Perception of COVID-19 Impact on Canadian Occupational Therapy Curricula: Academic and Fieldwork.

Background. Delivery of occupational therapy education programs in Canada faced significant disruptions and adaptations because of the COVID-19 pandemic. Curriculum changes were made rapidly under extreme conditions. Purpose. To document and explore changes to curricula (academic and fieldwork), instructional, and assessment methods implemented by Canadian occupational therapy programs in response to the pandemic and capture their perceived impact on student learning. Method. This convergent mixed method design study employed a cross-sectional descriptive survey followed by a member check focus group. Participant recruitment targeted Canadian occupational therapy university program directors, curriculum chairs, and fieldwork coordinators. Findings. Results highlight curriculum modifications included shifting from in-person to online delivery and re-sequencing or deferring in-person components. Fieldwork placements were similarly affected and included adoption of simulations and telepractice. Implications. The development of interpersonal "soft skills" are perceived as being the most disrupted, but the impact of student learning on actual practice is not yet known.

Learner Drawings of Interprofessional Education and Collaborative Practice: An Exploratory, Arts-Based Interview Study.

Interprofessional education and collaborative practice (IPECP) is a concept that supports the theory-to-practice transition of health professional students. Aligning with the global research priorities on building the science and scholarship through innovative evidence-informed strategies, the benefits of understanding stakeholder perspectives, notably learners, were considered an asset for this project. Informed by intergroup contact theory, this exploratory case study sought to gain insight into what perspectives and experiences rehabilitation medicine students encounter throughout their program that impacted their collaborative learning and practice experiences. The aim of this exploratory case study was to gain insight into learner perspectives in order to better inform how interprofessional education and practice is both taught and applied. The analysis of the drawings and interviews resulted in three themes: 1) Situate your client as an active member of the team; 2) Share professional perspectives across your team; and 3) Create team supports that are context specific. A thematic model using client engagement, team connectedness, and context-specific support was offered to describe how the emerging themes contribute to the socialization of health professionals within IPECP. In such a way, this study contributes to the body of literature by focusing on the student perspective. Additionally, it aims to contribute to methods used in interprofessional interview-based literature by using unique learner-driven drawings to elicit personal reflections of collaborative learning. The findings resulted in understanding the social impacts involving client engagement, team connectedness, and context-specific support.

Validity and reliability of the Musicians' Health Literacy Questionnaire, MHL-Q19.

High prevalence of musicians' physical and mental performance-related health issues (PRHI) has been demonstrated over the last 30 years. To address this, health promotion strategies have been implemented at some post-secondary music institutions around the world, yet the high prevalence of PRHI has persisted. In 2018, an international group of researchers formed the Musicians' Health Literacy Consortium to determine how best to decrease PRHI, and to examine the relationship between PRHI and health literacy. An outcome of the Consortium was the development of a new health literacy tool for musicians, the MHL-Q19, which drew from the theoretical framework of the European health literacy suite of tools, HLS-EU. The aim of the current study was to evaluate the validity and reliability of the MHL-Q19. Participants completed a battery of questionnaires, including the HLS-EU-Q16 for the assessment of general health literacy; the Musculoskeletal Pain Intensity and Interference Questionnaire for Musicians (MPIIQM); the RAND-12 quality of life questionnaire; and the General Self-Efficacy scale (GSE). We hypothesized that the MHL-Q19 would have a weak correlation with the HLS-EU-Q16; moderate correlation with the physical component scale and weak correlation with the mental component scale of the RAND-12; moderate correlation with the GSE; and finally, moderate correlation with pain interference and weak correlation with pain intensity of the MPIIQM. A total of 549 post-secondary music students from six English-speaking countries completed the battery of questionnaires, and 328 of these participants provided valid responses to the MHL-Q19 alone 2 weeks later. The tool showed acceptable internal consistency and test-retest reliability. Three of our hypotheses were supported, although the strength of the correlations varied from what we had predicted. The fourth hypothesis was not supported; our findings indicate that lower health literacy scores were weakly related to higher MPIIQM pain intensity and interference scores. The results of this study support the notion that musicians' health literacy is a distinct construct that cannot be fully evaluated with existing health literacy tools. Given that this is a new instrument, the evidence presented is positive and promising. Further studies will be needed to refine the tool.

Mental health, coping strategies, and social support among international students at a Canadian university.

