Tanya Packer

Travel agents as facilitators or inhibitors of travel: perceptions of people with disabilities.

Travel agents remain the primary source for people with disabilities to purchase travel products. How effectively travel agents perform this task has a direct impact on the ability of people with disabilities to travel. A good travel agent can facilitate travel, while a poor one creates another obstacle to participation in travel by people with disabilities. This paper examines the perception of people with disabilities towards the effectiveness of travel agents in Hong Kong. For the most part, respondents suggest that travel agents are largely deficient in catering to the needs of this specialist market. Two causes were identified: attitudinal and structural. Travel agents are largely ignorant of the needs of people with disabilities, which leads to overt or subtle discrimination. In addition, the financial realities of the retail travel sector in Hong Kong force agents to push high commission, easy to book packaged tours that may not be suitable for the tourist with a disability.

Understanding the complex interplay between tourism, disability and environmental contexts

Purpose. To explore and describe the complex issues and factors related to participation in tourism as perceived by people with disabilities in Hong Kong. Method. Naturalistic inquiry using key informant interviews and focus groups with 86 people with disabilities. Interviews were transcribed, translated and coded to develop themes and relationships. Triangulation of three investigators from different backgrounds occurred. Results. The Process of Becoming Travel Active emerged as a six-stage process, intricately related to the personal/disability context and the environmental/travel context. Personal and environmental factors contribute to the six-stage model explaining the complex interplay between tourism, disability and environmental context. Conclusion. Understanding the complexity provides insight into ways to increase active participation in tourism. Health, tourism and disability sectors have a role to play in the development of accessible tourism.

ACTIVITY AND POST-POLIO FATIGUE

Fatigue was studied in 12 subjects with post-polio sequelae (PPS). Results of the Fatigue Severity Scale (FSS) demonstrated a mean score of 4.8 +/- 1.6 (non-disabled scores = 2.3 +/- 0.7). The Human Activity Profile (HAP) was not sensitive enough to measure fatigue. Fifty percent of subjects scored below the first percentile based on age and sex matched norms. The Activity Record (ACTRE) results revealed that subjects spent 5% of their time resting and 1% in planning or preparation activities. Fatigue peaked in the late morning or early afternoon and was relieved by rest periods. Use of energy conservation and work simplification skills along with frequent rest periods was suggested as a possible method for managing PPS fatigue.

Self-management education programs for age-related macular degeneration: A systematic review

Objective:  To review the effectiveness of education programs to improve emotional status, daily living and self‐efficacy in adults older than 60 years with age‐related macular degeneration (AMD).

Self-management programs conducted within a practice setting: Who participates, who benefits and what can be learned?

OBJECTIVE To investigate the impact of generic and diabetes-specific self-management programs offered in a real world context. METHODS A quasi-experimental design with 12-week follow-up compared Living with a Chronic Condition and Living with Diabetes. Self-report data collected included: Self-management Knowledge and Skills; Health Related Quality of Life (HRQOL); Depression; Social Isolation; Loneliness; Self-efficacy; and Health Behaviours. RESULTS Participants (N=458) in the two programs differed on almost all baseline measures. Both demonstrated statistically significant improvements in Self-management Knowledge and Skills, as well as reductions in depression. In addition to younger age, low HRQOL, high self-efficacy and Positive and Active Engagement in Life, were the clinical factors most likely to lead to improvements in HRQOL and self-efficacy. Changes in different characteristics predicted different outcomes. CONCLUSION Both generic and disease-specific programs led to improved outcomes, despite the two programs attracting significantly different participants. Referral patterns also differed but GP referral rates were low for both. PRACTICE IMPLICATIONS Positive participant outcomes can be achieved in real life clinical settings. While younger people with a positive attitude may appear to gain more, it is important to encourage people from low socio-economic status to enter these programs so that social inequalities in health are not worsened.

