Models of Governance of Disability Therapy Support Workers in Rural and Remote Settings: A Systematic Scoping Review

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

This is an excellent paper contributing a scoping review to answer an important question of how allied health therapy for people with disability is governed in rural communities. It has direct relevance in Australia, but equally relevant internationally to inform social service delivery in geographically isolated communities.

The abstract clearly sets out the question, method and findings. The significance of the question is explained in the background. The method is rigorous and well explained following expected scoping review protocols, in a way that could be replicated. A quality assessment would enhance the review, but it is not critical to a scoping review.

The results are thoroughly presented and the analysis is useful, organised by the research questions and a narrative summary ordered by theme. The priority given to evidence of successful governance enhances this presentation. The discussion and conclusion draw the findings together with implications for governance and further research.

Author Response

Dear reviewer,

We are grateful for the time you took to read our paper and provide comments. A quality assessment on all papers was undertaken, however information relating to this must not have been clear to the reader. We have made the following adjustments to ensure the reader can find this information readily.

• p8 line 261-263 details methods used to assess the quality of included papers.
• We have added the following sentence on p8, Lines 279-281 to describe the outcome of the quality review:

The quality of papers included in this review ranged from high quality (n=8) to moderate (n=8) to low (n=9). Characteristics of all included studies, including details of the quality assessment, can be found in full in Additional file 1, Table 4.

• Under heading 4.5 ‘strength and quality of the evidence’ (p14, line 504) we have added reference to the table in the additional file where further information can be found.
• Within Table 4, additional file 1 we have made the title of the table clearer to identify the results of the quality review are contained in that table. 
• Within Table 4, additional file 1 we have ensured the outcome of the quality review is in bold (column N).
• Within Table 4, additional file 1 we have added an extra column and colour coded the results of the review so these are visually easier to interpret (column O).

We do hope these adjustments satisfy your request for further information.

With best wishes.

Reviewer 2 Report

Comments and Suggestions for Authors

Thank you for this very professional paper. Within the limits you set yourselves, I could find nothing to fault. The findings are valuable, although unsurprising. I am not familiar with the NDIS operationally, and I found it thought provoking that the workforce described here has overtones of a medical workforce, being derived from Allied Health Professionals, despite the NDIS being informed by the social model of disability. I also found myself wondering about risk management as an aspect of Governance that must be challenging when the workforce is so widely dispersed in rural regions. It surprised me that none of the papers mention this. You might like to comment on these two issues. Finally, it is a regret to this reader at least that none of your studies appear to have sought user perspectives on this workforce. Or is it that you have not mentioned or looked for it? I'd welcome some comment, particularly as you do note the absence of outcome measures in the literature.

Author Response

Dear reviewer,

We are grateful for the time you took to read our paper and provide comments. 

We have made the following adjustments to respond to your very useful observations and requests for further clarity:

• Under heading 5.1 Study Limitations, on page 16 we have added the following two paragraphs - 

Governance is commonly used as a risk management tool however none of the papers included in this review explicitly explored risk management as a concept or reported outcomes specifically relating to risk. Instead, a number of papers described risk management as either an inherent quality that is contained within a support worker’s capability profile (reported as relating to decision making skills or capability of making a risk assessment [30,32,48,49]) or relating to a set of capabilities such as specific clinical or technical skills [29] or knowledge of best practice and ethics [30] (Table 7A, Additional file 1). Given the challenges governing a workforce that is so widely dispersed in rural regions, research the specifically examines the relationship between DTSW risk-associated capabilities and the outcomes of care for PWD is an area where future research should focus.  

Finally, only seven of the included papers sought user perspectives on factors relating to governance of the DTSW workforce [30,34,35,37,38,48,50]. Given the focus of the NDIS on user engagement and user-driven care, the evidence base would benefit from research that specifically seeks user perspectives of what comprises good governance and how this might impact on outcomes of importance to them.

• We have also added additional information throughout the paper to assist the reader to locate further data/information relating to risk and user perspectives that is contained within the supporting files.

We do hope these adjustments satisfy your request for further information.

With best wishes.