Biomedical subjects

Kryss McKenna

Publications and source records attributed to Kryss McKenna.

At least 19 recordsLinked to original sources

PubMed2006

The value of an evidence database for occupational therapists: an international online survey.

BACKGROUND: Online evidence databases can provide access to high quality evidence at the point of care, making evidence-based practice more achievable. A discipline-specific online bibliographic database called OTseeker (www.otseeker.com) was designed for use by occupational therapists. The database is free, and contains citations and abstracts of systematic reviews, and critically appraised randomized controlled trials relevant to occupational therapy. OBJECTIVES: The aim of this study was to investigate search practices of database users, their views on its functionality, and the reported impact, if any, on their practice from using OTseeker. DESIGN: An online survey, placed on the database website for 30 days. SAMPLE: Potential participants were users of OTseeker during a 30-day period. A total of 498 people who had used the database more than once from over 40 countries completed the survey. RESULTS: Three hundred and nine (62%) participants believed that OTseeker had improved their ability to locate research about the effectiveness of occupational therapy interventions, and 92 (19%) agreed that the information in the database had contributed to a change in practice. Those reporting no practice changes agreed that use of OTseeker had improved their knowledge generally (n=189; 38%), confirmed their practice (n=75; 15%), or revealed that there was insufficient research relevant to their search topic (n=92; 19%). Features of the database which helped respondents locate research evidence included: having discipline-specific content, providing critical appraisal ratings for randomized controlled trials, and presenting search results ranked for methodological quality. CONCLUSION: This study confirms the value of a discipline-specific, online database for helping occupational therapists locate high quality research evidence. Information located on databases such as OTseeker can help change or confirm practice, and improve knowledge.

Australia↗

PubMed2006

The incidence of visual perceptual impairment in patients with severe traumatic brain injury.

PRIMARY OBJECTIVES: To investigate the incidence of visual perceptual impairments in a sample of patients with traumatic brain injury (TBI) using the Occupational Therapy Adult Perceptual Screening Test (OT-APST), compare incidence rates to a normative sample and explore the relationship between the presence of visual perceptual impairment and the severity of cognitive and functional impairment following TBI. RESEARCH DESIGN: Cohort study using a convenience sample of patients with TBI and a normative sample. METHODS AND PROCEDURES: Thirty-one patients with severe TBI and 195 healthy people were compared on the OT-APST and measures of cognition and function. MAIN OUTCOMES AND RESULTS: The most common impairments in the TBI sample were unilateral neglect (45.2%) and impairments of body scheme (25.8%) and constructional skills (25.8%). Significantly higher incidences of agnosia, apraxia, unilateral neglect and impairments in body scheme and constructional skills were found in the TBI sample compared to the normative sample. No significant relationship was found between the presence of visual perceptual impairments and the level of cognitive and functional impairment after TBI. CONCLUSIONS: Visual perceptual changes are evident in patients with severe TBI when compared to a normative sample. Routine use of a screening tool such as the OT-APST may help identify visual perceptual impairments in these patients and the need for more detailed assessment.

Adolescent↗

PubMed2006

Criterion validity of the Occupational Therapy Adult Perceptual Screening Test (OT-APST).

This paper reports on the criterion validity of the Occupational Therapy Adult Perceptual Screening Test (OT-APST) including concurrent criterion validity and its sensitivity and specificity. The performance of 208 people following stroke on the OT-APST and a reference tool (either the Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) or the LOTCA--Geriatric version (LOTCA-G)) was compared. The OT-APST subscale scores and performance outcome (intact or impaired) on related subscales of the reference tool was analyzed to evaluate the concurrent criterion validity of the OT-APST and its sensitivity and specificity at selected cut-off scores. Significant correlations were found between participants' performance (intact or impaired) on the reference tool and scores on the OT-APST. The sensitivity and specificity of the OT-APST were analyzed at selected cut-off scores to explore the validity of decisions based on OT-APST performance when compared with the reference tool. This study shows that the OT-APST is a tool with demonstrated concurrent criterion validity for the assessment of visual perception.

