Functional Limitations in Individuals With Long COVID.

OBJECTIVES: To examine the extent of long-term functional deficits experienced by individuals hospitalized for coronavirus disease 2019 (COVID-19). Specific objectives were to (1) describe changes in perceived global health, mobility, participation in daily activities, and employment status from pre-COVID-19 to ≥2 months after infection and (2) evaluate factors associated with change in function. DESIGN: We conducted a telephone survey (at least 2 months postinfection). SETTING: Population-based study of adults living at home. PARTICIPANTS: Adult residents in Laval, Quebec (n=121), who were discharged home posthospitalization for COVID-19. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Participants responded to a standard questionnaire (COVID-19 Yorkshire Rehabilitation Screen) regarding persistent symptoms and limitations in daily functioning. We calculated the prevalence of changes in perceived global health, mobility, personal care, participation in daily activities, and employment, and evaluated associated factors using bivariate analysis and multivariable logistic regression. RESULTS: Almost all participants (94%) were more fatigued and reported deterioration of their global health status (90%) at least 3 months after infection. The majority were more short of breath and experienced pain and anxiety. The change in outcomes indicates a substantial reduction in those reporting "good" health status, mobility, personal care, and daily activities and less employment. Time since diagnosis was significantly associated with global health, mobility, and participation in daily activities. CONCLUSIONS: This population-based study suggests that individuals hospitalized for COVID-19 infection have symptoms that affect daily functional activities many months after infection. It is imperative that the effect of infection be better understood so that those affected long term can receive the needed services.

Developing the Driving and Dementia Roadmap: a knowledge-to-action process.

OBJECTIVES: Despite three decades of research, gaps remain in meeting the needs of people with dementia and their family/friend carers as they navigate the often-tumultuous process of driving cessation. This paper describes the process of using a knowledge-to-action (KTA) approach to develop an educational web-based resource (i.e. toolkit), called the Driving and Dementia Roadmap (DDR), aimed at addressing some of these gaps. DESIGN: Aligned with the KTA framework, knowledge creation and action cycle activities informed the development of the DDR. These activities included systematic reviews; meta-synthesis of qualitative studies; interviews and focus groups with key stakeholders; development of a Driving and Dementia Intervention Framework (DD-IF); and a review and curation of publicly available resources and tools. An Advisory Group comprised of people with dementia and family carers provided ongoing feedback on the DDR's content and design. RESULTS: The DDR is a multi-component online toolkit that contains separate portals for current and former drivers with dementia and their family/friend carers. Based on the DD-IF, various topics of driving cessation are presented to accommodate users' diverse stages and needs in their experiences of decision-making and transitioning to non-driving. CONCLUSION: Guided by the KTA framework that involved a systematic and iterative process of knowledge creation and translation, the resulting person-centered, individualized and flexible DDR can bring much-needed support to help people with dementia and their families maintain their mobility, community access, and social and emotional wellbeing during and post-driving cessation.

Feasibility and Preliminary Effects of a 1-Week Vestibular Rehabilitation Day Camp in Children with Developmental Coordination Disorder.

AIM: This pilot study investigated the feasibility and preliminary effects of an intensive 1-week day camp program for children with Developmental Coordination Disorder (DCD) that focused on vestibular rehabilitation. METHODS: Ten participants (6-10 years) were assessed twice pre-intervention, post intervention, and at 8-week follow-up. Videonystagmography, Video Head Impulse Tests (vHIT), and Modified Emory Clinical Vestibular Chair Test (m-ECVCT) test were assessed at baseline. Outcomes measures were gaze stability (Dynamic Visual Acuity; DVA), functional gait (Functional Gait Assessment; FGA), balance (Sensory Organization Test), motor function (Bruininks-Oseretsky Test), and participation (Miller Function and Participation). RESULTS: No abnormal results were detected from the videonystagmography, vHIT and m-ECVCT. There was a 100% attendance rate at the camp and assessment sessions. FGA scores significantly improved following intervention and changes were maintained at follow-up. The number of children with abnormal DVA scores decreased from 3 to 1 to 0 between pre-intervention, post-intervention, and follow-up. There were no significant changes in any of the other outcomes following intervention. CONCLUSIONS: Intensive vestibular rehabilitation delivered in a day camp format is feasible and show positive preliminary effects on functional gait and dynamic visual acuity in children with DCD.

Participation in leisure activities in adolescents with congenital heart defects.

