1
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Rashid C, Pollock C, Aldworth M, Chow J, Kent M, Sapardanis K, Yentin S, Jaglal S, Colella TJ. Development of an Algorithm to Screen for Frailty Using the Clinical Frailty Scale with Postoperative Patients Entering Cardiac Rehabilitation. Physiother Can 2024; 76:78-85. [PMID: 38465304 PMCID: PMC10919360 DOI: 10.3138/ptc-2021-0098] [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: 09/25/2021] [Revised: 03/14/2022] [Accepted: 03/28/2022] [Indexed: 03/12/2024]
Abstract
Purpose Frailty is not commonly assessed on intake to cardiac rehabilitation (CR), but screening could enable targeted interventions and potentially reduce secondary complications. This study aimed to develop and retrospectively examine the feasibility of utilizing a CR-specific algorithm based on the Clinical Frailty Scale (CFS). Our CFS-CR algorithm endeavoured to screen for frailty in older adults (> 65 y) entering CR following cardiac surgery/procedure. Method The charts of 30 former patients (mean age: 74.0 ± 6.9 y) were examined by a clinician working in CR. Results The clinician was unable to score any of the patients based on their medical charts using the CFS-CR due to insufficient data. Documentation was typically limited in the areas of instrumental and basic activities of daily living whereas exercise data were readily available. Conclusions Current intake documentation in CR limited the ability to retrospectively screen for frailty. This finding suggests a need for a frailty-specific tool to support routine clinical screening. Prospective evaluation of the CFS-CR is warranted to further examine the clinical utility of the algorithm during CR intake assessments.
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Affiliation(s)
- Coomal Rashid
- From the: Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Courtney Pollock
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Madeleine Aldworth
- From the: Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer Chow
- From the: Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Michael Kent
- From the: Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Kristina Sapardanis
- From the: Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Sam Yentin
- From the: Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Susan Jaglal
- From the: Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- KITE, University Health Network Toronto Rehabilitation Institute, Toronto, Ontario, Canada
| | - Tracey Jf Colella
- From the: Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- KITE, University Health Network Toronto Rehabilitation Institute, Toronto, Ontario, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
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2
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Craven BC, Souza WH, Jaglal S, Gibbs J, Wiest MJ, Sweet SN, Athanasopoulos P, Lamontagne ME, Boag L, Patsakos E, Wolfe D, Hicks A, Maltais DB, Best KL, Gagnon D. Reducing endocrine metabolic disease risk in adults with chronic spinal cord injury: strategic activities conducted by the Ontario-Quebec RIISC team. Disabil Rehabil 2023:1-13. [PMID: 38018518 DOI: 10.1080/09638288.2023.2284223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 11/10/2023] [Indexed: 11/30/2023]
Abstract
PURPOSE The Rehabilitation Interventions for Individuals with a Spinal Cord Injury in the Community (RIISC) team aimed to develop and evaluate innovative rehabilitation interventions to identify endocrine metabolic disease (EMD) risk, intending to reduce the frequency and severity of EMD related morbidity and mortality among adults living with chronic spinal cord injury or disease (SCI/D). MATERIALS AND METHODS An interprovincial team from Ontario and Quebec reviewed available EMD literature and evidence syntheses and completed an inventory of health services, policies and practices in SCI/D care. The review outcomes were combined with expert opinion to create an EMD risk model to inform health service transformation. RESULTS EMD risk and mortality are highly prevalent among adults with chronic SCI/D. In stark contrast, few rehabilitation interventions target EMD outcomes. The modelled solution proposes: 1) abandoning single-disease paradigms and examining a holistic perspective of the individual's EMD risk, and 2) developing and disseminating practice-based research approaches in outpatient community settings. CONCLUSIONS RIISC model adoption could accelerate EMD care optimization, and ultimately inform the design of large-scale longitudinal pragmatic trials likely to improve health outcomes. Linking the RIISC team activities to economic evaluations and policy deliverables will strengthen the relevance and impact among policymakers, health care providers and patients.
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Affiliation(s)
- Beverley Catharine Craven
- Toronto Rehabilitation Institute, Lyndhurst Centre, University Health Network, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Wagner Henrique Souza
- Kite Research Institute, University Health Network, Lyndhurst Centre, Toronto, Canada
| | - Susan Jaglal
- Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Jenna Gibbs
- Department of Kinesiology and Physical Education, McGill University, Montreal, Canada
| | | | - Shane N Sweet
- Department of Kinesiology & Physical Education, McGill University, Montreal, Canada
| | - Peter Athanasopoulos
- Senior Manager Public Policy and Government Relations, Spinal Cord Injury Ontario, Toronto, Canada
| | | | - Lynn Boag
- University of Guelph, Guelph, Canada
| | - Eleni Patsakos
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | - Dalton Wolfe
- Department of Physical Medicine and Rehabilitation, Western University, Parkwood Institute Research, London, Canada
| | - Audrey Hicks
- Department of Kinesiology, McMaster University, Hamilton, Canada
| | - Désirée B Maltais
- Department of Rehabilitation, Physiotherapy Program, Laval University, Quebec City, Canada
| | - Krista Lynn Best
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Canada
| | - Dany Gagnon
- School of Rehabilitation, Université de Montréal, Montréal, Canada
- Centre for Interdisciplinary Research in Rehabilitation, Institut Universitaire sur la Réadaptation en Déficience Physique de Montréal (IURDPM), Montréal, Canada
- Rehabilitation, Université de Montréal, École de Réadaptation, Montréal, Canada
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3
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Ansari H, Jaglal S, Cheung AM, Kurdyak P. Characterization of Hip Fractures Among Adults With Schizophrenia in Ontario, Canada. JAMA Netw Open 2023; 6:e2310550. [PMID: 37115547 PMCID: PMC10148203 DOI: 10.1001/jamanetworkopen.2023.10550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
Importance Evidence suggests that individuals with schizophrenia are at an increased risk of hip fractures; however, the sex-specific burden of hip fractures among adults with schizophrenia has not been quantified and compared with the general population. Objective To describe sociodemographic and clinical characteristics of patients with hip fracture and schizophrenia and to quantify their sex-specific annual hip fracture rates relative to those without schizophrenia. Design, Setting, and Participants This repeated population-based, cross-sectional study leveraged multiple individually linked health administrative databases for patients in Ontario, Canada. We included patients aged 40 to 105 years with hip fracture-related hospitalization between April 1, 2009, and March 31, 2019. Statistical analysis was performed between November 2021 and February 2023. Exposure Schizophrenia diagnosis, ascertained using a validated algorithm. Main Outcomes and Measures The main outcome was sex-specific age-standardized annual hip fracture rate per 10 000 individuals and annual percent change in age-standardized rates. Rates were direct adjusted to the 2011 Ontario population, and joinpoint regression analysis was performed to evaluate annual percent change. Results We identified 117 431 hip fracture records; of these, there were 109 908 index events. Among the 109 908 patients with hip fracture, 4251 had schizophrenia and 105 657 did not. Their median age was 83 years (IQR, 75-89 years), and 34 500 (31.4%) were men. Patients with hip fracture and schizophrenia were younger at the index event compared with those without schizophrenia. Men had a median age of 73 vs 81 years (IQR, 62-83 vs 71-87 years; standardized difference, 0.46), and women had a median age of 80 vs 84 years (IQR, 71-87 vs 77-89 years; standardized difference, 0.32). A higher proportion of patients with vs without schizophrenia had frailty (53.7% vs 34.2%; standardized difference, 0.40) and previous fragility fractures (23.5% vs 19.1%; standardized difference, 0.11). The overall age-standardized rate per 10 000 individuals with vs without schizophrenia was 37.5 (95% CI, 36.4 to 38.6) vs 16.0 (95% CI, 15.9 to 16.1). Age-standardized rates were 3-fold higher in men with vs without schizophrenia (31.0 [95% CI, 29.5 to 32.6] vs 10.1 [95% CI, 10.0 to 10.2]) and more than 2-fold higher in women with vs without schizophrenia (43.4 [95% CI, 41.9 to 44.9] vs 21.4 [95% CI, 21.3 to 21.6]). Overall, joinpoint regression analysis identified a steady annual decrease of 0.7% (95% CI, -1.1% to -0.3%) in age-standardized rates for both study groups. Conclusions and Relevance The findings of this cross-sectional study suggest that individuals with schizophrenia experience an earlier age of onset and considerably higher rate of hip fractures compared with the general population, with implications for targeted fracture prevention and optimization of clinical bone health management over the course of their psychiatric illness.
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Affiliation(s)
- Hina Ansari
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Susan Jaglal
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Angela M Cheung
- Department of Medicine and Joint Department of Medical Imaging, University Health Network and Sinai Health System, University of Toronto, Toronto, Ontario, Canada
| | - Paul Kurdyak
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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4
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Senthinathan A, Penner M, Tu K, Morris A, Craven BC, Jaglal S. Identifying Outpatient Antibiotic Prescribers and Recipients in a primary care Spinal Cord Injury Cohort. Arch Phys Med Rehabil 2023. [DOI: 10.1016/j.apmr.2022.12.092] [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: 03/06/2023]
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5
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Kokorelias KM, Cronin SM, Munce SEP, Eftekhar P, McGilton KS, Vellani S, Colella TJF, Kontos P, Grigorovich A, Furlan A, Salbach NM, Jaglal S, Chan B, Cameron JI. Conceptualization of frailty in rehabilitation interventions with adults: a scoping review. Disabil Rehabil 2023; 45:117-153. [PMID: 34889703 DOI: 10.1080/09638288.2021.2012844] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Purpose: We aimed to synthesize the literature that considered frailty in the evaluation of rehabilitation interventions for adults (aged ≥18) by answering: (1) how is frailty defined in rehabilitation intervention research?; (2) how is frailty operationalized in rehabilitation intervention research?; (3) what are the characteristics of rehabilitation interventions for frail adults and what frailty related outcomes are assessed?Materials and methods: A scoping review was conducted. Data were analyzed using descriptive statistics and qualitative content analysis.Results: 53 articles met the inclusion criteria. Most studies were conducted in Europe and involved randomized control trials. The included studies reported on rehabilitation interventions that only included individuals aged 50 or older. Thirteen studies used Fried's definition of frailty, but most (n = 27) did not use any definition. Many studies did not differentiate between the conceptualization (e.g., definition) and operationalization (e.g., use of inclusion/exclusion criteria, outcome measures) of frailty. Most interventions focused on exercise. Instrumental activities of daily living reported most frequently as outcomes (n = 11).Conclusions: There is an absence of consistent definitions of frailty in rehabilitation interventions and current definitions tend to focus on physical functioning. The authors suggest rehabilitation researchers consider an expanded definition of frailty informed by the International Classification of Functioning, Disability and Health framework.IMPLICATIONS FOR REHABILITATIONRehabilitation professionals should use an expanded definition of frailty, informed by the International Classification of Functioning, Disability and Health framework, should include physical, mental, personal, environmental, and social factors to decrease, delay, or prevent frailty in adults.Rehabilitation professionals should consider a broader operationalization of frailty that is not dependent on age and physical functioning.Rehabilitation professionals that consider a broader conceptualization of frailty should tailor interventions to the specific needs of frail adults.
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Affiliation(s)
- Kristina M Kokorelias
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada.,KITE - Toronto Rehabilitation Institute - UHN, Toronto, Canada
| | - Shawna M Cronin
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada.,Department of Physical Therapy, University of Toronto, UHN, Toronto, Canada
| | - Sarah E P Munce
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada.,KITE - Toronto Rehabilitation Institute - UHN, Toronto, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Parvin Eftekhar
- KITE - Toronto Rehabilitation Institute - UHN, Toronto, Canada
| | - Katherine S McGilton
- KITE - Toronto Rehabilitation Institute - UHN, Toronto, Canada.,Lawrence S Bloomberg, Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Shirin Vellani
- KITE - Toronto Rehabilitation Institute - UHN, Toronto, Canada.,Lawrence S Bloomberg, Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Tracey J F Colella
- KITE - Toronto Rehabilitation Institute - UHN, Toronto, Canada.,Lawrence S Bloomberg, Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Pia Kontos
- KITE - Toronto Rehabilitation Institute - UHN, Toronto, Canada
| | | | - Andrea Furlan
- KITE - Toronto Rehabilitation Institute - UHN, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, Canada.,Institute for Work & Health, Toronto, Toronto, Canada
| | - Nancy M Salbach
- KITE - Toronto Rehabilitation Institute - UHN, Toronto, Canada.,Department of Physical Therapy, University of Toronto, UHN, Toronto, Canada
| | - Susan Jaglal
- KITE - Toronto Rehabilitation Institute - UHN, Toronto, Canada.,Department of Physical Therapy, University of Toronto, UHN, Toronto, Canada
| | - Brian Chan
- KITE - Toronto Rehabilitation Institute - UHN, Toronto, Canada
| | - Jill I Cameron
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada.,KITE - Toronto Rehabilitation Institute - UHN, Toronto, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
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6
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MacDermid JC, McClure JA, Richards L, Faber KJ, Jaglal S. Opioid use for a first-incident upper extremity fracture in 220,440 patients without recent prior use in Ontario, Canada: a retrospective cohort study. OTA Int 2022; 5:e202. [PMID: 36425087 PMCID: PMC9580049 DOI: 10.1097/oi9.0000000000000202] [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: 10/07/2021] [Accepted: 02/09/2022] [Indexed: 06/16/2023]
Abstract
To describe opioid use for a first upper extremity fracture in a cohort of patients who did not have recent opioid use. Design Descriptive epidemiological study. Setting Emergency Department, Hospital. Patients/Participants We obtained health administrative data records of adults presenting with a first adult upper extremity fracture from 2013 to 2017 in Ontario, Canada. We excluded patients with previous fractures, opioid prescription in the past 6 months or hospitalization >5 days after the fracture. Intervention Opioid prescription. Main Outcome Measurements We identified the proportion of patients filling an opioid prescription within 7 days of fracture. We described this based on different upper extremity fractures (ICD-10), Demographics (age, sex, rurality), comorbidity (Charlson Comorbidity Index, Rheumatoid arthritis, Diabetes), season of injury, and social marginalization (Ontario Marginalization Index-a data algorithm that combines a wide range of demographic indicators into 4 distinct dimensions of marginalization). We considered statistical differences (P< .01) that reached a standardized mean difference of 10% as being clinically important (standardized mean difference [SMD] ≥ 0.1). Results From 220,440 patients with a first upper extremity fracture (50% female, mean age 50), opioids were used by 34% of cases overall (32% in males, 36% in females, P< .001, SMD ≥ 0.1). Use varied by body region, with those with multiple or proximal fractures having the highest use: multiple shoulder 64%, multiple regions 62%, shoulder 62%, elbow 38%, wrist 31%, and hand 21%; and was higher in patients who had a nerve/tendon injury or hospitalization (P< .01, SMD ≥ 0.1). Social marginalization, comorbidity, and season of injury had clinically insignificant effects on opioid use. Conclusions More than one-third of patients who are recent-non-users will fill an opioid prescription within 7 days of a first upper extremity fracture, with usage highly influenced by fracture characteristics.Level of Evidence: Level II.
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Affiliation(s)
- Joy C MacDermid
- Departments of Surgery and Physical Therapy, University of Western Ontario and Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care
| | | | | | - Kenneth J Faber
- Department of Surgery, University of Western Ontario and Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, London
| | - Susan Jaglal
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
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7
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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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8
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Shepherd J, Tu K, Young J, Chishtie J, Craven BC, Moineddin R, Jaglal S. Identifying cases of spinal cord injury or disease in a primary care electronic medical record database. J Spinal Cord Med 2021; 44:S28-S39. [PMID: 34779726 PMCID: PMC8604482 DOI: 10.1080/10790268.2021.1971357] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE To identify cases of spinal cord injury or disease (SCI/D) in an Ontario database of primary care electronic medical records (EMR). DESIGN A reference standard of cases of chronic SCI/D was established via manual review of EMRs; this reference standard was used to evaluate potential case identification algorithms for use in the same database. SETTING Electronic Medical Records Primary Care (EMRPC) Database, Ontario, Canada. PARTICIPANTS A sample of 48,000 adult patients was randomly selected from 213,887 eligible patients in the EMRPC database. INTERVENTIONS N/A. MAIN OUTCOME MEASURE(S) Candidate algorithms were evaluated using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and F-score. RESULTS 126 cases of chronic SCI/D were identified, forming the reference standard. Of these, 57 were cases of traumatic spinal cord injury (TSCI), and 67 were cases of non-traumatic spinal cord injury (NTSCI). The optimal case identification algorithm used free-text keyword searches and a physician billing code, and had 70.6% sensitivity (61.9-78.4), 98.5% specificity (97.3-99.3), 89.9% PPV (82.2-95.0), 94.7% NPV (92.8-96.3), and an F-score of 79.1. CONCLUSIONS Identifying cases of chronic SCI/D from a database of primary care EMRs using free-text entries is feasible, relying on a comprehensive case definition. Identifying a cohort of patients with SCI/D will allow for future study of the epidemiology and health service utilization of these patients.
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Affiliation(s)
- John Shepherd
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada,Correspondence to: John Shepherd, Rehabilitation Sciences Institute, University of Toronto, 500 University Ave, Toronto, Ontario, Canada.
| | - Karen Tu
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada,North York General Hospital, Toronto, Ontario, Canada,Toronto Western Hospital Family Health Team, University of Toronto, Toronto, Ontario, Canada
| | - Jacqueline Young
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Jawad Chishtie
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - B. Catharine Craven
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada,KITE, Toronto Rehab – University Health Network, Toronto, Ontario, Canada,Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Rahim Moineddin
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada,Dalla Lana School of Public Health, Toronto, Ontario, Canada
| | - Susan Jaglal
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada,KITE, Toronto Rehab – University Health Network, Toronto, Ontario, Canada,Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
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9
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MacDermid JC, McClure JA, Richard L, Faber KJ, Jaglal S. Fracture profiles of a 4-year cohort of 266,324 first incident upper extremity fractures from population health data in Ontario. BMC Musculoskelet Disord 2021; 22:996. [PMID: 34844604 PMCID: PMC8630866 DOI: 10.1186/s12891-021-04849-7] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 11/05/2021] [Indexed: 11/22/2022] Open
Abstract
Background Understanding the profiles of different upper extremity fractures, particularly those presenting as a 1st incident can inform prevention and management strategies. The purpose of this population-level study was to describe first incident fractures of the upper extremity in terms of fracture characteristics and demographics. Methods Cases with a first adult upper extremity (UE) fracture from the years 2013 to 2017 were extracted from administrative data in Ontario. Fracture locations (ICD-10 codes) and associated characteristics (open/closed, associated hospitalization within 1-day, associated nerve, or tendon injury) were described by fracture type, age category and sex. Standardized mean differences of at least 10% (clinical significance) and statistical significance (p < 0.01) in ANOVA were used to identify group differences (age/sex). Results We identified 266,324 first incident UE fractures occurring over 4 years. The most commonly affected regions were the hand (93 K), wrist/forearm(80 K), shoulder (48 K) or elbow (35 K). The highest number of specific fractures were: distal radius (DRF, 47.4 K), metacarpal (30.4 K), phalangeal (29.9 K), distal phalangeal (24.4 K), proximal humerus (PHF, 21.7 K), clavicle (15.1 K), radial head (13.9 K), and scaphoid fractures (13.2 K). The most prevalent multiple fractures included: multiple radius and ulna fractures (11.8 K), fractures occurring in multiple regions of the upper extremity (8.7 K), or multiple regions in the forearm (8.4 K). Tendon (0.6% overall; 8.2% in multiple finger fractures) or nerve injuries were rarely reported (0.3% overall, 1.5% in distal humerus). Fractures were reported as being open in 4.7% of cases, most commonly for distal phalanx (23%). A similar proportion of females (51.5%) and males were present in this fracture cohort, but there were highly variant age-sex profiles across fracture subtypes. Fractures most common in 18–40-year-old males included metacarpal and finger fractures. Fractures common in older females were: DRF, PHF and radial head, which exhibited a dramatic increase in the over-50 age group. Conclusions UE fracture profiles vary widely by fracture type. Fracture specific prevention and management should consider fracture profiles that are highly variable according to age and sex. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04849-7.
