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Petrevska M, Wright FV, Khan A, Munce S, Fehlings D, Biddiss E. Evaluating the impact of movement tracking feedback on engagement with home exercise programmes of children with cerebral palsy using a new therapy app: a protocol for a mixed-methods single-case experimental design with alternating treatments. BMJ Open 2024; 14:e082761. [PMID: 38503423 PMCID: PMC10952875 DOI: 10.1136/bmjopen-2023-082761] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 02/26/2024] [Indexed: 03/21/2024] Open
Abstract
INTRODUCTION Children with cerebral palsy (CP) are prescribed home exercise programmes (HEPs) to increase the frequency of movement practice, yet adherence to HEPs can be low. This paper outlines the protocol for a single-case experimental design (SCED) with alternating treatments, using a new home therapy exercise application, Bootle Boot Camp (BBCamp), offered with and without movement tracking feedback. This study will explore the impact of feedback on engagement, movement quality, lower limb function and family experiences to help understand how technology-supported HEPs should be translated and the added value, if any, of movement tracking technology. METHODS AND ANALYSIS In this explanatory sequential mixed-methods study using a SCED, 16 children with CP (aged 6-12 years, Gross Motor Function Classification System levels I-II) will set lower limb goals and be prescribed an individualised HEP by their physiotherapist to complete using BBCamp on their home television equipped with a three-dimensional camera-computer system. Children will complete four weekly exercise sessions over 6 weeks. Children will be randomised to 1 of 16 alternating treatment schedules where BBCamp will provide or withhold feedback during the first 4 weeks. The version of BBCamp that results in the most therapeutic benefit will be continued for 2 final weeks. Goals will be re-evaluated and families interviewed. The primary outcome is adherence (proportion of prescribed exercise repetitions attempted) as a measure of behavioural engagement. Secondary outcomes are affective and cognitive engagement (smiley face ratings), exercise fidelity, lower limb function, goal achievement and participant experiences. SCED data will be analysed using visual and statistical methods. Quantitative and qualitative data will be integrated using joint displays. ETHICS AND DISSEMINATION Ethical approval was obtained from the Research Ethics Boards at Bloorview Research Institute and the University of Toronto. Results will be distributed through peer-reviewed journals and scientific conferences. TRIAL REGISTRATION NUMBER NCT05998239; pre-results.
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Affiliation(s)
- Marina Petrevska
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - F Virginia Wright
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ajmal Khan
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Sarah Munce
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Darcy Fehlings
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Elaine Biddiss
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
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Feng G, Posa S, Sureshkumar A, Simpson S, Bruno T, Morrow SA, Donkers S, Knox K, Feinstein A, Bayley M, Munce S, Simpson R. Experiences of people with multiple sclerosis and clinicians in using cognitive behavioural therapies for hidden symptoms: a systematic review and meta-aggregation. J Neurol 2024; 271:1084-1107. [PMID: 38219252 DOI: 10.1007/s00415-023-12116-z] [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] [Received: 08/23/2023] [Revised: 10/31/2023] [Accepted: 11/13/2023] [Indexed: 01/16/2024]
Abstract
PURPOSE Cognitive behavioural therapies (CBTs) are a standard of care for treatment of many 'hidden symptoms' in people with MS (PwMS), such as stress, depression, and fatigue. However, these interventions can vary widely in formatting and may not be tailored for PwMS. To optimize CBTs for MS, understanding the experiences of PwMS and clinicians is essential. This systematic review and meta-aggregation synthesizes existing qualitative data on stakeholder perspectives of CBTs for PwMS. METHODS Systematic searches across five major electronic databases were conducted. Studies reporting qualitative data were identified. Two reviewers performed screening, quality assessment, data extraction, and certainty of evidence assessments. Meta-aggregation was performed as per the Joanna Briggs Institute approach, entailing qualitative data extraction, developing categories, and synthesizing overall findings. RESULTS Twenty-eight studies were included in this review, comprising data from 653 PwMS and 47 clinicians. In the meta-aggregation, 122 qualitative results were extracted and grouped into nine categories. Categories were then combined into six synthesized findings: (1) setting the context-life with MS, (2) reasons for participating in CBTs, (3) acceptability of and experiences with participating in CBTs, (4) perceived benefits of CBTs, (5) perceived challenges with CBTs, and (6) suggestions to improve CBTs for PwMS. CONCLUSIONS A range of benefits including psychological, social, and lifestyle improvements were reported, but varied based on the design of the CBT intervention. Future CBT interventions should be tailored to participant needs, delivered in group settings, offer online options, and be delivered by a trained facilitator familiar with MS. Further exploration of the ideal CBT design for PwMS, as well as engagement with caregivers and clinicians treating MS, is warranted.
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Affiliation(s)
- Gregory Feng
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Stephanie Posa
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | | | - Sharon Simpson
- Forest Hill Centre for Cognitive Behavioural Therapy, Toronto, Canada
| | - Tania Bruno
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Sarah A Morrow
- Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
- London Health Sciences Centre, University of Western Ontario, London, Canada
| | - Sarah Donkers
- College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Katherine Knox
- Department of Physical Medicine and Rehabilitation, College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Anthony Feinstein
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Mark Bayley
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Sarah Munce
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Robert Simpson
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.
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Yau T, McIntyre M, Chan J, Bhogal D, Andreoli A, Bayley M, Leochico CFD, Kua A, Guo M, Munce S. Adverse events associated with the delivery of telerehabilitation: A scoping review protocol. PLoS One 2024; 19:e0297908. [PMID: 38381732 PMCID: PMC10880959 DOI: 10.1371/journal.pone.0297908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 01/16/2024] [Indexed: 02/23/2024] Open
Abstract
OBJECTIVE This scoping review aims to map the existing research on adverse events during the delivery of telerehabilitation. INTRODUCTION Telerehabilitation, a subset of telemedicine, has gained traction during the COVID-19 pandemic as a means to deliver rehabilitation services remotely. However, there exists a research gap as there has yet to be any scoping review, systematic review, or meta-analysis published to identify and summarize the current primary research on adverse events related to telerehabilitation as a whole. It is important to understand how adverse events, such as falls during physiotherapy or aspiration pneumonia during speech language pathology sessions, are associated with telerehabilitation delivery. This will help to identify key limitations for optimizing telerehabilitation delivery by allowing for the development of key risk-mitigation measures and quality indicators. It can also help improve the uptake of telerehabilitation among clinicians and patients. This review aims to fill this research gap by conducting a search of published literature on adverse events in telerehabilitation. Anticipated key findings of this scoping review include identifying the characteristics and frequencies of adverse events during telerehabilitation, the patient populations and types of telerehabilitation associated with the most adverse events, and the quality of reporting of adverse events. METHODS The review follows the Joanna Briggs Institute (JBI) methodological framework and adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. The review protocol has been registered and published on Open Science Framework. A comprehensive search strategy was implemented across multiple databases (MEDLINE ALL, EMBASE, APA PsycINFO, CENTRAL, and CINAHL). All stages (screening, extraction, and synthesis) will be conducted in duplicate and independently, with data extraction following the TIDieR framework, along with authors, year of publication (before or after COVID), population and sample size, and specific mode/s of telerehabilitation delivery. For synthesis, data will be summarized quantitatively using numerical counts and qualitatively via content analysis. The data will be grouped by intervention type and by type of adverse event. INCLUSION CRITERIA This scoping review will include qualitative and quantitative studies published between 2013 and 2023, written in English, and conducted in any geographic area. All modes of telerehabilitation delivery (asynchronous, synchronous, or hybrid) will be included. Systematic reviews, meta-analyses, commentaries, protocols, opinion pieces, conference abstracts, and case series with fewer than five participants will be excluded.
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Affiliation(s)
- Thomas Yau
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - McKyla McIntyre
- Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada
- Faculty of Medicine, Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, ON, Canada
| | - Josh Chan
- Western University, London, ON, Canada
| | - Damanveer Bhogal
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Angie Andreoli
- Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada
| | - Mark Bayley
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada
- KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada
- Department of Occupational Science and Occupational Therapy, University of Toronto Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, University of Toronto, Toronto, ON, Canada
| | - Carl Froilan D. Leochico
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- St. Luke’s Medical Center, Global City, Philippines
- Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Ailene Kua
- Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada
- KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada
| | - Meiqi Guo
- Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada
- Faculty of Medicine, Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, ON, Canada
| | - Sarah Munce
- Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada
- KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada
- Department of Occupational Science and Occupational Therapy, University of Toronto Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
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Singh H, Benn N, Fung A, Kokorelias KM, Martyniuk J, Nelson MLA, Colquhoun H, Cameron JI, Munce S, Saragosa M, Godhwani K, Khan A, Yoo PY, Kuluski K. Co-design for stroke intervention development: Results of a scoping review. PLoS One 2024; 19:e0297162. [PMID: 38354160 PMCID: PMC10866508 DOI: 10.1371/journal.pone.0297162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 12/29/2023] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Co-design methodology seeks to actively engage end-users in developing interventions. It is increasingly used to design stroke interventions; however, limited guidance exists, particularly with/for individuals with stroke who have diverse cognitive, physical and functional abilities. Thus, we describe 1) the extent of existing research that has used co-design for stroke intervention development and 2) how co-design has been used to develop stroke interventions among studies that explicitly used co-design, including the rationale, types of co-designed stroke interventions, participants involved, research methodologies/approaches, methods of incorporating end-users in the research, co-design limitations, challenges and potential strategies reported by researchers. MATERIALS AND METHODS A scoping review informed by Joanna Briggs Institute and Arksey & O'Malley methodology was conducted by searching nine databases on December 21, 2022, to locate English-language literature that used co-design to develop a stroke intervention. Additional data sources were identified through a hand search. Data sources were de-duplicated, and two research team members reviewed their titles, abstracts and full text to ensure they met the inclusion criteria. Data relating to the research objectives were extracted, analyzed, and reported numerically and descriptively. RESULTS Data sources used co-design for stroke intervention development with (n = 89) and without (n = 139) explicitly using the term 'co-design.' Among studies explicitly using co-design, it was commonly used to understand end-user needs and generate new ideas. Many co-designed interventions were technology-based (65%), and 48% were for physical rehabilitation or activity-based. Co-design was commonly conducted with multiple participants (82%; e.g., individuals with stroke, family members/caregivers and clinicians) and used various methods to engage end-users, including focus groups and workshops. Limitations, challenges and potential strategies for recruitment, participant-engagement, contextual and logistical and ethics of co-designed interventions were described. CONCLUSIONS Given the increasing popularity of co-design as a methodology for developing stroke interventions internationally, these findings can inform future co-designed studies.
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Affiliation(s)
- Hardeep Singh
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- The KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Natasha Benn
- The KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Agnes Fung
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Kristina M. Kokorelias
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- The KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Medicine, Geriatrics Division, Sinai Health System, University Health Network, Toronto, Canada
| | - Julia Martyniuk
- Gerstein Science Information Centre, University of Toronto Libraries, University of Toronto, Toronto, Canada
| | - Michelle L. A. Nelson
- Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada
| | - Heather Colquhoun
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Jill I. Cameron
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- The KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Sarah Munce
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- The KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Marianne Saragosa
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada
| | - Kian Godhwani
- Department of Psychology, University of Toronto Scarborough, Toronto, Canada
| | - Aleena Khan
- Biological Sciences, University of Toronto, Toronto, Canada
| | - Paul Yejong Yoo
- Division of Neurosciences and Mental Health, The Hospital for Sick Children Research Institute, Toronto, Canada
| | - Kerry Kuluski
- Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Institute for Better Health, Trillium Health Partners, Toronto, Canada
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Bhuiya AR, Sutherland J, Boateng R, Bain T, Skidmore B, Perrier L, Makarski J, Munce S, Lewis I, Graham ID, Holroyd-Leduc J, Straus SE, Stelfox HT, Strifler L, Lokker C, Li LC, Leung FH, Dobbins M, Puchalski Ritchie LM, Squires JE, Rac VE, Fahim C, Kastner M. A scoping review reveals candidate quality indicators of knowledge translation and implementation science practice tools. J Clin Epidemiol 2024; 165:111205. [PMID: 37939744 DOI: 10.1016/j.jclinepi.2023.10.021] [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] [Received: 06/19/2023] [Revised: 10/24/2023] [Accepted: 10/30/2023] [Indexed: 11/10/2023]
Abstract
OBJECTIVES To identify candidate quality indicators from existing tools that provide guidance on how to practice knowledge translation and implemenation science (KT practice tools) across KT domains (dissemination, implementation, sustainability, and scalability). STUDY DESIGN AND SETTING We conducted a scoping review using the Joanna Briggs Institute Manual for Evidence Synthesis. We systematically searched multiple electronic databases and the gray literature. Documents were independently screened, selected, and extracted by pairs of reviewers. Data about the included articles, KT practice tools, and candidate quality indicators were analyzed, categorized, and summarized descriptively. RESULTS Of 43,060 titles and abstracts that were screened from electronic databases and gray literature, 850 potentially relevant full-text articles were identified, and 253 articles were included in the scoping review. Of these, we identified 232 unique KT practice tools from which 27 unique candidate quality indicators were generated. The identified candidate quality indicators were categorized according to the development (n = 17), evaluation (n = 5) and adaptation (n = 3) of the tools, and engagement of knowledge users (n = 2). No tools were identified that appraised the quality of KT practice tools. CONCLUSIONS The development of a quality appraisal instrument of KT practice tools is needed. The results will be further refined and finalized in order to develop a quality appraisal instrument for KT practice tools.
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Affiliation(s)
- Aunima R Bhuiya
- Dalla Lana School of Public Health, Institute of Health Policy, Management, and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada.
| | - Justin Sutherland
- North York General Hospital, Research and Innovation, North York, Ontario, Canada
| | - Rhonda Boateng
- Dalla Lana School of Public Health, Institute of Health Policy, Management, and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
| | - Téjia Bain
- North York General Hospital, Research and Innovation, North York, Ontario, Canada
| | - Becky Skidmore
- Dalla Lana School of Public Health, Institute of Health Policy, Management, and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
| | - Laure Perrier
- Dalla Lana School of Public Health, Institute of Health Policy, Management, and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
| | - Julie Makarski
- North York General Hospital, Research and Innovation, North York, Ontario, Canada
| | - Sarah Munce
- University Health Network, Toronto, Ontario, Canada
| | - Iveta Lewis
- North York General Hospital, Research and Innovation, North York, Ontario, Canada
| | - Ian D Graham
- School of Epidemiology and Public Health, University of Ottawa and Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Jayna Holroyd-Leduc
- Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sharon E Straus
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine and the O'Brien Institute for Public Health, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
| | - Lisa Strifler
- Dalla Lana School of Public Health, Institute of Health Policy, Management, and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health, Toronto, Ontario, Canada
| | - Cynthia Lokker
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Linda C Li
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Fok-Han Leung
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; St. Michael's Hospital, Toronto, Ontario, Canada
| | - Maureen Dobbins
- School of Nursing, McMaster University, Hamilton, Ontario, Canada; National Collaborating Centre for Methods and Tools, Hamilton, Ontario, Canada
| | - Lisa M Puchalski Ritchie
- Dalla Lana School of Public Health, Institute of Health Policy, Management, and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Emergency Medicine, University Health Network, Toronto, Ontario, Canada
| | - Janet E Squires
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Valeria E Rac
- Dalla Lana School of Public Health, Institute of Health Policy, Management, and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada; Program for Health System and Technology Evaluation, Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada; Ted Rogers Centre for Heart Research at Peter Munk Cardiac Centre, Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Christine Fahim
- Dalla Lana School of Public Health, Institute of Health Policy, Management, and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Monika Kastner
- Dalla Lana School of Public Health, Institute of Health Policy, Management, and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada; North York General Hospital, Research and Innovation, North York, Ontario, Canada
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Bailey K, Avolio J, Lo L, Gajaria A, Mooney S, Greer K, Martens H, Tami P, Pidduck J, Cunningham J, Munce S, Toulany A. Social and Structural Drivers of Health and Transition to Adult Care. Pediatrics 2024; 153:e2023062275. [PMID: 38084099 DOI: 10.1542/peds.2023-062275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/08/2023] [Indexed: 01/02/2024] Open
Abstract
CONTEXT Youth with chronic health conditions experience challenges during their transition to adult care. Those with marginalized identities likely experience further disparities in care as they navigate structural barriers throughout transition. OBJECTIVES This scoping review aims to identify the social and structural drivers of health (SSDOH) associated with outcomes for youth transitioning to adult care, particularly those who experience structural marginalization, including Black, Indigenous, and 2-spirit, lesbian, gay, bisexual, transgender, queer or questioning, and others youth. DATA SOURCES Medline, Embase, CINAHL, and PsycINFO were searched from earliest available date to May 2022. STUDY SELECTION Two reviewers screened titles and abstracts, followed by full-text. Disagreements were resolved by a third reviewer. Primary research studying the association between SSDOH and transition outcomes were included. DATA EXTRACTION SSDOH were subcategorized as social drivers, structural drivers, and demographic characteristics. Transition outcomes were classified into themes. Associations between SSDOH and outcomes were assessed according to their statistical significance and were categorized into significant (P < .05), nonsignificant (P > .05), and unclear significance. RESULTS 101 studies were included, identifying 12 social drivers (childhood environment, income, education, employment, health literacy, insurance, geographic location, language, immigration, food security, psychosocial stressors, and stigma) and 5 demographic characteristics (race and ethnicity, gender, illness type, illness severity, and comorbidity). No structural drivers were studied. Gender was significantly associated with communication, quality of life, transfer satisfaction, transfer completion, and transfer timing, and race and ethnicity with appointment keeping and transfer completion. LIMITATIONS Studies were heterogeneous and a meta-analysis was not possible. CONCLUSIONS Gender and race and ethnicity are associated with inequities in transition outcomes. Understanding these associations is crucial in informing transition interventions and mitigating health inequities.
