Exploring the Sustainability of Home Modifications and Adaptations in Occupational Therapy

Background. Many occupational therapists make home modification recommendations; however, it is unknown if sustainability considerations (i.e., economic, social, and environmental) are contemplated during this process. Purpose. To understand occupational therapists' perceptions regarding the sustainability of home modifications. Method. This study adopted a qualitative description approach. Researchers utilized semistructured interviews as the primary means of data collection. Findings. The ten female occupational therapists interviewed had three or more years of experience working with home modifications. The analysis identified three themes: It's not easy being green: environmental sustainability, stretching a dollar: financial inequities, and barriers and benefits in the home modification process. Implications. Findings suggest OTs have a varied and a general understanding of how to implement sustainability concepts in their practice. There is also a need to make access to home modifications more equitable. Further research is needed to build a more robust understanding of how OT recommended home modifications can contribute to sustainability.

A qualitative study of clinicians' and individuals' with lower limb loss perspectives on the development of a novel online self-management program

PURPOSE

To explore the rehabilitation preferences and experiences of clinicians and patients for education after lower limb loss to facilitate the development of an online self-management program.

METHODS

A qualitative descriptive approach was used. Thirty-one clinicians (physiotherapists, occupational therapists, and prosthetists), and 26 patients with lower limb loss (transtibial and transfemoral amputation; mean age (SD) of 63.3 (9.1), years) were recruited. We used semi-structured focus groups and one-on-one interviews, and audio recorded the interviews. Data were analyzed using conventional content analysis.

RESULTS

Three themes were identified: (1) Needing education in rehabilitation described the education in current practice as one-on-one discussion and booklets and highlighted the limitations of education such as its length, static nature, and inaccessible for patients living in remote areas. (2) Getting back to activities prior to amputation emphasized how goal setting and social support could assist patients and facilitate self-management. (3) Augmenting learning highlighted the need for an accessible complementary source for education and potential solutions to overcome the barriers of online delivery.

CONCLUSIONS

Our findings underscore the importance of education in the rehabilitation of patients to help them get back to their activities. An online accessible tool may improve education by providing information and peer support.

Exploratory study on the adaptation of online services offered to people with disabilities, in the context of the COVID-19 pandemic

Aim: During the COVID-19 pandemic, many community organizations offering services to people with disabilities (PWD) changed their service delivery, switching from in-person to remote services. However, little is known about what it was like for organizations to quickly pivot their service delivery. The study explored barriers and facilitators to access community services for PWD and identified potential improvements to these services.Methods: The study used a mixed method, multiple case study design, which included a convenience sample of 27 participants recruited from four community organizations delivering services to PWD. Participating staff and members participated in six different focus groups and completed a questionnaire about their level of satisfaction regarding the evolution of the services. Inductive thematic analysis was conducted on the focus group data and the data from the questionnaires were descriptively analyzed.Results: The thematic analyses revealed four themes: "Succeeding in adapting the interventions to continue providing services", "Enjoying a lot of new things about the new online modality", "Key elements that have facilitated the transition" and "Facing some difficulties implementing online services". The median satisfaction score demonstrated that the participants were satisfied with the services. The success of these organizational changes relied on the adoption of new methods and approaches to service delivery.Conclusion: Through this study, barriers and facilitators that the organizations and their beneficiaries have experienced during the pandemic were identified as well as suggestions for improvement. The organizations consider maintaining online services beyond the pandemic to offer PWD easier access to community services.

Changes in functioning and health during the first 6-months of the COVID-19 pandemic among individuals with a spinal cord injury

STUDY DESIGN

Single-cohort longitudinal survey design.

OBJECTIVES

To identify what ongoing impact the COVID-19 pandemic has on functioning and health in individuals with SCI. Using the ICF model as a guide, outcome measures were chosen to explore potential constructs and aspects of health and functioning which may have been affected by regulations.

SETTING

Online, Canada.

METHODS

Participants provided demographic and clinical characteristics at baseline. They completed standardized online measures at three time points, each roughly one month apart (June, July, and August of 2020). The measures assessed mental health, resilience, boredom, social support, technology use, life space, and participation. Repeated measures ANOVAs were used to identify longitudinal changes for each measure.

RESULTS

We collected data from 21 participants with SCI (mean age 54 years, 12 male). We found a large effect size for participation (η2 = 0.20), which increased over time. We also found medium effect sizes in both anxiety (η2 = 0.12) and social network usage (η2 = 0.12). Anxiety decreased over time and social networking usage fluctuated slightly but with an increase from time point one to time point two.

CONCLUSION

The results indicate that individuals with spinal cord injury appear to be staying relatively stable during the pandemic with improvements in a few key aspects, such as potentially increased participation and decreased anxiety. The results also suggest that it is important to continue fostering ways for individuals with spinal cord injury to stay connected, engaged, and informed.

Positive and negative experiences of caregivers helping power wheelchair users: a mixed-method study

PURPOSE

This study aimed to better understand how the powered wheelchair (PWC) impacts the experiences of family caregivers of PWC users, and explore the strategies and resources used by caregivers to cope with their role.

MATERIALS AND METHODS

This mixed-methods study was part of a larger cross-sectional research study conducted in four Canadian cities. Twenty-three family caregivers of PWC users, who provided at least 2 h of support per week, completed the Power Mobility Caregiver Assistive Technology Outcome (PM-CATOM), an 18-item measure assessing PWC-related and overall burden experienced by family caregivers. We also conducted semi-structured interviews and analysed them using inductive content analysis.

RESULTS

From the quantitative PM-CATOM results, the caregivers perceived low level of burden for the wheelchair-related items, (Median:4.5; Range 3 to 5). Most perceived burden when physically helping the wheelchair user and when providing verbal hints. In terms of overall help, the caregivers experienced some level of burden (Median 3.5: Range 3 to 5). Most caregivers identified burden associated with the limitation to their recreational and/or leisure activities (52.2%) and feeling that they have more to do than they can handle. We identified 3 themes in the interviews: the burden experiences of caring for PWC users, the positive experiences of caregiving, and the coping strategies and resources used by caregivers of PWC users.

CONCLUSION

Our study showed that understanding the experiences of caregivers of AT users is central as they are directly and indirectly impacted by the PWC in their lives and caregiving roles.

Experiential Aspects of Participation in Employment and Mobility for Adults With Physical Disabilities: Testing Cross-Sectional Models of Contextual Influences and Well-Being Outcomes

OBJECTIVE

To use structural equation modeling to test research- and theory-informed models of potential predictors and outcomes of subjective experiences of employment and mobility participation in a national sample of people with physical disabilities.

DESIGN

Cross-sectional survey.

SETTING

Canada.

PARTICIPANTS

English or French-speaking adults with a physical impairment affecting mobility and restricting activities or participation, and who participated in employment (n=457) or mobility (n=711) life domains.

INTERVENTIONS

N/A.

MAIN OUTCOME MEASURES

Participants completed standardized measures of perceived health, and employment-specific and/or mobility-specific measures of perceived abilities, social support, accessibility and policies (predictor variables); the Measure of Experiential Aspects of Participation (MeEAP) in employment and/or mobility; and standardized measures of emotional well-being, social well-being and life satisfaction (outcome variables).

RESULTS

Analyses using structural equation modeling showed that in both employment and mobility domains, perceived health, abilities, social support, and accessibility were positively related to experiential aspects of participation. Participation experiences were positively related to social well-being, emotional well-being, and life satisfaction.

CONCLUSIONS

Results support and extend current theorizing on participation experiences among adults with physical disabilities. Intrapersonal and environmental factors may play a role in optimizing participation experiences in employment and mobility which, in turn, may lead to better well-being and life satisfaction. These results emphasize the importance of conceptualizing participation from an experiential perspective and provide a basis for advancing theory and practice to understand and improve the participation experiences and well-being of adults living with physical disabilities.

Understanding the experiences, needs, and strengths of people with incomplete spinal cord injury who can ambulate

PURPOSE

To identify the experiences, needs, and strengths of people with incomplete spinal cord injury who can ambulate and to explore and discuss potential supports, services, and programs that would best assist them in the community.

