Evidence for 24-hour posture management: A scoping review

© The Author(s) 2023. This is an open access article distributed under the Creative Commons Attribution License, to view a copy of the license, see: https://creativecommons.org/licenses/by/4.0/Introduction:: People with complex physical disabilities unable to change their position independently are at risk of developing postural deformities and secondary complications. 24-hour posture management is needed to protect body structure. With inconsistencies in current service provision, this research aimed to scope the evidence for a 24-hour posture management approach. Method:: A scoping review was conducted using four health and social science databases. Inclusion and exclusion criteria were applied; further papers were included through citation chaining. Results:: The evidence for 24-hour posture management was often low quality due to the complications of completing robust research studies in this complex specialty. However, many professionals in the field agree that a 24-hour approach to postural care is essential. Conclusion:: There is a need for clear national policy and guidance relating to postural care and scope for development of dedicated posture management services. Current NHS service provision is variable and inconsistent. Lack of postural care is a safeguarding and human rights issue. Specialist training and research in postural care within the Occupational Therapy profession is required to raise awareness of the role Occupational Therapists can play in preventing postural deformities and other secondary complications through providing good postural care.Peer reviewe

Measuring met and unmet assistive technology needs at the national level: Comparing national database collection tools across eight case countries

The development and implementation of assistive technology policy that meets the needs of citizens is dependent on accurate data collection and reporting of assistive technology use and unmet needs on a national level. This study reviews the methodology from instruments intended to capture national statistics on assistive technology use across eight case countries from varying regions and income levels. Recommendations are provided, which highlight the need for mandatory, census level data collection according to international standards for data collection in the areas of disability and assistive technology

Understanding Parents’ Perspectives of Support Services for People Living with Spina Bifida and/or Hydrocephalus in Ireland: A Qualitative Exploration

Purpose: In Ireland, the complex needs of people with Spina Bifida and/or Hydrocephalus (SB and/or H) are treated across primary care and tertiary specialist services. Traditionally, there has been much variation in how primary care services are delivered. To increase equity, ‘Progressing Disability Services for Children and Young People’ is a policy which is being implemented to reconfigure children’s services into multidisciplinary teams, for all disabilities. These changes, and an apparent discontinuity of support in the transition to adult services, requires further research exploring service delivery processes. Method: This study explored parents’ perspectives of support services for people with SB and/or H. Eight parents of people with SB and/or H participated in semi-structured interviews which were transcribed and analysed using thematic analysis. Results: Six themes were generated: (1) Difficulty accessing services; (2) Impact of waiting lists; (3) Onus on parents; (4) Importance of communication; (5) Reduced service provision following the implementation of ‘Progressing Disability Services’; and (6) Lack of adult services. Conclusions: While the service redesign for people with SB and/or H and their families is still in the implementation stage, this research contributes to the evolution of these changes by identifying the enhancing aspects such as effective communication and the inhibiting aspects including a parent’s perception of increased responsibility for supporting their family member and barriers in access to services

Outcome measures for wheelchair and seating: a critical appraisal

Background: Literature suggests that every aspect of wheelchair provision from referral to follow up and management has an impact on overall outcomes for wheelchair service users. The use of outcome measures (OMs) is called for to ensure best practice in this complex area. Objectives: To identify available outcome measures suitable for the evaluation of a wheelchair intervention and critically appraise measures deemed most suitable in terms of achievement of activity & participation and impact of the service on quality of life. Methods: OMs were be identified using databases: Medline, CINHAL, PsychInfo, and Google Scholar. An evaluation was conducted to establish those particularly useful and a critical appraisal was completed on these. Results: The five OMs identified as most relevant were the Wheelchair Outcome Measure (WhOM); Functioning Everyday in a Wheelchair (FEW); Goal Attainment Scale (GAS); Psychosocial Impact of Assistive Devices Scales (PIADS); and the Quebec User Evaluation of Satisfaction with assistive Technology (QUEST). A critical appraisal was competed on these identifying the strengths and limitations of each. Conclusion: No one outcome measure captures all necessary information and trade-offs are inevitable. When choosing an outcome measure for a service, the specific goals of the service evaluation and resources available need to be considered. This research presents a critical appraisal of five outcome measures deemed appropriate for the evaluation of a wheelchair intervention and highlights some areas for consideration so an informed decision can be made

Sustainable solutions for wheelchair and seating assistive technology provision: presenting a cosmopolitan narrative with rich pictures.

BACKGROUND: Concepts of sustainability are beginning to emerge in relation to appropriate provision of wheelchair and seating assistive technology (WSAT) from design to follow up and management. OBJECTIVES: 1. Raising awareness and understanding of and actively considering the complex nature of stakeholders' participation in the wheelchair and seating provision. 2. Establishing a consensus regarding key goals and sustainability indicators when developing an action plan for sustainable wheelchair and seating provision systems, that would allow for effective process monitoring and measurement. METHOD: Qualitative research design, involving key stakeholder perspectives by utilising a soft systems methodological framework including organisational ethnography and critical participatory action research was chosen to study this complex system. Research processes involved participant observation, individual interviews and a series of collaborative workshops. These processes were made up of four main pillars: 1) stakeholder identification, 2) understanding perspectives, 3) meaningful collaboration and 4) strategy development. Pillars 2 and 3, sought to understand stakeholder perspectives individually and collectively, are addressed in this article. RESULTS: Pillar 2 presents rich pictures which were created to represent collective experiences of wheelchair and seating provision. Pillar 3 presents solutions for building sustainable systems. Findings identified the complexity of the system and key areas for development. Specific concerns reported to exist related to individual and nationwide organisational roles, responsibilities and regulation which appeared to influence the disproportionate rhythm of the wheelchair and seating provision system. CONCLUSIONS: A better understanding of this primary need is required to set provision of WSAT for prioritisation at a public and policy level both nationally and internationally

