Nurturing the Seeds of Participation: Unveiling the Foundational Path for Understanding Aging in Place Barriers and Facilitators From the Perspective of Older Adults Using Mixed Methods and Translational Science.

Participation in society is a cornerstone for quality of life, active aging, and aging in place. While the majority of older adults prefer aging in place, health and financial challenges can hinder this vision. Conducted in suburban South Jersey, this study utilized mixed methods, including surveys and interviews with older adult participants. Surveys indicated that satisfaction with participation in the community is influenced by functional ability, healthcare service availability, and information access. Interviewees identified suggestions to overcome barriers (e.g., improve access to community and address ageism). Combined results provide a theory of change which suggests older adults' empowerment in community participation hinges on home living support, participation options aligning with ability and interest, and accessible information on community events. This person-centered planning approach emphasizes the importance of older adult and stakeholder participation in foundational community planning, offering translational foundational tools for evidence-based strategies to engage them in future community action plans (CAPs).

Development of a Frailty Ladder Using Rasch Analysis: If the Shoe Fits.

Background: The current measurement approach to frailty is to create an index of frailty status, rather than measure it. The purpose of this study is to test the extent to which a set of items identified within the frailty concept fit a hierarchical linear model (e.g., Rasch model) and form a true measure reflective of the frailty construct. Methods: A sample was assembled from three sources: community organization for at-risk seniors (n=141); colorectal surgery group assessed post-surgery (n=47); and hip fracture assessed post-rehabilitation (n=46). The 234 individuals (age 57 to 97) contributed 348 measurements. The frailty construct was defined according to the named domains within commonly used frailty indices, and items drawn to reflect the frailty came from self-report measures. Performance tests were tested for the extent to which they fit the Rasch model. Results: Of the 68 items, 29 fit the Rasch model: 19 self-report items on physical function and 10 performance tests, including one for cognition; patient reports of pain, fatigue, mood, and health did not fit; nor did body mass index (BMI) nor any item representing participation. Conclusion: Items that are typically identified as reflecting the frailty concept fit the Rasch model. The Frailty Ladder would be an efficient and statistically robust way of combining results of different tests into one outcome measure. It would also be a way of identifying which outcomes to target in a personalized intervention. The rungs of the ladder, the hierarchy, could be used to guide treatment goals.

Implementing complex interventions to mitigate burnout among qualified healthcare professionals: a realist review protocol.

INTRODUCTION: Reported burnout rates among qualified healthcare professionals (QHP) are alarming. Systematic reviews evaluating the effectiveness of burnout interventions for QHP exist; however, findings are contradictory. In addition, to date, there is no indication of how these interventions work and what specific intervention elements mitigate burnout. This review aims to explain how burnout interventions work and the contextual factors that mediate the intended outcomes. Our ultimate goal is to formulate actionable recommendations to guide the implementation of complex burnout interventions for QHP working in the hospital setting. METHODS AND ANALYSIS: In light of the heterogeneity and complexity of the interventions designed to address burnout, we will conduct a realist review using Pawson's five iterative stages to explore and explain how burnout interventions work, for whom, and in what circumstances. We will search PubMed, CINAHL, Scopus, PsycINFO and Web of Science from inception to December 2022. Grey literature sources will also be considered. The results will be reported according to the Realist and Meta-Narrative Evidence Syntheses-Evolving Standards quality and publication standards ETHICS AND DISSEMINATION: Findings will be disseminated in a peer-reviewed journal, conference presentations and through the development of infographics and relevant educational material to be shared with stakeholders and key institutions. This study is a secondary data analysis; thus, a formal ethics review is not applicable. PROSPERO REGISTRATION NUMBER: CRD42021293154.

Reducing research wastage by starting off on the right foot: optimally framing the research question.

