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BACKGROUND: Dementia caregiving is a dynamic and multidimensional process. To gain a comprehensive understanding of informal caregiving for people living with dementia (PLWD), it is pivotal to assess the quality of life (QoL) of informal caregivers. OBJECTIVE: To evaluate whether the care-recipient relationship type predicts changes in the QoL of informal caregivers of PLWD over a two-year period. METHODS: This was a secondary analysis of longitudinal data. The data were drawn from two waves of linked data from the National Health and Aging Trends Study (NHATS) and the National Study of Caregiving (NSOC) (2015: NHATS R5 & NSOC II; 2017: NHATS R7 & NSOC III). Caregivers were categorized into spousal, adult-child, "other" caregiver and "multiple" caregivers. QoL was assessed through negative emotional burden (NEB), positive emotional benefits and social strain (SS). Generalized estimating equation modelling was used to examine changes in caregivers' QoL outcomes across types of relationship over time. RESULTS: About, 882 caregivers were included who linked to 601 PLWD. After adjusting caregivers' socio-demographics, "other" caregivers had lower risk of NEB and SS than spousal caregivers (OR = 0.34, P = 0.003, 95%CI [0.17, 0.70]; OR = 0.37, P = 0.019, 95%CI 0.16, 0.85], respectively), and PLWD's dementia status would not change these significance (OR = 0.33, P = 0.003, 95%CI [0.16, 0.68]; OR = 0.31, P = 0.005, 95%CI [0.14, 0.71], respectively). CONCLUSIONS: The study demonstrates that spousal caregivers face a higher risk of NEB and SS over time, underscoring the pressing need to offer accessible and effective support for informal caregivers of PLWD, especially those caring for their spouses.
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Sobrecarga do Cuidador , Cuidadores , Demência , Qualidade de Vida , Humanos , Demência/psicologia , Feminino , Masculino , Cuidadores/psicologia , Idoso , Estudos Longitudinais , Sobrecarga do Cuidador/psicologia , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Fatores de Tempo , Cônjuges/psicologiaRESUMO
OBJECTIVES: To explore how to reach immigrant women through community agencies to raise awareness of the role of physical activity (PA) in reducing cancer risk. STUDY DESIGN: Qualitative description. METHODS: We conducted semi-structured telephone interviews with immigrant women and community agency managers to discuss the ideal design of an education session on PA and cancer risk, and identified themes using content analysis. RESULTS: Participants included 22 women (6 African or Caribbean Black, 4 Chinese, 3 Filipino, 5 Indian, 4 Pakistani) and 16 agency managers from across Canada. Women were not familiar with Canada's PA guidelines, and few were aware that PA reduces the risk of cancer. All expressed interest in education about PA and cancer. Diverse women and managers expressed similar preferences for education session design including content (e.g. PA amount/type), format (e.g. in person preferred but virtual more practical), personnel (external expert plus agency staff), cultural tailoring (e.g. translated supplemental take home information) and reinforcing (e.g. follow-up with participants) strategies. Women and managers identified few barriers to participating in education sessions, chiefly, that women lacked time due to work and family responsibilities; and noted several enablers of participation (e.g. emphasize social aspect, provide gift cards or recreation centre passes). CONCLUSIONS: We generated insight on the ideal characteristics of a community-based education session that could raise awareness among immigrant women of the importance of PA in reducing cancer risk. Further research is needed to assess the feasibility and impact of PA education sessions designed based on these findings.
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Emigrantes e Imigrantes , Exercício Físico , Entrevistas como Assunto , Neoplasias , Pesquisa Qualitativa , Humanos , Feminino , Emigrantes e Imigrantes/psicologia , Adulto , Pessoa de Meia-Idade , Exercício Físico/psicologia , Neoplasias/prevenção & controle , Neoplasias/etnologia , Canadá , Conhecimentos, Atitudes e Prática em Saúde , Educação em Saúde/métodos , Comportamento de Redução do RiscoRESUMO
Exercise has been found to have numerous benefits for individuals with cancer undergoing treatment. The primary objective of this study was to explore factors that influence the decision to join an exercise trial for individuals with a current diagnosis of breast cancer. A theory-informed survey was administered exploring factors (i.e., attitudes, subjective norms, perceived behavioral control) that influenced participants' decision to join the "NEXT-BRCA" exercise trial. Eligible participants included self-reported females over 18 years, diagnosed with stage 1-3 breast cancer undergoing treatment and cleared for exercise by their oncologist. Survey questions were analyzed using descriptive statistics and exploratory analysis was performed to determine if associations existed between personal characteristics (age, physical activity level, co-morbid conditions) and cancer characteristics (treatment received). Seventy-four participants completed the survey. Most participants (85% of respondents) were interested in increasing their level of physical activity. The most common attitudes contributing to participant's decision to participate in the trial included feelings that exercise was beneficial for improving physical (91%) and mental health (89%). Advice from the treating oncologist was ranked as the most important factor influencing their decision to join the trial (73%). Respondents hoped to gain exercise knowledge through educational materials (72%) and a structured exercise program (70%). Findings explore why individuals with breast cancer participate in exercise trials during treatment. This knowledge will enhance recruitment of future studies using similar interventions and assist clinicians to maximize education regarding exercise and access to exercise programs for individuals with breast cancer in the future.
