To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure email@example.com
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Cardiac rehabilitation (CR) is a multi-disciplinary intervention designed to stabilise, slow, or reverse CVD, restore health following a cardiac event and facilitate the prevention of further events. The Model of Therapeutic Engagement (MTE) is a comprehensive conceptual model for explaining the process of engagement in rehabilitation. Of concern is that the role of socio-environmental factors is absent from explaining individual engagement in the MTE. There is also a lack of prospective studies investigating the impact of socio-environmental barriers on engagement in CR programs over time. This study aimed to expand the MTE, by illuminating the role of socio-environmental barriers in a three-stage process of engagement in CR programs. A prospective study was conducted, with 217 individuals recruited from the Cardiology Ward in the Gold Coast University Hospital (GCUH) and the Robina Cardiac Rehabilitation Centre. The collected data were examined using a structural equation model that added socio-environmental factors into the MTE, using multi-group analyses. In this study, we found that socio-environmental factors were not associated with intention to engage in the CR program, but were related to actual attendance and maintenance of participation in CR programs. Knowing how these socio-environmental barriers affect the process of engagement at different stages may help to tailor more accessible CR programs for the population.
Housing for people with acquired brain injury (ABI) or spinal cord injury (SCI) remains a significant issue in Australia and internationally. This review examined the current research evidence regarding the efficacy of housing alternatives for adults with ABI or SCI in relation to four principal outcomes of interest: the person’s (1) community integration/participation, (2) independence, (3) psychosocial well-being and (4) quality of life. The review also sought to identify how the reported efficacy of the housing alternatives might be impacted by individual factors.
For this systematic review, quantitative empirical, peer-reviewed research published after 1 January 2003 was sought. Ten journal articles met the eligibility criteria. None of the included studies comprised an adult SCI sample.
The research identified lower levels of community integration/participation, independence, psychosocial well-being and quality of life for adults (particularly younger adults) with ABI living in ‘structured settings’ (i.e., residential care) compared to those living in ‘home-like’ environments (i.e., private homes) and ‘disability-specific’ settings (i.e., shared supported accommodation, group homes, foster care homes, cluster units).
More research is needed to compare ‘home-like’ and ‘disability-specific’ settings, and individual housing models more generally (i.e., living at home with friends vs with family vs living in shared supported accommodation vs living in residential care). This review identified a number of limitations in the current evidence base and several important directions for future research. Policymakers, architects, designers, builders, developers, funding agencies, international researchers as well as people with ABI or SCI and their families may benefit from the findings of this review.
The primary aim of this study was to test the causal structure of the model of therapeutic engagement (MTE) for the first time, to examine whether the model assists in understanding the process of patient engagement in cardiac rehabilitation (CR) programs. This study used a prospective design, following up patients from the Gold Coast University Hospital Cardiology ward who attended Robina Cardiac Rehabilitation Clinic. A structural equation model of the interactions among the proposed variables within the three stages of the MTE (intention to engage in CR programs, CR initiation, and sustained engagement) revealed significant relationships among these variables in a dataset of 101 patients who attended a CR program. However, no relationship was discerned between outcome expectancies and patient intention to engage in CR. Patients’ willingness to consider the treatment also mediated the relationship between perceived self-efficacy and patient intention to engage in CR. These findings help clarify the process proposed by Lequerica and Kortte (2010) in the context of patient engagement in CR programs. The findings also reveal information on how patients engage in CR programs. Importantly, this provides new information for healthcare providers, enabling them to more effectively engage patients according to their stage of engagement.
This study aimed to compile existing evidence about the proposed relationships among variables at three stages of the model of therapeutic engagement (MTE): patient intention to engage in cardiac rehabilitation (CR), CR initiation, and sustained engagement. This model has not been tested in any rehabilitation setting. Therefore, this systematic literature review is key to future research and application of MTE to predict and enhance patient engagement in CR. Model-centric systematic literature reviews have been conducted for each stage of the MTE. A coherent approach to understanding and monitoring the process of patient engagement in CR is absent. Few relevant studies included in the model-centric reviews met the criteria: eight in stage 1, four in stage 2, and six in stage 3 of the MTE. In total, the tenets of the MTE were supported in patient intention to engage in CR. However, there was less evidence quantifying the proposed relationships among variables that impact on CR initiation and sustained engagement. There is a scarcity of research examining rehabilitation engagement in depth to better understand the complicated process contributing to behavioural outcomes. No decision-support models currently exist to alert patients and healthcare provider to the factors that influence non-engagement.
