Implementation of the strengths model of case management for people with a traumatic brain injury: a qualitative pre-implementation study.

INTRODUCTION: People who sustain a traumatic brain injury (TBI) may have to live with permanent sequelae such as mental health problems, cognitive impairments, and poor social participation. The strengths-based approach (SBA) of case management has a number of positive impacts such as greater community integration but it has never been implemented for persons with TBI. To support its successful implementation with this population, it is essential to gain understanding of how the key components of the intervention are perceived within the organization applying the approach. OBJECTIVES: Documenting the barriers and facilitators in the implementation of the SBA as perceived by potential adopters. METHODS: A qualitative pre-implementation study was conducted using semi-structured interviews with community workers and managers of the community organization where the SBA is to be implemented. Data were analyzed using a deductive approach based on the Consolidated Framework for Implementation Research (CFIR). RESULTS: The major barriers are associated with the intervention (e.g. adaptability of the intervention) and the external context (e.g. the impact of the pandemic). Perceived facilitators are mainly associated with the internal context (e.g. compatibility with current values). CONCLUSION: The barriers and facilitators identified will inform the research team's actions to maximize the likelihood of successful implementation.

Implementation of a strengths-based approach in a traumatic brain injury community service; perspectives of community workers.

Background The strengths-based approach (SBA) was initially developed for people living with mental health issues but may represent a promising support option for community participation of people living with a traumatic brain injury (TBI). A community-based organisation working with people living with TBI is in the process of adapting this approach to implement it in their organisation. No studies explored an SBA implementation with this population. This study explores the implementation of key components of the SBA in a community-based organisation dedicated to people living with TBI. Methods A qualitative descriptive design using semi-structured interviews (n = 10) with community workers, before and during implementation, was used. Transcripts were analysed inductively and deductively. Deductive coding was informed by the SBA fidelity scale. Results Group supervision and mobilisation of personal strengths are key SBA components that were reported as being integrated within practice. These changes led to improved team communication and cohesiveness in and across services, more structured interventions, and greater engagement of clients. No changes were reported regarding the mobilisation of environmental strengths and the provision of individual supervision. Conclusion The implementation of the SBA had positive impacts on the community-based organisation. This suggests that it is valuable to implement an adaptation of the SBA for people living with TBI.

Impacts of the COVID-19 pandemic on health and social professionals working with people with disabilities: A qualitative study.

BACKGROUND: Since the beginning of the COVID-19 pandemic, protection and isolation measures established by the Canadian and Quebec governments have directly affected the work of health and social professionals (HSPs). These measures have added pressure on HSPs, complexified their work and added tasks to their already busy workload. However, few studies have explored in depth the impacts of the pandemic on HSPs working with people with disabilities. OBJECTIVE: The objective of this study was to qualitatively explore the experiences of HSPs working among people with disabilities in the province of Quebec, Canada, during the COVID-19 pandemic (January and February 2021), including the impact on their work, the relationships with their colleagues, and on their immediate social and familial environment. METHODS: HSPs participated in a semi-structured interview. A mixed thematic analysis approach, combining inductive and deductive coding, was carried out using N'Vivo 12. RESULTS: Fifty-five HSPs participated in the interviews (mean [SD] age, 42 [9]). They mostly identified as women (91% ). Three main themes representing the impacts of the pandemic were identified, including 1) Health and Well-being; 2) Family and social networks including the subthemes; 2.1) Fear of being a vector of contamination for their loved ones; 2.2) Work-family balance; 2.3) Social Network, and finally 3) Work, highlighting, including 3.1) Workload and adaptative strategies developed; 3.2) Relationship with colleagues; 3.3) Perceived support received at work, and 3.4) Services offered to patients. CONCLUSIONS: These findings highlight the importance of closely tracking and supporting the well-being of HSPs.

'Snapshot in time': a cross-sectional study exploring stakeholder experiences with environmental scans in health services delivery research.