AIM: To describe leisure participation in adolescents with congenital heart defects (CHD) and identify factors associated with intensity of participation. METHOD: Eighty adolescents with CHD were recruited (39 males, 41 females; mean age [SD] 15y 8mo [1y 8mo] range 11y 5mo-19y 11mo) of whom 78 completed the Children's Assessment of Participation and Enjoyment (CAPE) outcome measure of leisure participation. The measure has five subscales: recreational, active-physical, social, skill-based, and self-improvement. Associations between the CAPE and age, sex, and development were examined. Motor ability (Movement Assessment Battery for Children, Second Edition), cognition (Leiter International Performance Scale-Revised), behavior (Strengths and Difficulties Questionnaire), and motivation (Dimensions of Mastery Questionnaire) were assessed. RESULTS: Participants exhibited impaired motor (43.5%), behavioral (23.7%), and cognitive (29.9%) development. The most intense participation was in social (mean [SD] 3.3 [0.99]) and recreational (2.9 [0.80]) activity types on the CAPE. Male sex (p<0.05) and younger age were associated with greater physical activity (<15y: 1.87; ≥15y: 1.31, p<0.05). Greater engagement in social activities was related to better cognition (r=0.28, p<0.05), higher motor function (r=0.30-0.36, p<0.01), and fewer behavioral difficulties (r=-0.32 to -0.47, p<0.01). Cognitive ability (r=0.27, p<0.05), dexterity and aiming/catching (r=0.27-0.33, p<0.05), and behavior problems (r=0.38-0.49, p=0.001) were correlated with physical activity participation. Persistence in tasks, an aspect of motivation, correlated with physical (r=0.45, p<0.001) and social activity involvement (r=0.28, p<0.05). INTERPRETATION: Ongoing developmental impairments in adolescents with CHD are associated with decreased active-physical and social engagement, putting them at risk of poor physical and mental health. Health promotion strategies should be considered. WHAT THIS PAPER ADDS: Adolescents with congenital heart defects (CHD) have limited engagement in active-physical leisure activities. Cognitive, motor, and behavioral impairments are associated with decreased participation in leisure in children with CHD. Female sex and older age are associated with less engagement in leisure. Mastery motivation correlates with participation, suggesting an avenue for intervention.

Participación en actividades recreativas en adolescentes con cardiopatías congénitas OBJETIVO: Describir la participación en el tiempo libre en adolescentes con defectos cardíacos congénitos (CHD) e identificar los factores asociados con la intensidad de la participación. MÉTODO: Ochenta adolescentes con CHD fueron reclutados (39 varones, 41 mujeres; edad media [DE] 15 años 8 meses [1 año 8 meses] rango 11 año 5 meses- 19 año 11 meses) de los cuales 78 completaron la medida de resultado de la Evaluación de la Participación y el Disfrute de los Niños (Children's Assessment of Participation and Enjoyment [CAPE]) del ocio participación. La medida tiene cinco subescalas: recreación, actividad física, social, basada en habilidades y mejoría personal. Se examinaron las asociaciones entre el CAPE y la edad, el sexo y el desarrollo. Se evaluó la capacidad motora con la Batería de Evaluación de Movimiento para Niños (Movement Assessment Battery for Children, Segunda edición), la cognición (Leiter International Performance Scale-Revised), el comportamiento con el Cuestionario de Fortalezas y Dificultades (Strengths and Difficulties Questionnaire) y la motivación usando el cuestionario Dimensiones del Dominio (Dimensions of Mastery Questionnaire). RESULTADOS: Los participantes exhibieron problemas en el desarrollo motor (43.5%), conducta (23.7%) y en el desarrollo cognitivo (29.9%). La participación más intensa fue en los tipos de actividad social (media [DE] 3.3 [0.99]) y recreativa (2.9 [0.80]) en el CAPE. El sexo masculino (p <0.05) y la edad más joven se asociaron con una mayor actividad física (<15 años: 1.87; ≥15 años: 1.31, p <0.05). Una mayor participación en actividades sociales se relacionó con una mejor cognición (r = 0.28, p <0.05), una función motora más alta (r = 0.30-0.36, p <0.01) y menos dificultades en el comportamiento (r = -0.32 a -0.47, p < 0,01). La capacidad cognitiva (r = 0.27, p <0.05), la destreza manual y la habilidad para apuntar y atajar (r = 0.27-0.33, p <0.05) y los problemas de comportamiento (r = 0.38-0.49, p = 0.001) se correlacionaron con la participación en la actividad física. La capacidad de persistir en las tareas, un aspecto de la motivación se correlacionó con la participación física (r = 0.45, p <0.001) y la actividad social (r = 0.28, p <0.05). INTERPRETACIÓN: Los problemas de desarrollo en los adolescentes con CHD están asociados con una disminución de la participación física y social, lo que los pone a riesgo de una pobre salud física y mental. Deben buscarse estrategias para la promoción de la salud de esta población.

