School of Allied Health
Permanent link for this collectionhttps://hdl.handle.net/10292/10495
The School of Allied Health encompasses Physiotherapy, Podiatry, Occupational Therapy, and Rehabilitation.
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Item Allied Health Activity: The Challenges of Legitimising and Prioritising Meaningful Work(Physiotherapy New Zealand, 2026-03-21) McNicholl, Seamus G; Reid, Duncan; Bright, FelicityWith growing service demand and constrained budgets, allied health services across New Zealand hospitals are focused on prioritising high-impact and high-value care. To inform understandings of what constitutes “high-value care”, this study aimed to identify what allied health service activities are valued in a New Zealand District Health Board (DHB) setting. Semi-structured interviews were used to explore the perceptions of patients (n = 2), allied health staff (n = 4), and managers (n = 3) within one DHB as an exemplar. Following transcription, the data were analysed using conventional content analysis. There were differing perspectives between each participant group on high-value allied health care. Important allied health workplace activities were grouped into three categories: building relationships, providing meaningful allied health care, and backstage workplace activity. This research reveals the differences in perspective between what patients value and what organisations value. This tension may mean that allied health professionals struggle to prioritise and legitimise those aspects of care that matter most to patients.Item Challenges and Opportunities of General Practitioners and Physiotherapists Managing Return to Play Following Sports Related Concussion: A Qualitative Study(Physiotherapy New Zealand, 2026-03-21) Hancock, Colin; Chua, Jason; Theadom, Alice; Reid, DuncanPhysiotherapists in Aotearoa New Zealand, face challenges implementing evidence-based practice (EBP) for non-ambulatory children with cerebral palsy and intellectual disabilities (NACCPID) working within Hoffman’s model of EBP. Key challenges in the evidence component include limited NACCPID specific research. This project aims to review the literature on physiotherapy interventions for school-aged NACCPID to inform clinical practice and identify areas for future research within the Aotearoa New Zealand context. An integrative review was conducted, following Kutcher and LeBaron’s (2022) method. A systematic search, conducted in 2023, yielded 2,240 articles that were narrowed to 24 after applying inclusion criteria. Coding and thematic analysis were conducted in NVivo 12 following content analysis methods. Final codes were organised within the Te Whare Tapa Whā framework through collaborative review with a cultural advisor. This enabled a holistic view of health, addressing physical, mental, social, and spiritual wellbeing, incorporating Māori perspectives. Ten themes were generated relating to physiotherapy interventions for NACCPID: 1) individual needs; 2) self-esteem and positive emotions; 3) body systems; 4) optimising ability to move the body; 5) using the body to perform a task; 6) collaboration; 7) (in)dependence; 8) participation and inclusion; 9) resourcing; and, 10) accessible environments. Notably, power wheelchair training appears to have significant beneficial effects across all aspects of health, and it is important that the child and families’ individual needs, wants, likes, circumstances, and values are considered when choosing an intervention.Item 4DFlowNet: Super-resolution 4D Flow MRI Using Deep Learning and Computational Fluid Dynamics(Frontiers Media S.A., 2020-05-04) Ferdian, E; Suinesiaputra, A; Dubowitz, DJ; Zhao, D; Wang, A; Cowan, B; Young, AA4D flow magnetic resonance imaging (MRI) is an emerging imaging technique where spatiotemporal 3D blood velocity can be captured with full volumetric coverage in a single non-invasive examination. This enables qualitative and quantitative analysis of hemodynamic flow parameters of the heart and great vessels. An increase in the image resolution would provide more accuracy and allow better assessment of the blood flow, especially for patients with abnormal flows. However, this must be balanced with increasing imaging time. The recent success of deep learning in generating super resolution images shows promise for implementation in medical images. We utilized computational fluid dynamics simulations to generate fluid flow simulations and represent them as synthetic 4D flow MRI data. We built our training dataset to mimic actual 4D flow MRI data with its corresponding noise distribution. Our novel 4DFlowNet network was trained on this synthetic 4D flow data and was capable in producing noise-free super resolution 4D flow