Melissa Kendall | Griffith University (original) (raw)

Papers by Melissa Kendall

Disability & Rehabilitation, 2005

NeuroRehabilitation, 2014

Family member engagement is increasingly recognised as an influential factor in the rehabilitatio... more Family member engagement is increasingly recognised as an influential factor in the rehabilitation continuum following Acquired Brain Injury, including the inpatient setting and longer-term community integration phases. To explore the experiences of patients and family members about their involvement in brain injury rehabilitation. This study comprised individual and group interviews with 14 ex-patients and family members. Interviews explored effects of inpatient rehabilitation on family relationships. Interview audio recordings were analysed using an interpretive approach by two independent researchers. Findings clearly confirmed the significance of engaging family members in inpatient rehabilitation, and specifically reinforced the importance of informational, emotional, practical and peer support. However, the key finding of the study was the importance of hope, and the need for rehabilitation professionals to foster hope. Despite not having included any questions on this topic, ...

Brain Impairment, 2011

ABSTRACT Background: The Skills To Enable People and CommunitieS (STEPS) Program is a new informa... more ABSTRACT Background: The Skills To Enable People and CommunitieS (STEPS) Program is a new information, support and skills program that aims to develop sustainable networks of support for individuals with acquired brain injury (ABI) and their families in communities throughout Queensland, Australia. The program adopts a self-management approach and is delivered by trained peer and professional leaders. Aim: To explore the experiences of both peer and lay leaders in the delivery of the STEPS Skills Program and coordination of STEPS Network Groups. Method: A multiple qualitative case study design was utilised to explore the unique experiences of three trained STEPS Program Leaders. Data collection entailed in-depth semistructured interviews with participants and further incorporated routine STEPS Program Leader descriptive data. The data analysis involved a four-stage approach that included assembling the raw case data, constructing case records, producing case narratives and cross-case pattern analysis. Results: Case study narratives were produced to describe participant experiences with the STEPS Program. The cross-case pattern analysis revealed two dimensions of comparison. The first dimension describes the process by which participants became STEPS Program Leaders, while the second dimension reflects the growth outcomes experienced by participants through their involvement with the STEPS Program. Specific growth outcomes are described in relation to the following domains: ‘expansion of social roles and skills’, ‘appreciation of life’, ‘interpersonal relationships and communication’, ‘confidence, personal strength and accomplishment’ and ‘growth in self as a person’. The results are also described with respect to a model that depicts the process of growth through STEPS Program delivery. Conclusion: Posttraumatic growth of peer leaders after brain injury can be facilitated within a therapeutic intervention such as the STEPS Program.

Journal of the International Neuropsychological Society, 2011

The early onset of depression following traumatic brain injury (TBI) is associated with poorer ps... more The early onset of depression following traumatic brain injury (TBI) is associated with poorer psychosocial outcomes; however, the direction of this relationship is unclear. This study investigated the relationship between progress in resuming preinjury lifestyle (transition events), change in perceived functioning and level of depressive symptoms at discharge and 3-months postdischarge. As part of a prospective longitudinal study of brain injury outcomes, 96 consecutively discharged patients with TBI completed measures of transition events (Sentinel Events Questionnaire) and perceived functioning (Mayo-Portland Adaptability Inventory-4 Ability and Adjustment indices) at discharge and 3-months follow-up. Level of depressive symptoms was assessed at discharge and 3-months follow-up using the Depression Anxiety Stress Scale 21. After controlling for age and discharge depressive symptoms, change in perceived functioning was found to mediate the relationship between total transition events and depressive symptoms at 3-months postdischarge (β reduced from .21 to .14), with a significant indirect effect observed. The present findings indicate that lack of progress in resuming preinjury lifestyle contributes to postdischarge depressive symptoms through an influence on perceived functioning, thus providing an improved conceptualization of reactive depression in the context of brain injury.

Disability & Rehabilitation, 2010

Outcome measurement is an integral part of delivering rehabilitation services in community settin... more Outcome measurement is an integral part of delivering rehabilitation services in community settings. However, measurement is of little value if instruments are chosen ad hoc and are not administered consistently. The purpose of this study was to develop and test a participatory process of outcome measure selection which would engender consistent use of robust and appropriate instruments. The ICF provided the conceptual framework for a systematic review of the literature for relevant outcome measures. A summary of the critical appraisal of the clinimetric properties of the identified instruments was created. The summaries were reviewed and vetted by stakeholders including clinicians, researchers, and managers/policy makers. From the 300 identified and appraised measures, 28 were chosen and made available in a Compendium of Clinical Measures for Community Rehabilitation. The Compendium contains three core measures to be used routinely with all rehabilitation clients and a further 25 that cover particular discipline and client needs. This resource is now available to all clinicians working in the participating rehabilitation services. A participatory process combining rigorous review of the literature, expert opinion, and clinician feedback is recommended in the selection and implementation of outcome measures in rehabilitation settings in the community.

