A Sensibility Assessment of the Job Demands and Accommodation Planning Tool (JDAPT): A Tool to Help Workers with an Episodic Disability Plan Workplace Support.

Purpose Sensibility refers to a tool's comprehensiveness, understandability, relevance, feasibility, and length. It is used in the early development phase to begin assessing a new tool or intervention. This study examined the sensibility of the job demands and accommodation planning tool (JDAPT). The JDAPT identifies job demands related to physical, cognitive, interpersonal, and working conditions to better target strategies for workplace supports and accommodations aimed at assisting individuals with chronic health conditions. Methods Workers with a chronic health condition and workplace representatives were recruited from health charities, workplaces, and newsletters using convenience sampling. Cognitive interviews assessed the JDAPT's sensibility. A 70% endorsement rate was the minimum level of acceptability for sensibility concepts. A short screening tool also was administered, and answers compared to the complete JDAPT. Results Participants were 46 workers and 23 organizational representatives (n = 69). Endorsements highly exceeded the 70% cut-off for understandability, relevance, and length. Congruence between screening questions and the complete JDAPT suggested both workers and organizational representatives overlooked job demands when completing the screener. Participants provided additional examples and three new items to improve comprehensiveness. The JDAPT was rated highly relevant and useful, although not always easy to complete for someone with an episodic condition. Conclusions This study highlights the need for tools that facilitate accommodations for workers with episodic disabilities and provides early evidence for the sensibility of the JDAPT.

Assessing the Utility of the Montreal Cognitive Assessment in Screening for Cognitive Impairment in Patients With Systemic Lupus Erythematosus.

OBJECTIVE: Screening for cognitive impairment (CI) in systemic lupus erythematosus (SLE) relies on the American College of Rheumatology (ACR) neuropsychological battery (NB). By studying the concurrent criterion validity, our goal was to assess the Montreal Cognitive Assessment (MoCA) as a screening tool for CI compared to the ACR-NB and to evaluate the added value of the MoCA to the Automated Neuropsychological Assessment Metrics (ANAM). METHODS: A total of 285 adult SLE patients were administered the ACR-NB, MoCA, and ANAM. For the ACR-NB, patients were classified as having CI if there was a Z score of ≤-1.5 in ≥2 domains. The area under the curve (AUC) and sensitivities/specificities were determined. A discriminant function analysis was applied to assess the ability of the MoCA to differentiate between CI, undetermined CI, and non-CI patients. RESULTS: CI was not accurately identified by the MoCA compared to the ACR-NB (AUC of 0.66). Sensitivity and specificity were poor at 50% and 69%, respectively, for the cutoff of 26, and 80% and 45%, respectively, for the cutoff of 28. The MoCA had a low ability to identify CI status. The addition of the MoCA to the ANAM led to improvement on the AUC by only 2.5%. CONCLUSION: The MoCA does not have adequate concurrent criterion validity to accurately identify CI in patients with SLE. The low specificity of the MoCA may lead to overdiagnosis and concern among patients. Adding the MoCA to the ANAM does not substantially improve the accuracy of the ANAM. These results do not support using the MoCA as a screening tool for CI in patients with SLE.

Metrics and definitions used in the assessment of cognitive impairment in systemic lupus erythematosus: A systematic review.

OBJECTIVE: To review: 1) degree of conformity to the American College of Rheumatology neuropsychological battery (ACR-NB) among studies that used a NB, 2) review definitions of cognitive impairment (CI) from studies that used a NB, and 3) characterize measurement tools used to assess CI in systemic lupus erythematosus (SLE). METHODS: The literature search was conducted in Ovid Medline, Embase, and PsycINFO for articles on CI in adult SLE patients. We reviewed studies that used a NB and compared their tests to the ACR-NB to assess the degree of conformity. Definitions of CI from studies that used a NB were reviewed when sufficient information was available. We reviewed and categorized CI measurement tools into four broad categories: NB, screening, incomplete/mixed batteries, and computerized batteries. RESULTS: Of 8727 references, 118 were selected for detailed review and 97 were included in the final analysis. Of 43 studies that used a NB, none of the studies used the ACR-NB exactly as published. Many studies supplemented with other tests. Overall, there was inconsistent use of ACR-NB tests. Definitions for CI varied, with cut-offs ranging from 1 to 3 standard deviations below normative values on domains/tests varying in type and number. The most frequently used measurement tool for assessing CI in SLE was a NB. Use of screening tests and computerized batteries have also increased over the last decade. CONCLUSION: The assessment and definition of CI in SLE remains heterogeneous. A consensus meeting to address existing inconsistencies should be considered to harmonize the field of CI in SLE.