phase images with upsample factor of 2. We also tested the 4DFlowNet in actual 4D flow MR images of a phantom and normal volunteer data, and demonstrated comparable results with the actual flow rate measurements giving an absolute relative error of 0.6–5.8% and 1.1–3.8% in the phantom data and normal volunteer data, respectively.Item Recognising the Silent Squeeze: Why Physiotherapists Should Pay Attention to Degenerative Cervical Myelopathy [Editorial](Physiotherapy New Zealand, 2026-03-21) Chauhan, Rohil V; Segar, Anand H; Rice, David; White, Steven GItem Physiotherapy Interventions for School-aged Non-ambulatory Children With Cerebral Palsy Combined With Intellectual Disability – An Integrative Review(Physiotherapy New Zealand, 2026-03-21) Adams, Karen; Hill, Julia; Adlam, Marni; Blamires, JuliePhysiotherapists in Aotearoa New Zealand, face challenges implementing evidence-based practice (EBP) for non-ambulatory children with cerebral palsy and intellectual disabilities (NACCPID) working within Hoffman’s model of EBP. Key challenges in the evidence component include limited NACCPID specific research. This project aims to review the literature on physiotherapy interventions for school-aged NACCPID to inform clinical practice and identify areas for future research within the Aotearoa New Zealand context. An integrative review was conducted, following Kutcher and LeBaron’s (2022) method. A systematic search, conducted in 2023, yielded 2,240 articles that were narrowed to 24 after applying inclusion criteria. Coding and thematic analysis were conducted in NVivo 12 following content analysis methods. Final codes were organised within the Te Whare Tapa Whā framework through collaborative review with a cultural advisor. This enabled a holistic view of health, addressing physical, mental, social, and spiritual wellbeing, incorporating Māori perspectives. Ten themes were generated relating to physiotherapy interventions for NACCPID: 1) individual needs; 2) self-esteem and positive emotions; 3) body systems; 4) optimising ability to move the body; 5) using the body to perform a task; 6) collaboration; 7) (in)dependence; 8) participation and inclusion; 9) resourcing; and, 10) accessible environments. Notably, power wheelchair training appears to have significant beneficial effects across all aspects of health, and it is important that the child and families’ individual needs, wants, likes, circumstances, and values are considered when choosing an intervention.Item Reliability of Ankle Dorsiflexor Muscle Strength, Rate of Force Development, and Tibialis Anterior Electromyography After Stroke(F1000 Research Ltd, 2026-03-04) Olsen, Sharon; Taylor, Denise; Niazi, Imran Khan; Mawston, Grant; Rashid, Usman; Alder, Gemma; Stavric, Verna; Nedergaard, Rasmus Bach; Signal, NadaBackground Measures of hemiparetic ankle dorsiflexor muscle strength and rate of force development (RFD) are often used to determine the efficacy of rehabilitation interventions after stroke. However, evidence supporting the reliability of these measures is limited. This brief report provides a secondary analysis investigating the between-session reliability of isometric ankle dorsiflexor muscle strength, rate of force development (RFD), and tibialis anterior electromyography (TA EMG), in people with chronic stroke. Method Participants (n=15) completed three maximal isometric contractions of the ankle dorsiflexor muscles as fast as possible using a rigid dynamometer. Tests were repeated seven days later. Outcomes included ankle dorsiflexor isometric maximal voluntary contraction (MVC), RFD in the first 200ms (RFD200ms), time to reach 90% MVC, and peak TA EMG. Data were analysed for 13 participants using intra-class correlation coefficients (ICC) and standard error of the measure percentage (SEM%). Results Reliability was higher when analysing the mean of three trials rather than the best of three trials. There was excellent reliability for isometric dorsiflexor MVC (ICC 0.97 [95% CI 0.92, 0.99], SEM% 7%). However, for other outcomes, while the ICC indicated good reliability, the lower bound of the 95% confidence interval of the ICC fell in the moderate range for TA EMG (ICC 0.86 [95% CI 0.60, 0.96], SEM% 25%) and time to reach 90% MVC (ICC 0.80 [95% CI 0.53, 0.93], SEM% 23%) and in the poor range for dorsiflexor RFD200ms (ICC 0.79 [95% CI 0.48, 0.92], SEM% 24%). Conclusion The findings raise concerns about the reliability of measures of rapid force production in the dorsiflexor muscles after stroke. Given the functional significance of the ankle dorsiflexors, larger studies should be conducted to further investigate these concerns and explore reliable methods for measuring rapid force production in the hemiparetic dorsiflexor muscles.Item