Australian Journal of Rural Health, 2007

Australian Journal of Primary Health, 2013

People with traumatic spinal cord injury (SCI), although proportionally fewer in number, are know... more People with traumatic spinal cord injury (SCI), although proportionally fewer in number, are known to be high users of primary health care services; however, details of their visits to GPs are unclear. This study presents information about GP utilisation patterns of 193 people with SCI over a 5-year period. Results demonstrate substantially greater GP service utilisation, particularly for young men with SCI, compared with their counterparts in the general population. Interestingly, people with paraplegia were proportionally higher users of GP services than those with tetraplegia. Results indicate the need for specialist support for GPs to meet the SCI-specific needs of this patient group. Specialist SCI outreach teams may be a useful resource to primary health care practitioners.

Australian Critical Care, 2005

Physiotherapy Canada, 2003

Journal of Clinical Nursing, 2005

Aims and objectives. To provide a description of ward nurses perceptions of the intensive care u... more Aims and objectives. To provide a description of ward nurses perceptions of the intensive care unit liaison nurse role.Background. Critical care outreach services have become commonplace over recent years. In Australia, the intensive care unit liaison nurse, developed at a local level by healthcare providers, has emerged as a way of improving the continuity of care offered to this patient group. As a relatively new development in critical care services, evaluation of this role has been limited, particularly in relation to the perceptions of ward nurses who receive patients on discharge from intensive care unit.Design. Case study of one Australian hospital that utilizes an intensive care unit liaison nurse.Methods. Ten ward nurses were purposefully selected for their representativeness of the population and for their experience with the intensive care unit liaison nurse role. Each of these nurses participated in semi-structured in-depth interviews. Thematic analysis was used to analyse the data.Findings. Three major themes emerged from the interviews, highlighting role behaviours, contextual demands and outcomes associated with the intensive care unit liaison nurse role. The role behaviours of the liaison nurse included the professional characteristics of the individual and the primacy of clinical liaison as a role descriptor. Contextual demands were environmental characteristics relevant to providing patient, family and staff support. Outcomes of the role were perceived to include environmental preparation and education.Conclusions. This qualitative study has presented an overview of ward nurses perceptions of the intensive care unit liaison nurse role within one Australian hospital, illustrating the educative and empathic support that the liaison nurse role can provide to ward nurses.Relevance to clinical practice. Collaboration with ward nurses in developing specialist roles such as the intensive care unit liaison nurse is essential in ensuring improvements in patient and family care across the continuum.

Neuropsychological Rehabilitation, 2010

The objective of the study was to evaluate the effects of metacognitive skills training (MST) and... more The objective of the study was to evaluate the effects of metacognitive skills training (MST) and behavioural practice on error self-regulation during a naturalistic task after traumatic brain injury (TBI). A single-case study design was used and three participants (two males, one female) aged 26-43 years with severe TBI were included in the study. In the first study, after a four-session baseline of behavioural practice, two participants received eight MST sessions followed by four maintenance sessions. In the second study, a third participant received 16 sessions of behavioural practice to assess the extent to which error self-regulation improves through long-term task practice and therapist corrections. Participants prepared two different meals with a novel meal introduced later to examine skills generalisation. Behavioural outcomes included error frequency, checking and self-corrections. Data analysis involved a combination of visual analysis and two standard deviation (2-SD) band analysis. In the MST study, the two participants demonstrated a 38% and 76% reduction in error frequency (p < .05), a significant decrease in checks (p < .05), and a significant increase in self-corrections (p < .05) relative to baseline. In the behavioural practice study, the participant demonstrated reduced errors (25%), although this was not statistically significant, and a significant increase in checks (p < .05), but self-corrections did not significantly change (p > .05). This exploratory research suggests that, firstly, by targeting error self-regulation MST can potentially promote independence on complex everyday tasks; and secondly, although behavioural practice alone may facilitate some functional gains, it fails to promote more independent self-regulatory behaviours.

Disability and Rehabilitation, 2005

To investigate perceptions of functional change over time held by individuals with long duration ... more To investigate perceptions of functional change over time held by individuals with long duration spinal cord injury (SCI) living in Queensland, Australia. A retrospective telephone questionnaire was administered to 84 individuals who had sustained a SCI more than 20 years previously and were older than 15 at the time of injury. Motor subset scores of the Functional Independence Measure (FIM) and a single scale measuring mobility aids status (MAIDS), were collected for three points in time--post discharge from initial rehabilitation (D/C point); approximately 10 years post injury (Mid point) and currently (Current point). A significant number of participants perceived that their function had increased between the D/C and Mid points and had subsequently decreased between the Mid and Current points. Participants also reported an increasing dependence on mobility aids between the Mid point and the Current point. Those who reported functional decline between the Mid and Current points were significantly older than those who did not report functional decline but did not differ in duration of injury or age at onset. The results support the need for services that provide assessment and intervention for functional changes throughout the life span of people with SCI.

