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Manhas KP, Horlick S, Krysa J, Kovacs Burns K, Brehon K, Laur C, Papathanassoglou E, Ho C. Implementation of a Provincial Long COVID Care Pathway in Alberta, Canada: Provider Perceptions. Healthcare (Basel) 2024; 12:730. [PMID: 38610152 PMCID: PMC11011656 DOI: 10.3390/healthcare12070730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 03/18/2024] [Accepted: 03/21/2024] [Indexed: 04/14/2024] Open
Abstract
A novel, complex chronic condition emerged from the COVID-19 pandemic: long COVID. The persistent long COVID symptoms can be multisystem and varied. Effective long COVID management requires multidisciplinary, collaborative models of care, which continue to be developed and refined. Alberta's provincial health system developed a novel long COVID pathway. We aimed to clarify the perspectives of multidisciplinary healthcare providers on the early implementation of the provincial long COVID pathway, particularly pathway acceptability, adoption, feasibility, and fidelity using Sandelowki's qualitative description. Provider participants were recruited from eight early-user sites from across the care continuum. Sites represented primary care (n = 4), outpatient rehabilitation (n = 3), and COVID-19 specialty clinics (n = 2). Participants participated in structured or semi-structured virtual interviews (both group and 1:1 were available). Structured interviews sought to clarify context, processes, and pathway use; semi-structured interviews targeted provider perceptions of pathway implementation, including barriers and facilitators. Analysis was guided by Hsieh and Shannon as well as Sandelowski. Across the eight sites that participated, five structured interviews (n = 13 participants) and seven semi-structured interviews (n = 15 participants) were completed. Sites represented primary care (n = 4), outpatient rehabilitation (n = 3), and COVID-19 specialty clinics (n = 2). Qualitative content analysis was used on transcripts and field notes. Provider perceptions of the early implementation outcomes of the provincial long COVID pathway revealed three key themes: process perceptions; awareness of patient educational resources; and challenges of evolving knowledge.
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Affiliation(s)
- Kiran Pohar Manhas
- Neurosciences, Rehabilitation and Vision, Strategic Clinical Network, Alberta Health Services, 10301 Southport Lane SW, Calgary, AB T2W 1S7, Canada; (J.K.); (E.P.); (C.H.)
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
- Faculty of Nursing, University of Alberta, Edmonton, AB T6G 1C9, Canada
| | - Sidney Horlick
- School of Public Health, University of Alberta, Edmonton, AB T6G 1C9, Canada; (S.H.); (K.K.B.)
| | - Jacqueline Krysa
- Neurosciences, Rehabilitation and Vision, Strategic Clinical Network, Alberta Health Services, 10301 Southport Lane SW, Calgary, AB T2W 1S7, Canada; (J.K.); (E.P.); (C.H.)
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB T6G 2E1, Canada;
| | - Katharina Kovacs Burns
- School of Public Health, University of Alberta, Edmonton, AB T6G 1C9, Canada; (S.H.); (K.K.B.)
- Department of Clinical Quality Metrics, Alberta Health Services, Edmonton, AB T5J 3E4, Canada
| | - Katelyn Brehon
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB T6G 2E1, Canada;
| | - Celia Laur
- Women’s College Hospital Institute for Health System Solutions and Virtual Care, Toronto, ON M5S 1B2, Canada;
- Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, Toronto, ON M5T 3M6, Canada
| | - Elizabeth Papathanassoglou
- Neurosciences, Rehabilitation and Vision, Strategic Clinical Network, Alberta Health Services, 10301 Southport Lane SW, Calgary, AB T2W 1S7, Canada; (J.K.); (E.P.); (C.H.)
- Faculty of Nursing, University of Alberta, Edmonton, AB T6G 1C9, Canada
| | - Chester Ho
- Neurosciences, Rehabilitation and Vision, Strategic Clinical Network, Alberta Health Services, 10301 Southport Lane SW, Calgary, AB T2W 1S7, Canada; (J.K.); (E.P.); (C.H.)
- Division of Physical Medicine and Rehabilitation, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB T6G 1C9, Canada
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Horlick S, Krysa JA, Brehon K, Pohar Manhas K, Kovacs Burns K, Russell K, Papathanassoglou E, Gross DP, Ho C. Exploring Rehabilitation Provider Experiences of Providing Health Services for People Living with Long COVID in Alberta. Int J Environ Res Public Health 2023; 20:7176. [PMID: 38131727 PMCID: PMC10743286 DOI: 10.3390/ijerph20247176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 10/10/2023] [Accepted: 11/23/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND COVID-19 infection can result in persistent symptoms, known as long COVID. Understanding the provider experience of service provision for people with long COVID symptoms is crucial for improving care quality and addressing potential challenges. Currently, there is limited knowledge about the provider experience of long COVID service delivery. AIM To explore the provider experience of delivering health services to people living with long COVID at select primary, rehabilitation, and specialty care sites. DESIGN AND SETTING This study employed qualitative description methodology. Semi-structured interviews were conducted with frontline providers at primary care, rehabilitation, and specialty care sites across Alberta. Participants were interviewed between June and September 2022. METHOD Interviews were conducted virtually over zoom, audio-recorded, and transcribed with consent. Iterative inductive qualitative content analysis of transcripts was employed. Relationships between emergent themes were examined for causality or reciprocity, then clustered into content areas and further abstracted into a priori categories through their interpretive joint meaning. PARTICIPANTS A total of 15 participants across Alberta representing diverse health care disciplines were interviewed. RESULTS Main themes include: the importance of education for long COVID recognition; the role of symptom acknowledgement in patient-centred long COVID service delivery; the need to develop recovery expectations; and opportunities for improvement of navigation and wayfinding to long COVID services. CONCLUSIONS Provider experience of delivering long COVID care can be used to inform patient-centred service delivery for persons with long COVID symptoms.
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Affiliation(s)
- Sidney Horlick
- Neurosciences, Rehabilitation and Vision, Strategic Clinical Network, Alberta Health Services, Edmonton, AB T5J 3E4, Canada (J.A.K.); (K.P.M.); (K.R.); (E.P.)
- Faculty of Nursing, University of Alberta, Edmonton, AB T6G 1C9, Canada
| | - Jacqueline A. Krysa
- Neurosciences, Rehabilitation and Vision, Strategic Clinical Network, Alberta Health Services, Edmonton, AB T5J 3E4, Canada (J.A.K.); (K.P.M.); (K.R.); (E.P.)
- Division of Physical Medicine and Rehabilitation, University of Alberta, Edmonton, AB T6G 2E1, Canada
| | - Katelyn Brehon
- Rehabilitation Research Centre, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB T6G 2G4, Canada; (K.B.); (D.P.G.)
| | - Kiran Pohar Manhas
- Neurosciences, Rehabilitation and Vision, Strategic Clinical Network, Alberta Health Services, Edmonton, AB T5J 3E4, Canada (J.A.K.); (K.P.M.); (K.R.); (E.P.)
- Faculty of Nursing, University of Alberta, Edmonton, AB T6G 1C9, Canada
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Katharina Kovacs Burns
- School of Public Health, University of Alberta, Edmonton, AB T6G 1C9, Canada;
- Department of Clinical Quality Metrics, Alberta Health Services, Edmonton, AB T5J 3E4, Canada
| | - Kristine Russell
- Neurosciences, Rehabilitation and Vision, Strategic Clinical Network, Alberta Health Services, Edmonton, AB T5J 3E4, Canada (J.A.K.); (K.P.M.); (K.R.); (E.P.)
| | - Elizabeth Papathanassoglou
- Neurosciences, Rehabilitation and Vision, Strategic Clinical Network, Alberta Health Services, Edmonton, AB T5J 3E4, Canada (J.A.K.); (K.P.M.); (K.R.); (E.P.)
- Faculty of Nursing, University of Alberta, Edmonton, AB T6G 1C9, Canada
| | - Douglas P. Gross
- Rehabilitation Research Centre, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB T6G 2G4, Canada; (K.B.); (D.P.G.)
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB T6G 2G4, Canada
| | - Chester Ho
- Neurosciences, Rehabilitation and Vision, Strategic Clinical Network, Alberta Health Services, Edmonton, AB T5J 3E4, Canada (J.A.K.); (K.P.M.); (K.R.); (E.P.)
- Division of Physical Medicine and Rehabilitation, University of Alberta, Edmonton, AB T6G 2E1, Canada
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Manhas KP, Damji K, Brehon K, Jiang J, Faris P, Costello F. Barriers to Care for Poststroke Visual Deficits in Alberta, Canada. Can J Neurol Sci 2023; 50:773-776. [PMID: 35912690 DOI: 10.1017/cjn.2022.280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Poststroke visual impairment (VI) negatively affects rehabilitation potential and quality of life for stroke survivors. In this cross-sectional observational study, stroke survivors and providers were surveyed to quantify perspectives regarding care for poststroke VI in Alberta, Canada (n = 46 survivors; n = 87 providers). Few patients (35%) felt prepared to cope with VI at the time of discharge from acute stroke and inpatient rehabilitation settings. Less than 25% of stroke survivors, and <16% of providers, felt referral processes were adequate. 95.2% of providers and 82% of stroke survivors advocated for a provincial clinical pathway to improve care quality for poststroke VI.