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Neoplasias da Mama , Tomada de Decisões , Humanos , Feminino , Neoplasias da Mama/terapia , Neoplasias da Mama/psicologia , Pessoa de Meia-Idade , Adulto , Idoso , Exercício Físico , Inquéritos e Questionários , Terapia por Exercício , Participação do Paciente , Conhecimentos, Atitudes e Prática em SaúdeRESUMO
PURPOSE: Exercise and social support are non-pharmacological strategies that improve health and wellbeing in women treated for breast cancer (WTBC). However, strategies to facilitate support and exercise in WTBC are typically resource intensive. The purpose of this study was to examine whether various forms of social support received from a matched peer were associated with increased exercise among WTBC. METHODS: A daily diary study was conducted to examine naturally occurring social support as it relates to daily exercise behavior. Forty-six WTBC were matched (23 pairs) and completed pre-screening survey assessing eligibility and baseline levels of exercise. Participants were given Fitbit devices to track physical activity behavior and completed daily surveys across 3 weeks assessing perceptions of exercise-related social support at fixed times at the end of each day. RESULTS: Mixed models accounting for day of study, baseline support, and baseline exercise levels revealed that higher levels of daily exercise-related tangible social support were associated with more daily steps (b = 506, SE = 143) and more light physical activity (LPA) minutes (b = 7.01, SE = 3.15). Informational social support was associated with higher moderate to vigorous physical activity (MVPA) minutes (b = 3.18, SE = 1.60). CONCLUSIONS: Overall, peer matching programs aimed at increasing exercise-related social support among WTBC might encourage exercise behaviors, especially among women who share exercise-specific information (e.g., benefits, type, activities).
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Neoplasias da Mama , Humanos , Feminino , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/terapia , Exercício Físico , Atividade Motora , Apoio Social , Monitores de Aptidão FísicaRESUMO
BACKGROUND: Physical activity (PA) can be a beneficial strategy to mitigate physical, emotional, and social-related challenges in women living beyond breast cancer treatment (WBC). However, PA levels among WBC remain low. Optimizing social support provided in a peer-matched setting may increase PA behavior. Unfortunately, factors that lead to an ideal peer-match among WBC are not well understood. The purpose of this study was to contextualize the natural social support environment and PA behavior in newly formed peer WBC dyads participating in an ecological momentary assessment study. METHODS: WBC were matched with a partner and provided with a Fitbit activity tracker. Social support was measured using 21-daily surveys, and a 3-week follow-up survey. Descriptive statistics were calculated. Open-ended survey questions were analyzed using content analysis. Data were analyzed based on (i) social support types (informational, tangible, esteem, and emotional support); and (ii) WBC' reports of being in a good, neutral, or poor match at the end of the study. RESULTS: Women (n = 46; Mage = 42.4 ± 7.6 years; 89.2% stage I-III breast cancer) connected with their partner (58.1%) and participated in moderate-vigorous PA (MVPA)(77.1%) on most days over the 21-day study period. Women were identified as being in good (63%), neutral (20%), or poor (17%) dyad matches. The most frequently documented social support received by WBC was esteem support. Participants in a good match were more likely to report receiving all types of social support compared to neutral or poor matches. CONCLUSION & CLINICAL IMPLICATIONS: Findings describe the social support characteristics important to WBC for facilitating their PA participation in a partner-based setting. This study provides valuable insight that can inform the development of partner-based PA interventions for WBC.
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Neoplasias da Mama , Sobreviventes de Câncer , Humanos , Feminino , Neoplasias da Mama/psicologia , Apoio Social , Exercício Físico , Sobreviventes/psicologiaRESUMO
INTRODUCTION: The Canadian Frostbite Collaborative project is exploring frostbite patient care needs and current practices in Canada to inform the development of a Canadian frostbite care network (CFCN) as a national quality improvement initiative. METHODS: Using a quantitative and qualitative approach, this study aimed to define the landscape of current frostbite practices, challenges, and interest in future work. RESULTS: Current frostbite care practices were initially assessed through semistructured phone interviews of Canadian healthcare providers. Canadian healthcare providers managing frostbite in a range of health disciplines and contexts then participated in focus group sessions discussing the potential roles and opportunities as well as potential challenges in developing a CFCN. Roles and opportunities for a network in advancing frostbite care included facilitating research, educating stakeholders, facilitating collaboration, standardizing care, and advocating for frostbite care. Challenges identified in frostbite care and network development included managing resources, navigating the Canadian healthcare system, overcoming low numbers, and communicating with policymakers and frontline providers. CONCLUSIONS: Formalizing a CFCN may provide important opportunities and support in overcoming critical barriers to providing high-quality frostbite care across Canada.