The Immediate Effect of Lateral Wedging on First Metatarsophalangeal Joint Kinematics and Centre of Pressure(Elsevier BV, 2026-03-11) Jackson, Aaron; Sheerin, Kelly; Yoon, SangHoon; Wyatt, Hannah; Reid, Duncan; Carroll, MatthewBackground Lateral wedges are often prescribed to increase the first metatarsophalangeal joint (MPJ) range of motion or alter the centre of pressure (COP) in the foot. This study explored the effect of lateral wedge design and placement on first MPJ extension and COP during walking and running gait. Methods A randomised crossover design was used and 24 healthy participants ran and walked in 10 insole conditions comprising differing combinations of inclination, placement and contour. First MPJ extension and foot COP were examined. Time-series data were analysed across the stance phase using statistical parametric mapping. Results Lateral wedges significantly reduced first MPJ extension during both walking (p < 0.001; 100% of stance) and running (p = 0.004; 14–72%, and p = 0.017; 76–99% of stance). Similarly, lateral wedge placement reduced first MPJ joint extension during walking (p < 0.001; 100% of stance) and running (p = 0.003; 13–69%, and p = 0.012; 78–100%). Full-length or 6° lateral wedges shifted the COP medially relative to the midline of the foot (p = 0.01). Compared to sham, lateral wedges placed on contoured insoles exhibited a smaller reduction in first MPJ during walking (p = 0.008) and shifted the COP medially during both walking (p < 0.001) and running (p = 0.020). Conclusion Where the intention of using lateral wedging is to shift the COP medially, these data indicate that a wedge which is of higher inclination (6°) or spanning the full-length of the insole, should be used. Conversely, if the goal is to reduce extension at the first MPJ, these findings suggest that both 3° and 6° inclination wedges are suitable, with either forefoot or full-length applications proving effective.Item Australian Podiatry Research in Paediatrics: A Bibliometric Analysis(Wiley, 2026-03-12) Banwell, Helen A; Tehan, Peta; Carroll, Matthew; Williams, Cylie MBackground The purpose of this study was to undertake a bibliographic analysis of foot and lower leg research relating to paediatric podiatry by Australian or affiliated Australian authors. Methods The Scopus database search was conducted to identify all foot and lower limb research articles involving an Australian cohort of participants, published by Australian authors, or those affiliated with Australian institutions, pertaining to paediatric podiatry, in English from 1970 to 2024. We used bibliometric analysis through an open‐source tool based on the R language. We described citations, journals, authors and institutions; countries and publications were manually categorised according to research type, level of evidence and funding source. Results The search strategy yielded 280 eligible articles, which received a total of 8331 citations and were published by 793 authors in 104 journals. The most frequent journal was Gait & Posture (35 articles; 12%), and the most published institution was the University of Sydney (170 affiliations). Most of the Australian paediatric articles published focused on detection, screening and diagnosis ( n = 70, 25%) and only 33 articles (12%) provided Level I evidence. Seventy‐three paediatric articles (25%) received Category 1 funding; 154 articles (55%) reported no research funding. Conclusion Paediatric podiatry research represents 17% of Australian foot and lower limb research. Despite the smaller population base, paediatric research attracts a high level of engagement, moderate citation rates and low funding rates when compared to adult population studies. Paediatric podiatry research is primarily produced via Level 3 evidence. This highlights the need for an increase in the robustness of research methodologies in paediatric podiatry research to strengthen the quality and applicability of evidence informing clinical care for children and adolescent populations.Item Enabling Action: Re-envisaging Education of Health Professionals in Aotearoa New Zealand(Sage, 2022-07-30) Shaw, S; Atkins, D; Hoskyn, K; Stretton, T; Hamer, HHealth care in Aotearoa New Zealand is changing with the aim of becoming truly universal. Development of a new curriculum model in the education of health professionals can aid this goal through increased focus on community needs and flexibility for multiple health professional registrations. Universal health care and disability support is promoted as a defining feature of Aotearoa New Zealand, yet inequities are blatantly evident, with increasing calls for equity. Complexity of the issue and the multitude of stakeholders favour action research founded on Vision