The aim of this study was to investigate if physiotherapists had knowledge and skills in applying Bobath-based therapy (BB), also referred to as Neurodevelopmental Treatment, in the care of stroke patients and if they generally used the therapy in daily practice. This is because of the important emphasis placed on documenting the extent of the therapy given to the client groups compared in outcome studies measuring the efficacy of therapeutic interventions. The study took place as an intervention check for a large outcome study measuring the effects of BB therapy. BB therapy had been implemented on six wards, whereas six other wards did not use this approach. The physiotherapists (n /38) knowledge and skills in making decisions about applying the BB principles in all wards was measured in two steps. In step 1, the physiotherapists received a questionnaire focusing on their physiotherapy strategy, and Bobath education. In step 2, they received a case vignette describing a stroke patient and questions concerning the content of the physiotherapy provided to this patient. An expert panel judged the therapists responses to the questions of both steps. Of the physiotherapists working in the BB wards, 14 (74%) therapists generally used BB principles, whereas four (21%) therapists did not (one was uncertain). Of the physiotherapists working in the non-BB wards (n /19), three (16%) did use BB therapy whereas 10 (52%) therapists did not use the therapy (six responses were missing). The study showed that within the BB wards, the physiotherapists had followed sufficient BB education, as judged by a panel of experts, and demonstrated the knowledge and skills in applying the BB therapy, whereas in the other wards they did not. BB wards could therefore participate in the experimental group of the study measuring the effects of the Bobath therapy, and the non-BB wards could serve as proper control wards.
Risk matrices have been widely used in the industry under the notion that risk is a product of likelihood by severity of the hazard or safety case under consideration. When reliable raw data are not available to feed mathematical models, experts are asked to state their estimations. This paper presents two studies conducted in a large European airline and partially regarded the weighting of 14 experienced pilots’ judgment though software, and the calculation of agreement amongst 10 accident investigators when asked to assess the worst outcome, most credible outcome and risk level for 12 real events. According to the results, only 4 out of the 14 pilots could be reliably used as experts, and low to moderate agreement amongst the accident investigators was observed.
In safety science and practice, there have been various safety models, each of them reflecting a particular approach to safety management and accident causality. The large variety of models suggested in literature and applied in practice serve the communication of diverse perspectives towards safety and the need to consider contextual factors, but it does not allow the establishment of a common language within and across organisations and industry sectors. Considering the potential benefits of talking a lingua franca when it comes to safety and inspired by the Standard Model used in particle physics and recent suggestions from relevant studies, we thought of exploring the possibility to introduce a Standard Safety Model (STASAM). As a first step, we focused on four representative safety and accident models widely used, discussed and debated: the Swiss Cheese Model, AcciMap, Functional Resonance Analysis Method (FRAM) and Systems-Theoretic Accident Model and Processes (STAMP). We reviewed literature which compares the particular models, and we listed the strengths and weaknesses of each as a means to set the grounds for the STASAM. The combinations of these models with a focus to host their advantages and avoiding their disadvantages led to a three-level STASAM. The concept STASAM was used in two random incident investigation reports to assess its applicability and visualisation against the original models. The results of the application along with the STASAM concept were reviewed by three safety professionals and three safety researchers. The comments received were in the positive direction and indicated the potential of establishing an inclusive and commonly accepted safety/accident model. The next research phase will be the additional review of the STASAM and its pilot application to a variety of safety events and systems as a means to test its reliability and strengthen its validity.