Uncovering motivators and stumbling blocks: Exploring the clinical research experiences of speech-language pathologists

Purpose : Healthcare providers increasingly expect that allied health staff will not only translate research evidence into their clinical practice, but also generate research. Little is known about how well prepared clinicians are to meet these expectations. Research suggests that allied health professionals, including speech-language pathologists, have moderate levels of interest in research, but only little-to-moderate experience participating in research activities. The present study aimed to explore the experiences and attitudes of speech-language pathologists in regards to undertaking research in their clinical settings

Factors associated with the occurrence of sentinel events during transition from hospital to home for individuals with traumatic brain injury

Objective: To describe the timing and factors associated with the occurrence of sentinel events (financial strain, difficulty accessing therapy, return to work, accommodation change and independent transport use) during transition to the community for individuals with traumatic brain injury. Design: Longitudinal cohort design with data collected pre discharge and at 1, 3 and 6-month follow-ups. Subjects: Individuals with moderate to severe traumatic brain injury (n = 127), discharged home from acute care and inpatient rehabilitation. Methods: Data were collected using self-report questionnaires (sentinel events questionnaire, Mayo Portland Adaptability Inventory-4, Sydney Psychosocial Reintegration Scale, Depression Anxiety Stress Scale). Logistic regression was used to identify factors associated with sentinel events. Results: The most commonly reported events were independent transport use and return to work, reported on 104 and 90 occasions, respectively. A longer hospital stay and poorer community integration were related to negative events (e.g. reduced therapy). The inverse relationship was seen for positive events. Links existed between sentinel events (e.g. previous financial strain increased the likelihood of this event in transition). Conclusion: This paper highlights the interplay between personal and environmental factors and life events in shaping transition experiences. Individualised service planning and monitoring of sentinel events is important to promote successful community transition

Return to driving in the first 6 months of community integration after acquired brain injury

BACKGROUND: Return to driving is a goal and milestone in the recovery process following acquired brain injury (ABI). Knowledge of whether and when a person is likely to return to driving is important to people with ABI, family members and clinicians

Physiotherapists have accurate expectations of their patients’ future health-related quality of life after first assessment in a subacute rehabilitation setting

Background. Expectations held by health professionals and their patients are likely to affect treatment choices in subacute inpatient rehabilitation settings for older adults. There is a scarcity of empirical evidence evaluating whether health professionals expectations of the quality of their patients’ future health states are accurate. Methods. A prospective longitudinal cohort investigation was implemented to examine agreement (kappa coefficients, exact agreement, limits-of-agreement, and intraclass-correlation coefficients) between physiotherapists’ (n=23) prediction of patients’ discharge health-related quality of life (reported on the EQ-5D-3L) and the actual health-related quality of life self-reported by patients (n=272) at their discharge assessment (using the EQ-5D-3L). The mini-mental state examination was used as an indicator of patients’ cognitive ability. Results. Overall, 232 (85%) patients had all assessment data completed and were included in analysis. Kappa coefficients (exact agreement) ranged between 0.37–0.57 (58%–83%) across EQ-5D-3L domains in the lower cognition group and 0.53–0.68 (81%–85%) in the better cognition group. Conclusions. Physiotherapists in this subacute rehabilitation setting predicted their patients’ discharge health-related quality of life with substantial accuracy. Physiotherapists are likely able to provide their patients with sound information regarding potential recovery and health-related quality of life on discharge. The prediction accuracy was higher among patients with better cognition than patients with poorer cognition

Sex and gender differences in caregiving burden experienced by family caregivers of persons with dementia: a systematic review

Objectives Much is known about the demands of caregiving for a person with dementia (PWD) and its effects on family caregivers, however sex and gender aspects have received less attention. We synthesized the evidence on sex and gender distinctions in: (1) the caregiving burden and (2) the impact of caregiving on the physical and mental health of family caregivers of PWD. Design Systematic review. Data sources Medline, Embase, PsycINFO and Cumulative Index to Nursing and Allied Health Literature between January 2007 and October 2019 were searched Eligibility criteria for selecting studies Studies included in the review met the following criteria: (1) Examine experiences and/or impacts of caregiving among family caregivers of individuals with any form of dementia; (2) Report sex and/or gender distribution of study population and/or report results stratified by sex and/or gender, and (3) Include both male and female family caregivers. Data extraction and synthesis Two independent reviewers extracted the data and assessed risk of bias using the Critical Appraisal Skills Programme checklist and National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-sectional Studies. Data were synthesized using a narrative synthesis approach. Results A total of 22 studies were included. Caregiving burden was measured using various methods. A majority of studies reported higher burden among females. Most studies that did not report a sex and gender difference accounted for confounders. Findings on sex and gender differences on physical and mental health conditions were inconsistent with most studies failing to account for confounding variables in their analyses. Conclusions The current evidence on sex and gender differences in caregiving burden, mental and physical health is limited. Findings suggest the presence of sex and gender differences in caregiving burden. Given the variety of mental and physical health constructs that were examined, further research is required to substantiate the evidence