PURPOSE: Strongly framed research questions are clear as to the population (P), the exposures or interventions (E/I), comparison groups (C), outcomes (O), time when relevant (T), and what the investigator wants to know. A solid framework sets up the measurement model, analysis, and anticipated results. The purpose of this study was to estimate the extent to which research questions in journals that focused on patient-reported outcome measures (PROM) and quality of life (QOL) are clear. METHODS: All 440 research articles published in four PROM journals in 2020. excluding reviews, psychometric, and qualitative papers, were reviewed. Research questions were classified as: (i) adequately framed (ii) poorly framed; or (iii) unframed based on clarity criteria. Examples from each journal were presented and reframed to match results in the article. RESULTS: Of 440 articles, 195 (44.3%) were classified as adequately framed; 230 (52.2%) as poorly framed; and 15 (3.4%) as unframed. There was heterogeneity across journals (Chi-square: 20.8; 6 df; p = 0.002). Only 29% were framed according to what the investigators wanted to know; 72% were framed like a "to do" list; and 6% were framed as a research agenda. CONCLUSION: Almost half of the questions were poorly framed or unframed a practice that could contribute to research wastage. Even "adequately framed" questions rarely stated what they wanted to know a priori, increasing the risk of biased reporting. Researchers, reviewers, and editors should encourage the use established frameworks for research questions.

Primary adrenal insufficiency due to bilateral adrenal infarction in COVID-19: a case report.

CONTEXT: Coronavirus disease 2019 (COVID-19) is a proinflammatory and prothrombotic condition, but its impact on adrenal function has not been adequately evaluated. CASE REPORT: A 46-year-old woman presented with abdominal pain, hypotension, skin hyperpigmentation after COVID-19 infection. The patient had hyponatremia, serum cortisol <1.0 ug/dL, ACTH of 807 pg/mL and aldosterone <3 ng/dL. Computed tomography (CT) findings of adrenal enlargement with no parenchymal and minimal peripheral capsular enhancement after contrast were consistent with bilateral adrenal infarction. The patient had autoimmune hepatitis and positive antiphospholipid antibodies, but no previous thrombotic events. The patient was treated with intravenous hydrocortisone, followed by oral hydrocortisone and fludrocortisone. DISCUSSION: Among 115 articles, we identified nine articles, including case reports, of new-onset adrenal insufficiency and/or adrenal hemorrhage/infarction on CT in COVID-19. Adrenal insufficiency was hormonally diagnosed in five cases, but ACTH levels were measured in only three cases (high in one case and normal/low in other two cases). Bilateral adrenal non- or hemorrhagic infarction was identified in five reports (two had adrenal insufficiency, two had normal cortisol levels and one case had no data). Interestingly, the only case with well-characterized new-onset acute primary adrenal insufficiency after COVID-19 had a previous diagnosis of antiphospholipid syndrome. In our case, antiphospholipid syndrome diagnosis was established only after the adrenal infarction triggered by COVID-19. CONCLUSIONS: Our findings support the association between bilateral adrenal infarction and antiphospholipid syndrome triggered by COVID-19. Therefore, patients with positive antiphospholipid antibodies should be closely monitored for symptoms or signs of acute adrenal insufficiency during COVID-19.

Fatores determinantes do controle da criminalidade em gestão de políticas de segurança pública / Determinantes del control de la criminalidad en la gestión de políticas de seguridad pública / Determinants of crime control in public security policy management

Resumo É alvo central de discussões a temática relacionada à segurança pública no país, especialmente, no tocante aos índices de criminalidade. Este estudo aborda a temática a partir da Teoria Econômica da Escolha Racional e de teorias de base sociológica que buscam explicar as causas do crime. O objetivo do estudo foi identificar fatores determinantes para o controle dos índices de criminalidade a partir de dados do estado do Espírito Santo. Trata-se de um estudo de abordagem quantitativa. Foram utilizados dados secundários, tendo como referência o modelo teórico proposto. Adotou-se, ainda, como método de teste de hipóteses, o modelo de regressão linear, com o auxílio do software SPSS Statistics, versão 25. Os resultados da pesquisa demonstram que o elemento relativo à empregabilidade da população influencia direta e significativamente o controle dos índices de crimes de homicídios dolosos e de crimes contra o patrimônio. Ademais, conjugado ao emprego (atividades laborais formais), os fatores renda e educação da população demonstraram influenciar positivamente no controle dos crimes contra o patrimônio.

