Julie Pryor

Introduction: The rising global burden of chronic diseases has compelled healthcare practitioners to bolster their role in supporting individuals with long-term conditions in managing their health and well-being. Demand for health coaching continues to grow, but a limited body of knowledge makes it challenging to develop fit-for-purpose practitioner training. Aim: This study aims to examine what is known about how to implement health coaching for people with long-term conditions. Methods: Health databases were searched to identify peer-reviewed research articles. Data extraction was undertaken using a tool developed by the authors, and findings were charted, summarised and synthesised. Results: Seventy-six studies were included. Health coaching interventions span 17 different long-term conditions, are delivered by various providers (55% dedicated health coaches, 28% nurses) and occur primarily in community and public health settings (78%). Fundamental implementation guidance remains absent. With 69% lacking any named theoretical basis and 62% of studies failing to report training duration, practitioners receive inconsistent preparation for coaching patients with complex needs. Discussion: We found conceptual confusion and ambiguity across studies. Advancing the field will require identification of key theories, transferable core components and competency-based training standards. Themes of theorising, tailoring and training recur throughout this review. We offer a conceptual framework that synthesises concepts and bridges theory and practice, thus supporting practitioners to deliver person-centred coaching.

Aim: To identify how nurses contribute to patient rehabilitation following spinal cord injury. Design: An integrative review using Whittemore and Knafl's updated integrative review methodology. Methods: An initial systematic search found 24 articles that met the inclusion criteria of adults undergoing rehabilitation following an acquired spinal cord injury. A hand search of the reference lists of these articles identified one more article. The second search found another three articles. Data Sources: Embase, Emcare and Medline from 1996 to 9 August 2021 for the initial search. The second searches included repeating the initial search from 9 August 2021 to 23 January 2025 and the Proquest database on 30 July 2025. Results: The 28 reviewed articles revealed that: (1) nursing is central to the delivery of spinal cord injury rehabilitation services through the provision of nurse‐initiated care and support (comprising physical care and psychosocial support), nurse‐directed patient education and the co‐ordination of care; and (2) the relationships nurses build with their patients facilitate the effectiveness of rehabilitation for those patients. These relationships relate to the manner in which nurses tailor psychosocial support and patient education to be meaningful to the individual patient and support their biographical adjustment to life after SCI. Conclusion: Nursing is central to the effective delivery of spinal cord injury rehabilitation. Implications for the Profession and/or Patient Care: Nurse effectiveness may be enhanced by understanding the knowledge and skill required to sensitively integrate patient education with everyday care activities and intentionally fostering the development of these skills. Impact: This review highlights the centrality of nursing for rehabilitation effectiveness at both the individual patient and system level. Reporting Method: Preferred reporting items for systematic reviews and meta‐analyses. Patient or Public Contribution: No patient or public contribution was part of this review.

To explore the factors influencing human flourishing in the Traumatic Brain Injury (TBI) population within the first two years after injury. The PERMA (Positive Emotion, Engagement, Relationships, Meaning, Achievement) framework developed by Seligman was used to frame the topic of interest. A systematic review of the academic literature published between 1/4/1988 and 31/1/2025 was undertaken. Four databases were searched for research papers: CINAHL, Medline, Embase, and PsycINFO. Extracted data were analysed using content analysis to create a descriptive summary of the results. Sixty studies met the inclusion criteria. The individual factors influencing human flourishing included an ability to self-reflect, develop an inner self, or identity. Social and community facilitators comprised a supportive family, and healthy relationships. Structural facilitators included interventions such as art therapy and dignity conserving care. There are many factors influencing human flourishing in the TBI population within two years of injury. More research is needed to explore how these factors could be targeted for interventions in inpatient rehabilitation settings to enhance patient outcomes.

The aim of this study was to evaluate the feasibility of an alternative, rehabilitation-led model for managing obstructive sleep apnoea (OSA) in an Australian spinal cord injury (SCI) inpatient rehabilitation centre. The mixed-methods evaluation included quantitative analysis of clinical data and qualitative interviews with staff and patients to assess reach, effectiveness, adoption, acceptability, implementation, and sustainability (RE-AIM framework) of the OSA care model. During the 12-month pilot, 48 inpatients were screened, 24 were assessed for OSA, 12 were diagnosed and recommended treatment, 6 commenced continuous positive airway pressure (CPAP) therapy, and 4 were discharged on CPAP. No adverse events were recorded. Clinical staff reported significant benefits to patient care and improved knowledge about sleep and respiratory issues. Insufficient staff time and skills resulted in significant barriers to initiating treatment with CPAP. This is the first time an Australian SCI rehabilitation centre has implemented a rehabilitation-led OSA care model. Assessing and diagnosing OSA in the inpatient unit was feasible and sustainable but initiating treatment required additional staffing and ongoing training. Scaled implementation of rehabilitation-led OSA care could significantly improve access to OSA treatments and quality of life for people living with SCI.Implications for rehabilitationObstructive sleep apnoea (OSA) is the most common sleep disorder in spinal cord injury (SCI); yet it is under-diagnosed and under-treated.To improve access to care, an Australian SCI inpatient rehabilitation centre adapted and implemented an alternative, rehabilitation-led model of managing OSA.The alternative care model was safe, acceptable to staff and patients, and improved access to OSA assessments and treatments.Rehabilitation-led management of non-complicated OSA has the potential to improve outcomes for people living with SCI.To be sustainable, the rehabilitation-led care model should be adequately staffed with ongoing staff training opportunities available.