Developments in information and communication technologies have enabled electronic health and seen a huge expansion over the last decade. This has increased the possibility of self-management of health issues.
To assess the effectiveness of the Baby Buddy app on maternal self-efficacy and mental well-being three months post-birth in a sample of mothers recruited antenatally. In addition, to explore when, why and how mothers use the app and consider any benefits the app may offer them in relation to their parenting, health, relationships or communication with their child, friends, family members or health professionals.
We will use a mixed-methods approach, a cohort study, a qualitative element and analysis of in-app data. Participants will be first-time pregnant women, aged 16 years and over, between 12 and 16 weeks of gestation and recruited from five English study sites.
We will compare maternal self-efficacy and mental health at three months post-delivery in mothers who have downloaded the Baby Buddy app compared with those that have not downloaded the app, controlling for confounding factors. Women will be recruited antenatally between 12 and 16 weeks of gestation. Further follow-ups will take place at 35 weeks of gestation and three months post-birth. Data from the cohort study will be supplemented by in-app data that will include, for example, patterns of usage. Qualitative data will assess the impact of the app on the lives of pregnant women and health professionals using both focus groups and interviews.
Approval from the West Midlands-South Birmingham Research Ethics Committee (NRES) (16/WM/0029) and the University of the West of England, Bristol, Research Ethics Committee (HAS.16.08.001).
Findings of the study will be published in peer reviewed and professional journals, presented locally, nationally and at international conferences. Participants will receive a summary of the findings and the results will be published on Best Beginnings’ website.
A recent editorial claimed that the 2014 National Institute for Health and Care Excellence (NICE) guideline on psychosis and schizophrenia, unlike its equivalent 2013 Scottish Intercollegiate Guidelines Network (SIGN) guideline, is biased towards psychosocial treatments and against drug treatments. In this paper we underline that the NICE and SIGN guidelines recommend similar interventions, but that the NICE guideline has more rigorous methodology. Our analysis suggests that the authors of the editorial appear to have succumbed to bias themselves.
Work stress and burnout are common problems in rehabilitation services. Usually, attempts to account for stress and burnout focus on the qualities of the individual and the demands of the organisational environment. However, the current paper has responded to recent demands in the occupational stress literature to examine burnout from a third perspective, namely the institutional level. This level of analysis transcends the boundaries of organisations and can be defined by the various political, economic, social and legal constraints that characterise a broad area. It is argued that the rapid growth of insurance-based rehabilitation in Australia has created a unique institutional context that has significant implications for the development of stress and burnout among rehabilitation counsellors. Rehabilitation counsellors in this context face a diverse array of conflicting demands within a system that often does not support the goals of rehabilitation. It is proposed that the development of strategies to reduce stress and burnout in this area would benefit from an institutional-level analysis. While individualised stress management training clearly has a role in the minimisation of stress and burnout, it is proposed in the current paper that this issue has human resource management and educational implications that must be addressed.
Rehabilitation counselling is in need of a conceptual framework that will distinguish it from the medical notion of restoration and will provide a theoretical base from which rehabilitation counsellors can operate. The current paper presents a model of dishabilitation that highlights the processes that occur following acquired disability and that must be considered in designing a rehabilitation programme. The model suggests that the goal of rehabilitation should be the expansion of opportunities rather than the restoration of functions or previous position. By providing rehabilitation counsellors with a suitable “macro”level conceptualisation of rehabilitation, this approach will enable counsellors to implement “micro”level techniques in a manner that will empower individuals. Because intervention is aimed at opportunity expansion rather than the pursuit of specific goals, this approach allows individuals to retain control and to develop positive perceptions of themselves with their disability. The approach is also more sensitive to the impact of acquired disability on social networks and suggests that opportunities for families must also be expanded.