OBJECTIVE: To describe stakeholder characteristics and perspectives about experiences, challenges and information needs related to the use of environmental scans (ESs). DESIGN: Cross-sectional study. SETTING AND PARTICIPANTS: A web-based survey platform was used to disseminate an online survey to stakeholders who had experience with conducting ESs in a health services delivery context (eg, researchers, policy makers, practitioners). Participants were recruited through purposive and snowball sampling. The survey was disseminated internationally, was available in English and French, and remained open for 6 weeks (15 October to 30 November 2022). ANALYSIS: Descriptive statistics were used to describe the characteristics and experiences of stakeholders. Thematic analysis was used to analyse the open-text questions. RESULTS: Of 47 participants who responded to the survey, 94% were from Canada, 4% from the USA and 2% from Australia. Respondents represented academic institutions (57%), health agency/government (32%) and non-government organisations or agencies (11%). Three themes were identified: (a) having a sense of value and utility; (b) experiencing uncertainty and confusion; and (c) seeking guidance. The data suggest stakeholders found value and utility in ESs and conducted them for varied purposes including to: (a) enhance knowledge, understanding and learning about the current landscape or state of various features of health services delivery (eg, programmes, practices, policies, services, best practices); (b) expose needs, service barriers, challenges, gaps, threats, opportunities; (c) help guide action for planning, policy and programme development; and (d) inform recommendations and decision-making. Stakeholders also experienced conceptual, methodological and practical barriers when conducting ESs, and expressed a need for methodological guidance delivered through published guidelines, checklists and other means. CONCLUSION: ESs have value and utility for addressing health services delivery concerns, but conceptual and methodological challenges exist. Further research is needed to help advance the ES as a distinct design that provides a systematic approach to planning and conducting ESs.

Challenges and facilitators in the experience of caregiving for an older adult with traumatic brain injury: A longitudinal qualitative study in the first-year postinjury.

PURPOSE: To obtain a better understanding of the factors which complicate or facilitate the adjustment of caregivers after traumatic brain injury (TBI) in older adults. RESEARCH METHOD: At 4, 8, and 12 months post-TBI (mild to severe), 65 caregivers answered two open-ended questions regarding facilitators and challenges linked to the injury of their loved one. A thematic analysis was performed. RESULTS: Participants mentioned almost as many facilitators as challenges at each time point. Among the facilitators, we found the following themes: receiving social support, having access to rehabilitation, improvement of the injured loved one's health condition, returning to live at home, having access to home services, feeling useful, effective communication, and having time for oneself. The challenges identified were: health issues in the injured loved one, psychological impact on the caregiver, assuming a new role, relationship strain, and decrease in activities and outings. CONCLUSIONS: During the first year following TBI in older adults, caregivers were able to identify several facilitators despite the presence of challenging factors, suggesting effective coping and resilience. This knowledge can guide potential caregivers in their adaptation after TBI in an older adult, and we propose a simple tool to support this process. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Social participation experiences of older adults with an early-onset physical disability: a systematic review protocol.

OBJECTIVE: The objective of this review is to assess and synthesize the available qualitative evidence on the experiences of social participation of older adults with an early-onset physical disability. INTRODUCTION: Understanding the experiences of social participation among older adults with a physical disability acquired earlier in life can guide the development of interventions and policies. It will also help with fostering meaningful community participation and aid in improving the quality of their social participation. INCLUSION CRITERIA: This review will consider primary studies that explore the experiences of social participation of older adults with an early-onset physical disability. The review will focus on qualitative data, including methods such as phenomenology, grounded theory, ethnography, action research, and feminist research. Studies in French or English will be considered for inclusion, and there will be no limitation on publication dates. METHODS: A keyword search strategy will be carried out in MEDLINE (Ovid), PsycINFO (Ovid), CINAHL (EBSCOhost), Web of Science, and the Cochrane Library. ProQuest Dissertations and Theses (ProQuest) will be searched for unpublished articles. Two independent reviewers will perform the screening and inclusion process, assess the quality of the evidence, and complete data extraction. The JBI approach to critical appraisal, study selection, data extraction, and data synthesis (meta-aggregation) will be used. The ConQual approach will be used to establish confidence in the synthesized findings. REVIEW REGISTRATION: PROSPERO CRD42022371027.

