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Craven BC, Souza WH, Jaglal S, Gibbs J, Wiest MJ, Sweet SN, Athanasopoulos P, Lamontagne ME, Boag L, Patsakos E, Wolfe D, Hicks A, Maltais DB, Best KL, Gagnon D. Reducing endocrine metabolic disease risk in adults with chronic spinal cord injury: strategic activities conducted by the Ontario-Quebec RIISC team. Disabil Rehabil 2023:1-13. [PMID: 38018518 DOI: 10.1080/09638288.2023.2284223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 11/10/2023] [Indexed: 11/30/2023]
Abstract
PURPOSE The Rehabilitation Interventions for Individuals with a Spinal Cord Injury in the Community (RIISC) team aimed to develop and evaluate innovative rehabilitation interventions to identify endocrine metabolic disease (EMD) risk, intending to reduce the frequency and severity of EMD related morbidity and mortality among adults living with chronic spinal cord injury or disease (SCI/D). MATERIALS AND METHODS An interprovincial team from Ontario and Quebec reviewed available EMD literature and evidence syntheses and completed an inventory of health services, policies and practices in SCI/D care. The review outcomes were combined with expert opinion to create an EMD risk model to inform health service transformation. RESULTS EMD risk and mortality are highly prevalent among adults with chronic SCI/D. In stark contrast, few rehabilitation interventions target EMD outcomes. The modelled solution proposes: 1) abandoning single-disease paradigms and examining a holistic perspective of the individual's EMD risk, and 2) developing and disseminating practice-based research approaches in outpatient community settings. CONCLUSIONS RIISC model adoption could accelerate EMD care optimization, and ultimately inform the design of large-scale longitudinal pragmatic trials likely to improve health outcomes. Linking the RIISC team activities to economic evaluations and policy deliverables will strengthen the relevance and impact among policymakers, health care providers and patients.
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Affiliation(s)
- Beverley Catharine Craven
- Toronto Rehabilitation Institute, Lyndhurst Centre, University Health Network, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Wagner Henrique Souza
- Kite Research Institute, University Health Network, Lyndhurst Centre, Toronto, Canada
| | - Susan Jaglal
- Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Jenna Gibbs
- Department of Kinesiology and Physical Education, McGill University, Montreal, Canada
| | | | - Shane N Sweet
- Department of Kinesiology & Physical Education, McGill University, Montreal, Canada
| | - Peter Athanasopoulos
- Senior Manager Public Policy and Government Relations, Spinal Cord Injury Ontario, Toronto, Canada
| | | | - Lynn Boag
- University of Guelph, Guelph, Canada
| | - Eleni Patsakos
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | - Dalton Wolfe
- Department of Physical Medicine and Rehabilitation, Western University, Parkwood Institute Research, London, Canada
| | - Audrey Hicks
- Department of Kinesiology, McMaster University, Hamilton, Canada
| | - Désirée B Maltais
- Department of Rehabilitation, Physiotherapy Program, Laval University, Quebec City, Canada
| | - Krista Lynn Best
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Canada
| | - Dany Gagnon
- School of Rehabilitation, Université de Montréal, Montréal, Canada
- Centre for Interdisciplinary Research in Rehabilitation, Institut Universitaire sur la Réadaptation en Déficience Physique de Montréal (IURDPM), Montréal, Canada
- Rehabilitation, Université de Montréal, École de Réadaptation, Montréal, Canada
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Craven BC, Popovic MR, Musselman KE, Black C, Dow H. Reframing the Science and Practice of Spinal Cord Injury Rehabilitation: Two Decades of Reflection. Top Spinal Cord Inj Rehabil 2023; 29:iv-xi. [PMID: 38174127 PMCID: PMC10759888 DOI: 10.46292/1945-5763-29.suppl.iv] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