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Affiliation(s)
- Joy C MacDermid
- School of Physical Therapy, Western University, London, ON, Canada. .,ICES Western, London, ON, Canada. .,Department of Surgery, Western University, London, ON, Canada. .,Hand and Upper Limb Centre, St. Joseph's Health Centre, 268 Grosvenor St, London, ON, Canada.
| | | | | | - Kenneth J Faber
- Department of Surgery, Western University, London, ON, Canada.,Hand and Upper Limb Centre, St. Joseph's Health Centre, 268 Grosvenor St, London, ON, Canada
| | - Susan Jaglal
- Department of Physical Therapy, University of Toronto, Toronto, ON, M5G 1V7, Canada
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10
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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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11
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Papaioannou A, Ioannidis G, McArthur C, Hillier LM, Feldman S, Giangregorio L, Jaglal S, Jain R, Van der Horst ML, Adachi J. Preventing Fractures in Long-Term Care: Translating Recommendations to Clinical Practice. J Am Med Dir Assoc 2020; 22:36-42. [PMID: 32800745 DOI: 10.1016/j.jamda.2020.07.003] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/30/2020] [Accepted: 07/01/2020] [Indexed: 10/23/2022]
Abstract
The Ontario Osteoporosis Strategy for long-term care (LTC) aims to support fracture risk-reduction. LTC specific recommendations for fracture prevention were developed in 2015. This article describes the use of the Knowledge-to Action framework to guide the development and application of research evidence on fracture prevention in older adults. Knowledge translation activities highlighted fractures as a significant source of morbidity in LTC, significant gaps in fracture risk assessment and treatment, and barriers and facilitators to guideline implementation. Multifaceted knowledge translation strategies, targeting staff in LTC homes in Ontario, Canada to support fracture guideline implementation have included education, audit and feedback, team-based action planning, and engagement of LTC residents, their families, and health professionals. Provincial administrative databases were accessed to monitor fracture rates between 2005 and 2015. Our research has identified enablers and barriers to knowledge use such as limited knowledge of osteoporosis, fracture risk, and prevention. Province-wide over a 10-year period, hip fracture rates in LTC decreased from 2.3% to 1.9%, and any fracture rates decreased from 4% to 3.6%. This body of work suggests that multifaceted knowledge translation initiatives are feasible to implement in LTC and can improve the uptake of clinical recommendations for fracture prevention. A key aspect of our fracture prevention knowledge translation activities has been the full engagement of key stakeholders to assist in the co-development and design of knowledge translation products.
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Affiliation(s)
- Alexandra Papaioannou
- McMaster University, Hamilton, Ontario, Canada; GERAS Center for Aging Research, Hamilton, Ontario, Canada.
| | - George Ioannidis
- McMaster University, Hamilton, Ontario, Canada; GERAS Center for Aging Research, Hamilton, Ontario, Canada
| | - Caitlin McArthur
- McMaster University, Hamilton, Ontario, Canada; GERAS Center for Aging Research, Hamilton, Ontario, Canada
| | | | - Sid Feldman
- GERAS Center for Aging Research, Hamilton, Ontario, Canada; Baycrest Health Sciences, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Lora Giangregorio
- GERAS Center for Aging Research, Hamilton, Ontario, Canada; University of Waterloo, Waterloo, Ontario, Canada; Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada
| | - Susan Jaglal
- GERAS Center for Aging Research, Hamilton, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Ravi Jain
- Osteoporosis Canada, Toronto, Ontario, Canada
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12
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Wilson JR, Cronin S, Fehlings MG, Kwon BK, Badhiwala JH, Ginsberg HJ, Witiw C, Jaglal S. Epidemiology and Impact of Spinal Cord Injury in the Elderly: Results of a Fifteen-Year Population-Based Cohort Study. J Neurotrauma 2020; 37:1740-1751. [DOI: 10.1089/neu.2020.6985] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jefferson R. Wilson
- Division of Neurosurgery, University of Toronto, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Shawna Cronin
- Institute of Clinical Evaluative Sciences, University of Toronto, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Michael G. Fehlings
- Division of Neurosurgery, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Brian K. Kwon
- Spinal Program, Blusson Spinal Cord Center, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jetan H. Badhiwala
- Division of Neurosurgery, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Howard J. Ginsberg
- Division of Neurosurgery, University of Toronto, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Christopher Witiw
- Division of Neurosurgery, University of Toronto, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Susan Jaglal
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
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13
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Missiuna P, Shen J, Nahle I, Shen J, Alanazi M, Rutges J, Rocos B, Miyanji F, Lohkamp L, Grootjen L, Hachem L, Aldebeyan S, Machida M, Padhye K, Rushton P, Jentzsch T, Jentzsch T, Lewis S, Passias P, Pierce K, Lewis S, Passias P, Nielsen C, Glennie A, Crawford E, Schneider N, Ayling O, Christie S, Greene R, Singh S, Beauchamp-Chalifour P, Balasuberamaniam P, Singh S, Mercure-Cyr R, Wilson J, Evaniew N, Martin A, Rienmueller A, Martin A, Karim M, Martin A, Cheung A, Badhiwala J, Diotalevi L, Jaja B, Fallah N, Badhiwala J, Wasim A, Manson N, Lasry O, Crawford E, Brown A, MacLean MA, Khan O, Badhiwala J, Odai KG, Bailly N, Khan O, Evaniew N, Yamamoto S, Singh M, Kashigar A, Persad A, Fernandes RJR, Malakoutian M, Ahuja C, Morris S, Stukas S, Chen T, Babadagli E, Xu M, Nater A, Oitment C, Karim M, Aziz M, Pahuta M, Versteeg A, Sundararajan K, Tanguay R, Stratton A, Cushnie D, Correale M, Sadiq I, Badhiwala J, Passias P, Badhiwala J, McGregor S, Passias P, Badhiwala J, Chen T, Singh S, Ayling O, Bond M, Rienmueller A, Chen T, Lasry O, Lyons F, Ahmed U, Inglis T, Waheed Z, Wilson J, Nater A, Pahuta M, Klein G, McKibben N, Kassam F, Clement A, Kanawati A, Shaikh N, Kanawati A, Alshammari A, Kanawati A, Yamamoto S, Hamilton K, Huschi Z, Peng YN, Huschi Z, Filgueira É, Goulet J, Kashigar A, Chen T, Hadgaonkar S, MacLean M, Chen T, Kerr HL, Meagher J, Wilson J, Stevens M, Rocos B, Pai A, Kingwell S, Thibault J, Touchette C, Moskven E, Greene R, DeVries Z, Sarraj M, Bosakhar B, Thornley P, Donnellan J, Kishta W, Darby P, Nahle I, Alzakri A, Roy-Beaudry M, Joncas J, Turgeon I, Parent S, Shen J, Alzakri A, Roy-Beaudry M, Joncas J, Turgeon I, Parent S, Samson N, Lamontagne-Proulx J, Soulet D, Tremblay Y, Praud JP, Parent S, Parent S, Gross D, Renkens J, Schlösser T, Stadhouder A, Kruyt M, Mostert A, Tee J, de Klerk L, De Kleuver M, Castelein R, Zeller R, Lewis S, Tan T, Lebel D, Rushton P, Petcharaporn M, Samdani A, Newton P, Marks M, Drake J, Dirks P, Rutka J, Kulkarni A, Ibrahim G, Taylor M, Dewan M, Zeller R, Donze S, Damen L, Rutges J, Hokken-Koelega A, Mathieu F, Lamberti-Pasculi M, Hanak B, Zeller R, Kulkarni A, Drake J, Ibrahim G, Rushton P, Ghag R, Miyanji F, Zeller R, Lewis S, Lebel D, Peiro-Garcia A, Benavides B, Parsons D, Ferri-de-Barros F, Aldebeyan S, Ghag R, Miyanji F, Kutschke L, Laux C, Kabelitz M, Schüpbach R, Böni T, Farshad M, Nielsen C, Lewis S, Lenke L, Shaffrey C, Cheung K, Berven S, Qiu Y, Matsuyama Y, Pellisé-Urquiza F, Polly D, Sembrano J, Dahl B, Kelly M, de Kleuver M, Spruit M, Alanay A, Alas H, Kim HJ, Lafage R, Soroceanu A, Hockley A, Ames C, Klineberg E, Burton D, Diebo B, Bess S, Line B, Shaffrey C, Smith J, Schwab F, Lafage V, Passias P, Lafage R, Soroceanu A, Hockley A, Line B, Klineberg E, Bess S, Protopsaltis T, Shaffrey C, Schwab F, Scheer J, Smith J, Lafage V, Ames C, Lenke L, Shaffrey C, Cheung K, Berven S, Qiu Y, Matsuyama Y, Pellisé-Urquiza F, Polly D, Sembrano J, Dahl B, Kelly M, de Kleuver M, Spruit M, Alanay A, Bortz C, Pierce K, Alas H, Brown A, Soroceanu A, Hockley A, Vira S, Ahmad W, Naessig S, Diebo B, Raman T, Protopsaltis T, Buckland A, Gerling M, Lafage R, Lafage V, Lewis S, Lenke L, Shaffrey C, Cheung K, Berven S, Qiu Y, Matsuyama Y, Pellisé-Urquiza F, Polly D, Sembrano J, Dahl B, Kelly M, de Kleuver M, Spruit M, Alanay A, Bailey C, Rampersaud R, Fisher C, Chen T, McIntosh G, Rampersaud R, Karim M, Urquhart J, Fisher C, Street J, Dvorak M, Paquette S, Charest-Morin R, Ailon T, Glennie A, Manson N, Rampersaud R, Thomas K, Rasoulinejad P, Bailey C, Ailon T, Fisher C, Greene R, Glennie A, Duquette D, LeBlanc D, Martell B, Schmidt M, Christie S, Wong DBT, Di Paola C, Ailon T, Charest-Morin R, Dea N, Dvorak M, Fisher C, Kwon B, Paquette S, Street J, Street J, Flexman A, Charest-Morin R, Wasim A, Schwartz C, Stark R, Shrikumar M, Finkelstein J, Gara A, Banaszek D, Wong T, Ailon T, Bryce E, Charest-Morin R, Dea N, Dvorak M, Fisher C, Kwon B, Paquette S, Street J, Persad A, Spiess M, Wu A, Woo A, Hnenny L, Fourney D, Joshi H, Khan O, Badhiwala J, Rampersaud R, Lewis S, Massicotte E, Fehlings M, Cadotte D, Bailey C, Christie S, Dea N, Fisher C, Paquet J, Soroceanu A, Thomas KC, Rampersaud YR, Wilson J, Manson N, Johnson M, Hall H, McIntosh G, Jacobs B, Kalsi-Ryan S, Akbar MA, Badhiwala J, Wilson J, Tetreault L, Nouri A, Rienmuller A, Massicotte E, Fehlings M, Kalsi-Ryan S, Riehm L, Martin A, Badhiwala J, Akbar M, Massicotte E, Fehlings M, Kalsi-Ryan S, Akbar MA, Badhiwala J, Wilson J, Tetreault L, Nouri A, Rienmuller A, Massicotte E, Fehlings M, Jacobs B, Johnson M, Bailey C, Christie S, Paquet J, Nataraj A, Cadotte D, Wilson J, Manson N, Hall H, Thomas K, Rampersaud R, McIntosh G, Fisher C, Dea N, Wilson J, Jentzsch T, Jiang F, Badhiwala J, Moghaddamjou A, Akbar MA, Nater A, Rienmuller A, Ganau M, Massicotte E, Fehlings M, Tu L, Manouchehri N, Kim KT, So K, Webster M, Fisk S, Tigchelaar S, Dalkilic S, Sayre E, Streijger F, Macnab A, Kwon B, Shadgan B, Wilson J, Fehlings M, Bailly N, Wagnac E, Mac-Thiong JM, Goulet J, Petit Y, Badhiwala J, Grossman R, Geisler F, Fehlings M, Wilson J, Rivers C, Kwon B, Waheed Z, Buenaventura J, Humphreys S, Noonan V, Evaniew N, Dvorak M, Wilson J, Fehlings M, Shrikumar M, Balasuberamaniam P, Rapkin B, Schwartz C, Stark R, Finkelstein J, Bigney E, Darling M, Richardson E, El-Mughayyar D, Abraham E, Street J, Radomski L, Rampersaud R, Pierce K, Bortz C, Alas H, Naessig S, Ahmad W, Vira S, Diebo B, Sciubba D, Hassanzadeh H, Hockley A, Soroceanu A, Protopsaltis T, Buckland A, Passias P, Greene R, Christie SD, Badhiwala J, Fehlings M, Witiw C, Wilson J, Fehlings M, Nessek H, Wai E, Phan P, Diotalevi L, Beauséjour MH, Wagnac E, Mac-Thiong JM, Petit Y, Badhiwala J, Fehlings M, Mazlouman S, Belley-Côté E, Jacobs B, Kwon B, Malakoutian M, Theret M, Street J, Brown S, Rossi F, Oxland T, Singh P, Chandra S, Laratta J, Carreon L, Bisson E, Ghogawala Z, Yew A, Mkorombindo T, Mummaneni P, Glassman S, Kindrachuk M, Hnenny L, Wu A, Norton J, Fourney D, Gee A, Kerr HL, Kanawati A, Zdero R, Gurr K, Bailey C, Rasoulinejad P, Yamamoto S, Sadaram S, Speidel J, Liu J, Street J, Brown S, Oxland T, Khazaei M, Walji I, Dadabhoy M, Gulati N, Aiyar N, Ostmeier S, Hasan A, Senthilnathan V, Punjani N, Yao Y, Yue S, Ozdemir G, Lou Z, Luong W, Post A, Tootsi A, Chan P, Fehlings M, Yung A, George S, Prevost V, Bauman A, Kozlowski P, Samadi F, Fournier C, Parker L, Dong K, Streijger F, Moore W, Laule C, Kwon B, Gill J, Cooper J, Dong K, Streijger F, Street J, Paquette S, Ailon T, Charest-Morin R, Fisher C, Dvorak M, Dhall S, Mac-Thiong JM, Parent S, Bailey C, Christie S, Wellington C, Kwon B, Crawford E, Zhang Y, Hardisty M, Finkelstein J, Kureshi N, Julien L, Abidi R, Christie S, Parashin S, Gascoyne T, Goytan M, Chuang J, Liu K, Quraishi N, Pasku D, Wilson J, Fehlings M, Bozzo A, Reinmuller A, Martin A, Hananel SY, Thornley P, Gazendam A, Aoude A, Nielsen C, Rampersaud R, Dea N, Versteeg A, Sahgal A, Verlaan JJ, Morin RC, Rhines L, Sciubba D, Schuster J, Weber M, Lazary A, Fehlings M, Clarke M, Arnold P, Boriani S, Laufer I, Gokaslan Z, Fisher C, Rosenzweig D, Weber M, Fisk F, Versteeg A, Fisher C, Sahgal A, Gokaslan Z, Rhines L, Boriani S, Bettegowda C, Dea N, Gal R, Charest-Morin R, Verlaan JJ, Verkooijen L, Fisher C, Perruccio A, Rampersaud R, Eckenswiller D, Yu A, Klassen K, Lewkonia P, Thomas K, Jacobs B, Miller N, Swamy G, Yang M, Soroceanu A, Phan P, Wai E, Kingwell S, Moravek D, Tierney S, Street J, Sundararajan K, Bosma R, Faclier G, Di Renna T, Rampersaud R, Frederick A, Kassam F, Nicholls F, Swamy G, Lewkonia P, Thomas K, Jacobs B, Miller N, Tanguay R, Soroceanu A, Platt A, Traynelis V, Witiw C, Horn S, Weiser-Horwitz S, Bortz C, Segreto F, Pierce K, Lafage R, Hockley A, Vira S, Lafage V, Witiw C, Wilson J, Nassiri F, da Costa L, Nathens A, Fehlings M, Jacobs B, Alas H, Pierce K, Brown A, Bortz C, Hockley A, Soroceanu A, Vira S, Naessig S, Ahmad W, Lafage R, Lafage V, Witiw C, Wilson J, da Costa L, Nathens A, Fehlings M, Crawford E, McIntosh G, Rampersaud R, Fisher C, Manson N, Thomas K, Hall H, Rampersaud R, Dea N, McIntosh G, Charest-Morin R, Investigators CSORN, Ailon T, Fisher C, Evaniew N, Aldebeyan S, Thomas K, Sundararajan K, Oitment C, Lewis S, Perruccio A, Rampersaud R, Christie S, Yee A, Fisher C, Jarzem P, Roy JF, Bouchard J, Evans D, Kwon B, Splawinski J, Warren D, Street J, Morris S, Costello J, Farrell M, Humphreys S, Kurban D, Rivers C, Jeffrey M, Juutilainen S, Casha S, Christie S, Clarke T, Drew B, Ethans K, Fehlings M, Fox R, Linassi G, Marion T, O’Connell C, Paquet J, Reid J, Scott L, Fourney D, Schouten R, Rivers C, Chen M, Nunnerley J, Croot T, Young L, Patel A, Dvorak M, Kwon B, Rivers C, Buenaventura J, Humphreys S, Noonan V, Fallah N, Evaniew N, Dvorak M, Cronin S, Badhiwala J, Ginsberg H, Fehlings M, Kwon B, Jaglal S, Wilson J, Fehlings M, Fisk F, Versteeg A, Fisher C, Sahgal A, Gokaslan Z, Rhines L, Boriani S, Bettegowda C, Dea N, Martel A, Sahgal A, Finkelstein J, Whyne C, Hardisty M, Baksh N, Nguyen T, Brown S, Jaboin J, Lin C, Yach J, Hardisty M, Whyne C, Fernandez R, Gee A, Urquhart J, Bailey C, Rasoulinejad P, Zhang H, Shewchuk J, Street J, Wilson D, Oxland T, Fernandez R, Gee A, Urquhart J, Bailey C, Rasoulinejad P, Algarni N, Aljarboa N, Jarzem P, Fernandez R, Gee A, Urquhart J, Bailey C, Rasoulinejad P, Whyte T, Van Toen C, Melnyk A, Shewchuk J, Street J, Cripton P, Oxland T, Avila M, Hurlbert RJ, Neuburger L, Ahmed SU, Cheng Y, Fourney D, Hsu HC, Kao CH, Neuburger L, Ahmed SU, Cheng Y, Fourney D, Meves R, de Oliveira AI, da Silva HC, Richard-Denis A, Petit Y, Diotalevi L, Mac-Thiong JM, Laratta J, Bisson E, Carreon L, Yew A, Mkorombindo T, Glassman S, Christie S, Bouchard J, Fisher C, Roy JF, Yee A, Jarzem P, Khurjekar K, Kothari A, Zawar A, Sanchetui P, Shyam A, Touchette C, Han JH, Christie S, Pickett G, Yee A, Bouchard J, Christie S, Fisher C, Jarzem P, Roy JF, Hashem L, Urquhart J, Rasoulinejad P, Gurr K, Siddiqi F, Bailey C, Attabib N, Bigney E, Richardson E, El-Mughayyar D, Darling M, Manson N, Abraham E, Badhiwala J, Jiang F, Wilson J, Fehlings M, Dunning C, Oxner W, Stewart S, Glennie A, Hutchinson J, Oxland T, Zhang H, Shewchuk J, Wilson D, Street J, Wilk S, Wai E, Phan P, Stratton A, Mohammed S, Tsai E, Alkerayf F, Michalowski W, Phan P, Wai E, Hoda M, MacLean M, Brunette-Clément T, Abduljabba F, Weber M, Fourney D, Charest-Morin R, Flexman A, Street J, Frey M, Mackey S, De Carvalho D, Barrowman N, Smit K, Tice A, Mervitz D, Jarvis J, Kingwell S. Canadian Spine SocietyPresentation CPSS1: Spinal insufficiency fracture in the geriatric pediatric spinePresentation CPSS2: The clinical significance of tether breakages in anterior vertebral body growth modulation: a 2-year postoperative analysisPresentation CPSS3: Anterior vertebral body growth modulation for idiopathic scoliosis: early, mid-term and late complicationsPresentation CPSS4: Ovine model of congenital chest wall and spine deformity with alterations of respiratory mechanics: follow-up from birth to 3 monthsPresentation CPSS5: Test–retest reliability and minimum detectable change of the English translation of the Italian Spine Youth Quality of Life questionnaire in adolescents with idiopathic scoliosisPresentation B1. Abstract 31: Incidence of delayed spinal cord injury in pediatric spine deformity surgery seems to be higher than previously assumedPresentation B2. Abstract 155: What is the optimal surgical method for achieving successful symptom relief in pediatric high-grade spondylolisthesis?Presentation B3. Abstract 47: Vertebral body tethering: Truly motion preserving or rather limiting?Presentation B4. Abstract 180: Fusion rates in pediatric patients after posterior cervical spine instrumentationPresentation B5. Abstract 102: Effects of 8 years of growth hormone treatment on the onset and progression of scoliosis in children with Prader–Willi syndromePresentation B6. Abstract 144: Klippel–Feil syndrome: clinical phenotypes associated with surgical treatmentPresentation B7. Abstract 123: Anterior release for idiopathic scoliosis: Is it necessary for curve correction?Presentation B8. Abstract 62: Severe scoliosis: Do we know a better way? A retrospective comparative studyPresentation B9. Abstract 21: Intraoperative skull femoral traction in adolescent idiopathic scoliosis: the correlation of traction with side-bending radiographsPresentation B10. Abstract 147: What is the effect of intraoperative halo-femoral traction on correction of adolescent idiopathic scoliosis?Presentation B11. Abstract 174: Extreme long-term outcome of surgically versus non-surgically treated patients with adolescent idiopathic scoliosisPresentation B12. Abstract 172: The influence of multilevel spinal deformity surgery on the clinical outcome in the elderly: a prospective, observational, multicentre studyPresentation B13. Abstract 49: Demographics of a prospective evaluation of elderly deformity surgery: a prospective international observational multicentre studyPresentation B14. Abstract 119: Timing of conversion to cervical malalignment and proximal junctional kyphosis following surgical correction of adult spinal deformityPresentation B15. Abstract 44: Prioritization of realignment associated with superior clinical outcomes for surgical cervical deformity patientsPresentation B16. Abstract 50: Outcome of multilevel spinal deformity surgery in patients over 60 years of age: a multicentre international