Resumen La temática relacionada con la seguridad pública en el país es objeto central de discusión, especialmente con respecto a los índices de criminalidad. Este estudio aborda el tema a partir de la teoría económica de la elección racional y las teorías sociológicas que buscan explicar las causas del delito. El objetivo del estudio fue identificar los factores determinantes para el control de los índices de criminalidad con base en datos del estado de Espírito Santo. Este es un estudio con un enfoque cuantitativo. Se utilizaron datos secundarios, basados en el modelo teórico propuesto. El modelo de regresión lineal también se adoptó como método de prueba de hipótesis, con la ayuda del software SPSS Statistics versión 25. Los resultados de la investigación muestran que el elemento relacionado con la empleabilidad de la población influye directa y significativamente en el control de los índices de homicidios dolosos y delitos contra la propiedad. Además, combinado con el empleo (actividades laborales formales), los factores ingresos y educación de la población han demostrado tener una influencia positiva en el control de los delitos contra la propiedad.

Abstract The topic related to public security in Brazil is central in discussions regarding crime rates. This study approaches the theme from the economic theory of rational choice and sociological theories that seek to explain the causes of crime. The study's objective was to identify determining factors for controlling crime rates based on data from the state of Espírito Santo. This is a study with a quantitative approach. Secondary data were used, based on the proposed theoretical model. The linear regression model was also adopted as a hypothesis testing method, with the aid of the SPSS Statistics software version 25. The results show that the element related to the population's employability directly and significantly influences the control of crime rates, intentional homicides, and crimes against property. Furthermore, combined with employment (formal labor activities), the population's income and education positively influence the control of crimes against property.

Development of a patient-reported outcome measure of recovery after abdominal surgery: a hypothesized conceptual framework.

BACKGROUND: We initiated a research program to develop a novel patient-reported outcome measure (PROM) to assess postoperative recovery from the perspective of abdominal surgery patients. In light of FDA recommendations, the first stage of our program aimed to, based on previous literature and expert input, develop a hypothesized conceptual framework portraying the health domains that are potentially relevant to the process of recovery after abdominal surgery. METHODS: This study was conducted in three phases: (1) systematic review to identify PROMs with measurement properties appraised in the context of recovery after abdominal surgery, (2) content analysis to categorize the health domains covered by the PROMs according to the ICF, and (3) two-round Delphi study to gain expert input regarding which of these health domains are relevant to the process of recovery. Participants were experts in perioperative care identified through two major surgical societies (35 invited). RESULTS: The systematic review identified 19 PROMs covering 66 ICF domains. 23 experts (66%) participated in the Delphi process. After Round 2, experts agreed that 22 health domains (8 body functions, 14 activities and participation) are potentially relevant to the process of recovery after abdominal surgery. These domains were organized into a diagram, representing our hypothesized conceptual framework. CONCLUSIONS: This hypothesized conceptual framework is an important first step in our research program and will be further refined based on in-depth qualitative interviews with patients. The sound methodological approach used to derive this framework may be valuable for studies aimed to develop PROMs according to FDA standards.

Influência do alinhamento das imagens por TCFC nas medidas lineares virtuais das relações entre implantes dentários: estudo laboratorial / The influence of different CBCT image alignment position on the virtual linear measurements of dental implant relationships: a laboratory study