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Affiliation(s)
- Katherine Bailey
- Temerty Faculty of Medicine
- Institute of Health Policy, Management and Evaluation
| | | | - Lisha Lo
- Centre for Quality Improvement and Patient Safety
| | - Amy Gajaria
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Margaret and Wallace McCain Centre for Child, Youth, and Family Mental Health, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Sarah Mooney
- Stollery Children's Hospital, Alberta Health Services, Edmonton, Alberta, Canada
- Alberta Strategy for Patient Oriented Research Support Unit
- Faculty of Nursing, Grant MacEwan University, Edmonton, Alberta, Canada
| | - Katelyn Greer
- Alberta Strategy for Patient Oriented Research Support Unit
| | - Heather Martens
- Patient and Community Engagement Research (PaCER) Program, University of Calgary, Calgary, Alberta,Canada
- Alberta Health Services, Edmonton, Alberta, Canada
- KickStand, Mental Health Foundation, Edmonton, Alberta, Canada
| | - Perrine Tami
- Public Health and Preventative Medicine, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | | | | | - Sarah Munce
- Rehabilitation Sciences Institute
- Department of Occupational Science and Occupational Therapy
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Alene Toulany
- Temerty Faculty of Medicine
- Institute of Health Policy, Management and Evaluation
- Department of Pediatrics, Division of Adolescent Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health and Evaluative Sciences, Sickkids Research Institute, Toronto, Ontario, Canada
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Singh H, Fakembe SP, Brown RK, Cameron JI, Nelson MLA, Kokorelias KM, Nekolaichuk E, Salbach NM, Munce S, Tang T, Gray CS, Haghayegh AT, Colquhoun H. Stroke Experiences and Unmet Needs of Individuals of African Descent Living in High-Income Economy Countries: a Qualitative Meta-Synthesis. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01725-z. [PMID: 37523144 DOI: 10.1007/s40615-023-01725-z] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 07/07/2023] [Accepted: 07/14/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND Stroke service disparities experienced by individuals of African descent highlight the need to optimize services. While qualitative studies have explored participants' unique experiences and service needs, a comprehensive synthesis is lacking. To address current knowledge gaps, this review aimed to synthesize existing literature on the experiences of individuals of African descent impacted by a stroke living in high-income economy countries in terms of stroke prevention, management, and care. METHODS A qualitative meta-synthesis incorporating a meta-study approach was conducted to obtain comprehensive and interpretive insights on the study topic. Four databases were searched to identify qualitative English-language studies published in the year 2022 or earlier on the experiences of adults of African descent who were at risk or impacted by a stroke and living in high-income economy countries. Study methods, theory, and data were analyzed using descriptive and interpretive analyses. RESULTS Thirty-seven studies met our inclusion criteria, including 29 journal articles and 8 dissertations. Multiple authors reported recruitment as a key challenge in study conduct. Multiple existing theories and frameworks of health behaviours, beliefs, self-efficacy, race, and family structure informed research positionality, questions, and analysis across studies. Participant experiences were categorized as (1) engagement in stroke prevention activities and responses to stroke symptoms, (2) self-management and self-identity after stroke, and (3) stroke care experiences. CONCLUSIONS This study synthesizes the experiences and needs of individuals of African descent impacted by stroke. Findings can help tailor stroke interventions across the stroke care continuum, as they suggest the need for intersectional and culturally humble care approaches.
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Affiliation(s)
- Hardeep Singh
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada.
- The KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada.
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
| | - Semtetam Patience Fakembe
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada
| | - Racquel K Brown
- The KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jill I Cameron
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada
- The KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Michelle L A Nelson
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Kristina M Kokorelias
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Medicine, Geriatrics Division, Sinai Health System, University Health Network, Toronto, ON, Canada
| | - Erica Nekolaichuk
- Gerstein Science Information Centre, University of Toronto Libraries, University of Toronto, Toronto, ON, Canada
| | - Nancy M Salbach
- The KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sarah Munce
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada
- The KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Terence Tang
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
| | - Carolyn Steele Gray
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Arta Taghavi Haghayegh
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada
| | - Heather Colquhoun
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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8
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Chan-Víquez D, Khan A, Munce S, Fehlings D, Wright FV, Biddiss E. Understanding a videogame home intervention for children with hemiplegia: a mixed methods multi-case study. Front Med Technol 2023; 5:1217797. [PMID: 37502272 PMCID: PMC10368996 DOI: 10.3389/fmedt.2023.1217797] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 06/29/2023] [Indexed: 07/29/2023] Open
Abstract
Introduction Access to rehabilitation therapies is a salient and growing issue for children with cerebral palsy (CP) and their families, motivating interest in home-based interventions. Bootle Blast is a low-cost, movement-tracking videogame that can be used at home to encourage upper limb (UL) functional exercise tailored to each child's abilities and therapy goals. The study objectives were to: 1) Establish the extent to which children achieve their self-directed play-time goal over a 12-week intervention, 2) Measure changes in UL motor outcomes, and 3) Explore participants' experiences of using Bootle Blast at home. Methods Mixed methods case series study of four children with hemiplegic cerebral palsy (HCP), each with a participating parent. Participants played Bootle Blast at home for 12 weeks. Study assessments occurred at baseline, post-intervention and four week follow up. A post-intervention interview explored participants' experiences. Game-logs provided play time and progress data. Results Three of four participants (8-13 yrs., Manual Ability Classification Level I-II) completed the intervention. One dropped out at week 6. Play-time goals were achieved in most weeks, with two of four children surpassing their overall intervention goals. Outcomes varied across the three participants, however consistent improvements were observed on the Canadian Occupational Performance Measure and the Box and Blocks Test. Inductive analysis generated four main themes: 1) Intrinsic motivators fostered play engagement, 2) Virtual play for real-world gains, 3) Therapy on demand (at home), and 4) Shifting the onus from the parent to the game. Integration of qualitative and quantitative data was important for interpreting play patterns/usage and clinical outcomes. Discussion This mixed methods study describes a novel videogaming intervention designed for home-rehabilitation for children with HCP and provides preliminary evidence to guide future study design and research. Clinical Trial Registration [https://clinicaltrials.gov/ct2/show/NCT04009031?recrs=h&cond=Cerebral+Palsy&cntry=CA&city=Toronto&draw=2&rank=1], identifier [NCT04009031].
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Affiliation(s)
- Daniela Chan-Víquez
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Ajmal Khan
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Sarah Munce
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Darcy Fehlings
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - F. Virginia Wright
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Elaine Biddiss
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
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Hanafy S, Quilico E, Haag H(L, Khoo Y(B, Munce S, Lindsay S, Colantonio A, Mollayeva T. An educational intervention to promote a culture of gender equity among persons with traumatic brain injury and caregivers: A pilot study. Front Rehabil Sci 2023; 4:1160850. [PMID: 37180573 PMCID: PMC10169667 DOI: 10.3389/fresc.2023.1160850] [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] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 04/04/2023] [Indexed: 05/16/2023]
Abstract
Background Traumatic brain injury (TBI) outcomes are dependent on patients' biological sex (e.g., hormone levels) and sociocultural gender (e.g., norms, responsibilities). Informal caregivers additionally experience disruptions to identity and roles post-TBI. However, information on this topic remains largely unavailable to patients and caregivers. Purpose This study aimed to determine the effectiveness of a one-time educational intervention on sex and gender influences in TBI for patients and informal caregivers. Materials and methods We conducted a pilot pre-test/post-test randomized control-group design study. Groups (i.e., passive, active and control) consisted a total of 16 persons with TBI and caregivers (75% persons with TBI, 63% women). Individual and group learning gains, and group-average normalized gain, were computed for three learning domains: knowledge, attitude, and skill. An intervention with an average normalized gain of ≥30% was considered effective. Educational intervention evaluation and qualitative comments post-participation were summarized. Results The passive group demonstrated the highest average normalized gain across the three learning domains, including 100% for knowledge, 40% and 61% for attitude, and 37% for skill. The remaining groups did not reach an average normalized gain of ≥30%, except for the attitude domain of the control group (33% and 32%). Two key categories were identified qualitatively: (1) gendered self-expectations post-injury and (2) implications of gender stereotypes in rehabilitation, including the need for rehabilitation treatment to look beyond sex and gender. The post-participation educational session evaluation conveyed high appraisal of content, organization, and usability of the intervention. Conclusion A one-time passive educational intervention on sex and gender in TBI may improve knowledge, attitude, and skill on the topic of sex and gender among adults with TBI and caregivers. Obtaining knowledge and skill on sex and gender effects in TBI can potentially help persons with TBI and caregivers adapt to changes in roles and behaviours post-injury.
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Affiliation(s)
- Sara Hanafy
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Enrico Quilico
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Halina (Lin) Haag
- Faculty of Social Work, Wilfrid Laurier University, Waterloo, ON, Canada
| | - Yuelee (Ben) Khoo
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Sarah Munce
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Department of Occupational Science and Occupational Therapy, University ofToronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Sally Lindsay
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
- Department of Occupational Science and Occupational Therapy, University ofToronto, Toronto, ON, Canada
| | - Angela Colantonio
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Occupational Science and Occupational Therapy, University ofToronto, Toronto, ON, Canada
| | - Tatyana Mollayeva
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Occupational Science and Occupational Therapy, University ofToronto, Toronto, ON, Canada
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10
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Marzolini S, da Silva JN, Capone A, Barry-Hickey D, Pikula A, MacDonald SL, Munce S, Mastrangelo D, Oh P. Sex differences and predictors of completion of a 6-month exercise-based cardiac rehabilitation program in 1,536 people following stroke. J Stroke Cerebrovasc Dis 2023; 32:107129. [PMID: 37087771 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107129] [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: 01/10/2023] [Revised: 04/04/2023] [Accepted: 04/06/2023] [Indexed: 04/25/2023] Open
Abstract
OBJECTIVE To retrospectively examine sex-differences and predictors of completion in consecutively-referred patients to a 6-month exercise-based cardiac rehabilitation program (CRP) from 2006 to 2017. MATERIALS/METHODS People with hemiplegic gait participated in stroke-adapted-CRP; otherwise, traditional-CRP. Reasons for non-completion were ascertained by interview. Regression-analyses were conducted to determine non-completion in all patients and women and men separately. RESULTS There were 1536 patients (30.3% women), mean age 64.5 ± 12.5 with 23% initiating the stroke-adapted-CRP. Overall, 75.1% completed the CRP (87.3% stroke-adapted-CRP vs 71.5% traditional-CRP; p < .001). There was no difference in completion between women and men (74.5% vs 75.4%; p=0.7), or in attendance to pre-scheduled sessions (p=0.6) or reasons for non-completion (p > .05, all). The only sex difference in completion by age (decade) occurred in those <41 years (59% women vs 85% men; p=.02). Baseline predictors of non-completion among all patients included not being enrolled in the stroke-adapted-CRP, lower V̇O2peak, smoking, diabetes (prescribed insulin) and depression but not sex (p=.5) or age (p=.15). Unique predictors in women vs men were younger age, lower V̇O2peak, smoking, diabetes (prescribed insulin), depression, and cancer diagnoses. Unique to men was having >1 stroke and diabetes (any anti-diabetes medication). The strongest predictor of non-completion among all models was not being enrolled in stroke-adapted-CRP. CONCLUSIONS While there were no sex-differences in adherence to the CRP, women and men have mostly unique predictors of non-completion. Younger women are at greatest risk for non-completion. Practitioners should provide sex-specific, tailored strategies for enhancing completion with a focus on younger women and offering a stroke-adapted-CRP with close attention to those with diabetes.
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Affiliation(s)
- Susan Marzolini
- KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada; Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Exercise Sciences, Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada.
| | - Juliana Nunes da Silva
- KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada; Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Alessia Capone
- Department of Exercise Sciences, Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
| | - Danielle Barry-Hickey
- KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada
| | - Aleksandra Pikula
- Department of Medicine, Division of Neurology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Neurovascular Unit, University Health Network Toronto Western Hospital, Toronto, ON, Canada; Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Shannon L MacDonald
- KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada; Department of Medicine, Division of Neurology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Sinai Health, Toronto, ON, Canada
| | - Sarah Munce
- KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada; Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, ON, Canada
| | - David Mastrangelo
- KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada
| | - Paul Oh
- KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada; Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Exercise Sciences, Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
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11
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Munce S, Andreoli A, Bayley M, Guo M, Inness EL, Kua A, McIntyre M. Clinicians' Experiences of Implementing a Telerehabilitation Toolkit During the COVID-19 Pandemic: Qualitative Descriptive Study. JMIR Rehabil Assist Technol 2023; 10:e44591. [PMID: 36897634 PMCID: PMC10039414 DOI: 10.2196/44591] [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: 11/24/2022] [Revised: 02/01/2023] [Accepted: 02/27/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND Although the COVID-19 pandemic resulted in a rapid implementation and scale-up of telehealth for patients in need of rehabilitation, an overall slower scaling up to telerehabilitation has been documented. OBJECTIVE The purpose of this study was to understand experiences of implementing telerehabilitation during the COVID-19 pandemic as well as using the Toronto Rehab Telerehab Toolkit from the perspective of rehabilitation professionals across Canada and internationally. METHODS The study adopted a qualitative descriptive approach that consisted of telephone- or videoconference-supported interviews and focus groups. Participants included rehabilitation providers as well as health care leaders who had used the Toronto Rehab Telerehab Toolkit. Each participant took part in a semi-structured interview or focus group, lasting approximately 30-40 minutes. Thematic analysis was used to understand the barriers and enablers of providing telerehabilitation and implementing the Toronto Rehab Telerehab Toolkit. Three members of the research team independently analyzed a set of the same transcripts and met after each set to discuss their analysis. RESULTS A total of 22 participants participated, and 7 interviews and 4 focus groups were included. The data of participants were collected from both Canadian (Alberta, New Brunswick, and Ontario) and international sites (Australia, Greece, and South Korea). A total of 11 sites were represented, 5 of which focused on neurological rehabilitation. Participants included health care providers (ie, physicians, occupational therapists, physical therapists, speech language pathologists, and social workers), managers and system leaders, as well as research and education professionals. Overall, 4 themes were identified including (1) implementation considerations for telerehabilitation, encompassing 2 subthemes of "infrastructure, equipment, and space" and "leadership and organizational support"; (2) innovations developed as a result of telerehabilitation; (3) the toolkit as a catalyst for implementing telerehabilitation; and (4) recommendations for improving the toolkit. CONCLUSIONS Findings from this qualitative study confirm some of the previously identified experiences with implementing telerehabilitation, but from the perspective of Canadian and international rehabilitation providers and leaders. These findings include the importance of adequate infrastructure, equipment, and space; the key role of organizational or leadership support in adopting telerehabilitation; and availing resources to implement it. Importantly, participants in our study described the toolkit as an important resource to broker networking opportunities and highlighted the need to pivot to telerehabilitation, especially early in the pandemic. Findings from this study will be used to improve the next iteration of the toolkit (Toolkit 2.0) to promote safe, accessible, and effective telerehabilitation to those patients in need in the future.