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Qualidade da Assistência à Saúde , Humanos , CanadáRESUMO
PURPOSE: To assess whether there was an association between care-recipient relationship type and health-related quality of life (HRQL) of older persons living with dementia (PLWD) and their informal caregivers, and whether this association was affected by PLWD' dementia severity. METHODS: This was a secondary data analysis study. PLWD (n = 1230) and caregivers (n = 1871) were identified from participants in the National Health and Aging Trends Study (NHATS) Round 5 and the National Study of Caregiving (NSOC) II, respectively. A series of bivariate and multivariable regression models examined the associations among relationship type and HRQL in PLWD and caregivers, adjusted for socio-demographic variables and dementia severity. RESULTS: PLWD and caregivers' HRQL outcomes varied by relationship type. PLWD cared for by an adult-child caregiver, or multiple caregivers experienced higher functional limitations than those cared for by a spousal caregiver (ß = .79, CI [.39, 1.19]; ß = .50, CI [.17, .82], respectively). "Other" caregivers, such as extended family members or friends, had lower odds of experiencing negative emotional burden and social strain than spousal caregivers (ß = .79, CI [.39, 1.19]; ß = .50, CI [.17, .82], respectively). Lower odds of experiencing negative emotional burden were also found with multiple caregivers. The effect of an adult-child caregiver on social strain was no longer significant when the dementia severity of PLWD was included in the analysis. CONCLUSION: The type of care-recipient relationship impacts the HRQL in both PLWD and their informal caregivers. Dementia severity of the PLWD appears to affect this association.
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Cuidadores , Demência , Humanos , Idoso , Idoso de 80 Anos ou mais , Cuidadores/psicologia , Qualidade de Vida/psicologia , Vida Independente , Demência/psicologia , EmoçõesRESUMO
OBJECTIVE: To describe the characteristics of exercise programs for survivors of cancer conducted outside of a research laboratory (ie, home-based or community-based settings). DATA SOURCES: A systematic search of published literature was conducted using Medline, Pubmed, Cumulative Index of Nursing and Allied Health Literature, PsycINFO, SPORTdiscus, and Embase from 1980 to January 2021. Where conference abstracts were identified, authors were contacted for other articles. STUDY SELECTION: Two independent reviewers screened titles and abstracts and full texts of potentially relevant studies to determine eligibility, with discrepancies resolved by discussion. Included studies were reports of exercise programs or interventions in which participants exercise at home or in a community-based setting and including individuals diagnosed with cancer either undergoing treatment or who had completed treatment. DATA EXTRACTION: Data were extracted using the Oxford Implementation Index and coded under the 5 domains of the Consolidated Framework for Implementation Research (CFIR). Extraction and coding were completed by 2 independent reviewers, with discrepancies resolved through discussion. Data were synthesized narratively according to CFIR. DATA SYNTHESIS: A total of 58 publications describing 34 individual programs from around the world were included. Of these, only 14 publications had the specific goal of reporting on program implementation and development. A variety of intervention characteristics and characteristics of individuals involved in the intervention were described. Reporting of factors related to the CFIR domains of inner setting, outer setting, and implementation process were minimal. CONCLUSIONS: This review summarizes the characteristics of existing programs that have been reported in the literature and finds that partnerships and collaboration occur in the inner and outer settings and as part of the process of implementation. This review highlights key knowledge gaps to be answered to support the development of future community-based interventions.