Objetivo: verificar a variação das medidas lineares em função de angulações distintas dos implantes e dos alinhamentos diferentes das imagens de TCFC. Material e métodos: três mandíbulas artificiais de polietileno receberam 18 implantes dentários, com seis implantes em cada mandíbula, sendo: 1) dois angulados no sentido distal no lado direito posterior, 2) um angulado para vestibular e outro para lingual na região anterior, e 3) dois angulados no sentido mesial na região posterior esquerda. Com a mandíbula apoiada na mentoneira do equipamento e paralela ao plano horizontal, foram realizadas três aquisições tomográficas padronizadas, (voxel de 0,133 mm, FOV 6 x 8 cm, 89kV, 10 mA). Depois, foram realizadas uma medida perpendicular (da plataforma do implante ao rebordo mandibular) e outra inclinada (da plataforma do implante ao longo eixo do rebordo) nos cortes coronais e sagitais. As medidas foram realizadas com a base de mandíbula paralela ao plano horizontal e também após o volume ser rotacionado para o inferior no plano sagital. Os implantes foram numerados de um a seis e divididos em duplas. As medidas foram comparadas antes e após o alinhamento das imagens através do programa OnDemand3D. Resultados: foram observadas diferenças estatisticamente significantes entre as medidas realizadas nos implantes 1 e 2. Conclusão: as medidas lineares sofreram alteração em decorrência do posicionamento mandibular quando manipulado em software.

Objective: to verify the linear measure variation according to the distinct implants angulations and the different alignment from CBCT images. Material and methods: three polyethylene artifi cial models received 18 dental implants, 6 in each jaw, being: 1) two angled to distal on the right posterior side, 2) one angled to vestibular and another to lingual on the anterior region, 3) two angled to mesial way on the left posterior region. Each jaw was supported at a chinstrap of the equipment and parallel to the horizontal plane, and three standardized tomographic acquisitions were taken, (voxel size 0.133 mm, FOV 6 x 8 cm, 89kV, 10 mA). A perpendicular measure was made after the tomographic acquisitions (from the implant platform to the jaw border) and another inclined measure (from the implant platform to border long axis) both on coronal and sagittal acquisitions. Measurements were taken with the jaw base parallel to the horizontal plane and also when the volume was rotated to inferior on the sagittal plane. The implants were numbered from one to six and divided into couples. The measures were compared before and after image alignment by the OnDemand3D software. Results: statistically signifi cant differences were observed between the measurements performed on implants 1 and 2. Conclusion: the linear measurement values change in consequence of the jaw position when manipulated by the software.

Design and Validation of a Biofeedback Device to Improve Heel-to-Toe Gait in Seniors.

A feature of healthy human walking gait is a clearly defined heel-strike at initial contact, known as heel-to-toe gait. However, a common consequence of ageing is the deterioration of this heel first gait toward a flat foot, or "shuffling" gait. This leads to a shortened stride length, slowed gait speed, and an increased fall risk. Shuffling gait is normally treated by physiotherapy, however, therapist time is limited and training is restricted to a clinical environment. Gait rehabilitation could be expedited with the use of a device that distinguishes between heel-to-toe and shuffling gait and gives feedback to the user. This paper describes the design and validation of a device to achieve this. The device is innovative in that it both analyses the kinematics of the foot in real time and uses this information to classify the step quality in a manner that agrees with the subjective judgement of a physiotherapist. The device comprises a sensing module and a biofeedback module. The sensing module is a six axis inertial measurement unit that is strapped to the patient's foot. Raw data are streamed wirelessly to the biofeedback module (a smartphone), which runs an algorithm to detect step quality on the basis of angular velocity of the foot, and gives binary feedback to the user. Results from a validation study on the target population demonstrate very good classification performance, with an accuracy of 84.1% when compared with physiotherapist labels. The sensitivity is 92.4% at an operating point of 75% specificity, and the area under the ROC curve is 0.937. This performance should be more than adequate for clinical use and opens the door for investigations to determine how it can be used most effectively.

How Do We Value Postoperative Recovery?: A Systematic Review of the Measurement Properties of Patient-reported Outcomes After Abdominal Surgery.

