The impact of stroke on employment income: A cohort study using hospital and income tax data in Ontario, Canada.

OBJECTIVE: To document the impact of stroke on employment income among people employed at the time of stroke. DESIGN: Population-based cohort study. PARTICIPANTS: People hospitalized for stroke in Ontario, Canada (2010-2014) and people without stroke matched on demographic characteristics. MAIN MEASURES: Robust Poisson regression to estimate the effects of stroke on the probability of reporting employment income on tax returns over 3 years. Quantile regression difference-in-differences to estimate the changes in annual employment income attributable to stroke. RESULTS: Stroke survivors were increasingly less likely to report any employment income poststroke, incidence rate ratios (IRR) 0.87 at 1 year (95% confidence intervals [CI]; 0.85-0.88), 0.82 at 2 years (95% CI; 0.81-0.84) and 0.81 at 3 years (95% CI; 0.79-0.82). IRR for reporting at least 50% of prestroke income levels were 0.76 at 1 year (95% CI; 0.75-0.78), 0.75 at 2 years (95% CI; 0.73-0.77) and 0.73 at 3 years (95% CI; 0.71-0.75). IRR for reporting at least 90% of prestroke income levels were 0.72 at 1 year (95% CI; 0.70-0.74), 0.66 at 2 years (95% CI; 0.64-0.68) and again 0.66 at 3 years (95% CI; 0.64-0.68). Relative changes in annual employment income attributable to stroke varied from a decrease of 13.8% (95% CI; 8.7-18.9) at the 75th income percentile to a decrease of 43.1% (95% CI; 18.7-67.6) at the 25th income percentile. CONCLUSIONS: It is important for healthcare and service providers to recognize the impact of stroke on return to prestroke levels of employment income. Low-income stroke survivors experience a more drastic loss in employment income and may need additional social support.

Operational Definitions and Estimates of Return to Work Poststroke: A Systematic Review and Meta-Analysis.

OBJECTIVE: To examine operational definitions of return to work (RTW) poststroke and provide more precise estimates of RTW through meta-analysis. DATA SOURCES: A systematic search was conducted using MEDLINE, CINAHL, PsycINFO, and SCOPUS (2005 to March 26, 2018). The search strategy involved expansion of medical subjective headings using terms related to stroke and work. The reference lists of review articles and included studies were checked for additional relevant studies. STUDY SELECTION: Studies were included if they (1) quantitatively analyzed RTW outcomes or factors associated with RTW; (2) reported RTW outcomes for participants employed prior to stroke; and (3) were written in English or French. Two reviewers independently screened titles and abstracts. Of 7265 articles initially identified, 55 studies were included. DATA EXTRACTION: Data were extracted and study quality was assessed by 1 reviewer and verified by a second reviewer. DATA SYNTHESIS: Explicit and implicit operational definitions of RTW were determined and categorized. Ranges of RTW estimates were presented for study and participant characteristics. Pooled summary estimates were calculated for comparable studies by follow-up time poststroke: 55.7% at 1 year (95% confidence interval [95% CI], 51.3%-60.0%) and 67.4% at 2 years (95% CI, 60.4%-74.4%). Similar summary estimates were noted when only population-based studies were considered: 56.7% at 1 year (95% CI, 48.3%-65.1%) and 66.7% at 2 years (95% CI, 60.2%-73.2%). CONCLUSIONS: Operational definitions varied across studies and were often not explicitly reported. To promote comparability of RTW outcomes in future studies, we recommend working toward a universal operational definition and consistent follow-up times. The more precise estimates calculated in this review could be used as benchmarks for health care and social service providers.

Practicing During the COVID-19 Pandemic: Experiences of Canadian Hospital-Based Occupational Therapists.

Background. The COVID-19 pandemic disrupted hospital operations worldwide, including services delivered by occupational therapists (OTs). Purpose. This study aimed to understand the experiences of OTs at one Canadian, tertiary care hospital during the 2021-2022 period of the pandemic. Method. We used a qualitative descriptive approach to describe the experiences of OTs during the pandemic. Findings. While there were similarities in the 10 participating OTs' experiences, salient differences were largely linked to the method of service delivery. Inpatient OTs benefitted from the support of colleagues and developed coping strategies in response to high levels of workplace stress and anxiety and a perceived lack of support from many levels of society. Clinically, they spent more time on discharge planning with fewer resources. OTs providing virtual/hybrid services experienced unique challenges related to adapting their practice to a virtual platform, including challenges assessing patients. They described benefits associated with virtual/hybrid service delivery and brought up concerns around equity of service provision. Conclusion. OTs in this hospital setting faced challenges in providing patient care and supporting their own wellness during the pandemic. Future research could explore the role of leadership in supporting occupational therapy practice during public health emergencies.