MATERIAL AND METHODS

In this qualitative descriptive study, interviews were the primary means of data collection. These were supplemented with descriptive standardized measures of function and life satisfaction. Qualitative data were analyzed thematically.

RESULTS

Twenty-four participants were interviewed, their average age was 55 years and 46% were female. We identified three themes: 'I really couldn't go there', described the physical and social barriers experienced by participants, 'It'd be really nice to let the public know there are people out there like me' expressed the desire for greater social understanding of incomplete spinal cord injury, and 'I just don't quit', displayed the perseverance that participants demonstrated following their injury.

CONCLUSION

Findings indicate service providers to improve the inclusion of ambulatory individuals with incomplete spinal cord injury in their programs. Suggestions include designing programs (community, healthcare, return to work, peer support), environments using the principles of universal design for people with incomplete spinal cord injury who ambulate, and increasing consideration of their perspectives.Implication for rehabilitation:People with incomplete spinal cord injury who can ambulate live with invisible impairments, which are often not acknowledged by family, friends, health professionals, and people with complete spinal cord injuryThey may feel excluded from activities (organized by spinal cord injury associations) that were originally designed for people with complete spinal cord injuryGreater awareness among health professionals, friends, family, and people with complete spinal cord injury of the needs of people with incomplete spinal cord injury who can ambulate is needed to increase their inclusion.

Development of a co-created online self-management program for people with lower limb loss: self-management for amputee rehabilitation using technology (SMART)

PURPOSE

To develop an online self-management program for individuals with recent lower limb loss, called Self-Management for Amputee Rehabilitation using Technology (SMART).

MATERIALS AND METHODS

We used the Intervention Mapping Framework as a blueprint and involved stakeholders throughout the process. A six-step study was conducted including (1) needs assessment using interviews, (2) translating needs to content, (3) applying the content into a prototype using theory-based methods, (4) a usability assessment using think-aloud cognitive testing, (5) planning for future adoption and implementation, and (6) assessing feasibility using mixed-methods to generate a plan to assess the effectiveness on health-outcomes in a randomized controlled trial.

RESULTS

Following interviews with healthcare professionals (n = 31) and people with lower limb loss (n = 26), we determined the content of a prototype version. We then tested usability (n = 9) and feasibility (n = 12) by recruiting individuals with lower limb loss from different pools. We modified SMART to be assessed in a randomized controlled trial. SMART is a six-week online program with weekly contact of a peer mentor with lower limb loss who supported patients with goal-setting and action-planning.

CONCLUSIONS

Intervention mapping facilitated the systematic development of SMART. SMART may improve health outcomes, but this would need to be confirmed in future studies.Implications for rehabilitationLearning new coping strategies and habits are essential after lower limb loss.Given the limitations and inaccessibility of educational and rehabilitation programs, online self-management education can assist patients in their recovery.Self-Management for Amputee Rehabilitation using Technology (SMART) has the potential to augment the self-management behaviors in individuals with lower limb loss through an improvement in access to educational content, skill-based videos, and support of a peer.

Adaptive outdoor physical activities for adults with mobility disability: a scoping review

Introduction

Outdoor physical activity (PA) contributes to the physical and mental health and well-being of individuals with a mobility impairment. However, individuals are commonly excluded from outdoor PA because of accessibility challenges. No reviews summarizing evidence on factors that facilitate/hinder participation and inclusion of individuals with mobility disabilities in adaptive outdoor PA were identified.. This makes it challenging to establish the key components for implementing inclusive outdoor PA interventions. A scoping review was conducted to identify barriers and facilitators to participation in adaptive outdoor PA and identify suggestions for adaptive outdoor PA design.

Methods

A scoping review of qualitative and quantitative studies was conducted based on the methodological framework of Arksey and O'Malley with modifications by Levac. Barriers and facilitators were categorized into four levels based on a Social Ecological Model (SEM). Suggestions for interventions designed to overcome accessibility issues of outdoor PA were classified based on Universal Design (UD).

Results

Thirty-seven factors regarding barriers and facilitators of outdoor adaptive PA were extracted from 19 studies published between 2002 and 2023. Barriers and facilitators were identified primarily in four levels of the SEM, including intrapersonal, social-environmental, physical-environmental, and policy-related. Eleven design suggestions were identified and categorized according to the seven principles of UD. This study identified gaps in the presented barriers and facilitators and the design suggestions of the included studies, mainly at the social and environmental level, such as a lack of innovation in program delivery and logistics.

Conclusion

This study identified gaps in knowledge about facilitators and barriers to outdoor adaptive PA and in the design of interventions addressing them. Future research should focus on the strategies addressing these gaps by involving individuals with mobility disability in designing interventions to gain a better insight into their needs.

Experiences of adults with stroke attending a peer-led peer-support group

PURPOSE

Peer-support groups for stroke survivors are often organized and facilitated by health authorities and disability related organizations within rehabilitation programs. However, the benefits of peer-led, peer-support groups have not yet been evaluated. The purpose of this study was to explore participants' experiences in a community-based, peer-led, peer-support group for stroke survivors.

MATERIALS AND METHODS

Semi-structured interviews were conducted and analyzed following constructivist grounded theory with 11 participants who attended a peer-led, peer-support group for people with stroke. The data were also complemented with one quantitative rating question regarding their experience attending the group.

RESULTS

Three themes were identified. Meeting unmet needs after stroke captured how the group was created by stroke survivors to address life in the community post-stroke. Buddies helping buddies highlighted that stroke recovery is a shared process at the group, where members help and encourage each other to contribute what they can. Creating authentic friendships revealed how people experienced social connection and developed relationships in the peer-led, peer-support group.

CONCLUSIONS

Peer-led, peer-support groups may provide opportunities for stroke survivors to connect with like-minded people in their community to have fun while exploring their abilities.

Study of Rivaroxaban for Cerebral Venous Thrombosis: A Randomized Controlled Feasibility Trial Comparing Anticoagulation With Rivaroxaban to Standard-of-Care in Symptomatic Cerebral Venous Thrombosis

BACKGROUND

Emerging data suggest that direct oral anticoagulants may be a suitable choice for anticoagulation for cerebral venous thrombosis (CVT). However, conducting high-quality trials in CVT is challenging as it is a rare disease with low rates of adverse outcomes such as major bleeding and functional dependence. To facilitate the design of future CVT trials, SECRET (Study of Rivaroxaban for Cerebral Venous Thrombosis) assessed (1) the feasibility of recruitment, (2) the safety of rivaroxaban compared with standard-of-care anticoagulation, and (3) patient-centered functional outcomes.

METHODS

This was a phase II, prospective, open-label blinded-end point 1:1 randomized trial conducted at 12 Canadian centers. Participants were aged ≥18 years, within 14 days of a new diagnosis of symptomatic CVT, and suitable for oral anticoagulation; they were randomized to receive rivaroxaban 20 mg daily, or standard-of-care anticoagulation (warfarin, target international normalized ratio, 2.0-3.0, or low-molecular-weight heparin) for 180 days, with optional extension up to 365 days. Primary outcomes were annual rate of recruitment (feasibility); and a composite of symptomatic intracranial hemorrhage, major extracranial hemorrhage, or mortality at 180 days (safety). Secondary outcomes included recurrent venous thromboembolism, recanalization, clinically relevant nonmajor bleeding, and functional and patient-reported outcomes (modified Rankin Scale, quality of life, headache, mood, fatigue, and cognition) at days 180 and 365.

RESULTS

Fifty-five participants were randomized. The rate of recruitment was 21.3 participants/year; 57% of eligible candidates consented. Median age was 48.0 years (interquartile range, 38.5-73.2); 66% were female. There was 1 primary event (symptomatic intracranial hemorrhage), 2 clinically relevant nonmajor bleeding events, and 1 recurrent CVT by day 180, all in the rivaroxaban group. All participants in both arms had at least partial recanalization by day 180. At enrollment, both groups on average reported reduced quality of life, low mood, fatigue, and headache with impaired cognitive performance. All metrics improved markedly by day 180.