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Affiliation(s)
- Kiran Pohar Manhas
- Neurosciences, Rehabilitation & Vision, Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Karim Damji
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
- Department of Ophthalmology and Visual Sciences, Aga Khan University, Karachi, Pakistan
| | - Katelyn Brehon
- Faculty of Rehabilitation Medicine, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Jennis Jiang
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Peter Faris
- Health Services Statistical & Analytic Methods, Alberta Health Services, Calgary, Alberta, Canada
| | - Fiona Costello
- Departments of Clinical Neurosciences & Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Krysa JA, Horlick S, Pohar Manhas K, Kovacs Burns K, Buell M, Santana MJ, Russell K, Papathanassoglou E, Ho C. Accessing Care Services for Long COVID Sufferers in Alberta, Canada: A Random, Cross-Sectional Survey Study. Int J Environ Res Public Health 2023; 20:6457. [PMID: 37569003 PMCID: PMC10419146 DOI: 10.3390/ijerph20156457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 07/18/2023] [Accepted: 07/25/2023] [Indexed: 08/13/2023]
Abstract
Designing appropriate rehabilitation programs for long COVID-19 remains challenging. The purpose of this study was to explore the patient experience of accessing long COVID-19 rehabilitation and recovery services. In this cross-sectional, observational study, a telephone survey was administered to a random sample of persons with long COVID-19 in a Canadian province. Participants included adults who tested positive for COVID-19 between March and October 2021. Survey respondents (n = 330) included individuals who had been previously hospitalized for COVID-19 (n = 165) and those who had not been hospitalized ('non-hospitalized') for COVID-19 (n = 165). Significantly more previously hospitalized respondents visited a family doctor for long COVID-19 symptoms compared to non-hospitalized respondents (hospitalized: n = 109 (66.1%); non-hospitalized: n = 25 (15.2%); (p < 0.0001)). Previously hospitalized respondents reported significantly more referrals to specialty healthcare providers for long COVID-19 sym`ptoms (hospitalized: n = 45 (27.3%); non-hospitalized: n = 6 (3.6%); (p < 0.001)). A comparable number of respondents in both groups accessed care services that did not require a referral to manage their long COVID-19 symptoms (hospitalized: n = 31 (18.8%); non-hospitalized: n = 20 (12.1%); (p = 0.20)). These findings demonstrate the diversity of recovery services used by individuals with long COVID-19 and emphasize the need for multidisciplinary long COVID-19 rehabilitation and recovery care pathways.
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Affiliation(s)
- Jacqueline A. Krysa
- Neurosciences, Rehabilitation, and Vision Strategic Clinical Network, Alberta Health Services, Edmonton, AB T5J 3E4, Canada (M.B.); (K.R.)
- Division of Physical Medicine and Rehabilitation, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2E1, Canada
| | - Sidney Horlick
- Neurosciences, Rehabilitation, and Vision Strategic Clinical Network, Alberta Health Services, Edmonton, AB T5J 3E4, Canada (M.B.); (K.R.)
- Faculty of Nursing, University of Alberta, Edmonton, AB T6G 1C9, Canada
| | - Kiran Pohar Manhas
- Neurosciences, Rehabilitation, and Vision Strategic Clinical Network, Alberta Health Services, Edmonton, AB T5J 3E4, Canada (M.B.); (K.R.)
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Katharina Kovacs Burns
- School of Public Health, University of Alberta, Edmonton, AB T6G 1C9, Canada
- Department of Clinical Quality Metrics, Alberta Health Services, Edmonton, AB T5J 3E4, Canada
| | - Mikayla Buell
- Neurosciences, Rehabilitation, and Vision Strategic Clinical Network, Alberta Health Services, Edmonton, AB T5J 3E4, Canada (M.B.); (K.R.)
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Maria J. Santana
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Kristine Russell
- Neurosciences, Rehabilitation, and Vision Strategic Clinical Network, Alberta Health Services, Edmonton, AB T5J 3E4, Canada (M.B.); (K.R.)
| | - Elizabeth Papathanassoglou
- Neurosciences, Rehabilitation, and Vision Strategic Clinical Network, Alberta Health Services, Edmonton, AB T5J 3E4, Canada (M.B.); (K.R.)
- Faculty of Nursing, University of Alberta, Edmonton, AB T6G 1C9, Canada
| | - Chester Ho
- Neurosciences, Rehabilitation, and Vision Strategic Clinical Network, Alberta Health Services, Edmonton, AB T5J 3E4, Canada (M.B.); (K.R.)
- Division of Physical Medicine and Rehabilitation, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2E1, Canada
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Brehon K, MacIsaac R, Bhatia Z, Buck T, Charbonneau R, Crochetiere S, Donia S, Daoust J, Ho C, Kainth H, Loewen J, Lorch B, Mastrodimos K, Neunzig B, Papathanassoglou E, Parmar R, Pohar Manhas K, Tenove T, Velji E, Loyola-Sanchez A. Outcomes of Implementing a Webinar-Based Strategy to Improve Spinal Cord Injury Knowledge and Community Building: Convergent Mixed Methods Study. JMIR Rehabil Assist Technol 2023; 10:e46575. [PMID: 37351945 DOI: 10.2196/46575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 05/18/2023] [Accepted: 05/19/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND COVID-19 disrupted services received by persons with spinal cord injury (SCI) worldwide. The International Disability Alliance declared the need for a disability-inclusive response to the COVID-19 crisis, as decreased access to health care services for individuals living with varying levels of function was unacceptable. As a result, an SCI community in Canada created a novel webinar-based strategy aimed at improving access to self-management information for people living with SCI and other stakeholders. However, although telehealth practices have previously been used effectively in SCI management and rehabilitation, little to no scholarship has investigated the outcomes of implementing a webinar-based telehealth strategy in this population. OBJECTIVE This study aims to understand the outcomes of implementing the webinar series. Specifically, the authors aimed to determine the reach of the series; understand its impact on social connectedness, perceptions of disability, and overall quality of interactions among persons with SCI, their families, service providers, and the public at large; and explore the long-term sustainability of the initiative. METHODS The authors implemented a community-based participatory strategy to define a convergent mixed methods design to triangulate qualitative and quantitative data collected simultaneously. Quantitative methods included pop-up questions administered during the live webinars, surveys administered following webinars, and an analysis of YouTube analytics. Qualitative methods included semistructured interviews with persons with SCI and health care providers who attended at least one webinar. The results were integrated, following methods adapted from Creswell and Clark. RESULTS A total of 234 individuals attended at least 1 of the 6 webinars that took place during the 6-month study period. In total, 13.2% (31/234) of the participants completed the postwebinar survey, and 23% (7/31) participated in the semistructured interviews. The reach of the webinar series was mainly to persons with SCI, followed by health professionals, with most of them living in urban areas. The topics sexuality and research were the most viewed on YouTube. The knowledge disseminated during the webinars was mainly perceived as valid and useful, related to the fact that the presentation format involved people with lived experience and clinical experts. The webinars did not necessarily help build a new extended community of people involved in SCI but helped strengthen the existing community of people with SCI in Alberta. The webinar positively influenced the perceptions of normality and disability regarding people with SCI. The webinar format was perceived as highly usable and accessible. CONCLUSIONS The webinar series was associated with improved participant knowledge of what is possible to achieve after an SCI and their perceptions of disability. The long-term implementation of this initiative is feasible, but further considerations to increase its reach to rural areas and ensure the integration of diverse individuals should be taken.
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Affiliation(s)
- Katelyn Brehon
- Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada
| | - Rob MacIsaac
- Spinal Cord Injury Alberta, Edmonton, AB, Canada
| | - Zahra Bhatia
- Spinal Cord Injury Alberta, Edmonton, AB, Canada
| | - Taryn Buck
- Alberta Health Services, Edmonton, AB, Canada
| | - Rebecca Charbonneau
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
- Alberta Health Services, Calgary, AB, Canada
| | | | - Scott Donia
- Praxis Spinal Cord Institute, Vancouver, BC, Canada
| | | | - Chester Ho
- Alberta Health Services, Edmonton, AB, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Hardeep Kainth
- Alberta Health Services, Edmonton, AB, Canada
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | | | - Brandice Lorch
- Spinal Cord Injury Alberta, Edmonton, AB, Canada
- Patient Partner, Edmonton, AB, Canada
| | | | | | - Elizabeth Papathanassoglou
- Alberta Health Services, Edmonton, AB, Canada
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | | | - Kiran Pohar Manhas
- Alberta Health Services, Calgary, AB, Canada
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Terry Tenove
- Spinal Cord Injury Alberta, Edmonton, AB, Canada
| | - Elysha Velji
- Spinal Cord Injury Alberta, Edmonton, AB, Canada
| | - Adalberto Loyola-Sanchez
- Alberta Health Services, Edmonton, AB, Canada
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
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Brehon K, Carriere J, Churchill K, Loyola-Sanchez A, Papathanassoglou E, MacIsaac R, Tavakoli M, Ho C, Manhas KP. Evaluating Efficiency of a Provincial Telerehabilitation Service in Improving Access to Care During the COVID-19 Pandemic. Int J Telerehabil 2023; 15:e6523. [PMID: 38046552 PMCID: PMC10687995 DOI: 10.5195/ijt.2023.6523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023] Open
Abstract
Scope Early in the COVID-19 pandemic, community rehabilitation stakeholders from a provincial health system designed a novel telerehabilitation service. The service provided wayfinding and self-management advice to individuals with musculoskeletal concerns, neurological conditions, or post-COVID-19 recovery needs. This study evaluated the efficiency of the service in improving access to care. Methodology We used multiple methods including secondary data analyses of call metrics, narrative analyses of clinical notes using artificial intelligence (AI) and machine learning (ML), and qualitative interviews. Conclusions Interviews revealed that the telerehabilitation service had the potential to positively impact access to rehabilitation during the COVID-19 pandemic, for individuals living rurally, and for individuals on wait lists. Call metric analyses revealed that efficiency may be enhanced if call handling time was reduced. AI/ML analyses found that pain was the most frequently-mentioned keyword in clinical notes, suggesting an area for additional telerehabilitation resources to ensure efficiency.