Background: Advanced technologies are becoming increasingly accessible in rehabilitation. Current research suggests technology can increase therapy dosage, provide multisensory feedback, and reduce manual handling for clinicians. While more high-quality evidence regarding the effectiveness of rehabilitation technologies is needed, understanding of how to effectively integrate technology into clinical practice is also limited. Current implementation of rehabilitation technology is inconsistent, with low uptake among clinicians and frequent reports of technology abandonment. An Australian rehabilitation provider opened a new technology therapy center in 2022, offering a unique opportunity to generate practice-based evidence to inform future technology implementation and research. Objective: This study aimed to investigate the implementation and adoption of advanced technology within a real-world rehabilitation setting. Methods: This study was a longitudinal observational study in a rehabilitation organization with inpatient, outpatient, and community settings. Allied health clinicians (n=119) within the organization had access to advanced technologies, with patients receiving neurological, spinal cord injury, brain injury, or general rehabilitation. Interventions included 21 advanced technologies, including robotic, virtual reality (VR), sensor-based, and functional electrical stimulation devices. Clinicians received training for devices in a staged approach by external and internal trainers. Data were collected from patient electronic medical records from July 1, 2022, to June 30, 2023. Outcomes included frequency of advanced technology use, patient demographics (age, gender, and primary health condition), clinician discipline, rehabilitation service (inpatient, outpatient, or community), goals of technology therapy sessions, and therapy dosage achieved (minutes active, number of repetitions, and meters walked). Results: Clinicians used advanced technology 4208 times with 269 patients over 12 months; specifically, physiotherapists (2716/4208, 65%), occupational therapists (1396/4208, 33%), and allied health assistants (96/4208, 2%). The majority of patients had stroke, spinal cord injury, or brain injury diagnoses (188/269, 70%). Devices were typically used to target impairment and activity limitation–related goals. Frequently used devices included gait training body-weight support (VR treadmill and overground), overground robotic exoskeletons, and upper limb robotic VR devices. Outpatient services were the dominant users of advanced technology (3940/4208, 94%). Clinicians most commonly used devices for patients with stroke (1973/4208, 47%) and the greatest variety of devices for patients with stroke and spinal cord injury. The relative use of lower limb robotic devices was greater in inpatient services (91/178, 51%, vs outpatient services, 963/2335, 41%) (χ21=6.6, P=.01) and for patients with spinal cord injury (48/95, 51%, vs all other conditions, between 24%-31%; χ25=16.8, P=.005). Conclusions: The type and amount of advanced technology use differed between patient populations and rehabilitation settings. To support clinician use of advanced technology, devices should match the rehabilitation context. Tailored strategies are important, such as clinician training. Further practice-based research is required to provide guidance on implementation and to establish the effectiveness of advanced technology use.

The aim of this study was to explore spirituality in inpatient rehabilitation care from the patient's perspective. Participants were recruited from three inpatient rehabilitation services in Sydney, Australia. A qualitative research design was adopted. Demographic data collected included religious affiliation, age and gender. Participants completed a short survey, where they indicated the level of acceptability for 14 items which could be used in a spiritual history. This was followed by a semi-structured interview where participants discussed how they would like to be asked about spirituality, and by whom. Eighteen participants were recruited (10 females, 8 males; mean age 68.8 years) and were undertaking either general rehabilitation (n = 9) or neurorehabilitation (spinal cord injury n = 6, traumatic brain injury n = 3). The impact of loss and existential struggle was evident for participants with long-lasting injuries. These participants could identify sources of spiritual strength which helped them engage with hardship and described how staff could facilitate access to these sources of strength. Rehabilitation inpatients are willing to explore issues around spirituality. Staff can support inpatients to access sources of spiritual strength by creating a safe and trusting environment and finding out what is most meaningful to the patient.