CONCLUSIONS

Recruitment targets were reached, but many eligible participants declined randomization. There were numerically more bleeding events in patients taking rivaroxaban compared with control, but rates of bleeding and recurrent venous thromboembolism were low overall and in keeping with previous studies. Participants had symptoms affecting their well-being at enrollment but improved over time.

REGISTRATION

URL: https://www.

CLINICALTRIALS

gov; Unique identifier: NCT03178864.

Service delivery and programing adaptations for individuals with disabilities by municipalities and non-profit organizations during the COVID pandemic

Municipalities and nonprofit organizations play a major role in administrating services that support individuals with disabilities. The purpose of this study was to explore how these organizations responded to the COVID-19 pandemic in regards to service delivery and programming for people with disabilities. This qualitative interpretative description study used semi-structured individual interviews for data collection. Recordings of the interviews were transcribed. Then the transcripts were analyzed qualitatively for themes following an inductive approach. Twenty-six individuals working for nonprofit organization or municipalities participated in the study. Six themes were identified: doing more with less; adapting rather than creating new services; ongoing consultation with stakeholders; feeling successful at adapting the services; being innovative with fundraising and embracing radical change. Flexibility and iterative user-centered approach appeared to be common coping strategies. Remote services were privileged to adapt service delivery during the COVID-19 pandemic.

Perception of autonomy among people who use wheeled mobility assistive devices: dependence on environment and contextual factors

PURPOSE

To evaluate and compare the perceived autonomy of people using wheeled mobility assistive devices (WMADs) in five community-based environments. To evaluate how personal, environmental, and assistive device-related factors impact the perceived autonomy of WMAD users.

METHOD

A study-specific questionnaire was used to evaluate perceived satisfaction of WMAD users with their autonomy in five environments: the Home Environment, Buildings Outside of the Home Environment, Outdoor Built Environment, Outdoor Natural Environment, and Transportation. For each environment, participants rated their satisfaction with autonomy about 15 personal, environmental, and assistive device-related factors. Qualitative perceptions were also collected with open-ended questions.

RESULTS

Participants included 123 full- and part-time community-dwelling WMAD users. Participants' overall satisfaction with autonomy in the Outdoor Natural Environment was statistically significantly lower compared to the other four environments (p < 0.05). In all environments, the top factor respondents were most satisfied with was WMAD ease of use. Their least satisfaction was when negotiating stairs, curbs, or obstacles in the Home, Buildings Outside of the Home, and the Outdoor Built Environments. In the Outdoor Natural Environment, the most dissatisfaction was with manoeuvring on different terrains. Responses to open-ended questions supported the quantitative findings and highlighted the effects of various factors on autonomy (e.g., subject-environment familiarity).

CONCLUSIONS

WMAD users reported the greatest restriction to their autonomy in outdoor environments. Different context-specific factors were found to impact autonomy in different environments. Understanding how environment-specific contextual factors contribute to overall perception of autonomy may inform the development of future strategies to overcome identified limitations and challenges.Implications for RehabilitationWheeled mobility assistive device (WMAD) users experienced the highest autonomy in their home environments, specifically, when having access to home modification services.WMAD users had the lowest autonomy in the outdoor natural environment, with manoeuvrability on different terrains being the main predictor of the overall satisfaction with autonomy in this environment.Environment-specific contextual factors with significant impacts on perceived autonomy were identified that can inform the design and development of future WMADs (e.g., distance travelled, safety).

Accessible exercise for wheelchair users: comparing the usability of two adapted exercise machines

INTRODUCTION

Exercise is an important occupation for wheelchair users. Limited access to adapted aerobic exercise equipment in the community and lack of knowledge on how to exercise are barriers to exercise participation among wheelchair users. To address these barriers, the adapted rower (aROW) and adapted skier (aSKI) exercise machines and educational materials were created.

PURPOSE

1) To compare wheelchair users' perspectives of the effectiveness and usability of the aROW and aSKI. 2) To explore perceptions of educational materials to support use of the machines.

MATERIALS AND METHODS

A sequential, mixed-methods study design was used. Six wheelchair users trialled the machines, and completed an interview and two usability questionnaires. Qualitative data were analysed using thematic and conventional content analysis. Usability scores of both machines were compared using the Wilcoxon Signed Ranks Test.

RESULTS

Data show high usability of the aROW and aSKI. More set up challenges were reported for the aROW than the aSKI. Participants perceived both machines provided effective cardiovascular workouts, and each met their exercise goals differently. Participants preferred the instructional videos over instructional sheets and provided suggestions for improving both. The Wilcoxon Signed Ranks Test showed no statistically significant difference in usability between the aROW and aSKI.

CONCLUSION

Implementing the aROW and aSKI in the community may address some equity issues that wheelchair users face by providing more aerobic exercise options. Results will inform educational material revisions to support use of the machines.IMPLICATIONS FOR REHABILITATIONThe adapted rower (aROW) and adapted skier (aSKI) were perceived as highly usable, suggesting provision of more adapted aerobic exercise options, like the aROW and aSKI, may address some exercise-related equity issues wheelchair users experience.Wheelchair users may consider multiple factors when choosing adapted exercise equipment, highlighting the importance of providing multiple options for adapted aerobic exercise equipment to facilitate agency in choice of exercise.

Resilience practices among a broad spectrum of individuals with physical disabilities during the COVID-19 pandemic: A qualitative photo elicitation study

This community-based study explored resilience practices among people living with physical disabilities (i.e., stroke, spinal cord injury, and other physical disabilities) during the COVID-19 pandemic. In this photo elicitation study, during 1:1 interviews, participants shared and described photos that reflected their pandemic-related experiences. Data were analyzed thematically to identify resilience-related practices. Our analysis revealed three themes: (1) reflecting on the importance of family, friends, and community (e.g., recalling past memories and strengthening existing connections); (2) engaging in social and recreational activities (e.g., experiencing the outdoors and gardening); and (3) reframing personal contexts and social environment (e.g., adjusting to new social norms and overcoming physical barriers to navigating safely during the pandemic). The resilience that participants identified encompassed not only individual strategies but also family and community supports. Resilience can be fostered through community initiatives that support more equitable responses to health emergencies for people with disabilities.

Wheelchair Skills Test in simulated versus community settings: a mixed-methods crossover study of experienced motorized mobility scooter users

PURPOSE

The Wheelchair Skills Test (WST) is commonly conducted in a simulated setting. Although the WST can be done in the community setting, its usefulness in this setting has not been systematically evaluated. The purpose of this study was to compare the WST in the simulated versus community settings, and to explore participants' perceptions of performing in each environment.

METHODS

For this mixed-methods study, we studied 20 motorized mobility scooter users who had used their devices for ≥ 3 months. Each participant completed the WST Version 4.3 twice in random order - once in a simulated setting and once in their community within a two-week period. Semi-structured interviews were conducted after completion of the WST in both environments. A self-report version of the WST (WST-Q) was also completed that measured perceived capacity, frequency of skill performance, and confidence.

RESULTS

The mean (SD) total WST score in the simulated setting was 88.9% (8.6) and 92.7% (7.8) in the community setting. The two WST scores were moderately correlated (r = 0.306, p = 0.190). Community-setting WST scores were moderately correlated with WST-Q confidence scores. Simulated-setting scores were moderately correlated with WST-Q frequency scores. Although most participants preferred performing the WST in their communities due to convenience and familiarity, they perceived the simulated setting to be reflective of their community settings.

CONCLUSION

Despite challenges, community-based testing may provide a better reflection of everyday performance for scooter users than testing in a simulated environment.

Evaluating a pilot community-based self-management program for adults with spinal cord injury

OBJECTIVE

To evaluate outcomes and perceptions of participating in a pilot spinal cord injury (SCI) specific community-based self-management program.

DESIGN

A program evaluation conducted through the review of retrospective data.

SETTING

An outpatient vocational rehabilitation service in Singapore.

PARTICIPANTS

Adults with SCI who completed a self-management intervention.

INTERVENTION

A self-management educational program was delivered by healthcare professionals with involvement of peer mentors. Up to six self-selected topics were covered using a multi-modal teaching approach.