The REHAB-LAB model for individualized assistive device co-creation and production.

Assistive devices are designed to enhance individuals with disabilities' functional abilities. The rise of 3D printing technology enabled the production of individualized assistive devices (IADs). A REHAB-LAB is intended for IAD provision involving technical referents and occupational therapists. This study aimed to develop the REHAB-LAB logic model; to explore its fidelity and desirability; and to explore the characteristics of arising initiatives of IAD production. The REHAB-LAB logic model development involved stakeholders throughout the research process. A pragmatic multimethod approach followed two phases 1) logic model development and 2) exploration of its fidelity and desirability. The REHAB-LAB logic model presented the resources (equipment, space, human) required to implement IAD provision in a rehabilitation center, and the expected deliverables (activities and outputs). The REHAB-LAB logic model highlights the interdisciplinarity of IAD provision including occupational therapists, doctors, engineers, managers, and technical referents and places the users at the center of the IAD production. Results confirmed the fidelity and desirability of the REHAB-LAB logic model. The REHAB-LAB logic model can be used as a reference for future healthcare organizations wishing to implement an IAD provision. This research highlighted the interest of IAD provision based on the REHAB-LAB model involving users and transdisciplinary practices.

Reducing endocrine metabolic disease risk in adults with chronic spinal cord injury: strategic activities conducted by the Ontario-Quebec RIISC team.

PURPOSE: The Rehabilitation Interventions for Individuals with a Spinal Cord Injury in the Community (RIISC) team aimed to develop and evaluate innovative rehabilitation interventions to identify endocrine metabolic disease (EMD) risk, intending to reduce the frequency and severity of EMD related morbidity and mortality among adults living with chronic spinal cord injury or disease (SCI/D). MATERIALS AND METHODS: An interprovincial team from Ontario and Quebec reviewed available EMD literature and evidence syntheses and completed an inventory of health services, policies and practices in SCI/D care. The review outcomes were combined with expert opinion to create an EMD risk model to inform health service transformation. RESULTS: EMD risk and mortality are highly prevalent among adults with chronic SCI/D. In stark contrast, few rehabilitation interventions target EMD outcomes. The modelled solution proposes: 1) abandoning single-disease paradigms and examining a holistic perspective of the individual's EMD risk, and 2) developing and disseminating practice-based research approaches in outpatient community settings. CONCLUSIONS: RIISC model adoption could accelerate EMD care optimization, and ultimately inform the design of large-scale longitudinal pragmatic trials likely to improve health outcomes. Linking the RIISC team activities to economic evaluations and policy deliverables will strengthen the relevance and impact among policymakers, health care providers and patients.

Living with a spinal cord injury or disease (SCI/D) increases endocrine metabolic disease (EMD) risk.EMD-related outcomes include fracture; type II diabetes; and cardiovascular disease (myocardial infarction, sudden cardiac death and stroke), directly contributing to higher morbidity and mortality.Single-disease paradigms are not the ideal strategy to address multimorbidity contexts experienced in SCI/D.Practice-based research could be an alternative/adjunct to randomized control trials at generating evidence on current and emerging rehabilitation approaches.

A Clinical Practice Guide to Enhance Physical Activity Participation for Children with Developmental Coordination Disorder in Canada.

