Everyday functioning among older adults with subjective cognitive decline: a scoping review.

PURPOSE: Older adults with subjective cognitive decline (SCD) experience cognitive difficulties without objectively measurable cognitive impairments but which may affect their everyday functioning. However, everyday functioning in this population has not yet been characterized. We sought to describe the empirical literature on the everyday functioning of community-dwelling older adults with SCD, their recruitment methods, and the measurements used. METHODS: A scoping review was conducted for primary research articles including at least one measure of everyday functioning. Retrieved records were independently screened. Data were extracted then analyzed using descriptive statistics and summative content analysis. RESULTS: 6544 studies were screened; 21 studies were included. All were observational analytic studies. Most compared an SCD group with a group of healthy control (47.6%), mild cognitive impairment (71.5%), and/or dementia (33.3%). Subjective cognition was measured via interview (28.6%) or clinical question(s) (14.3%). Normal cognition was determined by a wide variety of cognitive tests. The most studied everyday functioning domain was instrumental activities of daily living (90.5%). Most studies used questionnaires (81.0%), and measured ability to do an everyday life task (76.2%). CONCLUSIONS: More research is needed on everyday functioning other than IADL, with greater focus on measures that consider an individual's real-life participation.

These is heterogeneity in the operational definitions and reporting of subjective cognitive decline in the empirical literature.Assessment of everyday functioning in the empirical literature on people with subjective cognitive decline is focused on the individual's ability to do instrumental activities of daily living.There is a need for consensus on: (1) standards to assess subjective and objective cognition in determining subjective cognitive decline; and (2) best practice in assessing changes in everyday functioning in people with subjective cognitive decline.Clinical and research assessment of older adults with subjective cognitive decline should be expanded to functional domains other than instrumental activities of daily living.

Recommended characteristics and processes for writing lay summaries of healthcare evidence: a co-created scoping review and consultation exercise.

BACKGROUND: Lay summaries (LSs) of scientific evidence are critical to sharing research with non-specialist audiences. This scoping review with a consultation exercise aimed to (1) Describe features of the available LS resources; (2) Summarize recommended LS characteristics and content; (3) Outline recommended processes to write a LS; and (4) Obtain stakeholder perspectives on LS characteristics and writing processes. METHODS: This project was a patient and public partner (PPP)-initiated topic co-led by a PPP and a researcher. The team was supported by three additional PPPs and four researchers. A search of peer-reviewed (Ovid MEDLINE, Scopus, Embase, Cochrane libraries, CINAHL, PsycINFO, ERIC and PubMed data bases) and grey literature was conducted using the Joanna Briggs Institute Methodological Guidance for Scoping Reviews to include any resource that described LS characteristics and writing processes. Two reviewers screened and extracted all resources. Resource descriptions and characteristics were organized by frequency, and processes were inductively analyzed. Nine patient and public partners and researchers participated in three consultation exercise sessions to contextualize the review findings. RESULTS: Of the identified 80 resources, 99% described characteristics of a LS and 13% described processes for writing a LS. About half (51%) of the resources were published in the last two years. The most recommended characteristics were to avoid jargon (78%) and long or complex sentences (60%). The most frequently suggested LS content to include was study findings (79%). The key steps in writing a LS were doing pre-work, preparing for the target audience, writing, reviewing, finalizing, and disseminating knowledge. Consultation exercise participants prioritized some LS characteristics differently compared to the literature and found many characteristics oversimplistic. Consultation exercise participants generally supported the writing processes found in the literature but suggested some refinements. CONCLUSIONS: Writing LSs is potentially a growing area, however, efforts are needed to enhance our understanding of important LS characteristics, create resources with and for PPPs, and develop optimal writing processes.

This study was suggested by a patient partner to place attention on the role patient and public partners (PPPs) could play in developing lay summaries. A lay summary (LS) is a summary of a research project written for members of the public, including patients. A lot of information is written about recommendations for LSs, but none of it has been summarized. This study: (1) Pulled together and summarized all existing resources that made recommendations on features of LSs and/or the steps for writing them; and (2) Conducted meetings with people interested in LSs (PPPs and researchers) to gather their perspectives on this summary of resources. The study engaged PPPs in all aspects, including co-leadership. We found 80 resources on LSs. Almost all (95%) of the resources were written by researchers for researchers, with only 18% involving PPPs. The most common recommendations were to avoid jargon (78%) and remove unnecessary and complex words (60%). Only 13% of the resources had information about the steps for writing a LS. People in our meetings did not always agree with the recommended LS characteristics and found them overly simplistic. They felt that identifying and writing for the intended audience of the LS was important, every study should have a LS, PPPs should have the opportunity to be involved, and greater attention should be paid to the steps involved in writing a LS. Lay summary development is a complex, multistep process requiring the inclusion of PPPs for their irreplaceable perspectives and contributions.