Validity Evidence for the Use of Automated Neuropsychologic Assessment Metrics As a Screening Tool for Cognitive Impairment in Systemic Lupus Erythematosus.

OBJECTIVE: Screening for cognitive impairment in systemic lupus erythematosus (SLE) conventionally relies on the American College of Rheumatology (ACR) neuropsychologic battery (NB), which is not universally available. To develop a more accessible screening approach, we assessed validity of the Automated Neuropsychological Assessment Metrics (ANAM). Using the ACR NB as the gold standard for cognitive impairment classification, the objectives were 1) to measure overall discriminative validity of the ANAM for cognitive impairment versus no cognitive impairment, 2) to identify ANAM subtests and scores that best differentiate patients with cognitive impairment from those with no cognitive impairment, and 3) to derive ANAM composite indices and cutoffs. METHODS: A total of 211 consecutive adult patients, female and male, with SLE were administered the ANAM and ACR NB. 1) For overall discriminative validity of the ANAM, we compared patients with cognitive impairment versus those with no cognitive impairment on 4 scores. 2) Six ANAM models using different scores were developed, and the most discriminatory subtests were selected using logistic regression analyses. The area under the receiver operating characteristic curve (AUC) was calculated to establish ANAM validity against the ACR NB. 3) ANAM composite indices and cutoffs were derived for the best models, and sensitivities and specificities were calculated. RESULTS: Patients with no cognitive impairment performed better on most ANAM subtests, supporting ANAM's discriminative validity. Cognitive impairment could be accurately identified by selected ANAM subtests with top models, demonstrating excellent AUCs of 81% and 84%. Derived composite indices and cutoffs demonstrated sensitivity of 78-80% and specificity of 70%. CONCLUSION: This study provides support for ANAM's discriminative validity for cognitive impairment and utility for cognitive screening in adult SLE. Derived composite indices and cutoffs enhance clinical applicability.

Financial Management Activity Process: Qualitative inquiry of adults with acquired brain injury.

BACKGROUND.: Little is known about the financial management occupations of people living with brain injury, despite the importance of these to adult autonomy. PURPOSE.: This work aims to develop a conceptual framework for financial management after adulthood acquired brain injury. METHOD.: This qualitative study used grounded theory methods. Data included semistructured interviews of 10 adults living with brain injury and two close others who assist with financial management occupations. Analysis included initial and focused coding, memo writing, constant comparison, theoretical sampling of questions, and member checking. FINDINGS.: The Financial Management Activity Process conceptual framework describes a complex action process. This includes accounting for factors influencing financial choices and actions, and identifying and using a trusted personalized process, including using financial management strategies aligned with the constraints of factors. IMPLICATIONS.: This conceptual framework may be useful to assessment and intervention development. It highlights the between-person and between-activity variability in financial management processes and strategy use.

OMERACT Filter 2.1: Elaboration of the Conceptual Framework for Outcome Measurement in Health Intervention Studies.

OBJECTIVE: The Outcome Measures in Rheumatology (OMERACT) Filter 2.0 framework was developed in 2014 to aid core outcome set development by describing the full universe of "measurable aspects of health conditions" from which core domains can be selected. This paper provides elaborations and updated concepts (OMERACT Filter 2.1). METHODS: At OMERACT 2018, we discussed challenges in the framework application caused by unclear or ambiguous wording and terms and incompletely developed concepts. RESULTS: The updated OMERACT Filter 2.1 framework makes benefits and harms explicit, clarifies concepts, and improves naming of various terms. CONCLUSION: We expect that the Filter 2.1 framework will improve the process of core set development.