Objective. This study aimed to explore the mental health status, coping strategies, and social support of international students in Canada. Participants. Undergraduate and graduate international students studying at one Canadian university participated in an online survey. Methods. The survey consisting of four assessments-the Mental Health Continuum-Short Form, Kessler Psychological Distress Scale, the Carver Brief-Cope Inventory, and the Multidimensional Scale of Perceived Social Support-was distributed during the winter and spring terms of 2020. Results. Of the 338 participants from 53 countries, 76% demonstrated optimal mental health without mental disorders; 86% used approach coping strategies. Those who are women, married, and Ph.D. students showed better mental health and lower psychological distress. Coping skills and social support significantly predict participants' psychological distress and subjective well-being. Conclusions. This study findings address the gaps in meeting the mental health needs of international students and raise awareness of this population's unique mental health status.

Alberta Rating Index for Apps: Study of Reliability and Validity.

Background. The number of mobile health applications is rapidly increasing, yet no reliable tool exists for occupational therapists and their clients to rate the quality of these apps. Purpose. To develop the Alberta Rating Index for Apps (ARIA). Methods. Through a sequential design in three phases, we developed a rating index for mobile health applications and examined its reliability and validity with 10 participants. Findings. The coefficients of reliability were 0.95 for occupational therapists, 0.60 for older adults, and 0.88 for adults with a mental health condition. ARIA's correlation with another scale used in app review studies, U-MARS, was low to moderate. Implications. ARIA showed a high inter-rater reliability in two of the three user groups. ARIA is comprehensive and includes criteria not captured by U-MARS, such as privacy and security. Further studies are warranted with diverse raters and health apps.

Measuring therapeutic relationship in physiotherapy: conceptual foundations.

The "therapeutic relationship" in physiotherapy refers to the beneficial or healing relationship between the patient and physiotherapist. Interest in researching therapeutic relationships in physiotherapy is growing and there is a need for a measure of therapeutic relationship with a strong conceptual foundation. Body of paper:We begin with a general discussion of the state of therapeutic relationship measurement in physiotherapy research - notably, how current research is based on measures borrowed and adapted from psychotherapy. Then, we introduce Miciak's physiotherapy therapeutic relationship framework, discuss why it offers a solid foundation for measurement development, and describe the key concepts in the framework. We then discuss various approaches to measuring therapeutic relationship, illustrating how Miciak's framework could be used to inform their development. We end by discussing current challenges in measuring therapeutic relationship and how these could be addressed.

Exploring the Educational Impact of Using a Single-Point Rubric Through Validation in Interprofessional Education.

There have been few studies regarding the impact on inter¬professional education (IPE) assessments and instruments to support learning and teaching. In this study, a single-point rubric was developed and evaluated to explore its educational impact on supporting learning and teaching. The research question was: To what degree does the single-point rubric support student learning and assist facilitators in developing feedback within the context of IPE? We tested the single-point rubric in the assessments within both interprofessional (IP) foundational and elective courses. One hundred eighty-seven rubrics across two IP courses were completed and collected. Of the 49 students and 17 facilitators who responded to the surveys, 3 students and 5 facilitators completed follow-up interviews. Two of the foundational course developers also participated in interviews. Kane's validity framework guided the validation process. Results showed that facilitators used the single-point rubric to provide structured and potentially helpful feedback. Students agreed with the feedback and could efficiently identify the strengths and weaknesses of their performance from the feedback. Students could use the suggestions from facilitators and their own engagement with the feedback to improve future IP learning. However, some facilitators did not provide students with suggestions for improvement, perhaps because they felt that they were not experienced enough to provide suggestions. Additional training is essential for facilitators to learn how to provide suggestions for improvement. The overall educational impact of the single-point rubric is positive, but future investigation with a larger sample size is required.

A Rasch analysis of the lumbar spine instability questionnaire.

Purpose: A 2014 study found that the Lumbar Spine Instability questionnaire predicts response to two different types of exercise therapy. This is the first decision tool that has predicted response to exercise for chronic low back pain. The objective of this study was to evaluate the Lumbar Spine Instability questionnaire using Rasch analysis. Methods: Baseline data from patients included in a randomized controlled trial with chronic non-specific low back pain were included. Rasch Measurement Theory was used to assess the ordering of items along a common scale, data-to-model fit, Person Separation Index, unidimensionality and Differential Item Functioning. Results: Responses from 172 patients (102 females) underwent Rasch analysis. All Lumbar Spine Instability questionnaire items had fit residuals between ± 2.5 and Chi-Square values were non-significant with Bonferroni corrections. The Lumbar Spine Instability questionnaire demonstrated a Person Separation Index of 0.64, which is below the recommended cut-off of 0.7. Differential Item Functioning by different pain levels was identified for one item. Conclusion: The Lumbar Spine Instability questionnaire was found to be unidimensional, suggesting that the use of a summary score is appropriate. However, the low Person Separation Index value suggests that more items may be needed to increase the questionnaire's ability to discriminate among individuals with high and low clinical instability.