prospective studyPresentation B17. Abstract 122: A simpler, modified frailty index weighted by complication occurrence correlates to pain and disability for adult spinal deformity patientsPresentation B18. Abstract 75: Change in Oswestry Disability Index at 24 months following multilevel spinal deformity surgery in patients over 60 years of age: a multicentre international prospective studyPresentation C19. Abstract 19: A prospective cohort study evaluating trends in the surgical treatment of degenerative spondylolisthesis in Canada and the utility of a novel surgical decision aidPresentation C20. Abstract 154: Decompression compared with decompression and fusion for degenerative lumbar spondylolisthesis: a Canadian Spine Outcomes and Research Network (CSORN) studyPresentation C21. Abstract ID 77: Lumbar degenerative spondylolisthesis: factors impacting decision to fusePresentation C22. Abstract 27: Patient-reported outcomes following surgery for lumbar disc herniation: comparison of a universal and multitier health care systemPresentation C23. Abstract 151: Do patients with recurrent lumbar disc herniations fair worse with discectomy than primary operations? A retrospective analysis from the Canadian Spine Outcomes and Research NetworkPresentation C24. Abstract 136: A province-wide assessment of the appropriateness of lumbar spine MRIPresentation D25. Abstract 32: Surgical site infection reduction — a 10-year quality improvement journeyPresentation D26. Abstract 34: The impact of frailty on patient-reported outcome measures following elective thoraco-lumbar spine surgeryPresentation D27. Abstract 8: Moving toward better health: exercise practice is associated with improved outcomes after spine surgeryPresentation D28. Abstract 33: Preoperative decolonization does not adversely affect the microbiologic spectrum of spine surgical site infectionPresentation D29. Abstract 61: Feedback: reducing after-hours spine cases using an encrypted messaging systemPresentation D30. Abstract 177: Complex spine surgery is safe and effective in the extremely elderly age group: results from an ambispective study of 722 patients over 75 years old from a single institutionPresentation E31. Abstract 38: Clinical predictors of achieving minimal clinically important difference after surgery for cervical spondylotic myelopathy: an external validation study from the Canadian Spine Outcomes and Research NetworkPresentation E32. Abstract 66: The natural history of degenerative cervical myelopathy: an ambispective longitudinal cohort studyPresentation E33. Abstract 159: Quantitative assessment of gait characteristics in degenerative cervical myelopathy (DCM): a prospective studyPresentation E34. Abstract 130: Prognostic factors in degenerative cervical myelopathy (DCM) for patients managed operatively and nonoperativelyPresentation E35. Abstract 175: Efficacy of surgical decompression in patients with cervical spondylotic myelopathy: results of a Canadian prospective multicentre studyPresentation E36. Abstract 67: Interobserver reliability of the modified Japanese Orthopedic Association (mJOA) score in degenerative cervical myelopathyPresentation F37. Abstract 128: Continuous optical monitoring of spinal cord hemodynamics during the first 7 days after injury in a porcine model of acute spinal cord injuryPresentation F38. Abstract 106: Development of a prediction model for central cord syndrome: an evaluation of motor recovery and the effectiveness of early surgery in a prospective, multicentre cohortPresentation F39. Abstract 135: Spinal cord dynamics under different clinical configurations of thoracolumbar burst fractures through numerical simulationsPresentation F40. Abstract 60: Predicting the heterogeneity of outcome following sensorimotor complete cervical spinal cord injury: trajectory-based analysis of 655 prospectively enrolled patientsPresentation F41. Abstract 167: Mortality in the year following discharge to the community from inpatient care for acute traumatic spinal cord injury: When and why?Presentation F42. Abstract 104: A novel method to classify patients with cervical incomplete spinal cord injury based on potential for recovery: a group-based trajectory analysis using prospective, multicentre data from over 800 patientsPresentation G43. Abstract 7: Responsiveness of standard spine outcome tools: Do they measure up?Presentation G44. Abstract 142: Patient outcomes: important psychological measuresPresentation G45. Abstract 84: Accuracy of surveillance for surgical site infections after spine surgery: a Bayesian latent class analysis using 4 independent data sourcesPresentation G46. Abstract 169: Econometric modelling: development of a surgical cost calculator for degenerative conditions of the lumbar spinePresentation G47. Abstract 124: The economic impact of nonreimbursable events in open, minimally invasive and robot-assisted lumbar fusion surgeryPresentation G48. Abstract 164: Are there sex differences in preoperative health status and health care delivery for patients undergoing scheduled lumbar surgery? An analysis from the Canadian Spine Outcomes and Research NetworkPresentation H49. Abstract 41: Patient phenotypes associated with functional outcomes after spinal cord injury: a principal component analysis in 1119 patientsPresentation H50. Abstract 103: Early versus late surgical decompression for acute traumatic spinal cord injury: a pooled analysis of prospective, multicentre data in 1548 patientsPresentation H51. Abstract 79: Clinical outcome correlation of diffusion tensor imaging and magnetic resonance imaging values: a systematic reviewPresentation H52. Abstract 137: A numerical study on the pathogenesis of central cord syndromePresentation H53. Abstract 42: Feasibility and utility of machine learning in prediction of bladder outcomes after spinal cord injury: analysis of 1250 patients from the European Multicenter Study about Spinal Cord Injury (EMSCI) registryPresentation H54. Abstract 18: Interventions to optimize spinal cord perfusion in patients with acute traumatic spinal cord injuries: a systematic reviewPresentation i55. Abstract 55: The effect of posterior lumbar spinal surgery on passive stiffness of rat paraspinal muscles 13 weeks post-surgeryPresentation i56. Abstract 43: A computed tomographic based morphometric analysis of the axis in adult populationPresentation i57. Abstract 92: Is there value to flexion–extension x-rays for degenerative spondylolisthesis? A multicentre retrospective studyPresentation i58. Abstract 98: The novel “7/20 EMG protocol” in combination with O-arm image-guided navigation for accurate lumbar pedicle placement while minimizing diagnostic radiation exposurePresentation i59. Abstract 148: Comparative biomechanical study of 2 types of transdiscal fixation implants for high-grade L5/S1 spine spondylolisthesis in a porcine modelPresentation i60. Abstract 85: The effects of fibre bundle size and vertebral level on passive stiffness of the lumbar paraspinal muscles in a rat modelPresentation J61. Abstract 157: A self-assembling peptide biomaterial to enhance human neural stem cell-based regeneration of the injured spinal cordPresentation J62. Abstract 162: Measuring demyelination, axonal loss and inflammation after human spinal cord injury with quantitative magnetic resonance imaging and histopathologyPresentation J63. Abstract 179: Characterization of ubiquitin C-terminal hydrolase L1 (UCH-L1) as a fluid biomarker of human traumatic spinal cord injuryPresentation J64. Abstract 13: Utility and role of virtual reality based simulation models in spinal decompression trainingPresentation J65. Abstract 160: Investigating the determinants for predicting surgical patient outcomes through the application of machine learning methodsPresentation J66. Abstract 143: Comparison of screw design and technique on cervical lateral mass screw fixationPresentation K67. Abstract 57: Development of clinical prognostic models for postoperative survival and quality of life in patients with surgically treated metastatic epidural spinal cord compressionPresentation K68. Abstract 170: Sarcomas of the spine: a 20-year survey of disease and treatment strategy in Ontario, CanadaPresentation K69. Abstract 15: Metastatic spine disease: Should patients with short life expectancy be denied surgical care? An international retrospective cohort studyPresentation K70. Abstract 29: Nanoparticle-functionalized polymethyl methacrylate bone cement for sustained chemotherapeutic drug deliveryPresentation K71. Abstract 90: Development of the Spine Oncology Study Group Outcomes Questionnaire – 8 Domain (SOSGOQ-8D)Presentation K72. Abstract 6: Treatment expectations of patients with spinal metastases: What do we tell our patients?Presentation L73. Abstract 48: Factors related to risk of opioid abuse in primary care patients with low back painPresentation L74. Abstract 65: QI/QA of a transitional outpatient pain program for spinePresentation L75. Abstract 168: The effect of preoperative opioid use on hospital length of stay in patients undergoing elective spine surgeryPresentation L76. Abstract 163: Disability or pain: Which best predicts patient satisfaction with surgical outcome? A Canadian Spine Outcomes and Research Network (CSORN) studyPresentation L77. Abstract 58: Rapid access to interventional pain management for lumbar nerve root pain through collaborative interprofessional provider networksPresentation L78. Abstract 63: Chronic preoperative opioid use associated with higher perioperative resource utilization and complications in adult spinal deformity patientsPresentation M79. Abstract 108: Cervical disc arthroplasty versus anterior cervical discectomy and fusion: a longitudinal analysis of reoperationsPresentation M80. Abstract 46: Preliminary results of randomized controlled trial investigating the role of psychological distress on cervical spine surgery outcomes: a baseline analysisPresentation M81. Abstract 110: Operative versus nonoperative treatment of geriatric odontoid fractures: a study of North American trauma centresPresentation M82. Abstract 74: Clinical outcome of posterior cervical foraminotomy versus anterior cervical discectomy and fusionPresentation M83. Abstract 45: “Reverse Roussouly”: ratios of cervical to thoracic shape curvature in an adult cervical deformity populationPresentation M84. Abstract 109: Treatment of acute traumatic central cord syndrome: a study of North American trauma centresPresentation N85. Abstract 118: Comparing minimally invasive versus traditional open lumbar decompression and fusion surgery: a Canadian Spine Outcomes and Research Network (CSORN) studyPresentation N86. Abstract 54: Time to return to work after lumbar spine surgeryPresentation N87. Abstract 28: Patient-reported outcomes following surgery for lumbar spinal stenosis: comparison of a universal and multitier health care systemPresentation N88. Abstract 93: Outcomes of surgery in older adults with lumbar spinal stenosisPresentation N89. Abstract 162: Functional objective assessment using the TUG test is a useful tool to evaluate outcome in lumbar spinal stenosisPresentation N90. Abstract 36: A Canadian Spine Outcomes and Research Network (CSORN) matched-cohort study comparing lumbar fusion and disk arthroplastyPresentation o91. Abstract 171: Development of clinical practice guidelines for the management of traumatic spinal column and cord injuries in British Columbia: an approach to standardizing care of spine trauma patientsPresentation o92. Abstract 22: Notes from a small island: stemming the tide of a spinal deluge. The use of encrypted software applications to ensure accountability, quality control and surgical consensus in a national acute adult spinal surgery centrePresentation o93. Abstract 129: Traumatic spinal cord injuries among Aboriginal and non-Aboriginal populations in Canada: an ambispective outcomes studyPresentation o94. Abstract 132: Traumatic spinal cord injury in New Zealand and Canada: a comparative analysisPresentation o95. Abstract 150: Exploring the reasons for readmission following traumatic spinal cord injuryPresentation o96. Abstract 59: Exploring the epidemiology and impact of spinal cord injury in the elderly: a 15-year Canadian population-based cohort studyPresentation P1. Abstract 139: Incidence and management of spinal metastasis in Ontario: a population-based studyPresentation P2. Abstract 91: A general population utility valuation study for the Spine Oncology Study Group Outcomes Questionnaire – 8DPresentation P3. Abstract 158: Metastatic vertebrae segmentation by augmented 3D convolutional neural networkPresentation P4. Abstract 73: Risk factors for failure of radiation therapy for spinal metastasesPresentation P5. Abstract 68: Significance of extracanalicular cement extravasation in thoracolumbar kyphoplastyPresentation P6. Abstract 120: Modelling fracture in osteoblastic vertebraePresentation P7. Abstract 97: The development of novel 2-in-1 patient-specific, 3D-printed laminar osteotomy guides with integrated pedicle screw guidesPresentation P8. Abstract 56: Effect of pelvic retroversion on pelvic geometry and muscle morphometry from upright magnetic resonance imagingPresentation P9. Abstract 161: Anatomic relationship between the accessory process of the lumbar spine and the pedicle screw entry pointPresentation P10. Abstract 20: Novel chair to measure lumbar spine extensors strength in adultsPresentation P11. Abstract 95: Error measurement between human spine, 3D scans, CT-based models, and 3D-printed modelsPresentation P12. Abstract 52: The diagnostic precision of computed tomography for traumatic cervical spine injury: an in vitro investigationPresentation P13. Abstract 94: Epidural abscess causing spinal cord infarctionPresentation P14. Abstract 83: The nerve root sedimentation sign on magnetic resonance imaging is not only correlated with neurogenic claudication: association with all types of leg-dominant mechanical painPresentation P15. Abstract 3: Accuracy of robot-assisted compared with freehand pedicle screw placement in spine surgery: a meta-analysis of randomized controlled trialsPresentation P16. Abstract 82: A positive nerve root sedimentation sign on magnetic resonance imaging is associated with improved surgical outcomes in patients with back dominant painPresentation P17. Abstract 16: Thoracolumbar burst fracture: McCormack load-sharing classification —systematic review and single-arm meta-analysisPresentation P18. Abstract 86: Morphological features of thoracolumbar burst fractures associated with neurologic recovery after thoracolumbar traumatic spinal cord injuryPresentation P19. Abstract 89: Radiographic parameters of listhesis and instability are not associated with health status or clinical outcomes in grade 1 degenerative spondylolisthesisPresentation P20. Abstract 37: Predictive socioeconomic factors following lumbar disk arthroplasty: a Canadian Spine Outcomes and Research Network (CSORN) studyPresentation P21. Abstract 25: Effect of in situ fusion in lumbar spondylolisthesis on clinical outcomes and spino-pelvic sagittal balancingPresentation P22. Abstract 10: Sex differences in the surgical management of lumbar degenerative disease: a systematic reviewPresentation P23. Abstract 35: Two-year results of lumbar disk arthroplasty: a Canadian Spine Outcomes and Research Network (CSORN) studyPresentation P24. Abstract 78: Does disc morphology affect the success of nonoperative treatment of chronic sciatica from a lumbar disc herniation?Presentation P25. Abstract 141: Opioid prescribing patterns: preliminary investigationPresentation P26. Abstract 133: Frailty is a better predictor of complications than age alone after surgical treatment of degenerative cervical myelopathy: an ambispective study of 5107 elderly patients from the National Surgical Quality Improvement Program databasePresentation P27. Abstract 26: Pathway analysis in spine surgery: a model for evaluating length of stayPresentation P29. Abstract 156: Patients with adolescent idiopathic scoliosis (AIS) have different cervical lordosis than the normal populationPresentation P31. Abstract 64: Investigation of thoracic spinal muscle morphology with upright magnetic resonance imagingPresentation P32. Abstract 80: Postoperative complication prediction between spinal surgeons and a machine learning model: a comparative studyPresentation P33. Abstract 81: Is using a simplified procedural classification as accurate as using current procedural terminology codes to predict future complications in spinal surgery?Presentation P34. Abstract 88: Preoperative patient performance status and frailty phenotype as predictive factors of outcome in surgically treated patients with metastatic spinal disease: a systematic literature reviewPresentation P35. Abstract 101: The measurements of frailty and their application to spine surgeryPresentation P36. Abstract 131: The effect of prolonged sitting on muscle reflexes of the low backPresentation P37. Abstract 87: Implementing a rapid discharge pathway for adolescent idiopathic scoliosis in Canada. Can J Surg 2020. [DOI: 10.1503/cjs.014720] [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: 11/01/2022] Open
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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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Abstract
OBJECTIVE To qualitatively explore factors affecting implementation of caregiver support programmes in healthcare institutions in a regional stroke system. DESIGN A qualitative descriptive study with the Ontario Stroke System (OSS) was conducted. Data were collected through focus groups and in-depth interviews. Transcripts were coded and analysed using inductive thematic analysis. SETTING Regional Stroke System, Ontario, Canada. PARTICIPANTS OSS stakeholders including medical directors, executives, programme directors, education coordinators, rehabilitation and community and long-term care specialists, primary care leaders and healthcare professionals. INTERVENTION Not applicable. MAIN OUTCOME MEASURES Data collection explored perceptions of the need for caregiver support programmes and factors that may affect their implementation. RESULTS Four focus groups (n=43) and 29 interviews were completed. Analyses identified themes related to (1) evidence that a caregiver programme will improve health and health system outcomes, (2) personnel requirements, (3) barriers associated with current billing and referral processes and (4) integration with current practice and existing workflow processes. CONCLUSIONS Implementation strategies to adopt caregiver programmes into clinical practice should incorporate evidence and consider personnel and existing workflow processes.