Supporting patient and public partners in writing lay summaries of scientific evidence in healthcare: a scoping review protocol.

INTRODUCTION: Despite growing interest among patient and public partners to engage in writing lay summaries, evidence is scarce regarding the availability of resources to support them. This protocol describes the process of conducting a scoping review to: (1) summarise the source, criteria and characteristics, content, format, intended target audience, patient and public involvement in preparing guidance and development processes in the available guidance for writing lay summaries; (2) contextualise the available guidance to the needs/preferences of patient and public partners and (3) create a patient and public partner-informed output to support their engagement in writing lay summaries. METHOD AND ANALYSIS: A scoping review with an integrated knowledge translation approach will be used to ensure the collaboration between patient/public partners and researchers in all steps of the review. To meet objective 1, the English language evidence within a healthcare context that provides guidance for writing lay summaries will be searched in peer-reviewed publications and grey literature. All screening and extraction steps will be performed independently by two reviewers. Extracted data will be organised by adapting the European Union's principles for summaries of clinical trials for laypersons. For objectives 2 and 3, a consultation exercise will be held with patient and public partners to review and contextualise the findings from objective 1. A directed content analysis will be used to organise the data to the needs of the public audience. Output development will follow based on the results. ETHICS AND DISSEMINATION: Ethics approval will be obtained for the consultation exercise. Our target audience will be stakeholders who engage or are interested in writing lay summaries. Our dissemination products will include a manuscript, a lay summary and an output to support patient and public partners with writing lay summaries. Findings will be published in a peer-reviewed journal and presented at relevant conferences. OPEN SCIENCE FRAMEWORK REGISTRATION: osf.io/2dvfg.

Strategy-training post-stroke via tele-rehabilitation: a pilot randomized controlled trial.

PURPOSE: Long-term limitations in social participation are common after stroke. Whether these can be attenuated through a tele-rehabilitation approach is unknown. We were particularly interested in examining transfer of learning effects which could result in broader improvements in social participation. METHODS: We adapted a strategy training rehabilitation approach (tele-CO-OP) for remote delivery. Participants with chronic stroke were randomized to receive the intervention (EXPT) or to a wait list (Control). Feasibility and acceptability were measured via attendance scores, satisfaction with the training and therapist evaluation of engagement with the training. The primary outcome measure was the Canadian Occupational Performance Measure (COPM), a standardized semi-structured interview which elicits difficulties in day-to-day life. RESULTS: Seventeen participants were randomized. Tele-CO-OP was found to be feasible and acceptable: participants reported high satisfaction and engagement, and missed few sessions. Large effect sizes for transfer of learning effects were observed in favor of receiving tele-CO-OP vs being waitlisted. Significant benefits were also conferred to the Control group following receipt of tele-CO-OP. The intervention also appeared to improve mood. CONCLUSIONS: This exploratory study demonstrates the feasibility and acceptability of tele-CO-OP and provides preliminary evidence for transfer of learning effects to untrained everyday social participation activities. Trial registration number: NCT02724813.

Stroke results in long-term limitations in social participation.The Cognitive Orientation to daily Occupational Performance (CO-OP) Approach provides a potential avenue for ameliorating these limitations.This pilot randomized controlled trial demonstrated that it is feasible to deliver tele-CO-OP and that positive benefits may accrue to those receiving the intervention for both trained and untrained activities.Tele-CO-OP is a promising intervention for addressing long-term participation limitations in individuals with chronic stroke.

Hope for "Continued Vitality": Qualitative Study of Adults With Traumatic Brain Injury and Low Mood on Their Rehabilitation.

Objective: Depression is highly comorbid with traumatic brain injury (TBI) with often complex and interacting symptomology that contributes to the experience of disability. Comorbid depression results in poorer TBI rehabilitation and downstream participation outcomes yet perspectives of this group regarding person-centered care is unknown. Purpose: This study aimed to explicate the perspectives of persons with TBI and depression on their values, preferences, and desired outcomes for optimal rehabilitation. Methods: A qualitative descriptive approach was taken. Thirteen adults [mean age: 40.5 (standard deviation 9.8)] diagnosed with TBI and with self-reported low mood were recruited through convenience sampling. Participants were predominantly female (n = 12) with concussion/mild TBI and at least 6 months post-injury. One-on-one, semi-structured interviews were conducted by phone with Canadian participants (March-May 2020). Interviews were transcribed; data were analyzed thematically by two researchers and the thematic map refined by the research team. Results: Three themes were identified on values, preferences, and desired outcomes in person-centered care. Participants valued "validation" from healthcare providers and the health system to feel seen and believed about their conditions and concerns. They preferred for healthcare providers to "share the burden of managing care" through improved interactions and better access to concussion care. Participants expressed that "meaningful outcomes" were to be symptom free, to resume valued life activities, and to be able to adapt/be resilient. The latter indicated hope for "continued vitality" for life participation despite past and ongoing challenges. Conclusions: Many adults with TBI and self-identified low mood expressed rehabilitation experiences that were invalidating. Their identified values, preferences, and desired outcomes provide directions for better person-centered care by healthcare providers and health systems to support participation.