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Affiliation(s)
- Katelyn Brehon
- Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
| | - Jay Carriere
- Department of Electrical and Software Engineering, University of Calgary, Calgary, Alberta, Canada
| | - Katie Churchill
- Allied Health Professional Practice and Education, Alberta Health Services, Alberta, Canada
- Department of Occupational Therapy, University of Alberta, Edmonton, Alberta, Canada
| | | | - Elizabeth Papathanassoglou
- Neurosciences, Rehabilitation, and Vision Strategic Clinical Network, Alberta Health Services, Alberta, Canada
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Rob MacIsaac
- Spinal Cord Injury Alberta, Edmonton, Alberta, Canada
| | - Mahdi Tavakoli
- Department of Electrical and Computer Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - Chester Ho
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
- Neurosciences, Rehabilitation, and Vision Strategic Clinical Network, Alberta Health Services, Alberta, Canada
| | - Kiran Pohar Manhas
- Neurosciences, Rehabilitation, and Vision Strategic Clinical Network, Alberta Health Services, Alberta, Canada
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
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Krysa JA, Buell M, Pohar Manhas K, Kovacs Burns K, Santana MJ, Horlick S, Russell K, Papathanassoglou E, Ho C. Understanding the Experience of Long COVID Symptoms in Hospitalized and Non-Hospitalized Individuals: A Random, Cross-Sectional Survey Study. Healthcare (Basel) 2023; 11:healthcare11091309. [PMID: 37174851 PMCID: PMC10178853 DOI: 10.3390/healthcare11091309] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/21/2023] [Accepted: 04/28/2023] [Indexed: 05/15/2023] Open
Abstract
The relationship between initial COVID-19 infection and the development of long COVID remains unclear. The purpose of this study was to compare the experience of long COVID in previously hospitalized and non-hospitalized adults in a community-based, cross-sectional telephone survey. Participants included persons with positive COVID-19 test results between 21 March 2021 and 21 October 2021 in Alberta, Canada. The survey included 330 respondents (29.1% response rate), which included 165 previously hospitalized and 165 non-hospitalized individuals. Significantly more previously hospitalized respondents self-reported long COVID symptoms (81 (49.1%)) compared to non-hospitalized respondents (42 (25.5%), p < 0.0001). Most respondents in both groups experienced these symptoms for more than 6 months (hospitalized: 66 (81.5%); non-hospitalized: 25 (59.5), p = 0.06). Hospitalized respondents with long COVID symptoms reported greater limitations on everyday activities from their symptoms compared to non-hospitalized respondents (p < 0.0001) and tended to experience a greater impact on returning to work (unable to return to work-hospitalized: 20 (19.1%); non-hospitalized: 6 (4.5%), p < 0.0001). No significant differences in self-reported long COVID symptoms were found between male and female respondents in both groups (p > 0.05). This study provides novel data to further support that individuals who were hospitalized for COVID-19 appear more likely to experience long COVID symptoms.
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Affiliation(s)
- Jacqueline A Krysa
- Neurosciences, Rehabilitation and Vision, Strategic Clinical Network, Alberta Health Services, Edmonton, AB T5J 3E4, Canada
- Division of Physical Medicine and Rehabilitation, University of Alberta, Edmonton, AB T6G 2E1, Canada
| | - Mikayla Buell
- Neurosciences, Rehabilitation and Vision, Strategic Clinical Network, Alberta Health Services, Edmonton, AB T5J 3E4, Canada
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Kiran Pohar Manhas
- Neurosciences, Rehabilitation and Vision, Strategic Clinical Network, Alberta Health Services, Edmonton, AB T5J 3E4, Canada
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Katharina Kovacs Burns
- School of Public Health, University of Alberta, Edmonton, AB T6G 1C9, Canada
- Department of Clinical Quality Metrics, Alberta Health Services, Edmonton, AB T5J 3E4, Canada
| | - Maria J Santana
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Sidney Horlick
- Neurosciences, Rehabilitation and Vision, Strategic Clinical Network, Alberta Health Services, Edmonton, AB T5J 3E4, Canada
- Faculty of Nursing, University of Alberta, Edmonton AB T6G 1C9, Canada
| | - Kristine Russell
- Neurosciences, Rehabilitation and Vision, Strategic Clinical Network, Alberta Health Services, Edmonton, AB T5J 3E4, Canada
| | - Elizabeth Papathanassoglou
- Neurosciences, Rehabilitation and Vision, Strategic Clinical Network, Alberta Health Services, Edmonton, AB T5J 3E4, Canada
- Faculty of Nursing, University of Alberta, Edmonton AB T6G 1C9, Canada
| | - Chester Ho
- Neurosciences, Rehabilitation and Vision, Strategic Clinical Network, Alberta Health Services, Edmonton, AB T5J 3E4, Canada
- Division of Physical Medicine and Rehabilitation, University of Alberta, Edmonton, AB T6G 2E1, Canada
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Manhas KP, Brehon K, Jiang J, Damji KF, Costello F. A qualitative description of barriers to visual rehabilitation experienced by stroke survivors with visual impairment in Alberta, Canada. BMC Health Serv Res 2023; 23:58. [PMID: 36658565 PMCID: PMC9854189 DOI: 10.1186/s12913-023-09064-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 01/13/2023] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Post-stroke visual impairment (VI) is a common but under-recognized care challenge. Common manifestations of post-stroke VI include: diplopia, homonymous hemianopia, oscillopsia secondary to nystagmus, and visual inattention or neglect. In acute care settings, post-stroke VI recognition and treatment are often sub-optimal as emphasis is placed on survival. Stroke survivors with VI often face inconsistencies when accessing care out of hospital because variable availability and subsidization of visual rehabilitation. We sought to identify gaps in care experienced by stroke survivors with VI from stroke survivors' and care providers' perspectives. METHODS We conducted a qualitative description study across 12 care sites in Alberta, Canada, using semi-structured interviews. Survivor interviews focused on the health system experience. Provider interviews discussed approaches to care, perceived gaps, and current resources. Interviews were audio-recorded and transcribed. Iterative content analysis was completed using NVivo 12. We promoted rigour through an audit trail, open-ended questions, thick description, and collaborative coding. RESULTS We completed 50 interviews: 19 survivor interviews and 31 provider interviews. The majority of survivors were male (n = 14) and recruited from community settings (n = 16). Providers varied in profession and location within the care continuum. Two key themes emerged from the provider and survivor interviews pertaining to (a) facets of visual rehabilitation (sub-themes: access, resources, and multidisciplinary professional interaction); and (b) functioning with post-stroke VI (sub-themes: early experiences post-stroke and living with VI in the real world). CONCLUSIONS The visual rehabilitation model needs to be optimized to ensure transparent inter-disciplinary communication and efficient referral pathways. Future research will focus on evaluating the effectiveness of post-stroke care from multiple perspectives in Alberta.
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Affiliation(s)
- Kiran Pohar Manhas
- Neurosciences, Rehabilitation and Vision, Strategic Clinical NetworkAlberta Health Services, 10301 Southport Lane SW, Calgary, AB T2W 1S7 Canada ,grid.22072.350000 0004 1936 7697Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB Canada ,grid.17089.370000 0001 2190 316XFaculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB Canada
| | - Katelyn Brehon
- grid.17089.370000 0001 2190 316XDepartment of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB Canada
| | - Jennis Jiang
- grid.22072.350000 0004 1936 7697Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB Canada
| | - Karim F. Damji
- grid.17089.370000 0001 2190 316XDepartment of Ophthalmology and Visual Sciences, Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, Edmonton, AB Canada ,grid.7147.50000 0001 0633 6224Department of Ophthalmology and Visual Sciences, Aga Khan University, Karachi, Pakistan
| | - Fiona Costello
- grid.22072.350000 0004 1936 7697Departments of Clinical Neurosciences and Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB Canada
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9
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Krysa JA, Ho C, O'Connell P, Pohar Manhas K. Clinical practice recommendations for prehabilitation and post-operative rehabilitation for arthroplasty: A scoping review. Musculoskeletal Care 2022; 20:503-515. [PMID: 35165992 DOI: 10.1002/msc.1621] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 01/29/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND The rising need for arthroplasty (joint replacement) has resulted in a significant increase in wait-times. Longer surgical wait-times may further exacerbate functional decline in adults with osteoarthritis as well as delay postoperative functional recovery. This review aims to better inform rehabilitation care provision before (prehabilitation) and after (post-rehabilitation) hip or knee arthroplasty based on recommendations from clinical practice guidelines (CPGs). METHODS This scoping review used a three-stage process to screen and extract articles, which resulted in 123 articles reviewed for analysis. Included CPGs were in the English language and focussed on rehabilitation interventions or practices involving adult patients preparing for or recuperating from hip and knee arthroplasty (published 2009-2020). RESULTS Patient assessments, use of assistive devices, as well as self-management and education programs were recommended before and after arthroplasty. Physiotherapy was recommended to support post-operative rehabilitation. Conversely, there was limited evidence supporting recommendations for or against physiotherapy during the prehabilitation phase of the arthroplasty care journey. CONCLUSIONS The findings from this review highlight the current gap in high-quality evidence supporting hip and knee arthroplasty rehabilitation CPGs before and after surgery. Findings warrant additional research to ensure patients are best prepared for surgery and supported for optimal recovery.
