Social participation experiences of older adults with an early-onset physical disability: a systematic review protocol

OBJECTIVE

The objective of this review is to assess and synthesize the available qualitative evidence on the experiences of social participation of older adults with an early-onset physical disability.

INTRODUCTION

Understanding the experiences of social participation among older adults with a physical disability acquired earlier in life can guide the development of interventions and policies. It will also help with fostering meaningful community participation and aid in improving the quality of their social participation.

INCLUSION CRITERIA

This review will consider primary studies that explore the experiences of social participation of older adults with an early-onset physical disability. The review will focus on qualitative data, including methods such as phenomenology, grounded theory, ethnography, action research, and feminist research. Studies in French or English will be considered for inclusion, and there will be no limitation on publication dates.

METHODS

A keyword search strategy will be carried out in MEDLINE (Ovid), PsycINFO (Ovid), CINAHL (EBSCOhost), Web of Science, and the Cochrane Library. ProQuest Dissertations and Theses (ProQuest) will be searched for unpublished articles. Two independent reviewers will perform the screening and inclusion process, assess the quality of the evidence, and complete data extraction. The JBI approach to critical appraisal, study selection, data extraction, and data synthesis (meta-aggregation) will be used. The ConQual approach will be used to establish confidence in the synthesized findings.

REVIEW REGISTRATION

PROSPERO CRD42022371027.

Learning to drive with neurological conditions: profile of users of an adapted driver training program and cognitive factors associated with success

PURPOSE

To describe the sociodemographic and cognitive profile of participants enrolled in an adapted driving program for individuals with neurological conditions, to explore the association between cognitive functioning and driving program outcome, and to describe driving habits after program completion.

METHODS

This study combined retrospective chart review and cross-sectional data collection.

RESULTS

The sample included 71 participants with neurological disorders (aged 15-56 years, M = 22.2 ± 8.6; 39% women). Driving program was either successful (47%), failed (7%), discontinued (34%), or ongoing (13%). Among 35 participants with complete neuropsychological and driving program outcome data, those who successfully completed the program showed better attention functioning, and better performance relative to global functioning for attention, executive functions, and working memory, compared to those who discontinued/failed the program. Among 21 participants who completed a telephone questionnaire on average 3.7 years after program enrollment, 67% obtained their driver's license and drove regularly. Participants reported high levels of satisfaction with the program.

CONCLUSION

These results suggest that approximately half of the persons enrolled in a driver training program designed for learners with neurological conditions, obtain a driver's license; and that attention, and to a lesser extent executive functioning and working memory, are related to driving program success.IMPLICATIONS FOR REHABILITATIONIn individual with neurological conditions, learning how to drive can be challenging.An adapted driver training program, involving collaboration between driving instructors and healthcare professionals, simplification of theoretical learning, and increasing driving practice opportunities, can be effective, both in terms of licensing success and client satisfaction.Conducting a pre-driving program neuropsychological assessment, with identification of cognitive strengths and weaknesses, can provide valuable information for clinicians and driving instructors for optimizing training and predicting outcome.Better performance in attention, and better relative to global cognitive functioning in attention, executive functions, and working memory, are related to higher success rate of an adapted driving program.

Subjective and objective burden and psychological distress in care partners of older adults with traumatic brain injury

PURPOSE/OBJECTIVE

In care partners of older persons (65 years and older) having sustained traumatic brain injury (TBI), the objectives were (a) to describe subjective burden (emotional, social, financial, and physical burden), objective burden (new roles and responsibilities), and psychological distress at 4 months postinjury, and (b) to explore the predictors of subjective burden and psychological distress.

RESEARCH METHOD/DESIGN

This is an observational study of care partners of older adults with TBI (n = 46; M_age = 65.2 years, SD = 11.2, 87% female). Participants completed the Zarit Burden Interview, the Hospital Anxiety and Depression Scale, the Brain Injury Complaint Questionnaire (measuring difficulties of the injured older adult perceived by the care partner), and the modified Medical Outcomes Study Social Support Survey.