OBJECTIVE: To appraise the level of evidence supporting the measurement properties of patient-reported outcome measures (PROMs) in the context of postoperative recovery after abdominal surgery. BACKGROUND: There is growing interest in using PROMs to support value-based care in abdominal surgery; however, to draw valid conclusions regarding patient-reported outcomes data, PROMs with robust measurement properties are required. METHODS: Eight databases (MEDLINE, EMBASE, Biosis, PsycINFO, The Cochrane Library, CINAHL, Scopus, Web of Science) were searched for studies focused on the measurement properties of PROMs in the context of recovery after abdominal surgery. The methodological quality of individual studies was evaluated using the consensus-based COSMIN checklist. Evidence supporting the measurement properties of each PROM was synthetized according to standardized criteria and compared against the International Society of Quality of Life Research minimum standards for the selection of PROMs for outcomes research. RESULTS: We identified 35 studies evaluating 22 PROMs [12 focused on nonspecific surgical populations (55%), 4 focused on abdominal surgery (18%), and 6 generic PROMs (27%)]. The great majority of the studies (74%) received only poor or fair quality ratings. Measurement properties of PROMs were predominantly supported by limited or unknown evidence. None of the PROMs fulfilled International Society of Quality of Life Research's minimum standards, hindering specific recommendations. CONCLUSIONS: There is very limited evidence supporting the measurement properties of existing PROMs used in the context of recovery after abdominal surgery. This precludes the use of these PROMs to support value-based surgical care. Further research is required to bridge this major knowledge gap. REVIEW REGISTRATION: International Prospective Register of Systematic Reviews (PROSPERO): CRD42014014349.

Where have all the pilot studies gone? A follow-up on 30 years of pilot studies in Clinical Rehabilitation.

INTRODUCTION: Pilot studies are meritorious for determining the feasibility of a definitive clinical trial in terms of conduct and potential for efficacy, but their possible applications for planning a future trial are not always fully realized. The purpose of this review was to estimate the extent to which pilot/feasibility studies: (i) addressed needed objectives; (ii) led to definitive trials; and (iii) whether the subsequent undertaking of a definitive trial was influenced by the strength of the evidence of outcome improvement. METHODS: Trials published in the journal Clinical Rehabilitation, since its inception, were eligible if the word 'pilot' or 'feasibility' was specified somewhere in the article. A total of 191 studies were reviewed, results were summarized descriptively, and between-group effect sizes were computed. RESULTS: The specific purposes of piloting were stated in only 58% ( n = 110) of the studies. The most frequent purpose was to estimate the potential for efficacy (85%), followed by testing the feasibility of the intervention (60%). Only 12% of the studies were followed by a definitive trial; <4% of studies had a main study underway or a published study protocol. There was no relationship between observed effect size and follow-up of pilot studies, although the confidence intervals were very wide owing to small number of trials that followed on. DISCUSSION: Labelling and reporting of pilot studies needs to be improved to be concordant with the recently issued CONSORT guidelines. Feasibility needs to be fully tested and demonstrated prior to committing considerable human and monetary resources.

Planning Health Services for Seniors: Can We Use Patient's Own Perception?

OBJECTIVES: The objectives of this study were to identify needs and to estimate whether self-reported health can be used as an indicator of service needs among seniors. METHODS: This was a cross-sectional survey. Age- and sex-adjusted logistic regression was used to estimate the link between functional status indicators and fair or poor self-reported health. Forward stepwise logistic regression was performed to identify the strongest contributors of poor health. Positive predictive value (PPV), sensitivity, and specificity were calculated to identify whether health perception could be used to identify people in need of physical rehabilitation services. RESULTS: 142 seniors agreed to answer the survey, yielding a response rate of 73%. Among the respondents (mean age 79±7; 60% women), 40% rated their health as fair or poor. Seniors perceiving their health as fair or poor had higher odds of reporting impairments, activity limitations, and participation restrictions (OR ranging from 2.37 95%CI: 1.03-5-45 to 12.22 95%CI: 2.68-55.78) in comparison to those perceiving their health as good or better. The strongest contributors for poor/fair health were depression, difficulty performing household tasks, pain, and dizziness (c-statistic = 0.91 and a maximum adjusted r-squared of 0.60). Self-rated health used as single-item showed a positive predictive value (PPV) of 1, sensitivity of 52%, and specificity of 100%. CONCLUSION: Our results indicate that all seniors participating in this study and reporting fair or poor health have indicators of need for further rehabilitation services. Asking patients to rate their own health may be an alternate way of querying about need, as many older persons are afraid to report disability because of fear of further institutionalization.