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Affiliation(s)
- Jacqueline A Krysa
- Neurosciences, Rehabilitation and Vision Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada
- Department of Physical Medicine and Rehabilitation, University of Alberta, Edmonton, Alberta, Canada
| | - Chester Ho
- Neurosciences, Rehabilitation and Vision Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada
- Department of Physical Medicine and Rehabilitation, University of Alberta, Edmonton, Alberta, Canada
| | - Petra O'Connell
- Neurosciences, Rehabilitation and Vision Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada
| | - Kiran Pohar Manhas
- Neurosciences, Rehabilitation and Vision Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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10
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Manhas KP, O’Connell P, Krysa J, Henderson I, Ho C, Papathanassoglou E. Development of a Novel Care Rehabilitation Pathway for Post-COVID Conditions (Long COVID) in a Provincial Health System in Alberta, Canada. Phys Ther 2022; 102:6619487. [PMID: 35778936 PMCID: PMC9384405 DOI: 10.1093/ptj/pzac090] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/22/2021] [Accepted: 01/26/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The purpose of this study was to describe the development and composition of a codesigned, multidisciplinary, integrated, systematic rehabilitation framework for post-COVID conditions (PCC) that spans the care continuum to streamline and standardize rehabilitation services to support persons with PCC in Alberta, Canada. METHODS A collaborative, consensus-based approach was used involving 2 iterative provincial taskforces in a Canadian provincial health system. The first taskforce (59 multidisciplinary stakeholders) sought to clarify the requisite facets of a sustainable, provincially coordinated rehabilitation approach for post-COVID rehabilitation needs based on available research evidence. The second taskforce (129 multidisciplinary stakeholders) translated that strategy and criteria into an operational framework for provincial implementation. Both taskforces sought to align with operational realities of the provincial health system. RESULTS The summation of this collaborative consensus approach resulted in the Provincial Post COVID-19 Rehabilitation Response Framework (PCRF). The PCRF includes 3 care pathways across the care continuum specifically targeting in-hospital care, continuing care, and community-based care with 3 key elements: (1) the use of specific symptom screening and assessment tools to systematically identify PCC symptoms and functional impairments, (2) pathways to determine patients' rehabilitation trajectory and guide their transition between care settings, and (3) self-management and education resources for patients and providers. CONCLUSION The PCRF aligns with international mandates for novel, codesigned, multidisciplinary approaches to systematically address PCC and its myriad manifestations across the care continuum. The PCRF allows for local adaptation and highlights equity considerations, allowing for further spread and scale provincially, nationally, and internationally. IMPACT The PCRF is a framework for health systems to ensure consistent identification, assessment, and management of the rehabilitation needs of postacute and chronic PCC. Rehabilitation providers and health systems can build from the PCRF for their local communities to reduce unmet needs and advance the standardization of access to rehabilitation services for persons with PCC.
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Affiliation(s)
- Kiran Pohar Manhas
- Address all correspondence to Kiran Pohar Manhas at: . Follow the author @KiranManhas2
| | - Petra O’Connell
- Neurosciences Rehabilitation & Vision Strategic Clinical Network™, Alberta Health Services, Edmonton, Alberta, Canada
| | - Jacqueline Krysa
- Faculty of Medicine & Dentistry, Division of Physical Medicine & Rehabilitation, University of Alberta, Edmonton, Alberta, Canada
| | - Isabel Henderson
- Clinical Operations, Emergency Coordination Centre/Readiness & Recovery Centre, Alberta Health Services, Edmonton, Alberta, Canada
| | - Chester Ho
- Neurosciences Rehabilitation & Vision Strategic Clinical Network™, Alberta Health Services, Edmonton, Alberta, Canada,Faculty of Medicine & Dentistry, Division of Physical Medicine & Rehabilitation, University of Alberta, Edmonton, Alberta, Canada
| | - Elisavet Papathanassoglou
- Neurosciences Rehabilitation & Vision Strategic Clinical Network™, Alberta Health Services, Edmonton, Alberta, Canada,Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
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11
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Krysa JA, Gregorio MP, Pohar Manhas K, MacIsaac R, Papathanassoglou E, Ho CH. Empowerment, Communication, and Navigating Care: The Experience of Persons With Spinal Cord Injury From Acute Hospitalization to Inpatient Rehabilitation. Front Rehabilit Sci 2022; 3:904716. [PMID: 36188987 PMCID: PMC9397833 DOI: 10.3389/fresc.2022.904716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 04/19/2022] [Indexed: 11/25/2022]
Abstract
Background Spinal cord injury (SCI) results in long-term functional impairments that significantly impact participation and role in the community. Newly injured persons are often reintroduced to the community with significant deficits in knowledge, including how to access and navigate community resources and supports. This warrants a better understanding of the patient experience of in-hospital care and discharge planning to ensure individuals with SCI are best supported during transitions in care and while living in the community. Objective To explore the lived experience of persons with acute SCI and their perceptions of care, focusing on the initial hospital experiences to inpatient rehabilitation. Methods A phenomenological research study was conducted using semi-structured interviews. Eligible participants had differing etiologies of SCI (including non-traumatic and traumatic SCI), were over the age of 18 at the time of initial care, and experienced acute hospital and inpatient rehabilitation at an Alberta-based institution within the last 10 years. One-on-one interviews took place between March and June 2021 over telephone or virtual platforms (Zoom). Interview transcripts, and field notes developed the text, which underwent hermeneutic analysis to develop central themes. Results The present study included 10 participants living with an SCI in Alberta, Canada. Most participants (80%) were male. Participants' age ranged from 24 to 69 years. The median years since initial SCI was 3 years. Interviews lasted 45–75 min. Seven participants identified as having a traumatic SCI injury and three identified as having a non-traumatic SCI. The interplay between empowerment and disempowerment emerged as the core theme, permeating participants' meanings and perceptions. Three main themes emerged from the interviews regarding the perceptions of the SCI patient experience. Each theme represents a perception central to their inpatient experience: desire to enhance functional independence to empower confidence and self-management; need for effective communication with healthcare providers to support recovery; and navigating appropriate care supports to enhance preparedness for discharge and returning home. Conclusion This study demonstrates the significant need to enhance education of person/family-centered SCI care, foster positive communication between care recipients and care providers, and facilitate better in-hospital access to appropriate navigation and wayfinding supports.
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Affiliation(s)
- Jacqueline A. Krysa
- Neurosciences, Rehabilitation, and Vision Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada
- Division of Physical Medicine and Rehabilitation, University of Alberta, Edmonton, AB, Canada
| | - Marianne Pearl Gregorio
- Neurosciences, Rehabilitation, and Vision Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Kiran Pohar Manhas
- Neurosciences, Rehabilitation, and Vision Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Rob MacIsaac
- Spinal Cord Injury Alberta, Edmonton, AB, Canada
| | - Elizabeth Papathanassoglou
- Neurosciences, Rehabilitation, and Vision Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Chester H. Ho
- Neurosciences, Rehabilitation, and Vision Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada
- Division of Physical Medicine and Rehabilitation, University of Alberta, Edmonton, AB, Canada
- *Correspondence: Chester H. Ho
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12
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Manhas KP, Olson K, Churchill K, Miller J, Teare S, Vohra S, Wasylak T. Exploring patient centredness, communication and shared decision-making under a new model of care: Community rehabilitation in canada. Health Soc Care Community 2022; 30:1051-1063. [PMID: 33825236 DOI: 10.1111/hsc.13304] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 12/16/2020] [Accepted: 01/05/2021] [Indexed: 05/27/2023]
Abstract
Patient-centred care and patient engagement in healthcare and health research are widely mandated by funders, health systems and institutions. Increasingly, shared decision-making (SDM) is recognised as promoting patient-centred care. We explore this relationship by studying SDM in the context of integrating novel patient-centred policies in community rehabilitation. There is little research on SDM in rehabilitation, and less so in the critical community context. Patient co-investigators led study co-design. We aimed to describe how patients and providers experience SDM at community rehabilitation sites that adopted a novel, patient-centred Rehabilitation Model of Care (RMoC). Guided by focused ethnography, we conducted focus groups and interviews. Patient and professional participants were recruited from 10 RMoC early-adopter community rehabilitation sites. Sites varied in geography, patient population and provider disciplines. Patient and community engagement researchers used a set-collect-reflect method to document patient perspectives. Researchers captured provider perspectives using a semi-structured question guide. We completed 11 focus groups and 18 interviews (n = 45 providers, n = 17 patients). We found that most early-adopter providers spoke in a shared, patient-first language that focused on patient readiness, barriers and active listening. Congruent patient perceptions reflected inclusion in decision-making, goal setting and positive relationships. Many patients queried how care would become and remain accessible before and after community rehabilitation care respectively. Remaining connected while in the community was described as important to patients. Providers identified barriers like time, team dynamics and lack of clarity on the RMoC aims, which challenged the initiative's long-term sustainability. Policy innovations can promote SDM and communication through multiple strategies and training to facilitate candid, encouraging conversations. Sustainability of SDM gains is paramount. Most providers moved beyond tokenistic engagement, but competing responsibilities and team member resistance could thwart continuity. Further research is needed to empirically assess respectful and compassionate communication and SDM in community rehabilitation long term.