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Duff J, Grant LC, Coker J, Monden KR. Anxiety in Response to Sustaining Spinal Cord Injuries and Disorders: When Should Clinicians Be Concerned? Arch Phys Med Rehabil 2023; 104:1409-1417. [PMID: 37040863 DOI: 10.1016/j.apmr.2023.03.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 02/17/2023] [Accepted: 03/22/2023] [Indexed: 04/13/2023]
Abstract
OBJECTIVE To recommend a cut-off score for the brief 2-item Generalized Anxiety Disorder (GAD-2) measure for persons with spinal cord injuries/disorders (PwSCI/D) and to estimate anxiety occurrence within this population using the full 7-item Generalized Anxiety Disorder (GAD-7). DESIGN Multicenter retrospective analyses. SETTING One inpatient rehabilitation center and 2 community sites for PwSCI/D. PARTICIPANTS PwSCI/D 18 years or older (N=909) were included for analysis using retrospectively collected GAD-2 and GAD-7 data. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE(S) Occurrence of anxiety symptoms were compared using cut-off scores of ≥8 and ≥10 on the GAD-7. A cut-off score recommendation for the GAD-2 was determined using ROC curve, and sensitivity and specificity analyses. RESULTS Occurrence of anxiety symptoms was 21% using a GAD-7 cut-off of ≥8 and 15% using a cut-off of ≥10. Analyses indicated optimal sensitivity for a GAD-2 score of ≥2 when a GAD-7 cut-off of ≥8 was used. CONCLUSIONS Anxiety occurrence is elevated among PwSCI/D compared with the general population. For PwSCI/D, it is recommended that a cut-off score of ≥2 is used for the GAD-2 to maximize sensitivity and that a threshold of ≥8 is used for the GAD-7 to ensure the maximum number of individuals presenting with symptoms of anxiety are recognized for diagnostic interview. Study limitations are discussed.
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Affiliation(s)
- Jane Duff
- Department of Clinical Psychology, National Spinal Injuries Centre (NSIC), Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, Aylesbury, United Kingdom.
| | - Lucy C Grant
- Department of Clinical Psychology, National Spinal Injuries Centre (NSIC), Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, Aylesbury, United Kingdom
| | | | - Kimberley R Monden
- Department of Rehabilitation Medicine, University of Minnesota Medical School, Minneapolis, MN
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Saust LT, Siersma VD, Bjerrum L, Hansen MP. Development of quality indicators for the diagnosis and treatment of urinary tract infections in general practice: a RAND appropriateness method. BMJ Open Qual 2023; 12:bmjoq-2022-002156. [PMID: 37230738 DOI: 10.1136/bmjoq-2022-002156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 05/07/2023] [Indexed: 05/27/2023] Open
Abstract
OBJECTIVE To develop a set of quality indicators for the diagnosis and antibiotic treatment of adult patients with suspected urinary tract infections in general practice. DESIGN A Research and Development/University of California Los Angeles appropriateness method was used. SETTING Danish general practice. SUBJECTS A panel of nine experts, mainly general practitioners, was asked to rate the relevance of 27 preliminary quality indicators. The set of indicators was based on the most recent Danish guidelines for the management of patients with suspected urinary tract infection. An online meeting was held to resolve misinterpretations and achieve consensus. MAIN OUTCOME MEASURES The experts were asked to rate the indicators on a nine-point Likert scale. Consensus of appropriateness was reached if the overall panel median rating was 7-9 with agreement. Agreement was defined as: no more than one expert rated the indicator outside the three-point region (1-3, 4-6 and 7-9) containing the median. RESULTS A total of 23 of the 27 proposed quality indicators attained consensus. One additional indicator was proposed by the panel of experts, leading to a final set of 24 quality indicators. All indicators focusing on the diagnostic process achieved consensus of appropriateness, while the experts agreed on three quarters of the proposed quality indicators concerning either the treatment decision or the choice of antibiotics. CONCLUSION This set of quality indicators may be used to strengthen general practice's focus on the management of patients with a possible urinary tract infection and to identify potential quality problems.