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Sobreviventes de Câncer , Neoplasias , Exercício Físico , Terapia por Exercício , Humanos , SobreviventesRESUMO
PURPOSE: To determine the feasibility (recruitment, retention, and adherence rates) of implementing a multi-dimensional knowledge translation (KT) intervention designed for women with breast cancer, and to explore preliminary estimates of effects of the implementation strategy on exercise level, exercise knowledge and behavior, health-related quality of life, and overall health status among breast cancer survivors. METHODS: Design: Implementation Trial. PARTICIPANTS: Community-dwelling women, over 18 years of age, currently undergoing chemotherapy for stage 1-3 BRCA. Randomization and Blinding: A blinded researcher randomized participants on a record-by-record basis to the intervention or control group. A researcher blinded to the group allocation of the participants conducted the statistical analysis. Intervention Group: Eight sessions of moderate intensity aerobic exercise along with eight self-management modules were delivered during chemotherapy within the cancer institution. CONTROL GROUP: Usual care. PRIMARY OUTCOME: Feasibility of implementation strategy measured through recruitment, retention, and adherence rates. RESULTS: Twenty-nine women were screened for this study. Twenty-seven met inclusion criteria and twenty-six participants were enrolled in the study. The implementation strategy was determined to be feasible and had a recruitment rate of 96%, retention rate of 100%, and adherence rate of 89%. The intervention group had significantly higher exercise levels (mean difference = 25.38, 95%CI = (9.35, 41.42)) post-intervention compared with the control group. No adverse events were reported. CONCLUSIONS: The implementation of this KT intervention is feasible and demonstrates preliminary effects for secondary outcomes for women with breast cancer during chemotherapy. Findings support the implementation of this intervention in a multi-center trial. TRIAL REGISTRATION: NCT03087461.
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Neoplasias da Mama/psicologia , Terapia por Exercício/métodos , Exercício Físico/fisiologia , Qualidade de Vida/psicologia , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
BACKGROUND: The McMaster Optimal Aging Portal (the Portal) was launched in 2014 as a knowledge translation (KT) tool to increase access to evidence-based health information. OBJECTIVE: The purpose of this study was to understand if and how dissemination of mobility information through the Portal impacts physical activity (PA) in older adults. METHODS: In this randomized controlled trial, participants (n=510) were assigned to a 12-week mobility-focused KT intervention or self-serve control group. The intervention included weekly email alerts and a study-specific social media hashtag linking to mobility-focused Portal materials. The control group was able to access the Portal on their own but did not receive targeted KT strategies. Participants completed questionnaires (including the Rapid Assessment of Physical Activity to quantify PA) at baseline, end of the study, and 3-month follow-up. RESULTS: Participants were predominantly female (430/510, 84.3%), mean age 64.7 years, with no baseline differences between groups. Over half (277/510, 54.3%) of the participants were classified as "active" at baseline. There was no significant between-group difference in the PA category. Overall, both groups increased their PA with improvements maintained at 3-month follow-up (P<.001). In planned subgroup analyses, the KT intervention had a significant effect for those with poor or fair baseline self-rated health (P=.03). CONCLUSIONS: No differences were found between those who received the targeted intervention and a control group with self-serve access to the Portal, except in subgroups with low self-rated health. Both groups did report increases in PA that were sustained beyond participation in a research study. Findings suggest that different KT strategies may be needed for different types of users, with more intense interventions being most impactful for certain groups (ie, those with lower self-rated health). TRIAL REGISTRATION: ClinicalTrials.gov NCT02947230; https://clinicaltrials.gov/ct2/show/NCT02947230.
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Exercício Físico/fisiologia , Pesquisa Translacional Biomédica/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Maintaining physical activity and physical function is important for healthy aging. We recently completed a randomized controlled trial of a targeted knowledge translation (KT) intervention delivered through the McMaster Optimal Aging Portal with the goal to increase physical activity and physical mobility in middle-aged and older adults, with results reported elsewhere. OBJECTIVE: The purpose of this process evaluation study is to explore which KT strategies were used by both intervention and control group participants, as well as the intervention groups' engagement, satisfaction, and perceived usefulness of the targeted KT intervention. METHODS: Data on engagement with the intervention materials were gathered quantitatively through Google Analytics and Hootsuite throughout the intervention. Qualitative data were collected through a combination of open-ended surveys and qualitative interviews with a subset of participants at the end of the study to further understand engagement, satisfaction, and usefulness of the KT strategies. RESULTS: Throughout the intervention period, engagement with content delivered through weekly emails was highest, and participants rated email content most favorably in both surveys and interviews. Participants were generally satisfied with the intervention, noting the ease of participating and the distillation of information in an easy-to-access format being beneficial features. Participants who did not find the intervention useful were those with already high levels of baseline physical activity or physical function and those who were looking for more specific or individualized content. CONCLUSIONS: This process evaluation provides insight into our randomized controlled trial findings and provides information that can be used to improve future online KT interventions. TRIAL REGISTRATION: ClinicalTrials.gov NCT02947230; https://clinicaltrials.gov/ct2/show/nct02947230 (Archived by WebCite at http://www.webcitation.org/78t4tR8tM).