Immersive Virtual Reality for the Reduction of State Anxiety in Clinical Interview Exams: Prospective Cohort Study.

BACKGROUND: Immersive virtual reality (VR) with head-mounted display was used to determine if clinical interview simulation could reduce the anxiety levels of first-year occupational therapy (OT) students as they prepared for upcoming Objective Structured Clinical Examinations (OSCEs). Anxiety among health science students is a potential problem that may diminish their performance during OSCEs. This investigation aimed to fill the gap in the literature regarding the effectiveness of VR to reduce anxiety in OT students. OBJECTIVE: This investigation aimed to uncover the effectiveness of immersive VR in reducing state anxiety in OT students who were preparing for OSCEs. METHODS: A prospective, experimental, nonrandomized controlled trial compared levels of state anxiety, test anxiety, and academic self-efficacy in two groups of first-year OT students; these levels were measured at four different time points by self-reported psychometric scales, analyzed with a mixed factorial analysis of variance (ANOVA). Members of Phase 1 (NoVR) were not exposed to the VR simulation and acted as a control group for members of Phase 2 (YesVR), who were exposed to the VR simulation. VR simulation featured a virtual clinic and a standardized patient who students could interview in natural language. Measures of student study strategies and previous experience with VR were also recorded. RESULTS: A total of 49 participants-29 in the NoVR group and 20 in the YesVR group-showed that state anxiety had a rise-then-fall trend, peaking at the time point just before the OSCE. At that point, the YesVR students showed significantly less state anxiety than did the NoVR students (t46.19=2.34, P=.02, Cohen d=0.65, ηp2=0.105). The mean difference was 6.78 units (95% CI 0.96-12.61). In similar trends for both groups, student test anxiety remained relatively static across the time points, while academic self-efficacy continually increased. A moderate positive correlation was found for total time spent studying and peak state anxiety (NoVR r=.46, n=28, P=.01; YesVR r=.52, n=19, P=.02). CONCLUSIONS: This investigation shows evidence of immersive VR's capability to reduce state anxiety in OT students preparing for clinical practical exams. Immersive VR simulation, used for the reduction of anxiety in health science students, can potentially lead to a future of positive mental health change from the virtual to the real world.

An Asthma Specialist's Consult Letter: What Do Parents Think About Receiving a Copy?

OBJECTIVE: Written summaries about visits with general practitioners' have influenced increased patient knowledge, satisfaction, recollection, and compliance, and strengthened the doctor-patient relationship. All previous studies about this communication pre-dated the electronic medical record (EMR) era, and none examined views from parents of children with asthma. We explored parents' perceptions about receiving a hard copy summary Letter immediately following the visit, with the pediatric asthma specialist about findings and the care plan for their child. METHODS: A Parent Advisory Council helped inform this pilot study, an observational cross-sectional electronic survey. Each Letter included a comprehensive summary of the child's visit with the specialist. RESULTS: Previous findings from patients about the benefits of receiving this Letter were strongly supported by data from 51 participants. Interestingly, more than 54% of respondents preferred receiving a hard copy Letter over an electronic copy, and 98% wanted other clinicians to adopt this practice. CONCLUSION: Parents of children with asthma value and want timely written information of this nature from other clinicians. PRACTICE IMPLICATIONS: These results can influence further asthma research to promote a change in the perceptions of clinicians, parents, and patients about timely access to health information in the EMR era.

Exploring assessor cognition as a source of score variability in a performance assessment of practice-based competencies.