Supporting post-stroke access to services and resources for individuals with low income: understanding usual care practices in acute care and rehabilitation settings.

PURPOSE: Following stroke, individuals who live in a low-income or are at risk of living in a low-income situation face challenges with timely access to social services and community resources. Understanding the usual care practices of stroke teams, specifically, how they support this access to services and resources, is an important first step in promoting the implementation of practice change. METHOD: A qualitative multiple-case study of acute care, inpatient, and outpatient rehabilitation stroke teams in an urban area of Canada. Semi-structured interviews and questionnaires about the workplace context were conducted with 19 professionals (social workers, occupational therapists, physiotherapists, speech-language pathologists) at four sites. RESULTS: In their usual practice, stroke teams prioritized immediate care needs. The stroke team professionals did not address income or resources unless it directly affected discharge. Usual care was influenced by factors such as time constraints, lack of knowledge about services and resources, and social service system limitations. CONCLUSION: To better support post-stroke access to social services and resource for low-income individuals, a multidisciplinary approach, with actions beginning earlier on and extending throughout the continuum of care, is recommended, in addition to system-level advocacy.

Access to social services and community resources for people with stroke and living in a low-income situation is not consistently addressed in acute care or rehabilitation settings.Supporting access to social services and community resources is influenced by the professionals' availability of time and resources, as well as knowledge about services and resources and the limitations of the social service system.Using a multidisciplinary approach, extending over the continuum of care from acute care to rehabilitation program may be a way forward to better support people with stroke and low income to access services and resources.

A systematic review of social service and community resource interventions following stroke.

PURPOSE: Finding and accessing social services and community resources are a challenge for stroke survivors and care partners. The purpose of this systematic review was to identify and review interventions that aimed to increase access and use of such services and resources post stroke. METHOD: A systematic review of the published literature was performed using MEDLINE, CINAHL, PsycINFO, and ProQuest Nursing and Allied Health (January 2008 to May 2020). Studies were included if they were quantitative designs and reported on outcomes of interventions addressing post-stroke access to social services or community resources. Results were synthesised narratively. RESULTS: 3566 titles and abstracts were reviewed. Ten articles met the inclusion criteria. The interventions included in this review varied in terms of target group, timing, and type of support provided (passive or active tailored information provision, referral service, navigation assistance). Outcome measures, for social service and community resource access, included discharge preparedness measures, service counts, observations, satisfaction evaluations, interviews, and open-ended questions. CONCLUSION: Overall, interventions demonstrated some improvements in information received and access to social services and community resources following stroke. Future research should focus on carrying out high quality studies that examine the effectiveness of various social service and community resource interventions, and on setting valid and reliable outcome measures.IMPLICATIONS FOR REHABILITATIONStroke survivors and care partners have unmet social service and community resource needs.Stroke survivors and care partners can benefit from interventions that provide information, referrals, and ongoing support to access services and resources.Clearly identifying social service and community resource needs is important for tailoring interventions to individual situations.Interventions should ideally be provided throughout the hospital stay, in acute care and rehabilitation, and continue on in the community.

Influence of low income on return to participation following stroke.

Purpose: Low income is known to influence participation post stroke, but the process by which this occurs is poorly understood.Methods: A qualitative multiple case study approach, focusing on the experience of returning to participation in personal projects among eight low-income francophone stroke survivors living in eastern Ontario (Canada). Data included semi-structured interviews with the stroke survivors and with their care partners, participant observations, assessment measures, and chart reviews.Results: Healthcare professionals inconsistently gave the stroke survivors needed information and assistance to access entitlements during discharge planning. Income support programs were difficult to access and once obtained, were not completely adequate to support essential necessities (food, medication) in addition to other goods and services related to valued activities. Housing was an important monthly expense that limited available monies for personal projects. Only in instances where participants were assisted with housing by informal networks were there adequate funds to pursue personal projects.Conclusion: This case study demonstrated that even in a universal healthcare system, post-stroke participation for those with low incomes was severely restricted. Changes at the clinical level and at the public policy level could facilitate participation.Implications for rehabilitationIncome influenced the experience of return to participation for the low-income stroke survivors by limiting their ability to afford housing, goods, and services.The macro environment, which regulates the healthcare and social service systems, was the strongest influence on return to participation for low income stroke survivors.Findings point to actions at the clinical and policy levels to help address this inequity.