RESULTS

A majority of care partners (88%) reported at least one form of objective burden (e.g., increased/decreased time spent in certain activities post-TBI), 29% perceived at least mild subjective burden, and 27% reported either significant anxiety or depressive symptoms. Linear regressions indicated that a higher number of difficulties reported regarding the injured person and poorer perceived social support predicted higher subjective burden and psychological distress. A younger age of the care partner also predicted a higher subjective burden.

CONCLUSIONS/IMPLICATIONS

This study provides a better understanding of the potential impacts of TBI in older age for care partners. Future research should examine how to support adequately care partners in their psychological adaptation after TBI in an elderly person. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Integrative Prevention at Work: A Concept Analysis and Meta-Narrative Review

Purpose The purpose of this study was to conceptualize integrative prevention at work and to identify its operational variables to support its application in occupational rehabilitation. Methods Based on Walker and Avant's specifications for concept analysis, we conducted a systematic five-step procedure (i.e., 1-identification of research question, 2-literature search through meta-narrative review, 3-manuscript selection, 4-extraction, 5-analysis). Results Analysis of information extracted from 20 manuscripts across diverse literature fields allowed to identify that the shared attributes of integrative prevention at work are: (a) coordination of the three levels of prevention, (b) integration of health promotion with prevention, (c) shared understanding of the goal, (d) engagement of stakeholders, and (e) variety of actions. The analysis also identified three antecedents and five consequences, situating the concept within the context of a change process. The results include recommendations for promoting the practical application of the concept. Conclusion The results of this study offer an informative, non-prescriptive, and operational definition of integrative prevention at work that all the stakeholders involved, including occupational rehabilitation professionals, can use.

Cognitive functioning following traumatic brain injury in older adults: associations with social participation and health-related quality of life

OBJECTIVES

To describe objective and subjective cognitive functioning older adults who sustained TBI at age 65 or over, and to determine whether cognitive functioning is associated with health-related quality of life (HRQoL) and social participation.

METHOD

The sample consisted of 40 individuals with TBI (mean age = 73 years; 65% mild, 35% moderate/severe TBI). On average 15 months post-injury, they completed measures of objective and subjective cognitive functioning (Telephone Interview for Cognitive Status-Modified, Alphaflex, Medical Outcomes Study Cognitive Functioning Scale), HRQoL (SF-12), and social participation (Participation Assessment with Recombined Tools - Objective).

RESULTS

Mean score for objective cognitive functioning was lower than normative values, while mean scores for executive functioning and subjective cognitive functioning were comparable to normative values. There was no relationship between objective and subjective measures. Subjective cognitive functioning and (to a lesser extent) global objective cognitive functioning were significantly associated with mental HRQoL but not with physical HRQoL or social participation.

CONCLUSION

These results underscore the importance of considering both subjective perception and objective performance when assessing and intervening on cognition to promote better mental HRQoL in older adults with TBI.

Strategies to reduce waiting times in outpatient rehabilitation services for adults with physical disabilities: A systematic literature review

Objective

Identifying effective strategies to reduce waiting times is a crucial issue in many areas of health services. Long waiting times for rehabilitation services have been associated with numerous adverse effects in people with disabilities. The main objective of this study was to conduct a systematic literature review to assess the effectiveness of service redesign strategies to reduce waiting times in outpatient rehabilitation services for adults with physical disabilities.

Methods

We conducted a systematic review, searching three databases (MEDLINE, CINAHL and EMBASE) from their inception until May 2021. We identified studies with comparative data evaluating the effect of rehabilitation services redesign strategies on reducing waiting times. The Mixed Methods Appraisal Tool was used to assess the methodological quality of the studies. A narrative synthesis was conducted.