Sex and gender differences in technology needs and preferences among informal caregivers of persons with dementia

Background: Dementia is a major public health concern associated with significant caregiver demands and there are technologies available to assist with caregiving. However, there is a paucity of information on caregiver needs and preferences for these technologies, particularly from a sex and gender perspective. To address this gap in research, the objectives of this study are to examine (1) the knowledge of technology, (2) perceived usefulness of technology, (3) feature preferences when installing and using technology and (4) sex and gender influences on technology needs and preferences among family caregivers of persons with dementia (PWD) across North America. Methods: A secondary analysis was conducted on an existing cross-sectional survey with family caregivers of PWDs. Respondents were recruited through the Alzheimer Society of Canada, the Victorian Order of Nurses and Adult Day Programs and other Canadian health care provision institutes. Descriptive statistics, bivariate and multivariate analyses were used to describe the study sample, uncover differences between male and female caregivers and examine sex and gender influences on caregivers’ technology needs and preferences. Results: A total of 381 eligible responses were received over a nine-month data collection period. The majority of respondents did not know much about and never used any technologies to assist with caregiving. “Being easy to install”, “easy to learn how to use” and “cost” were identified as the most important features when purchasing and setting up technology, while “reliability” was identified as the most important feature when using technology. Most respondents were willing to pay up to $500 to acquire individual technologies. Controlling for other socio-demographic variables, female respondents were more likely to have some or more knowledge about technology for caregiving while male respondents were more willing to pay higher amounts for these technologies compared to their female counterparts

Bridging knowledge, policies and practices across the ageing and disability fields: A protocol for a scoping review to inform the development of a taxonomy

Introduction Bridging is a term used to describe activities, or tasks, used to promote collaboration and knowledge exchange across fields. This paper reports the protocol for a scoping review which aims to identify and characterise peer reviewed evidence describing bridging activities, between the ageing and disability fields. The purpose is to clarify the concepts underpinning bridging to inform the development of a taxonomy, and identify research strengths and gaps. Methods A scoping review will be conducted. We will search Medline, Cumulative Index to Nursing and Allied Health Literature, Embase, PsycInfo, Sociological Abstracts and the Cochrane Library, to identify peer reviewed publications (reviews, experimental, observational, qualitative designs and expert commentaries) describing bridging activities. Grey literature, and articles not published in English will be excluded. Two investigators will independently complete article selection and data abstraction to minimise bias. A data extraction form will be iteratively developed and information from each publication will be extracted: (1) bibliographic, (2) methodological, (3) demographic, and (4) bridging information. Qualitative content analysis will be used to describe key concepts related to bridging. Conclusions To our knowledge, this will be the first scoping review to describe bridging of ageing and disability knowledge, services and policies. The findings will inform the development of a taxonomy to define models of bridging that can be implemented and further evaluated to enable integrated care and improve systems and services for those ageing with disability. Ethics and dissemination Ethics is not required because this is a scoping review of published literature. Findings will be disseminated through stakeholder meetings, conference presentations and peer reviewed publication.This work is supported by the Canadian Institutes of Health Research Planning and Dissemination Grant through the Institute of Aging

The British Army, information management and the First World War revolution in military affairs

Information Management (IM) – the systematic ordering, processing and channelling of information within organisations – forms a critical component of modern military command and control systems. As a subject of scholarly enquiry, however, the history of military IM has been relatively poorly served. Employing new and under-utilised archival sources, this article takes the British Expeditionary Force (BEF) of the First World War as its case study and assesses the extent to which its IM system contributed to the emergence of the modern battlefield in 1918. It argues that the demands of fighting a modern war resulted in a general, but not universal, improvement in the BEF’s IM techniques, which in turn laid the groundwork, albeit in embryonic form, for the IM systems of modern armies. KEY WORDS: British Army, Information Management, First World War, Revolution in Military Affairs, Adaptatio

Sentinel events associated with the transition from hospital to home: Experiences of individuals with traumatic brain injury and their family caregivers.

