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Author Archives: William Levack

Occupational performance coaching in Hong Kong

Occupational Performance Coaching Logo

RTRU Senior Lecturer, Dr Fiona Graham,  work on Occupational Performance Coaching (OPC; a parent-coaching intervention) has lead to a new collaborative research partnership with clinical researchers in Hong Kong.  Recently this group was awarded a grant by the Research Fund Secretariat from Food and Health Bureau, under the Health Care Promotion Scheme in Hong Kong in order to study “A parent-coaching intervention to promote community participation of young children with developmental disability.”  This project will be lead by Dr Chi-Wen (Will) Chien with input from Dr Graham and co-investigators Dr Yuen-yi (Cynthia) Lai and Dr Chung-Ying Lin.

Participation in community activities is important for children to learn skills, make friends, and have fun. Children with a disability and their families, however, are reported to participate less in the activities in their communities. This project will examine the cultural appropriateness of OPC when used in Hong Kong and its effectiveness to enable community participation of young children with developmental disability. The effect of OPC on child well-being will also be examined as an important mediator of children’s participation. A randomised control trial (aim to recruit over 75 children) will be conducted in Hong Kong. Parents in the experimental group will receive OPC.  Parents in the control group will receive information about community resources by phone. Findings will provide important information about the effectiveness and cultural appropriateness of OPC for Hong Kong citizens and will inform future service design for children and families in Hong Kong.

Exciting new NZ-Japan research collaboration

Screenshots from ADOC-E

RTRU has recently received a new funding grant from the Royal Society Te Apārangi to support a brand new research collaboration between occupational therapy researchers from Japan and Māori, Pacific, and Pākehā researchers in New Zealand.  Lead by yours truly (William Levack), this project involves the development and testing of a) an English-language version and b) a Māori/Pacific version of a Japanese iPad application called the “Aid for Decision-Making in Occupational Choice” (ADOC).

ADOC is designed to help health professionals engage with patients (adults and children) and their family/whānau in collaborative goal setting for rehabilitation (e.g. for people with stroke, spinal cord injury, cerebral palsy, or dementia). Despite the importance of goal setting in rehabilitation, past research has demonstrated that involving patients in goal setting can be difficult, with health professionals tending to dominate discussions around the selection of goals, and issues such as communication and cognitive impairments creating obstacles to robust patient involvement. This project will provide the ground work required for future research investigating the use of digital technology as a tool to support rehabilitation professionals to be more culturally responsive and person-centred in their clinical practice – improving the quality of their service delivery and increasing opportunities for more meaningful health outcomes for their patients.

My research collaborators for this project are Bernadette Jones (Ngāti Apa Ngā Wairiki), Dr Tristram Ingram (Ngāti Kahungunu ki Heretaunga, Ngāti Porou), Dr Dianne Sika-Paotonu, A/Prof Rebecca Grainger (from University of Otago), A/Prof Kounosuke Tomori and Dr Tatsunori Sawade (from Tokyo University of Technology), and A/Prof Kayoko Takahashi (from Kitasato University).  Funding from the Royal Society Te Apārangi will support travel between New Zealand and Japan to help us successfully complete this work.  Additional funding support for our various collaborative projects over the next two years has also be provided by the Japanese Society for the Promotion of Science and by a University of Otago Research Grant.

Report from Atlanta, Georgia – ACRM 2017

I’ve been at the American Congress of Rehabilitation Medicine (ACRM) Conference in Atlanta, USA, this week.  My main reason for going was to promote the work of Cochrane Rehabilitation to our North American colleagues.  However, I also had the opportunity of collaborating with a great group of academics and clinicians from the US for a half-day pre-conference workshop on self-management training in rehabilitation.  (This group included Veronica T. Rowe, PhD, OTR/L – University of Central Arkansas; Jeanne Langan, PT, PhD – University of Buffalo; Marsha Neville, OT, PhD – Texas Woman’s University; Shelley Dean, OTD, OTR/L – Crossway Pediatric Therapy; Candice Osborne, PhD, MPH, OTR – University of Texas Southwestern Medical Center.)

The conference was massive, with over 2000 attendees.  However, as many as 29 different conference streams could be running at the same time.  As a presenter this meant you could quite easily get lost in the crowd, and end up travelling half way around to the world to speak to just a handful of people.  Fortunately, the 75 minute symposium on the work of Cochrane Rehabilitation sparked a bit of interest, and I had a good turnout from an engaged audience – many of whom had extensive experience in systematic reviews and clinical guidelines.