Are There Differences in Workplace Accommodation Needs, Use and Unmet Needs Among Older Workers With Arthritis, Diabetes and No Chronic Conditions? Examining the Role of Health and Work Context.

The aging of workforces combined with the prevalence of age-related chronic diseases has generated interest in whether large numbers of older workers will need workplace accommodations. This research applied work functioning theory to examine accommodation availability, need and use in workers with arthritis, diabetes, or no chronic disabling diseases; factors associated with accommodation needs; and the relationship of accommodation needs met, unmet or exceeded to job outcomes. Participants were aged 50-67 years, employed, and had arthritis (n = 631), diabetes (n = 286), both arthritis/diabetes (n = 111) or no chronic disabling conditions (healthy controls n = 538). They were recruited from a national panel of 80,000 individuals and a cross-sectional survey was administered online or by telephone. Questionnaires assessed demographics, health, work context, workplace accommodations, and job outcomes. Chi-square analyses, analyses of variance, and regression analyses compared groups. Respondents were similar in many demographic and work context factors. As expected, workers with arthritis and/or diabetes often reported poorer health and employment outcomes. Yet, there were few differences across health conditions in need for or use of accommodations with most participants reporting accommodations needs met. In keeping with work functioning theory, unmet accommodation needs were largely related to work context, not health. Workers whose accommodation needs were exceeded reported better job outcomes than those with accommodation needs met. Findings highlight both work context and health in understanding workplace accommodations and suggest that many older workers can meet accommodation needs with existing workplace practices. However, additional research aimed at workplace support and the timing of accommodation use is needed.

Identifying and Addressing Barriers to Osteoporosis Treatment Associated with Improved Outcomes: An Observational Cohort Study.

OBJECTIVE: To identify and address patient-reported barriers in osteoporosis care after a fracture. METHODS: A longitudinal cohort of fragility fracture patients over 50 years of age was seen in a provincewide fracture liaison service. Followup interviews were done at 6 months for osteoporosis care indicators. Univariate statistics were used to describe baseline characteristics, osteoporosis-related outcomes, and reasons cited for not achieving them. Two phases of this program were compared (Phase I: education and communication, and Phase II: risk assessment education and communication). Phase II was further divided into those who fully participated and those who declined. RESULTS: Phase I (n = 3997) had lower testing and treatment rates than Phase II (n = 1363). Rates were highest in those confirmed as having participated in Phase II (n = 569). Phase II nonparticipants (n = 794) had results as in Phase I. In Phase I, the main patient-reported barriers for not visiting their physician or not having a bone mineral density (BMD) test were patient- and physician-oriented (e.g., being instructed by their physician to not have the BMD test). In Phase II, BMD testing was part of the program, thus the main barriers were around treatment choices. Phase II eligible nonparticipants experienced many of the same barriers as Phase I patients, with lower BMD testing rates (54.9% and 65.4%, respectively). CONCLUSION: Evaluating and addressing barriers to guideline implementation reduced those barriers and was associated with higher downstream treatment rates. Monitoring barriers in a program like this provides useful insights for program changes and research interventions.

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

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

Health Equity Considerations for Developing and Reporting Patient-reported Outcomes in Clinical Trials: A Report from the OMERACT Equity Special Interest Group.

OBJECTIVE: Despite advances integrating patient-centered outcomes into rheumatologic studies, concerns remain regarding their representativeness across diverse patient groups and how this affects equity. The Outcome Measures in Rheumatology (OMERACT) Equity Working Group aims to determine whether and how to address equity issues within the core outcome sets of domains and instruments. METHODS: We surveyed current and previous OMERACT meeting attendees and members of the Campbell and Cochrane Equity Group regarding whether to address equity issues within the OMERACT Filter 2.0 Core Outcome Sets and how to assess the appropriateness of domains, instruments, and measurement properties among diverse patients. At OMERACT 2016, results of the survey and a narrative review of differential psychosocial effects of rheumatoid arthritis (i.e., on men) were presented to stimulate discussion and develop a research agenda. RESULTS: We proposed 6 moments for which an equity lens could be added to the development, selection, or testing of patient-reported outcome measures (PROM): (1) recruitment, (2) domain selection, (3) feasibility in diverse settings, (4) instrument validity, (5) thresholds of meaning, and (6) consideration of statistical power of subgroup analyses for outcome reporting. CONCLUSION: There is a need to (1) conduct a systematic review to assess how equity and population characteristics have been considered in PROM development and whether these differences influence the ranking of importance of outcome domains or a patient's response to questionnaire items, and (2) conduct the same survey described above with patients representing groups experiencing health inequities.