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Affiliation(s)
- Victrine Tseung
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Susan Jaglal
- Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- Toronto Rehabilitation Institute, Toronto, Ontario, Canada
| | - Nancy Margaret Salbach
- Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- Toronto Rehabilitation Institute, Toronto, Ontario, Canada
| | - Jill I Cameron
- Toronto Rehabilitation Institute, Toronto, Ontario, Canada
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Singh H, Scovil CY, Yoshida K, Oosman S, Kaiser A, Craven C, Jaglal S, Musselman KE. Factors that influence the risk of falling after spinal cord injury: a qualitative photo-elicitation study with individuals that use a wheelchair as their primary means of mobility. BMJ Open 2020; 10:e034279. [PMID: 32102820 PMCID: PMC7045099 DOI: 10.1136/bmjopen-2019-034279] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Falls are a concern for wheelchair users with spinal cord injury (SCI). Falls can negatively impact the physical and psychological well-being of fallers. To date, the perspectives of wheelchair users with lived experiences of SCI on the contributors to falls has been understudied. Information about factors that influence fall risk would guide the development of effective fall prevention strategies. OBJECTIVES To gain a comprehensive understanding of the factors that influenced the risk of falling as perceived by wheelchair users with SCI. DESIGN A qualitative study using photo-elicitation interviews. SETTING A Canadian SCI rehabilitation hospital and the participants' home/community environments. PARTICIPANTS Twelve wheelchair users living in the community with chronic SCI. METHODS Participants captured photographs of situations, places or things that they perceived increased and decreased their risk of falling. Semistructured photo-elicitation interviews were conducted to discuss the content of the photographs and explore perceptions of fall risk factors. A hybrid thematic analysis and the Biological, Behavioural, Social, Economic, and Environmental model were used as a framework to organise/synthesise the data. RESULTS Overall, the findings indicated that the risk of falling was individualised, complex and dynamic to each person's life situation. Four main themes were revealed in our analysis: (1) Falls and fall risk caused by multiple interacting factors; (2) Dynamic nature of fall risk; (3) Single factors were targeted to reduce falls and fall-related injuries; and (4) Fall prevention experiences and priorities. CONCLUSIONS Each wheelchair user encountered numerous fall risk factors in their everyday lives. Information from this study can be used to set priorities for fall prevention. Fall prevention initiatives should consider a wheelchair user's fall risks in a holistic manner, acknowledging that a person's current situation, as well as anticipating their fall risks and fall prevention needs, will change over time.
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Affiliation(s)
- Hardeep Singh
- Rehabilitation Sciences Institute, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
- Lyndhurst Centre, KITE, Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada
| | - Carol Y Scovil
- Lyndhurst Centre, KITE, Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Karen Yoshida
- Rehabilitation Sciences Institute, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Sarah Oosman
- School of Rehabilitation Science, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Anita Kaiser
- Rehabilitation Sciences Institute, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
- Lyndhurst Centre, KITE, Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada
- Canadian Spinal Research Organization, Toronto, Ontario, Canada
| | - Catharine Craven
- Rehabilitation Sciences Institute, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
- Lyndhurst Centre, KITE, Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada
- Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Susan Jaglal
- Rehabilitation Sciences Institute, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
- Lyndhurst Centre, KITE, Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Kristin E Musselman
- Rehabilitation Sciences Institute, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
- Lyndhurst Centre, KITE, Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- School of Rehabilitation Science, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Sujic R, Luo J, Beaton DE, Bogoch ER, Sale JEM, Jaglal S, Jain R, Mamdani M. Multiple simultaneous fractures are associated with higher all-cause mortality: results from a province-wide fracture liaison service. Osteoporos Int 2020; 31:291-296. [PMID: 31720710 DOI: 10.1007/s00198-019-05207-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 10/23/2019] [Indexed: 10/25/2022]
Abstract
UNLABELLED Mortality rates in our fracture liaison service ranged from 2.7% at year 1 to 14.8% at year 5 post-screening. Presentation with multiple simultaneous fractures at screening was associated with higher risk of death. This finding indicates the need for increased focus on this high-risk group. PURPOSE To examine all-cause mortality rates in a provincial fracture liaison service (FLS) and the association between the index fracture type, particularly multiple simultaneous fractures, and the risk of death at follow-up. METHODS This cohort study includes fragility fracture patients aged 50+, enrolled in a provincial FLS in Ontario, Canada, between 2007 and 2010. All-cause mortality was assessed using administrative data. Multivariable Cox proportional hazards model was used to examine the risk of death 5 years after screening. RESULTS Crude mortality rates for 6543 fragility fracture patients were 2.7% at year 1, 5.6% at year 2, and 14.8% at year 5 after screening. After adjusting for age and sex, and relative to distal radius fracture, patients with multiple (simultaneous) fractures at screening had a higher risk of dying (HR = 1.8, 95%CI 1.3-2.4), followed by those with a hip fracture (HR = 1.5, 95%CI 1.3-1.8), a proximal humerus fracture (HR = 1.4, 95%CI 1.2-1.7), and other single fractures (HR = 1.4, 95%CI 1.1-1.7). Having an index ankle fracture was not associated with the risk of death over a distal radius fracture. As compared to the 50-65 age group, patients 66 years and older had a higher risk of death (for 66-70 age group: HR = 2.5, 95%CI 1.9-3.3; for 71-80: HR = 4.3, 95%CI 3.5-5.4; and for 81+: HR = 10.6, 95%CI 8.7-13.0). Females had a lower risk of death (HR = 0.5, 95%CI 0.5-0.6) than males. CONCLUSIONS Presenting with multiple fractures was an indicator of higher risk of death relative to a distal radius fracture. This finding indicates the need for increased focus on this high-risk group.
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Affiliation(s)
- R Sujic
- Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.
| | - J Luo
- ICES, Toronto, Ontario, Canada
| | - D E Beaton
- Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Institute for Work & Health, Toronto, Ontario, Canada
| | - E R Bogoch
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Mobility Program, St. Michael's Hospital, Toronto, Ontario, Canada
| | - J E M Sale
- Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - S Jaglal
- ICES, Toronto, Ontario, Canada
- Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - R Jain
- Ontario Osteoporosis Strategy, Osteoporosis Canada, Toronto, Ontario, Canada
| | - M Mamdani
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Centre for Healthcare Analytics Research & Training, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, 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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Díaz S, Zhao J, Cronin S, Jaglal S, Bombardier C, Furlan AD. Changes in Opioid Prescribing Behaviors among Family Physicians Who Participated in a Weekly Tele-Mentoring Program. J Clin Med 2019; 9:jcm9010014. [PMID: 31861584 PMCID: PMC7019354 DOI: 10.3390/jcm9010014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 12/10/2019] [Accepted: 12/17/2019] [Indexed: 11/29/2022] Open
Abstract
A weekly tele-mentoring program was implemented in Ontario to help address the growing opioid crisis through teaching and mentoring family physicians on the management of chronic pain and opioid prescribing. This study assessed opioid prescribing behaviours among family physicians who attended the tele-mentoring program compared to two groups of Ontario family physicians who did not attend the program. We conducted a retrospective cohort study with two control groups: a matched cohort, and a random sample of 3000 family physicians in Ontario. Each physician was followed from one year before the program, which is the index date, and one year after. We examined the number and proportion of patients on any opioid, on high dose opioids, and the average daily morphine equivalent doses prescribed to each patient. We included 24 physicians who participated in the program (2760 patients), 96 matched physicians (11,117 patients) and 3000 random family doctors (374,174 patients). We found that, at baseline, the tele-mentoring group had similar number of patients on any opioid, but more patients on high dose opioids than both control groups. There was no change in the number of patients on any opioid before and after the index date, but there was a significant reduction in high-dose opioid prescriptions in the extension for community healthcare outcomes (ECHO) group, compared to a non-significant increase in the matched cohort, and a non-significant reduction in the Ontario group during the same comparable periods. Participation in the program was associated with a greater reduction in high-dose opioid prescribing.
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Affiliation(s)
- Santana Díaz
- Institute of Medical Sciences, University of Toronto, Toronto, ON M5S, Canada
| | - Jane Zhao
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON M5G1L7, Canada
| | - Shawna Cronin
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5S, Canada
| | - Susan Jaglal
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5S, Canada
- Department of Physical Therapy, University of Toronto, Toronto, ON M5S, Canada
| | - Claire Bombardier
- Institute of Medical Sciences, University of Toronto, Toronto, ON M5S, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5S, Canada
- Department of Medicine, University of Toronto, Toronto, ON M5S, Canada
- Mount Sinai Hospital, Toronto, ON M5G1X5, Canada
- Institute for Work & Health, Toronto, ON M5G2E9, Canada
| | - Andrea D. Furlan
- Institute of Medical Sciences, University of Toronto, Toronto, ON M5S, Canada
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON M5G1L7, Canada
- Department of Medicine, University of Toronto, Toronto, ON M5S, Canada
- Institute for Work & Health, Toronto, ON M5G2E9, Canada
- Correspondence:
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20
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Chishtie JA, Babineau J, Bielska IA, Cepoiu-Martin M, Irvine M, Koval A, Marchand JS, Turcotte L, Jeji T, Jaglal S. Visual Analytic Tools and Techniques in Population Health and Health Services Research: Protocol for a Scoping Review. JMIR Res Protoc 2019; 8:e14019. [PMID: 31661081 PMCID: PMC6913692 DOI: 10.2196/14019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 03/15/2019] [Revised: 06/20/2019] [Accepted: 08/26/2019] [Indexed: 12/19/2022] Open
Abstract
Background Visual analytics (VA) promotes the understanding of data using visual, interactive techniques and using analytic and visual engines. The analytic engine includes machine learning and other automated techniques, whereas common visual outputs include flow maps and spatiotemporal hotspots for studying service gaps and disease distribution. The principal objective of this scoping review is to examine the state of science on VA and the various tools, strategies, and frameworks used in population health and health services research (HSR). Objective The purpose of this scoping review is to develop an overarching global view of established techniques, frameworks, and methods of VA in population health and HSR. The main objectives are to explore, map, and synthesize the literature related to VA in its application to the two main focus areas of health care. Methods We will use established scoping review methods to meet the study objective. As the use of the term visual analytics is inconsistent, one of the major challenges was operationalizing the concepts for developing the search strategy, based on the three main concepts of population health, HSR, and VA. We included peer reviewed and grey literature sources from 2005 till March 2019 in the search. Independent teams of researchers will screen the titles, abstracts and full text articles, whereas an independent researcher will arbiter conflicts. Data will be abstracted and presented using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews checklist and explanation by two independent researchers. Results As of late August 2019, the scoping review is in the full-text screening stage. Data synthesis will follow and the first results are expected to be submitted for publication in December 2019. In this protocol, the methods for undertaking this scoping review are detailed. We present how we operationalized the varied concepts of population health, health services, and VA. The main results of the scoping review will synthesize peer reviewed and grey literature sources on the main methods of VA in the interrelated fields of population health and health services research from January 2005 till March 2019. Conclusions VA is being increasingly used and integrated with emerging technologies to support decision making using large data sets. This scoping review of the VA tools, strategies, and frameworks applied to population health and health services aims to increase awareness of this approach for uptake by decision makers working within and toward developing learning health systems globally. International Registered Report Identifier (IRRID) DERR1-10.2196/14019
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Affiliation(s)
- Jawad Ahmed Chishtie
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Institute of Health Services and Policy Research, Canadian Institutes of Health Research, Ottawa, ON, Canada.,Ontario Neurotrauma Foundation, Toronto, ON, Canada
| | - Jessica Babineau
- Library & Information Services, University Health Network, Toronto, 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.,Canadian Institutes of Health Research, Ottawa, ON, Canada
| | - Monica Cepoiu-Martin
- Canadian Institutes of Health Research, Ottawa, ON, Canada.,University of Calgary, Calgary, AB, Canada
| | - Michael Irvine
- Canadian Institutes of Health Research, Ottawa, ON, Canada.,Department of Mathematics, University of British Columbia, Vancouver, BC, Canada.,British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Andriy Koval
- Canadian Institutes of Health Research, Ottawa, ON, Canada.,Department of Health Management and Informatics, University of Central Florida, Orlando, FL, United States
| | - Jean-Sebastien Marchand
- Canadian Institutes of Health Research, Ottawa, ON, Canada.,Universite de Sherbrooke, Quebec, QC, Canada
| | - Luke Turcotte
- Canadian Institutes of Health Research, Ottawa, ON, Canada.,School of Public Health and Health Systems, Applied Health Sciences, University of Waterloo, Waterloo, ON, Canada.,Canadian Institute for Health Information, Ottawa, ON, Canada
| | - Tara Jeji
- Ontario Neurotrauma Foundation, Toronto, ON, Canada
| | - Susan Jaglal
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
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21
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Zarshenas S, Colantonio A, Horn SD, Jaglal S, Jacob B, Cullen N. Occupational and Physical Therapy Activities and Level of Effort in Patients With Traumatic Brain Injury: Association With Functional Outcomes. PM R 2019; 12:339-348. [PMID: 31600430 DOI: 10.1002/pmrj.12260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 09/17/2019] [Indexed: 11/08/2022]
Abstract
BACKGROUND Although some attention has been given to the association of functional outcomes with rehabilitation intensity, the evidence is still sparse in this field. OBJECTIVE To investigate the effect of inpatient rehabilitation (IR) on discharge cognitive and motor function and the association of time spent in occupational and physical therapy and level of effort with cognitive and motor function in patients with traumatic brain injury (TBI). DESIGN Secondary analysis of TBI-Practice Based Evidence dataset. SETTINGS Inpatient rehabilitation. PARTICIPANTS One hundred forty-nine patients with TBI who were consecutively admitted for IR between 2008 and 2011 in Ontario, Canada. INTERVENTIONS Not applicable. MAIN OUTCOME MEASUREMENTS Admission and discharge Functional Independence Measure-Rasch Cognitive and Motor Scores. RESULTS Patients showed significant improvement in cognitive and motor function from admission to discharge (P < .0001). After controlling for confounding factors, discharge FIM-Rasch cognitive and motor scores were not associated with either level of effort or time spent in physical therapy activities. Discharge motor, but not cognitive function, was associated with more time spent in the complex (β = 0.20, confidence interval [CI] 0.005, 0.05) and less time spent in simple OT activities (β = -0.13, CI -0.13, -0.01). CONCLUSION This study provides valuable information for clinicians about the effectiveness of IR on the improvement of motor and cognitive outcomes and the importance of considering the amount of time spent in activities based on their level of complexity rather than the total time of therapy to improve motor outcomes in this population. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Sareh Zarshenas
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.,University Health Network, Toronto Rehabilitation Institute, University Centre, Toronto, Canada
| | - Angela Colantonio
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.,University Health Network, Toronto Rehabilitation Institute, University Centre, Toronto, Canada.,Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Susan D Horn
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake, UT
| | - Susan Jaglal
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.,University Health Network, Toronto Rehabilitation Institute, University Centre, Toronto, Canada
| | - Binu Jacob
- University Health Network, Toronto Rehabilitation Institute, University Centre, Toronto, Canada
| | - Nora Cullen
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.,University Health Network, Toronto Rehabilitation Institute, University Centre, Toronto, Canada
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22
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Singh H, Flett H, Hitzig S, Kaiser A, Craven BC, Jaglal S, Musselman K. A comparison of falls between wheelchair users and ambulators with spinal cord injury. Arch Phys Med Rehabil 2019. [DOI: 10.1016/j.apmr.2019.08.082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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23
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Sobolev B, Guy P, Sheehan KJ, Kuramoto L, Sutherland JM, Levy AR, Blair JA, Bohm E, Kim JD, Harvey EJ, Morin SN, Beaupre L, Dunbar M, Jaglal S, Waddell J. Mortality effects of timing alternatives for hip fracture surgery. CMAJ 2019; 190:E923-E932. [PMID: 30087128 DOI: 10.1503/cmaj.171512] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The appropriate timing of hip fracture surgery remains a matter of debate. We sought to estimate the effect of changes in timing policy and the proportion of deaths attributable to surgical delay. METHODS We obtained discharge abstracts from the Canadian Institute for Health Information for hip fracture surgery in Canada (excluding Quebec) between 2004 and 2012. We estimated the expected population-average risks of inpatient death within 30 days if patients were surgically treated on day of admission, inpatient day 2, day 3 or after day 3. We weighted observations with the inverse propensity score of surgical timing according to confounders selected from a causal diagram. RESULTS Of 139 119 medically stable patients with hip fracture who were aged 65 years or older, 32 120 (23.1%) underwent surgery on admission day, 60 505 (43.5%) on inpatient day 2, 29 236 (21.0%) on day 3 and 17 258 (12.4%) after day 3. Cumulative 30-day in-hospital mortality was 4.9% among patients who were surgically treated on admission day, increasing to 6.9% for surgery done after day 3. We projected an additional 10.9 (95% confidence interval [CI] 6.8 to 15.1) deaths per 1000 surgeries if all surgeries were done after inpatient day 3 instead of admission day. The attributable proportion of deaths for delays beyond inpatient day 2 was 16.5% (95% CI 12.0% to 21.0%). INTERPRETATION Surgery on admission day or the following day was estimated to reduce postoperative mortality among medically stable patients with hip fracture. Hospitals should expedite operating room access for patients whose surgery has already been delayed for nonmedical reasons.