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Affiliation(s)
- Laura Trolle Saust
- Department of Public Health, Section of General Practice and Research Unit for General Practice, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, Center for General Practice, Aalborg University, Aalborg, Denmark
| | - Volkert Dirk Siersma
- Department of Public Health, Section of General Practice and Research Unit for General Practice, University of Copenhagen, Copenhagen, Denmark
| | - Lars Bjerrum
- Department of Public Health, Section of General Practice and Research Unit for General Practice, University of Copenhagen, Copenhagen, Denmark
| | - Malene Plejdrup Hansen
- Department of Clinical Medicine, Center for General Practice, Aalborg University, Aalborg, Denmark
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Ghodsi Z, Jazayeri SB, Pourrashidi A, Sadeghi-Naeini M, Azadmanjir Z, Baigi V, Maroufi SF, Azarhomayoun A, Faghih-Jouybari M, Amirjamshidi A, Naghdi K, Habibi Arejan R, Shabani M, Sepahdoost A, Dehghanbanadaki H, Habibi R, Mohammadzadeh M, Bahreini M, O'Reilly GM, Vaccaro AR, Harrop JS, Davies BM, Yi L, Ghodsi SM, Rahimi-Movaghar V. Development of a comprehensive assessment tool to measure the quality of care for individuals with traumatic spinal cord injuries. Spinal Cord Ser Cases 2023; 9:12. [PMID: 37005413 PMCID: PMC10067818 DOI: 10.1038/s41394-023-00569-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 03/11/2023] [Accepted: 03/20/2023] [Indexed: 04/04/2023] Open
Abstract
OBJECTIVE To develop a comprehensive assessment tool to evaluate the Quality of Care (QoC) in managing individuals with traumatic spinal cord injuries (TSCI). METHOD At first, the concepts of QoC for TSCI were identified by conducting a qualitative interview along with re-evaluation of the results of a published scoping review (conceptualization). After operationalization of indicators, they were valued by using the expert panel method. Afterward, the content validity index (CVI) and content validity ratio (CVR) were calculated and served as cut-offs for indicator selection. Then specific questions were developed for each indicator and classified into three categories: pre-hospital, in-hospital, and post-hospital. Data availability of the National Spinal Cord Injury Registry of Iran (NSCIR-IR) was subsequently used to design questions that represent indicators in an assessment tool format. The comprehensiveness of the tool was evaluated using a 4-item Likert scale by the expert panel. RESULT Twelve experts participated in conceptualization and 11 experts participated in operationalization phase. Overall, 94 concepts for QoC were identified from published scoping review (87 items) and qualitative interviews (7 items). The process of operationalization and indicator selection led to the development of 27 indicators with acceptable content validity. Finally, the assessment tool contained three pre-hospital, twelve in-hospital, nine post-hospital, and three mixed indicators. Ninety-one percent of experts evaluated the entire tool as comprehensive. CONCLUSION Our study presents a health-related QoC tool that contains a comprehensive set of indicators to assess the QoC for individuals with TSCI. However, this tool should be used in various situations to establish construct validity further.
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Affiliation(s)
- Zahra Ghodsi
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Behnam Jazayeri
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Pourrashidi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Neurosurgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Sadeghi-Naeini
- Department of Neurosurgery, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Azadmanjir
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Health Information Management Department, Tehran University of Medical Sciences, Tehran, Iran
| | - Vali Baigi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Farzad Maroufi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Azarhomayoun
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Morteza Faghih-Jouybari
- Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Amirjamshidi
- Department of Neurosurgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Khatereh Naghdi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Maryam Shabani
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Hojat Dehghanbanadaki
- Metabolic Disorders Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Habibi
- Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Maryam Bahreini
- Emergency Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Gerard Michael O'Reilly
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Emergency and Trauma Centre, The Alfred, Melbourne, VIC, Australia
- National Trauma Research Institute, The Alfred, Melbourne, VIC, Australia
| | - Alexander R Vaccaro
- Department of Orthopedics and Neurosurgery, Thomas Jefferson University and the Rothman Institute, Philadelphia, PA, USA
| | - James S Harrop
- Department of Neurological and Orthopedic Surgery, Thomas Jefferson University, Philadelphia, PA, 19107, USA
| | - Benjamin M Davies
- Department of Academic Neurosurgery, University of Cambridge, Cambridge, UK
| | - Lu Yi
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Seyed Mohammad Ghodsi
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Vafa Rahimi-Movaghar
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.
- Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
- Universal Scientific Education and Research Network (USERN), Tehran, Iran.
- Institute of Biochemistry and Biophysics, University of Tehran, Tehran, Iran.
- Visiting Professor, Spine Program, University of Toronto, Toronto, ON, Canada.
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Faleiros F, de Oliveira Braga DC, Schoeller SD, Henriques SH, Cunha NBF, Videira LGN, da Silva Grillo ACL. Surveying people with spinal cord injuries in Brazil to ascertain research priorities. Sci Rep 2023; 13:654. [PMID: 36635338 PMCID: PMC9837118 DOI: 10.1038/s41598-022-26733-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 12/19/2022] [Indexed: 01/14/2023] Open
Abstract
Scientists are concerned that the research they conduct accurately portrays the needs of people living with spinal cord injuries (SCI). As such, this study set out to investigate the main problems faced by people with SCI and their expectations for research. This quantitative, exploratory, analytical, and cross-sectional study was carried out online, with a non-probabilistic sample of 618 Brazilian adults with SCI who had registered voluntarily to participate in the research of the Neurorehab group. The virtual questionnaire consisted of 22 questions based on ISCOS Data Sets. The majority (68.9%) of participants were male, with higher education or a post-graduate qualification (49.5%). Most injuries had experienced traumatic injuries (78.5%) and 58.7% were paraplegic. The mean age was 38.04 years (SD = 9.85). The main difficulties faced after SCI were locomotion/accessibility (70.9%), neurogenic bladder (68.8%), neurogenic bowel (48.2%), and sexuality (36.1%). The highest demand was for experimental studies on stem cells (22.5%), rehabilitation (14.2%), and cures (13.9%). Most (84.3%) of those who reported sexuality problems after SCI were men (p = 0.013). The findings obtained empower people with SCI by enabling them to influence the agenda of scientific research based on their expectations and difficulties. This survey will also aid organizations to engage stakeholders to implement a comprehensive SCI management program.
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Affiliation(s)
- Fabiana Faleiros
- Ribeirão Preto College of Nursing, University of Sao Paulo, Ribeirão Preto, Brazil.
| | | | | | - Sílvia Helena Henriques
- grid.11899.380000 0004 1937 0722Ribeirão Preto College of Nursing, University of Sao Paulo, Ribeirão Preto, Brazil
| | | | - Lorena Gomes Neves Videira
- grid.11899.380000 0004 1937 0722Ribeirão Preto College of Nursing, University of Sao Paulo, Ribeirão Preto, Brazil
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7
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Clinical and demographic predictors of symptoms of depression and anxiety in patients with spinal cord injury. Spinal Cord 2022; 60:1123-1129. [PMID: 35840743 DOI: 10.1038/s41393-022-00831-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 06/23/2022] [Accepted: 06/24/2022] [Indexed: 11/09/2022]
Abstract
Spinal Cord Injury (SCI) is a condition whose consequences can impact the physical, emotional, and social aspects of patient's life, including Depression and Anxiety disorders. STUDY DESIGN Using a cross-sectional design, sociodemographic and clinical data were extracted from 556 SCI patients at the time of initial assessment, prior to intensive rehabilitation treatment at the local rehabilitation institute. OBJECTIVES Identify the predictive and multivariate relationship between different sociodemographic and clinical variables of Depression and Anxiety symptoms in SCI patients. SETTING Lucy Montoro Rehabilitation Institute (LMRI), University of Sao Paulo, Sao Paulo, Brazil. METHODS We performed independent univariate and multivariate regression models using the Hospital Anxiety and Depression Scale (HADS) as dependent variable. RESULTS Symptoms of depression and anxiety present in SCI patients negatively correlate with the level of independence for locomotion, personal hygiene, bowel control, social interaction measured by the Functional Independence Scale (FIM), type of medication in use and the Language subtest of the MoCA Scale. Unlike previous studies, we did not find a relationship with the use of alcohol and illicit drugs, injury levels, etiological diagnosis or duration of injury. For the anxiety models, the main predictor was Depression symptoms, with SCI-related aspects not being significant. It was found that characteristics of the FIM Scale and cognitive aspects of the MoCA Scale were the main predictors of symptoms of Depression. Characteristics of the injury and motor deficit were not statistically significant. CONCLUSIONS These findings can potentially be used to guide clinical practices to identify patients at higher risk of experiencing symptoms of Depression and Anxiety.
