Anne Cusick

Community nurses are often the health professionals with whom older Australians living at home have most contact. The home environment has been identified to have a number of hazards associated with falls in older people. The Home-screen scale was specifically designed as a nurse-administered instrument to identify environmental and behavioral risks that alert nurses to the need for action to reduce fall risks in the home. A 14-item scale was administered to 1,165 older people receiving community nursing services. Psychometric investigation confirmed a 10-item scale with construct validity and internal consistency (α= 0.86, n= 989), explaining 60% of the construct of home safety (safe home environment and safe home behaviors). In addition, differences in mean scores were found in clients able and unable to transfer independently (t= 4.5 [df= 323.1]p < 0.001 [Group 1: M= 82.14, SD= 15.56; Group 2: M= 75.54, SD= 20.83, n= 989]). Similarly, an association existed between clients with low scores on the Home-screen scale and the perceived need for home modification. A score of 74 on this scale has been identified as a critical point for potential client injury. The use of this scale, both as an initial screening instrument and as a monitoring tool for community nurses working with older people, is recommended.

Aim:  Home programmes are used extensively for children with cerebral palsy. Even though there is consensus about the importance of home programme intervention, there is little evidence of efficacy and scant information regarding programme characteristics that might affect family participation. Instead, research to date has focussed on parental compliance with prescribed programmes and parent–child interactions.Methods:  Based on reviewed literature, this article proposes a model to guide development of home programmes for children with cerebral palsy. It is a starting point for therapists to consider the way in which they focus and structure their home programmes for children who have cerebral palsy.Results and Conclusions:  The paper identifies an urgent need to develop clinical guidelines for home programmes through rigorous formal processes and to evaluate the impact of occupational therapy home programmes.

The Canadian Occupational Performance Measure (COPM) is a commonly used outcome measure in rehabilitation. In this study it was adapted for very young children by deleting paid/unpaid work and household management categories and having parents act as proxies to rate child performance and their own satisfaction. To assess the internal consistency reliability, content and construct validity, responsiveness, and impact of half scores (20 not 10-point scale) of the adapted COPM. Parent proxies of subjects aged 2 - 8 (mean 3.9) years with spastic hemiplegic cerebral palsy (n = 41) participating in a clinical trial. There was a total of 214 occupational performance problems for analysis and an additional 56 which had used half score ratings. Internal consistency reliability and construct validity were evaluated using Cronbach alpha statistic. Proxy views explored content validity. Responsiveness was evaluated using pre-post intervention scores and a comparison with Goal Attainment Scaling scores which were assumed to be a suitable benchmark measure. The effect of half scores was assessed by two-sample t-tests. The COPM adaptations did not have a negative impact on internal consistency reliability as this was acceptable for performance (0.73) and satisfaction (0.83). The high Cronbach alpha scores indicated good construct validity. Content of occupations and rating approach was considered valid by proxies. Use of half scores did not result in significantly different performance ratings, but mean satisfaction ratings were significantly higher when half scores were used (p = 0.0001). This suggests that half scores may provide more precise proxy satisfaction ratings, but at the cost of rigour as internal consistency with satisfaction half scores was lower (0.63 vs. 0.82). Responsiveness to change in clinical status was demonstrated by significant pre-post scores and moderate correlations with goal attainment scores. The adapted COPM is a psychometrically robust tool and the use of half scores is not recommended.

Aim: To critically assess and develop recommendations for professional development (PD) for occupational therapists in a multisite specialist cerebral palsy occupational therapy service.Method: Quality improvement project based on principles of participatory action research: audit of PD resources/activity; stakeholder consultations and literature review.Results: The PD program goal, resources, strategies, activities and evaluations conducted at the centre were identified and described. Areas for improvement were identified by critically considering the PD program in the context of reviewed literature. There was an assumption that personal change through PD would help attain the organisational goal of clinically competent practitioners who use evidence-based practice in a family-centred context.Recommendations: Future PD plans and evaluations need to explicitly address this assumption. The use of structured reflection and the ‘clinical reasoning’ conceptual framework was recommended as one way to help personal change from PD to have workplace impact. This project provides a precedent and guide to occupational therapy PD planners regarding a whole-of-organisation approach to developing and maintaining competence through PD.

The efficacy of repeated botulinum toxin A (BTX-A) injections in two and three dose regimes, together with occupational therapy, on upper limb movement and function, was studied using an evaluator blinded, randomized, controlled two-group trial. Forty-two children (31 males, 11 females; range 2–8y, mean 4y [SD 1y 7mo]) with hemiplegic cerebral palsy (Gross Motor Function Classification System Level I) longitudinally participated for 30 months, with the first 6 months reported earlier (Lowe et al. 2006). The BTX-A group (n=21) received three injections (0, 6, and 18mo), while the delayed group had two (6 and 18mo; dose 0.5-2.1 units/kg, mean 1.5 [SD 0.18]; dilution 100 units/0.5ml). At 30 months, no difference existed between groups on any standardized measures. First and second injections showed significant treatment effect sizes, on Quality of Upper Extremity Skills Test (5.5 p=0.01: 4.5 p=0.03); parent Goal Attainment Scaling (GAS; 3.5 p=0.02: 3.9 p=0.01; therapist GAS 7.8 p=0.00: 4.0 p=0.03); Canadian Occupational Performance Measure (performance 0.4 p=0.05: 0.4 p=0.02; satisfaction 0.4 p=0.05: 0.37 p=0.08); and Pediatric Evaluation of Disability Inventory functional skills (1.8 p=0.00: 2.3 p=0.04). BTX-A was not linked to adverse events, suggesting repeated upper limb injections in children with hemiplegia receiving occupational therapy were safe and effective for improvement of movement and function.