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Exercício Físico/psicologia , Informática Médica/métodos , Avaliação de Processos em Cuidados de Saúde/métodos , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e QuestionáriosRESUMO
PURPOSE: The aim of this study is to explore the current literature examining the feasibility, safety, and efficacy of exercise interventions for individuals with myeloid leukemia. METHODS: A literature search was conducted in Ovid MEDLINE, AMED, Embase, PsycINFO, CINAHL, CENTRAL, and Web of Science using the terms "exercise" OR "physical activity" AND "myeloid leukemia." Two reviewers performed duplicate title/abstract and full text screening of clinical trials comparing outcomes for people with myeloid leukemia participating in an exercise program. Initial searches yielded 149 articles. Two reviewers independently extracted data using piloted forms and assessed risk of bias using Cochrane's tool. Data was extracted in relation to the study population, study intervention, comparator intervention, and outcomes assessed. RESULTS: Five trials were included in this review after 20 full-text articles were screened. Risk of bias was determined to be high in all five studies. Adherence rates were found to be low (<30 %) in all studies measuring this outcome. Positive improvements were found for fatigue, physical functioning, quality of life, and psychological distress for patients with AML; however, not all findings were significant. Leukocyte and BCR-ABL1 levels increased significantly post-exercise for participants with CML. Only one adverse event was reported. CONCLUSIONS: Exercise interventions appear safe and feasible for individuals with AML. Not enough evidence was presented to comment on the feasibility of exercise programs for individuals with CML. Inconclusive evidence was found on the effectiveness of exercise to minimize side effects for participants with AML.
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Terapia por Exercício/métodos , Exercício Físico/fisiologia , Leucemia Mieloide/reabilitação , Leucemia Mieloide/terapia , Modalidades de Fisioterapia/estatística & dados numéricos , Feminino , Humanos , Pessoa de Meia-Idade , Qualidade de VidaRESUMO
INTRODUCTION: Admission to health professional programs (HPPs) in Canada is competitive. The purpose of this study is to evaluate how factors identifiable by the admissions package may predict incidences of academic concerns in one physiotherapy program in Canada. REVIEW OF LITERATURE: Previous literature has identified many concepts that contribute to "academic success." Some HPPs have investigated if admissions criteria can predict students' academic performance. However, this has not been reported in physiotherapy programs in Canada. SUBJECTS: Study data included candidates' admissions' metrics and physiotherapy students' program data for 4 graduating cohorts, who were admitted from 2016 to 2019 inclusive (N = 256). METHODS: A retrospective, nonconcurrent cohort study was used to estimate the relationship between applicant's admissions data and students' program data pertaining to academic success. Data were summarized as frequencies for categorical variables and means for continuous variables. We calculated odds ratios (ORs) and probabilities of an academic or professional concern for standard scores. Significance was set at P < .05. RESULTS: Cohorts participating in the multiple mini-interview (MMI) had an academic concern incidence of 14/131. The virtual MMI (VMMI) cohort had an incidence of 7/125. Students with higher MMI scores were less likely to have an academic concern (OR = 0.52 [95% CI: 0.30-0.89, P = .017]). Grade point average was not significantly associated with an academic concern when combined with either MMI or VMMI (Ps > 0.05). Admissions round offer was also significantly associated with an academic concern (OR = 2.48 [95% CI: 1.00-6.12, P = .049]), with those beyond the initial round of offers having increased risk of concerns. DISCUSSION AND CONCLUSION: Results of the study reflect the generally low event rates for incidences of academic concerns and the relative homogeneity and range restriction of independent variables across the 4 cohorts of students. HPP's reflection on current admissions processes and ability to identify opportunities for change in admission processes helps ensure that programs are selecting candidates who are likely to succeed.
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Purpose: To evaluate the use of wall-mounted prompts in facilitating physical activity (PA)-related discussions between individuals with cancer and oncology care providers. Methods: Individuals with cancer were approached to participate in a survey-based pre-post study. Half of participants (n = 100) completed a survey prior to installation of wall-mounted prompts in clinic while the other half (n = 100) completed a survey following installation of the prompts. Survey questions included content of PA-related discussion, satisfaction with PA education across treatment, and current PA level. The post-prompt survey also asked questions related to the prompt. Survey responses were analyzed using descriptive statistics. Chi-squared tests were performed to determine significance between timepoints. Results: One hundred participants completed the survey at each timepoint. A significant difference was found pre and post-prompt in the number of PA discussions occurring overall during care (p = 0.03). Some participants (53%) were satisfied with the PA education received during treatment. There was no significant difference in occurrence of PA discussion (p = 0.36) pre and post-prompt and no difference in PA behaviour was observed (p = 0.130). Conclusions: Wall-mounted prompts may be effective in increasing the frequency of PA-related discussions between individuals with cancer and their oncology team across treatment. Additional strategies, such as easy referral to rehabilitation professionals, are also needed to facilitate safe and effective PA behaviour during and after cancer treatments.