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Catharine Craven B, Musselman K, Humphreys S, Walden K, Parsons J, Eapen J, Noonan VK, Cheng CL, Yousefi C, Chernesky J, Côté-Boileau É, Ibrahim N, Kalay AL, Kingston D, Clément L, Bayley M, Kua A, Patsakos E, Cheng C, Eng J, Ho C, Queree M, Farahani F, Flett H, Scovil C, Evbuomwan I, Athanasopoulos P, Wolf D, Ebsary S, McBride C, Adair B, Beaton N, Bury M, Cooper D, Dyer S, Howe S, Scott L, Stanley A. Transforming SCI rehabilitation care through innovation. J Spinal Cord Med 2021; 44:S5-S16. [PMID: 34779734 PMCID: PMC8604518 DOI: 10.1080/10790268.2021.1965449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- B. Catharine Craven
- Canadian Spinal Cord Injury – Rehabilitation Association,Correspondence to: B. Catharine Craven, Toronto Rehabilitation Institute, KITE Research Institute, University Health Network, Toronto, Ontario M4G 3V9, Canada.
| | | | - Suzanne Humphreys
- PRAXIS Spinal Cord Institute for Canadian Spinal Cord Injury – Rehabilitation Association
| | - Kristen Walden
- PRAXIS Spinal Cord Institute for Canadian Spinal Cord Injury – Rehabilitation Association
| | - Jessica Parsons
- PRAXIS Spinal Cord Institute for Canadian Spinal Cord Injury – Rehabilitation Association
| | - Jessica Eapen
- PRAXIS Spinal Cord Institute for Canadian Spinal Cord Injury – Rehabilitation Association
| | - Vanessa K Noonan
- PRAXIS Spinal Cord Institute for Canadian Spinal Cord Injury – Rehabilitation Association
| | - Christiana L Cheng
- PRAXIS Spinal Cord Institute for Canadian Spinal Cord Injury – Rehabilitation Association
| | - Charlene Yousefi
- PRAXIS Spinal Cord Institute and the Health Standards Organization for Canadian Spinal Cord Injury – Rehabilitation Association
| | - John Chernesky
- PRAXIS Spinal Cord Institute and the Health Standards Organization for Canadian Spinal Cord Injury – Rehabilitation Association
| | - Élizabeth Côté-Boileau
- PRAXIS Spinal Cord Institute and the Health Standards Organization for Canadian Spinal Cord Injury – Rehabilitation Association
| | - Nadine Ibrahim
- PRAXIS Spinal Cord Institute and the Health Standards Organization for Canadian Spinal Cord Injury – Rehabilitation Association
| | - Anifa Luyinga Kalay
- PRAXIS Spinal Cord Institute and the Health Standards Organization for Canadian Spinal Cord Injury – Rehabilitation Association
| | - Darryl Kingston
- PRAXIS Spinal Cord Institute and the Health Standards Organization for Canadian Spinal Cord Injury – Rehabilitation Association
| | - Louise Clément
- PRAXIS Spinal Cord Institute and the Health Standards Organization for Canadian Spinal Cord Injury – Rehabilitation Association
| | - M. Bayley
- University Health Network Can-SCIP, Steering Committee for Canadian Spinal Cord Injury – Rehabilitation Association
| | - A. Kua
- University Health Network Can-SCIP, Steering Committee for Canadian Spinal Cord Injury – Rehabilitation Association
| | - E. Patsakos
- University Health Network Can-SCIP, Steering Committee for Canadian Spinal Cord Injury – Rehabilitation Association
| | - C. Cheng
- University Health Network Can-SCIP, Steering Committee for Canadian Spinal Cord Injury – Rehabilitation Association
| | - J. Eng
- University Health Network Can-SCIP, Steering Committee for Canadian Spinal Cord Injury – Rehabilitation Association
| | - C. Ho
- University Health Network Can-SCIP, Steering Committee for Canadian Spinal Cord Injury – Rehabilitation Association
| | - M. Queree
- University Health Network Can-SCIP, Steering Committee for Canadian Spinal Cord Injury – Rehabilitation Association
| | - Farnoosh Farahani
- Spinal Cord Injury Implementation and Evaluation Quality Care Consortium for Canadian Spinal Cord Injury – Rehabilitation Association
| | - Heather Flett
- Spinal Cord Injury Implementation and Evaluation Quality Care Consortium for Canadian Spinal Cord Injury – Rehabilitation Association