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Affiliation(s)
- Sarah Munce
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Toronto, ON, Canada
| | - Angie Andreoli
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Mark Bayley
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Toronto, ON, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Meiqi Guo
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Elizabeth L Inness
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Ailene Kua
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - McKyla McIntyre
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, ON, Canada
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12
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Moosa S, Voth J, Bayley M, Chandra T, Foster E, Langer L, Comper P, Munce S. Optimizing early education provided at the Hull-Ellis Concussion and Research Clinic: A multiple methods evaluation from the Toronto Concussion Study. Brain Inj 2023:1-13. [PMID: 36879513 DOI: 10.1080/02699052.2023.2187092] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
OBJECTIVES The purpose of this study was to determine factors and characteristics associated with changes in knowledge among adults receiving education within the first 8 weeks post-concussion. The study also aimed to understand desired preferences (i.e. content, format) for education post-concussion from the perspective of patients and physicians. METHODS Patient-participants (17-85 years) were prospectively recruited within one week of a concussion. Participants received education over visits from Weeks 1 to 8 post-injury. Primary outcome measures were participant responses on a concussion knowledge questionnaire at Weeks 1 (n = 334) and 8 (n = 195), and feedback regarding education through interviews. Other variables collected included preexisting medical history, physician assessed recovery and symptoms. RESULTS There was a significant increase in average knowledge on the concussion knowledge questionnaire across time (71% vs 75% correct; p = 0.004). Participants with higher levels of education, female sex and preexisting diagnoses of depression or anxiety had more correct responses at Week 1. Healthcare providers had varying comfort levels addressing mood-related symptoms. CONCLUSIONS There is a need to tailor education provided to concussion patients based on preinjury characteristics, i.e., mood disorders and demographic factors. Healthcare providers may need additional training in addressing mood symptoms and should modify the approach to fit patients' unique needs.
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Affiliation(s)
- Sabreena Moosa
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada.,Human Biology, University of Toronto, Toronto, Canada
| | - Jennifer Voth
- Hotel-Dieu Grace Healthcare, Department of Kinesiology, University of Windsor, Windsor, Canada
| | - Mark Bayley
- Human Biology, University of Toronto, Toronto, Canada.,Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.,Physiatry, University of Toronto, Toronto, Canada
| | - Tharshini Chandra
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Evan Foster
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Laura Langer
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Paul Comper
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.,Rehabilitation Sciences Institute, Faculty of Kinesiology & Physical Education, University of Toronto, Toronto, Canada
| | - Sarah Munce
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.,Rehabilitation Sciences Institute, Faculty of Kinesiology & Physical Education, University of Toronto, Toronto, Canada.,Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
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13
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Alsbury-Nealy K, Colquhoun H, Jaglal S, Munce S, Salbach N. Referrals from Healthcare Professionals to Community-Based Exercise Programs Targeting People with Balance and Mobility Limitations: An Interviewer-Administered Survey. Physiother Can 2023. [DOI: 10.3138/ptc-2022-0069] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
Purpose: To describe program representatives’ perceptions of the: (1) type and work setting of healthcare professionals who refer to community-based exercise programs with healthcare-community partnerships (CBEP-HCPs) by community size; (2) nature, frequency, and utility of strategies used to promote referral from healthcare professionals to CBEP-HCPs; and (3) facilitators and barriers to CBEP-HCP promotion. Method: We invited individuals involved with the Together in Movement and Exercise (TIME™) program in 48 centres to participate in a cross-sectional survey. TIME™ is a group, task-oriented CBEP-HCP taught by fitness instructors; healthcare partners promote referrals. Data were summarized using frequencies and percentages. Content analysis was used for open-ended questions. Results: Twenty-three representatives of 27 TIME™ programs (56% response rate) participated. Out of 26 healthcare partners identified, 69% were physical therapists. We report the most common findings: programs received referrals from physical therapists ( n = 16, 70%); programs gave healthcare partners promotional materials (e.g., flyers) to facilitate referrals ( n = 17, 63%); strong relationships with healthcare partners facilitated promotion ( n = 18, 78%); and representatives perceived their lack of credibility challenged promotion ( n = 3, 23%). Conclusions: Physical therapists were the most common referral source. Healthcare partners were instrumental in program promotion. Future research is needed to leverage referrals from physical therapists in settings other than hospitals and to better understand the role of healthcare partners in CBEP-HCPs.
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Affiliation(s)
- Kyla Alsbury-Nealy
- From the: Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - H. Colquhoun
- From the: Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - S.B. Jaglal
- From the: Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- The KITE Research Institute, University Health Network, Toronto, Ontario, Canada
| | - S. Munce
- From the: Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- The KITE Research Institute, University Health Network, Toronto, Ontario, Canada
| | - N.M. Salbach
- From the: Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- The KITE Research Institute, University Health Network, Toronto, Ontario, Canada
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14
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Bhuiya AR, Makarski J, Hayden L, Perrier L, Munce S, Lewis I, Graham ID, Holroyd-Leduc J, Straus SE, Stelfox HT, Strifler L, Lokker C, Li LC, Leung FH, Dobbins M, Ritchie LMP, Squires J, Rac V, Fahim C, Kastner M. Identifying candidate quality indicators of tools that support the practice of knowledge translation: a scoping review protocol. JBI Evid Synth 2023; 21:264-278. [PMID: 36111878 DOI: 10.11124/jbies-22-00055] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE The objective of this scoping review is to identify and characterize relevant knowledge translation methods tools (those that provide guidance for optimized knowledge translation practice) to uncover candidate quality indicators to inform a future quality assessment tool for knowledge translation strategies. INTRODUCTION Knowledge translation strategies (defined as including knowledge translation interventions, tools, and products) target various knowledge users, including patients, clinicians, researchers, and policy-makers. The development and use of strategies that support knowledge translation practice have been rapidly increasing, making it difficult for knowledge users to decide which to use. There is limited evidence-based guidance or measures to help assess the overall quality of knowledge translation strategies. INCLUSION CRITERIA Empirical and non-empirical documents will be considered if they explicitly describe a knowledge translation methods tool and its development, evaluation or validation, methodological strengths or limitations, and/or use over time. The review will consider a knowledge translation methods tool if it falls within at least one knowledge translation domain (ie, implementation, dissemination, sustainability, scalability, integrated knowledge translation) in the health field. METHODS We will conduct a systematic search of relevant electronic databases and gray literature. The search strategy will be developed iteratively by an experienced medical information specialist and peer-reviewed with the PRESS checklist. The search will be limited to English-only documents published from 2005 onward. Documents will be independently screened, selected, and extracted by 2 researchers. Data will be analyzed and summarized descriptively, including the characteristics of the included documents, knowledge translation methods tools, and candidate quality indicators. SCOPING REVIEW REGISTRATION Open Science Framework ( https://osf.io/chxvq ).
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Affiliation(s)
- Aunima R Bhuiya
- Dalla Lana School of Public Health, Institute of Health Policy, Management, and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada
| | - Julie Makarski
- North York General Hospital, Research and Innovation, North York, ON, Canada
| | - Leigh Hayden
- Centre for Elder Research, Sheridan College, Oakville, ON, Canada
| | - Laure Perrier
- University of Toronto Libraries, University of Toronto, Toronto, ON, Canada
| | - Sarah Munce
- University Health Network, Toronto, ON, Canada
| | - Iveta Lewis
- North York General Hospital, Research and Innovation, North York, ON, Canada
| | - Ian D Graham
- School of Epidemiology and Public Health, University of Ottawa and Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Jayna Holroyd-Leduc
- Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Sharon E Straus
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine and the O'Brien Institute for Public Health, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - Lisa Strifler
- Dalla Lana School of Public Health, Institute of Health Policy, Management, and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada.,Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health, Toronto, ON, Canada
| | - Cynthia Lokker
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Linda C Li
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Fok-Han Leung
- St Michael's Hospital, Unity Health, Tornoto, ON, Canada
| | - Maureen Dobbins
- School of Nursing, McMaster University, Hamilton, ON, Canada
| | - Lisa M Puchalski Ritchie
- Dalla Lana School of Public Health, Institute of Health Policy, Management, and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada.,University Health Network, Toronto, ON, Canada.,Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Janet Squires
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Valeria Rac
- Dalla Lana School of Public Health, Institute of Health Policy, Management, and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada.,University Health Network, Toronto, ON, Canada.,Program for Health System and Technology Evaluation, Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada.,Ted Rogers Centre for Heart Research at Peter Munk Cardiac Centre, Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - Christine Fahim
- Dalla Lana School of Public Health, Institute of Health Policy, Management, and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada.,Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health, Toronto, ON, Canada
| | - Monika Kastner
- Dalla Lana School of Public Health, Institute of Health Policy, Management, and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada.,North York General Hospital, Research and Innovation, North York, ON, Canada
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15
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Hanafy S, Colantonio A, Mollayeva T, Munce S, Lindsay S. Employment and accommodation needs and the effect of COVID-19 on men and women with traumatic brain injury. Work 2022; 75:41-58. [PMID: 36591690 DOI: 10.3233/wor-220437] [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] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Traumatic brain injury (TBI) impacts an individual's workforce involvement post-injury. Support services and workplace accommodations that can help with work re-integration post-TBI may differ based on a person's sex and gender. The added impact of COVID-19 remains under-explored. OBJECTIVE We aimed to investigate the support services and workplace accommodation needs and the impact of COVID-19 on work and mental health for persons with TBI, considering sex and gender. METHODS A cross-sectional online survey was distributed. Descriptive and regression analyses were applied to uncover sex and gender differences, along with content analysis for open-ended responses. RESULTS Thirty-two persons with TBI (62% women, 38% men) participated. Physiotherapy, occupational therapy, and counselling services were indicated as the most needed services by women and men. Modified hours/days and modified/different duties were the most needed workplace accommodations. Mental challenges impacting well-being was a highlighted concern for both men and women. Women scored poorer on the daily activity domain of the Quality of Life after Brain Injury - Overall Scale (p = 0.02). Assistance with daily activities was highlighted by women for a successful transition to work, including housekeeping and caregiving. Men were more likely than women to experience change in employment status because of COVID-19 (p = 0.02). Further, a higher percentage of men expressed concern about the inability to pay for living accommodations, losing their job, and not having future job prospects. CONCLUSION Findings reveal important differences between men and women when transitioning to work post-TBI and emphasize the need for sex and gender considerations.
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Affiliation(s)
- Sara Hanafy
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Angela Colantonio
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Tatyana Mollayeva
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Sarah Munce
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Sally Lindsay
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
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16
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Sessford JD, Chan K, Kaiser A, Singh H, Munce S, Alavinia M, Musselman KE. Protocol for a single group, mixed methods study investigating the efficacy of photovoice to improve self-efficacy related to balance and falls for spinal cord injury. BMJ Open 2022; 12:e065684. [PMID: 36600385 PMCID: PMC9743364 DOI: 10.1136/bmjopen-2022-065684] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Many individuals living with spinal cord injury (SCI) experience falls and a fear of falling, both of which can impact participation in daily activities and quality of life. A single group, convergent mixed methods study will be conducted to examine the effects of a photovoice intervention on falls self-efficacy among individuals living with chronic SCI. Secondary objectives include examining the effects of photovoice on fear of falling, participation and quality of life and exploring participants' experiences and perceptions of the photovoice intervention through qualitative interviews. METHODS AND ANALYSIS Adults with SCI (n=40) will be divided into groups according to their mobility status (ie, those who ambulate and those who primarily use a wheelchair). The study will be conducted virtually over three consecutive phases, totalling 30 weeks. Each group will self-report falls for 12 weeks prior to and following the intervention (phases 1 and 3, respectively). The 6-week photovoice intervention (phase 2) will be comprised of two photo assignments, two individual interviews with a researcher and a peer mentor, and four group meetings. Participants will discuss these photos at the interviews and group meetings. Standardised questionnaires of falls self-efficacy, fear of falling, participation and life satisfaction will be administered at four time points (ie, beginning of each phase and the end of phase 3). Questionnaire scores will be examined over time using repeated-measures analysis of variance. A semistructured interview will be completed at the end of phase 3 to gain feedback on the photovoice intervention. Qualitative data will be analysed using reflexive thematic analysis. ETHICS AND DISSEMINATION Ethics approval was obtained prior to study enrolment. Findings will be shared through peer-reviewed scientific publications and participant-directed knowledge translation activities. TRIAL REGISTRATION NUMBER NCT04864262.
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Affiliation(s)
- James D Sessford
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Katherine Chan
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Anita Kaiser
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Hardeep Singh
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Sarah Munce
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Mohammad Alavinia
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Kristin E Musselman
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
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Hanafy S, Quilico E, Haag H(L, Khoo Y, Munce S, Lindsay S, Colantonio A, Mollayeva T. Sex and Gender Effects in Traumatic Brain Injury: An Educational Trial For Patients and Caregivers. Arch Phys Med Rehabil 2022. [DOI: 10.1016/j.apmr.2022.08.898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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18
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Jervis-Rademeyer H, Ong K, Djuric A, Munce S, Musselman KE, Marquez-Chin C. Therapists' perspectives on using brain-computer interface-triggered functional electrical stimulation therapy for individuals living with upper extremity paralysis: a qualitative case series study. J Neuroeng Rehabil 2022; 19:127. [PMID: 36419166 PMCID: PMC9684970 DOI: 10.1186/s12984-022-01107-2] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 10/31/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Brain computer interface-triggered functional electrical stimulation therapy (BCI-FEST) has shown promise as a therapy to improve upper extremity function for individuals who have had a stroke or spinal cord injury. The next step is to determine whether BCI-FEST could be used clinically as part of broader therapy practice. To do this, we need to understand therapists' opinions on using the BCI-FEST and what limitations potentially exist. Therefore, we conducted a qualitative exploratory study to understand the perspectives of therapists on their experiences delivering BCI-FEST and the feasibility of large-scale clinical implementation. METHODS Semi-structured interviews were conducted with physical therapists (PTs) and occupational therapists (OTs) who have delivered BCI-FEST. Interview questions were developed using the COM-B (Capability, Opportunity, Motivation-Behaviour) model of behaviour change. COM-B components were used to inform deductive content analysis while other subthemes were detected using an inductive approach. RESULTS We interviewed PTs (n = 3) and OTs (n = 3), with 360 combined hours of experience delivering BCI-FEST. Components and subcomponents of the COM-B determined deductively included: (1) Capability (physical, psychological), (2) Opportunity (physical, social), and (3) Motivation (automatic, reflective). Under each deductive subcomponent, one to two inductive subthemes were identified (n = 8). Capability and Motivation were perceived as strengths, and therefore supported therapists' decisions to use BCI-FEST. Under Opportunity, for both subcomponents (physical, social), therapists recognized the need for more support to clinically implement BCI-FEST. CONCLUSIONS We identified facilitating and limiting factors to BCI-FEST delivery in a clinical setting according to clinicians. These factors implied that education, training, a support network or mentors, and restructuring the physical environment (e.g., scheduling) should be targeted as interventions. The results of this study may help to inform future development of new technologies and interventions.