Managing mobility outcomes in vulnerable seniors ( MMOVeS): a randomized controlled pilot study.

OBJECTIVE: To estimate feasibility and potential for efficacy of an individualized, exercise-focused, self-management program (i.e. Managing Mobility Outcomes In Vulnerable Seniors ( MMOVeS)), in comparison to exercise information in improving mobility after six months among seniors recently discharged from hospital. DESIGN: Randomized pilot study. SETTING: Two McGill University-teaching hospitals. SUBJECTS: Community dwelling seniors, aged 70 years and older, recently discharged from either participating hospitals. INTERVENTIONS: The physiotherapy-facilitated intervention consisted of (1) evaluation of mobility capacity, (2) setting short- and long-term goals, (3) delineation of an exercise treatment plan, (4) an educational booklet to enhance mobility self-management skills, and (5) six monthly telephone calls. Control group received a booklet with information on exercises targeting mobility limitations in seniors. MAIN MEASURES: Mobility, pain, and health status were assessed at baseline and at six months using multiple indicators drawn from Disabilities of the Arm, Shoulder, and Hand (DASH) Score, Lower Extremity Functional Scale (LEFS) and Short-Form (SF)-36. RESULTS: In all, 26 people were randomized to the intervention (mean age: 81 ± 8; 39% women), and 23 were randomized to the control (mean age: 79 ± 7; 33% women). The odds ratio for the mobility outcomes combined was 3.08 and the 95% confidence interval excluded 1 (1.65-5.77). The odds ratio for pain and health perception favored the MMOVeS group, but the 95% confidence interval included the null value. CONCLUSIONS: This feasibility study highlights the potential for efficacy of an individualized, exercise-focused, self-management program in comparison to exercise information in improving mobility outcome for seniors. Furthermore, a home-program combining self-management skills and exercise taught with minimal supervision prove to be feasible. Finally, data from this study can be used to estimate sample size for a confirmatory trial.

Montreal Accord on Patient-Reported Outcomes (PROs) use series - Paper 3: patient-reported outcomes can facilitate shared decision-making and guide self-management.

BACKGROUND: There is a shift toward making health care patient centered, whereby patients are part of medical decision-making and take responsibility for managing their health. Patient-reported outcomes (PROs) capture the patient voice and can be used to engage patients in medical decision-making. OBJECTIVE: The objective of this paper is to present important factors from patients', clinicians', researchers', and decision-makers' perspectives that influence successful adoption of PROs in clinical practice. Factors recommended in this paper were informed by a patient partner. DISCUSSION: Based on themes arising from the Montreal Accord proceedings, we describe factors that influence the adoption of PROs and how PROs can have a positive effect by enhancing communication and providing opportunities to engage patients, carers, and clinicians in care. Consideration of patient factors (e.g., health literacy), family support and networks (e.g., peer-support networks), technology (e.g., e-health), and health care system factors (e.g., resources to implement PROs) is necessary to ensure PROs are successfully adopted. PRO evaluation plans most likely to succeed over the long term are those incorporating PROs identified by patients as necessary for self-management and that coincide with providers' needs for collaboratively developing treatment plans with patients and families.

Montreal Accord on Patient-Reported Outcomes (PROs) use series - Paper 2: terminology proposed to measure what matters in health.

BACKGROUND: We outline different health outcomes and describe how multiple perspectives can be harnessed to optimize accuracy of key data collected about patients with chronic conditions. The terms health status, health-related quality of life, and quality of life are often used interchangeably without recognizing that they have different meanings, as are the terms used to refer to the different components of function. Although the advantages and limitations of existing frameworks and perspectives are largely understood, greater precision is needed when using health outcome terminology and identifying optimal sources of information. OBJECTIVE: A refinement of the current taxonomy is proposed to distinguish between patient-reported outcomes and self-report outcomes and expand the concept of clinically reported outcomes to include those assessed by performance and emerging technologies. DISCUSSION: Health outcomes yield important information that can be used to improve the lives of many people. Now is the time to "talk the talk" as part of larger coordinated efforts within and across countries to identify and measure what matters most in health.