Purpose: This clinical practice guide (CPG) aims to provide evidence-based recommendations for promoting and enhancing the participation and integration of children with developmental coordination disorder (DCD) into physical activities that take place in the home, school, community, or rehabilitation clinic contexts. Methods: A panel of key stakeholders relevant to these contexts (parents, instructors, rehabilitation professionals) developed evidence-based recommendations using a consensus methodology after reviewing results from a recent systematic review of relevant literature. The quality of the evidence on which the recommendations were based was evaluated (2011 Oxford Centre for Evidence-Based Medicine Levels of Evidence scale) as was the strength of the final CPG recommendations (American Society of Plastic Surgeons Grade Recommendation Scale). Results: Recommendations (n = 50; 36% supported by robust, empirically derived evidence) for the different stakeholder groups fell into three categories: 1) Choose an appropriate activity for your child, 2) Harmonize the activity with the child's interests and abilities, and 3) Help the child learn new movements prior to the activity. Conclusions: This comprehensive CPG provides concrete recommendations, based on the currently available evidence, that can be used by stakeholders to address the physical activity participation and integration needs of children with DCD in a variety of contexts.

Objectif: ces directives cliniques visent à fournir des recommandations basées sur les données probantes pour promouvoir et améliorer la participation et l'intégration des enfants ayant un trouble développemental de la coordination (TDC) à des activités physiques qui se déroulent à la maison, à l'école, dans la communauté ou dans des cliniques de réadaptation. Méthodologie: un groupe d'intervenants clés dans ces contextes (parents, entraineurs, professionnels de la réadaptation) a préparé des recommandations fondées sur des données probantes au moyen d'une méthodologie de consensus, après avoir révisé les résultats d'une récente analyse systématique de publications pertinentes. La qualité des données probantes sur laquelle reposent les recommandations a été évaluée (échelle de qualité des preuves de l'Oxford Centre for Evidence-Based Medicine de 2011) de même que les catégories des recommandations définitives tirées des directives (échelle des catégories de recommandations de l'American Society of Plastic Surgeons). Résultats: les recommandations (n = 50; 36 % soutenues par des données probantes empiriques vigoureuses) des divers groupes d'intervenants se déclinaient en trois catégories : 1) choisir une activité appropriée pour l'enfant, 2) harmoniser l'activité selon les intérêts et les capacités de l'enfant, 3) aider l'enfant à s'approprier de nouveaux mouvements pour aller vers l'activité. Conclusions: ces directives cliniques complètes fournissent des recommandations concrètes d'après les données probantes disponibles, que peuvent utiliser les intervenants pour aborder la participation à l'activité physique et les besoins d'intégration des enfants ayant un TDC dans divers contextes.

Learning to drive with neurological conditions: profile of users of an adapted driver training program and cognitive factors associated with success.

PURPOSE: To describe the sociodemographic and cognitive profile of participants enrolled in an adapted driving program for individuals with neurological conditions, to explore the association between cognitive functioning and driving program outcome, and to describe driving habits after program completion. METHODS: This study combined retrospective chart review and cross-sectional data collection. RESULTS: The sample included 71 participants with neurological disorders (aged 15-56 years, M = 22.2 ± 8.6; 39% women). Driving program was either successful (47%), failed (7%), discontinued (34%), or ongoing (13%). Among 35 participants with complete neuropsychological and driving program outcome data, those who successfully completed the program showed better attention functioning, and better performance relative to global functioning for attention, executive functions, and working memory, compared to those who discontinued/failed the program. Among 21 participants who completed a telephone questionnaire on average 3.7 years after program enrollment, 67% obtained their driver's license and drove regularly. Participants reported high levels of satisfaction with the program. CONCLUSION: These results suggest that approximately half of the persons enrolled in a driver training program designed for learners with neurological conditions, obtain a driver's license; and that attention, and to a lesser extent executive functioning and working memory, are related to driving program success.IMPLICATIONS FOR REHABILITATIONIn individual with neurological conditions, learning how to drive can be challenging.An adapted driver training program, involving collaboration between driving instructors and healthcare professionals, simplification of theoretical learning, and increasing driving practice opportunities, can be effective, both in terms of licensing success and client satisfaction.Conducting a pre-driving program neuropsychological assessment, with identification of cognitive strengths and weaknesses, can provide valuable information for clinicians and driving instructors for optimizing training and predicting outcome.Better performance in attention, and better relative to global cognitive functioning in attention, executive functions, and working memory, are related to higher success rate of an adapted driving program.