Evidence of Reliability, Validity, and Practicality for the Canadian Physiotherapy Assessment of Clinical Performance.

Purpose: To investigate the internal consistency, construct validity, and practicality of the Canadian Physiotherapy Assessment of Clinical Performance (ACP), a descriptive measure used by physiotherapy students and their clinical instructors (CIs) at the mid- and endpoints of an internship to describe the students' behaviours as observed in the clinical education setting relative to what might be expected of an entry-level physiotherapist. Methods: This multi-centre study piloted the ACP in 10 university physiotherapy (PT) programmes. Both CIs and students undertaking clinical internships completed the ACP and the current tool, the Physical Therapist Clinical Performance Instrument (PT-CPI; Version 1997). Results: CIs assessing PT students' performance during internships representing a variety of areas of practice completed the ACP at the midpoint (n=132) and the endpoint (n=126) of the internship. The end-of-internship sample consisted of 55 junior, 30 intermediate, and 41 senior students. The ACP demonstrated strong internal consistency: Alpha coefficients for each role ranged from 0.94 to 0.99. Aligned items on the ACP and PT-CPI were significantly correlated (r=0.51-0.84). Senior PT students performed significantly better than intermediate students, who, in turn, performed better than junior students (p<0.0001). Effect sizes for midpoint to final scores on the ACP ranged from medium to large (0.40-0.74). Participants were satisfied with the online education module that provided instruction on how to use and interpret the ACP, as indicated by satisfaction scores and qualitative comments. Conclusions: The ACP is a reliable, valid, and practical measure to assess and describe the PT students' behaviours as observed during clinical education relative to what is expected of an entry-level physiotherapist.

Objectif : Examiner la cohérence interne, la validité de construit et l'utilité pratique de l'évaluation de la performance clinique (EPC) en physiothérapie au Canada, une mesure employée par les étudiants en physiothérapie et leurs instructeurs cliniques en milieu et en fin de stage clinique pour décrire les comportements des étudiants par rapport à ce qu'il y a lieu d'être attendu d'un physiothérapeute débutant. Méthodes : Cette étude multicentrique évaluait la mise à l'essai de l'EPC dans 10 programmes universitaires. Les instructeurs cliniques et les étudiants en stage clinique ont réalisé leurs évaluations à l'aide de l'EPC et de l'outil actuel, le PT-CPI (version 1997). Résultats : Des instructeurs cliniques représentant différents champs de pratique ont complété l'ECP en milieu (n=132) et en fin (n=126) de stage. L'échantillon de fin de stage était composé de 55 étudiants débutants, 30 étudiants intermédiaires et 41 étudiants avancés. L'ECP a démontré un haut degré de cohérence interne, soit des coefficients alpha de 0,94 à 0,99 pour chaque rôle. Une corrélation significative a été observée entre les éléments correspondants de l'ECP et du PT-CPI (r=0.51­0.84). Les étudiants avancés ont obtenu des résultats significativement meilleurs que les étudiants intermédiaires qui ont à leur tour obtenu des résultats significativement meilleurs que les étudiants débutants (p<0.0001). Les différences constatées entre les notes de l'ECP en milieu et en fin de stage révèlent une taille d'effet moyenne à forte (0,40 à 0,74). Les notes de satisfaction et les commentaires qualitatifs indiquent que les participants étaient satisfaits du module de formation en ligne qui expliquait comment utiliser et interpréter l'ACP. Conclusions : L'ECP est une mesure fiable, valide et pratique pour évaluer et décrire les comportements des étudiants observés en formation clinique par rapport à ce qu'il y a lieu d'attendre d'un physiothérapeute débutant.