OUTCOME MEASURES

Retrospective data collected at baseline, post-intervention, and three-month follow-up were analyzed. Outcome measures included the University of Washington Self-Efficacy scale (UW-SES), SCI Secondary Conditions Scale (SCI-SCS), Community Integration Questionnaire (CIQ), and employment. Post-program survey findings were also reviewed.

RESULTS

Data from fifteen participants revealed positive changes over time for the UW-SES (η² = .27), SCI-SCS (η² = .21), and CIQ (η² = .23). Self-efficacy scores increased from baseline to post-intervention with a large effect size (Hedge's g = 0.89), and from baseline to follow-up with a medium effect size (Hedge's g = 0.50). Participants reported overall perceived benefit and satisfaction with the program's design and relevance. They valued access to useful information, effective instructional methods, program customization, and participant empowerment and affirmation. Suggestions for program refinement included: more peer support, psycho-emotional support, and continued program adaptability and accessibility.

CONCLUSION

A SCI-specific community-based self-management program was associated with short-term improvements in self-efficacy and was well-received. Further research is required to determine its effectiveness, essential program features that promote successful outcomes, and cost-effectiveness of program implementation.

IKT Guiding Principles: demonstration of diffusion and dissemination in partnership

INTRODUCTION

Integrated knowledge translation (IKT) is a partnered approach to research that aims to ensure research findings are applied in practice and policy. IKT can be used during diffusion and dissemination of research findings. However, there is a lack of understanding how an IKT approach can support the diffusion and dissemination of research findings. In this study, we documented and described the processes and outcomes of an IKT approach to diffusing and disseminating the findings of consensus recommendations for conducting spinal cord injury research.

METHODS

Communication of the IKT Guiding Principles in two phases: a diffusion phase during the first 102 days from the manuscript's publication, followed by a 1147 day active dissemination phase. A record of all inputs was kept and all activities were tracked by monitoring partnership communication, a partnership tracking survey, a project curriculum vitae, and team emails. Awareness outcomes were tracked through Google Analytics and a citation-forward search. Awareness includes the website accesses, the number of downloads, and the number of citations in the 29 month period following publication.

RESULTS

In the diffusion period, the recommendations were viewed 60 times from 4 different countries, and 4 new downloads. In the dissemination period, the recommendations were viewed 1109 times from 39 different countries, 386 new downloads, and 54 citations. Overall, during dissemination there was a 17.5% increase in new visitors to the website a month and a 95.5% increase in downloads compared to diffusion.

CONCLUSION

This project provides an overview of an IKT approach to diffusion and dissemination. Overall, IKT may be helpful for increasing awareness of research findings faster; however, more research is needed to understand best practices and the the impact of an IKT approach on the diffusion and dissemination versus a non-partnered approach.

Perspectives of users for a future interactive wearable system for upper extremity rehabilitation following stroke: a qualitative study

BACKGROUND

Wearable sensor technology can facilitate diagnostics and monitoring of people with upper extremity (UE) paresis after stroke. The purpose of this study is to investigate the perspectives of clinicians, people living with stroke, and their caregivers on an interactive wearable system that detects UE movements and provides feedback.

METHODS

This qualitative study used semi-structured interviews relating to the perspectives of a future interactive wearable system including a wearable sensor to capture UE movement and a user interface to provide feedback as the means of data collection. Ten rehabilitation therapists, 9 people with stroke, and 2 caregivers participated in this study.

RESULTS

Four themes were identified (1) "Everyone is different" highlighted the need for addressing individual user's rehabilitation goal and personal preference; (2) "The wearable system should identify UE and trunk movements" emphasized that in addition to arm, hand, and finger movements, detecting compensatory trunk movements during UE movements is also of interest; (3) "Both quality and amount of movements are necessary to measure" described the parameters related to how well and how much the user is using their affected UE that participants envisioned the system to monitor; (4) "Functional activities should be practiced by the users" outlined UE movements and activities that are of priority in designing the system.

CONCLUSIONS

Narratives from clinicians, people with stroke, and their caregivers offer insight into the design of interactive wearable systems. Future studies examining the experience and acceptability of existing wearable systems from end-users are warranted to guide the adoption of this technology.

Older adults and social prescribing experience, outcomes, and processes: a meta-aggregation systematic review

OBJECTIVE

Social prescribing is a complex care model, which aims to address unmet non-medical needs and connect people to community resources. The purpose of this systematic review was to synthesize available evidence from qualitative methods (e.g. interviews or focus groups) on experience, outcomes, and processes for social prescribing and older adults (from the person or provider level).

STUDY DESIGN

This was a systematic review using the Joanna Brigg's meta-aggregative approach.

METHODS

We searched multiple online databases for peer-reviewed studies, which included older adults aged ≥60 years (group mean age) and social prescribing experience, outcomes, or processes. We included all qualitative or mixed methods designs from all years and languages. Date of the last primary search was March 24, 2022. Two authors used online software to conduct the screening independently and then decided on the final list of included studies via notes and online discussion.

RESULTS

We screened 376 citations (after duplicates) and included eight publications. There were 197 older adult participants (59% women), and many people were living with chronic health conditions. Few details were provided for participants' ethnicity, education, and related factors. We created five synthesized findings related to (1) the approach of social prescribing; implementation factors such as (2) relationships, (3) behavior change strategies, and (4) the environment; and (5) older adults' perceived health and psychosocial outcomes.

CONCLUSIONS

Despite the limited number of available studies, data provide an overview of people and processes involved with social prescribing, identified research and practice gaps, and possible next steps for implementing and evaluating social prescribing for older adults in primary care.

Responsiveness and trajectory of changes in the rating of everyday arm-use in the community and home (REACH) scale over the first-year post-stroke

OBJECTIVE

To examine the trajectory of the Rating of Everyday Arm-use in the Community and Home (REACH) scores over the first-year post-stroke, determine if REACH scores are modified by baseline impairment level and explore the responsiveness of the REACH scale through hypothesis testing.

DESIGN

Consecutive sample longitudinal study.

SETTING

Participants were recruited from an acute stroke unit and followed up at three, six, and 12 months post-stroke.

PARTICIPANTS

Seventy-three participants with upper limb weakness (Shoulder Abduction and Finger Extension score ≤ 8).

MAIN MEASURES

The REACH scale is a six-level self-report classification scale that captures how the affected upper limb is being used in one's own environment. The Fugl-Meyer Upper Limb Assessment (FMA-UL), Stroke Upper Limb Capacity Scale (SULCS), accelerometer-based activity count ratio and Global Rating of Change Scale (GRCS) were used to capture upper limb impairment, capacity, and use.

RESULTS

The following proportions of participants improved at least one REACH level: 64% from baseline to three months, 37% from three to six months and 13% from six to 12 months post-stroke. The trajectory of REACH scores over time was associated with baseline impairment. Change in REACH had a moderate correlation to change in SULCS and the GRCS but not FMA-UL or the activity count ratio.

CONCLUSIONS

Results of hypothesis testing provide preliminary evidence of the responsiveness of the REACH scale. On average, individuals with severe impairment continued to show improvement in use over the first year, while those with mild/moderate impairment plateaued and a small proportion decreased in the early chronic phase.

Perceived eHealth literacy and health literacy among people with spinal cord injury: A cross-sectional study

OBJECTIVES

This purpose of this research was to (1) to evaluate eHealth and general health literacy levels among individuals with spinal cord injury (SCI) and (2) to identify relationships between eHealth literacy, general health literacy, and various sociodemographic factors.

DESIGN

Cross-sectional.

SETTING

The study was conducted in the community setting.

PARTICIPANTS

As part of a larger study, a total of 50 community-dwelling individuals with SCI were recruited.

INTERVENTIONS

n/a.

OUTCOME MEASURES

Quantitative online survey data were collected on participants' sociodemographic characteristics, eHealth literacy (using the eHealth Literacy Scale), general health literacy (using the Brief Health Literacy Screening Tool).

RESULTS

The average age of participants was 49 years old; 25 participants were male and 25 were female. A total of 39 participants experienced traumatic SCI and 11 participants experienced non-traumatic SCI. Participants demonstrated moderate levels of eHealth literacy (31.6 out of 40) and general health literacy (17.6 out of 20). A significant, positive correlation was found between eHealth literacy and general health literacy. Significant, positive correlations were found between general health literacy and sociodemographic factors, including income and education. A significant, negative correlation was found between general health literacy and time since injury.