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Affiliation(s)
- Boris Sobolev
- School of Population and Public Health (Sobolev, Sutherland, Kim) and Centre for Hip Health and Mobility (Guy), The University of British Columbia, Vancouver, BC; Department of Population Health Sciences (Sheehan), School of Population Health and Environmental Sciences, King's College London, London, UK; Vancouver Coastal Health Research Institute (Kuramoto), Vancouver, BC; Department of Community Health and Epidemiology (Levy), Dalhousie University, Halifax, NS; Department of Orthopaedics and Rehabilitation (Blair), William Beaumont Army Medical Center, El Paso, Tex.; Section of Orthopaedic Surgery and George and Fay Yee Centre for Healthcare Innovation (Bohm), University of Manitoba, Winnipeg, Man.; Division of Orthopaedic Surgery (Harvey) and Department of Medicine (Morin), McGill University, Montréal, Que.; Departments of Physical Therapy and Division of Orthopaedic Surgery (Beaupre), University of Alberta, Edmonton, Alta.; Division of Orthopaedic Surgery (Dunbar), Dalhousie University, Halifax, NS; Department of Physical Therapy (Jaglal) and Division of Orthopaedic Surgery (Waddell), University of Toronto, Toronto, Ont.
| | - Pierre Guy
- School of Population and Public Health (Sobolev, Sutherland, Kim) and Centre for Hip Health and Mobility (Guy), The University of British Columbia, Vancouver, BC; Department of Population Health Sciences (Sheehan), School of Population Health and Environmental Sciences, King's College London, London, UK; Vancouver Coastal Health Research Institute (Kuramoto), Vancouver, BC; Department of Community Health and Epidemiology (Levy), Dalhousie University, Halifax, NS; Department of Orthopaedics and Rehabilitation (Blair), William Beaumont Army Medical Center, El Paso, Tex.; Section of Orthopaedic Surgery and George and Fay Yee Centre for Healthcare Innovation (Bohm), University of Manitoba, Winnipeg, Man.; Division of Orthopaedic Surgery (Harvey) and Department of Medicine (Morin), McGill University, Montréal, Que.; Departments of Physical Therapy and Division of Orthopaedic Surgery (Beaupre), University of Alberta, Edmonton, Alta.; Division of Orthopaedic Surgery (Dunbar), Dalhousie University, Halifax, NS; Department of Physical Therapy (Jaglal) and Division of Orthopaedic Surgery (Waddell), University of Toronto, Toronto, Ont
| | - Katie Jane Sheehan
- School of Population and Public Health (Sobolev, Sutherland, Kim) and Centre for Hip Health and Mobility (Guy), The University of British Columbia, Vancouver, BC; Department of Population Health Sciences (Sheehan), School of Population Health and Environmental Sciences, King's College London, London, UK; Vancouver Coastal Health Research Institute (Kuramoto), Vancouver, BC; Department of Community Health and Epidemiology (Levy), Dalhousie University, Halifax, NS; Department of Orthopaedics and Rehabilitation (Blair), William Beaumont Army Medical Center, El Paso, Tex.; Section of Orthopaedic Surgery and George and Fay Yee Centre for Healthcare Innovation (Bohm), University of Manitoba, Winnipeg, Man.; Division of Orthopaedic Surgery (Harvey) and Department of Medicine (Morin), McGill University, Montréal, Que.; Departments of Physical Therapy and Division of Orthopaedic Surgery (Beaupre), University of Alberta, Edmonton, Alta.; Division of Orthopaedic Surgery (Dunbar), Dalhousie University, Halifax, NS; Department of Physical Therapy (Jaglal) and Division of Orthopaedic Surgery (Waddell), University of Toronto, Toronto, Ont
| | - Lisa Kuramoto
- School of Population and Public Health (Sobolev, Sutherland, Kim) and Centre for Hip Health and Mobility (Guy), The University of British Columbia, Vancouver, BC; Department of Population Health Sciences (Sheehan), School of Population Health and Environmental Sciences, King's College London, London, UK; Vancouver Coastal Health Research Institute (Kuramoto), Vancouver, BC; Department of Community Health and Epidemiology (Levy), Dalhousie University, Halifax, NS; Department of Orthopaedics and Rehabilitation (Blair), William Beaumont Army Medical Center, El Paso, Tex.; Section of Orthopaedic Surgery and George and Fay Yee Centre for Healthcare Innovation (Bohm), University of Manitoba, Winnipeg, Man.; Division of Orthopaedic Surgery (Harvey) and Department of Medicine (Morin), McGill University, Montréal, Que.; Departments of Physical Therapy and Division of Orthopaedic Surgery (Beaupre), University of Alberta, Edmonton, Alta.; Division of Orthopaedic Surgery (Dunbar), Dalhousie University, Halifax, NS; Department of Physical Therapy (Jaglal) and Division of Orthopaedic Surgery (Waddell), University of Toronto, Toronto, Ont
| | - Jason M Sutherland
- School of Population and Public Health (Sobolev, Sutherland, Kim) and Centre for Hip Health and Mobility (Guy), The University of British Columbia, Vancouver, BC; Department of Population Health Sciences (Sheehan), School of Population Health and Environmental Sciences, King's College London, London, UK; Vancouver Coastal Health Research Institute (Kuramoto), Vancouver, BC; Department of Community Health and Epidemiology (Levy), Dalhousie University, Halifax, NS; Department of Orthopaedics and Rehabilitation (Blair), William Beaumont Army Medical Center, El Paso, Tex.; Section of Orthopaedic Surgery and George and Fay Yee Centre for Healthcare Innovation (Bohm), University of Manitoba, Winnipeg, Man.; Division of Orthopaedic Surgery (Harvey) and Department of Medicine (Morin), McGill University, Montréal, Que.; Departments of Physical Therapy and Division of Orthopaedic Surgery (Beaupre), University of Alberta, Edmonton, Alta.; Division of Orthopaedic Surgery (Dunbar), Dalhousie University, Halifax, NS; Department of Physical Therapy (Jaglal) and Division of Orthopaedic Surgery (Waddell), University of Toronto, Toronto, Ont
| | - Adrian R Levy
- School of Population and Public Health (Sobolev, Sutherland, Kim) and Centre for Hip Health and Mobility (Guy), The University of British Columbia, Vancouver, BC; Department of Population Health Sciences (Sheehan), School of Population Health and Environmental Sciences, King's College London, London, UK; Vancouver Coastal Health Research Institute (Kuramoto), Vancouver, BC; Department of Community Health and Epidemiology (Levy), Dalhousie University, Halifax, NS; Department of Orthopaedics and Rehabilitation (Blair), William Beaumont Army Medical Center, El Paso, Tex.; Section of Orthopaedic Surgery and George and Fay Yee Centre for Healthcare Innovation (Bohm), University of Manitoba, Winnipeg, Man.; Division of Orthopaedic Surgery (Harvey) and Department of Medicine (Morin), McGill University, Montréal, Que.; Departments of Physical Therapy and Division of Orthopaedic Surgery (Beaupre), University of Alberta, Edmonton, Alta.; Division of Orthopaedic Surgery (Dunbar), Dalhousie University, Halifax, NS; Department of Physical Therapy (Jaglal) and Division of Orthopaedic Surgery (Waddell), University of Toronto, Toronto, Ont
| | - James A Blair
- School of Population and Public Health (Sobolev, Sutherland, Kim) and Centre for Hip Health and Mobility (Guy), The University of British Columbia, Vancouver, BC; Department of Population Health Sciences (Sheehan), School of Population Health and Environmental Sciences, King's College London, London, UK; Vancouver Coastal Health Research Institute (Kuramoto), Vancouver, BC; Department of Community Health and Epidemiology (Levy), Dalhousie University, Halifax, NS; Department of Orthopaedics and Rehabilitation (Blair), William Beaumont Army Medical Center, El Paso, Tex.; Section of Orthopaedic Surgery and George and Fay Yee Centre for Healthcare Innovation (Bohm), University of Manitoba, Winnipeg, Man.; Division of Orthopaedic Surgery (Harvey) and Department of Medicine (Morin), McGill University, Montréal, Que.; Departments of Physical Therapy and Division of Orthopaedic Surgery (Beaupre), University of Alberta, Edmonton, Alta.; Division of Orthopaedic Surgery (Dunbar), Dalhousie University, Halifax, NS; Department of Physical Therapy (Jaglal) and Division of Orthopaedic Surgery (Waddell), University of Toronto, Toronto, Ont
| | - Eric Bohm
- School of Population and Public Health (Sobolev, Sutherland, Kim) and Centre for Hip Health and Mobility (Guy), The University of British Columbia, Vancouver, BC; Department of Population Health Sciences (Sheehan), School of Population Health and Environmental Sciences, King's College London, London, UK; Vancouver Coastal Health Research Institute (Kuramoto), Vancouver, BC; Department of Community Health and Epidemiology (Levy), Dalhousie University, Halifax, NS; Department of Orthopaedics and Rehabilitation (Blair), William Beaumont Army Medical Center, El Paso, Tex.; Section of Orthopaedic Surgery and George and Fay Yee Centre for Healthcare Innovation (Bohm), University of Manitoba, Winnipeg, Man.; Division of Orthopaedic Surgery (Harvey) and Department of Medicine (Morin), McGill University, Montréal, Que.; Departments of Physical Therapy and Division of Orthopaedic Surgery (Beaupre), University of Alberta, Edmonton, Alta.; Division of Orthopaedic Surgery (Dunbar), Dalhousie University, Halifax, NS; Department of Physical Therapy (Jaglal) and Division of Orthopaedic Surgery (Waddell), University of Toronto, Toronto, Ont
| | - Jason D Kim
- School of Population and Public Health (Sobolev, Sutherland, Kim) and Centre for Hip Health and Mobility (Guy), The University of British Columbia, Vancouver, BC; Department of Population Health Sciences (Sheehan), School of Population Health and Environmental Sciences, King's College London, London, UK; Vancouver Coastal Health Research Institute (Kuramoto), Vancouver, BC; Department of Community Health and Epidemiology (Levy), Dalhousie University, Halifax, NS; Department of Orthopaedics and Rehabilitation (Blair), William Beaumont Army Medical Center, El Paso, Tex.; Section of Orthopaedic Surgery and George and Fay Yee Centre for Healthcare Innovation (Bohm), University of Manitoba, Winnipeg, Man.; Division of Orthopaedic Surgery (Harvey) and Department of Medicine (Morin), McGill University, Montréal, Que.; Departments of Physical Therapy and Division of Orthopaedic Surgery (Beaupre), University of Alberta, Edmonton, Alta.; Division of Orthopaedic Surgery (Dunbar), Dalhousie University, Halifax, NS; Department of Physical Therapy (Jaglal) and Division of Orthopaedic Surgery (Waddell), University of Toronto, Toronto, Ont
| | - Edward J Harvey
- School of Population and Public Health (Sobolev, Sutherland, Kim) and Centre for Hip Health and Mobility (Guy), The University of British Columbia, Vancouver, BC; Department of Population Health Sciences (Sheehan), School of Population Health and Environmental Sciences, King's College London, London, UK; Vancouver Coastal Health Research Institute (Kuramoto), Vancouver, BC; Department of Community Health and Epidemiology (Levy), Dalhousie University, Halifax, NS; Department of Orthopaedics and Rehabilitation (Blair), William Beaumont Army Medical Center, El Paso, Tex.; Section of Orthopaedic Surgery and George and Fay Yee Centre for Healthcare Innovation (Bohm), University of Manitoba, Winnipeg, Man.; Division of Orthopaedic Surgery (Harvey) and Department of Medicine (Morin), McGill University, Montréal, Que.; Departments of Physical Therapy and Division of Orthopaedic Surgery (Beaupre), University of Alberta, Edmonton, Alta.; Division of Orthopaedic Surgery (Dunbar), Dalhousie University, Halifax, NS; Department of Physical Therapy (Jaglal) and Division of Orthopaedic Surgery (Waddell), University of Toronto, Toronto, Ont
| | - Suzanne N Morin
- School of Population and Public Health (Sobolev, Sutherland, Kim) and Centre for Hip Health and Mobility (Guy), The University of British Columbia, Vancouver, BC; Department of Population Health Sciences (Sheehan), School of Population Health and Environmental Sciences, King's College London, London, UK; Vancouver Coastal Health Research Institute (Kuramoto), Vancouver, BC; Department of Community Health and Epidemiology (Levy), Dalhousie University, Halifax, NS; Department of Orthopaedics and Rehabilitation (Blair), William Beaumont Army Medical Center, El Paso, Tex.; Section of Orthopaedic Surgery and George and Fay Yee Centre for Healthcare Innovation (Bohm), University of Manitoba, Winnipeg, Man.; Division of Orthopaedic Surgery (Harvey) and Department of Medicine (Morin), McGill University, Montréal, Que.; Departments of Physical Therapy and Division of Orthopaedic Surgery (Beaupre), University of Alberta, Edmonton, Alta.; Division of Orthopaedic Surgery (Dunbar), Dalhousie University, Halifax, NS; Department of Physical Therapy (Jaglal) and Division of Orthopaedic Surgery (Waddell), University of Toronto, Toronto, Ont
| | - Lauren Beaupre
- School of Population and Public Health (Sobolev, Sutherland, Kim) and Centre for Hip Health and Mobility (Guy), The University of British Columbia, Vancouver, BC; Department of Population Health Sciences (Sheehan), School of Population Health and Environmental Sciences, King's College London, London, UK; Vancouver Coastal Health Research Institute (Kuramoto), Vancouver, BC; Department of Community Health and Epidemiology (Levy), Dalhousie University, Halifax, NS; Department of Orthopaedics and Rehabilitation (Blair), William Beaumont Army Medical Center, El Paso, Tex.; Section of Orthopaedic Surgery and George and Fay Yee Centre for Healthcare Innovation (Bohm), University of Manitoba, Winnipeg, Man.; Division of Orthopaedic Surgery (Harvey) and Department of Medicine (Morin), McGill University, Montréal, Que.; Departments of Physical Therapy and Division of Orthopaedic Surgery (Beaupre), University of Alberta, Edmonton, Alta.; Division of Orthopaedic Surgery (Dunbar), Dalhousie University, Halifax, NS; Department of Physical Therapy (Jaglal) and Division of Orthopaedic Surgery (Waddell), University of Toronto, Toronto, Ont
| | - Michael Dunbar
- School of Population and Public Health (Sobolev, Sutherland, Kim) and Centre for Hip Health and Mobility (Guy), The University of British Columbia, Vancouver, BC; Department of Population Health Sciences (Sheehan), School of Population Health and Environmental Sciences, King's College London, London, UK; Vancouver Coastal Health Research Institute (Kuramoto), Vancouver, BC; Department of Community Health and Epidemiology (Levy), Dalhousie University, Halifax, NS; Department of Orthopaedics and Rehabilitation (Blair), William Beaumont Army Medical Center, El Paso, Tex.; Section of Orthopaedic Surgery and George and Fay Yee Centre for Healthcare Innovation (Bohm), University of Manitoba, Winnipeg, Man.; Division of Orthopaedic Surgery (Harvey) and Department of Medicine (Morin), McGill University, Montréal, Que.; Departments of Physical Therapy and Division of Orthopaedic Surgery (Beaupre), University of Alberta, Edmonton, Alta.; Division of Orthopaedic Surgery (Dunbar), Dalhousie University, Halifax, NS; Department of Physical Therapy (Jaglal) and Division of Orthopaedic Surgery (Waddell), University of Toronto, Toronto, Ont
| | - Susan Jaglal
- School of Population and Public Health (Sobolev, Sutherland, Kim) and Centre for Hip Health and Mobility (Guy), The University of British Columbia, Vancouver, BC; Department of Population Health Sciences (Sheehan), School of Population Health and Environmental Sciences, King's College London, London, UK; Vancouver Coastal Health Research Institute (Kuramoto), Vancouver, BC; Department of Community Health and Epidemiology (Levy), Dalhousie University, Halifax, NS; Department of Orthopaedics and Rehabilitation (Blair), William Beaumont Army Medical Center, El Paso, Tex.; Section of Orthopaedic Surgery and George and Fay Yee Centre for Healthcare Innovation (Bohm), University of Manitoba, Winnipeg, Man.; Division of Orthopaedic Surgery (Harvey) and Department of Medicine (Morin), McGill University, Montréal, Que.; Departments of Physical Therapy and Division of Orthopaedic Surgery (Beaupre), University of Alberta, Edmonton, Alta.; Division of Orthopaedic Surgery (Dunbar), Dalhousie University, Halifax, NS; Department of Physical Therapy (Jaglal) and Division of Orthopaedic Surgery (Waddell), University of Toronto, Toronto, Ont
| | - James Waddell
- School of Population and Public Health (Sobolev, Sutherland, Kim) and Centre for Hip Health and Mobility (Guy), The University of British Columbia, Vancouver, BC; Department of Population Health Sciences (Sheehan), School of Population Health and Environmental Sciences, King's College London, London, UK; Vancouver Coastal Health Research Institute (Kuramoto), Vancouver, BC; Department of Community Health and Epidemiology (Levy), Dalhousie University, Halifax, NS; Department of Orthopaedics and Rehabilitation (Blair), William Beaumont Army Medical Center, El Paso, Tex.; Section of Orthopaedic Surgery and George and Fay Yee Centre for Healthcare Innovation (Bohm), University of Manitoba, Winnipeg, Man.; Division of Orthopaedic Surgery (Harvey) and Department of Medicine (Morin), McGill University, Montréal, Que.; Departments of Physical Therapy and Division of Orthopaedic Surgery (Beaupre), University of Alberta, Edmonton, Alta.; Division of Orthopaedic Surgery (Dunbar), Dalhousie University, Halifax, NS; Department of Physical Therapy (Jaglal) and Division of Orthopaedic Surgery (Waddell), University of Toronto, Toronto, Ont
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Zarshenas S, Horn SD, Colantonio A, Jaglal S, Cullen N. Content of inpatient rehabilitation for patients with traumatic brain injury: A comparison of Canadian and American facilities. Brain Inj 2019; 33:1503-1512. [PMID: 31446781 DOI: 10.1080/02699052.2019.1658224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: To compare components of inpatient rehabilitation (IR) for patients with traumatic brain injury (TBI) between Canada and the US facilities. Design: Secondary analysis of the TBI-practice-based evidence dataset. Participants: Patients with TBI who had a higher Functional Independence Measure (FIMTM) cognitive function score (≥21) that were admitted to 1 IR facility in Canada (n = 103) and 9 IR facilities in the US (n = 401). Main measures: demographic and clinical characteristics, type and intensity of activities by discipline, discharge location, FIM-Rasch score, social participation and quality of life. Results: Time from injury to rehabilitation admission was significantly longer in the Canadian cohort and they experienced a longer rehabilitation length of stay (p < .001, Cohen's d > .8). Patients in Canada received a greater total time of individual therapy and lower intensity of interventions per week from all disciplines. They also showed a higher score at discharge in FIM components, while US patients had better cognitive recovery and community participation long-term post-discharge. Conclusions: This study informs stakeholders of the large variation in service provision for patients who were treated in these two countries. These findings suggest the need for robust analyzes to investigate predictors of short and long-term outcomes considering the variation in health-care delivery. List of abbreviations: TBI: traumatic brain injury, CSI: comprehensive severity index, LoS: length of stay, OT: occupational therapy, PT: physical therapy, SLP: speech language pathology, IR: inpatient rehabilitation.
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Affiliation(s)
- Sareh Zarshenas
- Rehabilitation Sciences Institute, University of Toronto , Toronto , Ontario , Canada.,University Centre, University Health Network, Toronto Rehabilitation Institute , Toronto , Ontario , Canada
| | - Susan D Horn
- Department of Population Health Sciences, University of Utah School of Medicine , Salt Lake City , UT , USA
| | - Angela Colantonio
- Rehabilitation Sciences Institute, University of Toronto , Toronto , Ontario , Canada.,University Centre, University Health Network, Toronto Rehabilitation Institute , Toronto , Ontario , Canada.,Occupational Science and Occupational Therapy, University of Toronto , Toronto , Ontario , Canada.,Dalla Lana School of Public Health, University of Toronto , Toronto , Ontario , Canada
| | - Susan Jaglal
- Rehabilitation Sciences Institute, University of Toronto , Toronto , Ontario , Canada.,University Centre, University Health Network, Toronto Rehabilitation Institute , Toronto , Ontario , Canada.,Department of Physical Therapy, University of Toronto , Toronto , Ontario , Canada
| | - Nora Cullen
- Rehabilitation Sciences Institute, University of Toronto , Toronto , Ontario , Canada.,University Centre, University Health Network, Toronto Rehabilitation Institute , Toronto , Ontario , Canada
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Sujic R, Beaton DE, Mamdani M, Cadarette SM, Luo J, Jaglal S, Sale JEM, Jain R, Bogoch E. Five-year refracture rates of a province-wide fracture liaison service. Osteoporos Int 2019; 30:1671-1677. [PMID: 31152183 DOI: 10.1007/s00198-019-05017-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 07/11/2018] [Accepted: 05/14/2019] [Indexed: 11/26/2022]
Abstract
UNLABELLED We examined the 5-year refracture rate of 6543 patients and found an overall rate of 9.7%. Adjusted analysis showed that presenting with multiple fractures was an indicator of a higher refracture risk; while presenting with an ankle fracture was associated with a lower refracture risk. INTRODUCTION To examine refractures among patients screened in a province-wide fracture liaison service (FLS). METHODS We assessed the 5-year refracture rate of fragility fracture patients aged 50+ who were screened at 37 FLS fracture clinics in Ontario, Canada. Refracture was defined as a new hip, pelvis, spine, distal radius, or proximal humerus fracture. Kaplan-Meier curves and Cox proportional hazards model adjusting for age, sex, and index fracture type were used to examine refracture rates. RESULTS The 5-year refracture rate of 6543 patients was 9.7%. Those presenting with multiple fractures at baseline (i.e., two or more fractures occurring simultaneously) had the highest refracture rate of 19.6%. As compared to the 50-65 age group, refracture risk increased monotonically with age group (66-70 years: HR = 1.3, CI 95%, 1.0-1.7; 71-80 years: HR = 1.7, CI 1.4-2.1; 81+ years: HR = 3.0, CI 2.4-3.7). Relative to distal radius, presenting with multiple fractures at screening was associated with a higher risk of refracture (HR = 2.3 CI 1.6-3.1), while presenting with an ankle fracture was associated with a lower risk of refracture (HR = 0.7 CI 0.6-0.9). Sex was not a statistically significant predictor of refracture risk in this cohort (HR = 1.2, CI 1.0-1.5). CONCLUSIONS One in ten patients in our cohort refractured within 5 years after baseline. Presenting with multiple fractures was an indicator of a higher refracture risk, while presenting with an ankle fracture was associated with a lower refracture risk. A more targeted FLS approach may be appropriate for patients at a higher refracture risk.