The aim of this discussion paper is to explore factors and contexts that influence how nurses might conceptualise and assign personhood for people with altered consciousness, cognition and behaviours. While a biomedical framing is founded upon a dichotomy between the body and self, such that the body can be subjected to a medical and objectifying gaze, relational theories of self, multiculturalism and technological advances for life‐sustaining interventions present new dilemmas which necessitate discussion about what constitutes personhood. The concept of personhood is dynamic and evolving: where historical constructs of rationality, agency, autonomy and a conscious mind once formed the basis for personhood, these ideas have been challenged to encompass embodied, relational, social and cultural paradigms of selfhood. Themes in this discussion include: the right to personhood, mind–body dualism versus the embodied self; personhood as consciousness, rationality and narratives of self; social relational contexts of personhood and cultural contexts of personhood. Patricia Benner's and Christine Tanner's clinical judgement model is then applied to consider the implications for nursing care that seeks to reflexively incorporate personhood. Nurse clinicians are able to move between conceptions of personhood and act to support the body, as well as presumed autonomy and relational, social and cultural personhood. In doing so, they use analytical, intuitive and narrative reasoning which prioritises autonomous constructions of self. They also incorporate relational and social contexts of the person receiving care within the possibilities of technological advances and constraints of contextual resources.

BACKGROUND Advanced technologies are becoming increasingly accessible in rehabilitation. Current research suggests technology can increase therapy dosage, provide multisensory feedback, and reduce manual handling for clinicians. While more high-quality evidence regarding the effectiveness of rehabilitation technologies is needed, understanding of how to effectively integrate technology into clinical practice is also limited. Current implementation of rehabilitation technology is inconsistent, with low uptake among clinicians and frequent reports of technology abandonment. An Australian rehabilitation provider opened a new technology therapy center in 2022, offering a unique opportunity to generate practice-based evidence to inform future technology implementation and research. OBJECTIVE This study aimed to investigate the implementation and adoption of advanced technology within a real-world rehabilitation setting. METHODS This study was a longitudinal observational study in a rehabilitation organization with inpatient, outpatient, and community settings. Allied health clinicians (n=119) within the organization had access to advanced technologies, with patients receiving neurological, spinal cord injury, brain injury, or general rehabilitation. Interventions included 21 advanced technologies, including robotic, virtual reality (VR), sensor-based, and functional electrical stimulation devices. Clinicians received training for devices in a staged approach by external and internal trainers. Data were collected from patient electronic medical records from July 1, 2022, to June 30, 2023. Outcomes included frequency of advanced technology use, patient demographics (age, gender, and primary health condition), clinician discipline, rehabilitation service (inpatient, outpatient, or community), goals of technology therapy sessions, and therapy dosage achieved (minutes active, number of repetitions, and meters walked). RESULTS Clinicians used advanced technology 4208 times with 269 patients over 12 months; specifically, physiotherapists (2716/4208, 65%), occupational therapists (1396/4208, 33%), and allied health assistants (96/4208, 2%). The majority of patients had stroke, spinal cord injury, or brain injury diagnoses (188/269, 70%). Devices were typically used to target impairment and activity limitation–related goals. Frequently used devices included gait training body-weight support (VR treadmill and overground), overground robotic exoskeletons, and upper limb robotic VR devices. Outpatient services were the dominant users of advanced technology (3940/4208, 94%). Clinicians most commonly used devices for patients with stroke (1973/4208, 47%) and the greatest variety of devices for patients with stroke and spinal cord injury. The relative use of lower limb robotic devices was greater in inpatient services (91/178, 51%, vs outpatient services, 963/2335, 41%) (χ21=6.6, P=.01) and for patients with spinal cord injury (48/95, 51%, vs all other conditions, between 24%-31%; χ25=16.8, P=.005). CONCLUSIONS The type and amount of advanced technology use differed between patient populations and rehabilitation settings. To support clinician use of advanced technology, devices should match the rehabilitation context. Tailored strategies are important, such as clinician training. Further practice-based research is required to provide guidance on implementation and to establish the effectiveness of advanced technology use.

Aim and Background: The Brannagan Executive Functions Assessment is an occupation-based approach for increasing self-awareness. This study explores the application of the Brannagan Executive Functions Assessment in traumatic brain injury return to work intervention. It describes changes in self-awareness, goal achievement and perspectives of occupational therapy and people with brain injury. Methods: Case study design using a mixed-methods approach: with pre-post evaluation of outcomes and semi-structured interviews. Participants with traumatic brain injury completed the assessment with two occupational tasks related to return to work. Primary outcomes were self-awareness (Self-awareness Deficits Interview and Awareness Questionnaire) and Goal performance/satisfaction using the Canadian Occupational Performance Measure. Mood was a secondary outcome. Analysis was descriptive for quantitative data, thematic for qualitative data. Results: Two participants with brain injury, two support people and one occupational therapist were recruited. One participant with brain injury had an increase in self-awareness scores. Brain injury participants and the occupational therapist identified benefits including an increased awareness of needing to incorporate planning to meet goals. Conclusion: The Brannagan Executive Functions Assessment offers benefits to practice in brain injury rehabilitation, facilitating a structured occupational approach to self-awareness and participation in meaningful return to work tasks.