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Affiliation(s)
- Kiran Pohar Manhas
- Alberta Health Services, Calgary, Canada
- Integrative Health Institute, University of Alberta, Edmonton, Canada
| | - Karin Olson
- Integrative Health Institute, University of Alberta, Edmonton, Canada
- Faculty of Nursing, University of Alberta, Edmonton, Canada
| | - Katie Churchill
- Alberta Health Services, Calgary, Canada
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Occupational Therapy, University of Alberta, Edmonton, Canada
| | - Jean Miller
- Patient and Community Engagement Research Program, O'Brien Institute for Public Health, University of Calgary, Calgary, Canada
| | - Sylvia Teare
- Patient and Community Engagement Research Program, O'Brien Institute for Public Health, University of Calgary, Calgary, Canada
| | - Sunita Vohra
- Integrative Health Institute, University of Alberta, Edmonton, Canada
- Departments of Pediatrics and Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | - Tracy Wasylak
- Alberta Health Services, Calgary, Canada
- Faculty of Nursing, University of Calgary, Calgary, Canada
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13
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Brehon K, Carriere J, Churchill K, Loyola-Sanchez A, O’Connell P, Papathanasoglou E, MacIsaac R, Tavakoli M, Ho C, Manhas KP. Evaluating the impact of a novel telerehabilitation service to address neurological, musculoskeletal, or coronavirus disease 2019 rehabilitation concerns during the coronavirus disease 2019 pandemic. Digit Health 2022; 8:20552076221101684. [PMID: 35603329 PMCID: PMC9121506 DOI: 10.1177/20552076221101684] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 04/27/2022] [Indexed: 01/08/2023] Open
Abstract
Introduction A novel telerehabilitation service provides wayfinding and self-management
advice to persons with neurological, musculoskeletal, or coronavirus disease
2019 related rehabilitation needs. Method We utilized multiple methods to evaluate the impact of the service. Surveys
clarified health outcomes (quality of life, self-efficacy, social support)
and patient experience (telehealth usability; general experience) 3-months
post-call. We analysed associations between, and within, demographics and
survey responses. Secondary analyses described health care utilization
during the first 6 months. Results Sixty-eight callers completed the survey (42% response rate). Self-efficacy
was significantly related to quality of life, interpersonal support and
becoming productive quickly using the service. Becoming productive quickly
was significantly related to quality of life. Education level was related to
ethnicity. Survey respondents’ satisfaction and whether they followed the
therapist's recommendations were not significantly associated with
demographics. Administrative data indicated there were 124 callers who
visited the emergency department before, on, or after their call. The
average (SD) frequency of emergency department visits before was 1.298 times
(1.799) compared to 0.863 times (1.428) after. Discussion This study offers insights into the potential impact of the
telerehabilitation service amidst pandemic restrictions. Usability
measurements showed that callers were satisfied, corroborating literature
from pre-pandemic contexts. The satisfaction and acceptability of the
service does not supplant preferences for in-person visits. The survey
sample reported lower quality of life compared with the provincial
population, conflicting with pre-pandemic research. Findings may be due to
added stressors associated with the pandemic. Future research should include
population-level comparators to better clarify impact.
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Affiliation(s)
- Katelyn Brehon
- Department of Physical Therapy, University of Alberta, Edmonton, Canada
| | - Jay Carriere
- Department of Electrical and Software Engineering, University of Calgary, Edmonton, Canada
| | | | | | - Petra O’Connell
- Neurosciences, Rehabilitation, and Vision Strategic Clinical Network, Alberta Health Services, Calgary, Canada
| | - Elisavet Papathanasoglou
- Neurosciences, Rehabilitation, and Vision Strategic Clinical Network, Alberta Health Services, Calgary, Canada
- Faculty of Nursing, University of Alberta, Edmonton, Canada
| | | | - Mahdi Tavakoli
- Department of Electrical Engineering, University of Alberta, Edmonton, Canada
| | - Chester Ho
- Department of Medicine, University of Alberta, Edmonton, Canada
- Neurosciences, Rehabilitation, and Vision Strategic Clinical Network, Alberta Health Services, Calgary, Canada
| | - Kiran Pohar Manhas
- Neurosciences, Rehabilitation, and Vision Strategic Clinical Network, Alberta Health Services, Calgary, Canada
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14
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Brehon K, Carriere J, Churchill K, Loyola-Sanchez A, O'Connell P, Papathanassoglou E, MacIsaac R, Tavakoli M, Ho C, Pohar Manhas K. Evaluating Community-Facing Virtual Modalities to Support Complex Neurological Populations During the COVID-19 Pandemic: Protocol for a Mixed Methods Study. JMIR Res Protoc 2021; 10:e28267. [PMID: 34101610 PMCID: PMC8315160 DOI: 10.2196/28267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/26/2021] [Accepted: 06/04/2021] [Indexed: 01/19/2023] Open
Abstract
Background The COVID-19 pandemic and concomitant governmental responses have created the need for innovative and collaborative approaches to deliver services, especially for populations that have been inequitably affected. In Alberta, Canada, two novel approaches were created in Spring 2020 to remotely support patients with complex neurological conditions and rehabilitation needs. The first approach is a telehealth service that provides wayfinding and self-management advice to Albertans with physical concerns related to existing neurological or musculoskeletal conditions or post-COVID-19 recovery needs. The second approach is a webinar series aimed at supporting self-management and social connectedness of individuals living with spinal cord injury. Objective The study aims to evaluate the short- and long-term impacts and sustainability of two virtual modalities (telehealth initiative called Rehabilitation Advice Line [RAL] and webinar series called Alberta Spinal Cord Injury Community Interactive Learning Seminars [AB-SCILS]) aimed at advancing self-management, connectedness, and rehabilitation needs during the COVID-19 pandemic and beyond. Methods We will use a mixed-methods evaluation approach. Evaluation of the approaches will include one-on-one semistructured interviews and surveys. The evaluation of the telehealth initiative will include secondary data analyses and analysis of call data using artificial intelligence. The evaluation of the webinar series will include analysis of poll questions collected during the webinars and YouTube analytics data. Results The proposed study describes unique pandemic virtual modalities and our approaches to evaluating them to ensure effectiveness and sustainability. Implementing and evaluating these virtual modalities synchronously allows for the building of knowledge on the complementarity of these methods. At the time of submission, we have completed qualitative and quantitative data collection for the telehealth evaluation. For the webinar series, so far, we have distributed the evaluation survey following three webinars and have conducted five attendee interviews. Conclusions Understanding the impact and sustainability of the proposed telehealth modalities is important. The results of the evaluation will provide data that can be actioned and serve to improve other telehealth modalities in the future, since health systems need this information to make decisions on resource allocation, especially in an uncertain pandemic climate. Evaluating the RAL and AB-SCILS to ensure their effectiveness demonstrates that Alberta Health Services and the health system care about ensuring the best practice even after a shift to primarily virtual care. International Registered Report Identifier (IRRID) DERR1-10.2196/28267
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Affiliation(s)
- Katelyn Brehon
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Jay Carriere
- Department of Electrical and Computer Engineering, University of Alberta, Edmonton, AB, Canada
| | - Katie Churchill
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Adalberto Loyola-Sanchez
- Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Alberta, Edmonton, AB, Canada
| | - Petra O'Connell
- Obesity Diabetes Nutrition Strategic Clinical Network, Alberta Health Services, Calgary, AB, Canada.,Neurosciences, Rehabilitation & Vision Strategic Clinical Network, Alberta Health Services, Calgary, AB, Canada
| | - Elisavet Papathanassoglou
- Neurosciences, Rehabilitation & Vision Strategic Clinical Network, Alberta Health Services, Calgary, AB, Canada
| | - Rob MacIsaac
- Spinal Cord Injury Alberta, Edmonton, AB, Canada
| | - Mahdi Tavakoli
- Department of Electrical and Computer Engineering, University of Alberta, Edmonton, AB, Canada
| | - Chester Ho
- Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Alberta, Edmonton, AB, Canada.,Neurosciences, Rehabilitation & Vision Strategic Clinical Network, Alberta Health Services, Calgary, AB, Canada
| | - Kiran Pohar Manhas
- Neurosciences, Rehabilitation & Vision Strategic Clinical Network, Alberta Health Services, Calgary, AB, Canada
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15
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Newton J, Wuerch E, Thomas N, Seo B, Lang E, Pohar Manhas K. Developing a Mobile App for Concussion to aid Patient Empowerment and Symptom Management. Cureus 2021; 13:e15972. [PMID: 34336464 PMCID: PMC8315863 DOI: 10.7759/cureus.15972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2021] [Indexed: 11/11/2022] Open
Abstract
Despite the high prevalence of concussions each year in Canada, access to consistent and science-based information on how to self-manage these injuries remains a significant hurdle for many patients. Currently, available mobile applications (apps) focus mainly on supporting patients with sports-related concussions, although falls account for more traumatic brain injuries (TBI) than sports-related TBI's in Alberta. Patients from a broader demographic may be limited from accessing information on how to correctly manage and track their symptoms as they feel that currently available resources are not applicable to them. Through collaboration between health system leaders, expert consultations, patients, and university students, a mobile app was designed as a platform to help patients manage and track symptoms at home, as well as to clarify misleading information and misconceptions surrounding injury. The team engaged numerous physicians, patient advisors, and health system leaders to improve upon the features of currently-existing concussion apps such as symptom tracking, insight into concussion, and strategies for returning to work/school that are more inclusive to adult, non-sports related injuries. We believe that these features will advance recovery by alleviating the burden of uncertainty and confusion for patients and their family members.