Prognostic factors for persistent symptoms in adults with mild traumatic brain injury: an overview of systematic reviews.

BACKGROUND: Mild traumatic brain injury (mTBI) is an increasing public health problem, because of its persistent symptoms and several functional consequences. Understanding the prognosis of a condition is an important component of clinical decision-making and can help to guide the prevention of persistent symptoms following mTBI. The prognosis of mTBI has stimulated several empirical primary research papers and many systematic reviews leading to the identification of a wide range of factors. We aim to synthesize these factors to get a better understanding of their breadth and scope. METHODS: We conducted an overview of systematic reviews. We searched in databases systematic reviews synthesizing evidence about the prognosis of persistent symptoms after mTBI in the adult population. Two reviewers independently screened all references and selected eligible reviews based on eligibility criteria. They extracted relevant information using an extraction grid. They also rated independently the risk of bias using the ROBIS tool. We synthesized evidence into a comprehensive conceptual map to facilitate the understanding of prognostic factors that have an impact on persistent post-concussion symptoms. RESULTS: From the 3857 references retrieved in a database search, we included 25 systematic reviews integrating the results of 312 primary articles published between 1957 and 2019. We examined 35 prognostic factors from the systematics reviews. No single prognostic factor demonstrated convincing and conclusive results. However, age, sex, and multiple concussions showed an affirmatory association with persistent post-concussion outcomes in systematic reviews. CONCLUSION: We highlighted the need for a comprehensive picture of prognostic factors related to persistent post-concussion symptoms. We believe that these prognostic factors would guide clinical decisions and research related to prevention and intervention regarding persistent post-concussion symptoms. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42020176676.

French Version of the Musculoskeletal Pain Intensity and Interference Questionnaire for Professional Orchestra Musicians (MPIIQM-F): Cross-Cultural Adaptation and Preliminary Validation.

BACKGROUND: The Musculoskeletal Pain Intensity and Interference Questionnaire for Professional Orchestra Musicians (MPIIQM) is a prominent patient-reported outcome measure (PROM) in the musicians' health literature. It has been published in at least four languages, but not in French. AIMS: To cross-culturally adapt the MPIIQM into French and establish the preliminary psychometric properties (validity, reliability, and responsiveness) of the MPIIQM-F. METHODS: Standardized cross-cultural adaptation methods included forward translations, an expert committee, and verbal field tests in the target population. Psychometric properties were assessed in a population of French-speaking professional orchestra musicians who participated in three evaluation sessions. Evaluated properties include content, face, structural and construct validity, reliability (internal consistency, test-retest reliability, minimal detectable change [MDC], measurement error), and responsiveness (effect size and standardized response means [SRM]). RESULTS: Sixty-one French-speaking orchestra musicians participated in the psychometric validation. Exploratory factor analysis revealed a two-factor solution equivalent to previous versions, confirming the Pain Intensity and Interference subscales. Spearman correlations for construct validity were as hypothesized for four of six hypotheses (minor deviances for the other two hypotheses) using the Brief Pain Inventory, Disability of the Arm, Shoulder and Hand Performing Arts Module, and PROMIS Global Health Scale as comparators. Reliability results demonstrated high internal consistency (Cronbach's a=0.84-0.89), excellent test-retest reliability (intraclass correlation coefficient = 0.91-0.97), and small measurement error with MDC for the overall scale <10%. Responsiveness resulted in moderate to large effect sizes and SRM (0.54-0.87). CONCLUSIONS: Preliminary validation of the MPIIQM-F suggests good validity, reliability, and responsiveness, indicating its suitability for use in French-speaking orchestra musicians.

"I hope it'll get better in the end, it didn't really get better": a qualitative study of access to specialized rehabilitation services as experienced by adults with persistent MTBI symptoms.