Results

Nineteen articles including various settings and populations met the selection criteria. They covered physiotherapy ( n = 11), occupational therapy ( n = 2), prosthetics ( n = 1), exercise physiology ( n = 1) and multidisciplinary ( n = 4) services. The methodological quality varied ( n = 10 high quality, n = 6 medium, n = 3 low); common flaws being missing information on the pre-redesign setting and characteristics of the populations. Seven articles assessed access processes or referral management strategies (e.g. self-referral), four focused on extending/modifying the roles of service providers (e.g. to triage) and eight changed the model of care delivery (e.g. mode of intervention). The different redesign strategies had positive effects on waiting times in outpatient rehabilitation services.

Conclusions

This review highlights the positive effects of many service redesign strategies. These findings suggest that there are several effective strategies to choose from to reduce waiting times and help better respond to the needs of persons experiencing physical disabilities.

Organizational knowledge translation strategies for allied health professionals in traumatology settings: realist review protocol

BACKGROUND

Knowledge translation (KT) is an important means of improving the health service quality. Most research on the effectiveness of KT strategies has focused on individual strategies, i.e., those directly targeting the modification of allied health professionals' knowledge, attitudes, and behaviors, for example. In general, these strategies are moderately effective in changing practices (maximum 10% change). Effecting change in organizational contexts (e.g., change readiness, general and specific organizational capacity, organizational routines) is part of a promising new avenue to service quality improvement through the implementation of evidence-based practices. The objective of this study will be to identify why, how, and under what conditions organizational KT strategies have been shown to be effective or ineffective in changing the (a) knowledge, (b) attitudes, and (c) clinical behaviors of allied health professionals in traumatology settings.

METHODS

This is a realist review protocol involving four iterative steps: (1) Initial theory formulation, (2) search for Evidence search, (3) knowledge extraction and synthesis, and (4) recommendations. We will search electronic databases such as PubMed, Embase, CINHAL, Cochrane Library, and Conference Proceedings Citation Index - Science. The studies included will be those relating to the use of organizational KT strategies in trauma settings, regardless of study designs, published between January 1990 and October 2020, and presenting objective measures that demonstrate change in allied health professionals' knowledge, attitudes, and clinical behaviors. Two independent reviewers will select, screen, and extract the data related to all relevant sources in order to refine or refute the context-mechanism-outcome (CMO) configurations developed in the initial theory and identify new CMO configurations.

DISCUSSION

Using a systematic and rigorous method, this review will help guide decision-makers and researchers in choosing the best organizational strategies to optimize the implementation of evidence-based practices.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42020216105.

Integrated Prevention at Work: Protocol for a Concept Analysis

Background

Integrated prevention at work promises to eliminate the boundaries between primary, secondary, and tertiary prevention actions taken by stakeholders in the world of work. It is receiving increasing attention from the scientific community because of its concerted and harmonized approach, which promotes employment access, return, and healthy long-term continuation. Although promising, integrated prevention is not yet well-defined, which makes it difficult to operationalize.

Objective

This manuscript exposes the protocol of a study aiming to conceptualize integrated prevention at work on the basis of scientific and experiential knowledge.

Methods

Using a concept analysis research design, data collection has been planned in 2 parts. A meta-narrative literature review will first be conducted to document how integrated prevention has been defined in the literature. Then, phone interviews will be conducted with key informers (ie, managers, workers, ergonomists, occupational therapists, psychologists, physiotherapists, union and insurance representatives) to document their viewpoints and understanding of integrated prevention at work. Qualitative data gathered during these 2 parts of research will be analyzed using template analysis, which allows data from literature and empirical collection to be analyzed simultaneously. The analysis will bring out the points of convergence, divergence, and complementarity between the information gleaned from literature and key informers’ experiences to arrive at a conceptualization of integrated prevention at work by identifying its uses, attributes, antecedents, and consequences. As a final step, validation and interpretation with a TRIAGE (Technique for Research of Information by Animation of a Group of Experts) group will be carried out in collaboration with the key informers to identify the tools for the implementation of integrated prevention at work and promote workers’ health and safety.

Results

This study is expected to offer a contemporary conceptualization of integrated prevention at work that clearly lays out the variables of this concept and elicits the viewpoints of the different stakeholders.