Canadian Physiotherapy Assessment of Clinical Performance: Face and Content Validity.

PURPOSE: To investigate face and content validity of a draft measure to be used across Canada to assess physiotherapy students' performance in clinical education, through broad consultation with physiotherapy clinical instructors (CIs) across Canada. METHODS: An online survey was used to collect input on the draft measure. In addition to demographics, the questionnaire included questions on the preferred rating scale, the items within the measure that should have their own rating scale, and general impressions. RESULTS: Among the 259 CIs who completed the survey, a discrete rating scale with six anchors and 10 boxes or a continuous-line rating scale with six anchors was preferred. Respondents favoured using one rating scale for each key competency in the Expert role but considered a single rating scale sufficient for assessing the Scholarly Practitioner role. CIs agreed that the proposed measure would allow them to assess a student who was performing poorly or very well. The name Canadian Physiotherapy Assessment of Clinical Performance (ACP) received the most votes in the questionnaire. CONCLUSIONS: CIs' collective preferences on the design, organization, and naming of the measure they will use in evaluating students are reflected in the second draft of the ACP.

Objectif : Examiner l'apparence et la validité du contenu d'un projet de mesure qui servira dans tout le Canada pour évaluer le rendement en formation clinique des étudiants en physiothérapie, grâce à une vaste consultation auprès des enseignants cliniques à l'échelle du Canada. Méthodes : Un sondage en ligne a permis de recueillir des commentaires sur le projet de mesure. Outre les données démographiques, le questionnaire comprenait des questions sur l'échelle de cotation préférée, les éléments de la mesure qui devraient avoir leur propre échelle de cotation et les impressions générales. Résultats : Les 259 enseignants cliniques qui ont répondu au sondage préféraient généralement une échelle de cotation discrète comportant 6 ancres et 10 cases ou une échelle de cotation doublée de 6 ancres. Les répondants préféraient utiliser une échelle de cotation pour chaque compétence clé du rôle d'expert, mais considéraient qu'une seule échelle de cotation était suffisante pour évaluer le rôle d'érudit. Les enseignants cliniques étaient d'accord avec le fait que la mesure proposée leur permettrait d'évaluer les étudiants dont le rendement était mauvais ou très bon. L'appellation « évaluation du rendement clinique (ERC) de la physiothérapie au Canada ¼ a obtenu le plus de votes dans le questionnaire. Conclusions : Les préférences collectives des enseignants cliniques en matière de conception, d'organisation, et d'appellation de la mesure qu'ils utiliseront pour évaluer les étudiants sont prises en compte dans la deuxième version de l'ERC.

Identifying instruments to quantify financial management skills in adults with acquired cognitive impairments.

INTRODUCTION: Financial management skills-that is, the skills needed to handle personal finances such as banking and paying bills-are essential to a person's autonomy, independence, and community living. To date, no comprehensive review of financial management skills instruments exists, making it difficult for clinicians and researchers to choose relevant instruments. The objectives of this review are to: (a) identify all available instruments containing financial management skill items that have been used with adults with acquired cognitive impairments; (b) categorize the instruments by source (i.e., observation based, self-report, proxy report); and (c) describe observation-based performance instruments by populations, overarching concepts measured, and comprehensiveness of financial management items. Objective (c) focuses on observation-based performance instruments as these measures can aid in situations where the person with cognitive impairment has poor self-awareness or where the proxy has poor knowledge of the person's current abilities. METHOD: Two reviewers completed two systematic searches of five databases. Instruments were categorized by reviewing published literature, copies of the instruments, and/or communication with instrument authors. Comprehensiveness of items was based on nine key domains of financial management skills developed by the authors. RESULTS: A total of 88 discrete instruments were identified. Of these, 44 were categorized as observation-based performance and 44 as self- and/or proxy-reports. Of the 44 observation-based performance instruments, 8 had been developed for acquired brain injury populations and 24 for aging and dementia populations. Only 7 of the observation-based performance instruments had items spanning 6 or more of the 9 financial management skills domains. CONCLUSIONS: The majority of instruments were developed for aging and dementia populations, and few were comprehensive. This review provides foundation for future instrument psychometric and clinimetric reviews. It a necessary first step in providing information to support decision making for clinicians and researchers selecting financial management skills instruments.