Objectif: évaluer l'utilisation des messages muraux pour faciliter les discussions sur l'activité physique (AP) entre les personnes atteintes d'un cancer et les professionnels de la santé en oncologie. Méthodologie: des personnes cancéreuses ont été invitées à participer à une étude avant-après par sondage. La moitié (n = 100) a rempli un sondage avant l'installation de messages muraux en clinique, tandis que l'autre moitié (n = 100) l'a rempli après l'installation de ces messages. Les questions du sondage incluaient le contenu des discussions liées à l'AP, la satisfaction envers l'éducation à l'AP tout au long du traitement et le taux d'AP actuelle. Le sondage avant-après comportait aussi des questions au sujet des messages. Les chercheurs ont analysé les réponses au sondage au moyen de statistiques descriptives et ont procédé à des tests du chi carré pour déterminer le caractère significatif entre chaque sondage. Résultats: au total, 100 participants ont rempli chacun des sondages. Les chercheurs ont observé une différence significative avant et après les messages quant au nombre de discussions globales sur l'AP pendant les soins (p = 0,03). Certains participants (53 %) étaient satisfaits de l'éducation sur l'AP donnée pendant le traitement. Il n'y avait pas de différence significative quant à l'occurrence de discussions sur l'AP (p = 0,36) avant et après le message ni quant aux comportements relatifs à l'AP (p = 0,130). Conclusions: les messages muraux peuvent contribuer à accroître la fréquence des discussions sur l'AP entre les personnes atteintes du cancer et leur équipe d'oncologie tout au long du traitement. D'autres stratégies, comme une orientation facile vers des professionnels de la réadaptation, s'imposent également pour favoriser un comportement sécuritaire et efficace à l'égard de l'AP pendant et après les traitements en oncologie.
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Purpose: To identify the entry-level curricular content related to Indigenous health recommended for entry-level physiotherapy (PT) programs in Canada and other similar countries. Methods: Design: Scoping review. Procedures: Four electronic databases were searched using the terms physiotherapy, Indigenous health, entry-level curriculum, and their derivatives. Grey literature sources were hand searched and included Canadian PT professional documents, PT Program websites, Truth and Reconciliation Commission (TRC) sources, and a Google search. Data related to curriculum characteristics, methods of delivery, and barriers and facilitators to implementation were extracted from relevant references. Stakeholders reviewed study findings. Results: Forty-five documents were included. Documents focused on Indigenous peoples in Canada, Aboriginal and Torres Strait Islanders in Australia, and Maori in New Zealand. Canadian PT programs appeared to rely on passive teaching methods while programs in Australia and New Zealand emphasized the importance of partnering and engaging with Indigenous people. Barriers to incorporating indigenous health curriculum included an overcrowded curriculum and difficulty establishing relevance of Indigenous content (i.e., meaning). Conclusions: Similarities and differences were found between curricula content and approaches to teaching IH in Canada and the other countries reviewed. Strategies to promote greater engagement of Indigenous people in the development and teaching of IH is recommended.
Objectif: déterminer le contenu du cursus en santé autochtone recommandé pour les programmes d'entrée en pratique en physiothérapie au Canada et dans des pays semblables. Méthodologie: étude exploratoire. Méthode : les chercheurs ont fouillé quatre bases de données électroniques à l'aide des termes physiotherapy, Indigenous health, entry-level curriculum et leurs dérivés. Ils ont fouillé manuellement les sources de documentation parallèle et y ont inclus des documents professionnels canadiens sur la physiothérapie, les sites Web des programmes de physiothérapie, les sources de la Commission de vérité et réconciliation (CVR) et une recherche dans Google. Les données liées aux caractéristiques du cursus, aux modes de prestation et aux obstacles et incitatifs à la mise en Åuvre provenaient de références pertinentes. Les intervenants ont examiné les résultats des études. Résultats: au total, 45 documents ont été retenus. Ils portaient sur les Autochtones du Canada, les Aborigènes et les insulaires du détroit de Torres en Australie et les Maori de la Nouvelle-Zélande. Les programmes de physiothérapie canadiens semblaient reposer sur des méthodes d'enseignement passives, tandis que ceux de l'Australie et de la Nouvelle-Zélande faisaient ressortir l'importance des partenariats et des relations avec les peuples autochtones. Les obstacles à l'intégration du cursus sur la santé autochtone incluaient un cursus surchargé et la difficulté à déterminer la pertinence du contenu sur les Autochtones (c'est-à-dire le sens). Conclusions: les chercheurs ont constaté des similarités et des différences de contenu entre les cursus et les approches d'enseignement de la santé autochtone au Canada et les autres pays analysés. Il est recommandé de trouver des stratégies pour favoriser une plus grande participation des peuples autochtones à la création et à l'enseignement de la santé autochtone.