PURPOSE: Persistent symptoms experienced by adults following mild traumatic brain injury (mTBI) can significantly impact their daily activities. It is often difficult for them to access specialized rehabilitation services. The aim of this study is to explore this population's experience surrounding access to specialized rehabilitation services, including waiting time. MATERIALS AND METHODS: This study used a qualitative phenomenological approach and was conducted using semi-structured interviews. Twelve adults with mTBI who had received specialized interdisciplinary rehabilitation services were recruited. The interviews focused on participants' recollection of their patient journey after injury, their perception of waiting, barriers and facilitators to access, and the impacts of these experiences on their condition. RESULTS: Participants reported experiencing symptoms such as anxiety, depression, worry, sadness, and discouragement before accessing specialized services. They all agreed that they did not receive clear information about their recovery process or the health services available to them, which exacerbated their mental health symptoms. CONCLUSION: The findings show that participants experienced uncertainty because they lacked information regarding recovery and access to health services after their injury. Education about symptoms and recovery, as well as emotional support for people with mTBI should be made available during the waiting period.

Adults with persistent post-mild traumatic brain injury (mTBI) symptoms experienced many challenges in accessing health services such as long wait times, which they perceived as impacting their recovery.According to those concerned, more support from qualified health professionals is needed in the first weeks or months following the injury.Participants unanimously support free and timely access to specialized mTBI rehabilitation services.

Subjective and objective burden and psychological distress in care partners of older adults with traumatic brain injury.

PURPOSE/OBJECTIVE: In care partners of older persons (65 years and older) having sustained traumatic brain injury (TBI), the objectives were (a) to describe subjective burden (emotional, social, financial, and physical burden), objective burden (new roles and responsibilities), and psychological distress at 4 months postinjury, and (b) to explore the predictors of subjective burden and psychological distress. RESEARCH METHOD/DESIGN: This is an observational study of care partners of older adults with TBI (n = 46; Mage = 65.2 years, SD = 11.2, 87% female). Participants completed the Zarit Burden Interview, the Hospital Anxiety and Depression Scale, the Brain Injury Complaint Questionnaire (measuring difficulties of the injured older adult perceived by the care partner), and the modified Medical Outcomes Study Social Support Survey. RESULTS: A majority of care partners (88%) reported at least one form of objective burden (e.g., increased/decreased time spent in certain activities post-TBI), 29% perceived at least mild subjective burden, and 27% reported either significant anxiety or depressive symptoms. Linear regressions indicated that a higher number of difficulties reported regarding the injured person and poorer perceived social support predicted higher subjective burden and psychological distress. A younger age of the care partner also predicted a higher subjective burden. CONCLUSIONS/IMPLICATIONS: This study provides a better understanding of the potential impacts of TBI in older age for care partners. Future research should examine how to support adequately care partners in their psychological adaptation after TBI in an elderly person. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

A systematic review of the determinants of implementation of a locomotor training program using a powered exoskeleton for individuals with a spinal cord injury.

BACKGROUND: Wearable powered exoskeletons represent a promising rehabilitation tool for locomotor training in various populations, including in individuals with a spinal cord injury. The lack of clear evidence on how to implement a locomotor powered exoskeleton training program raises many challenges for patients, clinicians and organizations. OBJECTIVE: To report determinants of implementation in clinical practice of an overground powered exoskeleton locomotor training program for persons with a spinal cord injury. DATA SOURCES: Medline, CINAHL, Web of Science. STUDY SELECTION: Studies were included if they documented determinants of implementation of an overground powered exoskeleton locomotor training program for individuals with spinal cord injury. DATA EXTRACTION: Eligible studies were identified by two independent reviewers. Data were extracted by one reviewer, based on constructs of the Consolidated Framework for Implementation Research, and validated by a second reviewer. RESULTS: Sixty-three articles were included. 49.4% of all determinants identified were related to the intervention characteristics, 29.6% to the individuals' characteristic and 13.5% to the inner setting. Recurrent barriers identified were the high prevalence of adverse events (e.g., skin issues, falls) and device malfunctions. Adequate training for clinicians, time and resource available, as well as discussion about patients' expectations were identified as facilitators. CONCLUSIONS: Powered exoskeleton training is a complex intervention. The limited information on the context and the implementation process domains may represent a barrier to a successful transition from knowledge to action.