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Affiliation(s)
- Hope Jervis-Rademeyer
- grid.17063.330000 0001 2157 2938Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada ,grid.231844.80000 0004 0474 0428The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Kenneth Ong
- grid.231844.80000 0004 0474 0428The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada ,grid.17063.330000 0001 2157 2938Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Alexander Djuric
- grid.231844.80000 0004 0474 0428The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada ,grid.17063.330000 0001 2157 2938Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Sarah Munce
- grid.17063.330000 0001 2157 2938Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada ,grid.231844.80000 0004 0474 0428The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada ,grid.17063.330000 0001 2157 2938Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
| | - Kristin E. Musselman
- grid.17063.330000 0001 2157 2938Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada ,grid.231844.80000 0004 0474 0428The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada ,grid.17063.330000 0001 2157 2938Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Cesar Marquez-Chin
- grid.231844.80000 0004 0474 0428The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada ,grid.17063.330000 0001 2157 2938Institute of Biomedical Engineering, University of Toronto, Toronto, Canada
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Singh H, Nelson MLA, Martyniuk J, Colquhoun H, Munce S, Cameron JI, Kokorelias KM, Pakkal O, Kuluski K. Scoping review protocol of the use of codesign methods in stroke intervention development. BMJ Open 2022; 12:e065150. [PMID: 36410803 PMCID: PMC9680189 DOI: 10.1136/bmjopen-2022-065150] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Codesign is an emerging research method to enhance intervention development by actively engaging non-researchers (eg, people who have had a stroke, caregivers and clinicians) in research. The involvement of non-researchers in research is becoming increasingly popular within health studies as it may produce more relevant and effective findings. The stroke population commonly exhibits challenges such as aphasia and cognitive changes that may limit their participation in codesign. However, the use of codesign within the stroke literature has not been comprehensively reviewed. This scoping review will determine: (1) what is the extent, range and nature of stroke research that has used codesign methods? (2) What codesign methods have been used to develop stroke interventions? (3) What considerations for codesigning interventions with people who have stroke are not captured in the findings? METHODS AND ANALYSIS This is a protocol for a scoping review to identify the literature relating to stroke, and codesign will be conducted on OVID Medline, OVID Embase, OVID PsychINFO, EBSCO CINAHL, the Cochrane Library, Scopus, PEDro-Physiotherapy Evidence Database and Global Index Medicus. Studies of any design and publication date will be included. Title and abstract and full-text review will be conducted independently by two reviewers. Data will be extracted, collated and then summarised descriptively using quantitative (eg, numerical descriptions) and qualitative (eg, textual descriptions) methods. Numerical summaries will map the extent (eg, number of studies), range (eg, types of studies) and nature (eg, types of interventions developed) of the literature on this topic. A thematic analysis will provide insights into the codesign methods (eg, activities, non-researchers), including heterogeneity across and within studies. ETHICS AND DISSEMINATION This review protocol does not require ethics approval as data has not been collected/analysed. The findings will highlight opportunities and recommendations to inform future codesign research in stroke and other populations who exhibit similar challenges/disabilities, and they will be disseminated via publications, presentations and stakeholder meetings. TRIAL REGISTRATION NUMBERREGISTRATION Open Science Framework: 10.17605/OSF.IO/NSD2W.
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Affiliation(s)
- Hardeep Singh
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- KITE, Toronto Rehabilitation Institute, Toronto, Ontario, Canada
- Rehabilitation Science Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Michelle LA Nelson
- Bridgepoint Collaboratory for Research and Innovation, Sinai Health System, Lunenfeld-Tanenbaum Research Institute, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Julia Martyniuk
- Gerstein Science Information Centre, University of Toronto, Toronto, Ontario, Canada
| | - Heather Colquhoun
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Science Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sarah Munce
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- KITE, Toronto Rehabilitation Institute, Toronto, Ontario, Canada
- Rehabilitation Science Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jill I Cameron
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Science Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Kristina Marie Kokorelias
- Geriatric Medicine, Department of Medicine, Sinai Health System/University Health Network, Toronto, ON, Canada
| | - Oya Pakkal
- Bridgepoint Collaboratory for Research and Innovation, Sinai Health System, Lunenfeld-Tanenbaum Research Institute, Toronto, Ontario, Canada
| | - Kerry Kuluski
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
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Alsbury-Nealy K, Scodras S, Munce S, Colquhoun H, Jaglal SB, Salbach NM. Models for establishing linkages between healthcare and community: A scoping review. Health Soc Care Community 2022; 30:e3904-e3920. [PMID: 36317803 DOI: 10.1111/hsc.14096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 01/28/2022] [Revised: 07/22/2022] [Accepted: 10/16/2022] [Indexed: 06/16/2023]
Abstract
Community-based programmes can support healthcare systems by delivering preventive services and health promotion. This study aimed to determine the nature, range, and extent of theoretical models that guide the development of linkages between healthcare settings and community programmes. A scoping review guided by the Joanna Briggs Institute methodology and the PRISMA-ScR was conducted. Four databases (MEDLINE, EMBASE, CINAHL and PsycINFO) were searched on August 8, 2020. Two reviewers independently screened articles by title and abstract and divided the remaining articles for full-text screening. Articles that described the development of a theoretical model to guide the establishment of linkages between healthcare settings and community programmes, were peer-reviewed, and in English, were included. Articles that solely applied linkage models were excluded. One reviewer extracted data on study and model characteristics (e.g. model purpose, model components and relationships between components from the included articles). Categorical data were summarised using frequencies and percentages. Conventional content analysis was used for variables that had lengthier descriptions and variable terminology. The search identified 8926 records. Six articles describing six unique models were included in the review. Of the four models that described intended users, three (75%) identified primary care. Healthcare settings were identified in all models, with three (50%) focusing on primary care. Models used two or more linkage strategies: (1) agreeing on sharing resources, staff, and information, (2) coordinating services and referral processes, (3) planning and evaluation, (4) leadership, policies, and funding, (5) boundary spanning and (6) brokering. All models used the linkage strategy of agreeing on sharing resources, staff, and information. Findings provide important considerations for healthcare and community programme providers planning linkages. Future research should investigate the role and characteristics of community programmes in linkages, and linkages with other types of healthcare settings.
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Affiliation(s)
- Kyla Alsbury-Nealy
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Stephanie Scodras
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sarah Munce
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Heather Colquhoun
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Susan B Jaglal
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nancy M Salbach
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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21
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Verville L, Cancelliere C, Connell G, Lee J, Mior S, Munce S, Kay R, Côté P. Exploring clinician perceptions of a care pathway for the management of shoulder pain: a qualitative study. BMC Health Serv Res 2022; 22:702. [PMID: 35614506 PMCID: PMC9131556 DOI: 10.1186/s12913-022-07999-z] [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] [Received: 01/19/2022] [Accepted: 04/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clinical care pathways may be useful tools to improve the quality of healthcare by facilitating the translation of evidence into practice. Our study is situated within a larger project, whereby end-users co-developed a care pathway for the management of shoulder pain. In this study, we explored end-user perceptions of the usefulness and practicality of implementing a care pathway to manage shoulder pain. We also solicited feedback for the pathway's improvement. METHODS We conducted a qualitative study using a transcendental phenomenological approach seen through a constructivist lens. Clinicians recorded themselves interacting with the care pathway while working through a clinical case. Clinicians described their thoughts and movements aloud as they completed the activity. Second, we conducted individual semi-structured interviews to discuss the usefulness and practicality of pathway implementation. Interview transcripts were coded independently by reviewers. Transcript codes and associated quotes were grouped into themes. Themes were sequenced and linked creating a 'web' of thematic connections. Summary statements were developed to synthesize the overall essence of the phenomena. RESULTS Nine clinicians participated. Participants included eight chiropractors and one medical physician. We found that clinicians believed the care pathway could be useful at various levels, including education (students, interns), for early career clinicians, for engaging patients, facilitating interprofessional communication, and as a reminder of information for certain, less familiar conditions. When discussing the practicality of implementing the care pathway into practice settings, clinicians expressed that agreement with the care pathway and its recommendations may influence its acceptability among clinicians. Additionally, integrating recommendations into practice may be a skill requirement included into clinical training. Clinicians described the importance of opinion leaders in the acceptability of new evidence. Various difficulties with the replicability of interventions into clinical care was also discussed. In general, clinicians suggested the layout of the care pathway was manageable, and there was sufficient information for clinical decision-making. Clinicians also made several recommendations for improvement. CONCLUSIONS End-user involvement and collaboration provides tangible instruction to improve care pathways themselves, their implementation strategies and helps to support and strengthen future research for overcoming individual, systemic and contextual barriers.
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Affiliation(s)
- Leslie Verville
- University of Ontario Institute of Technology (Ontario Tech University), Oshawa, Ontario, Canada.
| | - Carol Cancelliere
- University of Ontario Institute of Technology (Ontario Tech University), Oshawa, Ontario, Canada
| | - Gaelan Connell
- University of Ontario Institute of Technology (Ontario Tech University), Oshawa, Ontario, Canada
| | - Joyce Lee
- Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
| | - Silvano Mior
- Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
| | - Sarah Munce
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Robin Kay
- University of Ontario Institute of Technology (Ontario Tech University), Oshawa, Ontario, Canada
| | - Pierre Côté
- University of Ontario Institute of Technology (Ontario Tech University), Oshawa, Ontario, Canada
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Kokorelias KM, Nelson MLA, Cameron JI, Colquhoun H, Munce S, Hitzig SL, Salbach NM, Martyniuk J, Steele Gray C, Tang T, Wang RH, Lindsay P, Bayley M, Kaur N, Singh H. Exploring the poststroke experiences and unmet needs of South Asian communities in high-income countries: a scoping review protocol. BMJ Open 2022; 12:e059017. [PMID: 35477869 PMCID: PMC9047763 DOI: 10.1136/bmjopen-2021-059017] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION South Asian groups experience a higher burden of stroke and poorer functional outcomes after stroke than their White counterparts. However, within the stroke literature, there has been little focus on the unique poststroke needs of the South Asian community and opportunities for community-based services to address these needs. RESEARCH QUESTION What is the current knowledge base related to the experiences and needs, including unmet needs of people living with stroke and their caregivers from South Asian communities living in high-income countries? AIMS This is a protocol for a review that intends to synthesise existing studies of the poststroke experiences and needs of individuals from South Asian communities to uncover opportunities for community-based resources to address these needs. METHODS AND ANALYSIS This scoping review methodology will be guided by modified Arksey and O'Malley (2005) and Joanna Briggs Institute frameworks. A search on OVID Medline, OVID Embase, OVID PsycINFO, EBSCO CINAHL, the Cochrane Library, Scopus and Global Index Medicus will be conducted to synthesise existing peer-reviewed literature (all study designs). Grey literature will be searched through detailed hand searching. Literature focusing on the poststroke experiences and needs of South Asian groups impacted by stroke residing in high-income countries will be included. Study descriptors will be extracted (eg, study location, type, methodology). Data will be analysed descriptively and thematically. Team meetings will provide opportunities for peer debriefing, thereby enhancing analytic rigour. CONCLUSION AND IMPLICATIONS Findings will enhance knowledge of the poststroke experiences and needs of South Asian communities living in high-income countries and identify actionable opportunities for community-based resources to address needs. ETHICS AND DISSEMINATION Ethics approval was not required for this scoping review protocol. Community-based organisations will be consulted to provide insights into the analysis and assist with dissemination. Dissemination of findings will also occur through a publication and academic presentations.
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Affiliation(s)
- Kristina M Kokorelias
- St John's Rehab Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Michelle L A Nelson
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Jill I Cameron
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- KITE - Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada
- Rehabiliation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Heather Colquhoun
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Rehabiliation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sarah Munce
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- KITE - Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada
- Rehabiliation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sander L Hitzig
- St John's Rehab Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Rehabiliation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nancy M Salbach
- KITE - Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada
- Rehabiliation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Julia Martyniuk
- Gerstein Science Information Centre, University of Toronto, Toronto, Ontario, Canada
| | - Carolyn Steele Gray
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Terence Tang
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Rosalie H Wang
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- KITE - Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada
- Rehabiliation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Patrice Lindsay
- Heart and Stroke Foundation of Canada, Toronto, Ontario, Canada
| | - Mark Bayley
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
- KITE - Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada
- Rehabiliation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Physical Medicine and Rehabilitation, University of Toronto, Toronto, Ontario, Canada
| | - Navaldeep Kaur
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Hardeep Singh
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- KITE - Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada
- Rehabiliation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Chishtie J, Bielska IA, Barrera A, Marchand JS, Imran M, Tirmizi SFA, Turcotte LA, Munce S, Shepherd J, Senthinathan A, Cepoiu-Martin M, Irvine M, Babineau J, Abudiab S, Bjelica M, Collins C, Craven BC, Guilcher S, Jeji T, Naraei P, Jaglal S. Interactive Visualization Applications in Population Health and Health Services Research: Systematic Scoping Review. J Med Internet Res 2022; 24:e27534. [PMID: 35179499 PMCID: PMC8900899 DOI: 10.2196/27534] [Citation(s) in RCA: 5] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 04/27/2021] [Accepted: 10/08/2021] [Indexed: 11/15/2022] Open
Abstract
Background Simple visualizations in health research data, such as scatter plots, heat maps, and bar charts, typically present relationships between 2 variables. Interactive visualization methods allow for multiple related facets such as numerous risk factors to be studied simultaneously, leading to data insights through exploring trends and patterns from complex big health care data. The technique presents a powerful tool that can be used in combination with statistical analysis for knowledge discovery, hypothesis generation and testing, and decision support. Objective The primary objective of this scoping review is to describe and summarize the evidence of interactive visualization applications, methods, and tools being used in population health and health services research (HSR) and their subdomains in the last 15 years, from January 1, 2005, to March 30, 2019. Our secondary objective is to describe the use cases, metrics, frameworks used, settings, target audience, goals, and co-design of applications. Methods We adapted standard scoping review guidelines with a peer-reviewed search strategy: 2 independent researchers at each stage of screening and abstraction, with a third independent researcher to arbitrate conflicts and validate findings. A comprehensive abstraction platform was built to capture the data from diverse bodies of literature, primarily from the computer science and health care sectors. After screening 11,310 articles, we present findings from 56 applications from interrelated areas of population health and HSR, as well as their subdomains such as epidemiologic surveillance, health resource planning, access, and use and costs among diverse clinical and demographic populations. Results In this companion review to our earlier systematic synthesis of the literature on visual analytics applications, we present findings in 6 major themes of interactive visualization applications developed for 8 major problem categories. We found a wide application of interactive visualization methods, the major ones being epidemiologic surveillance for infectious disease, resource planning, health service monitoring and quality, and studying medication use patterns. The data sources included mostly secondary administrative and electronic medical record data. In addition, at least two-thirds of the applications involved participatory co-design approaches while introducing a distinct category, embedded research, within co-design initiatives. These applications were in response to an identified need for data-driven insights into knowledge generation and decision support. We further discuss the opportunities stemming from the use of interactive visualization methods in studying global health; inequities, including social determinants of health; and other related areas. We also allude to the challenges in the uptake of these methods. Conclusions Visualization in health has strong historical roots, with an upward trend in the use of these methods in population health and HSR. Such applications are being fast used by academic and health care agencies for knowledge discovery, hypotheses generation, and decision support. International Registered Report Identifier (IRRID) RR2-10.2196/14019
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Affiliation(s)
- Jawad Chishtie
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.,Center for Health Informatics, University of Calgary, Calgary, AB, Canada.,Alberta Health Services, Edmonton, AB, Canada
| | | | | | | | | | | | | | - Sarah Munce
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - John Shepherd
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Arrani Senthinathan
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | | | - Michael Irvine
- Department of Mathematics, University of British Columbia, Vancouver, BC, Canada.,British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Jessica Babineau
- Library & Information Services, University Health Network, Toronto, ON, Canada.,The Institute for Education Research, University Health Network, Toronto, ON, Canada
| | - Sally Abudiab
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Marko Bjelica
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - B Catharine Craven
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Sara Guilcher
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Tara Jeji
- Ontario Neurotrauma Foundation, Toronto, ON, Canada
| | - Parisa Naraei
- Department of Computer Science, Ryerson University, Toronto, ON, Canada
| | - Susan Jaglal
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
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24
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Aquino M, Griffith J, Vattaparambil T, Munce S, Hladunewich M, Seto E. Patients' and Providers' Perspectives on and Needs of Telemonitoring to Support Clinical Management and Self-care of People at High Risk for Preeclampsia: Qualitative Study. JMIR Hum Factors 2022; 9:e32545. [PMID: 35129445 PMCID: PMC8861860 DOI: 10.2196/32545] [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: 08/02/2021] [Revised: 11/24/2021] [Accepted: 11/28/2021] [Indexed: 11/13/2022] Open
Abstract
Background Preeclampsia is one of the leading causes of maternal mortality worldwide, with a global prevalence at 2%-8% of pregnancies. Patients at high risk for preeclampsia (PHRPE) have an increased risk of complications, such as fetal growth restriction, preterm delivery, abnormal clotting, and liver and kidney disease. Telemonitoring for PHRPE may allow for timelier diagnosis and enhanced management, which may improve maternal and perinatal outcomes. Objective The objective of this study is to determine the perceptions and needs of PHRPE and their health care providers with respect to telemonitoring through semistructured interviews with both groups. This study explored (1) what the needs and challenges of monitoring PHRPE are during pregnancy and in the postpartum period and (2) what features are required in a telemonitoring program to support self-care and clinical management of PHRPE. Methods This study used a qualitative descriptive approach, and thematic analysis was conducted. PHRPE and health care providers from a high-risk obstetrical clinic in a large academic hospital in Toronto, Canada, were asked to participate in individual semistructured interviews. Two researchers jointly developed a coding framework and separately coded each interview to ensure that the interviews were double-coded. The software program NVivo version 12 was used to help organize the codes. Results In total, 7 PHRPE and 5 health care providers, which included a nurse practitioner and physicians, participated in the semistructured interviews. Using thematic analysis, perceptions on the benefits, barriers, and desired features were determined. Perceived benefits of telemonitoring for PHRPE included close monitoring of home blood pressure (BP) measurements and appropriate interventions for abnormal BP readings; the development of a tailored telemonitoring system for pregnant patients; and facilitation of self-management. Perceived barriers to telemonitoring for PHRPE included financial and personal barriers, as well as the potential for increased clinician workload. Desired features of a secure platform for PHRPE included the facilitation of self-management for patients and decision making for clinicians, as well as the inclusion of evidence-based action prompts. Conclusions The perceptions of patients and providers on the use of telemonitoring for PHRPE support the need for a telemonitoring program for the management of PHRPE. Recommendations from this study include the specific features of a telemonitoring program for PHRPE, as well as the use of frameworks and design processes in the design and implementation of a telemonitoring program for PHRPE.