Matāuranga, a problem-solving philosophy based on the innovation potential of Māori knowledge, resources and people. Action research embraces collaboration with stakeholders to identify and implement solutions. Government ministries determine policy, with Responsible Authorities accrediting educational institutions, which in turn provide educational programs. Changing what and how students learn can increase their understanding of equity and community needs when they become practitioners, with the voice of service users being paramount.Item Exploring the Experience of Sleep and Fatigue in Male and Female Adults Over the 2 Years Following Traumatic Brain Injury: A Qualitative Descriptive Study(BMJ Publishing Group Limited, 2016-04-08) Theadom, A; Rowland, V; Levack, W; Starkey, N; Wilkinson-Meyers, L; McPherson, K; TBI Experiences GroupObjectives: To explore the experience of fatigue and sleep difficulties over the first 2 years after traumatic brain injury (TBI). Design: Longitudinal qualitative descriptive analysis of interviews completed as part of a larger longitudinal study of recovery following TBI. Data relating to the experience of fatigue and/or sleep were extracted and coded by two independent researchers. Setting: Community-based study in the Hamilton and Auckland regions of New Zealand. Participants: 30 adult participants who had experienced mild, moderate or severe brain injury within the past 6 months (>16 years of age). 15 participants also nominated significant others to take part. Interviews were completed at 6, 12 and 24 months postinjury. Results: Participants described feeling unprepared for the intensity, impact and persistent nature of fatigue and sleep difficulties after injury. They struggled to learn how to manage their difficulties by themselves and to adapt strategies in response to changing circumstances over time. Four themes were identified: (1) Making sense of fatigue and sleep after TBI; (2) accepting the need for rest; (3) learning how to rest and; (4) need for rest impacts on ability to engage in life. Conclusions: Targeted support to understand, accept and manage the sleep and fatigue difficulties experienced may be crucial to improve recovery and facilitate engagement in everyday life. Advice needs to be timely and revised for relevance over the course of recovery.Item A Critical Review of the Psychometric Properties of the Nijmegen Questionnaire for Hyperventilation Syndrome(Physiotherapy New Zealand | Kōmiri Aotearoa, 2015-03-01) Ogilvie, V; Kersten, PThe Nijmegen Questionnaire is commonly used by physiotherapists and other health professionals in clinical and research settings. This outcome measure was developed by researchers at the Nijmegen University in the Netherlands as a screening tool for the hyperventilation syndrome in the 1980s. However, the literature that supports the efficacy of its use is scarce. This paper examines the evidence in relation to the conceptual basis, validity, and reliability of the Nijmegen Questionnaire. A systematic review of the literature was carried out to identify studies that are related to the above measurement properties for the questionnaire. Studies identified were evaluated for their methodological qualities using the COSMIN checklist. The clinical utility of this instrument is also discussed. Issues associated with the development and validating process of this outcome measure are identified. There is also a lack of evidence in cultural validation given that the Nijmegen Questionnaire was developed in the Netherlands. While this is the only questionnaire currently available that is designed specifically for the screening of hyperventilation syndrome, administrators need to be aware of the issues identified in relation to validity and reliability when interpreting the results. Applying more robust validating processes to establish the efficacy of the Nijmegen Questionnaire appears to be a priority for researchers to improve the quality of health services for individuals suffering from hyperventilation syndrome.Item Understanding the Complexities of Recruitment and Retention of Allied Health Professionals in Rural Health Settings Across Aotearoa: A Qualitative Study(BMC, 2026-01-30) George, Jane; Kayes, Nicola; Larmer, PeterBackground: Rural and remote communities in Aotearoa New Zealand face significant challenges in recruiting and retaining Allied Health Professionals (AHPs). While targeted investment exists to increase the numbers of doctors and nurses entering the rural workforce, comparatively little attention has been given to Allied Health Scientific and Technical professions. This study aimed to explore what matters to AHPs’ in rural contexts and how these insights could inform recruitment and retention