Jacqueline Wesson

This study examined the diagnostic accuracy and clinical interpretation of the Occupational Therapy–Drive Home Maze Test (OT-DHMT) in an Australian fitness-to-drive assessment pathway. Participants were 136 drivers referred because of age-related or neurological fitness-to-drive concerns. Maze completion time and error count were recorded before an occupational therapy on-road assessment. On-road outcomes were dichotomized as pass, indicating eligibility for an unrestricted license, or fail, indicating not meeting criteria for an unrestricted license. Drivers who failed completed the OT-DHMT more slowly and made more errors than those who passed. Completion time showed fair discrimination (area under the curve [AUC] = .74), whereas error count showed poor discrimination (AUC = .68). An empirically derived threshold of >38.5 s provided more balanced sensitivity and specificity, whereas a locally used >60 s threshold was highly specific but had low sensitivity. Findings suggest that the OT-DHMT may support clinical reasoning but should not be used as a standalone predictor of on-road outcome.

Background: Effective implementation of guidelines into residential aged care facilities (RACFs) is important for high-quality care. The 12-month Evidence-based Medication knowledge Brokers in Residential Aged CarE (EMBRACE) helix–counterbalanced randomised controlled trial evaluated three strategies to implement Clinical Practice Guidelines for the Appropriate Use of Psychotropic Medications in People Living with Dementia and in Residential Aged Care: (i) passive distribution of Guideline material, (ii) pharmacist-led staff education and (iii) knowledge broker-led Guideline implementation. All three strategies reduced Guideline non-concordance over time, with no significant difference between strategies. This mixed-method process evaluation examined delivery of the implementation strategies, including contextual factors important for Guideline implementation. Methods: Semi-structured interviews conducted with 34 health and care professionals at 12 months were thematically analysed using a deductive approach informed by the Grant framework. Descriptive statistics summarised quantitative data from a post-trial survey completed by intervention pharmacists. Results: Distribution of Guideline materials occurred opportunistically with RACF staff preferring summary materials (e.g. one-page factsheets). Pharmacist-led staff education was tailored to be shorter, more frequent and delivered one-on-one or in small groups. Knowledge broker pharmacists spent a median 70% of time delivering quality improvement activities including audit and feedback and integrating psychotropic best practice into RACF procedures and digital systems. Facilitators of successful Guideline implementation included early engagement with aged care leadership and knowledge broker integration into the team. Conclusion: Guideline implementation efforts in RACFs may benefit from a multifaceted implementation approach involving early engagement with aged care leadership and contextualised delivery of implementation strategies according to staff preferences and needs.

Objective: To understand the perspectives of clinicians and researchers on the nature of safer mobility behaviour and how it is applied to fall prevention in people with Parkinson's disease. Design: A qualitative study using focus group discussions with reflexive thematic analysis. Setting: An international cohort participated in the study online via video conference. Participants: Nineteen physiotherapists, occupational therapists and/or researchers (median 18 years of experience) were included across five focus groups. Results: Empowerment was the central theme underpinning the promotion of safer mobility behaviour. Empowerment meant enabling people towards safe, effective and meaningful task engagement. This was embedded across three sub-themes. Firstly, a contextual approach was needed to understand the complex nature of mobility behaviour involving the combination of physical, cognitive, psychological and Parkinson's disease (e.g. disease progression and fluctuations) related influences. Secondly, an individual approach was needed to provide a holistic assessment evaluating the impact of these influences as well as tailoring interventions to address them. Thirdly, a collaborative approach was needed between clinicians, individuals and care-partners to ensure shared problem solving and goal setting. Conclusions: A novel approach to fall prevention was described in this study. It recognised a person's autonomy and dignity of risk through a balanced consideration of safety during meaningful activities. It also highlighted the role of expert clinicians to work alongside individuals and care-partners for safer strategy development. This study provides the foundation for the development and implementation of safer mobility behaviour strategies for fall prevention in people with Parkinson's disease.