I also had the opportunity to meet with a few key people in ACRM:

Street art of a giant crocodile on a buildingThere was a lot of interest in the potential for collaboration between ACRM and Cochrane Rehabilitation.  ACRM is already highly involved in systematic review and guidelines work – some of which they externally contract.  ACRM has an established relationship with the Campbell Collaboration – which is another excellent, but somewhat newer group than Cochrane, which also publishes systematic reviews but with more of a focus on the social sciences.  The main objective for both ACRM and Cochrane Rehabilitation at this stage is to find out about what each group is working on, so that can we work in synergy and avoid unnecessary duplication of activities.  Incidentally, much of the guideline work in America ends up in their National Guidelines Clearinghouse, which is a good resource to search when looking for such material.  Going forward, Cochrane Rehabilitation and the Evidence and Practice Committee of ACRM are aiming to maintain closer communications about events and activities that we get involved in.  Some initial discussion was held about possibly running a collaborative symposium at the ACRM conference in Chicago, 2019.

I also attended a great series of presentations by Tessa Hart, John Whyte, and colleagues about the Rehabilitation Treatment Taxomony, which has now been renamed the Rehabilitation Treatment Specification System (RTSS). I had wondered about the possibility of using this taxonomy in the context of my work with Cochrane Rehabilitation – attempting to identify and classify all rehabilitation-relevant Cochrane reviews. However, the taxonomy is not quite at the stage where it is actually a classification system yet.  Hart, Whyte and colleagues have completed some really interesting work to develop a framework for such a taxonomy in the future, but have yet to operationalise this framework into standardised classification system. Nonetheless, the RTSS already has some direct application to treatment description, and a lot to offer in terms of teaching clinical reasoning in the context of rehabilitation – something that I would be interested into introducing into our teaching material at RTRU.

My slides from the Cochrane Rehabilitation symposium: ACRM 2017 – Cochrane Rehab Symposium Slides

Experiences of younger adults with neurological conditions living in nursing homes

Whoop! Kerry Thornton and I have just published a new paper about the experiences of working-aged adults living in institutional residential care settings intended for much older people.  This qualitative metasynthesis arose from some work that Kerry did with me as a mini-research project towards her MHealSc(Rehabilitation).  This review was challenging to conduct because of the paucity of research in this area of study, and because of the diversity of social, economic and organisational contexts of institutional living arrangements worldwide.  We used ‘sensitivity analysis’ to endeavor to be as inclusive as possible with the data that we incorporated into the qualitative metasynthesis, while concurrently avoiding placing too much weight on less directly relevant or poorly conducted studies.  The full paper is available from the British Journal of Occupational Therapy website, where it is currently listed as an ‘early online’ publication: click here to link to the paper itself.  The paper is a pay-per-view publication – so email me if you can’t access a copy of it but would like to know more.

The problem of goal attainment scaling

Goal attainment scaling (GAS) is a popular method for individualized outcome measurement, but it comes with problems that limit its application.  This video provides an overview of why GAS appears attractive as an outcome measure, but also presents some seldom discussed criticisms of its application.

 

Congratulations Dr Emily Thomas PhD!!

Visual representation of change in self-identity after brain injury

A huge congratulations from RTRU to Dr Emily Thomas who was, just this month, awarded her PhD!  Emily’s thesis is entitled “Development of a measure of sense of self following traumatic brain injury” and can be downloaded from the OUR Archive website (click here for a direct link).

In addition to a number of conference presentations, Emily’s thesis has already resulted in one great publication (Thomas et al. 2014) and a book chapter (Thomas et al., 2015).  Another outcome from Emily’s thesis has been the finalisation of a new clinical measure: the Brain Injury Sense of Self Scale, which is a interval-level scale that can detect problems with self-identity after brain injury.  We are just in the process of setting up a new website to make this measure freely available.

Emily currently works as a rehabilitation consultants for the Solent NHS Trust in Southampton, UK.

References:

1. Thomas EJ, Levack WMM, Taylor WJ. Self-reflective meaning making in troubled times: Change in self-identity after traumatic brain injury. Qualitative Health Research 2014;24(8):1033-47.
2. Thomas EJ, Levack WMM, Taylor WJ. Rehabilitation and recovery of self-identity. In: McPherson KM, Gibson BE, Leplege A, eds. Rethinking Rehabilitation: Theory & Practice. Boca Raton: CRC Press 2015.