Brain Impairment, 2009

Cornwell, P., Fleming, J., Fisher, A., Kendall, M., Ownsworth, T. and Turner, B. (2009) Supportin... more Cornwell, P., Fleming, J., Fisher, A., Kendall, M., Ownsworth, T. and Turner, B. (2009) Supporting the needs of young adults with acquired brain injury during transition from hospital to home: The Queensland service provider perspective. Brain Impairment, 10 3: 325-340.

Disability and Rehabilitation, 2005

Clinical Rehabilitation, 2004

To determine those factors perceived to change or threaten function and quality of life among ind... more To determine those factors perceived to change or threaten function and quality of life among individuals with long duration spinal cord injury. Retrospective self-report using telephone-administered questionnaire. Queensland, Australia. Eighty-four community-resident persons with spinal cord injury. Functional Independence Measure, Delighted-Terrible Scale, Perceived Causes of Change Inventory. Pain and loss of strength were perceived to have caused change in function in 11.9% and 14.3% of participants respectively while these same factors were perceived to have caused change in quality of life in 19.0% and 17.9% of participants respectively. Even when measurable change had not occurred, pain and loss of strength were perceived threats to function in 45.2% and 44.0% of participants respectively, while these same factors were perceived threats to quality of life in 10.7% and 11.9% of individuals respectively. Emotional issues such as stress, depression, family functioning, financial status and employment were also perceived causes of change in quality of life. The ability of participants to identify the perceived causes of change in function and quality of life may have implications for preventative health care if these individuals are encouraged to seek assistance when these factors first become apparent.

Archives of Physical Medicine and Rehabilitation

Pershouse KJ, Barker RN, Kendall MB, Buettner PG, Kuipers P, Schuurs SB, Amsters DI. Investigatin... more Pershouse KJ, Barker RN, Kendall MB, Buettner PG, Kuipers P, Schuurs SB, Amsters DI. Investigating changes in quality of life and function along the lifespan for people with spinal cord injury.To track changes in quality of life and function for people with spinal cord injury (SCI) along the lifespan.A wave panel design in which data were collected annually over 5 years across 6 strata that represented different periods since injury.Telephone interviews with participants in their home environment.People (n=270) who had sustained a traumatic SCI in Queensland, Australia, over the previous 60 years.Not applicable.Quality of life was measured using the World Health Organization Quality of Life-8. Human functioning was measured in 3 components. Body structure/function was measured using the Secondary Conditions Surveillance Instrument. Activity was measured using the motor subscale of the FIM (mFIM) and the Clinical Outcomes Variables Scale. Participation was measured using the Community Integration Measure (CIM) and the Impact on Participation and Autonomy questionnaire.Quality of life remained relatively constant across the lifespan. For body structure/function, there was a significant increase in secondary conditions with time since injury. There was a significant decrease in activity as measured by the mFIM for higher functioning individuals. Participation, as measured by the CIM, showed a significant increase with time since injury, but not when adjusted for the American Spinal Injury Association Impairment Scale, income level, and living situation.The findings of this study highlight that people with SCI are able to maintain quality of life and participation along the lifespan; however, increases in secondary conditions and a decline in function over time are likely. Rehabilitation services could work more effectively at addressing secondary prevention through enhanced monitoring over time, while broader societal responses are likely to hold the key to optimizing human functioning.

Brain Injury, 2004

This study compared the psychometric properties of two community integration measures used with p... more This study compared the psychometric properties of two community integration measures used with people with acquired brain injury (ABI) in the community. Questionnaires were mailed-out to people with ABI and nominated proxies. Responses were obtained from 96 people with ABI and 121 proxies on the Community Integration Questionnaire (CIQ) and the Sydney Psychosocial Reintegration Scale (SPRS). Matched client-proxy scores were not significantly different. The SPRS had greater internal consistency and more normal distributions than the CIQ. Correlations between the three pairs of theoretically parallel sub-scales were modest (0.41-0.60). Multi-dimensional scaling did not support the theoretical structure of the sub-scales, but found two dimensions underpinning the measurement of community integration. Mail-out administration is associated with poor completion rates. The SPRS has sound psychometric properties when compared to the CIQ. Further research investigating the theoretical structure of community integration in ABI is recommended.