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Explore the use, characteristics, feasibility, and functional outcomes of rehabilitation interventions used for individuals with head and neck cancer (HNC) during treatment.Searches were conducted in four databases from Jan 2011 to Dec 31, 2022. Included studies had to include adults with HNC undergoing treatment, a rehabilitation intervention, an assessment of functional outcome(s) addressed by the International Classification of Functioning Framework (ICF) and be published in English language. Title and abstract screening, full-text review, and data extraction were completed independently, in duplicate. Descriptive statistics and a qualitative synthesis summarized findings.Twenty-seven studies were included in this review. The majority of studies were randomized controlled trials (70%). Most individuals represented in the included studies were males (92% of all participants) between 50 and 60 years of age. Interventions led by a speech language pathologist (33%) were most commonly described. Sixteen studies (59%) described primary outcomes that fit the ICF "impairment" domain.We identified few studies that explored the use, feasibility, and effectiveness of rehabilitation interventions for individuals with HNC during treatment. Future research should assess the effectiveness of rehabilitation interventions on functional outcomes beyond the ICF body function and structure domain.
Rehabilitation for individuals with Head and Neck Cancer (HNC) undergoing treatment should not only focus on impairment outcomes but also evaluate activity and participation outcomes as these directly impact overall function.Rehabilitation for individuals with HNC undergoing treatment should include a coordinated team of multidisciplinary rehabilitation professionals to optimize whole-body functioning.Studies on rehabilitation during HNC treatment should report more specifically on intervention adherence, safety, cohort retention, and fidelity.
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BACKGROUND: In Canada, approximately 86,000 people live with spinal cord injury (SCI), and there are an estimated 3675 new cases of traumatic or nontraumatic etiology per year. Most people with SCI will experience secondary health complications, such as urinary and bowel issues, pain syndrome, pressure ulcers, and psychological disorders, resulting in severe chronic multimorbidity. Moreover, people with SCI may face barriers in accessing health care services, such as primary care physicians' expert knowledge regarding secondary complications related to SCI. Telehealth, defined as the delivery of information and health-related services through telecommunication technologies, may help address some of the barriers, and indeed, the present global COVID-19 pandemic has emphasized the importance of integration of telehealth in health care systems. As a result of this crisis, health care providers have increased the usage of telehealth services, providing health services to individuals in need of community-based supportive care. However, the evidence on models of telehealth service delivery for adults with SCI has not been previously synthesized. OBJECTIVE: The purpose of this scoping review was to identify, describe, and compare models of telehealth services for community-dwelling adults with SCI. METHODS: This scoping review follows the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. Studies published between 1990 and December 31, 2022, were identified by searching the Ovid MEDLINE, Ovid Embase, Ovid PsycINFO, Web of Science, and CINAHL databases. Papers with specified inclusion criteria were screened by 2 investigators. Included articles focused on identifying, implementing, or evaluating telehealth interventions, including primary health care services and self-management services delivered in the community and home-based settings. One investigator performed a full-text review of each article, and data extraction included (1) study characteristics; (2) participant characteristics; (3) key characteristics of the interventions, programs, and services; and (4) outcome measures and results. RESULTS: A total of 61 articles reported telehealth services used for preventing, managing, or treating the most common secondary complications and consequences of SCI, including chronic pain, low physical activity, pressure ulcers, and psychosocial dysfunction. Where evidence exists, improvements in community participation, physical activity, and reduction in chronic pain, pressure ulcers, etc, following SCI were demonstrated. CONCLUSIONS: Telehealth may offer an efficient and effective option for health service delivery for community-dwelling individuals with SCI, ensuring continuity of rehabilitation, follow-up after hospital discharge, and early detection, management, or treatment of potential secondary complications following SCI. We recommend that the stakeholders involved with patients with SCI consider the uptake of hybridized (blend of web-based and in-person) health care delivery models to optimize the care continuum and self-management of SCI-related care. The findings of this scoping review may be used to inform policy makers, health care professionals, and stakeholders engaged in establishing web-based clinics for individuals with SCI.
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PURPOSE: To explore student and tutor perspectives on the learning efficacy of virtual, compared to in-person, problem-based tutorial (PBT) in occupational therapy, physiotherapy, and speech-language pathology health professional programs. MATERIALS AND METHODS: This was a quality improvement study using a cross sectional survey at a single institution. Separate student and tutor surveys were disseminated online. Students received the survey at two timepoints, tutors received the survey at one timepoint. Descriptive statistics summarized quantitative survey questions. Chi-squared or Fischer's Exact analyses explored differences between in-person and virtual PBT. Exploratory analyses determined if associations amongst programs and/or between cohorts existed on variables of interest. Open-ended survey questions were analyzed using content analysis. RESULTS: A total of 241 students and 85 tutors completed the survey. Results demonstrate most students and tutors were satisfied with the use of virtual tutorials (77%; 89% respectively) and felt that they were effective in exploring content within the PBT course. However, students in the most recent cohort rated virtual tutorials more highly (p = 0.01). CONCLUSIONS: Virtual modes of PBT were successful in achieving course objectives and led to high satisfaction in users. Health professional programs can use this information when designing virtual problem-based tutorial courses in the post-pandemic era.