Development of the Activity Card Sort - Australia

AIMS To develop the Activity Card Sort (ACS)--Australia as a tool to measure participation in activities of daily living for older adults. METHODS Secondary data analysis of activity diaries of older Australians in Brisbane and Adelaide were utilised for item generation. Survey of older adults and cluster analysis was used for item selection and determination of domains for the ACS-Australia. RESULTS The final ACS-Australia is comprised of 82 activity items, falling under the three domains of household activities, social/educational activities and leisure activities. CONCLUSIONS The ACS-Australia has robust properties, wide application and provides a culturally relevant tool to measure participation of older Australians, thus will facilitate rigorous clinical and population-based research.

Effectiveness of an online fatigue self-management programme for people with chronic neurological conditions: a randomized controlled trial

Objective: To evaluate an online fatigue self-management programme in a sample of adults with chronic neurological conditions. Design: Randomized controlled trial. Setting: Online fatigue self-management programme delivered across Australia. Participants: Ninety-five people with fatigue secondary to multiple sclerosis, Parkinson’s disease or post-polio syndrome. Interventions: An online fatigue self-management programme, an information-only fatigue self-management programme and a control group. Main measures: Groups were compared at pre test, post test and at three months on primary outcomes using the Fatigue Impact Scale, Activity Card Sort and Personal Wellbeing Index. Results: With the exception of the Personal Wellbeing Index at post test (F = 3.519; P =0.034) and the Physical Subscale of the Fatigue Impact Scale at follow-up (F = 3.473; P =0.035) there were no significant differences between the three groups on primary outcomes. Post-hoc testing showed the differences to be between the information-only and control groups (P = 0.036 and P = 0.030 respectively). Improvement in the information-only group was unexpected but appears to be similar to results of other online interventions. The fatigue self-management and information-only groups performed better than the control on some secondary outcome measures. Low power in the analysis may have contributed to the findings. Repeated-measures ANCOVA showed that the fatigue self-management and the information-only groups improved over time on the Fatigue Impact Scale and the Activity Card Sort (P<0.05). The control group showed no improvements over time.

Measuring changes in activity participation of older Australians: validation of the Activity Card Sort-Australia.

Objectives:  This study explored the psychometric properties of the Australian version of the Activity Card Sort (ACS‐Aus), a recently developed measure of activity participation for use with older adults. Concurrent, convergent construct, and discriminative construct validity were examined.

Validity and reliability of the Activity Card Sort - Hong Kong version.

It is pertinent for occupational therapists to measure the changing patterns of activity engagement of older adults who might have undergone the process of aging, institutionalization, and illness. The Activity Card Sort was developed to measure the level of activity engagement in the main areas of occupational performance. This study examined the reliability, internal consistency, and construct validity of the Hong Kong version of the Activity Card Sort. Using expert panel reviews, 65 activities were identified as culturally appropriate for inclusion in the Hong Kong version. Sixty geriatric clients who had experienced a stroke participated in the evaluation. Results showed that the Hong Kong version of the Activity Card Sort was able to discriminate between clients with different levels of functioning (t = −14.24; p = .00), and was positively associated with the Comprehensive Quality of Life Scale (r = 0.86; p = .00). Excellent test—retest reliability (r = 0.98) and internal consistency (r = 0.89) were demonstrated. The findings suggest the Hong Kong version of the Activity Card Sort is a reliable and valid instrument to use with the Hong Kong Chinese elderly population.

Designing appropriate rehabilitation technology: a mobility device for women with ambulatory disabilities in India.

Mobility is an essential requirement for personal independence and social participation. For persons with an ambulatory disability, a lack of mobility creates barriers to the realization of these goals. In developed countries, significant research and development has resulted in the technological advancement of assistive devices. Unfortunately, transfer of these technologies to developing countries has proven difficult. Consequently, effort has been directed at designing appropriate technology in these countries--most often in the form of wheelchairs and hand-driven tricycles. For activities within and around the home, however, especially in cultures where many activities are traditionally performed on the floor, wheelchairs and tricycles are often inappropriate solutions. In response to this, a novel mobility device has been designed for use by women with ambulatory disabilities living in rural and low-income areas of India. The device is intended to assist the user in performing activities of daily living which occur within and near the home, and at ground level. To this end, the device conceptually differs from traditional wheelchair designs in that it physically keeps the rider near to the floor. This paper describes the new device as well as the cross-cultural and cross-professional collaborative methodology used in its design.