Archives of Physical Medicine and Rehabilitation, 2007

Barker RN, Amsters DI, Kendall MD, Pershouse KJ, Haines TP. Reliability of the Clinical Outcome V... more Barker RN, Amsters DI, Kendall MD, Pershouse KJ, Haines TP. Reliability of the Clinical Outcome Variables Scale when administered via telephone to assess mobility in people with spinal cord injury.To examine the equivalence reliability and test-retest reliability of the Clinical Outcome Variables Scale (COVS) when administered via telephone (TCOVS) to people with spinal cord injury (SCI).Equivalence (telephone administration vs in-person) and test-retest reliability study.Assessments conducted in participants’ home environment.Equivalence reliability was examined in a convenience sample of 37 people with a diagnosis of traumatic SCI who had been discharged from the Queensland Spinal Injuries Unit to the community. In a separate group of participants, test-retest reliability of COVS when administered via telephone was examined in 43 people with SCI who were randomly selected from the Queensland Spinal Cord Injuries Service records.Not applicable.Reliability was assessed at the subscale and composite score level using intraclass correlation coefficients (ICC2,1) and Bland-Altman limits of agreement.Reliability was good for TCOVS and COVS for the composite score (ICC=.98), mobility subscale (ICC=.97), and ambulation subscale (ICC=.99). Reliability was also good for TCOVS test and retest assessments for the composite score (ICC=1), mobility subscale (ICC=1), and ambulation subscale (ICC=1). For all comparisons, most data points were within the 95% limits of agreement and the width of limits of agreement were considered to be clinically acceptable.The study findings confirm the equivalence and test-retest reliability of the TCOVS in an SCI population when administered by trained raters.

Disability & Rehabilitation, 2005

NeuroRehabilitation, 2014

Family member engagement is increasingly recognised as an influential factor in the rehabilitatio... more Family member engagement is increasingly recognised as an influential factor in the rehabilitation continuum following Acquired Brain Injury, including the inpatient setting and longer-term community integration phases. To explore the experiences of patients and family members about their involvement in brain injury rehabilitation. This study comprised individual and group interviews with 14 ex-patients and family members. Interviews explored effects of inpatient rehabilitation on family relationships. Interview audio recordings were analysed using an interpretive approach by two independent researchers. Findings clearly confirmed the significance of engaging family members in inpatient rehabilitation, and specifically reinforced the importance of informational, emotional, practical and peer support. However, the key finding of the study was the importance of hope, and the need for rehabilitation professionals to foster hope. Despite not having included any questions on this topic, ...

Brain Impairment, 2011

ABSTRACT Background: The Skills To Enable People and CommunitieS (STEPS) Program is a new informa... more ABSTRACT Background: The Skills To Enable People and CommunitieS (STEPS) Program is a new information, support and skills program that aims to develop sustainable networks of support for individuals with acquired brain injury (ABI) and their families in communities throughout Queensland, Australia. The program adopts a self-management approach and is delivered by trained peer and professional leaders. Aim: To explore the experiences of both peer and lay leaders in the delivery of the STEPS Skills Program and coordination of STEPS Network Groups. Method: A multiple qualitative case study design was utilised to explore the unique experiences of three trained STEPS Program Leaders. Data collection entailed in-depth semistructured interviews with participants and further incorporated routine STEPS Program Leader descriptive data. The data analysis involved a four-stage approach that included assembling the raw case data, constructing case records, producing case narratives and cross-case pattern analysis. Results: Case study narratives were produced to describe participant experiences with the STEPS Program. The cross-case pattern analysis revealed two dimensions of comparison. The first dimension describes the process by which participants became STEPS Program Leaders, while the second dimension reflects the growth outcomes experienced by participants through their involvement with the STEPS Program. Specific growth outcomes are described in relation to the following domains: ‘expansion of social roles and skills’, ‘appreciation of life’, ‘interpersonal relationships and communication’, ‘confidence, personal strength and accomplishment’ and ‘growth in self as a person’. The results are also described with respect to a model that depicts the process of growth through STEPS Program delivery. Conclusion: Posttraumatic growth of peer leaders after brain injury can be facilitated within a therapeutic intervention such as the STEPS Program.

Journal of the International Neuropsychological Society, 2011

The early onset of depression following traumatic brain injury (TBI) is associated with poorer ps... more The early onset of depression following traumatic brain injury (TBI) is associated with poorer psychosocial outcomes; however, the direction of this relationship is unclear. This study investigated the relationship between progress in resuming preinjury lifestyle (transition events), change in perceived functioning and level of depressive symptoms at discharge and 3-months postdischarge. As part of a prospective longitudinal study of brain injury outcomes, 96 consecutively discharged patients with TBI completed measures of transition events (Sentinel Events Questionnaire) and perceived functioning (Mayo-Portland Adaptability Inventory-4 Ability and Adjustment indices) at discharge and 3-months follow-up. Level of depressive symptoms was assessed at discharge and 3-months follow-up using the Depression Anxiety Stress Scale 21. After controlling for age and discharge depressive symptoms, change in perceived functioning was found to mediate the relationship between total transition events and depressive symptoms at 3-months postdischarge (β reduced from .21 to .14), with a significant indirect effect observed. The present findings indicate that lack of progress in resuming preinjury lifestyle contributes to postdischarge depressive symptoms through an influence on perceived functioning, thus providing an improved conceptualization of reactive depression in the context of brain injury.