practices. Methods: Drawing on Interpretive Descriptive methodology, semi-structured interviews were conducted with 18 AHPs from diverse professions, ethnicities and geographical locations across Aotearoa who had experience working in rural and/or remote settings. All participants were female, ranging in age from 23 to 63 years, representing seven allied health professions; social work (n = 7), physiotherapy (n = 4), occupational therapy (n = 2), music therapy (n = 2), psychology (n = 1), dietetics (n = 1), and pharmacy (n = 1). Participants identified as Pākehā | New Zealander (n = 11), Māori (n = 4), Samoan (n = 1), and beyond the Pacific (n = 2). Interviews explored career journeys, rural practice experiences, and employment decision factors. Data were analysed using six-phase Reflexive Thematic Analysis with ongoing researcher reflexivity and supervisory input. Results: Three key themes were constructed: (1) Sense of Connection and Belonging, highlighting the importance of feeling connected to teams, community and place; (2) Safe and Supported Practice, emphasising appropriate resources, professional development, and leadership relationships; (3) Creating Roles People Want to Come For, encompassing recruitment experiences, variety of work, growth pathways and scope of practice. These themes were infused with a cross-cutting concept of ‘Fit’, a felt sense of being in the right place, personally and professionally that emerged as a protective factor during challenges and key element for retention decisions. Conclusion: Successful recruitment and retention requires attention to both professional and personal factors, with particular emphasis on creating environments where AHPs feel valued, supported to develop their practice, and connected to their communities. The Fit concept offers a novel framework integrating professional, personal and place-based elements for understanding rural workforce retention. These insights provide evidence-based guidance for health policy makers, rural health organisations, professional bodies and tertiary education providers seeking to address persistent rural workforce shortages.Item Can Offset Analgesia Magnitude Provide Additional Information About Endogenous Pain Modulation in People With Knee Osteoarthritis? An Experimental Study(Lippincott, Williams & Wilkins, 2024-10-30) Johansson, Elin; Puts, Sofie; Rice, David; Beckwée, David; Leemans, Lynn; Bilterys, Thomas; Schiphof, Dieuwke; Bautmans, Ivan; Coppieters, Iris; Nijs, JoObjectives: To investigate the relationship between offset analgesia magnitude and the responsiveness to conditioned pain modulation (CPM), temporal summation of (second) pain (TSP), and clinical pain severity in people with knee osteoarthritis (KOA). Methods: Electrical stimuli were applied to 88 participants with KOA to measure offset analgesia at the volar forearm of the dominant hand, and CPM and TSP at the most symptomatic knee and ipsilateral volar wrist. Clinical pain severity was assessed using the pain subscale of the Knee injury and Osteoarthritis Outcome Score (KOOSPAIN). Linear mixed effects models evaluated pain modulatory effects across all tests, and Spearman's partial correlations assessed associations between offset analgesia, CPM, TSP, and KOOSPAIN while accounting for covariates of interest. Participants unable to validly finish all psychophysical tests were excluded from effect and correlation analyses but were evaluated for predictors of non-valid completion using bivariate Stochastic Search Variable Selection. Results: Significant pain modulation was observed across all psychophysical tests (P < 0.05) and no meaningful predictors of non-valid test completion were found. Offset analgesia magnitude did not significantly correlate with CPM, TSP, or KOOSPAIN (p ≥ 0.05), with a maximum partial correlation coefficient of ρ = 0.21. Discussion: Offset analgesia was not associated with CPM, TSP, or KOOSPAIN in people with KOA. Despite the lack of case-control studies comparing offset analgesia between people with KOA and healthy controls, these findings suggest that offset analgesia may provide information about endogenous pain modulation beyond CPM and TSP, though its clinical translation remains uncertain.Item Analysis of Gout Remission Definitions in a Randomised Controlled Trial of Colchicine Prophylaxis for People With Gout Initiating Allopurinol(The Journal of Rheumatology Publishing, 2024-08-01) Tabi-Amponsah, Adwoa Dansoa; Stamp, Lisa K; Horne, Anne; Drake, Jill; Stewart, Sarah; Gamble, Greg; Petrie, Keith J; Dalbeth, NicolaOBJECTIVE: To investigate the effect of colchicine prophylaxis on gout remission when commencing urate lowering therapy (ULT), and illness perceptions of people in remission, using two