Participação em atividades de lazer em adolescentes com defeitos cardíacos congênitos OBJETIVO: Descrever a participação em lazer de adolescentes com defeitos cardíacos congênitos (DCC) e identificar fatores associados com a intensidade de participação. MÉTODO: Oitenta adolescentes com DCC foram recrutados (39 do sexo masculino, 41 do sexo feminino; média de idade [DP] 15a 8m [1a 8m] variação 11a 5m-19a 11m), dos quais 78 completaram a medida de participação em lazer Avaliação da participação e diversão das crianças (APDC). A medida tem cinco subescalas: recreacional, ativa-física, social, baseada em habilidades, e auto-aprimoramento. Associações entre a APDC e idade, sexo e desenvolvimento foram examinadas. A capacidade motora (Bateria de avaliação do movimento para crianças, segunda edição), cognição (Escala internacional de desempenho de Leiter- Revisada), comportamento (Questionário de capacidades e dificuldades), e motivação (Questionário de Dimensões do Domínio) foram avaliados. RESULTADOS: Os participantes exibiram comprometimento do desenvolvimento motor (43,5%), comportamental (23,7%), e cognitivo (29,9%). A participação mais intensa segundo a APDC foi nos tipos social (média [DP] 3,3 [0,99]) e recreacional (2.9 [0,80]). O sexo masculino (p<0,05) e menor idade foram associados com maior nível de atividade física (<15a: 1,87; ≥15a: 1,31, p<0,05). Um maior engajamento em atividades sociais foi relacionado com uma melhor cognição (r=0,28, p<0,05), maior função motora (r=0,30-0,36, p<0,01), e menos dificuldades comportamentais (r=-0,32 a -0,47, p<0,01). A capacidade cognitiva (r=0,27, p<0,05), destreza e mirar/apreender (r=0,27-0,33, p<0,05), e problemas comportamentais (r=0,38-0,49, p=0,001) foram correlacionadas com a participação em atividades físicas. A persistência nas tarefas, um aspecto da motivação, se correlacionou com o envolvimento em atividades físicas (r=0,45, p<0,001) e sociais (r=0,28, p<0,05). INTERPRETAÇÃO: Alterações persistentes do desenvolvimento de adolescentes com DCC são associadas com engajamento ativo-físico e social reduzidos, o que os coloca em risco para sua saúde física e mental. Estratégias de promoção de saúde deveriam ser consideradas.

A Comparison of Developmental Outcomes of Adolescent Neonatal Intensive Care Unit Survivors Born with a Congenital Heart Defect or Born Preterm.

OBJECTIVE: To compare cognitive, motor, behavioral, and functional outcomes of adolescents born with a congenital heart defect (CHD) and adolescents born preterm. STUDY DESIGN: Adolescents (11-19 years old) born with a CHD requiring open-heart surgery during infancy (n = 80) or born preterm ≤29 weeks of gestational age (n = 128) between 1991 and 1999 underwent a cross-sectional evaluation of cognitive (Leiter International Performance Scale-Revised), motor (Movement Assessment Battery for Children-II), behavioral (Strengths and Difficulties Questionnaire), and functional (Vineland Adaptive Behavior Scale-II) outcomes. Independent samples t tests and Pearson χ2 or Fisher exact tests were used to compare mean scores and proportions of impairment, respectively, between groups. RESULTS: Adolescents born with a CHD and adolescents born preterm had similar cognitive, motor, behavioral, and functional outcomes. Cognitive deficits were detected in 14.3% of adolescents born with a CHD and 11.8% of adolescents born preterm. Motor difficulties were detected in 43.5% of adolescents born with a CHD and 50% of adolescents born preterm. Behavioral problems were found in 23.7% of adolescents in the CHD group and 22.9% in the preterm group. Functional limitations were detected in 12% of adolescents born with a CHD and 7.3% of adolescents born preterm. CONCLUSIONS: Adolescents born with a CHD or born preterm have similar profiles of developmental deficits. These findings highlight the importance of providing long-term surveillance to both populations and guide the provision of appropriate educational and rehabilitation services to better ameliorate long-term developmental difficulties.

Interventions that support major life transitions in older adulthood: a systematic review.

ABSTRACTBackground:Major life transitions can negatively impact the emotional well-being of older people. This study examined the effectiveness of interventions that target the three most common transitions in later life, namely bereavement, retirement, and relocation. METHODS: A systematic search was performed via MEDLINE, EMBASE, CINAHL, Cochrane Library, PsycINFO, and reference lists of retrieved non-randomized and randomized controlled trials (RCTs) in English that studied the effectiveness of interventions addressing the three transitions in those >50 years of age. Two researchers independently selected the publications, piloted the data extraction form, and critically appraised studies specific to transition type and study design. RESULTS: A total of 11 studies (bereavement: 7; retirement: 2; relocation: 2) of 8 unique interventions met the inclusion criteria of which nine were RCTs and two were of quasi-experimental designs were reviewed. Six studies were group-based interventions, three studies used individualized sessions, and one intervention used a combination of group and individualized programming. Group size varied (20-32 participants), as did qualifications of those administering the interventions. The methodological quality of included studies was weak. Findings suggest that group-based approaches provided by trained personnel can mitigate the negative health-related consequences associated with major transitions in later life. CONCLUSION: Evidence concerning interventions that address mental health challenges associated with these major transitions is limited. Future research should better characterize participants at study outset and use validated measures to capture effectiveness. Use of peer mentorship to navigate such transitions is promising, but given the small number of studies and their methodological weaknesses, further research on effectiveness is warranted.