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Affiliation(s)
- Maria Aquino
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada
| | - Janessa Griffith
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Women's College Hospital Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Tessy Vattaparambil
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada
| | - Sarah Munce
- Department of Occupational Sciences and Occupational Therapy, University of Toronto, Toronto, ON, Canada.,KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Michelle Hladunewich
- Division of Nephrology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Emily Seto
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada
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25
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Jefferies M, Peart T, Perrier L, Lauzon A, Munce S. Psychological Interventions for Individuals With Acquired Brain Injury, Cerebral Palsy, and Spina Bifida: A Scoping Review. Front Pediatr 2022; 10:782104. [PMID: 35386256 PMCID: PMC8978581 DOI: 10.3389/fped.2022.782104] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 02/10/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND With current medical advancements, more adolescents with neurodevelopmental disorders are transitioning from child- to adult-centred health care services. Therefore, there is an increasing demand for transitional services to help navigate this transition. Health care transitions can be further complicated by mental health challenges prevalent among individuals with cerebral palsy (CP), spina bifida (SB), and childhood onset acquired brain injury (ABI). Offering evidence-based psychological interventions for these populations may improve overall outcomes during transition period(s) and beyond. The objective of this scoping review is to identify key characteristics of psychological interventions being used to treat the mental health challenges of adolescents and adults with CP, SB, and childhood onset ABI. METHODS Methodological frameworks by Arksey and O'Malley, and Levac and colleagues were used to explore studies published between 2009 and 2019. Included studies were required to be written in English and report on a psychological intervention(s) administered to individuals at least 12 years of age with a diagnosis of CP, SB, or childhood onset ABI. All study designs were included. RESULTS A total of 11 studies were identified. Of these, eight reported psychological interventions for childhood onset ABI, while three reported on CP. No studies reporting on SB were identified. Commonly used interventions included acceptance and commitment therapy (ACT), psychotherapy, and cognitive behavioral therapy (CBT). CONCLUSIONS There are a limited number of studies investigating psychological interventions for individuals with childhood onset ABI and CP, and none for individuals with SB. Further research into effective psychological interventions for these populations will improve mental health outcomes and transitional services.
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Affiliation(s)
- Morgan Jefferies
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Taylor Peart
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Laure Perrier
- University of Toronto Libraries, University of Toronto, Toronto, ON, Canada
| | - Andrea Lauzon
- LIFESpan Service, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada.,LIFESpan Service, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Sarah Munce
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada.,LIFESpan Service, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada
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26
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Verville L, Cancelliere C, Connell G, Lee J, Munce S, Mior S, Kay R, Côté P. Exploring clinicians' experiences and perceptions of end-user roles in knowledge development: a qualitative study. BMC Health Serv Res 2021; 21:926. [PMID: 34488751 PMCID: PMC8420847 DOI: 10.1186/s12913-021-06955-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 04/19/2021] [Accepted: 08/13/2021] [Indexed: 11/10/2022] Open
Abstract
Background End-user involvement in developing evidence-based tools for clinical practice may result in increased uptake and improved patient outcomes. Understanding end-user experiences and perceptions about the co-production of knowledge is useful to further the science of integrated knowledge translation (iKT) – a strategy for accelerating the uptake and impact of research. Our study had two main objectives: (1) explore end-user (clinician) experiences of co-producing an evidence-based practice tool; and (2) describe end-user perceptions in knowledge development. Methods We used a qualitative study design. We conducted semi-structured interviews with clinicians and used a transcendental phenomenological approach to analyze themes/phenomena. In addition, we explored the interrelated themes between the thematic maps of each objective. Results Four themes emerged from clinicians’ experiences in co-producing the practice tool: ease/convenience of participating, need for support and encouragement, understanding the value of participating, and individual skillsets yield meaningful contributions. Stakeholder roles in knowledge tool development and improving dissemination of evidence and knowledge tools were themes that related to clinician perceptions in knowledge development. The review of interrelated thematic maps depicts an intertwined relationship between stakeholders and dissemination. Conclusions End-users provide invaluable insight and perspective into the development of evidence-based clinical tools. Exploring the experiences and perceptions of end-users may support future research endeavours involving iKT, such as the co-production of clinical resources, potentially improving uptake and patient health outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06955-7.
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Affiliation(s)
| | | | | | - Joyce Lee
- Canadian Memorial Chiropractic College, ON, Toronto, Canada
| | - Sarah Munce
- KITE-Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada
| | - Silvano Mior
- Canadian Memorial Chiropractic College, ON, Toronto, Canada
| | - Robin Kay
- Ontario Tech University, Oshawa, ON, Canada
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27
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Peterson A, Webster F, Gonzalez-Lara LE, Munce S, Owen AM, Weijer C. Caregiver reactions to neuroimaging evidence of covert consciousness in patients with severe brain injury: a qualitative interview study. BMC Med Ethics 2021; 22:105. [PMID: 34320966 PMCID: PMC8320067 DOI: 10.1186/s12910-021-00674-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 04/22/2021] [Accepted: 07/16/2021] [Indexed: 11/10/2022] Open
Abstract
Background Severe brain injury is a leading cause of death and disability. Diagnosis and prognostication are difficult, and errors occur often. Novel neuroimaging methods can improve diagnostic and prognostic accuracy, especially in patients with prolonged disorders of consciousness (PDoC). Yet it is currently unknown how family caregivers understand this information, raising ethical concerns that disclosure of neuroimaging results could result in therapeutic misconception or false hope. Methods To examine these ethical concerns, we conducted semi-structured interviews with caregivers of patients with PDoC who were enrolled in a concurrent neuroimaging research program designed to detect covert consciousness following severe brain injury. Caregivers held surrogate decision-making status for a patient. Interviews were conducted at two time points for each caregiver. The first interview occurred before the disclosure of neuroimaging results. The second occurred after disclosure. Descriptive analysis was applied to the data of four interview topics: (1) expectations for neuroimaging; (2) reactions to evidence of preserved cognition; (3) reactions to null results; and (4) understanding of the results and study. Results Twelve caregivers participated in the study; two caregivers shared surrogate decision-making status for one patient with PDoC. Twenty-one interviews were completed; one caregiver declined to participate in the post-disclosure interview. Three patients with PDoC associated with the study displayed evidence of covert consciousness. Overall, caregivers understood the neuroimaging research and results. Caregivers who received results of covert consciousness were generally pleased. However, there was some variation in expectations and reactions to these data and null results. Conclusion This study, for the first time, reveals caregiver expectations for and reactions to neuroimaging evidence of covert consciousness in patients with PDoC. Caregivers understood the neuroimaging research and results, casting doubt on speculative ethical concerns regarding therapeutic misconception and false hope. However, disclosure of neuroimaging result could be improved. Pre-disclosure consultations might assist professionals in shaping caregiver expectations. Standardization of disclosure might also improve comprehension of the results. Supplementary Information The online version contains supplementary material available at 10.1186/s12910-021-00674-8.
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Affiliation(s)
- Andrew Peterson
- Institute for Philosophy and Public Policy, George Mason University, Fairfax, USA.
| | - Fiona Webster
- Arthur Labatt Family School of Nursing, Western University, London, Canada
| | | | - Sarah Munce
- Toronto Rehabilitation Institute-University Health Network, Toronoto, Canada
| | - Adrian M Owen
- Brain and Mind Institute, Western University, London, Canada
| | - Charles Weijer
- Departments of Medicine, Epidemiology & Biostatistics, and Philosophy, Western University, London, Canada
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28
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Nelson MLA, Armas A, Thombs R, Singh H, Fulton J, Cunningham HV, Munce S, Hitzig S, Bettger JP. Synthesising evidence regarding hospital to home transitions supported by volunteers of third sector organisations: a scoping review protocol. BMJ Open 2021; 11:e050479. [PMID: 34226235 PMCID: PMC8258550 DOI: 10.1136/bmjopen-2021-050479] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Given the risks inherent in care transitions, it is imperative that patients discharged from hospital to home receive the integrated care services necessary to ensure a successful transition. Despite efforts by the healthcare sector to develop health system solutions to improve transitions, problems persist. Research on transitional support has predominantly focused on services delivered by healthcare professionals; the evidence for services provided by lay navigators or volunteers in this context has not been synthesised. This scoping review will map the available literature on the engagement of volunteers within third sector organisations supporting adults in the transition from hospital to home. METHODS AND ANALYSIS Using the well-established scoping review methodology outlined by the Joanna Briggs Institute, a five-stage review is outlined: (1) determining the research question, (2) search strategy, (3) inclusion criteria, (4) data extraction and (5) analysis and presentation of the results. The search strategy will be applied to 10 databases reflecting empirical and grey literature. A two-stage screening process will be used to determine eligibility of articles. To be included in the review, articles must describe a community-based programme delivered by a third sector organisation that engages volunteers in the provisions of services that support adults transitioning from hospital to home. All articles will be independently assessed for eligibility, and data from eligible articles will be extracted and charted using a standardised form. Extracted data will be analysed using narrative and descriptive analyses. ETHICS AND DISSEMINATION Ethics approval is not required for this scoping review. Members of an international special interest group focused on the voluntary sector will be consulted to provide insight and feedback on study findings, help with dissemination of the results and engage in the development of future research proposals. Dissemination activities will include peer-reviewed publications and academic presentations.
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Affiliation(s)
- Michelle LA Nelson
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute; Sinai Health, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Knowledge to Action, March of Dimes Canada, Toronto, Ontario, Canada
| | - Alana Armas
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute; Sinai Health, Toronto, Ontario, Canada
| | - Rachel Thombs
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute; Sinai Health, Toronto, Ontario, Canada
| | - Hardeep Singh
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute; Sinai Health, Toronto, Ontario, Canada
| | - Joseph Fulton
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute; Sinai Health, Toronto, Ontario, Canada
| | - Heather V Cunningham
- Gerstein Science Information Centre, University of Toronto, Toronto, Ontario, Canada
| | - Sarah Munce
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- LIFEspan Service, KITE, Toronto Rehabilitation Institute; University Health Network, Toronto, Ontario, Canada
- Faculty of Medicine, Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Sander Hitzig
- Faculty of Medicine, Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
- St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Gonzalez-Lara LE, Munce S, Christian J, Owen AM, Weijer C, Webster F. The multiplicity of caregiving burden: a qualitative analysis of families with prolonged disorders of consciousness. Brain Inj 2021; 35:200-208. [PMID: 33385307 DOI: 10.1080/02699052.2020.1865565] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objective: To understand the multiple and sometimes conflicting roles substitute decision makers (SDMs) of individuals in a vegetative state (VS), minimally conscious state (MCS), or with locked-in syndrome (LIS) perform while caring for a loved one and the competing priorities derived from these roles.Methods: We conducted semi-structured qualitative interviews using a constructive-grounded theory design. Twelve SDMs, who were also family members for 11 patients, were interviewed at two time points (except one) for a total of 21 in-depth interviews.Results: Participants described that caregiving is often the central role which they identify as their top priority and around which they coordinate and to some extent subordinate their other roles. In addition to caregiving, they participated in a wide variety of roles, which were sometimes in conflict, as they became caregivers for a loved one with chronic and complex needs. SDMs described the caregiver role as complex and intense that lead to physical, emotional, social, and economic burdens.Conclusion: SDMs report high levels of burdens in caring for a person with a prolonged disorder of consciousness. Lack of health system support that recognized the broader context of SDMs lives, including their multiple competing priorities, was a major contributing factor.
