Interventions that minimize challenging behavior and disability may make a significant difference to the level of community integration experienced by people with severe TBI.

Carolyn A. Unsworth. The clinical reasoning of no×ice and expert occupational therapists. Scand J Occup Ther 2001; 8: 163-173.Over the past 15 years, research in health sciences has consistently shown that differences in the performance of novice and expert clinicians are predominantly due to their clinical reasoning abilities. Furthering our knowledge of the ways expert and novice occupational therapists reason can help us to explicate the complexities of practice and ultimately assist novices to think like experts. This paper presents the ndings of a study which investigated qualitatively and quantitatively the clinical reasoning of novice and expert occupational therapists. Three expert and two novice occupational therapists working in rehabilitation settings wore head-mounted video cameras while completing three therapy sessions (assessment, treatment, discharge planning). Therapists then viewed the videos and reported back on their reasoning. These verbal reports were transcribed and analysed. While the quantitative results indicated several differences in both the amounts and types of clinical reasoning used by novices and experts, the qualitative analyses were more useful in revealing differences in the ways these two groups presented their clinical reasoning. The ndings suggest that novice therapists could bene t from spending more time re ecting on the therapy process, and discussing their therapy with expert colleagues. Key words : qualitati×e method, quantitati×e method, retrospecti×e ×erbal report, ×ideo-assisted recall. NOVICE EXPERT DIFFERENCESResearchers investigating the diagnostic and problem solving decision making of physicians and nurses have consistently found ve main differences between novices and experts [1]. Experts appear to possess a better knowledge base than novices which enables them to compare a current problem to their recollections of past cases. Experts also use less irrelevant information when making decisions, and seem to recall critical cues better than their novice counterparts. In addition, experts seem to employ more discon rmatory hypotheses than novices. Novice clinicians tend to con rm their hypotheses by collecting supporting information rather than testing a hypothesis through use of an appropriate discon rming hypothesis. Experts solve clinical problems faster than novices, and nally, experts have been found to have better general problem solving and clinical reasoning skills than novices [1]. This last difference is of most signi cance to occupational therapists. Occupational therapists are concerned with problem solving with their clients around occupational performance dif culties and ways to overcome them. Thus, rather than diagnosing the client's problem, the way therapists think in action and reason has been consistently identi ed as the key difference between novice and expert occupational therapists [2 -6].

This study investigated time use and the importance of instrumental activities of daily living (IADL) tasks to an older community‐dwelling population. In addition, the study compared occupational therapists’ and older people’s perception of importance of IADL tasks for maintaining community living. Thirty‐three subjects completed a time diary and an interview‐based questionnaire to ascertain their time use and the importance of IADL tasks. It was found that older people living in the community spent most of their time at home and alone, with nearly half the day being spent on IADL tasks. The subjects indicated that the three most important tasks were use of the telephone, use of transportation (including driving) and reading. Differences were found when the results from an earlier study of occupational therapists were compared with results from the present study of older people. The occupational therapists also considered use of the telephone as most important but then rated medication management and snack preparation as the most necessary activities for continued community living. These results emphasize the differences in the perception of ‘important’ between the two groups studied. The results from this research confirm the importance of IADL to both the occupational therapy profession and older people living at home in the community. Further, these results confirm the need for client‐centred practice and collaborative intervention planning for occupational therapy.

We have produced an outcome measure in the Australian context for speech pathology, physiotherapy, and occupational therapy. There are six speech pathology scales, nine physiotherapy scales, and 11 occupational therapy scales in the AusTOMs. A clinician chooses the relevant scale(s) for the client (based on the goals of therapy) and makes a rating across all domains for each scale. Further papers will report on the reliability, validity, and clinical usefulness of the AusTOMs.

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Current pressures to document outcomes and demonstrate the efficacy of occupational therapy intervention arise from fiscal restraints as much as from the humanitarian desire to provide the best quality health care to consumers. However, measuring outcomes is important in facilitating mutual goal setting, increasing the focus of therapy on the client, monitoring client progress, as well as demonstrating that therapy is valuable. The aims of this article are to provide the reader with an overview of what outcomes research is and to provide resources to aid the selection of outcomes assessments in a variety of practice areas. This article adopts the latest version of the World Health Organisation’s health classification system (International Classification of Impairments, Activities and Participation), as an organizing framework, and promotes the use of this framework when undertaking outcomes research.

Background: The number and proportion of drivers among people entering later life continues to rise. More information on patterns of driving for older adults is required to improve service provision and traffic planning. Objectives: To map the changes in driving status for a sample of drivers aged 65 years or older over the period 1994–2000, and to identify factors associated with older people continuing, modifying or relinquishing their status as drivers. Methods: The 752 participants were drawn from the Melbourne Longitudinal Studies on Healthy Ageing (MELSHA) program, a longitudinal study of people aged 65 years and older living in the community. Participants were interviewed or contacted for follow-up in 1994, 1996, 1998 and 2000 on a range of topics including their health, functional independence and driving status. Results: Although the number of recent drivers was smaller as participants died or were admitted to nursing homes over the 6-year data collection period, relatively few participants relinquished driving while remaining in the community. Many drivers reported modifying their driving habits over time, including decisions to restrict their driving to their local area during daylight only. Relationships were explored between driving status and the key variables of age, gender, marital status, instrumental activities of daily living (IADL) independence and self-rated measures of income, health, eyesight and hearing. Multivariate analyses indicated that drivers were more likely to modify their driving habits if they were older, dependent in IADL, and rated their eyesight as poor. Similar factors predicted relinquishing driving, but in addition, women were three times more likely to relinquish driving than men (even when health and disability were taken into account) and people who rated their incomes as ‘comfortable’ were more likely to relinquish driving than those with lower incomes. Conclusions: This study confirmed previous evidence that older drivers self-regulate by modifying their driving behavior as they age. However, since few drivers voluntarily relinquish driving, further research is required to identify ways of supporting older drivers to continue to drive safely.

For older people who have had a stroke, appropriate housing can promote independence and well being. However, suboptimal team accommodation recommendations may result in placement of an individual where their needs are not met, and their skills are not maximized. Although clinical judgments regarding patient discharge are routinely made by rehabilitation teams, this area has received limited research attention. This study examines how rehabilitation teams determine the most appropriate housing to recommend to stroke patients after their discharge from hospitals. A Social Judgment Theory approach was used to document and analyze the accommodation recommendations and policies of 13 rehabilitation teams (clinician n = 74). Teams were asked to consider 50 hypothetical stroke patients, and determine the most appropriate discharge housing to recommend to these patients. Each stroke patient was described in terms of 8 attributes: mobility status, ability to manage their own affairs, patient's choice of housing, personal activity of daily living (ADL) skills, domestic and community ADL skills, general health status, social situation, and premorbid living arrangements. Clinicians were provided with a response scale on which to record their recommendations. The results showed considerable yet reliable differences among teams concerning recommendations made, and judgment policies adopted. Although the highly structured and hypothetical nature of this research limits the external validity of findings, the results suggest that teams may also face difficulties with housing recommendations in the more complex clinical environment. Further studies to assess actual clinical team decision making are needed. Such studies could lead to the development of a standardized research-based protocol to help teams formalize and optimize their housing recommendations.