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Affiliation(s)
- Janna Newton
- Emergency Medicine, University of Calgary, Calgary, CAN
| | - Emily Wuerch
- Emergency Medicine, University of Calgary, Calgary, CAN
| | - Noel Thomas
- Emergency Medicine, University of Calgary, Calgary, CAN
| | - Boogyung Seo
- Emergency Medicine, University of Calgary, Calgary, CAN
| | - Eddy Lang
- Emergency Medicine, University of Calgary, Calgary, CAN
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16
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Manhas KP, Olson K, Churchill K, Vohra S, Wasylak T. Implementation of a novel rehabilitation model of care across Alberta, Canada: a focused ethnography. BMJ Open Qual 2021; 10:bmjoq-2020-001261. [PMID: 33758007 PMCID: PMC7993209 DOI: 10.1136/bmjoq-2020-001261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 03/03/2021] [Accepted: 03/07/2021] [Indexed: 11/21/2022] Open
Abstract
Background In 2017, a provincial health-system released a Rehabilitation Model of Care (RMoC) to promote patient-centred care, provincial standardisation and data-driven innovation. Eighteen early-adopter community-rehabilitation teams implemented the RMoC using a 1.5-year-long Innovation Learning Collaborative (in-person learning sessions; balanced scorecards). More research is required on developing, implementing and evaluating models of care. We aimed to explore experiences of early-adopter providers and provincial consultants involved in the community-rehabilitation RMoC implementation in Alberta, Canada. Methods Using focused ethnography, we used focus groups (or interviews for feasibility/confidentiality) and aggregate, site-level data analysis of RMoC standardised metrics. Purposive sampling ensured representation across geography, service types and patient populations. Team-specific focus groups were onsite and led by a researcher-moderator and cofacilitator. A semistructured question guide promoted discussions on interesting/challenging occurrences; perceptions of RMoC impact and perceptions of successful implementation. Focus groups and interviews were audio-recorded and transcribed alongside field notes. Data collection and analysis were concurrent to saturation. Transcripts coding involves collapsing similar ideas into themes, with intertheme relationships identified. Rigour tactics included negative case analysis, thick description and audit trail. Results We completed 11 focus groups and seven interviews (03/2018 to 01/2019) (n=45). Participants were 89.6% women, mostly Canadian trained and represented diverse rehabilitation professions. The implementation experience involved navigating emotions, operating among dynamics and integrating the RMoC details. Confident, satisfied early-adopter teams demonstrated traits including strong coping strategies; management support and being opportunistic and candid about failure. Teams faced common challenges (eg, emotions of change; delayed data access and lack of efficient, memorable communication across team and site). Implementation success targeted patient, team and system levels. Conclusions We recommend training priorities for future teams including evaluation training for novice teams; timelines for stepwise implementation; on-site, in-person time with a facilitator and full-team present and prolonged facilitated introductions between similar teams for long-term mentorship.
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Affiliation(s)
- Kiran Pohar Manhas
- Neurosciences, Rehabilitation & Vision Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
| | - Karin Olson
- Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Katie Churchill
- Health Professions, Strategy and Practice, Alberta Health Services, Calgary, Alberta, Canada
| | - Sunita Vohra
- Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Tracy Wasylak
- Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
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17
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Carriere J, Shafi H, Brehon K, Pohar Manhas K, Churchill K, Ho C, Tavakoli M. Case Report: Utilizing AI and NLP to Assist with Healthcare and Rehabilitation During the COVID-19 Pandemic. Front Artif Intell 2021; 4:613637. [PMID: 33733232 PMCID: PMC7907599 DOI: 10.3389/frai.2021.613637] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 01/08/2021] [Indexed: 01/16/2023] Open
Abstract
The COVID-19 pandemic has profoundly affected healthcare systems and healthcare delivery worldwide. Policy makers are utilizing social distancing and isolation policies to reduce the risk of transmission and spread of COVID-19, while the research, development, and testing of antiviral treatments and vaccines are ongoing. As part of these isolation policies, in-person healthcare delivery has been reduced, or eliminated, to avoid the risk of COVID-19 infection in high-risk and vulnerable populations, particularly those with comorbidities. Clinicians, occupational therapists, and physiotherapists have traditionally relied on in-person diagnosis and treatment of acute and chronic musculoskeletal (MSK) and neurological conditions and illnesses. The assessment and rehabilitation of persons with acute and chronic conditions has, therefore, been particularly impacted during the pandemic. This article presents a perspective on how Artificial Intelligence and Machine Learning (AI/ML) technologies, such as Natural Language Processing (NLP), can be used to assist with assessment and rehabilitation for acute and chronic conditions.
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Affiliation(s)
- Jay Carriere
- Department of Electrical and Computer Engineering, University of Alberta, Edmonton, AB, Canada
| | - Hareem Shafi
- Department of Electrical and Computer Engineering, University of Alberta, Edmonton, AB, Canada
| | - Katelyn Brehon
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Kiran Pohar Manhas
- Neurosciences, Rehabilitation, and Vision Strategic Clinical Network, Alberta Health Services, Calgary, AB, Canada
| | - Katie Churchill
- Department of Occupational Therapy, University of Alberta, Edmonton, AB, Canada.,Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Chester Ho
- Neurosciences, Rehabilitation, and Vision Strategic Clinical Network, Alberta Health Services, Calgary, AB, Canada.,Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Mahdi Tavakoli
- Department of Electrical and Computer Engineering, University of Alberta, Edmonton, AB, Canada
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18
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Blanchette MA, Saari M, Aubrecht K, Bailey C, Cheng I, Embrett M, Ghandour EK, Haw J, Koval A, Liu RH, Manhas KP, Mawani FN, Mcconnell-Nzunga J, Petricca K, Sim M, Singal D, Syrowatka A, Lai J. Making Contributions and Defining Success: An eDelphi Study of the Inaugural Cohort of CIHR Health System Impact Fellows, Host Supervisors and Academic Supervisors. ACTA ACUST UNITED AC 2020; 15:49-60. [PMID: 31755859 PMCID: PMC7017753 DOI: 10.12927/hcpol.2019.25980] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Context: The Health System Impact (HSI) Fellowship, an innovative training program developed by the Canadian Institutes of Health Research's Institute of Health Services and Policy Research, provides PhD-trained health researchers with an embedded, experiential learning opportunity within a health system organization. Methods/Design: An electronic Delphi (eDelphi) study was conducted to: (1) identify the criteria used to define success in the program and (2) elucidate the main contributions fellows made to their organizations. Through an iterative, two-round eDelphi process, perspectives were elicited from three stakeholder groups in the inaugural cohort of the HSI Fellowship: HSI fellows, host supervisors and academic supervisors. Discussion: A consensus was reached on many criteria of success for an embedded research fellowship and on several perceived contributions of the fellows to their host organization and academic institutions. This work begins to identify specific criteria for success in the fellowship that can be used to improve future iterations of the program.
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Affiliation(s)
- Marc-André Blanchette
- Département de chiropratique, Université du Québec à Trois-Rivières; Epidemiology, Biostatistics and Occupational Health, McGill University; Institut national d'excellence en santé et services sociaux, Trois-Rivières, QC
| | - Margaret Saari
- SE Research Centre, SE Health and School of Public Health and Health Systems, University of Waterloo, Waterloo, ON
| | - Katie Aubrecht
- Nova Scotia Health Authority Continuing Care-Research, Mount Saint Vincent University, Halifax, NS
| | - Chantelle Bailey
- Canadian Nurses Association and the Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON
| | - Ivy Cheng
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON
| | - Mark Embrett
- Canada Health Infoway, McMaster University, Toronto, ON
| | | | - Jennie Haw
- Canadian Blood Services, Western University, Ottawa, ON
| | - Andriy Koval
- Observatory for Population and Public Health, University of British Columbia, Vancouver, BC
| | - Rebecca H Liu
- University of Ottawa, Region of Peel Public Health, Toronto, ON
| | | | - Farah N Mawani
- MAP Centre for Urban Health Solutions St. Michael's Hospital; Faculty of Environmental Studies, York University, Toronto, ON
| | | | - Kadia Petricca
- North York General Hospital, Department of Research and Innovation, University of Toronto, IHPME, Toronto, ON
| | - Meaghan Sim
- Nova Scotia Health Authority; Healthy Populations Institute, Dalhousie University, Halifax, NS
| | - Deepa Singal
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB
| | - Ania Syrowatka
- Canadian Foundation for Healthcare Improvement, University of Toronto, Institute of Health Policy, Management and Evaluation, Toronto, ON
| | - Jonathan Lai
- Centre for Innovation in Autism and Intellectual Disabilities, Miriam Foundation, co-funded by Mitacs, School of Physical and Occupational Therapy, McGill University, Montreal, QC
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Manhas KP, Olson K, Churchill K, Faris P, Vohra S, Wasylak T. Measuring shared decision-making and collaborative goal setting in community rehabilitation: a focused ethnography using cross-sectional surveys in Canada. BMJ Open 2020; 10:e034745. [PMID: 32819982 PMCID: PMC7443299 DOI: 10.1136/bmjopen-2019-034745] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE To describe and measure the shared decision-making (SDM) experience, including goal-setting experiences, from the perspective of patients and providers in diverse community-rehabilitation settings. DESIGN Prospective, longitudinal surveys. SETTING 13 primary level-of-care community-rehabilitation sites in diverse areas varying in geography, patient population and provider discipline341 adult, English-speaking patient-participants, and 66 provider-participants. MEASURES Alberta Shared decision-maKing Measurement Instrument (dyadic tool measuring SDM), WatLX (outpatient rehabilitation experience) and demographic questionnaire. Survey packages distributed at two timepoints (T0=recruitment; T1=3 months later). RESULTS We found that among 341 patient-provider dyads, 26.4% agreed that the appointment at recruitment involved high-quality SDM. Patient perceptions of goal-setting suggested that 19.6% of patients did not set a goal for their care, and only 11.4% set goals in functional language that tied directly to an activity/role/responsibility that was meaningful to their life. Better SDM was clinically associated with higher total family income (p=0.045). CONCLUSIONS These findings provide evidence for the importance of SDM and goal setting in community rehabilitation. Among patients, lower ratings of SDM corresponded with less recognition of their preferences. Actionable strategies include supporting financially vulnerable patients in realising SDM through training of providers to make extra space for such patients to share their preferences and better preparing patients to articulate their preferences. We recommend more research into strategies that advance highly functional goal setting with patients, and that lessen survey ceiling effects.