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Affiliation(s)
| | - Sarah Munce
- Toronto Rehabilitation Institute - University Health Network
| | | | - Adrian M Owen
- The Brain and Mind Institute, Western University, London, Ontario, Canada
| | | | - Fiona Webster
- Labatt Family School of Nursing, Western University, London, Ontario, Canada
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30
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Chishtie JA, Marchand JS, Turcotte LA, Bielska IA, Babineau J, Cepoiu-Martin M, Irvine M, Munce S, Abudiab S, Bjelica M, Hossain S, Imran M, Jeji T, Jaglal S. Visual Analytic Tools and Techniques in Population Health and Health Services Research: Scoping Review. J Med Internet Res 2020; 22:e17892. [PMID: 33270029 PMCID: PMC7716797 DOI: 10.2196/17892] [Citation(s) in RCA: 13] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 07/01/2020] [Accepted: 09/24/2020] [Indexed: 01/27/2023] Open
Abstract
Background Visual analytics (VA) promotes the understanding of data with visual, interactive techniques, using analytic and visual engines. The analytic engine includes automated techniques, whereas common visual outputs include flow maps and spatiotemporal hot spots. Objective This scoping review aims to address a gap in the literature, with the specific objective to synthesize literature on the use of VA tools, techniques, and frameworks in interrelated health care areas of population health and health services research (HSR). Methods Using the 2018 PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines, the review focuses on peer-reviewed journal articles and full conference papers from 2005 to March 2019. Two researchers were involved at each step, and another researcher arbitrated disagreements. A comprehensive abstraction platform captured data from diverse bodies of the literature, primarily from the computer and health sciences. Results After screening 11,310 articles, findings from 55 articles were synthesized under the major headings of visual and analytic engines, visual presentation characteristics, tools used and their capabilities, application to health care areas, data types and sources, VA frameworks, frameworks used for VA applications, availability and innovation, and co-design initiatives. We found extensive application of VA methods used in areas of epidemiology, surveillance and modeling, health services access, use, and cost analyses. All articles included a distinct analytic and visualization engine, with varying levels of detail provided. Most tools were prototypes, with 5 in use at the time of publication. Seven articles presented methodological frameworks. Toward consistent reporting, we present a checklist, with an expanded definition for VA applications in health care, to assist researchers in sharing research for greater replicability. We summarized the results in a Tableau dashboard. Conclusions With the increasing availability and generation of big health care data, VA is a fast-growing method applied to complex health care data. What makes VA innovative is its capability to process multiple, varied data sources to demonstrate trends and patterns for exploratory analysis, leading to knowledge generation and decision support. This is the first review to bridge a critical gap in the literature on VA methods applied to the areas of population health and HSR, which further indicates possible avenues for the adoption of these methods in the future. This review is especially important in the wake of COVID-19 surveillance and response initiatives, where many VA products have taken center stage. International Registered Report Identifier (IRRID) RR2-10.2196/14019
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Affiliation(s)
- Jawad Ahmed Chishtie
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Advanced Analytics, Canadian Institute for Health Information, Toronto, ON, Canada.,Ontario Neurotrauma Foundation, Toronto, ON, Canada.,Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | | | - Luke A Turcotte
- Advanced Analytics, Canadian Institute for Health Information, Toronto, ON, Canada.,School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Iwona Anna Bielska
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.,Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada
| | - Jessica Babineau
- Library & Information Services, University Health Network, Toronto, ON, Canada
| | - Monica Cepoiu-Martin
- Data Intelligence for Health Lab, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Michael Irvine
- Department of Mathematics, University of British Columbia, Vancouver, BC, Canada.,British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Sarah Munce
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Sally Abudiab
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Marko Bjelica
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Saima Hossain
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Muhammad Imran
- Department of Epidemiology and Public Health, Health Services Academy, Islamabad, Pakistan
| | - Tara Jeji
- Ontario Neurotrauma Foundation, Toronto, ON, Canada
| | - Susan Jaglal
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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31
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Allin S, Shepherd J, Thorson T, Tomasone J, Munce S, Linassi G, McBride CB, Jiancaro T, Jaglal S. Web-Based Health Coaching for Spinal Cord Injury: Results From a Mixed Methods Feasibility Evaluation. JMIR Rehabil Assist Technol 2020; 7:e16351. [PMID: 32589148 PMCID: PMC7428932 DOI: 10.2196/16351] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 09/25/2019] [Revised: 06/10/2020] [Accepted: 06/14/2020] [Indexed: 01/16/2023] Open
Abstract
Background Individuals with spinal cord injury (SCI) are at high risk of experiencing secondary conditions like pressure injuries. Self-management programs may reduce the risk of complications, but traditional programs have proven to be insufficiently tailored to the needs of people with SCI. To overcome barriers to self-management support, a web-based, self-management program was developed for Canadians with SCI called SCI & U. Objective This study aims to evaluate the feasibility and potential impact of the SCI & U program in the context of a mixed methods pilot study. Methods The study followed an explanatory, sequential mixed methods design. Participants (N=11) were Canadians with SCI who had been living in the community for more than 1 year. Each took part in a self-paced, six-session self-management program guided by a trained peer health coach. During sessions, participants could discuss a health topic with their coach from a predefined list (eg, skin or bowel management). Quantitative data were gathered before and after program participation to assess program feasibility and impact. Feasibility measures included attrition rates, frequency of topics selected, and recorded goals, whereas impact measures included measures of self-efficacy (University of Washington Self-Efficacy Scale [UW-SES]), mood (Personal Health Questionnaire Depression Scale [PHQ-8]), secondary conditions (Spinal Cord Injury Secondary Conditions Scale [SCI-SCS]), and resilience (Spinal Cord Injury Quality of Life Resilience Scale [SCI-QOL-R]). Qualitative measures were based on postintervention interviews; these were designed to confirm and expand on quantitative Results Of the 11 participants, 10 completed pre- and postassessments, and 6 coaching sessions. Sessions lasted between 31 and 81 min (average 55, SD 13), and the duration of the program ranged from 35 to 88 days (average 56, SD 23). Diet and exercise were selected as topics 40% (20/50 sessions with topics) of the time, whereas topics such as mental health, bladder management, pain, and bowel management were chosen less frequently. Results gathered before and after the pilot study demonstrated improvements with moderate effect sizes on the UW-SES and the electronic health literacy scale (ie, Hedges g>0.5). Effect sizes for measures of resilience (SCI-QOL-R), depression (PHQ-8), and secondary conditions (SCI-SCS) were small (ie, Hedges g>0.3). Qualitative results confirmed a common focus on diet and exercise, and defined coaches as sources of accountability, information, reassurance and affirmation, and emotional and technical support. Conclusions Results demonstrated that a web-based self-management program is feasible and acceptable by Canadians with SCI. Results also indicated a web-based, peer-led self-management program may impact resilience, self-efficacy, mood, and secondary complications. Finally, results illuminated the role of the coach in facilitating behavior change. Future work seeks to validate results in the context of a randomized controlled trial.
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Affiliation(s)
- Sonya Allin
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - John Shepherd
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | | | - Jennifer Tomasone
- School of Kinesiology and Health Studies, Queens University, Kingston, ON, Canada
| | - Sarah Munce
- Toronto Rehabilitation Institute, Toronto, ON, Canada
| | - Gary Linassi
- Department of Physical Medicine and Rehabilitation, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | | | - Tizneem Jiancaro
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Susan Jaglal
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
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Kastner M, Makarski J, Hayden L, Lai Y, Chan J, Treister V, Harris K, Munce S, Holroyd-Leduc J, Graham ID, Straus SE. Improving KT tools and products: development and evaluation of a framework for creating optimized, Knowledge-activated Tools (KaT). Implement Sci Commun 2020; 1:47. [PMID: 32885203 PMCID: PMC7427906 DOI: 10.1186/s43058-020-00031-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 09/13/2019] [Accepted: 04/13/2020] [Indexed: 11/10/2022] Open
Abstract
Background Positive impacts of quality improvement initiatives on health care and services have not been substantial. Knowledge translation (KT) strategies (tools, products and interventions) strive to facilitate the uptake of knowledge thereby the potential to improve care, but there is little guidance on how to develop them. Existing KT guidance or planning tools fall short in operationalizing all aspects of KT practice activities conducted by knowledge users (researchers, clinicians, patients, decision-makers), and most do not consider their variable needs or to deliver recommendations that are most relevant and useful for them. Methods We conducted a 3-phase study. In phase 1, we used several sources to develop a conceptual framework for creating optimized Knowledge-activated Tools (KaT) (consultation with our integrated KT team, the use of existing KT models and frameworks, findings of a systematic review of multimorbidity interventions and a literature review and document analysis on existing KT guidance tools). In phase 2, we invited KT experts to participate in a Delphi study to refine and evaluate the conceptual KaT framework. In phase 3, we administered an online survey to knowledge users (researchers, clinicians, decision-makers, trainees) to evaluate the potential usefulness of an online mock-up version of the KaT framework. Results We developed the conceptual KaT framework, and iteratively refined it with 35 KT experts in a 3-round Delphi study. The final framework represents the blueprint for what is needed to create KT strategies. Feedback from 201 researcher, clinician, decision-maker and trainee knowledge users on the potential need and usefulness of an online, interactive version of KaT indicated that they liked the idea of it (mean score 4.36 on a 5-point Likert scale) and its proposed features (mean score range 4.30-4.79). Conclusions Our findings suggest that mostly Canadian KT experts and knowledge users perceived the KaT framework and the future development of an online, interactive version to be important and needed. We anticipate that the KaT framework will provide clarity for knowledge users about how to identify their KT needs and what activities can address these needs, and to help streamline the process of these activities to facilitate efficient uptake of knowledge.
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Affiliation(s)
- Monika Kastner
- North York General Hospital, Centre for Research and Innovation, 4001 Leslie Street, Toronto, Ontario M2K 1E1 Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, 155 College Street, Suite 425, Toronto, ON M5T 3M6 Canada
| | - Julie Makarski
- North York General Hospital, Centre for Research and Innovation, 4001 Leslie Street, Toronto, Ontario M2K 1E1 Canada
| | - Leigh Hayden
- North York General Hospital, Centre for Research and Innovation, 4001 Leslie Street, Toronto, Ontario M2K 1E1 Canada
| | - Yonda Lai
- Li Ka Shing Knowledge Institute of St. Michael's hospital, University of Toronto, 30 Bond Street, Toronto, ON M5B 1W8 Canada
| | - Joyce Chan
- North York General Hospital, Centre for Research and Innovation, 4001 Leslie Street, Toronto, Ontario M2K 1E1 Canada.,Li Ka Shing Knowledge Institute of St. Michael's hospital, University of Toronto, 30 Bond Street, Toronto, ON M5B 1W8 Canada
| | - Victoria Treister
- Li Ka Shing Knowledge Institute of St. Michael's hospital, University of Toronto, 30 Bond Street, Toronto, ON M5B 1W8 Canada
| | - Kegan Harris
- North York General Hospital, Centre for Research and Innovation, 4001 Leslie Street, Toronto, Ontario M2K 1E1 Canada
| | - Sarah Munce
- University Health Network, Toronto, Ontario Canada
| | - Jayna Holroyd-Leduc
- Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta Canada
| | - Ian D Graham
- School of Epidemiology and Public Health, Clinical Epidemiology Program, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario Canada
| | - Sharon E Straus
- Li Ka Shing Knowledge Institute of St. Michael's hospital, University of Toronto, 30 Bond Street, Toronto, ON M5B 1W8 Canada.,Department of Medicine, University of Toronto, Toronto, Canada
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Aquino M, Munce S, Griffith J, Pakosh M, Munnery M, Seto E. Exploring the Use of Telemonitoring for Patients at High Risk for Hypertensive Disorders of Pregnancy in the Antepartum and Postpartum Periods: Scoping Review. JMIR Mhealth Uhealth 2020; 8:e15095. [PMID: 32301744 PMCID: PMC7195666 DOI: 10.2196/15095] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [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: 06/20/2019] [Revised: 10/15/2019] [Accepted: 01/24/2020] [Indexed: 12/15/2022] Open
Abstract
Background High blood pressure complicates 2% to 8% of pregnancies, and its complications are present in the antepartum and postpartum periods. Blood pressure during and after pregnancy is routinely monitored during clinic visits. Some guidelines recommend using home blood pressure measurements for the management and treatment of hypertension, with increased frequency of monitoring for high-risk pregnancies. Blood pressure self-monitoring may have a role in identifying those in this high-risk group. Therefore, this high-risk pregnancy group may be well suited for telemonitoring interventions. Objective The aim of this study was to explore the use of telemonitoring in patients at high risk for hypertensive disorders of pregnancy (HDP) during the antepartum and postpartum periods. This paper aims to answer the following question: What is the current knowledge base related to the use of telemonitoring interventions for the management of patients at high risk for HDP? Methods A literature review following the methodological framework described by Arksey et al and Levac et al was conducted to analyze studies describing the telemonitoring of patients at high risk for HDP. A qualitative study, observational studies, and randomized controlled trials were included in this scoping review. Results Of the 3904 articles initially identified, 20 met the inclusion criteria. Most of the studies (13/20, 65%) were published between 2017 and 2018. In total, there were 16 unique interventions described in the 20 articles, all of which provide clinical decision support and 12 of which are also used to facilitate the self-management of HDP. Each intervention’s design and process of implementation varied. Overall, telemonitoring interventions for the management of HDP were found to be feasible and convenient, and they were used to facilitate access to health services. Two unique studies reported significant findings for the telemonitoring group, namely, spontaneous deliveries were more likely, and one study, reported in two papers, described inductions as being less likely to occur compared with the control group. However, the small study sample sizes, nonrandomized groups, and short study durations limit the findings from the included articles. Conclusions Although current evidence suggests that telemonitoring could provide benefits for managing patients at high risk for HDP, more research is needed to prove its safety and effectiveness. This review proposes four recommendations for future research: (1) the implementation of large prospective studies to establish the safety and effectiveness of telemonitoring interventions; (2) additional research to determine the context-specific requirements and patient suitability to enhance accessibility to healthcare services for remote regions and underserved populations; (3) the inclusion of privacy and security considerations for telemonitoring interventions to better comply with healthcare information regulations and guidelines; and (4) the implementation of studies to better understand the effective components of telemonitoring interventions.
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Affiliation(s)
- Maria Aquino
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada
| | - Sarah Munce
- Rumsey Centre, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Janessa Griffith
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Women's College Hospital Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Maureen Pakosh
- Library & Information Services, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Mikayla Munnery
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Emily Seto
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada
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Ma Z, Dhir P, Perrier L, Bayley M, Munce S. The Impact of Vocational Interventions on Vocational Outcomes, Quality of Life, and Community Integration in Adults with Childhood Onset Disabilities: A Systematic Review. J Occup Rehabil 2020; 30:1-21. [PMID: 31535267 DOI: 10.1007/s10926-019-09854-1] [Citation(s) in RCA: 4] [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] [Indexed: 06/10/2023]
Abstract
Purpose Despite the desire and ability to work, individuals with childhood onset disabilities are under-represented in employment. Vocational interventions alleviate some barriers to obtaining and maintaining employment for this population. The research question addressed is: What is the impact of vocational interventions on vocational outcomes, quality of life (QoL), and community integration (CI) in adults with childhood onset neurological disabilities including cerebral palsy (CP), spina bifida, and acquired brain injury (ABI)? Methods A literature search was conducted in multiple electronic databases. All experimental and observational studies with comparator group(s) were included. Two reviewers independently completed titles and abstracts screening, full text screening, data abstraction, and risk of bias assessment. Results Seventeen studies were eligible for final inclusion including three randomized-controlled trials, four non-randomized studies, and ten observational studies. Sixteen of seventeen studies included only individuals with ABI, while one study included individuals with CP. Vocational interventions from experimental studies were mainly components of multi-faceted interventions. Most observational studies were from the United States Vocational Rehabilitation Service. Conclusions Vocational interventions may be effective in improving vocational outcomes, QoL, and CI for individuals with ABI. There is limited experimental evidence on interventions that specifically target employment. Observational data suggest that receiving job placement assistance, on-the-job training and supports, counselling/guidance, maintenance, and supported employment successfully predicted employment outcomes.
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Affiliation(s)
- Zechen Ma
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Priya Dhir
- Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Laure Perrier
- University of Toronto Libraries, University of Toronto, Toronto, Canada
| | - Mark Bayley
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Sarah Munce
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.
- LIFEspan Service, Toronto Rehabilitation Institute, Rumsey Centre -University Health Network, 345 Rumsey Road, Toronto, ON, M4G 1R7, Canada.
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Palcu P, Munce S, Jaglal SB, Allin S, Chishtie JA, Silverstein A, Kim S. Understanding patient experiences and challenges to osteoporosis care delivered virtually by telemedicine: a mixed methods study. Osteoporos Int 2020; 31:351-361. [PMID: 31760454 PMCID: PMC7010610 DOI: 10.1007/s00198-019-05182-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 09/27/2019] [Indexed: 11/20/2022]
Abstract
This study sought to understand patient experiences, benefits, and challenges to osteoporosis care delivered virtually by telemedicine. Telemedicine bridges the access gap to specialized osteoporosis care in remote areas. Improving coordination of investigations, access to allied health members, and future initiatives may improve osteoporosis-related morbidity and mortality in this population. INTRODUCTION There is limited research on the role of telemedicine (TM) in the management of osteoporosis (OP). We previously reported that OP patients assessed by TM had a higher prevalence of fragility fractures, co-morbidities, and need for allied health resources than those serviced by the outpatient clinic. The purpose of this study is to understand the experiences, benefits, and challenges associated with receiving OP care by TM from the patient perspective. METHODS We adopted a convergent, mixed methods study design whereby both a quantitative component (mailed survey) and qualitative component (30-min telephone interviews) were conducted simultaneously. In addition to reporting survey data, thematic analysis was applied to interview data. RESULTS Participants were comfortable with virtual technology and perceived that their quality of care by TM was comparable to in-person visits. Expressed benefits included the convenience of timely care close to home, reduced burden of travel and costs, and enhanced sense of confidence with being assessed by an osteoporosis specialist. Perceived barriers included poor follow-up with allied health professionals in the TM program (e.g., physiotherapist) and coordination of tests and investigations. Many participants indicated interest in an OP self-management program, with content focusing on diet and lifestyle factors. CONCLUSION The TM program bridges the access gap for those living with OP in underserviced and remote areas. However, we identified the need to improve the existing processes to better coordinate access to allied health team members and arrangements for investigations. Participants also expressed interest for a virtual osteoporosis self-management program.
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Affiliation(s)
- P Palcu
- Faculty of Medicine, University of Toronto, Toronto, Canada
| | - S Munce
- Toronto Rehabilitation Institute-University Health Network, Toronto, Canada
| | - S B Jaglal
- Toronto Rehabilitation Institute-University Health Network, Toronto, Canada
- Institute of Health, Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Canada
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - S Allin
- Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - J A Chishtie
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - A Silverstein
- Division of Endocrinology and Metabolism, Women's College Hospital, 76 Grenville Street, Toronto, Ontario, M5S 1B2, Canada
| | - S Kim
- Faculty of Medicine, University of Toronto, Toronto, Canada.
- Division of Endocrinology and Metabolism, Women's College Hospital, 76 Grenville Street, Toronto, Ontario, M5S 1B2, Canada.