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Affiliation(s)
- R Sujic
- Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada.
| | - D E Beaton
- Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Institute for Work & Health, Toronto, ON, Canada
| | - M Mamdani
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Centre for Healthcare Analytics Research & Training, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - S M Cadarette
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - J Luo
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - S Jaglal
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
- Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - J E M Sale
- Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - R Jain
- Ontario Osteoporosis Strategy, Osteoporosis Canada, Toronto, ON, Canada
| | - E Bogoch
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Mobility Program, St. Michael's Hospital, Toronto, ON, Canada
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Munce SEP, Jaglal S, Kastner M, Nelson MLA, Salbach NM, Shepherd J, Sweet SN, Wilcock R, Thoms C, Bayley MT. Ontario Brain Injury Association Peer Support Program: a mixed methods protocol for a pilot randomised controlled trial. BMJ Open 2019; 9:e023367. [PMID: 30904839 PMCID: PMC6475259 DOI: 10.1136/bmjopen-2018-023367] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 11/18/2022] Open
Abstract
INTRODUCTION The objective of this study is to conduct a pilot randomised controlled trial (RCT) of the Ontario Brain Injury Association (OBIA) Peer Support Program. The RCT is designed to evaluate the effectiveness and dose-response of the Peer Support Program in improving participation and mood for people with moderate-to-severe traumatic brain injury compared with a wait-list control group. METHODS AND ANALYSIS The proposed research is a three-phase, mixed methods pilot RCT. Consistent with an integrated knowledge translation approach, the study design has been informed in consultation with the knowledge user (ie, OBIA). It will include an initial qualitative examination of barriers and enablers to the trial implementation (phase 1), a pilot RCT (phase 2) and conclude with a qualitative component (phase 3). A qualitative descriptive approach will be adopted for both qualitative phases of the study (n=20-25) and thematic analysis will be used. The 6 months phase-2 trial will be conducted with 60 participants. These participants will be randomised to one of three groups: a twice a week programme (n=20), a once a week programme (n=20) or the wait-list control group (n=20). The feasibility of participant recruitment and retention, data collection, as well as participant adherence to the OBIA Peer Support Program will be evaluated. The primary outcome measure will be participation, as measured by the Participation Assessment with Recombined Tools-Objective. Other proposed outcomes of interest will include mood, health-related quality of life and self-efficacy. ETHICS AND DISSEMINATION Ethics approval will be obtained from the principal author's institution (University Health Network Research Ethics Board). The results of this study will inform the development of a larger scale RCT and will inform future iterations of the OBIA Peer Support Program including a revised programme curriculum. TRIAL REGISTRATION NUMBER NCT03450460; Pre-results.
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Affiliation(s)
- Sarah E P Munce
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Susan Jaglal
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | | | - Michelle L A Nelson
- Bridgepoint Collaboratory, Lunenfeld-Tanenbaum Research Institute, 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
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - John Shepherd
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Shane N Sweet
- Department of Kinesiology and Physical Education, McGill University, Montreal, Quebec, Canada
- Center for Interdisciplinary Research in Rehabilitation of Greater Montreal, Toronto, Ontario, Canada
| | - Ruth Wilcock
- Ontario Brain Injury Association, St. Catherines, Ontario, Canada
| | - Carla Thoms
- Ontario Brain Injury Association, St. Catherines, Ontario, Canada
| | - Mark T Bayley
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, 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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Zarshenas S, Colantonio A, Alavinia SM, Jaglal S, Cullen N. Predictors of Discharge to Rehabilitation Facilities After Traumatic Brain Injury: A Systematic Review. Arch Phys Med Rehabil 2018. [DOI: 10.1016/j.apmr.2018.07.418] [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: 11/27/2022]
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Furlan AD, Zhao J, Voth J, Hassan S, Dubin R, Stinson JN, Jaglal S, Fabico R, Smith AJ, Taenzer P, Flannery JF. Evaluation of an innovative tele-education intervention in chronic pain management for primary care clinicians practicing in underserved areas. J Telemed Telecare 2018; 25:484-492. [PMID: 29991316 DOI: 10.1177/1357633x18782090] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [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: 11/16/2022]
Abstract
INTRODUCTION Inadequate knowledge and training of healthcare providers are obstacles to effective chronic pain management. ECHO (extension for community healthcare outcomes) uses case-based learning and videoconferencing to connect specialists with providers in underserved areas. ECHO aims to increase capacity in managing complex cases in areas with poor access to specialists. METHODS A pre-post study was conducted to evaluate the impact of ECHO on healthcare providers' self-efficacy, knowledge and satisfaction. Type of profession, presenting a case, and number of sessions attended were examined as potential factors that may influence the outcomes. RESULTS From June 2014 to March 2017, 296 primary care healthcare providers attended ECHO, 264 were eligible for the study, 170 (64%) completed the pre-ECHO questionnaire and 119 completed post-ECHO questionnaires. Participants were physicians (34%), nurse practitioners (21%), pharmacists (13%) and allied health professionals (32%). Participants attended a mean of 15 ± 9.19 sessions. There was a significant increase in self-efficacy (p < 0.0001) and knowledge (p < 0.0001). Self-efficacy improvement was significantly higher among physicians, physician assistants and nurse practitioners than the non-prescribers group (p = 0.03). On average, 96% of participants were satisfied with ECHO. Satisfaction was higher among those who presented cases and attended more sessions. DISCUSSION This study shows that ECHO improved providers' self-efficacy and knowledge. We evaluated outcomes from a multidisciplinary group of providers practicing in Ontario. This diversity supports the generalisability of our findings. Therefore, we suggest that this project may be used as a template for creating other educational programs on other medical topics.
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Affiliation(s)
- Andrea D Furlan
- 1 Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.,2 Department of Medicine, University of Toronto, Canada.,3 Institute of Medical Science, University of Toronto, Canada
| | - Jane Zhao
- 1 Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Jennifer Voth
- 4 Institute of Clinical Evaluative Sciences, Toronto, Canada
| | - Samah Hassan
- 1 Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.,3 Institute of Medical Science, University of Toronto, Canada
| | - Ruth Dubin
- 5 Department of Family Medicine, Queen's University, Kingston, Canada
| | - Jennifer N Stinson
- 6 Hospital for Sick Children, Toronto, Canada.,7 Institute of Health Policy, Management, and Evaluation, University of Toronto, Canada.,8 Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Canada
| | - Susan Jaglal
- 4 Institute of Clinical Evaluative Sciences, Toronto, Canada.,7 Institute of Health Policy, Management, and Evaluation, University of Toronto, Canada.,9 Department of Physical Therapy, University of Toronto, Canada
| | - Ralph Fabico
- 1 Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Andrew J Smith
- 10 Centre for Addiction and Mental Health, Toronto, Canada
| | - Paul Taenzer
- 11 Faculty of Health Sciences, Queens University, Kingston, Canada
| | - John F Flannery
- 1 Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.,2 Department of Medicine, University of Toronto, Canada
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Baron JS, Sullivan KJ, Swaine JM, Aspinall A, Jaglal S, Presseau J, White B, Wolfe D, Grimshaw JM. Self-management interventions for skin care in people with a spinal cord injury: part 1-a systematic review of intervention content and effectiveness. Spinal Cord 2018; 56:823-836. [PMID: 29802393 PMCID: PMC6128818 DOI: 10.1038/s41393-018-0138-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 11/19/2017] [Revised: 04/02/2018] [Accepted: 04/04/2018] [Indexed: 11/24/2022]
Abstract
Study design Systematic review. Objectives To review the content and effectiveness of skin care self-management interventions for people with SCI. Setting International. Methods We searched electronic bibliographic databases, trial registers, and relevant reference lists. Eligibility criteria for the reviews of intervention content and effectiveness were identical with the exception of study design. The review of intervention content included non-randomized and randomized controlled trials (RCTs). The review of effectiveness included RCTs. A Behavior Change Technique (BCT) taxonomy of 93 BCTs was used to code intervention content. Intervention effects on outcomes of interest are summarized descriptively. Effect sizes were calculated, and the Cochrane risk of bias tool applied. Results In all, 15 studies testing 17 interventions were included in the review of intervention content. Interventions in these studies included 28 BCTs. The most common were “instructions on how to perform behavior” (16 interventions), “credible source” (12 interventions), and “social support (unspecified)” (9 interventions). Ten RCTs were included in the review of intervention effectiveness and they measured knowledge, self-efficacy, and skills relating to skin care/pressure ulcer (PU) prevention, skin care behaviors, skin status (PU prevalence, severity, and time to PU), and health-care utilization for skin problems. Evidence to support intervention effects on these outcomes was limited, particularly for clinical outcomes. Risk of bias assessments was often inconclusive due to poor reporting. Conclusions There is potential to design SCI skin care interventions that include currently untested BCTs. Further research and better consistency in outcome measurements and reporting are required to synthesize evidence on effectiveness.
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Affiliation(s)
- Justine S Baron
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
| | - Katrina J Sullivan
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Jillian M Swaine
- Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA, Australia.,Institute for Health Research, University of Notre Dame Australia, Fremantle, WA, Australia
| | - Arlene Aspinall
- Rick Hansen Institute, Vancouver, BC, Canada.,Vancouver General Hospital, Vancouver, BC, Canada
| | - Susan Jaglal
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada.,Toronto Rehabilitation Institute, Toronto, ON, Canada
| | - Justin Presseau
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Barry White
- Rick Hansen Institute, Vancouver, BC, Canada
| | - Dalton Wolfe
- Parkwood Institute Research, Lawson Health Research Institute, London, ON, Canada.,University of Western Ontario, London, ON, Canada
| | - Jeremy M Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Department of Medicine, University of Ottawa, Ottawa, ON, 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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Sheehan KJ, Filliter C, Sobolev B, Levy AR, Guy P, Kuramoto L, Kim JD, Dunbar M, Morin SN, Sutherland JM, Jaglal S, Harvey E, Beaupre L, Chudyk A. Time to surgery after hip fracture across Canada by timing of admission. Osteoporos Int 2018; 29:653-663. [PMID: 29214329 DOI: 10.1007/s00198-017-4333-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 09/08/2017] [Accepted: 11/29/2017] [Indexed: 10/18/2022]
Abstract
UNLABELLED The extent of Canadian provincial variation in hip fracture surgical timing is unclear. Provinces performed a similar proportion of surgeries within three inpatient days after adjustment. Time to surgery varied by timing of admission across provinces. This may reflect different approaches to providing access to hip fracture surgery. INTRODUCTION The aim of this study was to compare whether time to surgery after hip fracture varies across Canadian provinces for surgically fit patients and their subgroups defined by timing of admission. METHODS We retrieved hospitalization records for 140,235 patients 65 years and older, treated surgically for hip fracture between 2004 and 2012 in Canada (excluding Quebec). We studied the proportion of surgeries on admission day and within 3 inpatient days, and times required for 33%, 66%, and 90% of surgeries across provinces and by subgroups defined by timing of admission. Differences were adjusted for patient, injury, and care characteristics. RESULTS Overall, provinces performed similar proportions of surgeries within the recommended three inpatient days, with all provinces requiring one additional day to perform the recommended 90% of surgeries. Prince Edward Island performed 7.0% more surgeries on admission day than Ontario irrespective of timing of admission (difference = 7.0; 95% CI 4.0, 9.9). The proportion of surgeries on admission day was 6.3% lower in Manitoba (difference = - 6.3; 95% CI - 12.1, - 0.6), and 7.7% lower in Saskatchewan (difference = - 7.7; 95% CI - 12.7, - 2.8) compared to Ontario. These differences persisted for late weekday and weekend admissions. The time required for 33%, 66%, and 90% of surgeries ranged from 1 to 2, 2-3, and 3-4 days, respectively, across provinces by timing of admission. CONCLUSIONS Provinces performed similarly with respect to recommended time for hip fracture surgery. The proportion of surgeries on admission day, and time required to complete 33% and 66% of surgeries, varied across provinces and by timing of admission. This may reflect different provincial approaches to providing access to hip fracture surgery.
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Affiliation(s)
- K J Sheehan
- Academic Department of Physiotherapy, School of Population Health and Environmental Sciences, Guy's Campus, King's College London, London, UK.
| | - C Filliter
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
| | - B Sobolev
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - A R Levy
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
| | - P Guy
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver, BC, Canada
| | - L Kuramoto
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - J D Kim
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - M Dunbar
- Division of Orthopaedic Surgery, Dalhousie University, Halifax, NS, Canada
| | - S N Morin
- Department of Medicine, McGill University, Montreal, QC, Canada
| | - J M Sutherland
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - S Jaglal
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - E Harvey
- Division of Orthopaedic Surgery, McGill University, Montreal, QC, Canada
| | - L Beaupre
- Department of Physical Therapy and Division of Orthopaedic Surgery, University of Alberta, Edmonton, AB, Canada
| | - A Chudyk
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
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Carlin L, Sibley K, Jenkinson R, Kontos P, McGlasson R, Kreder HJ, Jaglal S. Exploring Canadian surgeons' decisions about postoperative weight bearing for their hip fracture patients. J Eval Clin Pract 2018; 24:42-47. [PMID: 27709725 DOI: 10.1111/jep.12645] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 08/15/2016] [Accepted: 08/17/2016] [Indexed: 01/07/2023]
Abstract
For older adults with osteoporosis, a fall resulting in hip fracture is a life-changing event from which only one-third fully recover. Current best evidence argues strongly for elderly patients to bear weight on their repaired hip fracture immediately after their surgery to maximize their chances of full or nearly full recovery. Patient stakeholders in Canada have argued that some surgeons fail to issue "weight-bearing-as-tolerated" (WBAT) orders in all eligible cases, protecting their bony repair but contributing to increased mortality and long-term disability rates. In collaboration with a national stakeholder organization, Bone and Joint Canada, we interviewed 20 orthopedic surgeons across Canada who perform hip fracture repair surgery, with the aim of understanding their attitudes and behavior toward patient management regarding weight bearing. Qualitative content analysis, in which themes are identified and agreed by multiple coders, suggested that both patient characteristics and surgeon factors influence surgeons' postoperative weight-bearing orders. While almost all respondents agreed that weight bearing as tolerated is indeed therapeutic for most hip fracture repair or replacement patients, surgeons also described certain patient characteristics that would diminish the value of immediate weight bearing, including poor bone quality and certain types of fracture pattern. Surgeon factors that affect postoperative mobilization orders include choice of construct, previous experience of construct failure, and lack of local audit data regarding past weight-bearing decisions and patient outcomes. Thus, although familiar with best practice guidelines, surgeons also have "rules to break the rules." In an era when "good" medicine leans toward science rather than art, the role of individual experience in decision making with regard to hip fracture care continues to be important and would benefit from being discussed openly.
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Affiliation(s)
- Leslie Carlin
- Department of Physical Therapy, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | | | | | - Pia Kontos
- Toronto Rehabilitation Institute, Toronto, Ontario, Canada
| | | | - Hans J Kreder
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Susan Jaglal
- University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
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Singh H, Unger J, Zariffa J, Pakosh M, Jaglal S, Craven BC, Musselman KE. Robot-assisted upper extremity rehabilitation for cervical spinal cord injuries: a systematic scoping review. Disabil Rehabil Assist Technol 2018; 13:704-715. [PMID: 29334467 DOI: 10.1080/17483107.2018.1425747] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [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: 10/18/2022]
Abstract
Abstact Purpose: To provide an overview of the feasibility and outcomes of robotic-assisted upper extremity training for individuals with cervical spinal cord injury (SCI), and to identify gaps in current research and articulate future research directions. MATERIALS AND METHODS A systematic search was conducted using Medline, Embase, PsycINFO, CCTR, CDSR, CINAHL and PubMed on June 7, 2017. Search terms included 3 themes: (1) robotics; (2) SCI; (3) upper extremity. Studies using robots for upper extremity rehabilitation among individuals with cervical SCI were included. Identified articles were independently reviewed by two researchers and compared to pre-specified criteria. Disagreements regarding article inclusion were resolved through discussion. The modified Downs and Black checklist was used to assess article quality. Participant characteristics, study and intervention details, training outcomes, robot features, study limitations and recommendations for future studies were abstracted from included articles. RESULTS Twelve articles (one randomized clinical trial, six case series, five case studies) met the inclusion criteria. Five robots were exoskeletons and three were end-effectors. Sample sizes ranged from 1 to 17 subjects. Articles had variable quality, with quality scores ranging from 8 to 20. Studies had a low internal validity primarily from lack of blinding or a control group. Individuals with mild-moderate impairments showed the greatest improvements on body structure/function and performance-level measures. This review is limited by the small number of articles, low-sample sizes and the diversity of devices and their associated training protocols, and outcome measures. CONCLUSIONS Preliminary evidence suggests robot-assisted interventions are safe, feasible and can reduce active assistance provided by therapists. Implications for rehabilitation Robot-assisted upper extremity training for individuals with cervical spinal cord injury is safe, feasible and can reduce hands-on assistance provided by therapists. Future research in robotics rehabilitation with individuals with spinal cord injury is needed to determine the optimal device and training protocol as well as effectiveness.