| | - Carol Scovil
- Spinal Cord Injury Implementation and Evaluation Quality Care Consortium for Canadian Spinal Cord Injury – Rehabilitation Association
| | - Ivie Evbuomwan
- Spinal Cord Injury Implementation and Evaluation Quality Care Consortium for Canadian Spinal Cord Injury – Rehabilitation Association
| | - Peter Athanasopoulos
- Spinal Cord Injury Implementation and Evaluation Quality Care Consortium for Canadian Spinal Cord Injury – Rehabilitation Association
| | - Dalton Wolf
- Spinal Cord Injury Implementation and Evaluation Quality Care Consortium for Canadian Spinal Cord Injury – Rehabilitation Association
| | - Sophie Ebsary
- Canadian Activity-Based Therapy Community of Practice for Canadian Spinal Cord Injury – Rehabilitation Association
| | - Christopher McBride
- Spinal Cord Injury Canada for Canadian Spinal Cord Injury – Rehabilitation Association
| | - Bill Adair
- Spinal Cord Injury Canada for Canadian Spinal Cord Injury – Rehabilitation Association
| | - Nancy Beaton
- Spinal Cord Injury Canada for Canadian Spinal Cord Injury – Rehabilitation Association
| | - Michael Bury
- Spinal Cord Injury Canada for Canadian Spinal Cord Injury – Rehabilitation Association
| | - Darlene Cooper
- Spinal Cord Injury Canada for Canadian Spinal Cord Injury – Rehabilitation Association
| | - Shaun Dyer
- Spinal Cord Injury Canada for Canadian Spinal Cord Injury – Rehabilitation Association
| | - Stuart Howe
- Spinal Cord Injury Canada for Canadian Spinal Cord Injury – Rehabilitation Association
| | - Launel Scott
- Spinal Cord Injury Canada for Canadian Spinal Cord Injury – Rehabilitation Association
| | - Alan Stanley
- Spinal Cord Injury Canada for Canadian Spinal Cord Injury – Rehabilitation Association
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Hitzig SL, Jeyathevan G, Farahani F, Noonan VK, Linassi G, Routhier F, Jetha A, McCauley D, Alavinia SM, Omidvar M, Craven BC. Development of community participation indicators to advance the quality of spinal cord injury rehabilitation: SCI-High Project. J Spinal Cord Med 2021; 44:S79-S93. [PMID: 34779731 PMCID: PMC8604477 DOI: 10.1080/10790268.2021.1955204] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Community participation following spinal cord injury/disease (SCI/D) can be challenging due to associated primary impairments and secondary health conditions as well as difficulties navigating both the built and social-emotional environment. To improve the quality of SCI/D rehabilitation care to optimize community participation, the SCI-High Project developed a set of structure, process and outcome indicators for adults with SCI/D in the first 18 months after rehabilitation admission. A pan-Canadian Working Group of diverse stakeholders: (1) defined the community participation construct; (2) conducted a systematic review of available outcomes and their psychometric properties; (3) constructed a Driver diagram summarizing available evidence associated with community participation; and (4) prepared a process map. Facilitated meetings allowed selection and review of a set of structure, process and outcome indicators. The structure indicator is the proportion of SCI/D rehabilitation programs with availability of transition living setting/independent living unit. The process indicators are the proportion of SCI/D rehabilitation inpatients who experienced: (a) a therapeutic community outing prior to rehabilitation discharge; and, (b) those who received a pass to go home for the weekend. The intermediary and final outcome measures are the Moorong Self-Efficacy Scale and the Reintegration to Normal Living Index. The proposed indicators have the potential to inform whether inpatient rehabilitation for persons with SCI/D can improve self-efficacy and lead to high levels of community participation post-rehabilitation discharge.