Identifying prioritization criteria for patients with mtbi waiting for multidisciplinary rehabilitation services: A Delphi study.

INTRODUCTION: Rehabilitation service providers must take into account prognostic factors when making clinical decisions, which includes using these factors as prioritization criteria. The goal of this study was to establish consensus on patient prioritization criteria based on prognostic factors related to persistent symptoms for patients with mild traumatic brain injury (mTBI) waiting for outpatient specialized rehabilitation services. MATERIALS AND METHODS: We conducted a Delphi survey involving clinicians, researchers, decision makers, and patients. Before the survey, we presented the results of an overview of systematic reviews summarizing the evidence on prognostic factors related to post-concussion symptoms. RESULTS: After two rounds, the 17 experts reached consensus on the inclusion of 12 prioritization criteria: acute stress disorder, anxiety and depression, baseline mental and physical health, functional impacts and difficulties in performing daily habits after the trauma, motivation to receive services, multiple concussions, prior neurological problems, PTSD, quality of sleep, return to work failures, somatic complaints, suicidal ideation. CONCLUSION: Healthcare stakeholders must consider a wide range of factors to guide clinical decision-making, including about access to care and patient prioritization. This study shows that the Delphi technique can be used to reach consensus on such decisions regarding patients with mTBI who are waiting for outpatient specialized rehabilitation services.

Strategies to improve access to physical activity opportunities for people with physical disabilities.

Community-based physical activity opportunities have been shown to help adults with physical disabilities improve their participation in daily activities and reduce social isolation. Despite the known benefits, substantial barriers and challenges inhibit accessibility to these physical activity opportunities. To facilitate the co-construction of strategies to overcome accessibility issues pertaining to community-based physical activity opportunities. In total, 45 individuals with physical disabilities, patients at a rehabilitation hospital, staff members of disability organizations, staff of local or provincial government agencies/departments, kinesiologists, occupational therapists, graduate students, and peer mentors participated in one of four World Cafés held in their respective cities. World Café is a methodology for fostering collaborative, solution-focused conversation that aims to solve problems through collective intelligence. Participants were divided into groups of three to four people and invited to engage in evolving rounds of discussions responding to prompts about accessibility to physical activity in their communities. Transcripts were analyzed using content analysis. In total, 17 strategies were identified, addressing 5 areas: representation and visibility (e.g., prioritize hiring people with a disability), finances (e.g., reduce direct costs for participants), connection and social support (e.g., foster social networks that provide informational support), education and programming (e.g., enhance awareness of existing services and resources), and government programs and policies (e.g., enforce accessibility standards for indoor and outdoor spaces). The findings of this study provide strategies and practical applications for community programs and governments to consider for increasing access to physical activity opportunities for people with physical disabilities.

Adults living with physical disabilities experience numerous benefits (e.g., greater social connection and ability to complete everyday tasks) from participation in community-based physical activities. Despite the known benefits of physical activity for adults with physical disabilities, accessibility to community-based physical activity opportunities remain limited in Canada. The purpose of this study was to facilitate conversations among members of the disability and physical activity communities and co-develop strategies to improve access to community-based physical activity opportunities. In total, 45 participants in 3 Canadian cities were divided into small groups to engage in evolving rounds of discussions responding to access to physical activity in their communities. Altogether, 17 strategies targeting 5 areas related to accessibility were developed. The five areas included representation and visibility (e.g., prioritize hiring people with a disability), finances (e.g., reduce direct costs for participants), connection and social support (e.g., foster social networks that provide informational support), education and programming (e.g., enhance awareness of existing services and resources), and government programs and policies (e.g., enforce accessibility standards for indoor and outdoor spaces). The findings of this study provide practical strategies that community organizations and governments can implement to improve access to community-based physical activity opportunities for people with physical disabilities.