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Affiliation(s)
- Hardeep Singh
- a Toronto Rehabilitation Institute-University Health Network , Toronto , ON , Canada.,b Rehabilitation Sciences Institute , University of Toronto , Toronto , ON , Canada
| | - Janelle Unger
- a Toronto Rehabilitation Institute-University Health Network , Toronto , ON , Canada.,b Rehabilitation Sciences Institute , University of Toronto , Toronto , ON , Canada
| | - José Zariffa
- a Toronto Rehabilitation Institute-University Health Network , Toronto , ON , Canada.,b Rehabilitation Sciences Institute , University of Toronto , Toronto , ON , Canada.,c Institute of Biomaterials and Biomedical Engineering , University of Toronto , Toronto , ON , Canada
| | - Maureen Pakosh
- a Toronto Rehabilitation Institute-University Health Network , Toronto , ON , Canada
| | - Susan Jaglal
- a Toronto Rehabilitation Institute-University Health Network , Toronto , ON , Canada.,b Rehabilitation Sciences Institute , University of Toronto , Toronto , ON , Canada.,d Department of Physical Therapy , University of Toronto , Toronto , ON , Canada.,e Department of Health Policy, Management and Evaluation , University of Toronto , Toronto , ON , Canada
| | - B Catharine Craven
- a Toronto Rehabilitation Institute-University Health Network , Toronto , ON , Canada.,b Rehabilitation Sciences Institute , University of Toronto , Toronto , ON , Canada.,f Division of Physical Medicine and Rehabilitation, Faculty of Medicine , University of Toronto , Toronto , ON , Canada
| | - Kristin E Musselman
- a Toronto Rehabilitation Institute-University Health Network , Toronto , ON , Canada.,b Rehabilitation Sciences Institute , University of Toronto , Toronto , ON , Canada.,d Department of Physical Therapy , University of Toronto , Toronto , ON , Canada
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Sheth U, Wasserstein D, Jenkinson R, Moineddin R, Kreder H, Jaglal S. Practice patterns in the care of acute Achilles tendon ruptures : is there an association with level I evidence? Bone Joint J 2017; 99-B:1629-1636. [PMID: 29212686 DOI: 10.1302/0301-620x.99b12.bjj-2017-0465.r1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 07/17/2017] [Indexed: 11/05/2022]
Abstract
AIMS To determine whether the findings from a landmark Canadian trial assessing the optimal management of acute rupture of the Achilles tendon influenced the practice patterns of orthopaedic surgeons in Ontario, Canada. MATERIALS AND METHODS Health administrative databases were used to identify Ontario residents ≥ 18 years of age with an Achilles tendon rupture from April 2002 to March 2014. The rate of surgical repair (per 100 cases) was calculated for each calendar quarter. A time-series analysis was used to determine whether changes in the rate were chronologically related to the dissemination of results from a landmark trial published in February 2009. Non-linear spline regression was then used independently to identify critical time-points of change in the surgical repair rate to confirm the findings. RESULTS A total of 29 531 patients sustained an Achilles tendon rupture during the study period. Consistently, around 21 out of every 100 cases underwent surgical repair up to the first quarter of 2010. However, by the first quarter of 2014, only 6.5 cases per 100 had surgery. A statistically significant decrease in the rate of surgical repair was observed within one year of the presentation of landmark trial results in 2009 (p < 0.001). July 2009 was independently identified as a critical time at which the surgical repair rate began to significantly decline (p < 0.001). The dissemination of trial results was associated with a significant drop in the rate of surgical repair at non-teaching hospitals (p = 0.001). CONCLUSION The current study demonstrates that large, well-designed randomised trials, have the potential to encourage significant changes in the practice patterns of orthopaedic surgeons. Cite this article: Bone Joint J 2017;99-B:1629-36.
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Affiliation(s)
- U Sheth
- University of Toronto, 160-500 University Avenue, Toronto, Ontario, M5G 1V7, Canada
| | - D Wasserstein
- University of Toronto, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room MG323, Toronto, Ontario, M4N 3M5, Canada
| | - R Jenkinson
- University of Toronto, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room MG323, Toronto, Ontario, M4N 3M5, Canada
| | - R Moineddin
- University of Toronto, 160-500 University Avenue, Toronto, Ontario, M5G 1V7, Canada
| | - H Kreder
- University of Toronto, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room MG323, Toronto, Ontario, M4N 3M5, Canada
| | - S Jaglal
- University of Toronto, 160-500 University Avenue, Toronto, Ontario, M5G 1V7, Canada
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Beaton DE, Mamdani M, Zheng H, Jaglal S, Cadarette SM, Bogoch ER, Sale JEM, Sujic R, Jain R. Improvements in osteoporosis testing and care are found following the wide scale implementation of the Ontario Fracture Clinic Screening Program: An interrupted time series analysis. Medicine (Baltimore) 2017; 96:e9012. [PMID: 29310418 PMCID: PMC5728819 DOI: 10.1097/md.0000000000009012] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [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] [Indexed: 12/22/2022] Open
Abstract
We evaluated a system-wide impact of a health intervention to improve treatment of osteoporosis after a fragility fracture. The intervention consisted of assigning a screening coordinator to selected fracture clinics to identify, educate, and follow up with fragility fracture patients and inform their physicians of the need to evaluate bone health. Thirty-seven hospitals in the province of Ontario (Canada) were assigned a screening coordinator. Twenty-three similar hospitals were control sites. All hospitals had orthopedic services and handled moderate-to-higher volumes of fracture patients. Administrative health data were used to evaluate the impact of the intervention.Fragility fracture patients (≥50 years; hip, humerus, forearm, spine, or pelvis fracture) were identified from administrative health records. Cases were fractures treated at 1 of the 37 hospitals assigned a coordinator. Controls were the same types of fractures at the control sites. Data were assembled for 20 quarters before and 10 quarters after the implementation (from January 2002 to March 2010). To test for a shift in trends, we employed an interrupted time series analysis-a study design used to evaluate the longitudinal effects of interventions, through regression modelling. The primary outcome measure was bone mineral density (BMD) testing. Osteoporosis medication initiation and persistence rates were secondary outcomes in a subset of patients ≥66 years of age.A total of 147,071 patients were used in the analysis. BMD testing rates increased from 17.0% pre-intervention to 20.9% post-intervention at intervention sites (P < .01) compared with no change at control sites (14.9% and 14.9%, P = .33). Medication initiation improved significantly at intervention sites (21.6-23.97%; P = .02) but not at control sites (17.5-18.5%; P = .27). Persistence with bisphosphonates decreased at all sites, from 59.9% to 56.4% at intervention sites (P = .02) and more so from 62.3% to 54.2% at control sites (P < .01) using 50% proportion of days covered (PDC 50).Significant improvements in BMD testing and treatment initiation were observed after the initiation of a coordinator-based screening program to improve osteoporosis management following fragility fracture.
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Affiliation(s)
- Dorcas E. Beaton
- Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute of St. Michael's Hospital
- Institute of Health Policy, Management and Evaluation, University of Toronto
- Occupational Sciences and Occupational Therapy, University of Toronto
- Institute for Work & Health
| | - Muhammad Mamdani
- Institute of Health Policy, Management and Evaluation, University of Toronto
- Li Ka Shing Centre for Healthcare Analytics Research & Training, Li Ka Shing Knowledge Institute of St. Michael's Hospital
- Institute for Clinical Evaluative Sciences
- Leslie Dan Faculty of Pharmacy, University of Toronto
| | - Hong Zheng
- Institute for Clinical Evaluative Sciences
| | - Susan Jaglal
- Institute for Clinical Evaluative Sciences
- Toronto Rehabilitation Institute, University Health Network
- Department of Physical Therapy, University of Toronto
| | - Suzanne M. Cadarette
- Institute for Clinical Evaluative Sciences
- Leslie Dan Faculty of Pharmacy, University of Toronto
| | - Earl R. Bogoch
- Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute of St. Michael's Hospital
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto
| | - Joanna E. M. Sale
- Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute of St. Michael's Hospital
- Institute of Health Policy, Management and Evaluation, University of Toronto
| | - Rebeka Sujic
- Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute of St. Michael's Hospital
| | - Ravi Jain
- Ontario Osteoporosis Strategy, Osteoporosis Canada, Toronto, ON, Canada
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Munce SEP, Shepherd J, Perrier L, Allin S, Sweet SN, Tomasone JR, Nelson MLA, Guilcher SJT, Hossain S, Jaglal S. Online peer support interventions for chronic conditions: a scoping review protocol. BMJ Open 2017; 7:e017999. [PMID: 28947464 PMCID: PMC5623492 DOI: 10.1136/bmjopen-2017-017999] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Peer support is receiving increasing attention as both an effective and cost-effective intervention method to support the self-management of chronic health conditions. Given that an increasing proportion of Canadians have internet access and the increasing implementation of web-based interventions, online peer support interventions are a promising option to address the burden of chronic diseases. Thus, the specific research question of this scoping review is the following: What is known from the existing literature about the key characteristics of online peer support interventions for adults with chronic conditions? METHODS AND ANALYSIS: We will use the methodological frameworks used by Arksey and O'Malley as well as Levac and colleagues for the current scoping review. To be eligible for inclusion, studies must report on adults (≥18 years of age) with one of the Public Health Agency of Canada chronic conditions or HIV/AIDS. We will limit our review to peer support interventions delivered through online formats. All study designs will be included. Only studies published from 2012 onwards will be included to ensure relevance to the current healthcare context and feasibility. Furthermore, only English language studies will be included. Studies will be identified by searching a variety of databases. Two reviewers will independently screen the titles and abstracts identified by the literature search for inclusion (ie, level 1 screening), the full text articles (ie, level 2 screening) and then perform data abstraction. Abstracted data will include study characteristics, participant population, key characteristics of the intervention and outcomes collected. DISSEMINATION This review will identify the key features of online peer support interventions and could assist in the future development of other online peer support programmes so that effective and sustainable programmes can be developed.
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Affiliation(s)
| | - John Shepherd
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Laure Perrier
- Gerstein Science Information Centre, University of Toronto, Toronto, Ontario, Canada
| | - Sonya Allin
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Shane N Sweet
- Department of Kinesiology and Physical Education,Center for Interdisciplinary Research in Rehabilitation of Greater Montreal, McGill University, Montreal, Quebec, Canada
| | - Jennifer R Tomasone
- School of Kinesiology and Health Studies, Queen's University, Kingston, Ontario, Canada
| | - Michelle L A Nelson
- Department of Bridgepoint Collaboratory, Lunenfeld-Tanenbaum Research Institute, Toronto, Ontario, Canada
| | - Sara J T Guilcher
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Saima Hossain
- Gerstein Science Information Centre, University of Toronto, Toronto, Ontario, Canada
| | - Susan Jaglal
- 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
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Sheehan KJ, Sobolev B, Guy P, Tang M, Kuramoto L, Belmont P, Blair JA, Sirett S, Morin SN, Griesdale D, Jaglal S, Bohm E, Sutherland JM, Beaupre L. Feasibility of administrative data for studying complications after hip fracture surgery. BMJ Open 2017; 7:e015368. [PMID: 28473519 PMCID: PMC5623359 DOI: 10.1136/bmjopen-2016-015368] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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: 11/13/2022] Open
Abstract
PURPOSE There is limited information in administrative databases on the occurrence of serious but treatable complications after hip fracture surgery. This study sought to determine the feasibility of identifying the occurrence of serious but treatable complications after hip fracture surgery from discharge abstracts by applying the Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicator 4 (PSI-4) case-finding tool. METHODS We obtained Canadian Institute for Health Information discharge abstracts for patients 65 years or older, who were surgically treated for non-pathological first hip fracture between 1 January 2004 and 31 December 2012 in Canada, except for Quebec. We applied specifications of AHRQ Patient Safety Indicators 04, Version 5.0 to identify complications from hip fracture discharge abstracts. RESULTS Out of 153 613 patients admitted with hip fracture, we identified 12 383 (8.1%) patients with at least one postsurgical complication. From patients with postsurgical complications, we identified 3066 (24.8%) patient admissions to intensive care unit. Overall, 7487 (4.9%) patients developed pneumonia, 1664 (1.1%) developed shock/myocardial infarction, 651 (0.4%) developed sepsis, 1862 (1.1%) developed deep venous thrombosis/pulmonary embolism and 1919 (1.3%) developed gastrointestinal haemorrhage/acute ulcer. CONCLUSIONS We report that 8.1% of patients developed at least one inhospital complication after hip fracture surgery in Canada between 2004 and 2012. The AHRQ PSI-4 case-finding tool can be considered to identify these serious complications for evaluation of postsurgical care after hip fracture.
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Affiliation(s)
- Katie Jane Sheehan
- Department of Physiotherapy, Division of Health and Social Care, Kings College, London, UK
| | - Boris Sobolev
- School of Population & Public Health, University of British Columbia, Vancouver, Canada
| | - Pierre Guy
- Department of Orthopedics, University of British Columbia, Vancouver, Canada
| | - Michael Tang
- School of Population & Public Health, University of British Columbia, Vancouver, Canada
- Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, Canada
| | - Lisa Kuramoto
- Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, Canada
| | - Philip Belmont
- Department of Orthopaedic surgery, William Beaumont Army Medical Center, Texas Tech University Health Sciences Cente, El Paso, Texas, USA
| | - James A Blair
- Department of Orthopaedic surgery, William Beaumont Army Medical Center, Texas Tech University Health Sciences Cente, El Paso, Texas, USA
| | - Susan Sirett
- Decision Support, Vancouver Coastal Health Authority, Vancouver, Canada
| | | | - Donald Griesdale
- Departments of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, Canada
| | - Susan Jaglal
- Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Eric Bohm
- Division of Orthopaedic Surgery and Center for Healthcare Innovation, University of Manitoba, Winnipeg, Canada
| | - Jason M Sutherland
- School of Population & Public Health, University of British Columbia, Vancouver, Canada
| | - Lauren Beaupre
- Department of Physical Therapy and the Division of Orthopaedic Surgery, University of Alberta, Edmonton, Canada
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Sobolev B, Guy P, Sheehan KJ, Bohm E, Beaupre L, Morin SN, Sutherland JM, Dunbar M, Griesdale D, Jaglal S, Kuramoto L. Hospital mortality after hip fracture surgery in relation to length of stay by care delivery factors: A database study. Medicine (Baltimore) 2017; 96:e6683. [PMID: 28422882 PMCID: PMC5406098 DOI: 10.1097/md.0000000000006683] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [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] [Indexed: 11/29/2022] Open
Abstract
Two hypotheses were offered for the effect of shorter hospital stays on mortality after hip fracture surgery: worsening the quality of care and shifting death occurrence to postacute settings.We tested whether the risk of hospital death after hip fracture surgery differed across years when postoperative stays shortened, and whether care factors moderated the association.Analysis of acute hospital discharge abstracts for subgroups defined by hospital type, bed capacity, surgical volume, and admission time.153,917 patients 65 years or older surgically treated for first hip fracture.Risk of hospital death.We found a decrease in the 30-day risk of hospital death from 7.0% (95%CI: 6.6-7.5) in 2004 to 5.4% (95%CI: 5.0-5.7) in 2012, with an adjusted odds ratio [OR] 0.71 (95%CI: 0.63-0.80). In subgroup analysis, only large community hospitals showed the reduction of ORs by calendar year. No trend was observed in teaching and medium community hospitals. By 2012, the risk of death in large higher volume community hospitals was 34% lower for weekend admissions, OR = 0.66 (95%CI: 0.46-0.95) and 39% lower for weekday admissions, OR = 0.61 (95%CI: 0.40-0.91), compared to 2004. In large lower volume community hospitals, the 2012 risk was 56% lower for weekend admissions, OR = 0.44 (95%CI: 0.26-0.75), compared to 2004.The risk of hospital death after hip fracture surgery decreased only in large community hospitals, despite universal shortening of hospital stays. This supports the concern of worsening the quality of hip fracture care due to shorter stays.
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Affiliation(s)
- Boris Sobolev
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Pierre Guy
- Department of Orthopedics, University of British Columbia
| | - Katie J. Sheehan
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Eric Bohm
- Division of Orthopaedic Surgery and Center for Healthcare Innovation, University of Manitoba, Winnipeg
| | - Lauren Beaupre
- Departments of Physical Therapy and Division of Orthopaedic Surgery, University of Alberta, Edmonton
| | | | - Jason M. Sutherland
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Michael Dunbar
- Division of Orthopaedic Surgery, Dalhousie University, Halifax
| | - Donald Griesdale
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver
| | - Susan Jaglal
- Department of Physical Therapy, University of Toronto, Toronto
| | - Lisa Kuramoto
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, 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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Rotondi NK, Beaton DE, Ilieff M, Adhihetty C, Linton D, Bogoch E, Sale J, Hogg-Johnson S, Jaglal S, Jain R, Weldon J. The impact of fragility fractures on work and characteristics associated with time to return to work. Osteoporos Int 2017; 28:349-358. [PMID: 27492487 DOI: 10.1007/s00198-016-3730-4] [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: 05/12/2016] [Accepted: 07/29/2016] [Indexed: 11/30/2022]
Abstract
UNLABELLED We examined the impact of fragility fractures on the work outcomes of employed patients. The majority successfully returned to their previous jobs in a short amount of time, and productivity loss at work was low. Our findings underscore the fast recovery rates of working fragility fracture patients. INTRODUCTION The purpose of this study is to describe the impact of fragility fractures on the work outcomes of patients who were employed at the time of their fracture. METHODS A self-report anonymous survey was mailed to fragility fracture patients over 50 who were screened as part of the quality assurance programs of fracture clinics across 35 hospitals in Ontario, Canada. Measures of return to work (RTW), at-work productivity loss (Work Limitations Questionnaire), and sociodemographic, fracture-related, and job characteristics were included in the survey. Kaplan-Meier estimates of the cumulative proportion of patients still off work were computed. Factors associated with RTW time following a fragility fracture were examined using Cox proportional hazards modeling. RESULTS Of 275 participants, 242 (88 %) returned to work. Of these, the median RTW time was 20.5 days. About 86 % returned to the same job, duties, and hours as before their injury. Among full-time workers, the median number of lost hours due to presenteeism was 2.9 h (Q1-Q3 0.4-8.1 h). The median cost of presenteeism was $75.30 based on the month prior to survey completion. In multivariable analyses, female gender, needing surgery, and medium/heavy work requirements were associated with longer RTW time. Earlier RTW time was associated with elbow fracture and feeling completely better at time of survey completion. CONCLUSIONS The majority of fragility fracture patients successfully returned to their previous jobs in a short amount of time, and productivity loss at work was low. Our findings underscore their fast recovery rates and give reason for optimism regarding the resilience of this population.
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Affiliation(s)
- N K Rotondi
- Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond St., Toronto, Ontario, M5B 1W8, Canada.
| | - D E Beaton
- Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond St., Toronto, Ontario, M5B 1W8, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Institute for Work & Health, University of Toronto, Toronto, Ontario, Canada
| | - M Ilieff
- Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond St., Toronto, Ontario, M5B 1W8, Canada
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada
| | - C Adhihetty
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - D Linton
- Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond St., Toronto, Ontario, M5B 1W8, Canada
| | - E Bogoch
- Mobility Program, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - J Sale
- Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond St., Toronto, Ontario, M5B 1W8, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - S Hogg-Johnson
- Institute for Work & Health, University of Toronto, Toronto, Ontario, Canada
| | - S Jaglal
- Toronto Rehabilitation Institute, Toronto, Ontario, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - R Jain
- Osteoporosis Canada, Toronto, Ontario, Canada
| | - J Weldon
- Osteoporosis Canada, Toronto, Ontario, Canada
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Abstract
This article reports on the development of an instrument to measure dementia patients' and their families' experiences with care provision. Using the responses of 267 care recipient/caregiver dyads, exploratory factor analysis was used to extract an underlying structure of the dyads' assessments of their experiences with dementia networks of care. The results suggested that from the perspective of the care recipient and caregiver, it is the individuals who they interact with in their care journey that define and shape the evaluation of their experiences. In the early stages of dementia, the family physician plays a central role in helping dyads understand the disease and the networks of care that are available to them; in later stages of the disease, it is the activities of the health care worker who is central to the dyad's lived experiences of the care they are receiving. The third important construct linked to the period when a care recipient and caregiver dyad was increasingly aware that dementia services may be needed and the process of assessment and placement was underway. Having information about what resources are available and how they can be accessed, and being able to complete assessments and placements in a timely fashion, was central to their assessment of care networks.
