Rachelle Martin currently works at the Rehabilitation Teaching and Research Unit, Department of Medicine (Wellington), University of Otago. She also has a clinical research role at the Burwood Academy of Independent Living (BAIL) based at Burwood Hospital. Rachelle's clinical background (>20 years) is working as a physiotherapist in hospital and community settings. She is involved in a range of research projects focusing on outcomes that are considered important by users of rehabilitation services. Research method skills include qualitative methods (IPA, TA and GT), single-case experimental designs (SCEDs), and realist research methods. Rachelle's work is focused on translational research improving health outcomes for people experiencing disability.
Societal culture, space, and structure have been unprecedentedly disrupted during the COVID-19 pa... more Societal culture, space, and structure have been unprecedentedly disrupted during the COVID-19 pandemic creating disproportionate vulnerability for disabled people. However, the upheaval of many societal conditions has presented enabling opportunities for disabled people. We report on interviews with 30 disabled people during the first four-week Aotearoa New Zealand COVID-19 lockdown. Three key themes were interpreted: “I am experiencing less disability on a daily basis,” encapsulating the experience of reduced disabling barriers for participants; “Working from home: the flexibility I have been asking for,” summarizing the benefits of functioning in an enabling home/work space; and “Social connection opportunities are the same for everyone,” overviewing participants reports that online opportunities presented a greater sense of belonging than before lockdown. Study findings highlight that despite a constant fear of the negative impact posed by COVID-19, there were numerous opportunities to reduce ablism through applying empowering factors inherent in novel cultural spaces.
Internet Journal of Allied Health Sciences and Practice
Introduction: All healthcare workers are responsible for patient safety and quality improvement a... more Introduction: All healthcare workers are responsible for patient safety and quality improvement and need to “speak up” to communicate issues. As healthcare systems strain under the impact of reduced staffing and workloads increase, allied health new graduates are feeling under pressure and unsupported. Understanding their experiences of speaking up as they transition into the workforce will identify what support they require to fulfil their patient safety and quality improvement responsibilities. Method: An exploratory study was conducted to investigate how new graduates in allied health speak up. Informed by a realist theoretical position, this study was interested in what contexts and resources support new graduates to speak up or not. Two different focus groups with allied health new graduates were used to collect data. Reflexive thematic analysis was employed to draw out key themes and sub-themes. Results: Three main themes were generated –advocacy drives speaking up, scaffoldin...
Internet Journal of Allied Health Sciences and Practice
Introduction: For healthcare organizations to adapt and improve, staff need to speak up for patie... more Introduction: For healthcare organizations to adapt and improve, staff need to speak up for patient safety and quality improvement. Speaking up has been explored in nursing and medicine with little known about speaking up in allied health. This study is part of a larger project investigating speaking up in allied health new graduates. This paper is taking a realist position to look at the perspectives of supervisors of allied health new graduates and further develop the Initial Program Theory (IPT) developed from the new graduate study. Method: Data was collected from two focus groups. Inductive thematic analysis was employed to develop themes and further realist informed analysis was completed using context-mechanism-outcome configurations leading to a refined IPT. FINDINGS: This study reports on the causal mechanisms and contextual features which supervisors believe activate speaking up in new graduates. A further developed IPT which combines findings from both studies will be int...
Urinary incontinence post-stroke is associated with poor rehabilitation outcomes. Current stroke ... more Urinary incontinence post-stroke is associated with poor rehabilitation outcomes. Current stroke guidelines recommend that physiotherapists are involved in addressing urinary incontinence problems post-stroke to improve rehabilitation outcomes; however, physiotherapists’ perceptions of their role are not known. This study explored how New Zealand physiotherapists perceive their current role in urinary incontinence assessment and management post-stroke, along with exploring what limits or facilitates this role. Using an exploratory qualitative methodology, eight physiotherapists from across New Zealand were interviewed. Data were analysed using a qualitative descriptive approach presented in four main themes: (a) physiotherapists’ view of their scope of practice, (b) resources and training of physiotherapists, (c) lack of collaboration between professions, and (d) physiotherapists’ view of urinary incontinence assessment and management experienced by patients. The physiotherapists’ p...