Assistive technology policy : a position paper from the first global research, innovation, and education on assistive technology (GREAT) summit

Increased awareness, interest and use of assistive technology (AT) presents substantial opportunities for many citizens to become, or continue being, meaningful participants in society. However, there is a significant shortfall between the need for and provision of AT, and this is patterned by a range of social, demographic and structural factors. To seize the opportunity that assistive technology offers, regional, national and sub-national assistive technology policies are urgently required. This paper was developed for and through discussion at the Global Research, Innovation and Education on Assistive Technology (GREAT) Summit; organized under the auspices of the World Health Organization’s Global Collaboration on Assistive Technology (GATE) program. It outlines some of the key principles that AT polices should address and recognizes that AT policy should be tailored to the realities of the contexts and resources available. AT policy should be developed as a part of the evolution of related policy across a number of different sectors and should have clear and direct links to AT as mediators and moderators for achieving the Sustainable Development Goals. The consultation process, development and implementation of policy should be fully inclusive of AT users, and their representative organizations, be across the lifespan, and imbued with a strong systems-thinking ethos. Six barriers are identified which funnel and diminish access to AT and are addressed systematically within this paper. We illustrate an example of good practice through a case study of AT services in Norway, and we note the challenges experienced in less well-resourced settings. A number of economic factors relating to AT and economic arguments for promoting AT use are also discussed. To address policy-development the importance of active citizenship and advocacy, the need to find mechanisms to scale up good community practices to a higher level, and the importance of political engagement for the policy process, are highlighted. Policy should be evidence-informed and allowed for evidence-making; however, it is important to account for other factors within the given context in order for policy to be practical, authentic and actionable. IMPLICATIONS FOR REHABILITATION The development of policy in the area of asssitive technology is important to provide an overarching vision and outline resourcing priorities. This paper identifies some of the key themes that should be addressed when developing or revising assistive technology policy. Each country should establish a National Assistive Technology policy and develop a theory of change for its implementation

Measuring met and unmet assistive technology needs at the national level: Comparing national database collection tools across eight case countries

The development and implementation of assistive technology policy that meets the needs of citizens is dependent on accurate data collection and reporting of assistive technology use and unmet needs on a national level. This study reviews the methodology from instruments intended to capture national statistics on assistive technology use across eight case countries from varying regions and income levels. Recommendations are provided, which highlight the need for mandatory, census level data collection according to international standards for data collection in the areas of disability and assistive technology

Measuring met and unmet assistive technology needs at the national level: Comparing national database collection tools across eight case countries

The development and implementation of assistive technology policy that meets the needs of citizens is dependent on accurate data collection and reporting of assistive technology use and unmet needs on a national level. This study reviews the methodology from instruments intended to capture national statistics on assistive technology use across eight case countries from varying regions and income levels. Recommendations are provided, which highlight the need for mandatory, census level data collection according to international standards for data collection in the areas of disability and assistive technology

Music and Movement for Health: Protocol for a pragmatic cluster-randomised feasibility pilot trial of an arts-based programme for the health and wellbeing of older adults [version 1; peer review: 2 approved]

Background: Arts-based health programmes (ABHP) can enhance the physical and psychosocial health and wellbeing of older people. However, the feasibility and usefulness of such programmes in Ireland are currently unknown. The primary aim of this study is to examine the feasibility of the study design, its application to a music and movement for health programme and associated costs. The secondary aim is to obtain preliminary effect estimates of an ABHP on health and wellbeing in older adults. Methods: This study is a pragmatic cluster-randomised controlled feasibility trial. Community-dwelling adults, aged 65 years or older will be recruited in the mid-west region of Ireland via methods including social prescription, traditional and social media. The clusters, based on geographical region, will be block randomised to either the ABHP or control using 1:1 allocation ratio. The programme will comprise a 1.5-hour music and dance session each week for 12-weeks together with a 1-hour home-based music and movement programme for 12-weeks. A qualitative and quantitative process evaluation of the arts-based health programme will be performed. Outcomes: Primary outcomes for feasibility include recruitment rates (the number of participants recruited per cluster per month); retention rate (the number of participants who complete measures at baseline and at follow up post intervention, and minimum average attendance. Secondary outcomes will include physical function, balance, physical activity, loneliness, social isolation, cognition, mood, as well as quality of life and cost. Conclusions: If this pioneering study finds evidence to support feasibility and acceptability, a future larger-scale definitive trial will be conducted to examine the effectiveness of an arts-based health programme for older adults. This research aims to strengthen collaborative efforts to implement effective, sustainable and cost-effective programmes for older adults to support community connection, enhancing health and wellbeing, in turn reducing demands on the healthcare system. ISRCTN registration: ISRCTN35313497 (18/02/2022)