Future Rehabilitation Professionals' Intentions to Use Self-Management Support: Helping Students to Help Patients.

Purpose: We evaluated whether education in self-management support (SMS) increases future clinicians' intentions to use a new way of delivering rehabilitation services. Methods: A convenience sample of 10 students took a 5-week theoretical course, followed by 6 weeks spent assessing patients, establishing treatment plans, and monitoring their performance by telephone. Focus groups were held before and after the educational modules, with deductive mapping of themes to the Theory of Planned Behaviour and inductive analysis of additional themes. Results: Five themes and 22 subcategories emerged from the deductive-inductive focus group content analysis. After participating in the educational modules, students reported gaining knowledge about SMS and highlighted the lack of similar preparation during their academic courses. Nonetheless, they were hesitant to adopt SMS. Conclusion: Future clinicians gained knowledge and skills after being exposed to SMS courses, but their intention to adopt SMS in their future daily practice remained low. We also noted a lack of formal training in SMS in the academic setting. The findings from this study support incorporating SMS training into the curriculum, but to increase students' intention to use SMS as part of patient care, training may need to be in more depth than it was in the modules we used.

Objectif : nous avons évalué si la formation en soutien à l'autogestion (SAG) augmente l'intention des futurs cliniciens d'utiliser une nouvelle manière de prodiguer des services de réadaptation. Méthode : un échantillon de commodité de 10 étudiants ont suivi un cours théorique de 5 semaines, suivi d'un volet pratique de 6 semaines au cours duquel ils ont évalué des patients, déterminé leur plan de traitement et fait un suivi de leur progression par téléphone. Les groupes de discussion ont menés avant et après les modules éducatifs, avec une schématisation déductive de thèmes basée sur la théorie du comportement planifié et une analyse inductive de thèmes additionnels. Résultats : cinq thèmes et 22 sous-catégories ont émergé de l'analyse du contenu des discussions. Après avoir participé aux modules éducatifs, les étudiants ont indiqué avoir acquis des connaissances relatives au SAG et ont souligné l'absence de préparation similaire dans leurs cours universitaires. Néanmoins, ils étaient hésitants à adopter le SAG. Conclusion : les futurs cliniciens ont acquis des connaissances et des compétences après avoir suivi les cours sur le SAG. Cependant, leur intention d'adopter le SAG dans leur pratique quotidienne future reste faible. Nous avons aussi constaté une absence de formation en SAG dans le milieu universitaire. Les conclusions de cette étude justifient l'intégration au curriculum d'une formation en SAG. Afin d'augmenter l'intention des étudiants d'adopter le SAG, il y aurait cependant peut-être lieu d'approfondir la formation par rapport aux modules que nous avons utilisés.

Privação e plasticidade sensorial auditiva em idosos: potenciais corticais e questionários de autoavaliação / Auditory plasticity and deprivation in the elderly: cortical potentials and outcome measurements

Objetivo: Determinar os efeitos da privação sensorial auditiva e o uso de amplificação em adultos e idosos com perda auditiva sensorioneural. Métodos: Os sujeitos foram avaliados pelo registrodos Potenciais Evocados Auditivos de Longa Latência logo após odiagnóstico da perda auditiva e após um mês de uso dos aparelhos auditivos, considerando o período de aclimatização. Participaram 20 indivíduos, novos usuários de aparelhos auditivos com idades entre 28 e 88 anos, com perdas auditivas de grau moderado a severo. Resultados: Foram encontradas diferenças estatisticamente significantes entre os valores dos componentes N2 e P3 nos registros realizados antes e depois do uso da amplificação para cada orelha em todos os sujeitos. Não foram encontradas relações estatisticamente significantes entre N2 e P3 e as variáveis idade, duração da privação auditiva e o tempo de uso dos aparelhos auditivos. Conclusão: Os efeitos da privação auditiva e do uso da amplificação puderam ser observados pelas mudanças nos valores de latência dos Potenciais Evocados Auditivos de Longa Latência nos componentes N2 e P3. O uso da amplificação como estimulação efetiva pode prevenir ou minimizar a privação auditiva em adultos e idosos deficientes auditivos e pode ser considerado essencial para a plasticidade do Sistema Nervoso Auditivo Central. (AU)