Conclusions

This study will contribute to the advancement of knowledge about the professional injury prevention continuum. The clear identification of the uses, attributes, antecedents, and consequences of integrated prevention at work will offer concrete tools to stakeholders to implement innovative and promising approaches to integrated prevention at work.

International Registered Report Identifier (IRRID)

PRR1-10.2196/29869

Impact of the COVID-19 Pandemic on Older Adults: Rapid Review

BACKGROUND

The COVID-19 pandemic has drastically changed the lives of countless members of the general population. Older adults are known to experience loneliness, age discrimination, and excessive worry. It is therefore reasonable to anticipate that they would experience greater negative outcomes related to the COVID-19 pandemic given their increased isolation and risk for complications than younger adults.

OBJECTIVE

This study aims to synthesize the existing research on the impact of the COVID-19 pandemic, and associated isolation and protective measures, on older adults. The secondary objective is to investigate the impact of the COVID-19 pandemic, and associated isolation and protective measures, on older adults with Alzheimer disease and related dementias.

METHODS

A rapid review of the published literature was conducted on October 6, 2020, through a search of 6 online databases to synthesize results from published original studies regarding the impact of the COVID-19 pandemic on older adults. The Human Development Model conceptual framework-Disability Creation Process was used to describe and understand interactions between personal factors, environmental factors, and life habits. Methods and results are reported following the Preferred Reporting Items for Systematic Reviews and Meta-analyses Statement.

RESULTS

A total of 135 records were included from the initial search strategy of 13,452 individual studies. Of these, 113 (83.7%) studies were determined to be of level 4 according to the levels of evidence classification by the Centre for Evidence-Based Medicine. The presence of psychological symptoms, exacerbation of ageism, and physical deterioration of aged populations were reported in the included studies. Decreased social life and fewer in-person social interactions reported during the COVID-19 pandemic were occasionally associated with reduced quality of life and increased depression. Difficulties accessing services, sleep disturbances, and a reduction of physical activity were also noted.

CONCLUSIONS

Our results highlight the need for adequate isolation and protective measures. Older adults represent a heterogeneous group, which could explain the contradictory results found in the literature. Individual, organizational, and institutional strategies should be established to ensure that older adults are able to maintain social contacts, preserve family ties, and maintain the ability to give or receive help during the current pandemic. Future studies should focus on specific consequences and needs of more at-risk older adults to ensure their inclusion, both in public health recommendations and considerations made by policy makers.

Availability and Quality of Web Resources for Parents of Children With Disability: Content Analysis and Usability Study

BACKGROUND

The internet is a valuable resource for parents of typical children, who are looking for information about their children's growth and development and how to boost them. However, for parents of children with special needs, especially for non-English-speaking parents, there are anecdotal reports stating that specific and accurate information is not available on the internet.

OBJECTIVE

This study aims to describe the type of information available on the internet for French-speaking parents of children with disability as well as assess the quality of the information collected.

METHODS

We carried out a search of the existing relevant websites targeted at parents of children with disability. We used a validated instrument to extract structural, textual, and visual characteristics of these websites and evaluate their usability.

RESULTS

In all, 42 websites were analyzed; of these, the information had been validated by a trustworthy source in only 18 (43%) websites. Networking opportunities for parents were available in only 7 (17%) websites. Most websites provided information related to autism spectrum disorder (20/42, 42%) and learning disabilities (19/42, 45%), and only a few websites discussed other disability types such as behavorial disorders and developmental language disorders (4/42, 10% each). Community, social, and civic life (9/42, 22%); domestic life (12/42, 29%); and mobility (15/42, 36%) were the less frequently covered topics. With regard to the usability evaluation, 22 of the 42 (52%) websites received a global score <70%, whereas 20 (48%) scored ≥70.

CONCLUSIONS

Although the internet is an infinite source of information, it is not necessarily actionable for parents of children with disability. Some information remains difficult to find online, and networking opportunities with other parents dealing with similar challenges are scarce.