Informal caregiving is an integral part of the care of people with severe
mental illness, but the support needs of those providing such care are
not often met.
To determine whether interventions provided to people caring for those
with severe mental illness improve the experience of caring and reduce
We conducted a systematic review and meta-analyses of randomised
controlled trials (RCTs) of interventions delivered by health and social
care services to informal carers (i.e. family or friends who provide
support to someone with severe mental illness).
Twenty-one RCTs with 1589 carers were included in the review. There was
evidence suggesting that the carers' experience of care was improved at
the end of the intervention by psychoeducation (standardised mean
difference −1.03, 95% CI −1.69 to −0.36) and support groups (SMD =–1.16,
95% CI −1.96 to −0.36). Psychoeducation had a benefit on psychological
distress more than 6 months later (SMD =–1.79, 95% CI −3.01 to −0.56) but
not immediately post-intervention. Support interventions had a beneficial
effect on psychological distress at the end of the intervention (SMD
=–0.99, 95% CI −1.48 to −0.49) as did problem-solving bibliotherapy (SMD
=–1.57, 95% CI −1.79 to −1.35); these effects were maintained at
follow-up. The quality of the evidence was mainly low and very low.
Evidence for combining these interventions and for self-help and
self-management was inconclusive.
Carer-focused interventions appear to improve the experience of caring
and quality of life and reduce psychological distress of those caring for
people with severe mental illness, and these benefits may be gained in
first-episode psychosis. Interventions for carers should be considered as
part of integrated services for people with severe mental health
Consumer health organisations (CHOs), which operate outside the mainstream healthcare system with a specific focus on supporting people to self-manage their health conditions, have become widespread. Yet, there has been little systematic research into CHOs, including their perceived benefits and barriers, which encourage or deter their access by people with a variety of chronic health conditions.
This study explored the benefits of CHOs in self-management and also the barriers that inhibit their access, from the perspective of people with chronic conditions and their unpaid carers.
In-depth, semi-structured interviews were completed with 97 participants across four regions of Australia. The sample included a high representation of people from culturally and linguistically diverse backgrounds and Aboriginal and Torres Strait Islander people as well as non-indigenous Australians.
Three inter-related themes were identified that represented the benefits of involvement and participation in CHOs: knowledge and information, connection and support and experiential learning. However, limited access pathways emerged as a barrier that inhibited a person’s entry into CHOs. Furthermore, the person’s beliefs and experiences about their own health condition(s) also inhibited their continued participation in CHO programmes.
Although our findings confirm that CHOs are a valuable resource in alleviating the ‘work of being a patient’ for some people, there seems to be some barriers that prevent their full access and utilisation. Structured integration systems to increase the reliable delivery and accessibility of CHOs are needed to ensure that people who would benefit from accessing them can do so.
The Compulsory Third Party (CTP) system in Queensland is in need of modification to ensure efficacious rehabilitation outcomes for individuals injured in motor vehicle accidents (MVAs). In an attempt to address this concern, a study was conducted to examine the perceptions of three major stakeholders in this CTP process, namely, insurers, rehabilitation providers and solicitors. Further, the systemic chemistry inherent to the system was explored. Pervasive within this study was the notion that a culture of blame resulted from competing stakeholder agendas, the nature of the partnerships established between these stakeholders, and the widespread confusion resulting from the interplay of complex systemic factors. These systemic factors contributed significantly to ineffective rehabilitation and return to work for persons injured in MVAs. This paper is the first in a series about these concerns.
Successful rehabilitation of whiplash injuries is a concern for patients, practitioners and third party payers. Despite advances in scientific knowledge and developments in the field of medical investigations and imaging techniques over recent years, recovery from whiplash injury following motor vehicle accident remains uncertain and controversial. Ongoing symptomatology has been associated with limitations in returning to work and home functioning, however, relationships between neck disability, perceived difficulty in return to work and ability to cope with functional demands despite the pain, have been not been explored. This study examined the relationships between these factors by identifying what daily functional activities were difficult for whiplash injured workers, and also comparing the individual's ability to function despite the pain (pain self-efficacy), with ongoing neck disability (NDI) and perceived difficulty in the return to work process.