CONCLUSION

No previous studies we are aware of have evaluated perceived eHealth literacy and general health literacy among people with SCI. This study demonstrated the diverse range of eHealth literacy levels in SCI populations and how this, and other factors, may impact an individual's ability to self-manage and adopt to eHealth technologies.

Potential assistive technology preferences of informal caregivers of people with disability

Background

Preferences of informal caregivers of people with neurocognitive disorders for technological solutions are important in user- centered design approaches. It is crucial to take into consideration the needs and preferences of users when developing new technology to facilitate their uptake.

Objectives

The objective of this study was to determine caregiver preferences for potential technological solutions to help address their needs and compare technology preferences of caregivers who provide care to those with and without neurocognitive disorders (NCD).

Methods

This was a quantitative descriptive study. We surveyed informal caregivers of older adults with disability in Canada. Participants were asked to answer questions about their preferences for 10 potential technological solutions that could be developed to make caregiving easier.

Results

Data from 125 respondents (72 caregivers of people with NCD and 53 caregivers of people with non-NCD-related disabilities) were analyzed. Generally, caregivers preferred web-based solutions as these were among the first five choices for both groups combined. However, there were some differences in the order of preference of potential solutions in both groups.

Conclusion

Informal caregivers of people with NCD preferred web-based solutions to help address their needs.

Qualitative experiences of new motorised mobility scooter users relevant to their scooter skills: a secondary analysis

OBJECTIVE

To explore the experiences of new motorised mobility scooter users from the perspectives of the assessment and training of scooter skills.

DESIGN

Descriptive secondary analysis of qualitative data.

SETTING

Community.

PARTICIPANTS

20 New users of motorised mobility scooters.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Directed qualitative analysis of up to four semi-structured interviews over the course of the first year of scooter use, to identify themes and sub-themes that could inform recommendations regarding assessment and training protocols.

RESULTS

We identified two themes. The first related to potential new content. As one example of the sub-themes, there were many excerpts that dealt with the use of skills in various combinations and permutations that were used to carry out activities during everyday life and participate in society. These excerpts suggested the importance of training skills in combination to facilitate skill transfer (or generalizability). The second theme is related to enhancements of existing content. As one example of the sub-themes, there were several excerpts that dealt with scooter security. These excerpts led to the recommendation that removing and inserting the scooter key should be added to the assessment criteria for the "turns power on and off" skill of the Wheelchair Skills Test (WST) and its questionnaire version (WST-Q).

CONCLUSIONS

The experiences of scooter users over the first year of receiving a scooter appear to be relevant to the assessment and training of scooter skills and suggest themes for further study. Clinical trial registration number: NCT02696213 IMPLICATIONS FOR REHABILITATIONThe experiences of new scooter users are highly relevant to the assessment and training of scooter skills.These experiences suggest both potential new content and enhancements of existing content to the Wheelchair Skills Program Manual.

Protocol for a randomized controlled trial to assess the effect of Self-Management for Amputee Rehabilitation using Technology (SMART): An online self-management program for individuals with lower limb loss

BACKGROUND

Lower limb loss (LLL) is a distressing experience with psychological, physical, and social challenges. Education is needed to enhance the coping skills and confidence of patients to improve LLL outcomes. However, access to rehabilitation services and education is limited outside of urban centers. To address this service gap, we co-created an eHealth platform, called Self-Management for Amputee Rehabilitation using Technology (SMART).

OBJECTIVES

First, we will test the effect of SMART and usual care compared with usual care only on walking capacity and confidence among individuals with LLL. Second, we will describe key implementation factors for program delivery and adoption at the person- and provider-level.

METHODS

This is a Type 1 Effectiveness-Implementation Hybrid Design, mixed-methods, multi-site (British Columbia and Ontario, Canada), parallel, assessor-blinded randomized controlled trial. Participants will include adults with unilateral LLL, during early prosthetic fitting (<2 years after casting for initial prosthesis). Participants in both groups will receive usual care. The experimental group will receive SMART with weekly support sessions from a trained peer mentor for goal setting and action planning for six weeks. Participants will be encouraged to continue using SMART for an additional four weeks. The control group will receive usual care, and weekly social contacts for six weeks. The primary outcome measure is walking capacity operationalized as the performance based Timed Up and Go test. The secondary outcome is walking confidence using the Ambulatory Self-Confidence Questionnaire. Outcome measures will be assessed at baseline, immediately post-intervention, and four weeks follow-up. We will describe key implementation factors (such as, participant experience, intervention adoption, fidelity) throughout the study using questionnaires, semi-structured interviews, and direct observation.

RESULTS

No participants have been enrolled.

CONCLUSIONS

SMART has the potential to provide knowledge and skill development to augment rehabilitation outcomes for adults with LLL.

TRIAL REGISTRATION

NCT04953364 in Clinical Trial Registry (https://clinicaltrials.gov/).

Social Prescribing Outcomes for Trials (SPOT): Protocol for a modified Delphi study on core outcomes

PURPOSE

This is a study protocol to co-create with knowledge users a core outcome set focused on middle-aged and older adults (40 years+) for use in social prescribing research.

METHODS

We will follow the Core Outcome Measures in Effectiveness Trials (COMET) guide and use modified Delphi methods, including collating outcomes reported in social prescribing publications, online surveys, and discussion with our team to finalize the core outcome set. We intentionally center this work on people who deliver and receive social prescribing and include methods to evaluate collaboration. Our three-part process includes: (1) identifying published systematic reviews on social prescribing for adults to extract reported outcomes; and (2) up to three rounds of online surveys to rate the importance of outcomes for social prescribing. For this part, we will invite people (n = 240) who represent the population experienced in social prescribing, including researchers, members of social prescribing organizations, and people who receive social prescribing and their caregivers. Finally, we will (3) convene a virtual team meeting to discuss and rank the findings and finalize the core outcome set and our knowledge mobilization plan.

CONCLUSION

To our knowledge, this is the first study designed to use a modified Delphi method to co-create core outcomes for social prescribing. Development of a core outcome set contributes to improved knowledge synthesis via consistency in measures and terminology. We aim to develop guidance for future research, and specifically on the use of core outcomes for social prescribing at the person/patient, provider, program, and societal-level.

Patients' and therapists' experience and perception of exoskeleton-based physiotherapy during subacute stroke rehabilitation: a qualitative analysis

PURPOSE

To explore the experience and acceptability of an exoskeleton-based physiotherapy program for non-ambulatory patients during subacute stroke rehabilitation from the perspective of patients and therapists.

MATERIALS AND METHODS

This was a qualitative descriptive study using semi-structured interviews and thematic analysis. Fourteen patients with stroke who participated in the experimental arm of a randomized controlled trial investigating the efficacy of exoskeleton-based physiotherapy were recruited. Six physiotherapists who provided the intervention were also recruited.

RESULTS

Three themes were identified relating to the experience and acceptability of an exoskeleton-based physiotherapy program: (1) A matter of getting into the swing of things depicted the initial and ongoing learning process of using an exoskeleton; (2) More of a positive experience than anything else described the participants' mostly favorable attitude toward exoskeleton-based gait training; and (3) The best step forward captured participant-identified recommendations and considerations for the future integration of exoskeleton training into stroke rehabilitation.

CONCLUSIONS

Patients with stroke were even more optimistic than therapists toward the experience and benefits of exoskeleton-based gait training during subacute stroke rehabilitation. Future clinical practice should consider the balance between actual and perceived benefits, as well as the potential barriers to integrating an exoskeleton into stroke rehabilitation.IMPLICATIONS FOR REHABILITATIONPowered robotic exoskeletons can be used to provide higher duration and more repetitious walking practice for non-ambulatory patients with stroke.Patients with stroke view exoskeleton-based physiotherapy highly favorably, attributing greater opportunity and benefit to using the device during subacute rehabilitation.Physiotherapists should consider learning challenges, patient characteristics, and implementation barriers when integrating exoskeleton-based training within a treatment program.

