semi-structured interviews that explored the transition to home experience for seven participants with stroke at 4–6 weeks post discharge. Results All six dimensions were present in the descriptions of returning to home from stroke rehabilitation. The social, personal and occupational dimensions appeared to be the most prominent and often centred on loss or change. Conclusion People returning home after a stroke enter a different home environment than the one they experienced prior to stroke, with changes experienced in all dimensions of home. Closer attention to the dimensions during discharge preparation may enhance the transition experience.

The experiences of peer leaders in a driving cessation programme

Introduction Peer leaders are increasingly involved in health-related programmes due to the perceived benefits that they bring to the group process. This exploratory study examined the experiences of peer leaders in the University of Queensland Driver Retirement Initiative, an educational support group for older people undergoing driving cessation. Method Semi-structured interviews were conducted with five peer leaders (two men, three women, age range: 67–81 years) regarding their role and involvement as a peer leader in the University of Queensland Driver Retirement Initiative programme as well as their positive and negative experiences. Results Inductive thematic analysis revealed three themes: diversity of peer leaders, drawing on personal strengths and experiences, and taking the middle ground. Conclusion This study revealed that peer leaders drew from their diverse range of personal resources and experiences to perform the role of peer leader, using varying approaches to perform the role successfully. The provision of broad guidelines in training allowed individual approaches to be developed and this contributed to a positive experience for peer leaders in the University of Queensland Driver Retirement Initiative. These findings have implications for the development of future peer-led driving cessation programmes and the selection of their peer leaders.

Meanings of home for older people

The home environment is increasingly being recognised as an essential element in successful ageing as the majority of older people choose to remain at home while ageing. The home environment takes on increasing significance as ageing occurs. While the home is recognised as a physical environment, it is also experienced as having personal, social, and temporal dimensions that are often unique to the individual. This article explores the meaning of these dimensions of home for older people.

Clinical utility of the In-Home Occupational Performance Evaluation (I-HOPE) for major home modification practice in Australia

BACKGROUND/AIM The use of standardised measures in home modification practice is rare, in part due to a lack of suitable tools. One promising outcome measure designed for home modification practice is the In-Home Occupational Performance Evaluation (I-HOPE). This study aimed to investigate the clinical utility of the I-HOPE for major home modification practice in Australia. METHODS The I-HOPE was trialled in one major home modification service by five occupational therapists who participated in two focus groups. Feedback using a purposefully developed questionnaire was also collected from 25 adult clients who completed the I-HOPE. Data from the focus groups were thematically analysed, and the questionnaire responses were analysed using template analysis. RESULTS The analysis revealed four themes: client experience, training and resources, suitability to major home modification practice and improvements and future use. Therapists valued the person-focused nature of the I-HOPE; however, there were some clinical utility issues identified including confusion of the rating scales for clients, length of time to complete the tool and the need for more training and a clearer instruction manual. CONCLUSION It is suggested that the I-HOPE is a person-focused and valuable tool for community occupational therapy practice in the Australian context but may not be suited to specialised major home modification services. An app or online version of the tool for client use, and the availability of training resources which are accessed online would enhance the clinical utility of the tool.

The experience of the dimensions of home after discharge from hospital rehabilitation

Background: The time course of stroke recovery as well as the impact of exercise therapy on the pattern of (motor) recovery is poorly understood. Content: The present lecture will addresses the current knowledge about the predictability of the time course of body functions and activities post-stroke. There is growing evidence that the natural logarithmic pattern of functional recovery can be modified by early started, intensive task-oriented practice. However, the impact of practice on learningdependent and intrinsic, spontaneous mechanisms of neurological recovery is not well understood. Several, probably interrelated mechanisms, have been identified that drive recovery after stroke. These mechanisms underlying recovery are highly interactive and operate in different, sometimes limited time-windows after stroke. In this key note lecture, a hypothetical phenomenological model for understanding skill reacquisition after stroke will be presented. Subsequently, the longitudinal association of what and how patients learn when they show functional improvement after stroke will be discussed. Conclusions: There is growing evidence that the effects of neurorehabilitation are rather adaptive (substitution) than driven by mechanisms of ‘true neurological repair’ (restitution). Restitution is found to be limited to the time frame of spontaneous neurological recovery. Understanding functional recovery in terms of restitution and substitution should serve as a basis to optimize the timing, focus and intensity of evidence-based practice post stroke.

The unique experience of home for parents and carers of children with disabilities

Abstract The aim of this paper was to investigate the experience of home for parents and carers of children with disabilities in Australia. Data for this qualitative study were gathered using semi-structured interviews with four families living in their own homes. An inductive thematic analysis revealed two main themes. The first was titled ‘Aspects making everyday life easier’ explored the aspects of the home environment that facilitated home life for the child, including access to transport, services, family and home modifications. The second theme ‘Decisions and efforts to create opportunities for the child’ emphasized the efforts made by parents and carers to promote their child’s independence and participation including a strong consideration for their children’s future needs. The study indicated that the location of home, appropriate home modifications and planning for the future defined the experience of home for parents and carers. These findings identify some important considerations for occupational therapists when providing services in the homes of families with children who have a disability.

Patient Experience of Wearing Compression Garments Post Burn Injury: A Review of the Literature

This review was conducted to critically appraise the literature regarding the patient’s lived experience of, and adherence to, wearing compression garments post burn injury. Scholarly articles were identified from searches of the following databases: Pubmed, Cochrane Central, CINAHL, PsycINFO, and OT Seeker. Combinations of key words including compression therapy/garment, pressure therapy/garment, burn(s), adherence, and patient experience were utilized. Retrieved studies were included in the review if they were written in English, reported on adult burn populations, and the patient’s lived experience of wearing compression garments. Included studies were critically appraised and content analysis was completed on the results sections of the two qualitative studies. Nine studies investigating patient’s lived experiences were retained: one systematic review, one randomized controlled trial, five cross-sectional surveys, and two qualitative studies. An adherence framework provided a conceptual basis to categorize reported patient’s lived experiences. Results identified a strong focus on patient and treatment-related experiences with limited investigation of condition, patient-provider and health care system experiences. Minimal investigation has been completed regarding the impact of these patient’s lived experiences on the adherence to wearing compression garments. Additional research using qualitative methods is required to gain a deep understanding of patient’s experiences and perspectives of wearing compression garments and how these experiences influence on their adherence to wearing them. Identification of key experiences that lead to patients removing their compression garments may lead to modification of treatment and system approaches to better align with patients’ needs and development of potential interventions that promote adherence.