Adult↗

PubMed2006

Construct and ecological validity of the Occupational Therapy Adult Perceptual Screening Test (OT-APST).

This paper reports on the construct validity (scale design and convergent validity) and ecological validity of the Occupational Therapy Adult Perceptual Screening Test (OT-APST). The performance of 208 participants following stroke on the OT-APST and a reference tool (either the Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) or the LOTCA-Geriatric version (LOTCA-G)) was compared. The OT-APST performance of the stroke sample was compared with a healthy normative sample (n = 356). The relationship between the OT-APST performance and the Functional Independence Measure (FIM) score of the participants following stroke was also examined. Factor analysis and internal consistency results supported the scale design of the OT-APST. Significant correlations between the performance of the participants following stroke on the OT-APST and the reference tool supported the convergent validity of the OT-APST. The ability of the OT-APST to separate the two participant groups provided further evidence of its construct validity. Significant correlations between OT-APST and FIM scores supported the ecological validity of this tool. This study shows that the OT-APST is an ecologically valid tool with demonstrated construct validity in the assessment of visual perception.

Adult↗

PubMed2006

A programme of static positional stretches does not reduce hemiplegic shoulder pain or maintain shoulder range of motion--a randomized controlled trial.

OBJECTIVE: To evaluate the effectiveness of a programme of static positional stretches and positioning of the stroke-affected shoulder for maintaining shoulder external rotation and decreasing hemiplegic shoulder pain. DESIGN: Randomized controlled trial with pretest and posttest design. SETTING: Inpatient rehabilitation unit. SUBJECTS: Thirty-two participants (17 treatment, 15 comparison) with a first time stroke who were admitted for rehabilitation. INTERVENTIONS: Treatment participants completed a programme of static positional stretches of the stroke-affected shoulder twice daily and positioned the stroke-affected upper limb in an armrest support at all other times when seated. MAIN MEASURES: The main outcome measures were pain-free range of motion into external rotation, pain in the stroke-affected shoulder at rest and with movement, motor recovery and functional independence. RESULTS: All participants demonstrated a significant loss of external rotation (P = 0.005) with no significant group differences. All participants demonstrated a significant improvement in motor recovery (P < 0.01) and functional independence (P < 0.01) with no significant group differences. There were no significant effects for pain. The comparison group recorded a decrease in mean pain reported with movement from admission to discharge, and the treatment group recorded an increase. CONCLUSIONS: Participation in the management programme did not result in improved outcomes. The results of this study do not support the application of the programme of static positional stretches to maintain range of motion in the shoulder. The effect of increasing pain for the treatment group requires further investigation.

Aged↗

PubMed2005

Analysis of stroke patients' and carers' reading ability and the content and design of written materials: recommendations for improving written stroke information.

OBJECTIVE: This study (a) evaluated the reading ability of patients following stroke and their carers and the reading level and content and design characteristics of the written information provided to them, (b) explored the influence of sociodemographic and clinical characteristics on patients' reading ability, and (c) described an education package that provides well-designed information tailored to patients' and carers' informational needs. METHODS: Fifty-seven patients and 12 carers were interviewed about their informational needs in an acute stroke unit. Their reading ability was assessed using the Rapid Estimate of Adult Literacy in Medicine (REALM). The written information provided to them in the acute stroke unit was analysed using the SMOG readability formula and the Suitability Assessment of Materials (SAM). RESULTS: Thirteen (22.8%) patients and 5 (41.7%) carers had received written stroke information. The mean reading level of materials analysed was 11th grade while patients read at a mean of 7-8th grade. Most materials (89%) scored as only adequate in content and design. Patients with combined aphasia read significantly lower (4-6th grade) than other patients (p=0.001). CONCLUSION: Only a small proportion of patients and carers received written materials about stroke and the readability level and content and design characteristics of most materials required improvement. PRACTICE IMPLICATIONS: When developing and distributing written materials about stroke, health professionals should consider the reading ability and informational needs of the recipients, and the reading level and content and design characteristics of the written materials. A computer system can be used to generate written materials tailored to the informational needs and literacy skills of patients and carers.