Representation in rehabilitation research of adults with traumatic brain injury and depression: A scoping review.

Objective: To determine how well comorbid depression is described, defined, and measured in the rehabilitation literature that pertains to TBI and depression.Method: Scoping review of the rehabilitation sciences literature. Six databases were searched (to October 17, 2018) using the three core concepts of TBI, depression, and rehabilitation, as was for gray literature. Two independent reviewers reviewed documents for eligibility.Results: 3737 records were reviewed and 137 documents were analyzed. Primary studies (n = 126) were most prevalent and of quantitative descriptive design (n = 102). The number of participants with TBI and comorbid depression could only be determined for 81/126 (64%) of primary studies, in which they are the minority (median of 30% of sample). Depression reporting was heterogeneous and individuals with TBI and depression were not analyzed as a subgroup in most studies (n = 68, 55%). Depression self-report instruments are commonly used (14 instruments used in 111 studies). Few studies (n = 14, 19%) have participant samples with discrete severity levels of TBI and depression.Conclusions: Better participant representation and reporting of TBI and depression variables are needed to enhance comparability across studies and improve rehabilitation outcomes.

Scoping Review on Rehabilitation Scoping Reviews.

OBJECTIVE: To examine the extent, scope, and methodological quality of rehabilitation scoping reviews. DATA SOURCES: A comprehensive list of scoping reviews conducted in the broader health field (inception to July 2014), with a further update of that list (up to February 2017) using similar methods, including searching 9 electronic databases. STUDY SELECTION: Articles were included if they were scoping reviews within rehabilitation. Established review methods were used including (1) a PubMed filter detecting rehabilitation content and (2) title-and-abstract screening by 2 independent reviewers applied sequentially to articles from the existing list of scoping reviews and to the updated search results. Full-text articles were reviewed by 1 reviewer, with discrepancies resolved by another after pilot screening with > 80% agreement. Remaining discrepancies were resolved by external experts. DATA EXTRACTION: Two independent reviewers used piloted and standardized data extraction forms. DATA SYNTHESIS: We screened 1823 records, including 992 full texts, to identify 251 rehabilitation-related scoping reviews. Rehabilitation scoping reviews had an exponential yearly increase since 2008 (r2=0.89; P<.01). The literature addressed diverse topics (eg, spread over 43 condition groupings); 43% were published in Canada. Examples of methodological limitations included: 39% of reviews did not cite the use of a methodological framework, 96% did not include the appropriate flow diagram, 8% did not report eligibility criteria, and 57% did not report data extraction details. CONCLUSIONS: The increasing popularity of scoping reviews in rehabilitation has not been met by high standards in methodological quality. To increase the value of rehabilitation scoping reviews, rehabilitation stakeholders need to use existing methodological standards for the conduct, reporting, and appraisal of scoping reviews.

Therapists' experience of the cognitive orientation to daily occupational performance (CO-OP) approach: Shifting from conventional practice.

Background: The CO-OP ApproachTM has been increasingly used in research and practice, yet its critical elements and implementation challenges are largely undescribed. Obtaining therapists' perspectives on CO-OP may reveal insights into potential critical and mediating factors.Aim/Objective: To explore the experiences of CO-OP therapists by understanding their perceptions on the approach compared with conventional practice, and by identifying mediating factors in its implementation.Material and Method: This exploratory study utilized a qualitative descriptive design. A purposive sample of occupational therapists (n = 3) was interviewed. Data were analyzed using thematic analysis and themes were validated within a focus group.Results/Findings: Three themes were identified: 'CO-OP works,' 'CO-OP delivery is mediated by contextual factors,' and 'CO-OP shifts the therapeutic approach.' Therapists perceived CO-OP to be efficacious for client-centred goal attainment. Guided discovery and the problem-solving strategy were identified as unique and challenging CO-OP elements. Mediating factors such as level of cognitive impairment and quality of family member involvement may affect CO-OP efficacy.Conclusions: Therapists found CO-OP to be efficacious and adopted unique elements into their professional approaches.Significance: This is the first study to investigate CO-OP therapists' experiences. Future research is recommended to enhance training of therapists in key CO-OP features.

Optimising activity and participation outcomes for people with self-awareness impairments related to acquired brain injury: an interventions systematic review.