Objective: Determine the effects of sensory deprivation and use of amplification in adults and elderly individuals with sensorineural hearing loss. Design: The subjects underwent measurements of long latency auditory evoked potentials, soon after the diagnosis of hearing loss and once again after the use of amplification, considering the acclimatization period. Study sample: Participated in the study, 20 individuals, new hearing aid users. Their ages ranged from 28 to 88 years, with varying degrees of hearing loss, from mild to severe. Results: There was a significant difference between N2 and P3 latencies before and after the use of amplification for each ear. There was no statistically significant relationship between the N2 and P3 latencies and the variables age, duration of auditory deprivation and time of use of hearing aids. Conclusion: The effects of deprivation and use of stimulation can be observed through changes in latencies of N2 and P3 components of auditory evoked potentials latencies, in all subjects. The use of amplification as an effective stimulation may prevent or minimize sensory deprivation in hearing impaired adults and can be considered essential for the plasticity of the central auditory nervous system. (AU)

How have research questions and methods used in clinical trials published in Clinical Rehabilitation changed over the last 30 years?

Research in rehabilitation has grown from a rare phenomenon to a mature science and clinical trials are now common. The purpose of this study is to estimate the extent to which questions posed and methods applied in clinical trials published in Clinical Rehabilitation have evolved over three decades with respect to accepted standards of scientific rigour. Studies were identified by journal, database, and hand searching for the years 1986 to 2016.A total of 390 articles whose titles suggested a clinical trial of an intervention, with or without randomization to form groups, were reviewed. Questions often still focused on methods to be used (57%) rather than what knowledge was to be gained. Less than half (43%) of the studies delineated between primary and secondary outcomes; multiple outcomes were common; and sample sizes were relatively small (mean 83, range 5 to 3312). Blinding of assessors was common (72%); blinding of study subjects was rare (19%). In less than one-third of studies was intention-to-treat analysis done correctly; power was reported in 43%. There is evidence of publication bias as 83% of studies reported either a between-group or a within-group effect. Over time, there was an increase in the use of parameter estimation rather than hypothesis testing and there was evidence that methodological rigour improved.Rehabilitation trialists are answering important questions about their interventions. Outcomes need to be more patient-centred and a measurement framework needs to be explicit. More advanced statistical methods are needed as interventions are complex. Suggestions for moving forward over the next decades are given.

Classification of gait quality for biofeedback to improve heel-to-toe gait.

A feature of healthy gait is a clearly defined heel strike upon initial contact of the foot with the ground. However, a common consequence of ageing is deterioration of the heel first nature of gait towards a shuffling gait (flat foot at contact). Physiotherapy can be effective in correcting this but is costly and labour intensive. Gait rehabilitation could be accelerated with home exercise, guided by a biofeedback device that distinguishes between heel first and shuffling gait. This paper describes an algorithm that distinguishes between heel-to-toe gait and shuffling gait on the basis of angular velocity of the foot, using an inertial measurement unit. Measurements were made of normal and abnormal gait and used to develop an algorithm that distinguishes between good and bad steps. Results demonstrate very good algorithm performance, with a classification accuracy at the accuracy-optimal threshold of 92.7% when compared with physiotherapist labels. The sensitivity and specificity at this threshold are 84.4% and 97.5% respectively. These performance metrics suggest that this algorithm is usable in a biofeedback device.