BACKGROUND: A common feature of performance assessments is the use of human assessors to render judgements on student performance. From a measurement perspective, variability among assessors when assessing students may be viewed as a concern because it negatively impacts score reliability and validity. However, from a contextual perspective, variability among assessors is considered both meaningful and expected. A qualitative examination of assessor cognition when assessing student performance can assist in exploring what components are amenable to improvement through enhanced rater training, and the extent of variability when viewing assessors as contributing their individual expertise. Therefore, the purpose of this study was to explore assessor cognition as a source of score variability in a performance assessment of practice-based competencies. METHOD: A mixed-method sequential explanatory study design was used where findings from the qualitative strand assisted in the interpretation of results from the quantitative strand. Scores from one objective structured clinical examination (OSCE) were obtained for 95 occupational therapy students. Two Generalizability studies were conducted to examine the relative contribution of assessors as a source of score variability and to estimate the reliability of domain and holistic scores. Think-aloud interviews were conducted with eight participants assessing a subset of student performances from the OSCE in which they participated. Findings from the analysis of think-aloud data and consideration of assessors' background characteristics were used to assist in the interpretation of variance component estimates involving assessors, and score reliability. RESULTS: Results from two generalizability analyses indicated the highest-order interaction-error term involving assessors accounted for the second-highest proportion of variance, after student variation. Score reliability was higher in the holistic vs. analytic scoring framework. Verbal analysis of assessors' think-aloud interviews provided evidential support for the quantitative results. CONCLUSIONS: This study provides insight into the nature and extent of assessor variability during a performance assessment of practice-based competencies. Study findings are interpretable from the measurement and contextual perspectives on assessor cognition. An integrated understanding is important to elucidate the meaning underlying the numerical score because the defensibility of inferences made about students' proficiencies rely on score quality, which in turn relies on expert judgements.

Community pharmacists' clinical reasoning: a protocol analysis.

Background There are two fundamental approaches to clinical reasoning, intuitive and analytical. These approaches have yet to be well explored to describe how pharmacists make decisions to determine medication appropriateness. Objective (1) to identify the cognitive actions (i.e., operators) that pharmacists employ when they move from one cue (i.e., concept) to another, and (2) to describe the overall clinical reasoning approach taken by pharmacists when checking for medication appropriateness. Setting Pharmacists from a chain pharmacy in Canada were invited to participate in this study. Method Data was collected in private rooms using video recordings to capture simulated patient-pharmacist interactions of a new prescription medication. A simulated case scenario was used to gather two types of verbal reports, concurrent think-aloud and structured retrospective think-aloud from pharmacists. All verbal reports were video-recorded, transcribed verbatim, and analyzed using protocol analysis. Main outcome measure Pharmacists' reasoning approaches when making medication appropriateness decisions. Results A total of 17 pharmacists participated. Pharmacists were most likely to use analytical clinical reasoning approaches when checking prescriptions and three used no clinical reasoning. When the pharmacists were asked specific questions regarding the decision-making model for pharmacy (i.e., check for indication, efficacy, safety, and adherence), 50% reported using analytical decision-making approaches, with a third of the decisions being made in hindsight. Conclusion The majority of the pharmacists followed an analytical decision-making approach to clinical reasoning. When the pharmacists were asked prompting questions about their medication-related decisions, they employed a combination of intuitive and analytical approaches. The pharmacists had the competency to check for medication appropriateness; though this knowledge was mostly restructured during the process of hindsight reasoning.

Examining the Associations Between Objective Structured Clinical Examination (OSCE) Scores and Fieldwork Performance: Results from an Occupational Therapy Program.

The purpose of this study was to explore the associations between scores obtained on objective structured clinical examinations (OSCEs) and on fieldwork placements within an occupational therapy program. Scores from four OSCEs and four fieldwork evaluations were obtained for 95 occupational therapy students. Associations between OSCE scores and fieldwork scores were investigated using Spearman's rank order correlations and contingency table analyses. Results showed that three out of the four OSCEs were positively associated with performance on fieldwork placement occurring immediately after completion of coursework within the program. Poor performance on the final OSCE predicted poor performance on the final two fieldwork placements. These results provide preliminary validity evidence for the use of OSCEs to predict subsequent performance in fieldwork placements. Revisions to program OSCEs and additional support for preceptors in the appropriate use of the fieldwork evaluation tool are recommended.

Facilitating implementation of the Decision-Making Capacity Assessment (DMCA) Model: senior leadership perspectives on the use of the National Implementation Research Network (NIRN) Model and frameworks.