definitions of gout remission. METHODS: Data from a 12-month double-blind placebo-controlled trial of 200 people with gout commencing allopurinol were analyzed. Participants were randomly assigned to prophylaxis with 0.5mg daily colchicine or placebo for six months, followed by six months of additional follow-up. Gout remission was assessed using the 2016 preliminary definition or simplified definition without patient reported outcomes. Illness perceptions were assessed using a gout-specific brief illness perception questionnaire (BIPQ). RESULTS: In the first six months, few participants were in remission according to either the 2016 preliminary definition (3% for colchicine and 4% for placebo) or the simplified definition (7% for colchicine and 12% for placebo). In the second six months, after study drug (colchicine or placebo) discontinuation, fewer participants in the colchicine group than in the placebo group were in remission according to the 2016 preliminary definition (4% vs. 14%, p=0.03), and the simplified definition (14% vs 28%, p=0.02). Participants fulfilling remission using either definition had more favorable perceptions about their gout symptoms and illness concerns, as well as consequences, when using the simplified definition. CONCLUSION: Using either definition, six months of colchicine prophylaxis when initiating ULT does not provide an advantage in the fulfilment of gout remission. People fulfilling either definition report fewer symptoms, lower concern about their gout, and when using the simplified definition, are less affected by gout.Item The Influence of Multiple Cognitive Workload Levels of an Exergame on Dorsal Attention Network Connectivity at the Source Level(Elsevier BV, 2024-07-06) Ghani, U; Niazi, I; Signal, N; Kumari, N; Amjad, I; Haavik, H; Taylor, DThis study investigates how adding a cognitive task on a balance board (exergame) affects connectivity in the dorsal attention network (DAN) during an exergame task. Healthy young adults performed a soccer ball-moving task by tilting a balance board with their feet while their brain activity was measured using electroencephalography (EEG). In this exergame, the speed of obstacles in front of the goal manipulated the cognitive workload. Higher speed means a higher cognitive workload. The study found significant changes in functional connectivity within DAN regions, specifically in the alpha band. During the shift from easy to medium cognitive task, we observed a significant increase in connectivity (p= 0.0436) between the right inferior temporal (ITG R) and the Left middle temporal (MTG L). During the transition from easy to hard cognitive tasks, strengthened interactions (p= 0.0324) between inferior temporal (ITG) and parsopercularis (pOPPER) were found. This suggests that the proposed balanceboard-based exergame enhances the functionality of specific brain regions, such as ITG and MTG regions, and improves connectivity in the frontal cortex. We also found a correlation between brain activity and performance data, highlighting that increased cognitive workload resulted in decreased performance and heightened frontal alpha activity. These findings align with research suggesting that adding cognitive games to physical activity-based tasks in rehabilitation programs can boost brain activity, resulting in improved decision-making and visual processing skills. This information can help clinicians tailor rehabilitation methods that target specific brain regions.Item Risk Redux? Therapeutic Risk Taking and the Role of Supported Decision Making in Mental Health Settings(Wiley, 2026-02-18) Hamer, HP; Lampshire, D; Thom, K; Sutton, D; MacIntyre, G; Cogan, NThe prevailing culture of risk aversion and defensive practice within mental health systems significantly undermines recovery and well-being. In response, many Western jurisdictions are undergoing a fundamental transformation of mental health legislation, shifting towards a human rights-based approach. This transition emphasises supported decision-making, a reduction in coercive practices, and a stronger focus on recovery-oriented care. As services shift towards being human rights-led, clinicians need to move from making decisions for individuals in their best interests to considering what support is required to enable people to make their own choices; a difficult shift within services that remain risk-averse within a substitute decision-making regime. This paper reconceptualises risk not solely as a threat to be managed, but as a potential catalyst for recovery and empowerment. The authors call for a movement away from defensive, risk-averse models towards defensible and considered practices that thoughtfully balance safety with individual autonomy. At the heart of