A strategic initiative to facilitate knowledge translation research in rehabilitation

BACKGROUND

While there is a growing body of literature supporting clinical decision-making for rehabilitation professionals, suboptimal use of evidence-based practices in that field persists. A strategic initiative that ensures the relevance of the research and its implementation in the context of rehabilitation could 1) help improve the coordination of knowledge translation (KT) research and 2) enhance the delivery of evidence-based rehabilitation services offered to patients with physical disabilities. This paper describes the process and methods used to develop a KT strategic initiative aimed at building capacity and coordinating KT research in physical rehabilitation and its strategic plan; it also reports the initial applications of the strategic plan implementation.

METHODS

We used a 3-phase process consisting of an online environmental scan to identify the extent of KT research activities in physical rehabilitation in Quebec, Canada. Data from the environmental scan was used to develop a strategic plan that structures KT research in physical rehabilitation. Seven external KT experts in health science reviewed the strategic plan for consistency and applicability.

RESULTS

Sixty-four KT researchers were identified and classified according to the extent of their level of involvement in KT. Ninety-six research projects meeting eligibility criteria were funded by eight of the fourteen agencies and organizations searched. To address the identified gaps, a 5-year strategic plan was developed, containing a mission, a vision, four main goals, nine strategies and forty-two actions.

CONCLUSION

Such initiatives can help guide researchers and relevant key stakeholders, to structure, organize and advance KT research in the field of rehabilitation. The strategies are being implemented progressively to meet the strategic initiative's mission and ultimately enhance users' rehabilitation services.

Identifying clinicians' priorities for the implementation of best practices in cognitive rehabilitation post-acquired brain injury

PURPOSE

To identify clinicians' perceptions of current levels of implementation of cognitive rehabilitation best practices, as well as individual and consensual group priorities for implementing cognitive rehabilitation interventions as part of a multi-site integrated knowledge translation initiative.

METHOD

A two-step consensus-building methodology was used, that is the Technique for Research of Information by Animation of a Group of Experts (TRIAGE), including a cross-sectional electronic survey followed by consensual in-person group discussions to identify implementation priorities from a list of evidence-based practices for cognitive rehabilitation following traumatic brain injury and stroke. Thirty-eight professionals from three rehabilitation teams (n = 9, 13 and 16) participated, including neuropsychologists, occupational therapists, speech-language pathologists, educators, clinical coordinators and program managers. Descriptive statistics were used to document the perceived levels of implementation as well as individual and consensual group priorities.

RESULTS

Most of the best practices (81-100%) were perceived as at least partially implemented by a minimum of 50% of the participants but only 20-25% of the practices were considered fully implemented. Findings suggest that current practices are mostly consistent with general cognitive rehabilitation principles suggested in guidelines but that further efforts are needed to support the application of specific cognitive rehabilitation strategies and interventions. Executive function and self-awareness retraining, as well as interventions promoting the generalization of skills, were among the highest implementation priorities. Consensual in-person group discussions, included as part of the TRIAGE process, also helped to define and operationalize these best practices into more specific intervention components according to the teams' needs and priorities.

CONCLUSIONS

TRIAGE consensus-building methodology can be used to engage stakeholders and support clinicians' decision-making regarding the identification of implementation priorities in cognitive rehabilitation post-ABI in order to tailor the implementation process to local needs.IMPLICATIONS FOR REHABILITATIONThe Technique for Research of Information by Animation of a Group of Experts (TRIAGE) can be used to support clinicians' decision-making regarding the identification of implementation priorities in cognitive rehabilitation post-ABI.The combination of individual consultations followed by consensual in-person group discussions, as part of the TRIAGE process, may help clinicians in defining and operationalizing best practices into more specific intervention components to implement.Effective implementation strategies are needed to support the use of specific cognitive rehabilitation interventions in prioritized areas, such as executive function and self-awareness retraining, as well as generalization of skills.Some differences in clinicians' perceived priorities point up the importance of tailoring implementation to local needs and contexts from the early stages in the process.