Adult↗

PubMed2005

Length of stay, discharge destination, and functional improvement: utility of the Australian National Subacute and Nonacute Patient Casemix Classification.

BACKGROUND AND PURPOSE: Although implemented in 1998, no research has examined how well the Australian National Subacute and Nonacute Patient (AN-SNAP) Casemix Classification predicts length of stay (LOS), discharge destination, and functional improvement in public hospital stroke rehabilitation units in Australia. METHODS: 406 consecutive admissions to 3 stroke rehabilitation units in Queensland, Australia were studied. Sociodemographic, clinical, and functional data were collected. General linear modeling and logistic regression were used to assess the ability of AN-SNAP to predict outcomes. RESULTS: AN-SNAP significantly predicted each outcome. There were clear relationships between the outcomes of longer LOS, poorer functional improvement and discharge into care, and the AN-SNAP classes that reflected poorer functional ability and older age. Other predictors included living situation, acute LOS, comorbidity, and stroke type. CONCLUSIONS: AN-SNAP is a consistent predictor of LOS, functional change and discharge destination, and has utility in assisting clinicians to set rehabilitation goals and plan discharge.

Aged↗

PubMed2005

Sources of stress experienced by occupational therapists and social workers in mental health settings.

This study examined the sources of stress experienced by occupational therapists and social workers employed in Australian public mental health services and identified the demographic and work-related factors related to stress using a cross-sectional survey design. Participants provided demographic and work-related information and completed the Mental Health Professionals Stress Scale. The overall response rate to the survey was 76.6%, consisting of 196 occupational therapists and 108 social workers. Results indicated that lack of resources, relationships and conflicts with other professionals, workload, and professional self-doubt were correlated with increased stress. Working in case management was associated with stress caused by client-related difficulties, lack of resources, and professional self-doubt. The results of this study suggest that Australian occupational therapists and social workers experience stress, with social workers reporting slightly more overall stress than occupational therapists.

Adult↗

PubMed2005

Development of a standardized occupational therapy screening tool for visual perception in adults.

Occupational therapy assessment and treatment of visual perceptual impairments are integral to the rehabilitation of clients following stroke and other acquired brain injuries. Occupational therapists need to identify the nature of visual perceptual performance impairments in order to choose rehabilitation intervention strategies appropriate for remediation of specific problems or to compensate for limitations in daily function. This paper describes the variations in visual perception terminology and occupational therapy approaches to visual perceptual assessment. Limitations of existing assessment tools for visual perception are highlighted in terms of reliability, validity, normative information, length of time to administer, and comprehensiveness in screening for visual perceptual impairment. In response to these limitations, a battery of items, called the Occupational Therapy Adult Perceptual Screening Test (OT-APST) was selected to screen adults comprehensively for impairments of agnosia, visuospatial skills including body scheme and neglect, constructional skills, apraxia, and acalculia. It also includes a subtest to evaluate functional skills directly observed during screening. This new battery has established reliability, validity and age-stratified normative data for adults 16 to 97 years of age. The OT-APST is recommended for use in conjunction with observational assessment of activities of daily living for clients with stroke and acquired brain injury.

Adult↗

PubMed2005

Appraising the quality of randomized controlled trials: inter-rater reliability for the OTseeker evidence database.

RATIONALE AND AIMS: 'OTseeker' is an online database of randomized controlled trials (RCTs) and systematic reviews relevant to occupational therapy. RCTs are critically appraised and rated for quality using the 'PEDro' scale. We aimed to investigate the inter-rater reliability of the PEDro scale before and after revising rating guidelines. METHODS: In study 1, five raters scored 100 RCTs using the original PEDro scale guidelines. In study 2, two raters scored 40 different RCTs using revised guidelines. All RCTs were randomly selected from the OTseeker database. Reliability was calculated using Kappa and intraclass correlation coefficients [ICC (model 2,1)]. RESULTS: Inter-rater reliability was 'good to excellent' in the first study (Kappas >or= 0.53; ICCs >or= 0.71). After revising the rating guidelines, the reliability levels were equivalent or higher to those previously obtained (Kappas >or= 0.53; ICCs >or= 0.89), except for the item, 'groups similar at baseline', which still had moderate reliability (Kappa = 0.53). In study 2, two PEDro scale items, which had their definitions revised, 'less than 15% dropout' and 'point measures and variability', showed higher reliability. In both studies, the PEDro items with the lowest reliability were 'groups similar at baseline' (Kappas = 0.53), 'less than 15% dropout' (Kappas <or= 0.68) and 'point measures and variability data' (Kappas <or= 0.68). CONCLUSION: The PEDro scale is a reliable instrument for rating the quality of RCTs. Revised rating guidelines are provided for scale items that are difficult to rate, and helped to improve inter-rater reliability.