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McIntyre A, Marrocco SL, McRae SA, Sleeth L, Hitzig S, Jaglal S, Linassi G, Munce S, Wolfe DL. A Scoping Review of Self-Management Interventions Following Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2020; 26:36-63. [PMID: 32095066 PMCID: PMC7015175 DOI: 10.1310/sci2601-36] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 11/11/2022]
Abstract
Objective: To conduct a scoping review to identify what components of self-management are embedded in self-management interventions for spinal cord injury (SCI). Methods: In accordance with the approach and stages outlined by Arksey and O'Malley (2005), a comprehensive literature search was conducted using five databases. Study characteristics were extracted from included articles, and intervention descriptions were coded using Practical Reviews in Self-Management Support (PRISMS) (Pearce et al, 2016), Barlow et al (2002), and Lorig and Holman's (2003) taxonomy. Results: A total of 112 studies were included representing 102 unique self-management programs. The majority of the programs took an individual approach (52.0%) as opposed to a group (27.4%) or mixed approach (17.6%). While most of the programs covered general information, some provided specific symptom management. Peers were the most common tutor delivering the program material. The most common Barlow components included symptom management (n = 44; 43.1%), information about condition/treatment (n = 34; 33.3%), and coping (n = 33; 32.4%). The most common PRISMS components were information about condition and management (n = 85; 83.3%), training/rehearsal for psychological strategies (n = 52; 51.0%), and lifestyle advice and support (n = 52; 51.0%). The most common Lorig components were taking action (n = 62; 60.8%), resource utilization (n = 57; 55.9%), and self-tailoring (n = 55; 53.9%). Conclusion: Applying self-management concepts to complex conditions such as SCI is only in the earliest stages of development. Despite having studied the topic from a broad perspective, this review reflects an ongoing program of research that links to an initiative to continue refining and testing self-management interventions in SCI.
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Affiliation(s)
- Amanda McIntyre
- Lawson Health Research Institute, Parkwood Institute, Ontario, Canada
| | | | | | - Lindsay Sleeth
- Lawson Health Research Institute, Parkwood Institute, Ontario, Canada
| | - Sander Hitzig
- St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Ontario, Canada
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Susan Jaglal
- Department of Physical Therapy, University of Toronto, Ontario, Canada
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada
| | - Gary Linassi
- Department of Physical Medicine and Rehabilitation, College of Medicine, University of Saskatchewan, Saskatchewan, Canada
| | - Sarah Munce
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada
- Department of Occupational Science and Occupational Therapy, University of Toronto
| | - Dalton L. Wolfe
- Lawson Health Research Institute, Parkwood Institute, Ontario, Canada
- Health Sciences, Western University, Ontario, Canada
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Kokorelias KM, Munce S, McGilton KS, Cronin SM, Wang CD, Eftekhar P, Cheng DK, Vellani S, Jaglal S, Salbach NM, Kontos P, Colella TJF, Grigorovich A, Cameron JI. Frailty in the context of rehabilitation interventions for adults: protocol for a scoping review. BMJ Open 2019; 9:e024838. [PMID: 30772856 PMCID: PMC6398710 DOI: 10.1136/bmjopen-2018-024838] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Although a growing number of frail adults can benefit from rehabilitation services, few are included in rehabilitation services, and reasons for their exclusion are not well understood. To inform research directions in rehabilitation for all adults (aged 18 years and older), we will conduct a scoping review to describe (1) the characteristics of frail adult individuals included in rehabilitation interventions (eg, age range, inclusion and exclusion criteria that are applied), (2) the type of rehabilitation interventions that are used for individuals who are considered frail and (3) the commonly reported outcome measures used for these rehabilitation interventions. METHODS This scoping review will be guided by Arksey and O'Malley's methodological framework. Ageline, Cochrane CINAHL, Embase, MEDLINE, Pubmed, OTSeeker, PeDRO, PsycINFO and Scopus databases will be systematically searched for articles relevant to rehabilitation interventions and health services. To be eligible for inclusion, studies must report on the outcomes from an intervention that involves all individuals (aged 18 and older) who are considered frail. Only English-language, peer-reviewed publications between 1990 and 2018 will be included. A two-step screening process will consist of (1) a title and abstract review and (2) full-text review. In both levels of screening, a minimum of two investigators will independently screen the title and abstract of all retrieved citations for inclusion against a set of minimum inclusion criteria. ANALYSIS Results will be presented as a narrative synthesis to facilitate the integration of diverse evidence. ETHICS AND DISSEMINATION This study does not require ethics approval. By examining the current state of rehabilitation interventions for frail adults, this scoping review can offer insight into rehabilitation needs and models of care. It can also guide future rehabilitation research for frail adults. We will share our results with frail adults during a consultation meeting and publish a manuscript in a peer-reviewed rehabilitation journal.
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Affiliation(s)
- Kristina M Kokorelias
- Rehabiliation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada
| | - Sarah Munce
- LIFEspan Service, Toronto Rehabilitation Institute, Toronto, Ontario, Canada
| | - Kathy S McGilton
- Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada
- Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Shawna M Cronin
- Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Chen D Wang
- Rehabiliation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada
| | - Parvin Eftekhar
- Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Darren K Cheng
- Rehabiliation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada
| | - Shirin Vellani
- Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada
- Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Susan Jaglal
- Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Nancy M Salbach
- Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Pia Kontos
- Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Tracey J F Colella
- Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- Toronto Rehabilitation Institution, University Health Network, Cardiac Rehabilitation and Prevention Program, Toronto, Ontario, Canada
| | - Alisa Grigorovich
- Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Jill I Cameron
- Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
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Foster B Sc E, Fraser JE, Inness PhD EL, Munce S, Biasin L, Poon V, Bayley M. Examining physiotherapist use of structured aerobic exercise testing to decrease barriers to aerobic exercise. Physiother Theory Pract 2018; 35:787-796. [PMID: 29611774 DOI: 10.1080/09593985.2018.1457110] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Objective: To determine the frequency of physiotherapist-administered aerobic exercise testing/training, the proportion of physiotherapists who administer this testing/training, and the barriers that currently exist across different practice environments. A secondary objective is to identify the learning needs of physiotherapists for the development of an education curriculum in aerobic exercise testing and training with electrocardiograph (ECG) administration and interpretation. Design: National, cross-sectional survey. Participants: Registered physiotherapists practicing in Canada. Results: Out of 137 participants, most (75%) physiotherapists prescribed aerobic exercise on a regular basis (weekly); however, 65% had never conducted an aerobic exercise test. There were no significant differences in frequency of aerobic exercise testing across different practice environments or across years of physiotherapy experience. Physiotherapists perceived the main barriers to aerobic exercise testing as being a lack of equipment/space (78%), time (65%), and knowledge (56%). Although most (82%) were uncomfortable administering 12-lead ECG-monitored aerobic exercise tests, 60% stated they would be interested in learning more about ECG interpretation. Conclusion: This study found that physiotherapists are regularly implementing aerobic exercise. This exercise was infrequently guided by formal aerobic exercise testing, which could increase access to safe and effective exercise within the optimal aerobic training zone. As well, this could facilitate training in patients with cardiovascular diagnoses that require additional testing for medical clearance. Increased ECG training and access to equipment for physiotherapists may augment pre-screening aerobic exercise testing. This training should include learning the key arrhythmias for aerobic exercise test termination as defined by the American College of Sports Medicine.
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Affiliation(s)
- Evan Foster B Sc
- a Toronto Rehabilitation Institute , University Health Network , Toronto , Ontario , Canada
| | - Julia E Fraser
- a Toronto Rehabilitation Institute , University Health Network , Toronto , Ontario , Canada
| | - Elizabeth L Inness PhD
- a Toronto Rehabilitation Institute , University Health Network , Toronto , Ontario , Canada.,b Department of Physical Therapy , University of Toronto , Toronto , Ontario , Canada
| | - Sarah Munce
- a Toronto Rehabilitation Institute , University Health Network , Toronto , Ontario , Canada
| | - Louis Biasin
- a Toronto Rehabilitation Institute , University Health Network , Toronto , Ontario , Canada.,b Department of Physical Therapy , University of Toronto , Toronto , Ontario , Canada
| | - Vivien Poon
- a Toronto Rehabilitation Institute , University Health Network , Toronto , Ontario , Canada.,b Department of Physical Therapy , University of Toronto , Toronto , Ontario , Canada
| | - Mark Bayley
- a Toronto Rehabilitation Institute , University Health Network , Toronto , Ontario , Canada.,c Division of Physical Medicine and Rehabilitation , University of Toronto , Toronto , Ontario , Canada
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Allin S, Shepherd J, Tomasone J, Munce S, Linassi G, Hossain SN, Jaglal S. Participatory Design of an Online Self-Management Tool for Users With Spinal Cord Injury: Qualitative Study. JMIR Rehabil Assist Technol 2018; 5:e6. [PMID: 29563075 PMCID: PMC5885063 DOI: 10.2196/rehab.8158] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [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: 06/06/2017] [Revised: 11/15/2017] [Accepted: 01/06/2018] [Indexed: 11/13/2022] Open
Abstract
Background Rehospitalization rates resulting from secondary conditions in persons with spinal cord injuries (SCI) are high. Self-management programs for many chronic conditions have been associated with decreases in hospital readmissions. However, in the SCI community, evidence suggests that satisfaction with traditional self-management programs is low. Users with SCI have indicated preference for programs that are online (rather than in-person), that target SCI-specific concerns, and are led by peers with SCI. There is currently no program with all of these features, which addresses self-management of secondary conditions after SCI. Objective The aim of this study was to provide details of a participatory design (PD) process for an internet-mediated self-management program for users with SCI (called SCI & U) and illustrate how it has been used to define design constraints and solutions. Methods Users were involved in development as codesigners, codevelopers, and key informants. Codesigners and codevelopers were recruited from consumer advocacy groups and worked with a core development team. Key informants were recruited from geographically distributed advocacy groups to form a product advisory council that met regularly with the core team. During meetings, codesigners and informants walked through stages of work that typify PD processes such as exploration, discovery, and prototyping. This paper details the process by analyzing 10 meetings that took place between August 2015 and May 2016. Meetings were recorded, transcribed, and subjected to an inductive thematic analysis; resulting themes were organized according to their relationship to PD stages. Results A total of 16 individuals participated in meeting discussions, including 7 researchers and 9 persons with SCI from 4 Canadian provinces. Themes of trust, expertise, and community emerged in every group discussion. The exploration stage revealed interest in online self-management resources coupled with concerns about information credibility. In general, participants indicated that they felt more confident with information received from trusted, in-person sources (eg, peers or health care professionals) than information found online. The discovery stage saw participants propose and discuss concepts to filter credible information and highlight community expertise, namely (1) a community-curated resource database, (2) online information navigators, and (3) group chats with peers. Several tools and techniques were collectively prototyped in an effort to foster trust and community; these are illustrated in the Results section. Conclusions A PD process engaging users as codesigners, codevelopers, and informants can be used to identify design concerns and prototype online solutions to promote self-management after SCI. Future work will assess the usability of the collectively designed tools among a broad population of Canadians with SCI and the tools’ impact on self-efficacy and health.
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Affiliation(s)
- Sonya Allin
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - John Shepherd
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Jennifer Tomasone
- School of Kinesiology and Health Studies, Queen's University, Kingston, ON, Canada
| | - Sarah Munce
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Gary Linassi
- College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | | | - Susan Jaglal
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
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Nelson ML, McKellar KA, Munce S, Kelloway L, Hans PK, Fortin M, Lyons R, Bayley M. Addressing the Evidence Gap in Stroke Rehabilitation for Complex Patients: A Preliminary Research Agenda. Arch Phys Med Rehabil 2017; 99:1232-1241. [PMID: 28947162 DOI: 10.1016/j.apmr.2017.08.488] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 05/01/2017] [Revised: 08/16/2017] [Accepted: 08/23/2017] [Indexed: 12/21/2022]
Abstract
Evidence suggests that a stroke occurs in isolation (no comorbid conditions) in less than 6% of patients. Multimorbidity, compounded by psychosocial issues, makes treatment and recovery for stroke increasingly complex. Recent research and health policy documents called for a better understanding of the needs of this patient population, and for the development and testing of models of care that meet their needs. A research agenda specific to complexity is required. The primary objective of the think tank was to identify and prioritize research questions that meet the information needs of stakeholders, and to develop a research agenda specific to stroke rehabilitation and patient complexity. A modified Delphi and World Café approach underpinned the think tank meeting, approaches well recognized to foster interaction, dialogue, and collaboration between stakeholders. Forty-three researchers, clinicians, and policymakers attended a 2-day meeting. Initial question-generating activities resulted in 120 potential research questions. Sixteen high-priority research questions were identified, focusing on predetermined complexity characteristics-multimorbidity, social determinants, patient characteristics, social supports, and system factors. The final questions are presented as a prioritized research framework. An emergent result of this activity is the development of a complexity and stroke rehabilitation research network. The research agenda reflects topics of importance to stakeholders working with stroke patients with increasingly complex care needs. This robust process resulted in a preliminary research agenda that could provide policymakers with the evidence needed to make improvements toward better-organized services, better coordination between settings, improved patient outcomes, and lower system costs.
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Affiliation(s)
- Michelle L Nelson
- Bridgepoint Collaboratory, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada.
| | - Kaileah A McKellar
- Bridgepoint Collaboratory, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
| | - Sarah Munce
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Linda Kelloway
- Cardiac Care Network of Ontario, Toronto, Ontario, Canada
| | - Parminder Kaur Hans
- Bridgepoint Collaboratory, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
| | - Martin Fortin
- Department of Family Medicine, Sherbrooke University, Sherbrooke, Quebec, Canada
| | - Renee Lyons
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Mark Bayley
- University of Toronto, Toronto, Ontario, Canada; Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
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Guilcher S, Munce S, Conklin J, Packer T, Verrier M, Marras C, Bereket T, Versnel J, Riopelle R, Jaglal S. The financial burden of prescription drugs for neurological conditions in Canada: Results from the National Population Health Study of Neurological Conditions. Health Policy 2017; 121:389-396. [DOI: 10.1016/j.healthpol.2017.01.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 01/13/2017] [Accepted: 01/25/2017] [Indexed: 11/25/2022]
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Nelson MLA, McKellar KA, Yi J, Kelloway L, Munce S, Cott C, Hall R, Fortin M, Teasell R, Lyons R. Stroke rehabilitation evidence and comorbidity: a systematic scoping review of randomized controlled trials. Top Stroke Rehabil 2017; 24:374-380. [DOI: 10.1080/10749357.2017.1282412] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Michelle L. A. Nelson
- Bridgepoint Collaboratory, Lunenfeld-Tanenbaum Research Institute, Sinai Health Systems, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, Canada
| | - Kaileah A. McKellar
- Bridgepoint Collaboratory, Lunenfeld-Tanenbaum Research Institute, Sinai Health Systems, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Juliana Yi
- Bridgepoint Collaboratory, Lunenfeld-Tanenbaum Research Institute, Sinai Health Systems, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | | | - Sarah Munce
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Cheryl Cott
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Ruth Hall
- Institute of Clinical Evaluative Sciences, Toronto, Canada
| | - Martin Fortin
- Département de médecine de famille, Universite de Sherbrooke, Sherbrooke, Canada
| | - Robert Teasell
- St. Joseph’s Stroke Rehabilitation Program, Lawson Health Research Institute, Western University, London, Canada
| | - Renee Lyons
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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Allin S, Bleakney R, Zhang J, Munce S, Cheung AM, Jaglal S. Evaluation of Automated Fracture Risk Assessment Based on the Canadian Association of Radiologists and Osteoporosis Canada Assessment Tool. J Clin Densitom 2016; 19:332-9. [PMID: 27067299 DOI: 10.1016/j.jocd.2016.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 02/09/2016] [Accepted: 02/16/2016] [Indexed: 10/22/2022]
Abstract
Fracture risk assessments are not always clearly communicated on bone mineral density (BMD) reports; evidence suggests that structured reporting (SR) tools may improve report clarity. The aim of this study is to compare fracture risk assessments automatically assigned by SR software in accordance with Canadian Association of Radiologists and Osteoporosis Canada (CAROC) recommendations to assessments from experts on narrative BMD reports. Charts for 500 adult patients who recently received a BMD exam were sampled from across University of Toronto's Joint Department of Medical Imaging. BMD measures and clinical details were manually abstracted from charts and were used to create structured reports with assessments generated by a software implementation of CAROC recommendations. CAROC calculations were statistically compared to experts' original assessments using percentage agreement (PA) and Krippendorff's alpha. Canadian FRAX calculations were also compared to experts', where possible. A total of 25 (5.0%) reported assessments did not conform to categorizations recommended by Canadian guidelines. Across the remainder, the Krippendorff's alpha relating software assigned assessments to physicians was high at 0.918; PA was 94.3%. Lower agreement was associated with reports for patients with documented modifying factors (alpha = 0.860, PA = 90.2%). Similar patterns of agreement related expert assessments to FRAX calculations, although statistics of agreement were lower. Categories of disagreement were defined by (1) gray areas in current guidelines, (2) margins of assessment categorizations, (3) dictation/transcription errors, (4) patients on low doses of steroids, and (5) ambiguous documentation of modifying factors. Results suggest that SR software can produce fracture risk assessments that agree with experts on most routine, adult BMD exams. Results also highlight situations where experts tend to diverge from guidelines and illustrate the potential for SR software to (1) reduce variability in, (2) ameliorate errors in, and (3) improve clarity of routine adult BMD exam reports.