Journal of Psychosocial Rehabilitation and Mental Health
Residential treatment of addiction remains a key element in addictions management, though high ra... more Residential treatment of addiction remains a key element in addictions management, though high rates of attrition and relapse are reported, and underlying mechanisms of change remain unclear. This study aimed to complete the first stage of a realist evaluation—to develop an initial programme theory that would explain possible contexts and mechanisms of change leading to outcomes from a residential treatment programme for substance use disorders. Realist evaluation using key informant interviews and document review. Residential treatment centre in New Zealand. Four key informants (managers and caseworkers). Retroductive analysis (inductive and deductive) of semi-structured interviews and content analysis of documents. We identified one intermediate outcome of identity change that contributed to successful completion of residential treatment. The mechanisms leading to these outcomes were the development of a sense of belonging to the recovery community and a sense of hope and purpose....
Background: Rates of return-to-work after stroke are low, yet work is known to positively impact ... more Background: Rates of return-to-work after stroke are low, yet work is known to positively impact people’s wellbeing and overall health outcomes.Objective: To understand return-to-work trajectories, barriers encountered, and resources that may be used to better support participants during early recovery and rehabilitation.Participants: The experiences of 31 participants (aged 25–76 years) who had or had not returned to work after stroke were explored.Methods: Interview data were analysed using reflexive thematic analysis methods within a broader realist research approach.Results: Participants identified an early need to explore a changed and changing occupational identity within a range of affirming environments, thereby ascertaining their return-to-work options early after stroke. The results articulate resources participants identified as most important for their occupational explorations. Theme 1 provides an overview of opportunities participants found helpful when exploring work ...
Purpose Early intervention vocational rehabilitation (EIVR) can improve return to work (RTW) outc... more Purpose Early intervention vocational rehabilitation (EIVR) can improve return to work (RTW) outcomes for people with spinal cord injury (SCI). However, mechanisms explaining how and why EIVR works are not well understood. This study aims to develop a conceptual framework describing key mechanisms of EIVR intervention effect following SCI. Methods We synthesised data from a realist literature review with data from interviews of people with SCI (n = 30), a survey of people with SCI who had received EIVR (n = 37), a focus group of EIVR providers and a focus group of community vocational providers. We first synthesised the literature review and interviews to develop an initial programme theory describing the contexts in which mechanisms are activated to produce EIVR outcomes. Then we used data from the survey and focus groups to further refine the EIVR programme theory. Finally, a conceptual framework was developed to support knowledge dissemination. Results By ensuring consistent mess...
Background To positively impact the social determinants of health, disabled people need to contri... more Background To positively impact the social determinants of health, disabled people need to contribute to policy planning and programme development. However, they report barriers to engaging meaningfully in consultation processes. Additionally, their recommendations may not be articulated in ways that policy planners can readily use. This gap contributes to health outcome inequities. Participatory co-production methods have the potential to improve policy responsiveness. This research will use innovative methods to generate tools for co-producing knowledge in health-related policy areas, empowering disabled people to articulate experience, expertise and insights promoting equitable health policy and programme development within Aotearoa New Zealand. To develop these methods, as an exemplar, we will partner with both tāngata whaikaha Māori and disabled people to co-produce policy recommendations around housing and home (kāinga)—developing a nuanced understanding of the contexts in whi...
BACKGROUND: Early intervention vocational rehabilitation (EIVR) is used to optimize return to wor... more BACKGROUND: Early intervention vocational rehabilitation (EIVR) is used to optimize return to work (RTW) outcomes for people following spinal cord injury (SCI). However, theoretical clarity is required about how EIVR works, for whom and under what circumstances. OBJECTIVE: To develop a theoretical understanding of how people respond to EIVR following SCI and the contexts in which mechanisms of intervention effect are likely to be activated. METHODS: Realist research methods were used to analyze interviews with 30 participants who had received EIVR following SCI. RESULTS: We conceptualized the reporting of our analyses using a travel metaphor, encapsulating the types and degree of wayfinding support participants required to think about, plan and action their vocational aspirations. Developing, maintaining and enacting hope, supporting self-identity and vocational identity, and focusing on environmental context adaptations required to enact vocational aspirations, appear to be critica...