OBJECTIVE: Dementia and other chronic conditions can compromise a person's ability to make independent personal and financial decisions. In the wake of an ageing population and rising incidence of chronic conditions, the number of persons who may require Decision-Making Capacity Assessments (DMCAs) is likely to increase. Legislation (e.g., Trusteeship, Guardianship, Medical Assistance in Dying) also necessitates that DMCAs adhere to legislative requirements and principles. An intentional, explicit and systematic means of implementing standardized DMCA best-practices is advisable. This single exploratory case-study examined the perspectives of senior leaders and clinical experts regarding the utility of using the National Implementation Research Network (NIRN) Model to facilitate implementation, spread and sustainability of a DMCA Model. Participants learned about the NIRN Model and discussed its application during working and focus groups, all of which were audio-recorded, transcribed, and analyzed using thematic analysis. RESULTS: Participants found that the NIRN Model aligned well with the DMCA Model, and offered utility to support implementation, spread and sustainability of DMCA best-practices. Participants also noted barriers related to its language, inability to capture personal change, resource requirements, and complexity. It was recommended that a NIRN-informed DMCA-specific implementation framework and toolkit be developed and NIRN-champions be available to guide implementation.

Collecting clinical data in primary ciliary dyskinesia- challenges and opportunities.

Rationale: Primary ciliary dyskinesia (PCD) is under diagnosed and underestimated. Most clinical research has used some form of questionnaires to capture data but none has been critically evaluated particularly with respect to its end-user feasibility and utility. Objective: To critically appraise a clinical data collection questionnaire for PCD used in a large national PCD consortium in order to apply conclusions in future PCD research. Methods: We describe the development, validation and revision process of a clinical questionnaire for PCD and its evaluation during a national clinical PCD study with respect to data collection and analysis, initial completion rates and user feedback. Results: 14 centers participating in the consortium successfully completed the revised version of the questionnaire for 173 patients with various completion rates for various items. While content and internal consistency analysis demonstrated validity, there were methodological deficiencies impacting completion rates and end-user utility. These deficiencies were addressed resulting in a more valid questionnaire. Conclusions: Our experience may be useful for future clinical research in PCD. Based on the feedback collected on the questionnaire through analysis of completion rates, judgmental analysis of the content, and feedback from experts and end users, we suggest a practicable framework for development of similar tools for various future PCD research.

Sleep and Children with Cerebral Palsy: A Review of Current Evidence and Environmental Non-Pharmacological Interventions.

Between 23%-46% of children with cerebral palsy experience sleep problems. Many of the sensory-motor and cognitive features of cerebral palsy (such as immobility, pain, and seizures) act as predisposing factors for sleep problems in this population. This paper presents the background related to the etiology and consequences of sleep problems in children with cerebral palsy. The relationship between pain and sleep is emphasized, as the risk of pain is highly prevalent in children with cerebral palsy. The review concludes with a discussion of the evidence-base for environmental non-pharmacological interventions based on light, temperature, sound and bedding to promote sleep for children with cerebral palsy.

Developing an index for the orthodontic treatment need in paediatric patients with obstructive sleep apnoea: a protocol for a novel communication tool between physicians and orthodontists.

INTRODUCTION: Sleep disordered breathing in the paediatric population can manifest as an array of different systemic symptoms; among them is a distinct malocclusion and craniofacial phenotype. Emerging research suggests that the treatment of this malocclusion and/or craniofacial phenotype through orthodontic intervention may help with the symptoms of these patients. Selecting the patients who would benefit from orthodontic treatment can be a difficult task for the physician with minimal dental training. Therefore the aim of this study is to develop a simple index to be used by medical professionals to identify those paediatric patients with orthodontic treatment needs who may benefit their obstructive sleep apnoea (OSA) symptoms. METHODS AND ANALYSIS: The methodology in this project has been devised through the WHO's recommendations on developing an index, with modifications based on the specific needs of this study. Based on the available literature, a draft index will be produced and subjected to multiple iterative revisions based on the feedback from: the Index Development Group, a group of multidisciplinary and internationally acclaimed experts in the field; the External Review Group, a group of potential end users and interested parties and the Steering Committee. Once the index has been formalised, it will be subjected to a pair of reliability tests using physicians and orthodontists scored 2 weeks apart. Subsequently, the index will be validated using dichotomous responses from orthodontists on whether they would treat a patient for OSA symptoms, and comparing the responses to the score of the index on the same patient. ETHICS AND DISSEMINATION: The index will be translated into French and will be presented in orthodontic and medical conferences, workshops, seminars, round table discussions, and free copies for download will be made available on the website of the University of Alberta Interdisciplinary Airway Research Clinic (iarc.ualberta.ca). Furthermore, the index will be published in a peer-reviewed medical journal to further increase the exposure of the index.