LSVT BIG in late stroke rehabilitation: A single-case experimental design study.

BACKGROUND.: Late stroke rehabilitation interventions often target impairment with limited carryover to daily occupation. PURPOSE.: This study explored whether the LSVT BIG program could lead to improved performance in client-identified occupations and decreased impairment late poststroke. METHOD.: A single-case experimental design with one repetition was completed. Participants were two adults who had experienced a stroke 3 and 12 years previously. Each participant selected up to six occupational goals, and the intervention was applied to half. Repeated measures were taken using the Canadian Occupational Performance Measure and the Rating of Everyday Arm-Use in the Community and Home. Additional measures of performance and impairment were applied pre- and postintervention. FINDINGS.: Performance improved on either self-assessment or blinded-rater assessment for all but one activity (trained or untrained). IMPLICATIONS.: LSVT BIG is a promising intervention to improve occupational performance. Further research is required to clarify elements of the program essential to improving occupational performance.

Goal setting dynamics that facilitate or impede a client-centered approach.

BACKGROUND: Client-centred goal setting is central to the process of enabling occupation. Yet, there are multiple barriers to incorporating client-centred goal setting in practice. We sought to determine what might facilitate or impede the formation of client-centred goals in a context highly supportive of client-centred goal setting Methods: We used conversational analysis to examine goal-setting conversations that took place during a pilot trial of Occupational Performance Coaching for stroke survivors. Twelve goal-setting sessions were purposively selected, transcribed, and analyzed according to conventions for conversation analysis. RESULTS: Two main types of interactions were observed: introductory actions and goal selection actions. Introductory actions set the context for goal setting and involved sharing information and seeking clarification related to goal requirements and clients' occupational performance competencies. Goal selection actions were a series of interactions whereby the goals were explored, endorsed or dropped. CONCLUSION: Client-centred occupational performance goals may be facilitated through placing goal-setting in the context of life changes and lifelong development of goals, and through listening to clients' stories. Therapists may improve consistency in adoption of client-suggested goals through clarifying meaning attached to goals and being attuned to power dynamics and underlying values and beliefs around risk and goal attainability.

Validation transculturelle de contenu de la version franco-canadienne de l'échelle COREQ.

Purpose: The main purpose of this article is to produce a French-Canadian translation of the Consolidated criteria for reporting qualitative studies (COREQ) scale under the proposed name "échelle COREQ" and to assess the transcultural validity of its content. The secondary purpose is to examine the inter-rater reliability of the French-Canadian version of the COREQ scale. Method: A modified approach to Vallerand's methodology (1989) for cross-cultural validation was used. First, a parallel back-translation of the COREQ scale was performed, by both professionals and clinicians. Next, a first committee of experts(P1) examined the translations to create a first draft of the French-Canadian version of the COREQ scale. This draft was then evaluated and modified by a second committee of experts (P2). Finally, 28future professionals (master's students in physiotherapy) rated this second draft of the tool for clarity using a seven-point scale (1:very clear; 7:very ambiguous). The principal co-investigators then reviewed the problematic elements and proposed final changes. Two independent raters used this French-Canadian version of the COREQ scale to assess 13qualitative studies that were published in French after the year2007. The kappa coefficient was used to examine inter-rate reliability. Results: The different elements of the final version of the COREQ scale received an average ambiguity rating between 1.04 and 2.56. These low values show a high level of clarity for the French-Canadian version of the COREQ scale. In relation to the total score of the COREQ scale, inter-rater reliability (n = 2) is considered to be average to excellent for 62.5% of individual elements, according to the kappa values obtained. Conclusions: A valid French-Canadian version of the COREQ scale was created using this rigorous five-step process.

La version franco-canadienne du « STrengthening the Reporting of OBservational studies in Epidemiology ¼ (STROBE) Statement : L'outil STROBE.