Disability & Rehabilitation, 2010

Outcome measurement is an integral part of delivering rehabilitation services in community settin... more Outcome measurement is an integral part of delivering rehabilitation services in community settings. However, measurement is of little value if instruments are chosen ad hoc and are not administered consistently. The purpose of this study was to develop and test a participatory process of outcome measure selection which would engender consistent use of robust and appropriate instruments. The ICF provided the conceptual framework for a systematic review of the literature for relevant outcome measures. A summary of the critical appraisal of the clinimetric properties of the identified instruments was created. The summaries were reviewed and vetted by stakeholders including clinicians, researchers, and managers/policy makers. From the 300 identified and appraised measures, 28 were chosen and made available in a Compendium of Clinical Measures for Community Rehabilitation. The Compendium contains three core measures to be used routinely with all rehabilitation clients and a further 25 that cover particular discipline and client needs. This resource is now available to all clinicians working in the participating rehabilitation services. A participatory process combining rigorous review of the literature, expert opinion, and clinician feedback is recommended in the selection and implementation of outcome measures in rehabilitation settings in the community.

Australian Journal of Rural Health, 2007

Australian Journal of Primary Health, 2013

People with traumatic spinal cord injury (SCI), although proportionally fewer in number, are know... more People with traumatic spinal cord injury (SCI), although proportionally fewer in number, are known to be high users of primary health care services; however, details of their visits to GPs are unclear. This study presents information about GP utilisation patterns of 193 people with SCI over a 5-year period. Results demonstrate substantially greater GP service utilisation, particularly for young men with SCI, compared with their counterparts in the general population. Interestingly, people with paraplegia were proportionally higher users of GP services than those with tetraplegia. Results indicate the need for specialist support for GPs to meet the SCI-specific needs of this patient group. Specialist SCI outreach teams may be a useful resource to primary health care practitioners.

Australian Critical Care, 2005

Physiotherapy Canada, 2003

Journal of Clinical Nursing, 2005

Aims and objectives. To provide a description of ward nurses perceptions of the intensive care u... more Aims and objectives. To provide a description of ward nurses perceptions of the intensive care unit liaison nurse role.Background. Critical care outreach services have become commonplace over recent years. In Australia, the intensive care unit liaison nurse, developed at a local level by healthcare providers, has emerged as a way of improving the continuity of care offered to this patient group. As a relatively new development in critical care services, evaluation of this role has been limited, particularly in relation to the perceptions of ward nurses who receive patients on discharge from intensive care unit.Design. Case study of one Australian hospital that utilizes an intensive care unit liaison nurse.Methods. Ten ward nurses were purposefully selected for their representativeness of the population and for their experience with the intensive care unit liaison nurse role. Each of these nurses participated in semi-structured in-depth interviews. Thematic analysis was used to analyse the data.Findings. Three major themes emerged from the interviews, highlighting role behaviours, contextual demands and outcomes associated with the intensive care unit liaison nurse role. The role behaviours of the liaison nurse included the professional characteristics of the individual and the primacy of clinical liaison as a role descriptor. Contextual demands were environmental characteristics relevant to providing patient, family and staff support. Outcomes of the role were perceived to include environmental preparation and education.Conclusions. This qualitative study has presented an overview of ward nurses perceptions of the intensive care unit liaison nurse role within one Australian hospital, illustrating the educative and empathic support that the liaison nurse role can provide to ward nurses.Relevance to clinical practice. Collaboration with ward nurses in developing specialist roles such as the intensive care unit liaison nurse is essential in ensuring improvements in patient and family care across the continuum.

Neuropsychological Rehabilitation, 2010

The objective of the study was to evaluate the effects of metacognitive skills training (MST) and... more The objective of the study was to evaluate the effects of metacognitive skills training (MST) and behavioural practice on error self-regulation during a naturalistic task after traumatic brain injury (TBI). A single-case study design was used and three participants (two males, one female) aged 26-43 years with severe TBI were included in the study. In the first study, after a four-session baseline of behavioural practice, two participants received eight MST sessions followed by four maintenance sessions. In the second study, a third participant received 16 sessions of behavioural practice to assess the extent to which error self-regulation improves through long-term task practice and therapist corrections. Participants prepared two different meals with a novel meal introduced later to examine skills generalisation. Behavioural outcomes included error frequency, checking and self-corrections. Data analysis involved a combination of visual analysis and two standard deviation (2-SD) band analysis. In the MST study, the two participants demonstrated a 38% and 76% reduction in error frequency (p < .05), a significant decrease in checks (p < .05), and a significant increase in self-corrections (p < .05) relative to baseline. In the behavioural practice study, the participant demonstrated reduced errors (25%), although this was not statistically significant, and a significant increase in checks (p < .05), but self-corrections did not significantly change (p > .05). This exploratory research suggests that, firstly, by targeting error self-regulation MST can potentially promote independence on complex everyday tasks; and secondly, although behavioural practice alone may facilitate some functional gains, it fails to promote more independent self-regulatory behaviours.