Supporting ethics educators in Canadian occupational therapy and physical therapy programs: A national interprofessional knowledge exchange project.

Ethics education is the cornerstone of professional practice, fostering knowledge and respect for core ethical values among healthcare professionals. Ethics is also a subject well-suited for interprofessional education and collaboration. However, there are few initiatives to gather experiences and share resources among ethics educators in rehabilitation. We thus undertook a knowledge exchange project to: 1) share knowledge about ethics training across Canadian occupational and physical therapy programs, and 2) build a community of educators dedicated to improving ethics education. The objectives of this paper are to describe this interprofessional knowledge exchange project involving ethics educators (with a diversity of professional and disciplinary backgrounds) from Canadian occupational and physical therapy programs as well as analyze its outcomes based on participants' experiences/perceptions. Two knowledge exchange strategies were employed: an interactive one-day workshop and a wiki platform. An immediate post-workshop questionnaire evaluated the degree to which participants' expectations were met. Structured telephone interviews 9-10 months after the workshop collected participants' perceptions on whether (and if so, how) the project influenced their teaching or led to further interprofessional collaborations. Open-ended questions from the post-workshop questionnaires and individual interviews were analyzed using qualitative methods. Of 40 ethics educators contacted, 23 participated in the workshop and 17 in the follow-up interview. Only 6 participants logged into the wiki from its launch to the end of data collection. Five themes emerged from the qualitative analysis: 1) belonging and networking; 2) sharing and collaborating; 3) changing (or not) ways of teaching ethics; 4) sustaining the network; and 5) envisioning the future of ethics education. The project attained many of its goals, despite encountering some challenges. While the wiki platform proved to be of limited benefit in advancing the project goals, the interactive format and collaborative nature of the one-day workshop were described as rewarding and effective in bringing together occupational therapy and physical therapy educators to meet, network, and share knowledge.

Educational and rehabilitation service utilization in adolescents born preterm or with a congenital heart defect and at high risk for disability.

AIM: This historical cohort study describes the use of educational and rehabilitation services in adolescents born preterm or with a congenital heart defect (CHD). METHOD: Parents of 76 young people (mean age 15y 8mo [SD 1y 8mo]) with CHD and 125 born ≤29 weeks gestational age (mean age 16y [SD 2y 5mo]) completed a demographics questionnaire including educational and rehabilitation resource utilization within the previous 6 months. Rehabilitation services included occupational therapy, physical therapy, speech language pathology, psychology. Developmental (Leiter Brief IQ, Movement-ABC, Strengths and Difficulties Questionnaire) and functional (Vineland) status of the young people was assessed. Pearson χ2 tests were used to perform simple pairwise comparisons of categorical outcomes across the two groups (CHD, preterm). Univariate logistic regression was used to examine predictors of service utilization. RESULTS: Developmental profiles of the two groups (CHD/preterm) were similar (29.9%/30% IQ<80; 43.5%/50.0% motor difficulties; 23.7%/22.9% behavior problems). One-third received educational supports or attended segregated schools. Only 16% (preterm) and 26.7% (CHD) were receiving rehabilitation services. Services were provided predominantly in the school setting, typically weekly. Few received occupational therapy or physical therapy (1.3-7.6%) despite functional limitations. Leiter Brief IQ<70 was associated with receiving educational supports (CHD: OR 5.53, 95% CI 1.29-23.68; preterm: OR 14.63, 3.10-69.08) and rehabilitation services (CHD: OR 4.46, 1.06-18.88; preterm: OR 5.11, 1.41-18.49). Young people with motor deficits were more likely to require educational (CHD: OR 5.72, 1.99-16.42; preterm: OR 3.11, 1.43-6.77) and rehabilitation services (preterm: OR 3.97, 1.21-13.03). INTERPRETATION: Although young people with impairments were more likely to receive educational and rehabilitation services, many may not be adequately supported, particularly by rehabilitation specialists. Rehabilitation services at this important transition phase could be beneficial in optimizing adaptive functioning in the home, school, and community.

Factors Associated With Moderate to Vigorous Physical Activity in Adolescents Born Preterm.

PURPOSE: Little is known about the physical activity of adolescents born prematurely. This study aimed to: 1) describe relationships between moderate to vigorous physical activity (MVPA) in adolescents born prematurely and various factors and, 2) compare their MVPA level to guidelines. METHOD: A secondary analysis was performed using data from 64 adolescents (16.1 ± 2.5 years old, born £29 weeks gestation; 57.8% girls). Time spent in MVPA was based on accelerometry data. Sociodemographic, prematurity and comorbidity variables were based on questionnaire data or, for movement difficulty, from the results of the Movement Assessment Battery for Children-Second Edition. RESULTS: Multiple regression analysis showed that participants who were older (b = -4.52, p < .001), female (b = 14.18, p = .014), with movement difficulty (b = 18.64, p = .014), with health problems (b = 11.78, p = .036) and without hyperactive behavior (trend, b = 2.04, p = .099) spent less time in MVPA. Together these variables explained 44.4% of the variance in MVPA. Most participants (79.7%) did not meet Canadian MVPA guidelines. CONCLUSION: Study results suggest that physical activity interventions should especially target adolescents born prematurely who are older, female, with health problems, and with marked movement difficulties.