 

Self-led management of rheumatoid arthritis

The management of rheumatoid arthritis (RA) has transformed in recent decades so the inflammatory arthritis is often well controlled with medications used in a treat-to-target strategy.  This “T2T” strategy requires measurement of RA disease activity using validated measures and increasing treatment until disease remission or at least a low disease activity state is achieved.  Currently the RA activity is determined during clinic visits however these are currently at arbitrary intervals so people are may be seen when they are well and appointments are not always available when people have increased arthritis activity and need medical help.  Some data suggest the assessment of RA activity by people with RA correlates fairly well with the assessment of disease activity by health professionals. RTRU academic, Dr Rebecca Grainger, has begun to explore the possibility of the assessment and monitoring of RA being led by the person with the disease rather than the health system.  In this new tech world, a phone app seem to be a good option to try.  Dr Grainger, in collaboration with her colleagues in RTRU, Hutt Hospital, and the Department of Information Science at University of Otago, first conducted a systematic review of all apps that could enable measurement of RA disease activity by people with RA and for those data to be transmitted to their rheumatology team for monitoring.  (This review can be downloaded for free here.)  They found the 19 potentially useable app for longitudinal assessment of disease activity,which fell into two categories: 1) simple calculators of disease activity or 2) data tracking tools for people with RA.  However, no apps used all the required validated instruments and allowed for data transmission. One high quality app “Arthritis Power” does a great job of longitudinal tracking of validated patient-reported outcomes (PRO’s) and is used for patient-led research but is not suitable for use in “telerheumatology” due to lack of measurement of tender and swollen joints, a key feature of RA activity measured by rheumatologists.

Next steps in this research has been to  involve people with RA and rheumatology health professionals to identify required features and functionality of an app for RA disease activity measurement, along with barriers to uptake and advantages of remote monitoring approach.  With this information, Dr Grainger’s team has built an app and currently planning how this may be integrated into clinical practice.  In parallel with this with, they have also co-designed with people with RA a training package of videos to teach joint count techniques.  This will be evaluated in clinics in Wellington, Christchurch and Dunedin in late 2017. Their goal is to enable people with RA to engage in their health care in ways that works for them while still providing appropriate assessment and oversight.  Not necessarily “self-management” but “self-led management:”.

How to write a discussion chapter

We created a new YouTube channel just for RTRU!  Here’s my first ever video for our new channel, which is on the topic of how to write a discussion chapter or section in a Masters or PhD thesis or for a publication in an academic journal.

 

Taking charge of chronic lung disease

Just this month, my colleagues and I were award a significant research grant from the Health Research Council of New Zealand to undertake a feasibility study to test a brief self-management intervention for people who have been admitted to hospital for problems with chronic obstructive lung disease.  I am undertaking this study with colleagues from the Department of Medicine (Bernadette Jones, Dr Tristram Ingham, and Prof. Mark Weatherall) in collaboration with Dr James Fingleton, a respiratory physician at the Capital & Coast DHB and researcher from the Medical Research Institute of New Zealand.  Also involved are Amanda McNaughton and Harry McNaughton who are currently living overseas.

The purpose of this study is to test a new intervention designed to help people more actively engage in the management of their own health and wellbeing after hopsitalisation for chronic obstructive lung disease (COPD), and to increase uptake of pulmonary rehabilitation – an existing programme of exercise and education that is known to reduce rehospitalisation rates for people with COPD. Every year in NZ there are over 12,000 hospital admissions for COPD, costing $60 million annually. Many of these are for repeat admission.  Our intervention,  if successful, could reduce costs of hospitalisation for COPD as well as improve people health and quality of life with the condition.  The intervention is cultural responsive and strength-based, focusing on empowering people to take charge of their own health rather than just providing them with inhalers, pills, instruction or information.  This research builds on our past work examining uptake of pulmonary rehabilitation in New Zealand, cultural factors influence uptake of pulmonary rehabilitation, and Dr Harry McNaughton past work with Dr Matire Harwood exploring a similar kind of self-management intervention for people with stroke.  We aim to begin work on this 2-year study this month.

A feasibility study, incidentally, is one that focuses on gathering information about the methods for a clinical trial to make sure that the clinical trial is a scientifically valid as possible before you begin.  Fully powered clinical trials are very expensive!  So you don’t want to begin one with question in your mind about whether participants will actually engage with your intervention or whether your assumption about your outcome measurements tool are correct.  In this feasibility study we will be testing our study methods, gathering information about clinical outcomes to inform a power calculation for a full clinical trial, and evaluate the acceptability of our intervention and study methods from the perspective of our study participants and their families.

Riding for wellbeing

RTRU PhD candidate, Rachelle Martin, attended the New Zealand Riding for the Disabled (NZRDA) national training days (27-28 May 2017) to provide preliminary feedback for her research evaluating the effectiveness of therapeutic horse riding to NZRDA board members, riding coaches and RDA group managers. The programme of study has included three phases of research: two qualitative studies exploring the context and potential mechanisms of effect by which therapeutic horse riding impacts on the health and wellbeing of children with disabilities, and a single-case experimental design study measuring to what extent, and in whom, these effects can be demonstrated. Rachelle is in the final stages of data collection and aims to submit her thesis in January 2018.