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

Evaluation of the state-wide implementation of an allied health workforce redesign system: Utilisation of the Calderdale framework

Background: Increasing demand for allied health services is driving workforce redesign towards greater productivity within budgetary constraints. To date, there has been limited research into workforce redesign tools at an organisational level. The aim of this article was to evaluate an implementation of The Calderdale Framework for state-wide service delivery workforce redesign within allied health settings across Queensland. Method: A multi-phase methodology with mixed methods of data collection was used. This included analysis of documents, staff surveys, and semi-structured, in-depth interviews with staff from work units utilising the Framework across the state. Findings: The primary mechanisms for implementation were staff training and provision of centralised resources. Across the state, all health services engaged in training and most completed associated workforce redesign projects. However, the number and type of projects varied across the state as did the successful projects. Feedback from staff indicated the structured nature of the framework was viewed positively, but was time intensive to perform. Local contextual factors heavily influenced workforce redesign success. Conclusion Key factors pertaining to state-wide workforce redesign include: providing coordinated and centralised systems to support staff, ensuring adequate training, prioritising the development of key local staff, and proactively managing local contextual factors

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

STRENGTH and the Health Care Team: changing interprofessional and client-centered practices

Background: Client-centered practice in stroke rehabilitation is strongly influenced by interprofessional team functioning and collaborative goal setting. The hospital context is problematic for client-centered practice and reduces the ability of the health care team and client with stroke to appreciate the impact of stroke on functioning within the home environment. Objective: The purpose of this study was to trial Stroke Rehabilitation Enhancing and Guiding Transition Home (STRENGTH), an approach to rehabilitation that provides clients, carers, and hospital-based therapists with weekly opportunities to develop goals and undertake therapy sessions in the home and community before hospital discharge. Methods: Nine participants, comprising 3 occupational therapists, 4 physiotherapists, and 2 speech pathologists, completed a custom-made survey and participated in a semi-structured focus group at the completion of the 6-month trial of STRENGTH. The survey and focus group questioned the participants on their experiences and impressions of STRENGTH. Results: Inductive thematic analysis of the focus group identified 2 themes: "influences of context on team functioning" and "experiences of the program." The quantitative data supported the value of STRENGTH for team functioning and client outcomes. Conclusions: The findings provide an overall endorsement for STRENGTH from the therapists' perspectives and highlight the positive impact of environmental context on team functioning, collaborative goal setting, and ultimately client-centered practice

Charting the recovery of dysphagia in two complex cases of post-thermal burn injury: physiological characteristics and functional outcomes

Purpose: This study examined the physiological deficits, recovery pattern, and outcomes observed clinically and instrumentally in two participants with dysphagia post-thermal burn. Methods: Participants were followed prospectively using clinical and instrumental tools of assessment until dysphagia recovery. Clinical swallowing examinations were carried out every 1-2 days, or as clinically indicated. Instrumental assessment using fiberoptic endoscopic examination of swallowing was carried out at fortnightly intervals. Results: Despite variability in the achievement of oral intake milestones, both cases demonstrated protracted recovery from dysphagia contributed to by medical instability and lengthy periods of ventilation and intubation. Instrumental assessment confirmed silent aspiration in both participants, likely owing to decreased laryngopharyngeal sensation. By discharge, participants had returned to their pre-morbid diets. Conclusions: This study highlights the protracted and complex recovery pattern associated with dysphagia following thermal burn injury. The presence of silent aspiration emphasizes the need for instrumental assessment to objectively assess aspiration risk and to facilitate dysphagia recovery within this population

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

Evaluation of the State-Wide Implementation of an Allied Health Workforce Redesign System: Utilisation of the Calderdale Framework

Background: Increasing demand for allied health services is driving workforce redesign towards greater productivity within budgetary constraints. To date, there has been limited research into workforce redesign tools at an organisational level. The aim of this article was to evaluate an implementation of The Calderdale Framework for state-wide service delivery workforce redesign within allied health settings across Queensland. Method: A multi-phase methodology with mixed methods of data collection was used. This included analysis of documents, staff surveys, and semi-structured, in-depth interviews with staff from work units utilising the Framework across the state. Findings: The primary mechanisms for implementation were staff training and provision of centralised resources. Across the state, all health services engaged in training and most completed associated workforce redesign projects. However, the number and type of projects varied across the state as did the successful projects. Feedback from staff indicated the structured nature of the framework was viewed positively, but was time intensive to perform. Local contextual factors heavily influenced workforce redesign success. Conclusion: Key factors pertaining to state-wide workforce redesign include: providing coordinated and centralised systems to support staff, ensuring adequate training, prioritising the development of key local staff, and proactively managing local contextual factors

Impact of nasogastric tubes on swallowing physiology in older, healthy subjects: a randomized controlled crossover trial

Background & aims: The presence of a nasogastric tube (NGT) affects swallowing physiology but not function in healthy young adults. The swallowing mechanism changes with increasing age, therefore the impact of a NGT on swallowing in elderly individuals is likely to be different but is not yet known. The aims of this study were to determine the effects of NGTs of different diameter on (1) airway penetration-aspiration, (2) pharyngeal residue, and (3) pharyngeal transit, in older healthy subjects