Disability and Rehabilitation, 2005

To investigate perceptions of functional change over time held by individuals with long duration ... more To investigate perceptions of functional change over time held by individuals with long duration spinal cord injury (SCI) living in Queensland, Australia. A retrospective telephone questionnaire was administered to 84 individuals who had sustained a SCI more than 20 years previously and were older than 15 at the time of injury. Motor subset scores of the Functional Independence Measure (FIM) and a single scale measuring mobility aids status (MAIDS), were collected for three points in time--post discharge from initial rehabilitation (D/C point); approximately 10 years post injury (Mid point) and currently (Current point). A significant number of participants perceived that their function had increased between the D/C and Mid points and had subsequently decreased between the Mid and Current points. Participants also reported an increasing dependence on mobility aids between the Mid point and the Current point. Those who reported functional decline between the Mid and Current points were significantly older than those who did not report functional decline but did not differ in duration of injury or age at onset. The results support the need for services that provide assessment and intervention for functional changes throughout the life span of people with SCI.

Brain Impairment, 2009

Cornwell, P., Fleming, J., Fisher, A., Kendall, M., Ownsworth, T. and Turner, B. (2009) Supportin... more Cornwell, P., Fleming, J., Fisher, A., Kendall, M., Ownsworth, T. and Turner, B. (2009) Supporting the needs of young adults with acquired brain injury during transition from hospital to home: The Queensland service provider perspective. Brain Impairment, 10 3: 325-340.

Disability and Rehabilitation, 2005

Clinical Rehabilitation, 2004

To determine those factors perceived to change or threaten function and quality of life among ind... more To determine those factors perceived to change or threaten function and quality of life among individuals with long duration spinal cord injury. Retrospective self-report using telephone-administered questionnaire. Queensland, Australia. Eighty-four community-resident persons with spinal cord injury. Functional Independence Measure, Delighted-Terrible Scale, Perceived Causes of Change Inventory. Pain and loss of strength were perceived to have caused change in function in 11.9% and 14.3% of participants respectively while these same factors were perceived to have caused change in quality of life in 19.0% and 17.9% of participants respectively. Even when measurable change had not occurred, pain and loss of strength were perceived threats to function in 45.2% and 44.0% of participants respectively, while these same factors were perceived threats to quality of life in 10.7% and 11.9% of individuals respectively. Emotional issues such as stress, depression, family functioning, financial status and employment were also perceived causes of change in quality of life. The ability of participants to identify the perceived causes of change in function and quality of life may have implications for preventative health care if these individuals are encouraged to seek assistance when these factors first become apparent.

Archives of Physical Medicine and Rehabilitation

Pershouse KJ, Barker RN, Kendall MB, Buettner PG, Kuipers P, Schuurs SB, Amsters DI. Investigatin... more Pershouse KJ, Barker RN, Kendall MB, Buettner PG, Kuipers P, Schuurs SB, Amsters DI. Investigating changes in quality of life and function along the lifespan for people with spinal cord injury.To track changes in quality of life and function for people with spinal cord injury (SCI) along the lifespan.A wave panel design in which data were collected annually over 5 years across 6 strata that represented different periods since injury.Telephone interviews with participants in their home environment.People (n=270) who had sustained a traumatic SCI in Queensland, Australia, over the previous 60 years.Not applicable.Quality of life was measured using the World Health Organization Quality of Life-8. Human functioning was measured in 3 components. Body structure/function was measured using the Secondary Conditions Surveillance Instrument. Activity was measured using the motor subscale of the FIM (mFIM) and the Clinical Outcomes Variables Scale. Participation was measured using the Community Integration Measure (CIM) and the Impact on Participation and Autonomy questionnaire.Quality of life remained relatively constant across the lifespan. For body structure/function, there was a significant increase in secondary conditions with time since injury. There was a significant decrease in activity as measured by the mFIM for higher functioning individuals. Participation, as measured by the CIM, showed a significant increase with time since injury, but not when adjusted for the American Spinal Injury Association Impairment Scale, income level, and living situation.The findings of this study highlight that people with SCI are able to maintain quality of life and participation along the lifespan; however, increases in secondary conditions and a decline in function over time are likely. Rehabilitation services could work more effectively at addressing secondary prevention through enhanced monitoring over time, while broader societal responses are likely to hold the key to optimizing human functioning.