Being a Parent of Children with Disabilities during the COVID-19 Pandemic: Multi-Method Study of Health, Social Life, and Occupational Situation.

Parents of children with disabilities face challenges in their daily lives, but little is known about their experience of the COVID-19 pandemic. The objective of the study was to explore the experiences of parents of children with disabilities during the COVID-19 pandemic in Quebec, Canada. Forty parents of children with disabilities from Quebec, Canada (mean [SD] age: 41.2 [6.7]; 93% women) were selected from the Ma Vie et la pandémie (MAVIPAN) study. All 40 parents completed the MAVIPAN online questionnaires including the Depression, Anxiety and Stress Scale (DASS-21), Warwick-Edinburgh Mental Wellbeing short 7-item scale (WEMWBS), Social Provisions Scale-10 item (SPS-10), and the UCLA Loneliness Scale (UCLA-LS). A multi-method analysis was used to summarize questionnaires and thematically explore parents' experiences. Parents reported deterioration in their mental (50.0%) and physical (27.5%) health, with moderate levels of depression, stress, and anxiety, yet moderately positive well-being. Additional experiences included reduction in available supports (71.4%) and feelings of social isolation (51.4%). Our results highlighted reduced mental and physical health, limited and modified access to certain services, and reduction of social supports for some parents of children with disabilities. Health professionals, policymakers, and governments should be mindful of these challenges experienced by parents of children with disabilities.

A six-participant pilot single-subject study of an individualized pain management program for people with spinal cord injury.

STUDY DESIGN: Single-subject repeated measures design. OBJECTIVES: To explore the impacts of a novel individualized interdisciplinary pain self-management program for persons living with spinal cord injury pain. SETTING: A large rehabilitation institute for adults with physical disabilities in Quebec city (Quebec, Canada). METHODS: Six persons having sustained a spinal cord injury and experiencing chronic pain participated. Following a five-week pre-intervention phase (baseline repeated measures) and a clinical evaluation, individualized intervention objectives were developed in collaboration with each participant. Then, participants completed a ten-week intensive intervention and a six-month consolidation phase. The program included cognitive behavioral therapy, and physical and pharmacological interventions, which were group- and individual-based. Outcome measures were the Canadian Occupational Performance Measure (COPM), the French-Canadian Chronic Pain Self-efficacy Scale (FC-CPSES), the Brief Pain Inventory (BPI), and the Hospital Anxiety and Depression Scale (HADS). RESULTS: For five out of the six participants, a majority of outcomes improved during either of the intervention phases or both. Improvements in occupational performance were clinically significant for three participants. Pain interference and anxiety improved significantly in five participants, while pain self-efficacy and depressive symptoms improved in four participants. CONCLUSIONS: The results suggest that the pain self-management program was effective to reduce the impact of spinal cord injury pain. Further research is needed to replicate these results in a larger study and comprehend the factors favoring or undermining improvements with such programs, as well as their persistence over time.

Integrative Prevention at Work: A Concept Analysis and Meta-Narrative Review.

Purpose The purpose of this study was to conceptualize integrative prevention at work and to identify its operational variables to support its application in occupational rehabilitation. Methods Based on Walker and Avant's specifications for concept analysis, we conducted a systematic five-step procedure (i.e., 1-identification of research question, 2-literature search through meta-narrative review, 3-manuscript selection, 4-extraction, 5-analysis). Results Analysis of information extracted from 20 manuscripts across diverse literature fields allowed to identify that the shared attributes of integrative prevention at work are: (a) coordination of the three levels of prevention, (b) integration of health promotion with prevention, (c) shared understanding of the goal, (d) engagement of stakeholders, and (e) variety of actions. The analysis also identified three antecedents and five consequences, situating the concept within the context of a change process. The results include recommendations for promoting the practical application of the concept. Conclusion The results of this study offer an informative, non-prescriptive, and operational definition of integrative prevention at work that all the stakeholders involved, including occupational rehabilitation professionals, can use.