Problem-based learning (PBL) involves the active engagement of students in self-directed learning where learning gaps are identified, and information is retrieved and critically appraised to apply clinical reasoning to healthcare decisions.Traditionally, the PBL process has been implemented in-person through the use of small group tutorial with six to eight students and a tutor, however, the COVID-19 pandemic led to a quick transition to virtual tutorials.This study found that virtual modes of conducting PBL tutorial were successful in achieving course objectives and both students and tutors were satisfied with using virtual means to achieve course objectives in three professional rehabilitation programs (Occupational Therapy, Physiotherapy, Speech Language Pathology).Health professional programs in rehabilitation can use this information when designing courses using PBL processes in the future, and clinicians can use this information when considering the use of virtual means for care and for collaboration between professionals in various healthcare settings.
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Individuals with pre-clinical mobility limitation (PCML) are at a high risk of future functional loss and progression to disability. The purpose of this scoping review was to provide a comprehensive understanding of PCML intervention studies in middle-aged and older adults. We present the interventions that have been tested or planned, describe how they have been conducted and reported, identify the knowledge gaps in current literature, and make recommendations about future research directions. An initial search of 2,291 articles resulted in 14 articles that met criteria for inclusion. Findings reveal that: (1) there is limited published work on PCML interventions, especially in middle-aged populations; and (2) the complexity and variety of PCML measures make it difficult to compare findings across PCML studies. Despite the diversity of measures, this review provides preliminary evidence that rehabilitation interventions on PCML help to delay or prevent disability progression.
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Purpose: To determine if cancer survivors who perform physical activity (PA) during chemotherapy have improved levels of cognitive function compared to those who do not. Method: E-databases (Ovid MEDLINE, Embase, CINAHL, PsycINFO, AMED) were searched from inception to February 4, 2020. Quantitative studies that assessed cognitive outcomes for adults with any cancer type who received chemotherapy concurrent with PA were selected. Risk of bias was assessed using Cochrane's RoB 2, ROBINS-I, and Newcastle-Ottawa scales. A meta-analysis was performed using standardized mean difference (SMD). Results: Twenty-two studies (15 randomized controlled trials [RCTs] and 7 non-RCTs) met the inclusion criteria. The meta-analysis demonstrated that combined resistance and aerobic training had a small yet statistically significant effect on social cognition compared to usual care (SMD 0.23 [95% CI: 0.04, 0.42], p = 0.020). Conclusions: Combined resistance and aerobic exercise may benefit social cognition in cancer survivors undergoing chemotherapy. Due to high risk of bias and low quality of evidence of included studies, we recommend further investigation to support these findings and make specific PA recommendations.
Objectif : déterminer si les survivants du cancer qui font de l'activité physique (AP) pendant la chimiothérapie ont une meilleure fonction cognitive que ceux qui n'en font pas. Méthodologie : les chercheurs ont fouillé des bases de données électroniques (Ovid MEDLINE, Embase, CINAHL, PsycINFO, AMED) à compter de leur création jusqu'au 4 avril 2020. Ils ont sélectionné les études quantitatives qui évaluaient les issues cognitives des adultes atteints de quelque type de cancer que ce soit et qui avaient été sous chimiothérapie tout en faisant de l'AP. Ils ont évalué le risque de biais au moyen des échelles RoB 2 et ROBINS-I de Cochrane et de l'échelle de Newcastle-Ottawa et ont effectué une méta-analyse au moyen de la différence moyenne standardisée (DMS). Résultats : au total, 22 études (15 essais cliniques randomisés [ÉCR] et sept essais cliniques non randomisés [non-ÉCR]) respectaient les critères d'inclusion. La méta-analyse a démontré que la combinaison d'exercices de résistance et d'exercices aérobiques avait un effet statistique petit, mais significatif, sur la cognition sociale par rapport aux soins habituels (DMS = 0,23 [IC a 95 % : 0,04, 0,42], p = 0,020). Conclusions : la combinaison d'exercices de résistance et d'exercices aérobiques peut être bénéfique à la cognition sociale des survivants du cancer sous chimiothérapie. Étant donné le risque élevé de biais et la faible qualité des données probantes des études retenues, les chercheurs recommandent de poursuivre les recherches pour appuyer ces résultats et faire des recommandations particulières en matière d'AP.