Purpose: The main purpose is to produce a French-Canadian translation of the "STrengthening the Reporting of OBservational studies in Epidemiology" (STROBE) Statement under the proposed name of "outil STROBE" and to assess the cross-cultural validity of its content. The secondary purpose is to examine its preliminary interrater reliability. Method: A modified approach to Vallerand's cross-cultural validation methodology was used. First, professional translators and clinical practitioners produced a parallel reverse translation of the "STROBE Statement." Then, a committee of experts (P1) examined the translated versions and created a first experimental draft of the "outil STROBE." This draft was assessed and modified by a second committee of experts (P2). Finally, 32 future professionals doing their master's degree in physiotherapy and occupational therapy assessed this second experimental version of the tool using an ambiguity scale of 8 points (0 meaning "not at all ambiguous" and 7 meaning "extremely ambiguous"). The main co-researchers examined the problematic elements and proposed final modifications. Ten observational studies published in French after 1980 were assessed by two independent raters using the French-Canadian version of the "outil STROBE." The kappa coefficient was used to examine interrater reliability. Results: For the different elements of the final version of the "outil STROBE," the averages on the ambiguity scale varied from 0.0 to 2.4. No element received an average below 2.4, which showed a high level of clarity. The interrater reliability (n = 2) for the "outil STROBE" is thought to be good for 74% of individual elements, according to the kappa coefficient values obtained. Conclusions: The process's five rigorous steps enabled the production of a valid French-Canadian version of the "STROBE Statement."

La version franco-canadienne de l'outil Assessment of Multiple Systematic Reviews (AMSTAR).

Objectives: The primary objective was to produce a French-Canadian translation of AMSTAR (a measurement tool to assess systematic reviews) and to examine the validity of the translation's contents. The secondary and tertiary objectives were to assess the inter-rater reliability and factorial construct validity of this French-Canadian version of AMSTAR. Methods: A modified approach to Vallerand's methodology (1989) for cross-cultural validation was used.1 First, a parallel back-translation of AMSTAR2 was performed, by both professionals and future professionals. Next, a first committee of experts (P1) examined the translations to create a first draft of the French-Canadian version of the AMSTAR tool. This draft was then evaluated and modified by a second committee of experts (P2). Following that, 18 future professionals (master's students in physiotherapy) rated this second draft of the instrument for clarity using a seven-point scale (1: very clear; 7: very ambiguous). Lastly, the principal co-investigators then reviewed the problematic elements and proposed final changes. Four independent raters used this French-Canadian version of AMSTAR to assess 20 systematic reviews that were published in French after the year 2000. An intraclass correlation coefficient (ICC) and kappa coefficient were calculated to measure the tool's inter-rater reliability. A Cronbach's alpha coefficient was also calculated to measure internal consistency. In addition, factor analysis was used to evaluate construct validity in order to determine the number of dimensions. Results: The statements on the final version of the AMSTAR tool received an average ambiguity rating of between 1.0 and 1.4. No statement received an average rating below 1.4, which indicates a high level of clarity. Inter-rater reliability (n=4) for the instrument's total score was moderate, with an intraclass correlation coefficient of 0.61 (95% confidence interval [CI]: 0.29, 0.97). Inter-rater reliability for 82% of the individual items was good, according to the kappa values obtained. Internal consistency was excellent, with a Cronbach's alpha coefficient of 0.91 (95% CI: 0.83, 0.99). The French-Canadian version of AMSTAR is a unidimensional tool, as confirmed by factor analysis and community values greater than 0.30. Conclusion: A valid French-Canadian version of AMSTAR was created using this rigorous five-step process. This version is unidimensional, with moderate inter-rater reliability for the elements overall, and with excellent internal consistency. This tool could be valuable to French-Canadian professionals and researchers, and could also be of interest to the international Francophone community.

[Not Available]. / Une version franco-canadienne de la Physiotherapy Evidence Database (PEDro) Scale : L'Échelle PEDro.

PURPOSE: To prepare a Canadian French translation of the PEDro Scale under the proposed name l'Échelle PEDro, and to examine the validity of its content. METHODS: A modified approach of Vallerand's cross-cultural validation methodology was used, beginning with a parallel back-translation of the PEDro scale by both professional translators and clinical researchers. These versions were reviewed by an initial panel of experts (P1), who then created the first experimental version of l'Échelle PEDro. This version was evaluated by a second panel of experts (P2). Finally, 32 clinical researchers evaluated the second experimental version of l'Échelle PEDro, using a 5-point clarity scale, and suggested final modifications. RESULTS: The various items on the final version of l'Échelle PEDro show a high degree of clarity (from 4.0 to 4.7 on the 5-point scale). CONCLUSION: The four rigorous steps of the translation process have produced a valid Canadian French version of the PEDro scale.