The Wobbly Hub & Double Spokes project: people with a disability in rural areas.

The Wobbly Hub and Double Spokes project aims to develop, implement and evaluate new models of therapy service delivery for people with a disability living in rural areas. Based on our research work in Western NSW and the experience of the team, we have developed four streams of enquiry related to people with a disability in rural areas: Insights into rural contexts; access to supports; alternative service models and workforce development.Department of Ageing, Disability and Home Care, NSW Government

Occupational Therapy with Australian Indigenous children and their families: A rural and remote perspective

Background/aim: Occupational therapy service delivery must be adapted when working with Indigenous communities, as there is a diversity of beliefs, values and customs. There are currently no evidence-based models of therapy service delivery to rural and remote Indigenous children and their families. This study aims to explore occupational therapy service delivery to rural and remote Indigenous children and their families. Methods: Semi-structured telephone interviews were conducted with seven occupational therapists with experience with Australian rural and remote Indigenous children and their families. A thematic analysis was conducted on each interview with constant comparison to refine themes across interviews. Results: A total of six service delivery themes emerged from the data gathered in the interviews; flexible and accessible services; tailored services; culturally sensitive therapist; culturally inclusive services; occupational therapy awareness; and collaboration. These results linked with the need for long-term solutions, as the limited access to occupational therapy within these communities is a social injustice. Conclusion: The findings demonstrate that each Indigenous community is unique. Therapists work in collaboration with the community and use their critical reasoning skills to adjust practice accordingly. Significance of the study: This study contributes to growing knowledge about occupational therapy service provision in rural and remote Indigenous communities with children and their families. The findings will assist therapist in these communities to provide culturally aligned services. They also advocate for these communities by emphasising the basic human right violations that Indigenous communities are experiencing by not having access to consistent and culturally appropriate occupational therapy services

Telerehabilitation in the Middle East North Africa Region: A Structured Review

A structured review using the PRISMA guidelines, MeSH keywords and eight health databases was conducted (1990 to March 2021). Telerehabilitation research evidence from the Middle East and North Africa region (MENA) was summarized. Twelve studies from Iran, Israel, Morocco, and Saudi Arabia met inclusion criteria; nearly all had been published within the past five years. Methodological quality was moderate to good in the four randomized controlled trials, five cohort-studies and three cross-section surveys. There were seven intervention studies in cardiovascular, musculoskeletal, neurology or burn rehabilitation and three patient perception and two practitioner perception studies. Narrative synthesis revealed content themes relating to rehabilitation availability and accessibility; patient/practitioner perceptions of telerehabilitation; telerehabilitation to augment traditional services; and barriers to telerehabilitation. Telerehabilitation practice in MENA has been demonstrated as feasible, acceptable to patients, and effective in practitioner-designed cohort specific programs. Practitioners are generally positive but lack experience and need training, enabling technological systems, and policy frameworks. &nbsp

Perspectives of Saudi Occupational Therapists Regarding Telerehabilitation: A Qualitative Study

Background: Telerehabilitation is emerging in Saudi Arabia. This study investigated occupational therapy professionals’ perspectives on using telerehabilitation in their practice. Method: Data were collected through semi-structured phone interviews conducted with nine Saudi occupational therapists. A pragmatic qualitative evaluation approach was used. Findings: Experience and perceptions of participants regarding telerehabilitation were represented as follows: awareness and knowledge of telerehabilitation; how telerehabilitation increases occupational therapy availability and access in Saudi Arabia; telerehabilitation in the pandemic; telerehabilitation is preferred; suitability of telerehabilitation in Saudi Arabia; telerehabilitation care pathways; telerehabilitation readiness in Saudi Arabia; and telerehabilitation willingness by Saudi occupational therapists. Conclusion: Saudi occupational therapists have good knowledge and awareness of telerehabilitation, and some had used it during the pandemic. They showed positive attitudes and a willingness to use telerehabilitation if appropriate technology infrastructure, official policy standards and guidelines, training, data security, and financial resources could be provided to support implementation

Telepractice for children with complex disability: Guidelines for quality allied health services

Telepractice has the potential to spread allied health professionals’ (AHPs’) reach further into rural Australia. There are fewer AHPs in rural and remote Australia compared to metropolitan areas. This means that children with disabilities living in rural areas may not receive the therapy services they need. Providing therapy services via telepractice could reduce these inequities and ensure that all children receive the supports they need, regardless of where they live. Telepractice guidelines in allied health rightly insist that telepractice services should be equivalent in quality to those delivered in-person (Speech Pathology Australia [SPA], 2014). Therefore, telepractice services should not simply be an option of last resort, but should be a quality option for disability services. Yet, how can AHPs ensure that their telepractice services are equivalent in quality to those they deliver in-person? As a first step towards exploring this issue, we conducted a research study funded by the auDA Foundation in 2016-17, and in partnership with Therapy Connect, a private allied health practice. We collected information about the allied health telepractice services received by four children with complex disabilities and their families living in rural or remote Australia. We found that AHPs, despite being geographically remote from children and families, could deliver services consistent with contemporary practice and supported children to achieve positive, functional outcomes. We identified the essential components of successful telepractice models needed to achieve real outcomes for children with disabilities through this and other research conducted by the Wobbly Hub Rural Research Team. Our key learnings from this research informed the development of guidelines for telepractice delivery of allied health services to children with complex disability, as summarised in this document.auDA Foundation Grant, 2016-201