Background The transition arising as individuals with brain injury move from hospital to home is emerging as a distinct rehabilitation phase, and the beginning of community integration. Previous research has shown that individuals with traumatic brain injury (TBI) and their families have challenging experiences during this transition including reduced independence, relationship problems, caregiver strain, and reduced participation in meaningful activity. Life course theory is a paradigm used to understand how life events and societal changes influence transitions and the life course, and is therefore relevant to research investigating individual experiences during the transition phase following TBI. Research identifying key events which arise during the transition from hospital to home, and influence the overall experience for individuals with TBI and their caregivers is needed to understand the transition process and to inform service improvements during this phase. Research Aims Specific thesis aims were to 1) investigate the occurrence of sentinel events and other factors which influence the transition from hospital to home for individuals with TBI and their family caregivers; and 2) to investigate the experiences and perceptions of individuals with TBI and their family caregivers regarding the transition from hospital to home and the sentinel events occurring during this phase. Methodology This research used a sequential explanatory mixed methods design with two phases. Phase one was a prospective longitudinal cohort investigation. A sample of 127 individuals with TBI, and 83 caregivers completed questionnaires pre-discharge and then at 1, 3 and 6-months post-hospital discharge. Key outcome measures were a visual analogue scale measuring perceived transition success, and a sentinel events questionnaire developed for the thesis based on life course theory. Other measures were used to collect data on psychosocial integration, level of disability, emotional wellbeing, quality of life, environmental barriers, and caregiver strain. Mixed effect modelling identified factors associated with higher ratings of transition success and logistic regression identified factors related to the occurrence of sentinel events during the transition phase. Phase two, a qualitative investigation, involved semi structured in-depth interviews with 16 individuals with TBI and 10 family caregivers. The focus of the interviews was to understand the experiences of individuals with TBI and their family members during the transition phase, and interviews were guided by life course theory. The sample was purposefully selected from those involved in phase one based on data related to perceived transition success and occurrence of sentinel events. Data were analysed thematically using a Framework approach. Findings according to thesis aims The first thesis aim, to examine the sentinel events and other factors influencing transition, was addressed in phase one of the study. The most commonly reported events related to regaining independence (e.g., regaining independence at home or in use of transport). Least common (though still reported by 28% of individuals with TBI) was relationship breakdown. The sentinel events most influential with respect to transition success were 1) return to work, 2) returning to independent transport use, 3) changing living situation, 4) financial strain and 5) experiencing difficulty accessing therapy. Individuals with a more severe injury and lower levels of community integration were more likely to experience negative events in transition (e.g., financial strain). Conversely, those with a less severe injury were more likely to experience positive events (e.g., return to work). Level of community integration, quality of life and injury severity also influenced the perceptions of individuals with TBI regarding transition success. Higher stress levels and poorer community integration (of the individual with TBI) were related to lower perceptions of transition success for family caregivers. The second thesis aim was to examine the experiences and perceptions of individuals with TBI and their caregivers about transition. Qualitative findings indicated that the transition experience for individuals with TBI was characterised by a drive to return to a “normal life” and changes in their perspective on life. Normality was defined as returning to work or other meaningful activities, regaining independence, and maintaining important relationships. A changed life perspective was displayed by either altering life priorities orbeing forced to accept changes in life. The dominant experiences of transition for family caregivers were feeling the weight of the caring responsibility, and hoping the individual with TBI would regain a sense of normality. The two themes were linked as caregivers’ sense of responsibility stemmed from wanting to protect the individual and help them return to normal life. Conclusions and recommendations A synthesis of qualitative and quantitative findings highlighted the variation in individual experiences and the dynamic nature of the transition phase. There was no distinct end-point to the transition phase; instead it represented a period of the life course influenced by personal factors, environmental factors, and sentinel events. The complex and critical nature of the transition phase is highlighted by the the links between transition and adjustment to disability. Research into rehabilitation approaches (e.g., meaningful use of time) and models of service delivery targeting the transition phase is required to provide optimal supports for families during this critical life course transitio

Linked lives: the experiences of family caregivers during the transition from hospital to home following traumatic brain injury

The transition from hospital to home following traumatic brain injury (TBI) has been identified as the point where responsibility for care shifts from rehabilitation services to informal family caregivers. There has, however, been little research examining the experiences of family members during this important transition that involves adopting or, in some cases, resuming a caring role (e.g., a parent caring for an adult child). The aim of this qualitative investigation was to understand the experiences of family caregivers during the transition from hospital to home, defined as the first six months postdischarge. The sample included 10 family caregivers, of which all were female and either a mother, spouse or ex-partner of an individual with TBI. Semistructured interviews were conducted on average nine months following community reentry and data were analysed thematically using a framework approach. The overarching theme was that caregivers wished to move past the injury. This desire to move forward stemmed from a realisation of how their life had changed and the weight of the care responsibility. Caregivers were also aware of how the life of the individual with a TBI had changed and hoped for a return to normality (by regaining independence, engaging in meaningful occupation and having meaningful relationships). Implications of the findings for research and clinical practice are discussed. There is a need for services to support family caregivers during the transition from hospital to home