Impaired self-awareness related to acquired brain injury (ABI-ISA) can result in limitations in daily living activities and community participation. We hypothesise that with the appropriate interventions, outcomes for adults with ABI-ISA can be enhanced. The objectives of the study were to describe and examine critically the non-pharmacological intervention literature and to identify intervention elements that optimise everyday living outcomes in adults with ABI-ISA. Two reviewers selected articles and extracted data using five databases, a review protocol, and systematic review standards (i.e., Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Assessing the Quality and Applicability of Systematic Reviews (AQASR)). Included studies reported quantitative activity and participation intervention outcomes for people with stated or measured ABI-ISA, and the methodological quality of randomised controlled trials (RCT) was rated using the Physiotherapy Evidence Database scale (PEDro). Seventeen articles discussing 15 unique intervention studies were found, including two RCTs of good methodological quality. All studies reported improvements on measures of everyday living, utilised interventions with multiple therapeutic elements, and used various forms of external feedback. Evidence supports the use of intervention protocols including elements of experiential practice, external feedback, Socratic guided discussion, and metacognitive strategy training.

Systematic Review of Measurement Property Evidence for 8 Financial Management Instruments in Populations With Acquired Cognitive Impairment.

OBJECTIVES: To critically appraise the measurement property evidence (ie, psychometric) for 8 observation-based financial management assessment instruments. DATA SOURCES: Seven databases were searched in May 2015. STUDY SELECTION: Two reviewers used an independent decision-agreement process to select studies of measurement property evidence relevant to populations with adulthood acquired cognitive impairment, appraise the quality of the evidence, and extract data. Twenty-one articles were selected. DATA EXTRACTION: This review used the COnsensus-based Standards for the selection of health Measurement Instruments review guidelines and 4-point tool to appraise evidence. After appraising the methodologic quality, the adequacy of results and volume of evidence per instrument were synthesized. Measurement property evidence with high risk of bias was excluded from the synthesis. DATA SYNTHESIS: The volume of measurement property evidence per instrument is low; most instruments had 1 to 3 included studies. Many included studies had poor methodologic quality per measurement property evidence area examined. Six of the 8 instruments reviewed had supporting construct validity/hypothesis-testing evidence of fair methodologic quality. There is a dearth of acceptable quality content validity, reliability, and responsiveness evidence for all 8 instruments. CONCLUSIONS: Rehabilitation practitioners assess financial management functions in adults with acquired cognitive impairments. However, there is limited published evidence to support using any of the reviewed instruments. Practitioners should exercise caution when interpreting the results of these instruments. This review highlights the importance of appraising the quality of measurement property evidence before examining the adequacy of the results and synthesizing the evidence.

Study protocol for a scoping review on rehabilitation scoping reviews.

INTRODUCTION: Scoping reviews are increasingly popular in rehabilitation. However, significant variability in scoping review conduct and reporting currently exists, limiting potential for the methodology to advance rehabilitation research, practice and policy. Our aim is to conduct a scoping review of rehabilitation scoping reviews in order to examine the current volume, yearly distribution, proportion, scope and methodological practices involved in the conduct of scoping reviews in rehabilitation. Key areas of methodological improvement will be described. Methods and analysis: We will undertake the review using the Arksey and O'Malley scoping review methodology. Our search will involve two phases. The first will combine a previously conducted scoping review of scoping reviews (not distinct to rehabilitation, with data current to July 2014) together with a rehabilitation keyword search in PubMed. Articles found in the first phase search will undergo a full text review. The second phase will include an update of the previously conducted scoping review of scoping reviews (July 2014 to current). This update will include the search of nine electronic databases, followed by title and abstract screening as well as a full text review. All screening and extraction will be performed independently by two authors. Articles will be included if they are scoping reviews within the field of rehabilitation. A consultation exercise with key targets will inform plans to improve rehabilitation scoping reviews. Ethics and dissemination: Ethics will be required for the consultation phase of our scoping review. Dissemination will include peer-reviewed publication and conferences in rehabilitation-specific contexts.

Forensic Occupational Therapy in Canada: The Current State of Practice.

Although occupational therapists have been practicing in forensic settings for many years, there is a paucity of literature regarding the nature of this practice in Canada. The purpose of this study was to describe the practices of Canadian occupational therapists in forensic mental health. An online survey was designed based on the Canadian Practice Process Framework. Following purposive and snowball sampling, responses were analysed with descriptive statistics and content analysis. Twenty-seven clinicians responded (56% response rate). Respondents indicated commonalities in workplaces, client caseloads and practice challenges. The outstanding need in Canada to demonstrate client outcomes through the use of evaluation instruments reflects those practice gaps identified internationally. Education, advocacy and research are critical areas for the development of Canadian forensic occupational therapy. Although findings heavily reflect one provincial context and may not be generalizable to nonhospital settings, a number of priority areas were identified. Future efforts should clarify the role of forensic occupational therapy to stakeholders, and validate their contributions through research that evaluates intervention efficacy and meaningful outcomes. Copyright © 2016 John Wiley & Sons, Ltd.