Study design A descriptive qualitative study. Objectives To evaluate a pilot project enabling peo... more Study design A descriptive qualitative study. Objectives To evaluate a pilot project enabling people with spinal cord injury (SCI) to have their support workers accompany them into a non-SCI specialist/public hospital (excluding ICU) to perform selected care. Setting The study was conducted in New Zealand. Methods Interviews and focus groups with people with SCI, support workers, care agency staff, and hospital staff who participated in the pilot project. Results Twenty-five individuals participated in the study. Two themes captured participants’ experiences of the pilot: ‘Maintaining individualised care’ and ‘Role, tasks and responsibilities. Support workers were described as knowledgeable about SCI care needs and being better positioned to provide individualised care for people with SCI than general nursing staff. Participants with SCI felt less anxious having a support worker with them, and perceived less risk of acquiring secondary health complications during the hospital admission. Good communications is important to ensure there is a shared understanding of the role and responsibilities of having an unregistered support worker in the hospital environment. Conclusions Having their regular support worker during admission to public hospital improved the SCI-specific care received. Support workers reduced the demand on hospital nursing staff who did not always have the time or specialist SCI knowledge to provide individualised care. People with SCI may be more likely to access medical assistance earlier and not defer hospital admissions if they can have support workers accompany them into hospital.
IntroductionReturn to work after spinal cord injury (SCI) is linked to well-being and better phys... more IntroductionReturn to work after spinal cord injury (SCI) is linked to well-being and better physical and mental health outcomes. In New Zealand, work rates after SCI are lower than the general population. Vocational rehabilitation is one method of supporting return to work. Although the best model has not been determined, there is evidence supporting early intervention. However, most vocational rehabilitation research focuses on return to work outcomes without considering why vocational rehabilitation works, for whom and under what circumstances. Given this knowledge gap, we detail a realist synthesis protocol aiming to explain how contextual factors trigger relevant mechanisms to facilitate return to work after SCI.Methods and analysisThis study will use a realist synthesis approach, following Realist And MEta-narrative Evidence Synthesis: Evolving Standards (RAMESES) guidelines. First, we will undertake a realist review of existing published and grey literature. Second, to assist...
Physical & occupational therapy in pediatrics, Jan 13, 2017
To develop a model for understanding mechanisms of change in health outcomes for riders with disa... more To develop a model for understanding mechanisms of change in health outcomes for riders with disabilities participating in therapeutic horse riding (THR). Using grounded theory methods we collected and analyzed data from interviews with 16 child riders and 18 caregivers, teachers and primary therapists, and from participant-observation during THR sessions. The central concept underpinning the model illustrating mechanisms of change was "gaining the tools to go on." Riders' experiences suggested the THR landscape (i.e., "where the tools are gathered") allowed for an expanded range of experiences in which riders could participate. Riders experienced an expansion of self-concept by learning to move, succeed, connect, and adapt (i.e., "the tools gathered") within the THR landscape. Riders then iteratively translated an expanded view of self into other environments, reflecting "how and where the tools are used." Findings suggest that positive c...
Supplemental Material for Exploring how therapeutic horse riding improves health outcomes using a... more Supplemental Material for Exploring how therapeutic horse riding improves health outcomes using a realist framework by Rachelle A Martin, Fiona P Graham, William MM Levack, William J Taylor and Lois J Surgenor in British Journal of Occupational Therapy
A new type of carbon-fibre triplanar orthotic (CTO) was recently introduced to New Zealanders aff... more A new type of carbon-fibre triplanar orthotic (CTO) was recently introduced to New Zealanders affected by polio. This study aimed to assess CTO recipients’ experiences and perceptions of these orthotics. A qualitative descriptive study based on semi-structured interviews was conducted to explore experiences of people who have had polio regarding the impact of CTOs on health and wellbeing, the process of training and adjustment, and how benefits from the CTOs were or were not achieved. Participants described substantial investments of time, energy and money needed to acquire and adapt to CTOs (Theme 1). They expected the CTOs to improve their posture, mobility, relieve pain and prevent deterioration in functioning. However, frequently there was a mismatch between reality and expectations (Theme 2). Ongoing orthotic and rehabilitation support plus sustained commitment and effort by CTO recipients contributed to benefits gained from these orthotics (Theme 3). When considering purchase of a CTO, people who have had polio should be aware of the time, energy, effort and personal cost required to fully benefit from the new orthotic. They should also be aware that individual responses to orthotics, including subjective reports of success, can be highly variable.