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Affiliation(s)
- Kiran Pohar Manhas
- Strategic Clinical Networks, Alberta Health Services, Calgary, Alberta, Canada
| | - Karin Olson
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Katie Churchill
- Health Professions, Strategy & Practice, Alberta Health Services, Calgary, Alberta, Canada
| | - Peter Faris
- Analytics (DIMR), Health Services Statistical & Analytic Methods, Alberta Health Services, Calgary, Alberta, Canada
| | - Sunita Vohra
- Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Tracy Wasylak
- Strategic Clinical Networks, Alberta Health Services, Calgary, Alberta, Canada
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Manhas KP, Olson K, Churchill K, Vohra S, Wasylak T. Experiences of shared decision-making in community rehabilitation: a focused ethnography. BMC Health Serv Res 2020; 20:329. [PMID: 32306972 PMCID: PMC7168887 DOI: 10.1186/s12913-020-05223-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 04/13/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Shared decision-making (SDM) can advance patient satisfaction, understanding, goal fulfilment, and patient-reported outcomes. We lack clarity on whether this physician-focused literature applies to community rehabilitation, and on the integration of SDM policies in healthcare settings. We aimed to understand patient and provider perceptions of shared decision-making (SDM) in community rehabilitation, particularly the barriers and facilitators to SDM. METHODS We used a focused ethnography involving 14 community rehabilitation sites across Alberta, including rural, regional-urban and metropolitan-urban sites. We conducted semi-structured interviews that asked participants about their positive and negative communication experiences (n = 23 patients; n = 26 providers). RESULTS We found SDM experiences fluctuated between extremes: Getting Patient Buy-In and Aligning Expectations. The former is provider-driven, prescriptive and less flexible; the latter is collaborative, inquisitive and empowering. In Aligning Expectations, patients and providers express humility and openness, communicate in the language of ask and listen, and view education as empowering. Patients and providers described barriers and facilitators to SDM in community rehabilitation. Facilitators included geography influencing context and connections; consistent, patient-specific messaging; patient lifestyle, capacity and perceived outlook; provider confidence, experience and perceived independence; provider training; and perceptions of more time (and control over time) for appointments. SDM barriers included lack of privacy; waitlists and financial barriers to access; provider approach; how choices are framed; and, patient's perceived assertiveness, lack of capacity, and level of deference. CONCLUSIONS We have found both excellent experiences and areas for improvement for applying SDM in community rehabilitation. We proffer recommendations to advance high-quality SDM in community rehabilitation based on promoting facilitators and overcoming barriers. This research will support the spread, scale and evaluation of a new Model of Care in rehabilitation by the provincial health system, which aimed to promote patient-centred care.
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Affiliation(s)
- Kiran Pohar Manhas
- c/o Strategic Clinical Networks™, Alberta Health Services, Southport Tower, 10301 Southport Lane SW, Calgary, Alberta, T2W 1S7, Canada. .,Integrative Health Institute, University of Alberta, Edmonton, Alberta, Canada.
| | - Karin Olson
- Integrative Health Institute, University of Alberta, Edmonton, Alberta, Canada.,Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Katie Churchill
- c/o Strategic Clinical Networks™, Alberta Health Services, Southport Tower, 10301 Southport Lane SW, Calgary, Alberta, T2W 1S7, Canada.,Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Occupational Therapy, University of Alberta, Edmonton, Alberta, Canada
| | - Sunita Vohra
- Integrative Health Institute, University of Alberta, Edmonton, Alberta, Canada.,Departments of Pediatrics and Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Tracy Wasylak
- c/o Strategic Clinical Networks™, Alberta Health Services, Southport Tower, 10301 Southport Lane SW, Calgary, Alberta, T2W 1S7, Canada.,Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
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Manhas KP, Cui X, Tough SC. The Experience of Establishing Data Sharing & Linkage Platforms for Administrative, Research and Community-Service Data. Int J Popul Data Sci 2019; 4:465. [PMID: 32935021 PMCID: PMC7299464 DOI: 10.23889/ijpds.v4i1.465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Innovative data platforms (e.g. biobanks, repositories) continually emerge to facilitate data sharing. Extant and emerging data platforms must navigate myriad tensions for successful data sharing and re-use. Two Alberta data platforms navigated such processes and factors regarding administrative, research and nonprofit data: the Child & Youth Data Laboratory (CYDL) and Secondary Analysis to Generate Evidence (SAGE). Objectives To clarify the social and policy factors that influenced CYDL and SAGE establishment and implementation, and the relationships, if any, between these factors and data type. Methods This paper involves a qualitative secondary analysis of two developmental evaluations on CYDL and SAGE establishment. Six-years post-implementation, the CYDL evaluation entailed document review; website user analysis; interviews (n=30); online stakeholder survey (n=260); and an environmental scan. One-year post implementation, the SAGE evaluation included 15 interviews and document review. We used thematic analysis and comparisons with the literature to identify key factors. Results Three (not mutually exclusive) categories of social and policy factors influenced the navigation towards CYDL and SAGE realization: trusting relationships; sustainability amidst readiness; and privacy within social context. For these platforms to be able to manage, link or share data, trust had to be fostered and maintained across multiple, dynamic and intersecting relationships between primary data producers, data subjects, secondary users and institutions. Platform sustainability required capacity building and innovation. Privacy and information sharing evolved culturally and correspondingly for these data platforms, which required constant flexibility and awareness. Conclusions This analysis calls for more empirical research on the value of data re-use or the detriment in not re-using data. While the culture of information sharing is progressing towards greater openness and capacity for data sharing and re-use, successful data platforms must advocate, facilitate and mobilize analysis and innovation using data re-use while being cognizant of social and policy influences.
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Affiliation(s)
- Kiran Pohar Manhas
- Alberta Health Services, Seventh Street Plaza, 14th Floor, North Tower, 10030-107 Street NW, Edmonton, Alberta T5J 3E4, Canada
| | - Xinjie Cui
- PolicyWise with Children & Families, 9925 109 St NW, Edmonton, AB T5K 2J8, Canada https://policywise.com/
| | - Suzanne C Tough
- University of Calgary, Departments of Paediatrics and Community Health Sciences, Faculty of Medicine, 2500 University Drive NW Calgary, AB, Canada T2N 1N4 https://www.ucalgary.ca/stough/about
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Manhas KP, Dodd SX, Page S, Letourneau N, Adair CE, Cui X, Tough SC. Sharing longitudinal, non-biological birth cohort data: a cross-sectional analysis of parent consent preferences. BMC Med Inform Decis Mak 2018; 18:97. [PMID: 30419910 PMCID: PMC6233367 DOI: 10.1186/s12911-018-0683-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 10/19/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mandates abound to share publicly-funded research data for reuse, while data platforms continue to emerge to facilitate such reuse. Birth cohorts (BC) involve longitudinal designs, significant sample sizes and rich and deep datasets. Data sharing benefits include more analyses, greater research complexity, increased opportunities for collaboration, amplification of public contributions, and reduced respondent burdens. Sharing BC data involves significant challenges including consent, privacy, access policies, communication, and vulnerability of the child. Research on these issues is available for biological data, but these findings may not extend to BC data. We lack consensus on how best to approach these challenges in consent, privacy, communication and autonomy when sharing BC data. We require more stakeholder engagement to understand perspectives and generate consensus. METHODS Parents participating in longitudinal birth cohorts completed a web-based survey investigating consent preferences for sharing their, and their child's, non-biological research data. Results from a previous qualitative inquiry informed survey development, and cognitive interviewing methods (n = 9) were used to improve the question quality and comprehension. Recruitment was via personalized email, with email and phone reminders during the 14-day window for survey completion. RESULTS Three hundred and forty-six of 569 parents completed the survey in September 2014 (60.8%). Participants preferred consent processes for data sharing in future independent research that were less-active (i.e. no consent or opt-out). Parents' consent preferences are associated with their communication preferences. Twenty percent (20.2%) of parents generally agreed that their child should provide consent to continue participating in research at age 12, while 25.6% felt decision-making on sharing non-biological research data should begin at age 18. CONCLUSIONS These finding reflect the parenting population's preference for less project-specific permission when research data is non-biological and de-identified and when governance practices are highly detailed and rigourous. Parents recognize that children should become involved in consent for secondary data use, but there is variability regarding when and how involvement occurs. These findings emphasize governance processes and participant notification rather than project-specific consent for secondary use of de-identified, non-biological data. Ultimately, parents prefer general consent processes for sharing de-identified, non-biological research data with ultimate involvement of the child.
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Affiliation(s)
- Kiran Pohar Manhas
- Community Health Sciences, University of Calgary, Calgary, Canada
- University of Alberta, Edmonton, Canada
- Alberta Health Services, Calgary, Canada
| | | | - Stacey Page
- Community Health Sciences, University of Calgary, Calgary, Canada
- Conjoint Health Research Ethics Board, University of Calgary, Calgary, Canada
| | | | - Carol E. Adair
- Community Health Sciences, University of Calgary, Calgary, Canada
| | - Xinjie Cui
- PolicyWise for Children & Families, Edmonton, AB Canada
| | - Suzanne C. Tough
- PolicyWise for Children & Families, Calgary, Canada
- Pediatrics & Community Health Sciences, University of Calgary, Calgary, Canada
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Manhas KP, Lau J, Cui X. Governance Challenges to Promoting Data Readiness and Data Linkage for Not-for-Profit Organizational Service Data. Int J Popul Data Sci 2018. [DOI: 10.23889/ijpds.v3i4.675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
IntroductionData collected by myriad not-for-profit (NFPs) agencies while providing social services represent a significant untapped source of intelligence. While much research has been conducted on the governance and capacity to share administrative and research data, little work has been done in the area of NFP data sources.
Objectives and ApproachSix NFP agencies in Calgary participated in a data sharing project to measure various aspects of poverty. This collaboration required understanding the legal, ethical, policy and data challenges to working with data collected in the NFP sector. This case study will expose (a) the legal analysis on legal and governance issues for, and obligations of, NFPs when aiming to share and re-use information beyond service delivery in Alberta, Canada; and (b) the practical and policy challenges faced by the NFPs and repository. The legal analysis involved a systematic search of academic and grey literature; relevant legislation and case-law (especially privacy law).