this shift is the innovative Dimensions of Safety framework, which assists practitioners in navigating complex decision-making processes while aligning their approaches with both human rights principles and the person's right to self-determination. This framework encourages therapeutic risk-taking as a means of fostering personal growth, resilience and empowerment. Furthermore, it incorporates cultural and spiritual dimensions to ensure care is equitable and inclusive. A trauma-informed perspective is also central, recognising the impact of past adversity on current mental health and decision-making skills. By challenging the dominance of substituted decision-making and promoting collaborative, rights-based care, this framework offers a practical and ethical pathway towards mental health systems that are safer, more inclusive and genuinely supportive of recovery and autonomy.Item Communities With Participation-Enabling Skills: A Study of Children With Traumatic Brain Injury and Their Shared Occupations(Routledge, 2016-08-30) Jones, M; Hocking, C; McPherson, KMany ideas about participation in rehabilitation literature focus inwards towards individuals, or individuals and their family, acting in but apart from their environment. Authors position individuals as “participating in” occupations or social settings, or point towards the outcomes for those who do or do not participate. This perspective arguably contributes to occupational injustices, hampering positive change. Literature has not furnished a broader gaze that appreciates individuals and their participation context as one. Actions that occur amongst people collectively with context, in an ongoing cycle of change, receive little attention. Guided by a Deweyan transactional perspective, six case studies exploring the participation of 9–12 year old children with traumatic brain injury generated more contextualised understandings. Interviews with children and community members, photographs, observations, and document-review provided information about actions and changes occurring amongst children and their environment, where these were seen as continuous with one another. This paper describes the Participation-enabling skills that were revealed amongst children and adults who shared in occupations. Community members demonstrated varying ability in using actions that facilitated both themselves and others to take part in occupations. The Participation-enabling skills were fostered during shared occupation. The congruence of the skills with themes in occupational science and therapy literature is explored, and their relevance to social change is proposed.Item Longitudinal Validity and Reliability of the Myeloma Patient Outcome Scale (MyPOS) Was Established Using Traditional, Generalizability and Rasch Psychometric Methods(Springer, 2017-11-01) Ramsenthaler, C; Gao, W; Siegert, RJ; Schey, SA; Edmonds, PM; Higginson, IJPurpose: The Myeloma Patient Outcome Scale (MyPOS) was developed to measure quality of life in routine clinical care. The aim of this study was to determine its longitudinal validity, reliability, responsiveness to change and its acceptability. Methods: This 14-centre study recruited patients with multiple myeloma. At baseline and then every two months for 5 assessments, patients completed the MyPOS. Psychometric properties evaluated were as follows: (a) confirmatory factor analysis and scaling assumptions (b) reliability: Generalizability theory and Rasch analysis, (c) responsiveness and minimally important difference (MID) relating changes in scores between baseline and subsequent assessments to an external criterion, (d) determining the acceptability of self-monitoring. Results: 238 patients with multiple myeloma were recruited. Confirmatory factor analysis found three subscales; criteria for scaling assumptions were satisfied except for gastrointestinal items and the Healthcare support scale. Rasch analysis identified limitations of suboptimal scale-to-sample targeting, resulting in floor effects. Test–retest reliability indices were good (R = > 0.97). Responsiveness analysis yielded an MID of +2.5 for improvement and -4.5 for deterioration. Conclusions: The MyPOS demonstrated good longitudinal measurement properties, with potential areas for revision being the Healthcare Support subscale and the rating scale. The new psychometric approaches should be used for testing validity of monitoring in clinical settings.Item The Impact of Disease Related Symptoms and Palliative Care Concerns on Health-related Quality of Life in Multiple Myeloma: A Multi-Centre Study(BMC, 2016-07-07) Ramensthaler, C; Osborne, TR; Gao, W; Siegert, R; Edmonds, PM; Schey, SA; Higginson, IJBackground: Multiple myeloma, the second most common haematological