Societal culture, space, and structure have been unprecedentedly disrupted during the COVID-19 pa... more Societal culture, space, and structure have been unprecedentedly disrupted during the COVID-19 pandemic creating disproportionate vulnerability for disabled people. However, the upheaval of many societal conditions has presented enabling opportunities for disabled people. We report on interviews with 30 disabled people during the first four-week Aotearoa New Zealand COVID-19 lockdown. Three key themes were interpreted: “I am experiencing less disability on a daily basis,” encapsulating the experience of reduced disabling barriers for participants; “Working from home: the flexibility I have been asking for,” summarizing the benefits of functioning in an enabling home/work space; and “Social connection opportunities are the same for everyone,” overviewing participants reports that online opportunities presented a greater sense of belonging than before lockdown. Study findings highlight that despite a constant fear of the negative impact posed by COVID-19, there were numerous opportunities to reduce ablism through applying empowering factors inherent in novel cultural spaces.
Internet Journal of Allied Health Sciences and Practice
Introduction: All healthcare workers are responsible for patient safety and quality improvement a... more Introduction: All healthcare workers are responsible for patient safety and quality improvement and need to “speak up” to communicate issues. As healthcare systems strain under the impact of reduced staffing and workloads increase, allied health new graduates are feeling under pressure and unsupported. Understanding their experiences of speaking up as they transition into the workforce will identify what support they require to fulfil their patient safety and quality improvement responsibilities. Method: An exploratory study was conducted to investigate how new graduates in allied health speak up. Informed by a realist theoretical position, this study was interested in what contexts and resources support new graduates to speak up or not. Two different focus groups with allied health new graduates were used to collect data. Reflexive thematic analysis was employed to draw out key themes and sub-themes. Results: Three main themes were generated –advocacy drives speaking up, scaffoldin...
Internet Journal of Allied Health Sciences and Practice
Introduction: For healthcare organizations to adapt and improve, staff need to speak up for patie... more Introduction: For healthcare organizations to adapt and improve, staff need to speak up for patient safety and quality improvement. Speaking up has been explored in nursing and medicine with little known about speaking up in allied health. This study is part of a larger project investigating speaking up in allied health new graduates. This paper is taking a realist position to look at the perspectives of supervisors of allied health new graduates and further develop the Initial Program Theory (IPT) developed from the new graduate study. Method: Data was collected from two focus groups. Inductive thematic analysis was employed to develop themes and further realist informed analysis was completed using context-mechanism-outcome configurations leading to a refined IPT. FINDINGS: This study reports on the causal mechanisms and contextual features which supervisors believe activate speaking up in new graduates. A further developed IPT which combines findings from both studies will be int...
Urinary incontinence post-stroke is associated with poor rehabilitation outcomes. Current stroke ... more Urinary incontinence post-stroke is associated with poor rehabilitation outcomes. Current stroke guidelines recommend that physiotherapists are involved in addressing urinary incontinence problems post-stroke to improve rehabilitation outcomes; however, physiotherapists’ perceptions of their role are not known. This study explored how New Zealand physiotherapists perceive their current role in urinary incontinence assessment and management post-stroke, along with exploring what limits or facilitates this role. Using an exploratory qualitative methodology, eight physiotherapists from across New Zealand were interviewed. Data were analysed using a qualitative descriptive approach presented in four main themes: (a) physiotherapists’ view of their scope of practice, (b) resources and training of physiotherapists, (c) lack of collaboration between professions, and (d) physiotherapists’ view of urinary incontinence assessment and management experienced by patients. The physiotherapists’ p...