Detecting incipient schizophrenia: a validation of the Azima battery in first episode psychosis.

Early psychosis intervention aims to accurately detect adolescents and young adults at risk for major mental disorders, particularly schizophrenia, yet early biomedical diagnostic accuracy remains poor. However, phenomenological approaches focusing on eliciting and understanding the subjective experience of help-seeking youth better detect incipient schizophrenia. The Azima Battery is an occupational therapy projective assessment that uses expressive media in a standard setup, in order to phenomenologically elicit and describe the activity performance and narratives of individuals at risk of, or on, the psychotic-spectrum.The purpose of this study was to estimate the predictive validity of the Azima Battery with youth seeking help for a first episode of psychosis, and identify patterns of performance distinctive of a diagnosis of schizophrenia 1-year later. A mixed methods phenomenological approach was used to calculate the predictive validity of the Azima Battery in detecting incipient schizophrenia, and to qualitatively identify patterns of performance. Study results demonstrate that the diagnostic accuracy of the Azima Battery is greater than psychiatric interviewing for a future diagnosis of schizophrenia (N = 62: 88.7 % vs 42 %). Performance elements and patterns statistically distinctive of schizophrenia are described, and relate to the structure of the created objects. Therefore, the Azima Battery is a valid measure for clinical use by occupational therapists working in early intervention for psychosis as a complement to traditional psychiatric interviewing.

Candidates' and interviewers' perceptions of multiple-mini interviews for admission to an occupational therapy professional program.

Multiple-Mini Interviews (MMIs) were used to assess professional attributes of candidates seeking admission to an occupational therapy professional entry-level master's program. Candidates and interviewers were invited to complete a questionnaire comprised of quantitative and open-ended questions following the MMIs. The MMIs were perceived to be fair, enjoyable, and capable of capturing professional attributes. Descriptive analysis of candidates' data revealed perceptions regarding logistics, interview station content, process, and interviewers. Interviewers commented on the positive and challenging aspects of the scenarios and the MMI process. Admissions committees need to consider several logistical, content, and process issues when designing and implementing MMIs as a selection tool.

Long COVID in Persons With Self-Reported Arthritis: Symptoms, Associated Factors, and Functional Limitations.

OBJECTIVE: The aim is to describe both long COVID symptoms and associated factors in a cohort of individuals with a self-reported history of arthritis as well as change in function in persons with arthritis and long COVID compared to pre-COVID status. METHODS: Among 2,764 persons with a confirmed COVID-19 diagnosis who responded to an online survey at least 12 weeks post-infection, 171 reported a history of arthritis and formed our study sample. We calculated the frequency of long COVID defined as troubled by persistent symptoms and evaluated associated factors using bivariate analysis and multivariable logistic regression. Among those with long COVID, we describe limitations in activity and function in comparison to pre-COVID status. RESULTS: In our sample, 53.5% (n = 91) reported being troubled by ongoing symptoms at the time of completing the questionnaire (long COVID), with the most frequent symptoms as the following: fatigue, myalgia, weakness, breathlessness, low mood, anxiety, and sleep disturbance. Factors associated with long COVID were female sex, having been hospitalized for COVID, and having at least 1 other chronic disease. Persons with long COVID had substantial declines in function, notably in global health status, usual activities, mobility, personal care, and employment status. Also, 37% of those with long COVID reported moderate to severe increase in pain. CONCLUSION: Persons with arthritis who have long COVID have substantial limitations in function compared to their pre-COVID status. There is a need to implement effective interventions to improve functional status in persons with arthritis and long COVID.

Decline in Mobility and Balance in Persons With Post-COVID-19 Condition.