Safer mobility behavior is an emerging concept for fall prevention in people with Parkinson’s disease (PwPD). There is currently no assessment tool nor optimal intervention to support mobility behavior in PwPD. Therefore, this study aimed to gain a consensus of assessment and intervention components targeting safer mobility behavior. A modified Delphi study was conducted across 60 lived experience and 43 clinician/researcher participants over three rounds with consensus at 80%. In Round 1, assessment and intervention components were generated through interviews and focus groups. After two survey rounds, all components reached consensus in favor of their inclusion. Physical and cognitive ability were ranked as the top assessment components. Exercise, movement, and cognitive strategy training were ranked as the top intervention components. Integrated assessments, tailored interventions on disease-specific symptoms and care-partner involvement were emphasized. This study provides the components needed for the future application of promoting safer mobility behavior in PwPD.

Objective: To evaluate the predictive validity and potential clinical relevance of the DriveSafe DriveAware assessment for predicting on-road driving outcomes in medically at-risk drivers. Design: Prospective cohort study. Setting: Fitness-to-drive assessment pathway involving a driver licensing authority, medical review clinic, and occupational therapy driver assessors in the Australian Capital Territory, Australia. Participants: A convenience sample of 138 drivers referred for occupational therapy driving assessment because of medical fitness-to-drive concerns. Methods: Participants completed the DriveSafe DriveAware, comprising DriveSafe and DriveAware subtests, before an on-road driving assessment. On-road outcomes were dichotomised as pass (unrestricted licence) or fail (conditional licence, reassessment, or licence cancellation). Receiver operating characteristic analyses, Youden's Index, and classification accuracy metrics were calculated. Results: DriveSafe DriveAware demonstrated strong classification performance, with 86% sensitivity, 100% specificity, 100% positive predictive value, and 93% overall accuracy. Eighty-seven percent of participants were classified as Likely to Pass or Likely to Fail , with 13% classified as Further Testing . No participants classified as Further Testing achieved an unconditional pass. DriveSafe and DriveAware subtests showed excellent discrimination (area under the curve = 0.96 and 0.95, respectively). Optimal cut-offs were broadly consistent with previously proposed thresholds. Drivers who failed the on-road assessment were older and had lower DriveSafe and DriveAware subtest scores than those who passed. Conclusion: DriveSafe DriveAware showed strong predictive validity in this sample and may support triage and clinical decision-making within fitness-to-drive assessment pathways.

Background: Although ageing is universal, spinal cord injury (SCI) intensifies age‐related physical, psychosocial, cognitive, and functional challenges, with greater consequences for independence and quality of life. Improved life expectancy exposes limitations in prevailing ‘ageing well’ frameworks that exclude disability. Methods: This qualitative study used a phenomenological approach. Semi‐structured interviews were conducted online with community‐dwelling adults aged ≥ 50 years who sustained SCI before age 65 and at least 2 years previously, and carers of people who met these criteria. Interviews were recorded, transcribed verbatim, and analysed thematically. Results: Twenty‐five interviews were completed (22 people with SCI and 3 carers). Participants described ageing as inevitable but distinctly shaped by SCI. Three themes captured their experiences: (1) Compounding vulnerabilities: the experience of accelerated ageing , describing progressive bodily change, health instability, and adjustment to ageing; (2) Converging impacts of biological change and policy gaps , highlighting cumulative functional impacts alongside challenges navigating services and environmental and attitudinal barriers; and (3) Ageing with meaning through participation , emphasising agency, self‐advocacy, and maintaining engagement in work, leisure, and social roles. Adequate disability funding and health and system literacy supported participation, whereas limited SCI‐specific knowledge within health and care services and resource constraints undermined ageing well. Conclusions: Ageing well with SCI is shaped by individual adaptation and modifiable system‐level factors. Policies that ensure equitable resourcing, strengthen ageing (including SCI‐competent services), and support meaningful participation may improve quality of life as this population grows. Lived Experience or Public Contribution: People with lived experience of spinal cord injury were actively involved throughout the research process. A consumer advisory panel (CAP) was established following a national expression‐of‐interest process and comprised eight individuals with lived experience, one carer and a researcher with lived experience. The CAP contributed to study design, recruitment strategies, and interpretation and validation of findings, and supported aspects of data analysis. Panel members represented diverse injury characteristics, time since injury and environmental contexts, enabling identification and consideration of assumptions and biases. In addition, people with lived experience participated as interviewees in the study. Trial Registration: This study was not a clinical trial.