Journal of Psychosocial Rehabilitation and Mental Health
Residential treatment of addiction remains a key element in addictions management, though high ra... more Residential treatment of addiction remains a key element in addictions management, though high rates of attrition and relapse are reported, and underlying mechanisms of change remain unclear. This study aimed to complete the first stage of a realist evaluation—to develop an initial programme theory that would explain possible contexts and mechanisms of change leading to outcomes from a residential treatment programme for substance use disorders. Realist evaluation using key informant interviews and document review. Residential treatment centre in New Zealand. Four key informants (managers and caseworkers). Retroductive analysis (inductive and deductive) of semi-structured interviews and content analysis of documents. We identified one intermediate outcome of identity change that contributed to successful completion of residential treatment. The mechanisms leading to these outcomes were the development of a sense of belonging to the recovery community and a sense of hope and purpose....
Background: Rates of return-to-work after stroke are low, yet work is known to positively impact ... more Background: Rates of return-to-work after stroke are low, yet work is known to positively impact people’s wellbeing and overall health outcomes.Objective: To understand return-to-work trajectories, barriers encountered, and resources that may be used to better support participants during early recovery and rehabilitation.Participants: The experiences of 31 participants (aged 25–76 years) who had or had not returned to work after stroke were explored.Methods: Interview data were analysed using reflexive thematic analysis methods within a broader realist research approach.Results: Participants identified an early need to explore a changed and changing occupational identity within a range of affirming environments, thereby ascertaining their return-to-work options early after stroke. The results articulate resources participants identified as most important for their occupational explorations. Theme 1 provides an overview of opportunities participants found helpful when exploring work ...
Purpose Early intervention vocational rehabilitation (EIVR) can improve return to work (RTW) outc... more Purpose Early intervention vocational rehabilitation (EIVR) can improve return to work (RTW) outcomes for people with spinal cord injury (SCI). However, mechanisms explaining how and why EIVR works are not well understood. This study aims to develop a conceptual framework describing key mechanisms of EIVR intervention effect following SCI. Methods We synthesised data from a realist literature review with data from interviews of people with SCI (n = 30), a survey of people with SCI who had received EIVR (n = 37), a focus group of EIVR providers and a focus group of community vocational providers. We first synthesised the literature review and interviews to develop an initial programme theory describing the contexts in which mechanisms are activated to produce EIVR outcomes. Then we used data from the survey and focus groups to further refine the EIVR programme theory. Finally, a conceptual framework was developed to support knowledge dissemination. Results By ensuring consistent mess...
Background To positively impact the social determinants of health, disabled people need to contri... more Background To positively impact the social determinants of health, disabled people need to contribute to policy planning and programme development. However, they report barriers to engaging meaningfully in consultation processes. Additionally, their recommendations may not be articulated in ways that policy planners can readily use. This gap contributes to health outcome inequities. Participatory co-production methods have the potential to improve policy responsiveness. This research will use innovative methods to generate tools for co-producing knowledge in health-related policy areas, empowering disabled people to articulate experience, expertise and insights promoting equitable health policy and programme development within Aotearoa New Zealand. To develop these methods, as an exemplar, we will partner with both tāngata whaikaha Māori and disabled people to co-produce policy recommendations around housing and home (kāinga)—developing a nuanced understanding of the contexts in whi...
BACKGROUND: Early intervention vocational rehabilitation (EIVR) is used to optimize return to wor... more BACKGROUND: Early intervention vocational rehabilitation (EIVR) is used to optimize return to work (RTW) outcomes for people following spinal cord injury (SCI). However, theoretical clarity is required about how EIVR works, for whom and under what circumstances. OBJECTIVE: To develop a theoretical understanding of how people respond to EIVR following SCI and the contexts in which mechanisms of intervention effect are likely to be activated. METHODS: Realist research methods were used to analyze interviews with 30 participants who had received EIVR following SCI. RESULTS: We conceptualized the reporting of our analyses using a travel metaphor, encapsulating the types and degree of wayfinding support participants required to think about, plan and action their vocational aspirations. Developing, maintaining and enacting hope, supporting self-identity and vocational identity, and focusing on environmental context adaptations required to enact vocational aspirations, appear to be critica...