Brain Injury, 2004

This study compared the psychometric properties of two community integration measures used with p... more This study compared the psychometric properties of two community integration measures used with people with acquired brain injury (ABI) in the community. Questionnaires were mailed-out to people with ABI and nominated proxies. Responses were obtained from 96 people with ABI and 121 proxies on the Community Integration Questionnaire (CIQ) and the Sydney Psychosocial Reintegration Scale (SPRS). Matched client-proxy scores were not significantly different. The SPRS had greater internal consistency and more normal distributions than the CIQ. Correlations between the three pairs of theoretically parallel sub-scales were modest (0.41-0.60). Multi-dimensional scaling did not support the theoretical structure of the sub-scales, but found two dimensions underpinning the measurement of community integration. Mail-out administration is associated with poor completion rates. The SPRS has sound psychometric properties when compared to the CIQ. Further research investigating the theoretical structure of community integration in ABI is recommended.

Archives of Physical Medicine and Rehabilitation, 2007

Barker RN, Amsters DI, Kendall MD, Pershouse KJ, Haines TP. Reliability of the Clinical Outcome V... more Barker RN, Amsters DI, Kendall MD, Pershouse KJ, Haines TP. Reliability of the Clinical Outcome Variables Scale when administered via telephone to assess mobility in people with spinal cord injury.To examine the equivalence reliability and test-retest reliability of the Clinical Outcome Variables Scale (COVS) when administered via telephone (TCOVS) to people with spinal cord injury (SCI).Equivalence (telephone administration vs in-person) and test-retest reliability study.Assessments conducted in participants’ home environment.Equivalence reliability was examined in a convenience sample of 37 people with a diagnosis of traumatic SCI who had been discharged from the Queensland Spinal Injuries Unit to the community. In a separate group of participants, test-retest reliability of COVS when administered via telephone was examined in 43 people with SCI who were randomly selected from the Queensland Spinal Cord Injuries Service records.Not applicable.Reliability was assessed at the subscale and composite score level using intraclass correlation coefficients (ICC2,1) and Bland-Altman limits of agreement.Reliability was good for TCOVS and COVS for the composite score (ICC=.98), mobility subscale (ICC=.97), and ambulation subscale (ICC=.99). Reliability was also good for TCOVS test and retest assessments for the composite score (ICC=1), mobility subscale (ICC=1), and ambulation subscale (ICC=1). For all comparisons, most data points were within the 95% limits of agreement and the width of limits of agreement were considered to be clinically acceptable.The study findings confirm the equivalence and test-retest reliability of the TCOVS in an SCI population when administered by trained raters.

The training needs of rehabilitation professionals in the area of sexuality and sexual function, ... more The training needs of rehabilitation professionals in the area of sexuality and sexual function, particularly following spinal cord injury (SCI) has received little attention in the literature. Specifically, there is negligible theoretical discussion related to staff training needs, as well as a paucity of standardised scales to measure these needs. A conceptual model was developed encompassing staff knowledge, comfort, and attitudes towards sexuality following SCI. Using this model, a scale was developed, evaluated, and refined. Factor analysis supported the construct validity of the scale in measuring the existing conceptual model outlined but highlighted the existence of a separate construct related to personal approaches from clients. The subsequently named Knowledge, Comfort, Approach and Attitudes towards Sexuality Scale (KCAASS) demonstrated high levels of internal consistency across the four conceptual domains. The KCAASS has utility for rehabilitation facilities interested in identifying and targeting training initiatives related to addressing client sexuality needs following SCI.
sex, training, rehabilitation, spinal cord injury, interprofessional, measurement

While there is evidence to support consideration of client sexuality needs in the provision of re... more While there is evidence to support consideration of client sexuality needs in the provision of rehabilitation services to people with spinal cord injury (SCI), the interdisciplinary team rarely receives training in this area. The current study aimed to examine the effectiveness of a consumer-driven sexuality training program in improving staff knowledge, comfort (general and personal) and attitudes. Using a local needs assessment to identify training needs and the Permission, Limited Information, Specific Suggestions and Intensive Therapy (PLISSIT) model as a training framework, a sexuality training program was developed in one Australian SCI service. A randomized controlled trial was conducted and significant improvement was found in all domains for the treatment group – Knowledge(χ2 = 46.141, p < 0.001),Comfort (χ2 = 23.338, p < 0.001), Approach(χ2 = 23.925, p < 0.001) and Attitude (χ2 = 15.235, p < 0.001) compared to the control group. Changes were found to be maintained at three month follow-up – Knowledge (Z = −5.116, p < 0.001), Comfort (Z = −3.953, p < 0.001), Approach (Z = −4.103, p < 0.001) and Attitudes (Z = −2.655, p < 0.001). These results support the use of an individualized needs-based sexuality training program in fostering staff knowledge, comfort and attitudinal change in an interdisciplinary SCI rehabilitation service.
Rehabilitation, spinal cord injury, interprofessional, training, sex