OBJECTIVES: Post-COVID-19 condition (PCC) may impact mobility and balance and affect physical function. The objectives of the study were to estimate the prevalence of decline in balance and mobility in individuals with PCC; explore the association between comorbidities and sociodemographic characteristics with decline in balance and mobility; and evaluate correlations between decline in mobility and balance with change in performance of usual activities, personal care, and global health perception. METHODS: The design was a cross-sectional study of persons with a COVID-19 diagnosis that was confirmed at least 3 months before the study. Those with PCC, defined as those still troubled by symptoms, were evaluated for decline in mobility and balance and with associated clinical and demographic factors using bivariate analysis and multivariable logistic regression. Correlations between decline in mobility and balance were also examined with change in ability to perform usual activities, personal care, and global health perception. RESULTS: In 1031 persons with PCC, mobility deteriorated in 44.9%, and balance deteriorated in 37.1%. Older age, hospitalization, comorbidities, and obesity were associated with decline in mobility, while decline in balance was associated with older age and comorbidities. Reduced mobility was associated with changes in ability to carry out usual activities (rp = 0.6), conduct personal care (rp = 0.6), and global health status (rp = 0.5). Correlations between decline in balance and these same outcomes were 0.5, 0.5, and 0.45, respectively. CONCLUSIONS: Almost half the participants with PCC had reduced mobility, and over a third reported deterioration in balance, with associated difficulties with daily functioning. Factors associated with greater decline help identify those most at risk. IMPACT: Many people with PCC experience changes in mobility and balance, which can affect functional capacities and lead to physical therapist consultations. Further study should assess specific needs of these patients and determine effective physical therapist interventions to meet these needs. LAY SUMMARY: Many persons with post-COVID-19 condition (PCC) experience symptoms resulting in functional problems, such as difficulties with personal care and performing usual activities. This study focused on difficulty in mobility and problems with balance. Almost half of persons with PCC in the study had declines in getting around and over a third had declines in balance. These problems were associated with older age and having other comorbid health conditions and were linked with decline in ability to perform personal care, carry out usual activities, and perceived global health status.

Older Drivers Reduced Engagement in Distracting Behaviors Over a Six-Year Period: Findings From the Candrive Longitudinal Study.

OBJECTIVES: Baltes and Baltes' "selective optimization with compensation" model is pertinent to driving but evidence about the use of compensation using longitudinal designs is scarce. Therefore, we sought to determine if older drivers reduced their engagement in distracting behaviors while driving, over a 6-year period. METHODS: We used data captured over several annual assessments from a cohort of 583 drivers aged 70 and older to determine if their engagement in 12 distracting behaviors (e.g., listening to the radio, talking with passengers) declined over time. We adjusted our multivariable model for several potential confounders of the association between our outcome variable and time. RESULTS: Overall, and after adjustment for potential confounders, the participants reduced their engagement in distracting behaviors over the study period (odds ratio [OR] = 0.96, 95% confidence interval [CI] = 0.95-0.97). Baseline age was negatively associated with engagement in distracting behaviors (OR = 0.95, 95% CI = 0.94-0.96). Men engaged in more distracting behaviors than women (OR = 1.15, 95% CI = 1.03-1.27), as did participants living in the largest urban centers compared to participants living in the smallest areas (OR = 1.21, 95% CI = 1.04-1.41). The number of kilometers driven per year (for every 10,000 km) was positively associated with the proportion of distracting behaviors drivers engaged in (OR = 1.13, 95% CI = 1.08-1.19). DISCUSSION: Drivers in our cohort reduced their engagement in distracting behaviors over the study period. This suggests that older drivers adjust their driving over time, which aligns with age-related theories and models about compensation.

A Systematic Review of Effective Interventions and Strategies to Support the Transition of Older Adults From Driving to Driving Retirement/Cessation.

Background and Objectives: In most western countries, older adults depend on private cars for transportation and do not proactively plan for driving cessation. The objective of this review was to examine current research studies outlining effective interventions and strategies to assist older adults during their transition from driver to driving retirement or cessation. Research Design and Methods: A search was completed across 9 databases using key words and MeSH terms for drivers, cessation of driving, and older adult drivers. Eligibility screening of 9,807 titles and abstracts, followed by a detailed screening of 206 papers, was completed using the Covidence platform. Twelve papers were selected for full-text screen and data extraction, comprising 3 papers with evidence-based intervention programs and 9 papers with evidence-informed strategies. Results: Three papers met the research criteria of a controlled study for programs that support and facilitate driving cessation for older adults. Nine additional studies were exploratory or descriptive, which outlined strategies that could support older drivers, their families, and/or healthcare professionals during this transition. Driving retirement programs/toolkits are also presented. Discussion and Implications: The driver retirement programs had promising results, but there were methodological weaknesses within the studies. Strategies extracted contributed to 6 themes: Reluctance and avoidance of the topic, multiple stakeholder involvement is important, taking proactive approach is critical, refocus the process away from assessment to proactive planning, collaborative approach to enable "ownership" of the decision is needed, and engage in planning alternative transportation should be the end result. Meeting the transportation needs of older adults will be essential to support aging in place, out-of-home mobility, and participation, particularly in developed countries where there is such a high dependency on private motor vehicles.

Assessments used to diagnose developmental coordination disorder: do their underlying constructs match the diagnostic criteria?