Modifiable Sociostructural and Environmental Factors That Impact the Health and Quality of Life of People With Spinal Cord Injury: A Scoping Review

Objective

The objective of this scoping review was to identify the modifiable factors that impact the health and quality of life (QOL) of community-dwelling people with spinal cord injury (SCI).

Methods

Empirical journal articles were identified using three academic databases: CINAHL Complete, MEDLINE with Full Text, and PsycINFO. Full-text journal articlesincluded studies of participants who were community-dwelling with traumatic or nontraumatic SCI and were over the age of 18 years without cognitive impairment; published between 2000 and 2021; focused on modifiable factors impacting health and QOL; and conducted inAustralia, Europe, orNorth America. A data table was used to extract article information including authors, year of publication, country, sample, design and methods, purpose/objectives, and main findings. Qualitative data analysis software was used to categorize major findings inductively through content analysis.

Results

Thirty-one peer-reviewed articles consisting of qualitive, quantitative, and mixed-methods study design were included. This scoping review revealed modifiable factors that impact the health and QOL of community-dwelling people with SCI: sociostructural factors (social attitudes, health care access, information access, and funding and policies) and environmental factors (built environment, housing, transportation, assistive technology, and natural environment).

Conclusion

Future research should examine the influence of the modifiable factors on health and QOL using qualitative inquiry, adopting a community-based participatory research approach, and considering the implications of individual characteristics and resources.

A systematic review of systematic reviews of needs of family caregivers of older adults with dementia

Family caregivers provide vital assistance to older adults living with dementia. An accurate assessment of the needs of caregivers supports the development and provision of appropriate solutions to address these needs. This review of systematic reviews analyzes and synthesizes the needs identified by family caregivers. We conducted a systematic review of systematic reviews using the AMSTAR guideline. Electronic databases were searched for systematic reviews on the needs of caregivers in the context of dementia using a combination of keywords and medical subject headings. Records resulting from the search were screened by two reviewers. Data on the needs of caregivers were extracted from the articles and analyzed using a narrative synthesis approach. Out of the 17 potentially eligible systematic reviews obtained initially, 6 met the inclusion criteria. In total, 20 main needs were identified in the reviews included in this study. The need for information and social support were prominent in this review. Factors such as gender, resources available to the caregiver and the care recipient's health status may influence caregivers' needs. Interventions can be tailored toward addressing the most prominent needs of caregivers such as adequate information and resources and available programs may further accommodate and offer need-tailored support to them.

Living in a reshaped reality: Exploring social participation and self-identity after TBI

Individuals with a moderate to severe traumatic brain injury (TBI) experience substantial changes in their life. This constructivist grounded theory study aimed to develop an explanatory model that explores the impact of changes in social participation and self-identity after sustaining a TBI. Sixteen participants with moderate to severe TBI (mean age = 49.8, 69% male) were recruited, and were on average 16.4 years post-injury (SD = 10.4). Data from semi-structured interviews were analysed thematically. An overarching theme of "living in a reshaped reality" was identified, which depicted how changes in social participation and self-identity influenced ongoing experiences with TBI. Three main themes were generated: (1) "there's nothing that's the same" highlighted the daily challenges individuals faced post-injury, (2) "rebuilding and restarting" described how individuals with TBI navigated through their unfamiliar reality, and (3) "embrace it and run with it" explored participants' reactions towards life with a TBI. An explanatory model was developed, consisting of the overarching theme ("living in a reshaped reality") with the three integrated themes. Future research and clinical practices can build on this understanding to develop programmes to help individuals address their needs in post-injury life.

What If Deliberately Dying Is an Occupation?

In some legal and societal circumstances, people freely and capably plan, organize, and precipitate their own death. Drawing on published literature, we critically reflect on how deliberately ending one's own life fits with the current definitions of the concept of occupation. Using an occupational science and occupational therapy theoretical reflection, we argue that deliberately dying can for some people be considered a purposeful and meaningful occupation. Implications for such an occupational therapy practice are discussed: attending to the occupational needs of specific groups of people, reconsidering definitions and conceptual work, advocating for occupational justice in ending life activities, reflecting on ethical conundrums around self-harm activities within the scope of practice, and exploring deliberate death as a purposeful and meaningful occupation. Because deliberately dying is something that some people do, in this article we aim to open a dialogue within the field of occupational science and occupational therapy about this sensitive and potentially controversial issue.

Knowledge, Attitudes, and Practice of Pelvic Floor Muscle Training in People With Spinal Cord Injury: A Cross-Sectional Survey

BACKGROUND

There is emerging evidence that pelvic floor muscle training (PFMT) may be useful for treating some urogenital conditions in people with spinal cord injury (SCI). Future clinical investigations would benefit from understanding the extent to which people with SCI are aware of and practicing PFMT, and their attitude toward this therapy.

OBJECTIVE

The goal of this study was to assess the knowledge, attitudes, and practices related to PFMT among people with SCI.

METHODS

We distributed an internet survey internationally via SCI related organizations for 2 months. We used descriptive statistics to summarize each survey item, and Chi-square and Mann-Whitney U tests to explore the differences in results between sexes and level of motor-function.

RESULTS

Complete data from 153 respondents were analyzed. Sixty-two percent of respondents were female and 71% reported having complete paralysis. More than half of respondents reported being aware of PFMT (63%); more females than males reported knowledge of PFMT (p = 0.010). Females (p = 0.052) and people with partial paralysis (p = 0.008) reported a stronger belief that they would benefit from PFMT. Few people with SCI had practiced PFMT (20%), and of those who practiced, most of them had SCI resulting in partial paralysis (p = 0.023).

CONCLUSIONS

While people with SCI may be aware of and have favorable attitudes toward PFMT, few had practiced PFMT and there were notable differences in attitudes toward PFMT depending on the sex and level of motor function of the respondents.

'Make the Most of the Situation'. Older Adults' Experiences during COVID-19: A Longitudinal, Qualitative Study

The COVID-19 pandemic restrictions have been associated with increased social isolation and reduced participation in older adults. This longitudinal qualitative study drew on life course theory to analyse data from a series of four sequential semi-structured interviews conducted between May 2020-February 2021 with adults aged 65+ (n = 12) to explore older adults' experiences adjusting to the COVID-19 pandemic. We identified three themes: (1) Struggling 'You realize how much you lost' describes how older adults lost freedoms, social connections and activities; (2) Adapting 'whatever happens, happens, I'll do my best', revealing how older adults tried to maintain well-being, participation and connection; and (3) Appreciating 'enjoy what you have', exploring how older adults found pleasure and contentment. Engagement in meaningful activities and high-quality social interactions supported well-being during the COVID-19 pandemic for older adults. This finding highlights the need for policies and services to promote engagement during longstanding global crises.

Providing Accessible ReCreation Outdoors-User-driven Research on Standards: Mobile and virtual interviews for winter assessments (Preprint)

Background

Although there have been recent efforts to improve access to Canadian national parks, many remain not fully accessible to people with disabilities. Winter conditions, in particular, present challenges that limit their participation in outdoor activities.

Objective

This study aimed to develop a novel method to assess park access during winter, which will inform recommendations for national park standards to meet the needs of all park visitors (regardless of ability) during winter conditions.

Methods

A larger participatory mixed methods research project exploring park access was adapted. A 3-phase approach has already been proposed to achieve the study objectives. In the first phase, a scoping review of the existing accessibility standards will be conducted. In the second phase, objective audits of trails and features in 6 parks, 3 in western Canada and 3 in eastern Canada, will be conducted, as well as mobile interviews with 24 various participants in each region regarding their experiences of and recommendations for improving the park’s accessibility. In the final phase, a Delphi participatory consensus development process will be used, based on the data gathered in the first 2 phases, to prioritize recommendations for standards. This paper will focus on the second phase of the study, specifically on whether the in-person winter mobile interviews (ie, walking and wheeling interviews) with people who have a wide range of disabilities while visiting 3 parks in 2 provinces were modified. Changes were made to accommodate the extreme winter weather conditions in Quebec while using safe and informative data collection methods.