Cross-cultural adaptation of the Health Education Impact Questionnaire: experimental study showed expert committee, not back-translation, added value.

OBJECTIVES: To assess the contribution of back-translation and expert committee to the content and psychometric properties of a translated multidimensional questionnaire. STUDY DESIGN AND SETTING: Recommendations for questionnaire translation include back-translation and expert committee, but their contribution to measurement properties is unknown. Four English to French translations of the Health Education Impact Questionnaire were generated with and without committee or back-translation. Face validity, acceptability, and structural properties were compared after random assignment to people with rheumatoid arthritis (N = 1,168), chronic renal failure (N = 2,368), and diabetes (N = 538). For face validity, 15 bilingual people compared translations quality with the original. Psychometric properties were examined using confirmatory factor analysis (metric and scalar invariance) and item response theory. RESULTS: Qualitatively, there were five types of translation errors: style, intensity, frequency/time frame, breadth, and meaning. Bilingual assessors ranked best the translations with committee (P = 0.0026). All translations had good structural properties (root mean square error of approximation <0.05; comparative fit index [CFI], ≥0.899; and Tucker-Lewis index, ≥0.889). Full measurement invariance was observed between translations (ΔCFI ≤ 0.01) with metric invariance between translations and original (lowest ΔCFI = 0.022 between fully constrained models and models with free intercepts). Item characteristic curve analyses revealed no significant differences. CONCLUSION: This is the first experimental evidence that back-translation has moderate impact, whereas expert committee helps to ensure accurate content.

Development of the Canadian Physiotherapy Assessment of Clinical Performance: A New Tool to Assess Physiotherapy Students' Performance in Clinical Education.

PURPOSE: To develop the first draft of a Canadian tool to assess physiotherapy (PT) students' performance in clinical education (CE). Phase 1: to gain consensus on the items within the new tool, the number and placement of the comment boxes, and the rating scale; Phase 2: to explore the face and content validity of the draft tool. METHODS: Phase 1 used the Delphi method; Phase 2 used cognitive interviewing methods with recent graduates and clinical instructors (CIs) and detailed interviews with clinical education and measurement experts. RESULTS: Consensus was reached on the first draft of the new tool by round 3 of the Delphi process, which was completed by 21 participants. Interviews were completed with 13 CIs, 6 recent graduates, and 7 experts. Recent graduates and CIs were able to interpret the tool accurately, felt they could apply it to a recent CE experience, and provided suggestions to improve the draft. Experts provided salient advice. CONCLUSIONS: The first draft of a new tool to assess PT students in CE, the Canadian Physiotherapy Assessment of Clinical Performance (ACP), was developed and will undergo further development and testing, including national consultation with stakeholders. Data from Phase 2 will contribute to developing an online education module for CIs and students.

Objectif : Créer le premier projet d'outil canadien d'évaluation de la formation clinique des étudiants en physiothérapie. Phase 1: dégager un consensus sur les éléments constituants du nouvel outil, le nombre et l'emplacement des encadrés servant aux commentaires et l'échelle d'évaluation; Phase 2: explorer l'apparence et la validité du contenu du projet d'outil. Méthodes : On a utilisé, au cours de la Phase 1, la méthode Delphi et, au cours de la Phase 2, des entrevues cognitives menées auprès de nouveaux diplômés et de formateurs cliniques, ainsi que des entrevues détaillées menées auprès de spécialistes de l'éducation clinique et de la mesure. Résultats : On a dégagé un consensus sur la première version du nouvel outil au cours du cycle 3 du processus Delphi, que 21 participants ont terminé. On a réalisé des entrevues avec 13 formateurs cliniques, 6 nouveaux diplômés et 7 experts. Les nouveaux diplômés et les formateurs cliniques ont pu interpréter l'outil avec précision, qu'ils croyaient pouvoir appliquer à une expérience d'éducation clinique récente, et ont suggéré des améliorations. Les spécialistes ont fourni des conseils marquants. Conclusions : La première version d'un nouvel outil d'évaluation de la formation clinique des étudiants en physiothérapie, l'évaluation du rendement clinique (ERC) en physiothérapie canadienne, a été mis au point et fera l'objet d'autres améliorations et essais, y compris d'une consultation nationale des intervenants. Les données tirées de la Phase 2 contribueront à l'élaboration du module d'éducation en ligne.