This study examined the constructs underlying the Movement Assessment Battery for Children-2 (M-ABC-2), Bruninks-Oseretsky Test of Motor Proficiency (BOTMP) and Vineland Adaptive Behavior Scale-2 (VABS-2) using the framework of the International Classification of Functioning Disability and Health-Child Youth version (ICF-CY) and the diagnostic criteria of developmental coordination disorder (DCD). Two independent raters coded and matched items to ICF-CY codes as per the eight ICF linking rules developed by Cierza and colleagues. Content density and inter-rater reliability were also calculated. The majority of codes assigned to the M-ABC-2 and BOTMP related to body functions (54% and 64% respectively). For the VABS-2, 91% of codes pertained to activities and participation. The M-ABC-2, BOTMP, and the VABS-2 emphasize the ICF-CY constructs differently. The VABS-2 may be useful in the evaluation of performance of daily life activities and participation in children with DCD.

Candrive-Development of a Risk Stratification Tool for Older Drivers.

BACKGROUND: Assessing an older adult's fitness-to-drive is an important part of clinical decision making. However, most existing risk prediction tools only have a dichotomous design, which does not account for subtle differences in risk status for patients with complex medical conditions or changes over time. Our objective was to develop an older driver risk stratification tool (RST) to screen for medical fitness-to-drive in older adults. METHODS: Participants were active drivers aged 70 and older from 7 sites across 4 Canadian provinces. They underwent in-person assessments every 4 months with an annual comprehensive assessment. Participant vehicles were instrumented to provide vehicle and passive Global Positioning System (GPS) data. The primary outcome measure was police-reported, expert-validated, at-fault collision adjusted per annual kilometers driven. Predictor variables included physical, cognitive, and health assessment measures. RESULTS: A total of 928 older drivers were recruited for this study beginning in 2009. The average age at enrollment was 76.2 (standard deviation [SD] = 4.8) with 62.1% male participants. The mean duration for participation was 4.9 (SD = 1.6) years. The derived Candrive RST included 4 predictors. Out of 4 483 person-years of driving, 74.8% fell within the lowest risk category. Only 2.9% of person-years were in the highest risk category where the relative risk for at-fault collisions was 5.26 (95% confidence interval = 2.81-9.84) compared to the lowest risk group. CONCLUSIONS: For older drivers whose medical conditions create uncertainty regarding their fitness-to-drive, the Candrive RST may assist primary health care providers when initiating a conversation about driving and to guide further evaluation.

Long COVID symptoms in a population-based sample of persons discharged home from hospital.

OBJECTIVES: The impact of long COVID among persons hospitalized and discharged home is unknown. We aimed to (1) report the prevalence of long COVID in persons hospitalized for COVID-19 and discharged home; (2) estimate the prevalence of physical, sensory, and psychological/mental health impairments; and (3) explore associated factors. METHODS: We conducted a telephone survey of adult residents in Laval, Quebec, who were discharged home ≥ 2 months post-hospitalization for COVID-19. Participants responded to a standard questionnaire regarding persistent symptoms. We calculated the prevalence of long COVID and of persistent types of symptoms and evaluated associated factors using bivariate analysis and multivariable logistic regression. RESULTS: In our sample (n = 398), 70% reported physical symptoms, 58% psychological problems, and 16% sensory impairments. 31.5% reported being troubled by persistent symptoms (long COVID). Factors associated with long COVID were a greater number of symptoms (odds ratio (OR) = 1.97, 95% confidence interval (CI) = 1.69-2.28) and increased hospital stay (OR = 1.03, 95% CI = 1.01-1.06). Other factors associated with physical and psychological symptoms were female sex (OR = 2.17, 95% CI = 1.27-3.71 and OR = 2.06, 95% CI = 1.25-3.39; respectively), higher education level (OR = 2.10, 95% CI = 1.20-3.68 and OR = 2.43, 95% CI = 1.44-4.14; respectively), and obesity (OR = 1.95, 95% CI = 1.15-3.34 and OR = 1.70, 95% CI = 1.05-2.77; respectively). CONCLUSION: In this population-based study of persons hospitalized for COVID-19 and discharged home, nearly one third were troubled by symptoms for 2 months or more post-discharge. There was a high proportion with persistent physical and psychological/mental health symptoms. Further research will assess the specific needs of these patients to inform health policy makers on service requirements for these persons.