ResultsThe legal analysis demonstrated three key things. First, in many circumstances an NFP is not held to any information-handling legal obligations. This does not absolve NFPs from social privacy expectations, especially involving vulnerable populations. Second, privacy best practices are available to NFPs from other more-regulated sectors and from NFP sector standards. The trifecta of purpose, reasonableness and minimal extent are critical. Third, adhering to privacy best practices would not be overly costly, more efficient, and less risky of negative publicity and lost public trust from privacy complaints. These findings informed the NFP data sharing project. The six participant NFPs varied greatly in their approach to consent, governance and information-handling, which affected their data-readiness for cross-organizational data linkage and analysis.
Conclusion/ImplicationsUnlike government, most NFPs have limited experience with data linkage. This paper informs ethical approaches to include NFP data in broad cross-sector data linkage. Appropriate data governance is imperative for data sharing amongst NFPs, researchers and public organizations, which promotes community service delivery, evaluation and improvements to benefit vulnerable families.
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Page SA, Manhas KP, Muruve DA. A survey of patient perspectives on the research use of health information and biospecimens. BMC Med Ethics 2016; 17:48. [PMID: 27527514 PMCID: PMC4986353 DOI: 10.1186/s12910-016-0130-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 07/28/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Personal health information and biospecimens are valuable research resources essential for the advancement of medicine and protected by national standards and provincial statutes. Research ethics and privacy standards attempt to balance individual interests with societal interests. However these standards may not reflect public opinion or preferences. The purpose of this study was to assess the opinions and preferences of patients with kidney disease about the use of their health information and biospecimens for medical research. METHODS A 45-item survey was distributed to a convenience sample of patients at an outpatient clinic in a large urban centre. The survey briefly addressed sociodemographic and illness characteristics. Opinions were sought on the research use of health information and biospecimens including consent preferences. RESULTS Two hundred eleven of 400 distributed surveys were completed (response rate 52.8 %). Respondents were generally supportive of medical research and trusting of researchers. Many respondents supported the use of their information and biospecimens for health research and also preferred consent be sought for use of health information and biospecimens. Some supported the use of their information and biospecimens for research without consent. There were significant differences in the opinions people offered regarding the research use of biospecimens compared to health information. Some respondent perspectives about consent were at odds with current regulatory and legal standards. CONCLUSIONS Clinical health data and biospecimens are valuable research resources, critical to the advancement of medicine. Use of these data for research requires balancing respect for individual autonomy, privacy and the societal interest in the greater good. Incongruence between some respondent perspectives and the regulatory standards suggest both a need for public education and review of legislation to increase understanding and ensure the public's trust is maintained.
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Affiliation(s)
- Stacey A Page
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, TRW Building, 3rd Floor, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada. .,Conjoint Health Research Ethics Board, Research Services, University of Calgary, MacKimmie Library Tower, 3rd Floor, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada.
| | - Kiran Pohar Manhas
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, TRW Building, 3rd Floor, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.,Alberta Centre for Child, Family & Community Research, Child Development Centre, 2888 Shaganappi Trail NW, Calgary, AB, T3B-6A8, Canada
| | - Daniel A Muruve
- Department of Medicine, Division of Nephrology and Hypertension, Snyder Institute for Chronic Diseases, University of Calgary, 3280 Hospital Dr. NW, Calgary, AB, T2N 4Z6, Canada
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Manhas KP, Page S, Dodd SX, Letourneau N, Ambrose A, Cui X, Tough SC. Parental perspectives on consent for participation in large-scale, non-biological data repositories. Life Sci Soc Policy 2016; 12:1. [PMID: 26790860 PMCID: PMC4720627 DOI: 10.1186/s40504-016-0034-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 01/07/2016] [Indexed: 05/13/2023]
Abstract
BACKGROUND Data sharing presents several challenges to the informed consent process. Unique challenges emerge when sharing pediatric or pregnancy-related data. Here, parent preferences for sharing non-biological data are examined. METHODS Groups (n = 4 groups, 18 participants) and individual interviews (n = 19 participants) were conducted with participants from two provincial, longitudinal pregnancy cohorts (AOB and APrON). Qualitative content analysis was applied to transcripts of semi-structured interviews. RESULTS Participants were supportive of a broad, one-time consent model or a tiered consent model. These preferences were grounded in the perceived obligations for reciprocity and accuracy. Parents want reciprocity among participants, repositories and researchers regarding respect and trust. Furthermore, parents' worry about the interrelationships between the validity of the consent processes and secondary data use. CONCLUSIONS Though parent participants agree that their research data should be made available for secondary use, they believe their consent is still required. Given their understanding that obtaining and informed consent can be challenging in the case of secondary use, parents agreed that a broad, one-time consent model was acceptable, reducing the logistical burden while maintaining respect for their contribution. This broad model also maintained participant trust in the research and secondary use of their data. The broad, one-time model also reflected parents' perspectives surrounding child involvement in the consent process. The majority of parents felt decision made during childhood were the parents responsibility and should remain in parental purview until the child reaches the age of majority.
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Affiliation(s)
- Kiran Pohar Manhas
- Child Development Centre, c/o 2888 Shaganappi Trail NW, Calgary, AB, T3B 6A8, Canada.
| | - Stacey Page
- MacKimmie Library Tower, 2500 University Drive Northwest, Calgary, AB, T2N 1N4, Canada.
| | - Shawn X Dodd
- Child Development Centre, c/o 2888 Shaganappi Trail NW, Calgary, AB, T3B 6A8, Canada.
| | - Nicole Letourneau
- Child Development Centre, c/o 2888 Shaganappi Trail NW, Calgary, AB, T3B 6A8, Canada.
| | | | - Xinjie Cui
- Child and Youth Data Lab, Alberta Center for Child Family and Community Research, 9925 109 St NW, Edmonton, AB, T5J 3M9, Canada.
| | - Suzanne C Tough
- Child Development Centre, c/o 2888 Shaganappi Trail NW, Calgary, AB, T3B 6A8, Canada.
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Abstract
BACKGROUND Scholarly work is needed to develop the conceptual and theoretical understanding of trust to nursing practice. The transition from hospital care to complex pediatric homecare involves nurses in myriad roles, including management and care provision. Complex pediatric homecare transforms children, families, professionals, and communities, but its exact implications are unclear. RESEARCH OBJECTIVES To conduct an ethical inquiry into the role and responsibilities of nurses in the qualitative experience of adults involved in the hospital-to-home transition of young, ventilator-dependent children. RESEARCH DESIGN We followed methods described by Franco Carnevale. We used a sociologically grounded theoretical orientation-trust-to re-interpret qualitative data for an ethical inquiry into a specific facet of that data. PARTICIPANTS AND STUDY CONTEXT The participants included 26 adults, including 14 nurses, involved in the hospital-to-home transition in a Canadian province. Participants represented family, hospital, home, and government. ETHICAL CONSIDERATIONS The Conjoint Health Research Ethics Board at the University of Calgary approved this study. FINDINGS First, the concept and practice of trust was salient to the experience of transition. For example, responsibilities' allocation between hospital-based professionals to mothers, home-based nurses, and non-professionals necessitated reliance and vulnerability. Second, the consequences of distrust connected to recognized challenges. For example, tensions along rural-urban, medical-family, and professional-personal divide each revealed suspicion and uncertainty that led to isolation and anxiety for all involved. Third, recommendations to improve the experience and mitigate the challenges of transition can be grounded in trust promotion. For example, transition-specific education programs and codes of ethics would promote openness, recognize mutual vulnerability, and advance trust in transition. CONCLUSIONS The challenges to transition evidenced distrust, while trust represents a powerful tool to counter these challenges and their implications. A climate of trust could bridge divides between mothers and professionals; rural and urban professionals; and professionals with differing relationships with the family.
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Affiliation(s)
- Kiran Pohar Manhas
- University of Calgary, Canada; Alberta Centre for Child, Family & Community Research, Canada
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Manhas KP, Mitchell I. Children with complex care needs going home: The relevance of ethical ideas of proximity. Paediatr Child Health 2013; 14:369-70. [PMID: 20592969 DOI: 10.1093/pch/14.6.369] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2009] [Indexed: 11/15/2022] Open
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Manhas KP, Mitchell I. Extremes, uncertainty, and responsibility across boundaries: facets and challenges of the experience of transition to complex, pediatric home care. J Child Health Care 2012; 16:224-36. [PMID: 22247185 DOI: 10.1177/1367493511430677] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The availability of complex, pediatric home care (CPHC) allows ventilator-dependent children to live at home not hospital. The process of transition from hospital to home encompasses the morphing of responsibilities from uniquely hospital based to CPHC based. This study promoted contextualized understanding of transition using in-depth case-study methodology. A total of 26 adults were interviewed for their roles and responsibilities in transition; they represented members of the family, hospital team, home team, and government programs. Interview analyses revealed four major facets of transition, each accompanied by a significant challenge. Transition (a) was a continuous shift in responsibility challenged by precarious human resources, (b) was peppered with losses producing uncertainty and grief, (c) was focused on crossing jurisdictions in the face of polarization around knowledge, and (d) was heavily reliant on mothers leading to expectations of maternal extraordinariness. The overarching conceptualization emerged that transition entailed extremes and uncertainty in the bridging of boundaries.
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Affiliation(s)
- Kiran Pohar Manhas
- Department of Community Health Sciences, University of Calgary, Alberta Centre for Child, Family & Community Research, Calgary, AB T3B 6A8, Canada.
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