Australia↗

PubMed2005

Australian occupational therapists' use of an online evidence-based practice database (OTseeker).

INTRODUCTION: Online databases can support the implementation of evidence-based practice by providing easy access to research. OTseeker (http://www.otseeker.com), an electronic evidence database, was introduced in 2003 to assist occupational therapists to locate and interpret research. OBJECTIVES: This study explored Australian occupational therapists' use and perceptions of OTseeker and its impact on their knowledge and practice. METHODS: A postal survey questionnaire was distributed to two samples: (i) a proportionate random sample of 400 occupational therapists from all states and territories of Australia, and (ii) a random sample of occupational therapists working in 95 facilities in two Australian states (Queensland and New South Wales). RESULTS: The questionnaire was completed by 213 participants. While most participants (85.9%) had heard of OTseeker, only 103 (56.6%) had accessed it, with lack of time being the main reason for non-use. Of the 103 participants who had accessed OTseeker, 68.9% had done so infrequently, 63.1% agreed that it had increased their knowledge and 13.6% had changed their practice after accessing information on OTseeker. CONCLUSION: Despite OTseeker being developed to provide occupational therapists with easy access to research, lack of time was the main reason why over half of the participants in this study had not accessed it. This exploratory research suggests, however, that there is potential for the database to influence occupational therapists' knowledge and practice about treatment efficacy through access to the research literature.

Attitude of Health Personnel↗

PubMed2004

Investigation of factors related to employment outcome following traumatic brain injury: a critical review and conceptual model.

PURPOSE: The purpose of this article is to critically review the literature to examine factors that are most consistently related to employment outcome following traumatic brain injury (TBI), with a particular focus on metacognitive skills. It also aims to develop a conceptual model of factors related to employment outcome. METHOD: The first stage of the review considered 85 studies published between 1980 and December 2003 which investigated factors associated with employment outcome following TBI. English-language studies were identified through searches of Medline and PsycINFO, as well as manual searches of journals and reference lists. The studies were evaluated and rated by two independent raters (Kappa=0.835) according to the quality of their methodology based upon nine criteria. Fifty studies met the criteria for inclusion in the second stage of the review, which examined the relationship between a broad range of variables and employment outcome. RESULTS: The factors most consistently associated with employment outcome included pre-injury occupational status, functional status at discharge, global cognitive functioning, perceptual ability, executive functioning, involvement in vocational rehabilitation services and emotional status. CONCLUSIONS: A conceptual model is presented which emphasises the importance of metacognitive, emotional and social environment factors for improving employment outcome.

Brain Injuries↗

PubMed2004

Producing computer-generated tailored written information for stroke patients and their carers: system development and preliminary evaluation.

PURPOSE: The aim of this project was to design and evaluate a system that would produce tailored information for stroke patients and their carers, customised according to their informational needs, and facilitate communication between the patient and health professional. METHOD: A human factors development approach was used to develop a computer system, which dynamically compiles stroke education booklets for patients and carers. Patients and carers are able to select the topics about which they wish to receive information, the amount of information they want, and the font size of the printed booklet. The system is designed so that the health professional interacts with it, thereby providing opportunities for communication between the health professional and patient/carer at a number of points in time. RESULTS: Preliminary evaluation of the system by health professionals, patients and carers was positive. A randomised controlled trial that examines the effect of the system on patient and carer outcomes is underway.

Australia↗

PubMed2004

Generic versus specialist clinical work roles of occupational therapists and social workers in mental health.