For full text http://www98.griffith.edu.au/dspace/handle/10072/53961 Historically, the managem... more For full text http://www98.griffith.edu.au/dspace/handle/10072/53961

Historically, the management of sexuality issues in spinal cord injury rehabilitation has received scant attention as a staff training issue. This has occurred despite evidence in the literature identifying significant barriers to the provision of sexuality rehabilitation. This paper reports on a needs assessment conducted within an Australian spinal cord injury rehabilitation service to identify the training needs of staff in relation to client sexuality. Using the Knowledge, Comfort, Approach and Attitudes Towards Sexuality Scale (KCAASS), a previously developed theoretical model and questionnaire, 90 multidisciplinary staff were surveyed. A combination of open and closed questioning techniques were used. While the findings suggest some differences between disciplines, the training needs of the interdisciplinary team were surprisingly similar. Knowledge is required in the areas of counselling, professional boundary setting, fertility and assistive devices while specific training is needed to promote staff comfort in dealing with personal approaches from clients.
rehabilitation, sex, spinal cord injury, training, interprofessional, needs assessment

Professional boundaries between practitioners and clients are essential to the delivery of ethica... more Professional boundaries between practitioners and clients are essential to the delivery of ethical and professional health services yet often prove difficult to address. A research agenda was initiated comprising a literature review, needs assessment, the development, implementation and evaluation of a Professional Boundaries for Health Practitioner (PBHP) training course. This agenda led the authors to critically reflect on the barriers of rumours, dismissiveness and time that were identified to the provision of training in this field. From these reflections, an
interprofessional training framework was developed. This paper focuses on the importance of two facets of reflective practice in this process. These were (1) the importance of the integration of reflection and critical thinking skills in practitioner training; (2) critical reflection undertaken by the authors in identifying barriers to practitioner participation in work based training and determining the scope and nature of training that enhances ethical practices and meets practitioner
needs.
Professional boundaries. Interprofessional. Training. Education.

This article reports on the Boundaries in Practice (BIP) Scale developed to measure knowledge, co... more This article reports on the Boundaries in Practice (BIP) Scale developed to measure knowledge, comfort, ethical decision making, and experience. Few instruments used in studies conducted on professional/ client boundaries have been validated. The BIP demonstrated sound face, content and
construct validity, and adequate internal consistency reliability. The BIP Scale provides the first reliable and valid means of investigating multiple boundary domains across health disciplines and teams. The sensitivity and complexity of boundary issues and the serious consequences of breaches highlight the importance of a valid and reliable measure in building empirical knowledge in this field.

http://informahealthcare.com/doi/abs/10.1080/13561820802491006\. Boundary violations that threaten... more http://informahealthcare.com/doi/abs/10.1080/13561820802491006. Boundary violations that threaten professional-client relationships are rarely discussed at the coalface. There is an assumption that healthcare practitioners have the skills necessary to manage professional boundary dilemmas with clients. The issue, if addressed, is usually confined to discipline specific education and training. A one-day Professional Boundaries for Health Professionals (PBHP) training program was developed in response to real life practice dilemmas experienced by health practitioners across the continuum of care. The program was delivered to 109 participants throughout the state of Queensland, Australia, from government and non-government organizations. Participants were doctors, nurses, allied health (physiotherapists, occupational therapists, social workers, psychologists, dietitians, speech therapists), therapy assistants and personal care staff from a diverse range of hospital and community settings. Evaluations of PBHP suggest that the interprofessional learning context was valued with specific advantages identified in the use of adult learning approaches, the teaching of ethical decision making principles, the value of supervision and peer support and the opportunities provided for critical reflection. The effectiveness of training for healthcare practitioners in this area is discussed as a meaningful way of developing skills and engendering collaborative relationships between professional (e.g., occupational therapist, social worker) and paraprofessional (e.g., therapy assistant, personal care worker) groups. A combination of intensive training in professional boundaries and opportunities for ongoing professional development are important for all health practitioners.

http://link.springer.com/article/10.1007%2Fs11195-010-9177-1 Discipline specific and multidiscip... more http://link.springer.com/article/10.1007%2Fs11195-010-9177-1
Discipline specific and multidisciplinary training programs have been developed to provide practitioners working in health and disability fields with various combinations of knowledge, skills, attitudes and practitioner comfort important for such discussions. There is little, however, which demonstrates the long term effectiveness of such training programs. The current study is a 2-year follow-up to a randomized controlled trial that examined the effectiveness of a sexuality training program for rehabilitation practitioners working within spinal cord injury rehabilitation. Using both questionnaire-based and qualitative data, findings suggest that training can have long-lasting effects on practitioner knowledge, comfort and attitudes in addressing sexuality issues with clients. Training that is developed around the individualized needs of practitioners and the settings within which they work may be particularly effective. Future research is needed to explore the applicability of this type of training to other rehabilitation and healthcare settings.