Telepractice for children with complex disability: Quality service delivery

Telepractice is the delivery of therapy services at a distance by linking clinicians to clients, carers, or others, via technology such as web-based videoconferencing. Funded by auDA Foundation in 2016-17, and in partnership with TherapyConnect, a private allied health practice, we collected information about the telepractice services received by four children with disability and their families living in rural or remote Australia. We found that quality allied health services can be provided via telepractice to children with complex disability and their families. We also identified essential components of successful telepractice models.auDA Foundation Grant, 2016-201

Issues affecting therapist workforce and service delivery in the disability sector in rural and remote New South Wales, Australia: perspectives of policymakers, managers and senior therapists

Introduction: The disability sector encompasses a broad range of conditions and needs, including children and adults with intellectual and developmental disabilities, people with acquired disabilities, and irreversible physical injuries. Allied health professionals (therapists), in the disability sector, work within government and funded or charitable non-government agencies, schools, communities, and private practice. This article reports the findings of a qualitative study of therapist workforce and service delivery in the disability sector in rural and remote New South Wales (NSW), Australia. The aim was to investigate issues of importance to policy-makers, managers and therapists providing services to people with disabilities in rural and remote areas. Methods: The project gathered information via semi-structured interviews with individuals and small groups. Head office and regional office policy-makers, along with managers and senior therapists in western NSW were invited to participate. Participants included 12 policy-makers, 28 managers and 10 senior therapists from NSW government agencies and non-government organisations (NGOs) involved in providing services and support to people with disabilities in the region. Information was synthesised prior to using constant comparative analysis within and across data sets to identify issues.Results: Five broad themes resonated across participants’ roles, locations and service settings: (1) challenges to implementing policy in rural and remote NSW; (2) the impact of geographic distribution of workforce and clients; (3) workforce issues - recruitment, support, workloads, retention; (4) equity and access issues for rural clients; and (5) the important role of the NGO sector in rural service delivery and support. Conclusions: Although commitment to providing best practice services was universal, policy-related information transfer between organisations and employees was inconsistent. Participants raised some workforce and service delivery issues that are similar to those reported in the rural health literature but rarely in the context of allied health and disability services. Relatively recent innovations such as therapy assistants, information technology, and trans-disciplinary approaches, were raised as important service delivery considerations within the region. These and other innovations were expected to extend the coverage provided by therapists. Nongovernment organisations played a significant role in service delivery and support in the region. Participants recognised the need for therapists working for different organisations, in rural areas, to collaborate both in terms of peer support and service delivery to clients

Policy Development and Implementation for Disability Services in Rural New South Wales, Australia

Throughout their lives, all people, including those who have a disability, use a broad range of community services. Community services are important in assisting people with a range of impairments to participate in their communities. Vast geographic distances and a lack of therapists in rural and remote regions of Australia pose significant barriers for implementing policy aimed at supporting people with a disability. The aim of this study was to investigate the extent to which metropolitan-formulated policy encompassed the unique geographic, demographic, and sociocultural challenges experienced by rural therapists and people with a disability in New South Wales (NSW). Twenty-seven policy documents were reviewed and categorized into tier 1 (higher level strategic policies) and tier 2 (specific operational policies). Tier 1 policy documents provided consistent messages about the need to develop strategies and service delivery options to address geographic, cultural, and age-related barriers facing all people in NSW including those who have a disability. Tier 2 documents revealed a lack of attention to the practical differences between implementing the policy principles in metropolitan compared with rural areas. Study findings identify that the implementation of metropolitan-formulated policy does not always encompass the unique challenges experienced by therapists providing services to rural people with a disability and their carers. This study highlights the importance of “rural proofing” policy to consider people who live and work in rural areas

Rural Carers of People with Disabilities: Making Choices to Move or to Stay

When a child is born with, or an individual acquires, a disability in rural Australia, one of the decisions faced by the family is whether to remain living in a rural area or move to a larger metropolitan centre to access support services such as therapy. Understanding the factors that rural carers weigh up in making the decision to move or stay can inform the successful implementation of the National Disability Insurance Scheme (NDIS) in rural areas. Seventy-eight rural carers were recruited to participate in individual interviews or focus groups to discuss access to therapy services. Data were analysed using modified grounded theory involving thematic analysis and constant comparison. Participants made decisions about whether to stay living in their rural community or to move to a larger centre to receive therapy services according to three interlinked factors: personal factors related to their other family caring responsibilities; social factors including their informal support networks of family, friends, and community; and economic factors including employment and the time and cost of travelling to access specialist services in larger centres. These factors need to be considered in the roll-out of the NDIS to ensure that rural service users enjoy the benefit of a real choice to live in a rural area without reducing their access to support services.This research was funded by the National Health and Medical Research Council and New South Wales Family and Community Services, Ageing Disability and Home Care, Western Region in partnership with the Faculty of Health Sciences, University of Sydney

The need for new models for delivery of therapy intervention to people with a disability in rural and remote areas of Australia

Early therapy intervention by occupational therapists, physiotherapists, and speech pathologists (therapists) is recognised to yield benefits across the lifecourse (Carpenter, 2007; Law, 2002; Thomaidis, Kaderoglou, Stefou, Damianou, & Bakoula, 2000; Ziviani, Feeney, Rodger, & Watter, 2010). As a result,there have recently been increases in funding for therapy positions in disability services in New South Wales(NSW), Australia (New South Wales Government, 2006). However, research by Keane, Smith, Lincoln,and Fisher (2011), Chisholm, Russell, and Humphreys (2011), and Denham and Shaddock (2004) indicated that there is a shortage of therapists living and working in rural and remote areas of Australia