Choosing where to put your energy: a qualitative analysis of the role of physical activity in the lives of working adults with arthritis.

OBJECTIVE: Research points to many potential benefits of physical activity (PA) for those with arthritis. However, PA has not typically been examined within the context of other life roles. This study examined the perceptions of PA among individuals managing arthritis in addition to employment and other role demands. METHODS: Eight focus groups were conducted with 24 women and 16 men (age range 29-72 years) who were currently or recently employed (within 2 years) and had osteoarthritis or inflammatory arthritis. Participants were recruited from community newspaper advertisements, rheumatology clinics, and arthritis groups. Discussions were audiotaped and transcribed. Transcripts were analyzed using qualitative content analysis. RESULTS: All groups discussed the impact of arthritis on a range of PAs. Overall, participants discussed PA as positively influencing their health and well-being. Yet, several overarching themes highlighted the complexity of PA, including 1) PA as a potential cause of arthritis; 2) the reciprocal impact of arthritis on PA and PA on arthritis; 3) physical and psychological benefits and harms of PA, such as difficulty making PA decisions when living in pain or when faced with episodic symptoms; 4) perceived choices about engagement in PA (e.g., role overload); and 5) social support. CONCLUSION: The relationships among work, health, and other roles were complex. Competing demands, pain, energy, episodic symptoms, support, and decisions to disclose one's illness at work influenced PA. Changes to PA not only affected physical health but also people's self-identity. PA interventions may be improved by taking into account the demands of multiple life roles.

Confirmatory factor analysis of the Work Limitations Questionnaire (WLQ-25) in Workers' Compensation Claimants with chronic upper-limb disorders.

PURPOSE: To examine the factorial validity of the Work Limitations Questionnaire (WLQ-25) among workers' compensation claimants with chronic upper-limb disorders. METHODS: Attendees of the WSIB Shoulder and Elbow Specialty clinic in Toronto, Ontario, Canada, completed a survey that includes the WLQ-25 [4 subscales: time-management (TM), physical demands (PD), mental-interpersonal (MI), and output demands (OD)]. Confirmatory factor analyses (n = 2262) were conducted to evaluate and compare alternative 4- and 5-factor WLQ-25 structures [MI subscale intact vs. separated into mental demands (MD) and interpersonal demands (IP) subscales]. Model fit indices, saliency of factor loadings, and convergent/divergent validity of latent factors (r = 0.4 - 0.85 expected) were concurrently assessed. RESULTS: The 4-factor WLQ-25 showed acceptable model fit after allowing the residuals of a pair of PD items to correlate (CFI = 0.924, TLI = 0.915, RMSEA = 0.057, SRMR = 0.054); however, significantly lower-than-expected correlations between the PD factor and all other factors (r = -0.11 - -0.03) were also observed. Model fit for the 5-factor WLQ-25 was even more optimal (CFI = 0.934, TLI = 0.925, RMSEA = 0.053, SRMR = 0.051), with MD and IP factors correlating at r = 0.83. CONCLUSIONS: Evidence of factorial validity was demonstrated by the WLQ-25; however, users should be attentive of an instrumentation issue that could be directly related to the psychometric performance of its PD subscale.

Management of work disability in rheumatic conditions: a review of non-pharmacological interventions.