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Affiliation(s)
| | | | | | | | - Kevin Brazil
- McMaster University and St Joseph's Health System Research
Network, Hamilton, Canada
| | - Carole Cohen
- University of Torontoand Sunnybrook and Women's College Health
Sciences Centre, Ontario, 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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Aleem I, Xu Y, Rampersaud YR, Pahuta M, St-Pierre GH, Crawford E, Zarrabian M, St-Pierre GH, Yang M, Scheer J, St-Pierre GH, Lou E, Malleck S, Soroceanu A, Soroceanu A, White B, Holtz KA, Fallah N, Noonan V, Finkelstein J, Rivers C, Tee J, Paquet J, Rutges J, Martin AR, Martin AR, Jack A, Malakoutian M, Kwon B, St-Pierre GH, Nater A, Versteeg A, Pahuta M, Fenton E, Nagoshi N, Tetreault L, Witiw C, Santaguida C, Aziz M, Khashan M, Tomkins-Lane C, Miyanji F, Johnson M, Tee J, Roffey DM, Evaniew N, Nouri A, Tetreault L, Arnold P, Tetreault L, Fehlings M, Wilson J, Smith JS, Charest-Morin R, Charest-Morin R, Marion T, Marion T, Kato S, Miyanji F, Enright A, Daly E, Fehlings M, Dakson A, Dakson A, Leck E, Khashan M, Abraham E, Manson N, Pahuta M, Duncan J, Ahmed A, Eck J, Rhee J, Currier B, Nassr A, Yen D, Johnson A, Bidos A, Schultz S, Fanti C, Young B, Drew B, Puskas D, Henry D, Frombach A, Mitera G, Coyle D, Werier J, Wai E, Hurlbert J, Ravinsky R, Bidos A, Rampersaud YR, Bidos A, Fanti C, Young B, Drew B, Puskas D, Rampersaud R, Yang M, Hurlbert J, Thomas K, St-Pierre GH, Duplessis S, Ailon T, Smith J, Shaffrey C, Klineberg E, Schwab F, Ames C, Yang M, Hurlbert J, Thomas K, Nataraj A, Zheng R, Hill D, Moreau M, Hedden D, Southon S, Johnson M, Goytan M, Passmore S, McIntosh G, Smith J, Lafage V, Klineberg E, Ailon T, Ames C, Shaffrey C, Gupta M, Kebaish K, Scubbia D, Hart R, Hostin R, Schwab F, Kelly M, Smith J, Scheer J, Lafage V, Protopsaltis T, Lafage R, Hostin R, Kebaish K, Gupta M, Hart R, Schwab F, Ames C, Dea N, Street J, Dvorak M, Lipson R, Noonan VK, Kwon BK, Mills PB, Noonan V, Shum J, Rivers C, Street J, Park SE, Chan E, Plashkes T, Dvorak M, Fallah N, Bedi M, Chan E, Rivers C, Street J, Plashkes T, Dvorak M, Noonan V, Fallah N, Ho C, Tsai E, Rivers C, Truchon C, Linassi AG, O’Connell C, Townson A, Ahn H, Drew B, Dvorak M, Fehlings MG, Schwartz C, Noreau L, Warner F, Noonan V, Fallah N, Fisher C, O’Connell C, Tsai E, Ahn H, Attabib N, Christie S, Drew B, Finkelstein J, Fourney D, Paquet J, Parent S, Kuerban D, Dvorak M, Paquet J, Noonan V, Kwon B, Tsai E, Christie S, Rivers C, Kuerban D, Ahn H, Attabib N, Bailey C, Drew B, Fehlings M, Finkelstein J, Fourney D, Hurlbert RJ, Parent S, Fisher C, Dvorak M, Noonan V, Kwon B, Tsai E, Christie S, Rivers C, Ahn H, Attabib N, Bailey C, Drew B, Fehlings M, Finkelstein J, Fourney D, Hurlbert RJ, Parent S, Kuerban D, Dvorak M, Kwon B, Dvorak M, Aleksanderek I, Cohen-Adad J, Cadotte DW, Kalsi-Ryan S, De Leener B, Wang J, Crawley A, Mikulis DJ, Ginsberg H, Fehlings MG, Aleksanderek I, Cohen-Adad J, Tarmohamed Z, Tetreault L, Smith N, Cadotte DW, Crawley A, Ginsberg H, Mikulis DJ, Fehlings MG, Nataraj A, Fouad K, Street J, Wilke HJ, Stavness I, Dvorak M, Fels S, Oxland T, Streijger F, Fallah N, Noonan V, Paquette S, Boyd M, Ailon T, Street J, Fisher C, Dvorak M, Hurlbert J, Fehlings M, Tetreault L, Kopjar B, Arnold P, Dekutoski M, Finkelstein J, Fisher C, France J, Gokaslan Z, Massicotte E, Rhines L, Rose P, Sahgal A, Schuster J, Vaccaro A, Dea N, Boriani S, Varga PP, Luzzati A, Fehlings M, Bilsky M, Rhines L, Reynolds J, Dekutoski M, Gokaslan Z, Germscheid N, Fisher C, van Walraven C, Coyle D, Werier J, Wai E, Mercier P, Bains I, Jacobs WB, Tetreault L, Nakashima H, Nouri A, Fehlings M, Kopjar B, Wilson J, Arnold P, Fehlings M, Tetreault L, Kopjar B, Massicotte E, Fehlings M, Fehlings M, Kopjar B, Arnold P, Defino H, Kale S, Yoon ST, Barbagallo G, Bartels R, Zhou Q, Vaccaro A, Johnson M, Passmore S, Goytan M, Glazebrook C, Golan J, McIntosh G, Barker J, Weber M, Hu R, Norden J, Sinha A, Smuck M, Desai S, Samdani AF, Shah SA, Asghar J, Yaszay B, Shufflebarger HL, Betz RR, Newton P, Passmore S, McCammon J, Goytan M, McIntosh G, Fisher C, Alfasi A, Hashem EL, Papineau GD, Kingwell SP, Wai EK, Belley-Côté EP, Fallah N, Noonan VK, Rivers CS, Dvorak MF, Tetreault L, Dalzell K, Zamorano JJ, Fehlings M, Shamji M, Rhee J, Wilson J, Andersson I, Dembek A, Pagarigan K, Dettori J, Fehlings M, Kopjar B, Tetreault L, Nakashima H, Fehlings M, Kopjar B, Arnold P, Kotter M, Fehlings M, Wilson J, Arnold P, Shaffrey C, Shamji M, Mroz T, Skelly A, Chapman J, Tetreault L, Aarabi B, Casha S, Jaglal S, Voth J, Yee A, Fehlings M, Klineberg E, Shaffrey CI, Lafage V, Schwab FJ, Protopsaltis T, Scheer JK, Ailon T, Ramachandran S, Daniels A, Mundis G, Gupta M, Deviren V, Ames CP, Street J, Stobart L, Ryerson CJ, Flexman A, Street J, Flexman A, Rivers C, Kuerban D, Cheng C, Noonan V, Dvorak M, Fisher C, Kwon B, Street J, Ailon T, Boyd M, Dvorak M, Fisher C, Kwon B, Paquette S, Street J, Lewis S, Reilly C, Shah SA, Clements DH, Samdani AF, Desai S, Lonner BS, Shufflebarger HL, Betz RR, Newton P, Johnson M, Passmore S, Goytan M, Manson N, Bigney E, Wagg K, Abraham E, Nater A, Tetreault L, Kopjar B, Arnold P, Dekutoski M, Finkelstein J, Fisher C, France J, Gokaslan Z, Massicotte E, Rhines L, Rose P, Sahgal A, Schuster J, Vaccaro A, Leck E, Christie S, Leck E, Christie S, Dakson A, Christie S, Weber M, McIntosh G, Barker J, Golan J, Wagg K, Armstrong M, Bigney E, Daly E, Manson N, Bigney E, Wagg K, Daly E, Abraham E, Perruccio A, Badley E, Rampersaud R. 2016 Canadian Spine Society Abstracts. Can J Surg 2016; 59:S39-63. [PMID: 27240290 DOI: 10.1503/cjs.006916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Papaioannou A, Kennedy CC, Ioannidis G, Cameron C, Croxford R, Adachi JD, Mursleen S, Jaglal S. Comparative trends in incident fracture rates for all long-term care and community-dwelling seniors in Ontario, Canada, 2002-2012. Osteoporos Int 2016; 27:887-897. [PMID: 26801930 PMCID: PMC5096943 DOI: 10.1007/s00198-015-3477-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [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: 09/21/2015] [Accepted: 12/29/2015] [Indexed: 01/25/2023]
Abstract
SUMMARY In this population-based study, we compared incident fracture rates in long-term care (LTC) versus community seniors between 2002 and 2012. Hip fracture rates declined more rapidly in LTC than in the community. An excess burden of fractures occurred in LTC for hip, pelvis, and humerus fractures in men and hip fractures only in women. INTRODUCTION This study compares trends in incident fracture rates between long-term care (LTC) and community-dwelling seniors ≥65 years, 2002-2012. METHODS This is a population-based cohort study using administrative data. Measurements were age/sex-adjusted incident fracture rates and rate ratios (RR) and annual percent change (APC). RESULTS Over 11 years, hip fracture rates had a marked decline occurring more rapidly in LTC (APC, -3.49 (95% confidence interval (CI), -3.97, -3.01)) compared with the community (APC, -2.93 (95% CI, -3.28, -2.57); p < 0.05 for difference in slopes). Humerus and wrist fracture rates decreased; however, an opposite trend occurred for pelvis and spine fractures with rates increasing over time in both cohorts (all APCs, p < 0.05). In 2012, incident hip fracture rates were higher in LTC than the community (RRs: women, 1.55 (95% CI, 1.45, 1.67); men, 2.18 (95% CI, 1.93, 2.47)). Higher rates of pelvis (RR, 1.48 (95% CI, 1.22, 1.80)) and humerus (RR, 1.40 (95% CI, 1.07, 1.84)) fractures were observed in LTC men, not women. In women, wrist (RR, 0.76 (95% CI, 0.71, 0.81)) and spine (RR, 0.52 (95% CI, 0.45, 0.61)) fracture rates were lower in LTC than the community; in men, spine (RR, 0.75 (95% CI, 0.57, 0.98) but not wrist fracture (RR, 0.91 (95% CI, 0.67, 1.23)) rates were significantly lower in LTC than the community. CONCLUSION Previous studies in the community have shown declining hip fracture rates over time, also demonstrated in our study but at a more rapid rate in LTC. Rates of humerus and wrist fractures also declined. An excess burden of fractures in LTC occurred for hip fractures in women and for hip, pelvis, and humerus fractures in men.
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Affiliation(s)
- A Papaioannou
- GERAS Centre, Hamilton Health Sciences, 88 Maplewood Avenue, Hamilton, ON, L8M 1W9, Canada.
- Division of Geriatrics, Department of Medicine, McMaster University, 88 Maplewood Avenue, Hamilton, ON, L8M 1W9, Canada.
| | - C C Kennedy
- GERAS Centre, Hamilton Health Sciences, 88 Maplewood Avenue, Hamilton, ON, L8M 1W9, Canada
| | - G Ioannidis
- GERAS Centre, Hamilton Health Sciences, 88 Maplewood Avenue, Hamilton, ON, L8M 1W9, Canada
- Division of Geriatrics, Department of Medicine, McMaster University, 88 Maplewood Avenue, Hamilton, ON, L8M 1W9, Canada
- Division of Rheumatology, Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - C Cameron
- International Centre for Disability and Rehabilitation, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada
| | - R Croxford
- Institute for Clinical Evaluative Sciences, University of Toronto, 155 College Street, Suite 424, Toronto, ON, M5T 3M6, Canada
| | - J D Adachi
- Division of Rheumatology, Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - S Mursleen
- GERAS Centre, Hamilton Health Sciences, 88 Maplewood Avenue, Hamilton, ON, L8M 1W9, Canada
| | - S Jaglal
- Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada
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Sheehan KJ, Sobolev B, Guy P, Bohm E, Hellsten E, Sutherland JM, Kuramoto L, Jaglal S. Constructing an episode of care from acute hospitalization records for studying effects of timing of hip fracture surgery. J Orthop Res 2016; 34:197-204. [PMID: 26228250 PMCID: PMC4995103 DOI: 10.1002/jor.22997] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 07/20/2015] [Indexed: 02/04/2023]
Abstract
Episodes of care defined by the event of hip fracture surgery are widely used for the assessment of surgical wait times and outcomes. However, this approach does not consider nonoperative deaths, implying that survival time begins at the time of procedure. This approach makes treatment effect implicitly conditional on surviving to treatment. The purpose of this article is to describe a novel conceptual framework for constructing an episode of hip fracture care to fully evaluate the incidence of adverse events related to time after admission for hip fracture. This admission-based approach enables the assessment of the full harm of delay by including deaths while waiting for surgery, not just deaths after surgery. Some patients wait until their conditions are optimized for surgery, whereas others have to wait until surgical service becomes available. We provide definitions, linkage rules, and algorithms to capture all hip fracture patients and events other than surgery. Finally, we discuss data elements for stratifying patients according to administrative factors for delay to allow researchers and policymakers to determine who will benefit most from expedited access to surgery.
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Saverino C, Swaine B, Jaglal S, Lewko J, Vernich L, Voth J, Calzavara A, Colantonio A. Rehospitalization After Traumatic Brain Injury: A Population-Based Study. Arch Phys Med Rehabil 2016; 97:S19-25. [DOI: 10.1016/j.apmr.2015.04.016] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 04/15/2015] [Accepted: 04/23/2015] [Indexed: 10/23/2022]
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Viprey M, Caillet P, Canat G, Jaglal S, Haesebaert J, Chapurlat R, Schott AM. Low Osteoporosis Treatment Initiation Rate in Women after Distal Forearm or Proximal Humerus Fracture: A Healthcare Database Nested Cohort Study. PLoS One 2015; 10:e0143842. [PMID: 26630534 PMCID: PMC4667917 DOI: 10.1371/journal.pone.0143842] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 11/10/2015] [Indexed: 11/22/2022] Open
Abstract
Treatment initiation rates following fragility fractures have often been reported to be low and in recent years numerous programs have been implemented worldwide to increase them. This study aimed at describing osteoporosis (OP) treatment initiation in a representative sample of women who were hospitalized for a distal forearm fracture (DFF) or proximal humerus fracture (PHF) in 2009–2011 in France. The data source was a nationwide sample of 600,000 individuals, extracted from the French National Insurance Healthcare System database. All women aged 50 years and older who were hospitalized for a DFF or PHF between 2009 and 2011 and who had not received any OP treatment in the preceding 12 months were included in a retrospective cohort study. OP treatments initiated during the year following the fracture were analyzed. From 2009 to 2011, 729 women were hospitalized for a DFF or a PHF and 284 were on OP treatment at the time of the fracture occurrence. Among the 445 women who had no prevalent OP treatment, 131 (29.4%) received supplementation treatment only (vitamin D and/or calcium) and 42 (9.4%) received a pharmacologic OP treatment in the year following their fracture. Pharmacological OP treatments included bisphosphonates (n = 21), strontium ranelate (n = 14), hormone replacement therapy (n = 4), or raloxifene (n = 3). General practitioners prescribed 75% of initial OP treatments. Despite the guidelines published in 2006 and the numerous initiatives to promote post-fracture OP treatment, OP treatment initiation rate in women who were hospitalized for a fragility fracture remained low in 2009–2011 in France.
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Affiliation(s)
- Marie Viprey
- Pôle Information Médicale, Evaluation, Recherche, Hospices Civils de Lyon, Lyon, France
- Faculté de Médecine Lyon Est, Université Claude Bernard Lyon 1, Lyon, France
- * E-mail:
| | - Pascal Caillet
- Pôle Information Médicale, Evaluation, Recherche, Hospices Civils de Lyon, Lyon, France
- Faculté de Médecine Lyon Est, Université Claude Bernard Lyon 1, Lyon, France
- Département d'épidémiologie, hygiène hospitalière et santé publique, Centre Hospitalier Universitaire d’Amiens, Amiens, France
- INSERM U1033, Lyon, France
| | - Guillaume Canat
- Pôle Information Médicale, Evaluation, Recherche, Hospices Civils de Lyon, Lyon, France
- Département de l’Information Médicale, Groupe Hospitalier Sud Réunion, Centre Hospitalier Universitaire de la Réunion, Saint Pierre, France
| | - Susan Jaglal
- Department of Physical Therapy, Toronto Rehabilitation Institute-UHN Chair, University of Toronto, Toronto, Canada
| | - Julie Haesebaert
- Pôle Information Médicale, Evaluation, Recherche, Hospices Civils de Lyon, Lyon, France
| | - Roland Chapurlat
- Faculté de Médecine Lyon Est, Université Claude Bernard Lyon 1, Lyon, France
- INSERM U1033, Lyon, France
- Service de Rhumatologie et de Pathologie Osseuse, Groupement Hospitalier Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Anne-Marie Schott
- Pôle Information Médicale, Evaluation, Recherche, Hospices Civils de Lyon, Lyon, France
- Faculté de Médecine Lyon Est, Université Claude Bernard Lyon 1, Lyon, France
- INSERM U1033, Lyon, France
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Saverino C, Swaine B, Jaglal S, Lewko J, Vernich L, Calzavara A, Colantonio A. Re-hospitalization after Traumatic Brain Injury: A Population Based Study. Arch Phys Med Rehabil 2015. [DOI: 10.1016/j.apmr.2015.10.066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Pooransingh S, Misir A, Ramdath D, Ramsewak S, Jaglal S, Cameron C, Goel V. Barriers and facilitators to establishing a national public health observatory. Rev Panam Salud Publica 2015; 38:403-409. [PMID: 26837526] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 07/29/2015] [Indexed: 06/05/2023] Open
Abstract
OBJECTIVE To determine what stakeholders perceive as barriers and facilitators to creating a national public health observatory (PHO) in Trinidad and Tobago. METHODS A descriptive study was conducted based on 15 key informant interviews carried out from April to September 2013. The key informants worked within the health care sector in Trinidad and Tobago. Using a semi-structured interview guide, information was collected on knowledge, attitudes, and beliefs about creating a PHO; barriers and facilitators to creating and sustaining a PHO; legal considerations; and human resource and information technology requirements. Common themes of the responses were identified. RESULTS The majority of participants supported the development of a national PHO, recognized its value in informing their work, and indicated that a national PHO could 1) provide information to support evidence-informed decision-making for health policy and strategic planning; 2) facilitate data management by establishing data policies, procedures, and standards; 3) increase the use of data by synthesizing and disseminating information; and 4) provide data for benchmarking. However, a number of barriers were identified, including 1) the perception that data collection is not valued; 2) untimely availability of data; 3) limited data synthesis, dissemination, and utilization to inform decision-making; and 4) challenges related to the allocation of human resources and existing information technology. CONCLUSIONS Key informants support the development of a national PHO in Trinidad and Tobago. The findings align well within the components of the conceptual framework for establishing national health observatories. A stepwise approach to establishing a national PHO in Trinidad and Tobago, beginning with structural components and followed by functional components, is recommended. A national PHO in Trinidad and Tobago could serve as a model for other countries in the Caribbean.
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Affiliation(s)
- Shalini Pooransingh
- University of the West Indies, St Augustine, Mount Hope, Trinidad and Tobago,
| | - Akenath Misir
- Office of the County Medical Officer of Health-Victoria, San Fernando, Trinidad and Tobago
| | - Dan Ramdath
- University of the West Indies, St Augustine, Mount Hope, Trinidad and Tobago,
| | - Samuel Ramsewak
- University of the West Indies, St Augustine, Mount Hope, Trinidad and Tobago,
| | | | - Cathy Cameron
- International Centre for Disability and Rehabilitation, Toronto, Ontario, Canada
| | - Vivek Goel
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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