Background: Over half of older adults in long-term care (LTC) experience concern about falling (CaF), yet existing CaF measurement tools do not adequately capture concerns related to daily activities specific to LTC, limiting their usefulness for assessment and management. This study aimed to: (i) develop a co-designed LTC-specific scale by working directly with older residents, adapting relevant Iconographical Falls Efficacy Scale (IconFES) items and adding newly identified activities reflecting their daily lives and CaF (IconFES-LTC), and (ii) identify gaps in current CaF management practices in LTC. Methods: Semi-structured interviews were conducted with 15 LTC residents (aged 60+ years) to identify daily activities associated with CaF and with 10 LTC staff members to explore resident experiences, barriers and facilitators to implementing a CaF scale, and gaps in current CaF management. Interviews were analysed using reflexive thematic analysis to identify patterns across resident and staff perspectives. The draft IconFES-LTC was pilot-tested with nine residents and further refined. Results: The final IconFES-LTC comprises 20 items, including seven adapted from the original IconFES. Items reflect common activities of daily living, undertaken within and outside the facility. Interviews further identified key practice gaps, including the absence of a suitable CaF measure, low participation in exercise programmes, limited falls prevention knowledge and a lack of evidence-based programmes addressing CaF in LTC. Conclusion: Co-designed with LTC residents and staff, the IconFES-LTC offers a context-specific approach to assessing CaF in LTC settings and may inform targeted fall-prevention strategies, with further psychometric validation required in larger, more diverse populations.

Background: Managing medications safely can be challenging for people with dementia and carers living in the community and medication errors can be a source of preventable harm. Resources to support people in medication management must address their information needs and prioritise these alongside those of broader stakeholders. Objective: We aimed to generate content statements for inclusion in tailored medication management literacy resources for people with dementia and carers. Design and Methods: Using a community-based participatory research approach, we established a Medication Management Guidance Partnership: collaboration between the research team, research advisory group, and partner organisations. A mixed-method approach generated 49 statements (Phase 1) then we conducted an online modified Delphi process to gain consensus (Rounds 1 and 2) and prioritise statement order (Round 3) for inclusion in resources (Phase 2). Primary criterion for consensus required ≥80% of participants rating statements as important (≥7 on 9-point Likert-type scale). Secondary criteria assessed response variability, and statements were required to meet all criteria for inclusion. Results: People with dementia (n = 5), carers (n = 5), healthcare professionals and/or national consumer organisation representatives (n = 13) reached consensus on 44 statements across six information domains. ‘Information about decision-making’ was ranked highest, followed by ‘general question prompts’, ‘information about common medications’, ‘addressing complexities,’ ‘getting guidance in different languages’ and ‘additional supports.’ Conclusion: Our ‘menu’ of statements about medication management priorities, endorsed by end-users, can be used to guide development of resources to improve medication management and potentially reduce medication-related harm in this population.

Background: The number of people ageing with spinal cord injury (SCI) is increasing due to improved life expectancy and population ageing. Ageing with SCI is complex, shaped by interactions among SCI‐related, age‐related, personal and environmental factors, resulting in highly individualised support needs. This study explored how health professionals (HPs) understand and respond to the complexities of supporting people ageing with SCI. Methods: This qualitative study conducted semistructured interviews via Zoom with HPs ( n = 21) supporting people ageing with SCI in community settings. Data were analysed using inductive thematic analysis informed by a phenomenological approach. A Consumer Advisory Panel contributed to study design, recruitment and interpretation and validation of findings. Results: Four interconnected themes were identified: (1) understanding the multidimensional nature of ageing with SCI, (2) facilitating adjustment to ageing with SCI, (3) strategies and practices to support ageing with SCI and (4) the personal journey of HPs. HPs described ageing with SCI as a complex, individualised process that requires specialised support, including SCI‐specific expertise, relationship‐based practice, advocacy, shared decision‐making and recognition of lived experience. Facilitating adjustment to age‐related change, promoting autonomy and supporting participation in meaningful activities and roles were central to care. However, fragmented systems, funding limitations and workforce challenges constrained preventative and person‐centred care, contributing to moral tension, emotional burden and burnout, with implications for workforce sustainability. Conclusions: HPs supporting people to age well with SCI require specialised clinical, advocacy and relationship‐based skills, delivered through collaborative partnerships with people with lived experience. In practice, the implementation of these approaches is often constrained by poorly aligned health, disability and aged care systems, placing substantial emotional demands on HPs. System‐level reform is needed to support continuity of care, preventative approaches, relationship‐based care and sustainability of workforce expertise.