Because of its substantial personal social and economic costs, workforce participation among individuals with rheumatic diseases has received considerable research attention. This chapter reviews non-pharmacological employment interventions for people with rheumatic diseases, focussing on the comprehensiveness of interventions, whether they have been targeted to those groups identified as most at risk, and intervention outcomes and effectiveness. Findings highlight that early diagnosis and treatment of rheumatic diseases may not be enough to keep individuals employed and that comprehensive work interventions may have positive psychological effects, as well as result in increased work participation. However, we lack data addressing the optimum time to intervene and subgroup analyses to determine whether some groups are at increased risk for poor work outcomes. Consistent inclusion of behavioural and psychological outcomes to evaluate interventions and compare studies is also needed, along with cost-benefit studies, to determine the long-term feasibility of work interventions.

Rasch analysis informed modifications to the Work Instability Scale for Rheumatoid Arthritis for use in work-related upper limb disorders.

OBJECTIVE: The Work Instability Scale for Rheumatoid Arthritis (RA-WIS) is a promising prognostic tool for future work disability outcomes. Rasch analysis was conducted to examine the psychometric performance of the RA-WIS in work-related upper limb disorders. STUDY DESIGN AND SETTING: Eligible injured workers (n=396) attending a Shoulder and Elbow Specialty clinic participated in a 1-year study with surveys fielded at four time points. Fit of RA-WIS data (range, 0-23 with 23=highest work instability) to the Guttman structure was evaluated by item-fit, person-fit, item-trait interaction statistics, and the person separation index (PSI). Differential item functioning (DIF) was evaluated by two-way analyses of variance of the residuals across age, sex, location of injury, perceived exertion at work, and repeated testing over time. Unidimensionality was evaluated by principal component analysis of residuals and tests of local independence. RESULTS: RA-WIS data showed significant deviations from the Guttman structure (item-trait interaction χ(2)=181.6, P<0.0001, PSI=0.86). A sequential removal of the six most misfitting items was performed, resulting in a 17-item scale that met all Rasch model expectations (χ(2)=57.5, P=0.007, PSI=0.83), including unidimensionality, local independence of items, and the absence of DIF across all tested factors. CONCLUSION: A new 17-item Upper Limb Work Instability Scale that satisfied assumptions for interval-level scaling was derived.

A coordinator program in post-fracture osteoporosis management improves outcomes and saves costs.

BACKGROUND: The orthopaedic unit at a university teaching hospital hired an osteoporosis coordinator to identify patients with a fragility fracture and to coordinate their education, assessment, referral, and treatment of underlying osteoporosis. We report the results of an analysis of the cost-effectiveness of the use of a coordinator (in comparison with the use of no coordinator) in avoiding future costs of subsequent hip fracture. METHODS: A one-year decision-analysis model was developed. The health outcome was subsequent hip fracture; only direct hospital costs were considered. With use of patient-level data from a previously described coordinator program and data from the literature, the expected annual incidence of subsequent hip fracture was calculated, on the basis of the type of index fracture (wrist, hip, humerus, other), attribution to osteoporosis, age, and gender. The rate of patient referral, the initiation of osteoporosis treatment, and adherence to therapy were modeled to modify the expected incidence of future hip fracture in the presence of a coordinator (with use of data from the program) and in the absence of a coordinator (with use of data from the literature). Sensitivity analysis modeling techniques were used to assess variable uncertainty and to evaluate coordinator cost-effectiveness. RESULTS: Deterministic cost-effectiveness analysis showed that a tertiary care center that hired an osteoporosis coordinator who manages 500 patients with fragility fractures annually could reduce the number of subsequent hip fractures from thirty-four to thirty-one in the first year, with a net hospital cost savings of C$48,950 (Canadian dollars in year-2004 values), with use of conservative assumptions. Probabilistic sensitivity analysis indicated a 90% probability that hiring a coordinator costs less than C$25,000 per hip fracture avoided. Hiring a coordinator is a cost-saving measure even when the coordinator manages as few as 350 patients annually. Greater savings are anticipated after the first year and when additional costs such as rehabilitation and dependency costs are considered. CONCLUSIONS: Employment of an osteoporosis coordinator to manage outpatients and inpatients who have fragility fractures is predicted to reduce the incidence of future hip fractures and to save money (a dominant strategy). A probabilistic sensitivity analysis showed a high probability of cost-effectiveness of this intervention from the hospital cost perspective.