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1.  A systematic review protocol to evaluate the psychometric properties of measures of function within adult neuro-rehabilitation 
Systematic Reviews  2015;4:86.
Background
Spasticity in the upper limb is common after acquired brain impairment and may have a significant impact on the ability to perform meaningful daily activities. Traditionally, outcome measurement in spasticity rehabilitation has focused on impairment, however, improvements in impairments do not necessarily translate to improvements in an individual’s ability to perform activities or engage in life roles. There is an increasing need for outcome measures that capture change in activity performance and life participation.
Methods/Design
We will conduct a systematic review of the psychometric properties of instruments used to measure upper limb functional outcomes (activity performance and participation) in patients with spasticity. Assessments (n = 27) will be identified from a recently published systematic review of assessments that measure upper limb function in neurological rehabilitation for adults with focal spasticity, and a systematic review of each assessment will then be conducted. The databases MEDLINE, CINAHL and EMBASE will be searched from inception. Search strategies will include the name of the assessment and the COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) published search strategy for identifying studies of measurement properties. The methodological rigour of the testing of the psychometric quality of instruments will be undertaken using the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist. International Classification of Functioning, Disability and Health (ICF) definitions of impairment, activity and participation will be used for content analysis of items to determine the extent to which assessments are valid measures of activity performance and life participation. We will present a narrative synthesis on the psychometric properties and utility of all instruments and make recommendations for assessment selection in practice.
Discussion
This systematic review will present a narrative synthesis on the psychometric properties and utility of assessments used to evaluate function in adults with upper limb focal spasticity. Recommendations for assessment selection in practice will be made which will aid clinicians, managers and funding bodies to select an instrument fit for purpose. Importantly, appropriate assessment selection will provide a mechanism for capturing how applicable to everyday life the outcomes from individualised rehabilitation programs for the upper limb really are.
Systematic review registration
PROSPERO CRD42014013190
Electronic supplementary material
The online version of this article (doi:10.1186/s13643-015-0076-5) contains supplementary material, which is available to authorized users.
doi:10.1186/s13643-015-0076-5
PMCID: PMC4470035  PMID: 26071172
Botulinum toxin; Upper limb; Activity performance; Participation; Neuro-rehabilitation; Outcome measurement
2.  Functional assessments used by occupational therapists with older adults at risk of activity and participation limitations: a systematic review and evaluation of measurement properties 
Systematic Reviews  2012;1:45.
Background
Older adults experience activity and participation limitations that are associated with ageing. Activity and participation limitations affect an older adult’s ability to engage in meaningful daily activities and valued life roles. Occupational therapists provide interventions to reduce such limitations and monitor client change to ensure that interventions are effective. Client change should be measured through the use of valid and reliable assessments. Yet occupational therapists can favour the use of non-standardised assessments leading to inaccurate reflections of client change and difficulties in comparing the effectiveness of interventions. A number of reasons have been suggested as to why therapists may favour non-standardised assessments, including a lack of knowledge (of assessments and their properties) and lack of skill.
Methods/design
This paper describes the systematic review protocol that will be used to identify functional assessments used in randomised trials of occupational therapy interventions for older adults (≥70 years of age). Interventions will focus on enhancing functional independence for either older adults transitioning from hospital to home, or community dwelling older adults. We will search Medline, EBSCO and OTseeker using a pre-determined search strategy to identify Functional assessments. These assessments will be recorded and, in phase two, their measurement properties analysed.
Discussion
This protocol provides a comprehensive guideline for conducting the proposed systematic review. The results of this systematic review will provide a thorough and unbiased identification and evaluation of measurement properties of functional assessment tools used in randomised trials to evaluate occupational therapy intervention. This information can be used to determine which assessment has superior measurement properties and will inform occupational therapy practice.
doi:10.1186/2046-4053-1-45
PMCID: PMC3582570  PMID: 23067564
Occupational therapy; Function; Older adults; Assessment; Measurement properties
3.  Occupational therapy discharge planning for older adults: A protocol for a randomised trial and economic evaluation 
BMC Geriatrics  2012;12:34.
Background
Decreased functional ability is common in older adults after hospitalisation. Lower levels of functional ability increase the risk of hospital readmission and nursing care facility admission. Discharge planning across the hospital and community interface is suggested to increase functional ability and decrease hospital length of stay and hospital readmission. However evidence is limited and the benefits of occupational therapists providing this service has not been investigated.
This randomised trial will investigate the clinical effectiveness of a discharge planning program in reducing functional difficulties of older adults post-discharge. This trial will also examine the cost of the intervention and cost effectiveness when compared to in-hospital discharge planning.
Methods/design
400 participants admitted to participating hospitals will be recruited. Participants will be 70 years of age and over, have no significant cognitive impairment and be independently mobile at discharge. This study protocol was approved by the ethics committee of Ryde Rehabilitation Human Research Ethics Committee, Western Sydney Local Health District (Westmead Campus) Human Research Ethics Committee, Alfred Health Human Research ethics committee for the randomised trial and NSW Population and Health Service Human Research Ethics Committee for data linkage. Participants will provide informed written consent.
Participants will be randomly allocated to the intervention or control group. The intervention group will receive discharge planning therapies primarily within their home environment while the control group will receive an in-hospital consultation, both provided by trained occupational therapists. Primary outcome measures will be the Nottingham Extended Activities of Daily Living Scale (NEADL) and the Late Life Disability Index (LLDI) which will measure functional independence, and participation and limitation in daily life activities.
Discussion
This trial will investigate the effectiveness and cost effectiveness of occupational therapy discharge planning in reducing functional difficulties. Results will have a direct impact on healthcare practice and policy.
Trial registration
ACTRN12611000615987.
doi:10.1186/1471-2318-12-34
PMCID: PMC3426463  PMID: 22768848
Activities of daily living; Home assessment; Ageing; Randomised trial; Discharge planning; Occupational therapy

Results 1-3 (3)