RéSUMé: OBJECTIFS: L'impact de la présence de la COVID longue chez les personnes hospitalisées et lors de leur congé de l'hôpital est inconnu. Dans le cadre de cette étude, nous visions à 1) rapporter la prévalence de la présence de la COVID longue chez les personnes hospitalisées en raison de la COVID-19 et lors de leur congé à la maison; 2) estimer la prévalence des déficiences physiques, sensorielles et psychologiques/cognitives; et 3) explorer les facteurs associés. MéTHODES: Nous avons mené une enquête téléphonique auprès des résidents adultes de Laval, au Québec, qui ont reçu leur congé de l'hôpital plus de deux mois après avoir été hospitalisés en raison de la COVID-19. Les participants ont répondu à un questionnaire standard concernant leurs symptômes résiduels. Nous avons calculé la prévalence de la COVID longue et le type de symptômes résiduels et nous avons évalué les facteurs associés en utilisant une analyse bivariée et une régression logistique multivariable. RéSULTATS: Dans notre échantillon (n=398), 70 % ont déclaré des symptômes physiques, 58 % des problèmes psychologiques et 16 % des déficiences sensorielles. 31,5 % ont déclaré être perturbés par des symptômes résiduels (COVID longue). Les facteurs associés à la COVID longue étaient un plus grand nombre de symptômes (Rapport de cotes (OR)=1,97, intervalle de confiance à 95% (IC)=1,69-2,28) et une durée d'hospitalisation plus longue (OR=1,03, IC 95%=1,01-1,06). Les autres facteurs associés aux symptômes physiques et psychologiques étaient le sexe féminin (OR=2,17, IC 95%=1,27-3,71 et OR=2,06, IC 95%=1,25-3,39; respectivement), un niveau d'éducation plus élevé (OR=2,10, IC 95%=1,20-3,68 et OR=2,43, IC 95%=1,44-4,14; respectivement) et l'obésité (OR=1,95, IC 95%=1,15-3,34 et OR=1,70, IC 95%=1,05-2,77; respectivement). CONCLUSION: Dans cette étude effectuée sur une population de personnes hospitalisées pour la COVID-19 et lors de leur congé de l'hôpital, près d'un tiers ont été perturbées par la présence de symptômes résiduels présents pendant 2 mois ou plus après leur congé. Une forte proportion d'entre elles présentait des symptômes physiques et psychologiques/enjeux de santé mentale persistants. Des recherches futures permettront d'évaluer les besoins spécifiques de ces individus afin d'informer les décideurs politiques en santé de leurs besoins afin d'offrir des services adaptés à leur condition.

Predictive validity of Prechtl's Method on the Qualitative Assessment of General Movements: a systematic review of the evidence.

AIM: The aim of this systematic review was to examine the evidence for the predictive validity of Prechtl's Method on the Qualitative Assessment of General Movements (GMsA) with respect to neurodevelopmental outcomes. METHOD: Six electronic databases (PsychINFO, Embase, Health and Psychosocial Instruments, PubMed, and AMED) were searched using the following keywords to identify all studies that examined the predictive validity of the GMsA: 'general movements', 'assessment', 'movement', 'child development', 'infant', and 'predictive value of test'. Only English- and French-language studies were included, whereas studies that focused on spontaneous mobility in preterm infants, but not necessarily the GMsA, or which did not report on the predictive value of the GMsA were excluded. A total of 39 studies were included in the final analysis. RESULTS: Studies were separated according to the age at follow-up: 12 to 23 months, 2 to 3, 4 to 11, and 12 to 18 years. All used a longitudinal cohort study design; however, the outcome measures differed greatly amongst the studies. Values for sensitivity, specificity, positive predictive value, and negative predictive value varied amongst studies. The overall trend indicated that the presence of abnormalities in the quality of fidgety movements at 12 weeks adjusted age is more predictive of adverse outcomes than abnormal writhing movements. INTERPRETATION: The GMsA demonstrates potential as a cost-effective, non-intrusive means of infant examination. However, current studies include important sources of bias. Future methodologically rigorous studies with functional outcomes are suggested.

Practice management of musculoskeletal injuries in active children.

BACKGROUND: Although increasing participation in physical activities has significant health benefits, there are no guidelines to help professionals decide when it is safe to return to activity after injury. OBJECTIVE: To examine the specific criteria (eg, strength, pain) that expert sport medicine clinicians use for return to activity decisions in children with musculoskeletal injuries. METHODS: The authors conducted an online cross-sectional survey of certified Canadian sport medicine doctors (MDs) and sport rehabilitation specialists (physiotherapists (PTs) or athletic therapists (ATs)). The authors asked how they would measure each of the following signs in the context of a knee injury: sport-specific skills, pain, swelling, strength, range of motion (ROM) and balance. Clinicians also ranked the importance of each sign with respect to influencing their recommendations for each of five clinical vignettes. RESULTS: The overall response rate was 33.6% (464/1380) with similar rates for each profession. For each clinical sign, all three professions preferred the same measure to determine readiness to return to play: standardised testing for sport-specific skills, impact on function for pain, palpation for swelling, manual muscle testing for strength, visual inspection for ROM and standing on one leg with eyes closed for balance. Regarding importance of specific signs for return to activity, all professions had similar responses for one vignette, but MDs differed from PTs and ATs for the remaining four. Finally, pain was ranked as the no 1 or 2 most important sign in all five vignettes by 41.0% of MDs, 18.1% of ATs and 11.3% of PTs, whereas sport-specific skills was chosen by 9.6% MDs, 12.0% ATs and 16.1% PTs. CONCLUSION: Our results provide the foundation for future work leading towards the development of interdisciplinary consensus guidelines.