To summarize evidence on the use of upper extremity casting designed to achieve reductions in contracture, tone, pain, function, oedema or spasticity in the elbow, wrist or hand of adults and children with neurological conditions. A search was conducted of the Cochrane Database of Systematic Reviews; the electronic databases MEDLINE, EMBASE, CINAHL, PEDro, OT-Seeker; Google Scholar; reference lists of retrieved trial reports and review articles. Two independent reviewers determined whether retrieved study abstracts met inclusion criteria: human subjects; &amp;gt;50% of participants children or adults described as having brain injury, cerebral palsy or stroke. Methodological quality of randomized controlled trials was rated using the PEDro scale (1-10 highest). Thirty-one papers were retrieved and 23 studies appraised: three were randomized controlled trials and four were systematic reviews. Over three-quarters of the studies, excluding systematic reviews, were lower level evidence (n = 4 level V; n = 4 level IV; n = 1 level III). Methodological quality of randomized controlled trials was high (PEDro 8, 8 and 9) and there were modest positive short-term outcomes for two trials, although they did not include no-stretch comparison conditions. Safety issues typically included pain or skin breakdown; two adverse events were not cast related. While theoretical rationales suggest upper limb casting should be effective there is insufficient high-quality evidence regarding impact or long-term effects to either support or abandon this practice. High variability in casting protocols indicates little consistency or consensus in practice. As maximum or low-load stretch are rationales for cast application, the absence of no-stretch conditions in existing trials is a major weakness in current evidence.

Lannin, N., Gustafsson, L., Cusick, A., Walker, M., Steultjens, E., Fricke, J., Turton, A., Wågø Aas, R., Logan, P., Froude, E., McCluskey, A., Drummond, A., Corr, S., Fletcher-Smith, J., Radford, K., Pinnington, L., Novak, I. and Wallen, M.(2009), Scholarly communication and ...

... Becoming an evidence-based practitioner through professional development. Anne Cusick 1 ,; Annie McCluskey 2. Article first published online: 24 DEC 2001. ... BECOMING ANEVIDENCE-BASED PRACTITIONER THROUGH CONTINUING PROFESSIONAL DEVELOPMENT. ...

Previous studies have identified a low preference for mental health careers among students and practitioners in occupational therapy. Factors implicated include the social stigma of mental health in the community, fieldwork experience, academic preparation, and work setting factors such as role ambiguity and chronicity of clients. Of these factors, fieldwork may be the most important influence. A survey was administered to 181 undergraduate occupational therapy students, with 60.3% responding. The results indicated that student experience in the field was central in influencing work preferences. The setting was viewed as attractive by some students, offering features such as unique occupational therapy role, less structure and opportunity for creativity, while other students perceive the setting as threatening with features such as demanding work, chronicity of clients and problems related to the occupational therapy role. Students who preferred to work in mental health responded with comments that primarily characterised the occupational therapy work role. Students who did not plan to work in mental health provided responses where the emphasis was on the students' perception of their personal and professional ability to "withstand" the work role and demands which they described. Recommendations for further research are made.

Aim:  To explore continuing professional development (CPD) resources and needs of Australian emergency department occupational therapists.Method:  Australian websites and occupational therapy newsletters were searched to identify CPD resources/opportunities. Occupational therapists with recent clinical experience in Australian emergency departments were surveyed on strengths, weaknesses, opportunities and threats to their service, research information needs, supervision/mentor arrangements and quality assurance activity.Results:  No Australian CPD opportunities were identified; 1.3% of the 2008 OT AUSTRALIA conference topics were emergency department specific. Forty-one Australian hospitals employed a total of 51 occupational therapists of whom 30 responded. Half were supervised by occupational therapists; 20 had occupational therapy mentors; 23 perceived that they were very independent; seven did quality assurance projects; 25 had unmet research needs; 27 thought their service was effective; and service strengths, weaknesses, opportunities and threats to service could be identified by most occupational therapists.Conclusion:  Australian occupational therapists in emergency departments need specialised CPD opportunities. The information needs and strengths, weaknesses, opportunities and threats provide a CPD topic planning guide.

Background  Some emergency departments (EDs) in the UK, North America and Australia have provided occupational therapy (OT) services for over 10 years; however, little is known about practice patterns as previous literature has focussed on single programmes or the generic contribution of allied health multidisciplinary teams to ED throughput and safe discharge.Aim  To describe practice patterns of OT services in Australian EDs.Method  Of 129 Australian public hospital EDs, 41 were identified to have offered OT services in the past 5 years (32%). Using snowball sampling an investigator designed survey was sent to 51 occupational therapists who were identified to have worked in these EDs in the past 5 years.Findings  30 subjects (58% response rate) from 21 sites participated. Mean age 30.4, 29 females, one male and an average of 9-year clinical experience. OT service was usually provided within multidisciplinary or interdisciplinary teams by full-time employed staff and patients were overwhelmingly Australian Triage Scale level 4 or 5 and were over 65 years. Few standardized assessment or outcome measures were used. The OT role was consistently focussed on functional assessment and provision of interventions such as equipment prescription, patient education and referral to community and support services to ensure safe discharge or inform inpatient admission decisions.