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Affiliation(s)
- Sander L. Hitzig
- St. John’s Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Gaya Jeyathevan
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
| | - Farnoosh Farahani
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
| | | | - Gary Linassi
- Department of Physical Medicine and Rehabilitation, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - François Routhier
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Québec, Canada
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec City, Québec, Canada
| | - Arif Jetha
- Institute for Work & Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | - S. Mohammad Alavinia
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
| | - Maryam Omidvar
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
| | - B. Catharine Craven
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
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10
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Bateman EA, Sreenivasan VA, Farahani F, Casemore S, Chase AD, Duley J, Evbuomwan IK, Flett HM, Ventre A, Craven BC, Wolfe DL. Improving practice through collaboration: Early experiences from the multi-site Spinal Cord Injury Implementation and Evaluation Quality Care Consortium. J Spinal Cord Med 2021; 44:S147-S158. [PMID: 34779729 PMCID: PMC8604479 DOI: 10.1080/10790268.2021.1936946] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
CONTEXT Dedicated implementation efforts are critical to bridging the gaps between current practices and best practices. A quality improvement collaborative (QIC), the Spinal Cord Injury Implementation and Evaluation Quality Care Consortium (SCI IEQCC), was established to meet this need, bringing together a network of clinicians and administrators to systematically improve the quality and equity of tertiary spinal cord injury or disease (SCI/D) rehabilitation care in Ontario, Canada. METHODS Clinicians and leaders from five tertiary SCI/D rehabilitation centers and two not-for-profit SCI/D advocacy groups comprised a network dedicated to supporting implementation of the SCI-High quality indicators in prioritized domains of SCI rehabilitation and related best practices by: (1) building capacity through implementation science education of frontline clinicians; (2) providing resources and support to empower frontline clinicians to lead quality improvement efforts within their institutions; (3) promoting wider learning through a network for sharing ideas, efforts, and experiences; and (4) collecting indicator data to facilitate provincial evaluation of goal attainment. RESULTS Network members and sites collaborated to implement best practices within six priority domains; in 18 months, significant progress has been made in emotional wellbeing, sexual health, walking, and wheeled mobility despite disruptions due to the COVID-19 pandemic. These efforts encompass heterogeneous challenges and strategies, ranging from developing clinical skills programs, to streamlining processes, to manipulating physical space. CONCLUSION A QIC targeting SCI/D rehabilitation demonstrates promise for advancing the implementation of best practices, building implementation science capacity across multiple sites, and for promoting collaboration amongst SCI/D rehabilitation centers and organizational partners.