Results

In Quebec, one park, where winter conditions are safer, has been assessed in person (n=4). Web-based interviews were used to facilitate the assessment of other winter and summer conditions in two other parks (n=8). Winter and web-based interviews were completed in April 2022. Data are currently being collected and analyzed, and results will be completed by December 2022.

Conclusions

We expect that adapting the protocol to gather further information on winter conditions and access to parks will provide high-quality and rich data to better inform park access standards. This participatory mixed methods research will inform the development of park standards that consider the accessibility needs of all people.

International Registered Report Identifier (IRRID)

DERR1-10.2196/38715

The COVID-19 Pandemic Related Lived Experiences of Individuals With a Spinal Cord Injury/Disease

Introduction

COVID-19 related restrictions and recommendations have impacted everyone. Those living with a disability, such as individuals with a spinal cord injury (SCI), may have had pandemic related changes made yet more challenging by societal failures to accommodate their mobility, physical abilities, and health care needs. To better understand participants experiences we drew upon Heidegger's phenomenology and the mobilities paradigm. The objective of this study was to explore COVID-19 pandemic related lived-experiences of individuals with an SCI.

Materials and Methods

This study used an interpretive phenomenological methodology. Semi-structured interviews were the primary means of data collection. These were conducting in May and June of 2020, roughly 2–3 months into the pandemic. Transcript data were analyzed using a phenomenological methodology.

Results

We interviewed 22 participants with SCI, the mean age was 54 years, and nine were females. We identified three themes: (1) Experiencing changes to mobility and daily life described how new rules had impacted everyday life and usual routines, particularly in regard to mobility. (2) Struggling with new challenges explored some of the negative experiences of the pandemic. (3) Being resilient in the face of a new normal conveyed the resilience participants exhibited despite challenges.

Conclusion

Although our findings indicate some positive changes and highlight the strengths that many individuals with SCI have, they also accentuate issues with ableism within the medical system. Certain changes were made primarily because people without disabilities needed them, and several COVID-19 changes were made without consulting individuals with disabilities. With physical movement restricted, our findings emphasize the importance of the movement of information and a need for increased dialogue with people in the SCI community about their ongoing pandemic related needs.

Predictors of Psychological Distress and Confidence Negotiating Physical and Social Environments Among Mobility Device Users

OBJECTIVE

We conducted an intersectional analysis to explore how demographic characteristics and mobility device use were associated with psychological distress (depression and anxiety) and confidence negotiating physical and social environments.

DESIGN

Cross-sectional data were collected using the Hospital Anxiety and Depression Scale, modified Wheelchair Use Confidence Scale, and self-reported functional independence scale.

PARTICIPANTS

The sample included 105 participants. Primary mobility devices used included mobility scooters (27%), power wheelchairs (26%), manual wheelchairs (25%), walkers (11%), and cane or crutch (12%). The mean age of participants was 58 yrs, 53% were female, and 52% lived alone and were functionally independent with the use of assistive technology.

RESULTS

We were able to explain between 39% and 65% of the variance (adjusted R2) in the dependent variables with parsimonious regression models. Age was an independent predictor of all outcomes. Women were less confident negotiating the physical environment, and walker use was associated with depression and lower confidence negotiating physical environments, but increased confidence negotiating social environments.

CONCLUSIONS

Age is associated with psychosocial outcomes for assistive device users, and those who use walkers may experience increased challenges with depression and negotiating the physical environment. Pending confirmatory research, the findings may have important implications for targeted interventions related to device provision.

Providing Accessible Recreation Outdoors—User-Driven Research on Standards (PARCOURS): Protocol for a Multiphase Study

Background

Canada’s national parks are world-renowned. However, despite recent attempts to improve access, many are not accessible to people with disabilities. With the advent of provincial and federal legislation, standards are being developed to assist with the design and management of parks.

Objective

The overarching objective of this study is to inform accessibility standards for federal parks that meet the needs of all park visitors, regardless of ability. The specific objectives of this study are to identify park accessibility standards that exist internationally, identify the accessibility challenges that people with disabilities face in park environments, and prioritize and recommend accessibility standards for national parks.

Methods

A 3-phase approach will be used to achieve the study objectives. In the first phase, a scoping review of the existing accessibility standards will be conducted. The second phase will include objective audits of trails and features in 6 parks, 3 in western Canada and 3 in eastern Canada, as well as mobile interviews with 24 diverse participants in each region regarding their experiences of and recommendations for improving the park’s accessibility. In the final phase, a Delphi participatory consensus development process will be used, based on the data gathered in the first 2 phases, to prioritize recommendations for standards.

Results

We expect to find gaps in existing standards that do not account for the diverse range of accessibility requirements that people with disabilities have for visiting parks. We also expect to find that existing standards, on their own, may not be enough to ensure equitable access to all the experiences and amenities that parks have to offer. Development of subsequent guidelines and best practices may be necessary to address complex scenarios for which standards may not be the best approach to ensuring accessibility.

Conclusions

The participatory and mixed methods approaches used in this study will provide rich insights for developing accessible park standards that consider the diverse needs of people with disabilities. The findings will also support the development or enhancement of park standards at all levels of government.

International Registered Report Identifier (IRRID)

DERR1-10.2196/33611

Patient perspectives and self-rated knowledge of nerve transfer surgery for restoring upper limb function in spinal cord injury

BACKGROUND

Nerve transfer surgery has the potential to restore upper limb function in patients with spinal cord injury (SCI); however, there has been limited exploration of patient perception of nerve transfer.

OBJECTIVE

To explore the perspectives of patients with chronic SCI (>2 years from injury) on nerve transfer surgery, and to determine if an educational intervention improved participants' perceived knowledge levels about the procedure.

DESIGN

Mixed-methods study including qualitative semi-structured interviews and self-reported rating scales. Pre- and post-interviews were completed following an educational presentation.

SETTING

Two local SCI clinics.

PARTICIPANTS

Ten patients with chronic traumatic SCI and neurological level of injury C3-C7 (motor complete or incomplete), recruited via snowball sampling (six male, four female).

INTERVENTION

An educational slide presentation on nerve transfer concepts.

MAIN OUTCOME MEASURES

The primary study outcome measure is the participants' responses to interview questions. The secondary study outcome measure is their self-reported knowledge levels of nerve transfer before and after education.

RESULTS

Regaining upper limb function was a priority for all participants. Although most participants had heard of nerve transfer, none were offered it at the time of their SCI, and only two stated that they had any peers who had undergone the procedure. The educational module significantly increased self-rated scores on understanding of nerve transfer (p < .05). Although all participants were open to nerve transfer after the educational module, they described weighing different factors, including (1) potential for loss versus gain of function, (2) inadequate knowledge about nerve transfer, (3) recovery time, and (4) determining their eligibility for the surgery.

CONCLUSIONS

These findings suggest that people with SCI have limited understanding of nerve transfer as a potential option and would benefit from educational opportunities to help them make informed decisions. This study may inform the development of patient resources to improve pre-surgical consultation and informed decision-making.

Virtual Arm Boot Camp (V-ABC): study protocol for a mixed-methods study to increase upper limb recovery after stroke with an intensive program coupled with a grasp count device

Background

Encouraging upper limb use and increasing intensity of practice in rehabilitation are two important goals for optimizing upper limb recovery post stroke. Feedback from novel wearable sensors may influence practice behaviour to promote achieving these goals. A wearable sensor can potentially be used in conjunction with a virtually monitored home program for greater patient convenience, or due to restrictions that preclude in-person visits, such as COVID-19. This trial aims to (1) determine the efficacy of a virtual behaviour change program that relies on feedback from a custom wearable sensor to increase use and function of the upper limb post stroke; and (2) explore the experiences and perceptions of using a program coupled with wearable sensors to increase arm use from the perspective of people with stroke.

