The Real Me: Insight into Youths with Physical Disabilities' TranXition to Adulthood through Digital Images

AIMS

Youths with physical disabilities experience various obstacles in their transition to adulthood which can contribute to poorer health and socioeconomic outcomes in later life, compared to their non-disabled peers. Transitional care offers these youths the necessary support to overcome such obstacles. The objective of this study was to explore participants' experiential learning in the development of life skills within the transitional care program TranXition, and their perceived contribution of the program to their goal attainment.

METHODS

Data were collected using photo-elicitation. Five participants were recruited from the TranXition program to audio-visually record (photographs or videos) their meaningful experiences in the program and to reflect on them during interviews.

RESULTS

Participants felt the TranXition program helped them build their self-awareness and self-efficacy, and to feel more confident and skilled, whether at home, in school or in the community. Moreover, they appreciated the program's group cohesion which facilitated learning life skills from others in order to achieve their goals. Finally, results suggest that group interventions, while important, may need to be complemented by individual consultations.

CONCLUSIONS

Rehabilitation programs in real-world settings, such as the TranXition program, may be a promising adjunct to traditional transitional care for youths with physical disabilities.

Level of patients' knowledge, confidence, and acceptance regarding the role of residents in a family medicine teaching clinic

BACKGROUND

Although participation of patients is essential for completing the training of medical residents, little is known about the relationships among patients' level of knowledge about the role and responsibilities of medical residents, their confidence in residents' abilities, and their acceptance toward receiving care from residents. The study sought to clarify if and how these three patient-resident relationship components are interrelated.

METHODS

This is a cross-sectional study using a self-administered questionnaire distributed in 2016 to a convenience sample of adult patients (≥ 18 years old) visiting a family medicine teaching clinic. Proportions and chi-square statistics were used to describe and compare groups, respectively.

RESULTS

Of the 471 patients who answered the questionnaire, only 28% were found to be knowledgeable about the role of family medicine residents. Between 54% and 83% of patients reported being highly confident in the ability of residents to perform five routine tasks. Of the patients surveyed, 69% agreed to see a resident during their next appointments. Patients with a high level of confidence in residents' abilities were more likely to agree to see a resident during future appointments (p <0.0001). There was no significant association between level of knowledge and either confidence or acceptance.

CONCLUSIONS

Although the majority of patients had poor knowledge about the role of residents, this was not related to their acceptance of being cared for by residents. A higher level of confidence in residents' ability to perform certain tasks was associated with greater acceptance toward seeing a resident during future appointments.

Improving body functions through participation in community activities among young people with physical disabilities

AIM

To examine the impact of engagement in a self-chosen community-based activity on three relevant body functions (motor, cognitive, and affective) as well as on the performance of the selected activity.

METHOD

An individual-based interrupted time series design with multiple baselines was used. Seven young people (four males, three females) aged 15 to 25 years (median 18y; interquartile range 17-20y) with physical disabilities participated in an 8-week community activity of choice (e.g. swimming, playing piano). Change in three relevant body functions, underpinning the specific chosen activity, including motor (e.g. Functional Reach Test, Trunk Impairment Scale, dynamometers), cognitive and affective (Behavior Assessment System for Children), as well as activity performance (Canadian Occupational Performance Measure) were measured repeatedly, providing individual outcome trajectories. Linear and mixed-effects models were used.

RESULTS

Significant improvements in at least one aspect of motor function (6 out of 6), cognition (3 out of 3), affect (5 out of 7), and performance (7 out of 7) were observed. Specifically, the intervention had a moderate to large effect on hyperactivity (1.45, 95% confidence interval [CI] 1.0-1.9) with a smaller effect on anxiety (0.21, 95% CI 0.10-0.32) and inadequacy (0.21, 95% CI 0.02-0.39). Concurrently, a notable effect size for activity performance (4.61, 95% CI 0.76-8.46) was observed. Average change across motor outcomes was substantial (3.7 SDs from baseline), yet non-significant.

INTERPERTATION

Findings provide initial evidence of the benefits resulting from participation-based interventions, emphasizing the merit of meaningful 'real-life' young people-engaging therapy.

WHAT THIS PAPER ADDS

Participation-based interventions can impact body-function level outcomes. Significant improvements in the performance of chosen activities were observed. Significant improvements were also seen in cognitive and affective body functions. Improvements in motor-related outcomes were substantial but not statistically significant.

Impact of diet deprivation and subsequent overallowance during gestation on lactation performance of primiparous sows

The impact of diet deprivation followed by overallowance during gestation on metabolic status of pregnant gilts and their lactation performance was determined. Gilts were fed a standard diet until day 27 of gestation and were subsequently reared under a control (CTL; n = 28) or an experimental (treatment, TRT; n = 26) dietary regimen. The experimental regimen provided 70% (restriction diet, RES) and 115% (overallowance diet, OVER) of the protein and NE contents provided by the CTL diet. The RES diet was given from days 28 to 74 of gestation followed by the OVER diet from day 75 until farrowing. Blood samples were obtained from all gilts on days 28, 75, and 110 of gestation, and on days 3 and 20 of lactation to measure concentrations of IGF-1, urea, FFA, and glucose. Milk samples were collected from 12 sows per treatment on day 19 of lactation and sow feed intake was recorded daily throughout lactation. Piglets were weighed at 24 h (after standardization of litter size), and on days 7, 14, and 21 (weaning). The TRT gilts gained less BW than CTL gilts (17.3 vs. 31.7 kg; P < 0.01) from days 28 to 75 of gestation and more BW (29.5 vs. 21.9 kg; P < 0.01) from days 75 to 110, but their overall gain from mating to day 110 was lower (61.4 vs. 67.2 kg; P < 0.05). Metabolic status during gestation was affected, with TRT gilts having less IGF-1 and urea, and more FFA than CTL gilts on day 75 (P < 0.01), and more urea on day 110 (P < 0.01). Growth rate of suckling piglets, sow lactation feed intake, and standard milk composition in late lactation (DM, fat, protein, lactose) were not affected by treatment (P > 0.10). In conclusion, diet deprivation of gilts as of day 28 of gestation followed by overfeeding from day 75 of gestation until farrowing did not improve lactation performance. It is likely that the compensatory growth that took place in late gestation was not adequate to illicit beneficial effects.

Focus on participation for children and youth with disabilities: Supporting therapy practice through a guided knowledge translation process

Introduction

Participation in community leisure occupations of children with disabilities is important, yet poorly integrated into practice. This knowledge translation strategy tested an intervention to increase clinicians' awareness and to bring about change in practice toward a focus on participation.

Method

During this qualitative study, 14 clinicians participated in six learning sessions facilitated by a knowledge broker. Three months post-intervention, clinicians were individually interviewed, by drawing on the Professional Evaluation and Reflection on Change Tool, to evaluate potential change in practice. Two researchers independently performed thematic data analysis.

Results

Impact on practice emerged in both the personal and professional levels (for example, empowerment, validation of clinical wisdom, change in thinking and behavior). Clinicians suggested strategies for integrating participation in their day-to-day practice, illustrating a substantial intention for change, while describing barriers and facilitators for implementation (for example, organizational mandate). Two additional themes described the overall experience of the intervention: motivation to learn (for example, desire to link research to practice) and elements of the learning environment (for example, meeting informational needs).

Conclusion

This strategy was effective in redirecting clinicians' focus toward the notion of participation and establishing readiness for change. This shift can potentially facilitate new programs in occupational therapy that are participation-based and community-focused.