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Affiliation(s)
- Emma A. Bateman
- Department of Physical Medicine & Rehabilitation, Western University, London, Canada
- Parkwood Institute, St. Joseph’s Health Care London, London, Canada
| | | | - Farnoosh Farahani
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Canada
| | | | | | | | - Ivie K. Evbuomwan
- Parkwood Institute Research, Lawson Health Research Institute, London, Canada
| | - Heather M. Flett
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Canada
- Brain and Spinal Cord Rehabilitation Program Toronto Rehabilitation Institute – University Health Network, Toronto, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Anellina Ventre
- Brain and Spinal Cord Rehabilitation Program Toronto Rehabilitation Institute – University Health Network, Toronto, Canada
| | - B. Catharine Craven
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Canada
- Brain and Spinal Cord Rehabilitation Program Toronto Rehabilitation Institute – University Health Network, Toronto, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, Canada
| | - Dalton L. Wolfe
- Parkwood Institute Research, Lawson Health Research Institute, London, Canada
- School of Health Studies, Western University, London, Canada
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Craven BC, Alavinia SM, Wiest MJ, Farahani F, Hitzig SL, Flett H, Jeyathevan G, Omidvar M, Bayley MT. Methods for development of structure, process and outcome indicators for prioritized spinal cord injury rehabilitation Domains: SCI-High Project. J Spinal Cord Med 2019; 42:51-67. [PMID: 31573444 PMCID: PMC6781197 DOI: 10.1080/10790268.2019.1647386] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background: High-quality rehabilitation care following spinal cord injury or disease (SCI/D) is critical for optimizing neurorecovery and long-term health outcomes. This manuscript describes the methods used for developing, refining, and implementing a framework of structure, process, and outcome indicators that reflect high-quality rehabilitation among adults with SCI/D in Canada. Methods: This quality improvement initiative was comprised of the following processes: (1) prioritization of care Domains by key stakeholders (scientists, clinicians, therapists, patients and stakeholder organizations); (2) assembly of 11 Domain-specific Working Groups including 69 content experts; (3) conduct of literature searches, guideline and best practice reviews, and outcome synthesis by the Project Team; (4) refinement of Domain aim and construct definitions; (5) conduct of cause and effect analysis using Driver diagrams; (6) selection and development of structure, process and outcome indicators; (7) piloting and feasibility analysis of indicators and associated evaluation tools; and, (8) dissemination of the proposed indicators. Result: The Project Team established aims, constructs and related structure, process, and outcome indicators to facilitate uniform measurement and benchmarking across 11 Domains of rehabilitation, at admission and for 18 months thereafter, among adult Canadians by 2020. Conclusion: These processes led to the selection of a feasible set of indicators that once implemented should ensure that adults with SCI/D receive timely, safe, and effective rehabilitation services. These indicators can be used to assess health system performance, monitor the quality of care within and across rehabilitation settings, and evaluate the rehabilitation outcomes of the population to ultimately enhance healthcare quality and equity.
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Affiliation(s)
- B. Catharine Craven
- KITE, Toronto Rehab – University Health Network, Toronto, Ontario, Canada,Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, Ontario, Canada,Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada, B. Catharine Craven, KITE – Toronto Rehab – University Health Network, 206-H 520 Sutherland Drive, Toronto, Ontario, Canada M4G3V9; Ph: 416-597-3422 x6122.
| | - S. Mohammad Alavinia
- KITE, Toronto Rehab – University Health Network, Toronto, Ontario, Canada,Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Matheus J. Wiest
- KITE, Toronto Rehab – University Health Network, Toronto, Ontario, Canada
| | - Farnoosh Farahani
- KITE, Toronto Rehab – University Health Network, Toronto, Ontario, Canada
| | - Sander L. Hitzig
- St. John’s Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada,Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Heather Flett
- KITE, Toronto Rehab – University Health Network, Toronto, Ontario, Canada,Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada,Departmenet of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Gaya Jeyathevan
- KITE, Toronto Rehab – University Health Network, Toronto, Ontario, Canada
| | - Maryam Omidvar
- KITE, Toronto Rehab – University Health Network, Toronto, Ontario, Canada
| | - Mark T. Bayley
- KITE, Toronto Rehab – University Health Network, Toronto, Ontario, Canada,Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, Ontario, Canada,Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
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