Early intervention services for psychosis aim to detect emergent symptoms, reduce the duration of untreated psychosis, and improve access to effective treatments.
To evaluate the effectiveness of early intervention services, cognitive–behavioural therapy (CBT) and family intervention in early psychosis.
Systematic review and meta-analysis of randomised controlled trials of early intervention services, CBT and family intervention for people with early psychosis.
Early intervention services reduced hospital admission, relapse rates and symptom severity, and improved access to and engagement with treatment. Used alone, family intervention reduced relapse and hospital admission rates, whereas CBT reduced the severity of symptoms with little impact on relapse or hospital admission.
For people with early psychosis, early intervention services appear to have clinically important benefits over standard care. Including CBT and family intervention within the service may contribute to improved outcomes in this critical period. The longer-term benefits of this approach and its component treatments for people with early and established psychosis need further research.
The incidence and clinical features of campylobacter enteritis were studied in a defined general practice population over a period of three years. Specimens of faeces were cultured from a representative sample of patients suffering from acute enteritis. Of 168 patients submitting a specimen to the laboratory 34 (20·2%) were positive for thermophilic Campylobacter species. The projected campylobacter infection rate varied from 5·4% per annum in infancy to 0·3% per annum in the 5- to 14-year-olds with a mean of 1·1% per annum for the whole study population.
During the same period campylobacters were isolated from 484 (14·9%) of 3250 patients suffering from acute enteritis whose general practitioners had sent faecal specimens to the laboratory, confirming the importance of this organism in the aetiology of acute enteritis in the community.
Successful rehabilitation outcomes rest on the quality of the links among multiple stakeholders. However, the literature has increasingly recognised the challenges in creating effective partnerships between stakeholders such as external health professionals, employers and injured workers. This study presents findings from an industry-directed project aimed at investigating the links between external health professionals and the employer in relation to return-to-work rehabilitation. Semistructured interviews were conducted with general practitioners (GPs), psychologists, and organisation-based rehabilitation personnel. Findings indicated several major points of consideration to facilitate health professional and employer partnerships, including educating stakeholders about organisational rehabilitation services and key contact personnel within the organisation, establishing standard communication protocols, understanding organisational culture and providing explicit organisational support for the rehabilitation process. To ensure appropriate and timely outcomes for injured workers, the current findings highlight the proactive and educative role that employers must assume when acting in partnership for rehabilitation.
The costs of occupational stress are rising and employers increasingly need to address occupational stress, prevention and rehabilitation issues. However, there is a relative lack of understanding about implementing strategies within specific organisational contexts. Extant literature indicates a need for integrated prevention and rehabilitation strategies that address specific organisational climates that contribute to stress. The Queensland Police Service (QPS) is one policing organisation facing significant occupational stress issues requiring organisational solutions. This article describes a Participatory Action Research case study, the aim of which is to develop an occupational rehabilitation system within the QPS to address identified stress issues. A combination of background information, interview and focus group data is being used to determine stress issues and provide potential solutions to specifically address the needs of the QPS. The findings of this study emphasise the importance of participant involvement in identifying issues and generating solutions, as well as demonstrating the value of taking a systemic approach. The findings suggest that the use of the Participatory Action Research approach is invaluable in promoting the long-term success of the QPS change process.
This study documents the findings of a qualitative investigation of the structure, process, and outcomes of an Intensive Case Management (ICM) program that was implemented in several government departments to improve the management of psychological injury and to reduce costs. The study demonstrated that the ICM model was effective in meeting its intended outcomes. Specifically, the model facilitated the delivery of timely and coordinated services to the workplace, and consequently, reduced the incidence of claim lodgment, assisted with accommodated return to work and minimised time away from work. Issues for future consideration included how the model could be integrated more firmly into the organisational culture and how to incorporate systematic follow-up and the capacity to address longer-term issues for injured workers.