Methods

This mixed-methods study will utilize a prospective controlled trial with random allocation to immediate or 3-week delayed entry to determine the efficacy of a 3-week behaviour change program with a nested qualitative description study. The intervention, the Virtual Arm Boot Camp (V-ABC) features feedback from a wearable device, which is intended to increase upper limb use post stroke, as well as 6 virtual sessions with a therapist. Sixty-four adults within 1-year post stroke onset will be recruited from seven rehabilitation centres. All outcomes will be collected virtually. The primary outcome measure is upper limb use measured by grasp counts over 3 days from the wearable sensor (TENZR) after the 3-week intervention. Secondary outcomes include upper limb function (Arm Capacity and Movement Test) and self-reported function (Hand Function and Strength subscale from the Stroke Impact Scale). Outcome data will be collected at baseline, post-intervention and at 2 months retention. The qualitative component will explore the experiences and acceptability of using a home program with a wearable sensor for increasing arm use from the point of view of individuals with stroke. Semi-structured interviews will be conducted with participants after they have experienced the intervention. Qualitative data will be analysed using content analysis.

Discussion

This study will provide novel information regarding the efficacy and acceptability of virtually delivered programs to improve upper extremity recovery, and the use of wearable sensors to assist with behaviour change.

Trial registration

ClinicalTrials.govNCT04232163. January 18, 2020.

Expectations of a Health-Related Mobile Self-Management App Intervention Among Individuals With Spinal Cord Injury

Background

Our research team developed a mobile application (app) to facilitate health-related self-management behaviors for secondary conditions among individuals with spinal cord injury (SCI). To facilitate mobile app adoption and ongoing use into the community, it is important to understand potential users' expectations and needs.

Objectives

The primary objective of this study was to explore user expectations of a mobile app intervention designed to facilitate self-management behavior among individuals with SCI.

Methods

Data were collected via one-on-one, semi-structured interviews with a subsample of 20 community-dwelling participants enrolled in a larger, clinical trial. Analysis of the transcripts was undertaken using a six-phase process of thematic analysis.

Results

Our analysis identified three main themes for expectations of the mobile app intervention. The first theme, desiring better health outcomes, identified participants' expectation of being able to improve their psychological, behavioral, and physical health outcomes and reduce associated secondary conditions. The second theme, wanting to learn about the mobile app's potential, identified participants' interest in exploring the functionality of the app and its ability to promote new experiences in health management. The third theme, desiring greater personal autonomy and social participation, identified participants' desire to improve their understanding of their health and the expectation for the app to facilitate social engagement with others in the community.

Conclusion

By exploring end-users' expectations, these findings may have short-term effects on improving continued mobile health app use among SCI populations and long-term effects on informing future development of mobile app interventions among chronic disease populations.

Barriers and Facilitators to eHealth Technology Use Among Community-Dwelling Individuals With Spinal Cord Injury: A Qualitative Study

Background

As eHealth technologies become a more prevalent means to access care and self-manage health, it is important to identify the unique facilitators and barriers to their use. Few studies have evaluated the use or potential use of eHealth technologies in spinal cord injury (SCI) populations.

Objectives

The primary objective of this study was to explore and identify barriers and facilitators to engagement with eHealth technologies among individuals with SCI.

Methods

A qualitative descriptive study was conducted. Data were collected via one-on-one, semi-structured interviews with a subsample of 20 community-dwelling participants enrolled in a larger clinical trial. Analysis of the transcripts was undertaken using a four-phase process of content analysis.

Results

Our analysis identified three barriers to engagement with eHealth technologies, including (1) overcoming a digital divide to comprehending and utilizing eHealth technologies, (2) navigating internet resources that provide too much information, and (3) interacting with these technologies despite having limited hand function. Our analysis also identified three facilitators to using eHealth technologies, including (1) having previous successful experiences with eHealth technologies, (2) being able to use voice activation features, and (3) being able to interact in an online community network.

Conclusion

By exploring barriers and facilitators to eHealth technology use, these findings may have a short-term impact on informing researchers and clinicians on important factors affecting engagement of individuals with SCI with telemedicine, mobile, and web applications (apps) and a long-term impact on informing future development of eHealth interventions and tools among chronic disease populations.

Prevalence of Walking Limitation After Acute Stroke and Its Impact on Discharge to Home

OBJECTIVE

The purpose of this study was to provide contemporary estimates of the prevalence of lower extremity motor impairment and walking limitation after first-ever stroke and to characterize the predictive nature of early walking ability for being discharged home after acute hospitalization.

METHODS

In this cohort study, data were collected from a metropolitan acute care hospital in Canada at admission for 487 adults with first-ever acute ischemic or hemorrhagic stroke. Lower extremity motor impairment and walking limitation were measured using the National Institutes of Health Stroke Scale and AlphaFIM, respectively. Parallel multivariable logistic regression models were built to predict discharge home after acute hospitalization compared with further hospitalization.

RESULTS

For patients surviving a first-ever stroke, 44.1% presented with some degree of lower extremity motor impairment and 46.0% were unable to walk. In a multivariable model built around a binary classification of walking (Nagelkerke R2 = 0.41), those with any ability to walk at admission (with or without therapist assistance) had 9.48 times greater odds of being discharged home (odds ratio = 9.48, 95% CI = 6.11-14.92) than those who were unable. In a parallel multivariable model built around an ordinal classification of walking (Nagelkerke R2 = 0.49), patients had 2.07 times greater odds (odds ratio = 2.07, 95% CI = 1.82-2.38) of being discharged home for each increment on a 6-point walking scale (total dependence to complete independence) assessed at acute admission.

CONCLUSION

Approximately one-half of patients with first-ever stroke present with lower extremity weakness and walking limitation. Early walking ability is a significant predictor of returning home after acute hospitalization, independent of stroke severity. Discharge planning may be facilitated early after stroke with the familiar assessment of walking ability.

IMPACT

An early assessment of walking function within days of stroke admission can help to streamline discharge planning.

LAY SUMMARY

Nearly one-half of all individuals who experience a first-time stroke have walking difficulty when they arrive at the hospital. The severity of the walking limitation can predict whether a patient will eventually be discharged home or go on to further hospitalization.

Efficacy of an exoskeleton-based physical therapy program for non-ambulatory patients during subacute stroke rehabilitation: a randomized controlled trial

BACKGROUND

Individuals requiring greater physical assistance to practice walking complete fewer steps in physical therapy during subacute stroke rehabilitation. Powered exoskeletons have been developed to allow repetitious overground gait training for individuals with lower limb weakness. The objective of this study was to determine the efficacy of exoskeleton-based physical therapy training during subacute rehabilitation for walking recovery in non-ambulatory patients with stroke.

METHODS

An assessor-blinded randomized controlled trial was conducted at 3 inpatient rehabilitation hospitals. Patients with subacute stroke (< 3 months) who were unable to walk without substantial assistance (Functional Ambulation Category rating of 0 or 1) were randomly assigned to receive exoskeleton-based or standard physical therapy during rehabilitation, until discharge or a maximum of 8 weeks. The experimental protocol replaced 75% of standard physical therapy sessions with individualized exoskeleton-based sessions to increase standing and stepping repetition, with the possibility of weaning off the device. The primary outcome was walking ability, measured using the Functional Ambulation Category. Secondary outcomes were gait speed, distance walked on the 6-Minute Walk Test, days to achieve unassisted gait, lower extremity motor function (Fugl-Meyer Assessment), Berg Balance Scale, Patient Health Questionnaire, Montreal Cognitive Assessment, and 36-Item Short Form Survey, measured post-intervention and after 6 months.

RESULTS

Thirty-six patients with stroke (mean 39 days post-stroke) were randomized (Exoskeleton = 19, Usual Care = 17). On intention-to-treat analysis, no significant between-group differences were found in the primary or secondary outcomes at post-intervention or after 6 months. Five participants randomized to the Exoskeleton group did not receive the protocol as planned and thus exploratory as-treated and per-protocol analyses were undertaken. The as-treated analysis found that those adhering to exoskeleton-based physical therapy regained independent walking earlier (p = 0.03) and had greater gait speed (p = 0.04) and 6MWT (p = 0.03) at 6 months; however, these differences were not significant in the per-protocol analysis. No serious adverse events were reported.

CONCLUSIONS

This study found that exoskeleton-based physical therapy does not result in greater improvements in walking independence than standard care but can be safely administered at no detriment to patient outcomes. Clinical Trial Registration The Exoskeleton for post-Stroke Recovery of Ambulation (ExStRA) trial was registered at ClinicalTrials.gov (NCT02995265, first registered: December 16, 2016).