Occupational therapy in pulmonary rehabilitation programs: A scoping review.

Pulmonary rehabilitation (PR) is a multidisciplinary intervention forming the cornerstone of chronic respiratory disease management, improving individuals' exercise capacities and abilities to complete activities of daily living (ADLs). Although the occupational therapy (OT) scope of practice focuses on similar outcomes as PR, the tasks/roles and benefit of including OT in PR has not been reviewed. This scoping review synthesized the i) tasks/roles, ii) recommendations of guidelines, iii) prevalence and iv) effects of OT as part of PR programs. Searching of four databases (MEDLINE, EMBASE, CINAHL and Cochrane), OT association websites, and hand searching was performed, and 51 records were included. The OT tasks/roles most reported include teaching energy conservation techniques (n = 23), addressing ADLs (n = 17), and assisting with breathlessness management (n = 10). Using the Canadian Model of Occupational Performance and Engagement these tasks/roles were grouped into person (n = 16 unique tasks/roles), occupation (n = 6 tasks/roles), environment (n = 5 tasks/roles), and other (n = 3 tasks/roles) domains and were endorsed by two available practice guidelines addressing OT in PR programs. From 13 PR surveys across four continents, 17-92% of PR programs included OT. Inclusion of OT in PR resulted in positive effects on ADLs, pulmonary function, dyspnea, quality of life, and mortality. Although an increasing number of PR programs include occupational therapists in their multidisciplinary teams, there is a paucity of original studies and guidelines reporting on the tasks/roles and benefits of OT in PR. Further research is needed to clearly define the tasks/roles of OT in multidisciplinary PR teams and contributions to enhancing patient outcomes.

The Role of Occupational Therapy in Pulmonary Rehabilitation Programs: Protocol for a Scoping Review.

BACKGROUND: Chronic respiratory diseases are highly prevalent and compromise an individual's ability to perform activities of daily living (ADLs) and participate in meaningful life roles. Pulmonary rehabilitation (PR) is a well-established intervention aimed at restoring an individual's exercise capacity and improving their ability to complete their ADLs. Occupational therapists help individuals engage in meaningful "occupations," improving their health and well-being. Given the concordance in the aims of PR and the occupational therapy (OT) scope of practice, occupational therapists appear to be well suited as key players in PR programs. However, the benefits of adding OT to PR programs have been sparsely reported in the literature and the role of OT in PR has never been synthesized or reported in national and international guidelines. OBJECTIVE: The aim of this review is to explore the role of OT in PR programs, the current guideline recommendations for the inclusion of OT in PR programs, the estimated prevalence of OT in PR programs, and the reported or anticipated effects of OT interventions in PR programs. METHODS: The review will be conducted following the Joanna Briggs Institute (JBI) methodology for scoping reviews. A comprehensive search will be undertaken in the Cochrane Database of Systematic Reviews, EMBASE, MEDLINE, and CINAHL (EBSCO) to identify and retrieve relevant literature published in English, French, or Portuguese. Gray literature on international OT association websites will also be identified, including position statements and guidelines relevant to PR programs. All literature published since the establishment of the effectiveness of PR for chronic respiratory disease in 1994 that explores OT in PR programs for these patients will be included. Search results will be exported to Covidence for title, abstract, and full-text screening by two independent reviewers. Data will be extracted by two independent reviewers using a pilot-tested template including the following: the number of PR programs including OT (specifically from surveys), the purpose of the study, the study design, patient characteristics, respiratory conditions included, PR components, OT role, outcomes, and results. Findings will be presented using a narrative summary, supplemented by figures and/or tables. Key themes will be displayed in an infographic or schematic. RESULTS: The study was initiated in January 2021 and registered with the Open Science Framework (OSF) in February 2021, prior to title and abstract screening. Data collection and analysis and drafting of the manuscript will occur throughout 2021, with expected publication in 2022. CONCLUSIONS: The results of this scoping review will help health care professionals improve patient care by broadening their understanding and awareness of the role of OT in PR programs. This role clarification may help to inform program development and clinical decision making and will serve to optimize the delivery of multidisciplinary care for patients in PR programs, ultimately improving patient outcomes. TRIAL REGISTRATION: OSF Registries ZH63W; https://osf.io/zh63w. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/30244.

Inclusion of female participants in cardiovascular research: a case study of Ontario NSERC-funded programs.

This study explored inclusion of female participants in Natural Sciences and Engineering Research Council of Canada Discovery Grant (NSERC-DG)-funded human cardiovascular research at Ontario universities between 2010-2018. Ninety-six publications were examined and 4 principal investigators were interviewed. Females were excluded/underrepresented in 63% of publications with 49% male-only and 5% female-only samples. The sex-bias appears to be explained by dependence on research knowledge and methodologies that maintain and reproduce a firmly established discourse of the male norm. Novelty Female participants were underrepresented in NSERC DG-funded cardiovascular research at Ontario universities between 2010-2018.

Impact of the societal response to COVID-19 on access to healthcare for non-COVID-19 health issues in slum communities of Bangladesh, Kenya, Nigeria and Pakistan: results of pre-COVID and COVID-19 lockdown stakeholder engagements.

INTRODUCTION: With COVID-19, there is urgency for policymakers to understand and respond to the health needs of slum communities. Lockdowns for pandemic control have health, social and economic consequences. We consider access to healthcare before and during COVID-19 with those working and living in slum communities. METHODS: In seven slums in Bangladesh, Kenya, Nigeria and Pakistan, we explored stakeholder perspectives and experiences of healthcare access for non-COVID-19 conditions in two periods: pre-COVID-19 and during COVID-19 lockdowns. RESULTS: Between March 2018 and May 2020, we engaged with 860 community leaders, residents, health workers and local authority representatives. Perceived common illnesses in all sites included respiratory, gastric, waterborne and mosquitoborne illnesses and hypertension. Pre-COVID, stakeholders described various preventive, diagnostic and treatment services, including well-used antenatal and immunisation programmes and some screening for hypertension, tuberculosis, HIV and vectorborne disease. In all sites, pharmacists and patent medicine vendors were key providers of treatment and advice for minor illnesses. Mental health services and those addressing gender-based violence were perceived to be limited or unavailable. With COVID-19, a reduction in access to healthcare services was reported in all sites, including preventive services. Cost of healthcare increased while household income reduced. Residents had difficulty reaching healthcare facilities. Fear of being diagnosed with COVID-19 discouraged healthcare seeking. Alleviators included provision of healthcare by phone, pharmacists/drug vendors extending credit and residents receiving philanthropic or government support; these were inconsistent and inadequate. CONCLUSION: Slum residents' ability to seek healthcare for non-COVID-19 conditions has been reduced during lockdowns. To encourage healthcare seeking, clear communication is needed about what is available and whether infection control is in place. Policymakers need to ensure that costs do not escalate and unfairly disadvantage slum communities. Remote consulting to reduce face-to-face contact and provision of mental health and gender-based violence services should be considered.