Study design A descriptive qualitative study. Objectives To evaluate a pilot project enabling peo... more Study design A descriptive qualitative study. Objectives To evaluate a pilot project enabling people with spinal cord injury (SCI) to have their support workers accompany them into a non-SCI specialist/public hospital (excluding ICU) to perform selected care. Setting The study was conducted in New Zealand. Methods Interviews and focus groups with people with SCI, support workers, care agency staff, and hospital staff who participated in the pilot project. Results Twenty-five individuals participated in the study. Two themes captured participants’ experiences of the pilot: ‘Maintaining individualised care’ and ‘Role, tasks and responsibilities. Support workers were described as knowledgeable about SCI care needs and being better positioned to provide individualised care for people with SCI than general nursing staff. Participants with SCI felt less anxious having a support worker with them, and perceived less risk of acquiring secondary health complications during the hospital admission. Good communications is important to ensure there is a shared understanding of the role and responsibilities of having an unregistered support worker in the hospital environment. Conclusions Having their regular support worker during admission to public hospital improved the SCI-specific care received. Support workers reduced the demand on hospital nursing staff who did not always have the time or specialist SCI knowledge to provide individualised care. People with SCI may be more likely to access medical assistance earlier and not defer hospital admissions if they can have support workers accompany them into hospital.
IntroductionReturn to work after spinal cord injury (SCI) is linked to well-being and better phys... more IntroductionReturn to work after spinal cord injury (SCI) is linked to well-being and better physical and mental health outcomes. In New Zealand, work rates after SCI are lower than the general population. Vocational rehabilitation is one method of supporting return to work. Although the best model has not been determined, there is evidence supporting early intervention. However, most vocational rehabilitation research focuses on return to work outcomes without considering why vocational rehabilitation works, for whom and under what circumstances. Given this knowledge gap, we detail a realist synthesis protocol aiming to explain how contextual factors trigger relevant mechanisms to facilitate return to work after SCI.Methods and analysisThis study will use a realist synthesis approach, following Realist And MEta-narrative Evidence Synthesis: Evolving Standards (RAMESES) guidelines. First, we will undertake a realist review of existing published and grey literature. Second, to assist...
Physical & occupational therapy in pediatrics, Jan 13, 2017
To develop a model for understanding mechanisms of change in health outcomes for riders with disa... more To develop a model for understanding mechanisms of change in health outcomes for riders with disabilities participating in therapeutic horse riding (THR). Using grounded theory methods we collected and analyzed data from interviews with 16 child riders and 18 caregivers, teachers and primary therapists, and from participant-observation during THR sessions. The central concept underpinning the model illustrating mechanisms of change was "gaining the tools to go on." Riders' experiences suggested the THR landscape (i.e., "where the tools are gathered") allowed for an expanded range of experiences in which riders could participate. Riders experienced an expansion of self-concept by learning to move, succeed, connect, and adapt (i.e., "the tools gathered") within the THR landscape. Riders then iteratively translated an expanded view of self into other environments, reflecting "how and where the tools are used." Findings suggest that positive c...
Supplemental Material for Exploring how therapeutic horse riding improves health outcomes using a... more Supplemental Material for Exploring how therapeutic horse riding improves health outcomes using a realist framework by Rachelle A Martin, Fiona P Graham, William MM Levack, William J Taylor and Lois J Surgenor in British Journal of Occupational Therapy
A new type of carbon-fibre triplanar orthotic (CTO) was recently introduced to New Zealanders aff... more A new type of carbon-fibre triplanar orthotic (CTO) was recently introduced to New Zealanders affected by polio. This study aimed to assess CTO recipients’ experiences and perceptions of these orthotics. A qualitative descriptive study based on semi-structured interviews was conducted to explore experiences of people who have had polio regarding the impact of CTOs on health and wellbeing, the process of training and adjustment, and how benefits from the CTOs were or were not achieved. Participants described substantial investments of time, energy and money needed to acquire and adapt to CTOs (Theme 1). They expected the CTOs to improve their posture, mobility, relieve pain and prevent deterioration in functioning. However, frequently there was a mismatch between reality and expectations (Theme 2). Ongoing orthotic and rehabilitation support plus sustained commitment and effort by CTO recipients contributed to benefits gained from these orthotics (Theme 3). When considering purchase of a CTO, people who have had polio should be aware of the time, energy, effort and personal cost required to fully benefit from the new orthotic. They should also be aware that individual responses to orthotics, including subjective reports of success, can be highly variable.
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Papers by Rachelle A Martin