OBJECTIVE: There has been limited research in Australia examining the extent of generic and specialist work activities carried out by occupational therapists and social workers since the introduction of mental health reform. The aim of the project was to: (i) identify specific clinical work activities of occupational therapists and social workers; and (ii) identify whether they are performing a greater proportion of generic than specialist clinical or discipline specific core skills. METHOD: A cross-sectional survey of 304 (response rate 76.6%) occupational therapists and social workers working in mental health was conducted. For the purposes of the study a new instrument was developed to cover broad categories of clinical work activities. RESULTS: The majority of the respondents were female, under the age of 30 years, who had worked in their current position less than 5 years. Generic work activities were the primary activities of the two professional groups, with nine of the 10 activities undertaken most frequently being generic in nature. Social work respondents performed more work activities while occupational therapists undertook more specialist clinical activities. CONCLUSIONS: Occupational therapists and social workers are required to have common competencies in addition to discipline-specific competencies in order to undertake broad-spectrum mental health service activities. This has implications for the skill mix, education and training and recruitment of staff.

Adult↗

PubMed2004

Using a matrix in life transition research.

Life transitions can be planned or can occur unexpectedly. They can cause a major change to a person's life patterns and well-being. Older adulthood is a time for many life transitions as a result of changes in life roles and health status. In this exploratory study, the authors investigate the transition involved in driving cessation for older people. In analyzing and organizing the data, they develop a matrix that incorporated descriptive and temporal factors associated with the transition. This matrix is useful in organizing and communicating the findings as a whole and could be used in describing individual experiences. It might be of use for the organization of qualitative data about other life transitions such as illness, retirement, and the development and adoption of new behaviors.

Activities of Daily Living↗

PubMed2004

Stroke education materials on the World Wide Web: an evaluation of their quality and suitability.

Web-based information is a valuable resource for people affected by stroke, however its accuracy and quality have been questioned. In this study, 30 stroke education websites were reviewed using accountability, readability, and reliability measures. Fifteen consumers and 11 health professionals evaluated six sites in terms of their design, content, and ease of use. The websites mostly met accountability criteria, but their reliability scores were low and their readability was high. Consumers' opinions were consistently higher than health professionals', but scores indicated their preferences for particular websites, especially in terms of design. The importance of considering consumers' preferences when designing and recommending websites is highlighted.

Consumer Behavior↗

PubMed2003

The suitability of written education materials for stroke survivors and their carers.

This study evaluated the suitability of written materials for stroke survivors and their carers. Twenty stroke survivors and 14 carers were interviewed about the stroke information they had received and their perceptions of the content and presentation of materials of increasing reading difficulty. The mean readability level of materials (grade 9) was higher than participants' mean reading ability (grade 7-8). Satisfaction with materials decreased as the content became more difficult to read. Seventy-five percent reported that their information needs were not met in hospital. More stroke survivors with aphasia wanted support from health professionals to read and understand written information, and identified simple language, large font size, color, and diagrams to complement the text as being important features of written materials. Simple materials that meet clients' information needs and design preferences may optimally inform them about stroke.

Adult↗

PubMed2002

Predicting discharge outcomes for stroke patients in Australia.

OBJECTIVE: This study aimed to describe discharge outcomes and explore their correlates for patients rehabilitated after stroke at an Australian hospital from 1993 to 1998. DESIGN: Data on length of stay, discharge functional status, and discharge destination were retrospectively obtained from medical records. Patients' actual rehabilitation length of stay was compared with the Australian National Sub-Acute and Non-Acute Patient predicted length of stay. The change in length of stay over the 5-yr period from 1993 to 1998 was documented. RESULTS: Patients' mean converted motor FIM scores improved from 53.1 at admission to 74.1 at discharge. Lower admission-converted motor FIM scores were related to longer length of stay, lower discharge-converted motor FIM scores, and the need for a change in living situation on discharge. CONCLUSION: The results of this study provide Australian data on discharge outcomes after stroke to assist in the planning and delivery of appropriate interventions to individual patients during rehabilitation.

Activities of Daily Living↗