cancer, remains incurable. Its incidence is rising due to population ageing. Despite the impact of the disease and its treatment, not much is known on who is most in need of supportive and palliative care. This study aimed to (a) assess symptom severity, palliative care concerns and health-related quality of life (HRQOL) in patients with multiple myeloma, and (b) to determine which factors are associated with a lower quality of life. We further wanted to know (c) whether general symptom level has a stronger influence on HRQOL than disease characteristics. Methods: This multi-centre cross-sectional study sampled two cohorts of patients with multiple myeloma from 18 haematological cancer centres in the UK. The Myeloma Patient Outcome Scale (MyPOS) was used to measure symptoms and concerns. Measures of quality of life included the EORTC QLQ-C30, its myeloma module and the EuroQoL EQ-5D. Data were collected on socio-demographic, disease and treatment characteristics and phase of illness. Point prevalence of symptoms and concerns was determined. Multiple regression models quantified relationships between independent factors and the MyPOS, EORTC global quality of life item and EQ5D Index. Results: Five-hundred-fifty-seven patients, on average 3.5 years (SD: 3.4) post-diagnosis, were recruited. 18.2 % had newly diagnosed disease, 47.9 % were in a treatment-free interval and 32.7 % had relapsed/progressive disease phase. Patients reported a mean of 7.2 symptoms (SD: 3.3) out of 15 potential symptoms. The most common symptoms were pain (72 %), fatigue (88 %) and breathlessness (61 %). Those with relapsed/progressive disease reported the highest mean number of symptoms and the highest overall palliative care concerns (F = 9.56, p < 0.001). Factors associated with high palliative care concerns were a general high symptom level, presence of pain, anxiety, low physical function, younger age, and being in the advanced stages of disease. Conclusion: Patients with multiple myeloma have a high symptom burden and low HRQOL, in the advanced and the earlier stages of disease. Identification of patients in need of supportive care should focus on assessing patient-reported outcomes such as symptoms and functioning regularly in clinical practice, complementary to traditional biomedical markers.Item The UK Functional Assessment Measure (UK FIM+FAM): Psychometric Evaluation in Patients Undergoing Specialist Rehabilitation Following a Stroke From the National UK Clinical Dataset(Public Library of Science, 2016-01-29) Nayar, M; Vanderstay, R; Siegert, RJ; Turner-Stokes, LThe UK Functional Assessment Measure (UKFIM+FAM) is the principal outcome measure for the UK Rehabilitation Outcomes Collaborative (UKROC) national database for specialist rehabilitation. Previously validated in a mixed neurorehabilitation cohort, this study is the first to explore its psychometric properties in a stroke population, and compare left and right hemispheric strokes (LHS vs RHS). We analysed in-patient episode data from 62 specialist rehabilitation units collated through the UKROC database 2010-2013. Complete data were analysed for 1,539 stroke patients (LHS: 588, RHS: 566 with clear localisation). For factor analysis, admission and discharge data were pooled and randomised into two equivalent samples; the first for exploratory factor analysis (EFA) using principal components analysis, and the second for confirmatory factor analysis (CFA). Responsiveness for each subject (change from admission to discharge) was examined using paired t-tests and differences between LHS and RHS for the entire group were examined using non-paired t-tests. EFA showed a strong general factor accounting for >48% of the total variance. A three-factor solution comprising motor, communication and psychosocial subscales, accounting for >69% total variance, provided acceptable fit statistics on CFA (Root Mean Square Error of Approximation was 0.08 and Comparative Fit Index/ Tucker Lewis Index 0.922/0.907). All three subscales showed significant improvement between admission and discharge (p<0.001) with moderate effect sizes (>0.5). Total scores between LHS and RHS were not significantly different. However, LHS showed significantly higher motor scores (Mean 5.7, 95%CI 2.7, 8.6 p<0.001), while LHS had significantly lower cognitive scores, primarily in the communication domain (-6.8 95%CI -7.7, -5.8 p<0.001). To conclude, the UK FIM+FAM has a three-factor structure in stroke, similar to the general neurorehabilitation population. It is responsive to change during in-patient rehabilitation, and distinguishes between LHS and RHS. This tool extends stroke outcome measurement beyond physical disability to include cognitive, communication and psychosocial function.