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Affiliation(s)
- Sonya Allin
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada.
| | - Robert Bleakney
- Department of Medical Imaging, Mount Sinai Hospital and the University Health Network, Toronto, ON, Canada; Joint Department of Medical Imaging (JDMI), University Health Network, Toronto, ON, Canada; Centre of Excellence in Skeletal Health Assessment, University of Toronto, Toronto, ON, Canada
| | - Julie Zhang
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Sarah Munce
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Angela M Cheung
- Department of Medical Imaging, Mount Sinai Hospital and the University Health Network, Toronto, ON, Canada; Joint Department of Medical Imaging (JDMI), University Health Network, Toronto, ON, Canada; Centre of Excellence in Skeletal Health Assessment, University of Toronto, Toronto, ON, Canada; University Health Network Osteoporosis Program, Toronto General Hospital, Toronto, ON Canada
| | - Susan Jaglal
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada; Osteoporosis Research Program, Women's College Research Institute, Toronto, ON, Canada
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Allin S, Munce S, Jaglal S, Butt D, Young J, Tu K. Capture of osteoporosis and fracture information in an electronic medical record database from primary care. AMIA Annu Symp Proc 2014; 2014:240-248. [PMID: 25954325 PMCID: PMC4419931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
In a large database of EMR records, we explore: 1) completeness in capture of bone mineral density (BMD) T-scores required for diagnosis of osteoporosis; 2) concordance of BMD exam information with other osteoporosis information; and 3) evidence of osteoporosis screening among fracture patients. To explore completeness of exam capture, BMD exams in the EMR were related to a provincial billing database. To explore concordance of information and screening rates, 7500 EMR records were reviewed for osteoporosis and fracture details. Results show that 98% of exams billed to the province for EMR patients were found in the EMR. However, documented osteoporosis was substantiated with BMD results only 55.8% of the time. Of 151 charts for fragility fracture patients, 1 in 4 contained no evidence of osteoporosis investigation. In summary, while EMR information about osteoporosis is of variable quality, EMR records shed light on osteoporosis management indicators and completely capture BMD results.
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Affiliation(s)
| | | | - Susan Jaglal
- University of Toronto, Toronto, ON, Canada ; Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Debra Butt
- University of Toronto, Toronto, ON, Canada ; Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | | | - Karen Tu
- University of Toronto, Toronto, ON, Canada ; Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
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Jaglal SB, Guilcher SJT, Bereket T, Kwan M, Munce S, Conklin J, Versnel J, Packer T, Verrier M, Marras C, Pitzul KB, Riopelle R. Development of a Chronic Care Model for Neurological Conditions (CCM-NC). BMC Health Serv Res 2014; 14:409. [PMID: 25236443 PMCID: PMC4262116 DOI: 10.1186/1472-6963-14-409] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [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: 02/14/2014] [Accepted: 09/15/2014] [Indexed: 11/15/2022] Open
Abstract
Background Persons with neurological conditions and their families face a number of challenges with the provision of health and community-based services. The purpose of this study was to understand the existing health and community service needs and gaps in care and to use this information to develop a model to specify factors and processes that may improve the quality of care and health and well-being for persons with neurological conditions. Methods We conducted semi-structured interviews with health care professionals, community-based non-health care professionals working with individuals with neurological conditions, and policy makers –from the Ministries of Health, Community and Social Services, Transportation and Education– across Canada. We used a purposive sampling and snowballing approach to obtain maximum variation across professions, sector and geography (provinces and territories, rural and urban). Data analysis was an iterative, constant comparative process involving descriptive and interpretive analyses and was initially guided by the components of the Expanded Chronic Care Model. Results A total of 180 individuals completed the interviews: 39% (n = 70) health care professionals, 47% (n = 85) community-based non-health care professionals, and 14% (n = 25) policy makers. Based on the data we developed the Chronic Care Model for Neurological Conditions (CCM-NC). The major needs/gaps are represented by the following themes: acceptance and openness to neurological conditions, evidence informed policy, investments and funding, supported transitions, caregiver support, and life enhancing resources (education, employment, housing and transportation), knowledge and awareness of neurological conditions and availability and access to health services. The model maintains that intersectoral collaboration across the health system, community and policy components is needed. It recognizes that attitudes, policies, enhanced community integration and health system changes are needed to develop activated patients and families, proactive service delivery teams, a person-centred health system and healthy public policy for persons with neurological conditions. Conclusion The CCM-NC will generate debate and discussion about the actions needed in each of the model components to enable people with neurological conditions to sustain healthier lives. Next steps include validating the model with persons with neurological conditions, in and outside of the Canadian context and developing and evaluating interventions to test the model. Electronic supplementary material The online version of this article (doi:10.1186/1472-6963-14-409) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Susan B Jaglal
- Department of Physical Therapy, University of Toronto, Toronto, Canada.
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Allin S, Munce S, Carlin L, Butt D, Tu K, Hawker G, Sale J, Jaglal S. Fracture risk assessment after BMD examination: whose job is it, anyway? Osteoporos Int 2014; 25:1445-53. [PMID: 24610580 PMCID: PMC3988517 DOI: 10.1007/s00198-014-2661-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 02/16/2014] [Indexed: 11/05/2022]
Abstract
UNLABELLED Fracture risk assessments on bone mineral density reports guide family physicians' treatment decisions but are subject to inaccuracy. Qualitative analysis of interviews with 22 family physicians illustrates their pervasive questioning of reported assessment accuracy and independent assumption of responsibility for assessment. Assumption of responsibility is common despite duplicating specialists' work. INTRODUCTION Fracture risk is the basis for recommendations of treatment for osteoporosis, but assessments on bone mineral density (BMD) reports are subject to known inaccuracies. This creates a complex situation for referring physicians, who must rely on assessments to inform treatment decisions. This study was designed to broadly understand physicians' current experiences with and preferences for BMD reporting; the present analysis focuses on their interpretation and use of the fracture risk assessments on reports, specifically METHODS A qualitative, thematic analysis of one-on-one interviews with 22 family physicians in Ontario, Canada was performed. RESULTS The first major theme identified in interview data reflects questioning by family physicians of reported fracture risk assessments' accuracy. Several major subthemes related to this included questioning of: 1) accuracy in raw bone mineral density measures (e.g., g/cm(2)); 2) accurate inclusion of modifying risk factors; and 3) the fracture risk assessment methodology employed. A second major theme identified was family physicians' independent assumption of responsibility for risk assessment and its interpretation. Many participants reported that they computed risk assessments in their practice to ensure accuracy, even when provided with assessments on reports. CONCLUSIONS Results indicate family physicians question accuracy of risk assessments on BMD reports and often assume responsibility both for revising and relating assessments to treatment recommendations. This assumption of responsibility is common despite the fact that it may duplicate the efforts of reading physicians. Better capture of risk information on BMD referrals, quality control standards for images and standardization of risk reporting may help attenuate some inefficiency.
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Affiliation(s)
- S Allin
- Department of Physical Therapy, University of Toronto, 160-500 University Ave., M5G 1V7, Toronto, Ontario, Canada,
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Jaglal S, Hawker G, Croxford R, Cameron C, Schott AM, Munce S, Allin S. Impact of a change in physician reimbursement on bone mineral density testing in Ontario, Canada: a population-based study. CMAJ Open 2014; 2:E45-50. [PMID: 25077129 PMCID: PMC4084743 DOI: 10.9778/cmajo.2013-0052] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [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: 01/13/2023] Open
Abstract
BACKGROUND On Apr. 1, 2008, a revision was made to the fee schedule for bone mineral density testing with dual-energy x-ray absorptiometry (DXA) in the province of Ontario, Canada, reducing the frequency of repeat screening in individuals at low risk of osteoporosis. We evaluated whether the change in physician reimbursement successfully promoted appropriate bone mineral density testing, with reduced use among women at low risk and increased use among women and men at higher risk of osteoporosis-related fracture. METHODS We analyzed data from administrative databases on physician billings, hospital discharges and emergency department visits. We included all physician claims for DXA in the province to assess patterns in bone mineral density testing from Apr. 1, 2002, to Mar. 31, 2011. People at risk of an osteoporosis-related fracture were defined as women and men aged 65 years or more and those who had a recent (< 6 mo) fracture after age 40 years. Joinpoint regression analysis was used to examine trends in DXA testing. RESULTS Before the policy change, the overall number of DXA tests increased from 433 419 in 2002/03 to 507 658 in 2007/08; after revision of the fee schedule, the number decreased to 422 915 by 2010/11. Most of this reduction was due to a decrease in the age-standardized rate of DXA testing among women deemed to be at low risk, from 5.7 per 100 population in 2008/09 to 1.8 per 100 in 2010/11. In the high-risk group of people aged 65 or more, the age-standardized rate of testing increased after the policy change among men but decreased among women. Among those at high risk because of a recent clinical fracture, the age-standardized rate of DXA testing increased for both sexes and then decreased after the policy change. INTERPRETATION A change in reimbursement designed to restrict access to bone mineral density testing among low-risk women was associated with an overall reduction in testing. Efforts to communicate guidelines for bone mineral density testing with greater clarity, particularly as they relate to high-risk individuals, need to be explored.
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Affiliation(s)
- Susan Jaglal
- Department of Physical Therapy, University of Toronto, Toronto, Ont
- Institute for Clinical Evaluative Sciences, Toronto, Ont
| | - Gillian Hawker
- Institute of Health, Policy, Management and Evaluation, University of Toronto, Toronto, Ont
- Women’s College Research Institute, Toronto, Ont
| | - Ruth Croxford
- Institute for Clinical Evaluative Sciences, Toronto, Ont
| | - Cathy Cameron
- Department of Physical Therapy, University of Toronto, Toronto, Ont
| | | | - Sarah Munce
- Institute of Health, Policy, Management and Evaluation, University of Toronto, Toronto, Ont
| | - Sonya Allin
- Department of Physical Therapy, University of Toronto, Toronto, Ont
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ont
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Munce S, Kastner M, Cramm H, Lal S, Deschêne SM, Auais M, Stacey D, Brouwers M. Applying the knowledge to action framework to plan a strategy for implementing breast cancer screening guidelines: an interprofessional perspective. J Cancer Educ 2013; 28:481-487. [PMID: 23749437 DOI: 10.1007/s13187-013-0490-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Integrated knowledge translation (IKT) interventions may be one solution to improving the uptake of clinical guidelines. IKT research initiatives are particularly relevant for breast cancer research and initiatives targeting the implementation of clinical guidelines and guideline implementation initiatives, where collaboration with an interdisciplinary team of practitioners, patients, caregivers, and policy makers is needed for producing optimum patient outcomes. The objective of this paper was to describe the process of developing an IKT strategy that could be used by guideline developers to improve the uptake of their new clinical practice guidelines on breast cancer screening. An interprofessional group of students as well as two faculty members met six times over three days at the KT Canada Summer Institute in 2011. The team used all of the phases of the action cycle in the Knowledge to Action Framework as an organizing framework. While the entire framework was used, the step involving assessing barriers to knowledge use was judged to be particularly relevant in anticipating implementation problems and being able to inform the specific KT interventions that would be appropriate to mitigate these challenges and to accomplish goals and outcomes. This activity also underscored the importance of group process and teamwork in IKT. We propose that an a priori assessment of barriers to knowledge use (i.e., level and corresponding barriers), along with the other phases of the Knowledge to Action Framework, is a strategic approach for KT strategy development, implementation, and evaluation planning and could be used in the future planning of KT strategies.
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Affiliation(s)
- Sarah Munce
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, ON, Canada.
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Allin S, Munce S, Schott AM, Hawker G, Murphy K, Jaglal SB. Quality of fracture risk assessment in post-fracture care in Ontario, Canada. Osteoporos Int 2013; 24:899-905. [PMID: 22930241 PMCID: PMC3572386 DOI: 10.1007/s00198-012-2111-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Accepted: 07/11/2012] [Indexed: 11/29/2022]
Abstract
UNLABELLED As fracture risk assessment is a basis for treatment decisions, accurate risk assessments on bone mineral density (BMD) reports are important. Over 50 % of sampled BMD reports for Ontarians with fracture histories underestimated fracture risk by a single category. Risk assessments in Ontario may not accurately inform treatment recommendations. INTRODUCTION The shifting emphasis on fracture risk assessment as a basis for treatment recommendations highlights the importance of ensuring that accurate fracture risk assessments are present on reading specialists' BMD reports. This study seeks to determine the accuracy of fracture risk assessments on a sample of BMD reports from 2008 for individuals with a history of fracture and produced by a broad cross section of Ontario's imaging laboratories. METHODS Forty-eight BMD reports for individuals with documented history of fragility fracture were collected as part of a cluster randomized trial. To compute fracture risk, risk factors, and BMD T-scores from reports were abstracted using a standardized template and compared to the assessments on the reports. Cohen's kappa was used to score agreement between the research team and the reading specialists. RESULTS The weighted kappa was 0.21, indicating agreement to be at the margin of "poor to fair." More than 50 % of the time, reported fracture risks did not reflect fracture history and were therefore underestimated by a single category. Over 30 % of the reports containing a "low" fracture risk assessment were assessed as "moderate" fracture risk by the research team, given fracture history. Over 20 % of the reports with a "moderate" fracture risk were assessed as "high" by the research team, given fracture history. CONCLUSIONS This study highlights the high prevalence of fracture risk assessments that are underestimated. This has implications in terms of fracture risk categorization that can negatively affect subsequent follow-up care and treatment recommendations.
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Affiliation(s)
- S. Allin
- Toronto Rehabilitation Institute, University of Toronto, 160-500 University Ave., Toronto, Ontario M5G 1V7 Canada
| | - S. Munce
- Institute of Health, Policy, Management and Evaluation, University of Toronto, 160-500 University Ave., Toronto, Ontario M5G 1V7 Canada
| | | | - G. Hawker
- Institute of Health, Policy, Management and Evaluation, University of Toronto, 160-500 University Ave., Toronto, Ontario M5G 1V7 Canada
- Women’s College Research Institute, Toronto, Canada
- Department of Medicine, University of Toronto, 160-500 University Ave., Toronto, Ontario M5G 1V7 Canada
| | - K. Murphy
- Department of Medical Imaging, University of Toronto, 160-500 University Ave., Toronto, Ontario M5G 1V7 Canada
| | - S. B. Jaglal
- Toronto Rehabilitation Institute, University of Toronto, 160-500 University Ave., Toronto, Ontario M5G 1V7 Canada
- Institute of Health, Policy, Management and Evaluation, University of Toronto, 160-500 University Ave., Toronto, Ontario M5G 1V7 Canada
- Women’s College Research Institute, Toronto, Canada
- Department of Physical Therapy, University of Toronto, 160-500 University Ave., Toronto, Ontario M5G 1V7 Canada
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Couris C, Guilcher S, Munce S, Fung K, Craven C, Verrier M, Jaglal S. Poster 56: Incidence of Traumatic Spinal Cord Injury in Men and Women Aged 18 and Older in the Province of Ontario. Arch Phys Med Rehabil 2008. [DOI: 10.1016/j.apmr.2008.08.159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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