"None of us are lying": an interpretive description of the search for legitimacy and the journey to access quality health services by individuals living with Long COVID.

BACKGROUND: Understanding of Long COVID has advanced through patient-led initiatives. However, research about barriers to accessing Long COVID services is limited. This study aimed to better understand the need for, access to, and quality of, Long COVID services. We explored health needs and experiences of services, including ability of services to address needs. METHODS: Our study was informed by the Levesque et al.'s (2013) "conceptual framework of access to health care." We used Interpretive Description, a qualitative approach partly aimed at informing clinical decisions. We recruited participants across five settings. Participants engaged in one-time, semi-structured, virtual interviews. Interviews were transcribed verbatim. We used reflexive thematic analysis. Best practice to ensure methodological rigour was employed. RESULTS: Three key themes were generated from 56 interviews. The first theme illustrated the rollercoaster-like nature of participants' Long COVID symptoms and the resulting impact on function and health. The second theme highlighted participants' attempts to access Long COVID services. Guidance received from healthcare professionals and self-advocacy impacted initial access. When navigating Long COVID services within the broader system, participants encountered barriers to access around stigma; appointment logistics; testing and 'normal' results; and financial precarity and affordability of services. The third theme illuminated common factors participants liked and disliked about Long COVID services. We framed each sub-theme as the key lesson (stemming from all likes and dislikes) that, if acted upon, the health system can use to improve the quality of Long COVID services. This provides tangible ways to improve the system based directly on what we heard from participants. CONCLUSION: With Long COVID services continuously evolving, our findings can inform decision makers within the health system to better understand the lived experiences of Long COVID and tailor services and policies appropriately.

Humor: A Grief Trigger and Also a Way to Manage or Live With Your Grief.

In 2020-2021, a qualitative study was undertaken using an interpretive description methodology to identify what triggers grief in the first 2 years following the death of a beloved family member, and to gain other helpful insights about grief triggers from bereaved Canadian adult volunteers. In that study, a purposive sampling method was used to select 10 bereaved Canadian adult volunteers for in-depth, semi-structured interviews. This paper reports on the humor findings, as revealed to be a particularly complex grief trigger for many participants, as well as a periodic way for most to manage or live with their grief. Participant quotes and an extended discussion are included to illustrate the importance of these humor findings in relation to grief, and to inform bereaved people, bereavement service providers, and the general public about both helpful aspects and some cautionary considerations about humor.

Children's Sleep During COVID-19: How Sleep Influences Surviving and Thriving in Families.

OBJECTIVE: The COVID-19 pandemic has the potential to disrupt the lives of families and may have implications for children with existing sleep problems. As such, we aimed to: (1) characterize sleep changes during the COVID-19 pandemic in children who had previously been identified as having sleep problems, (2) identify factors contributing to sleep changes due to COVID-19 safety measures, and (3) understand parents' and children's needs to support sleep during the pandemic. METHODS: Eighty-five Canadian parents with children aged 4-14 years participated in this explanatory sequential, mixed-methods study using an online survey of children's and parents' sleep, with a subset of 16 parents, selected based on changes in their children's sleep, participating in semi-structured interviews. Families had previously participated in the Better Nights, Better Days (BNBD) randomized controlled trial. RESULTS: While some parents perceived their child's sleep quality improved during the COVID-19 pandemic (14.1%, n = 12), many parents perceived their child's sleep had worsened (40.0%, n = 34). Parents attributed children's worsened sleep to increased screen time, anxiety, and decreased exercise. Findings from semi-structured interviews highlighted the effect of disrupted routines on sleep and stress, and that stress reciprocally influenced children's and parents' sleep. CONCLUSIONS: The sleep of many Canadian children was affected by the first wave of the COVID-19 pandemic, with the disruption of routines influencing children's sleep. eHealth interventions, such as BNBD with modifications that address the COVID-19 context, could help families address these challenges.

Older women's experiences of companion animal death: impacts on well-being and aging-in-place.

BACKGROUND: Companion animal death is a common source of grief, although the extent and context of that grief is poorly understood, especially in older adulthood. The aim of this multiple-methods study was to develop a greater understanding of the impact of companion animal death on older women living alone in the community, as older women are a distinct at-risk group, and the supports that should be available to help these individuals with their grief. METHODS: Participants were recruited from across Alberta, a Canadian province, through seniors' organizations, pet rescue groups, and social media groups of interest to older women. After completing a pre-interview online questionnaire to gain demographic information and standardized pet attachment and grief measures data, participants were interviewed through the Zoom ® computer program or over the telephone. An interpretive description methodology framed the interviews, with Braun and Clarke's 6-phase analytic method used for thematic analysis of interview data. RESULTS: In 2020, twelve participants completed the pre-interview questionnaires and nine went on to provide interview data for analysis. All were older adult (age 55+) women, living alone in the community, who had experienced the death of a companion animal in 2019. On the standardized measures, participants scored highly on attachment and loss, but low on guilt and anger. The interview data revealed three themes: catastrophic grief and multiple major losses over the death of their companion animal, immediate steps taken for recovery, and longer-term grief and loss recovery. CONCLUSIONS: The findings highlight the importance of acknowledging and addressing companion animal grief to ensure the ongoing well-being and thus the sustained successful aging-in-place of older adult women in the community.

Positive Association between Patients' Perception of Chronic Pain Rehabilitation as a Personally Meaningful Experience and the Flourishing Aspect of Well-Being.

Chronic pain rehabilitation helps to reduce pain and restore valued life roles. Patients may have more positive outcomes when they perceive rehabilitation to be personally meaningful. This study examined associations between self-reported, personally meaningful rehabilitation and well-being. A pilot study was conducted using an online survey of people with chronic pain and experiences of rehabilitation. The PROMIS Pain Interference Short Form 8a and The Flourishing Scale were used to explore well-being. A modified self-report measure, the Meaningfulness in Rehabilitation Scale, was pilot-tested for construct validity and used in the survey. Of the 48 participants (81% female; 19% male), most attended a generalist therapy practice (62%) once per week (33%) or once per fortnight (29%). No statistically significant relationship was found between self-reported meaningfulness in rehabilitation and pain interference or other patient and therapy characteristics (duration of chronic pain category, type of therapy practice, resolution of rehabilitation category, and frequency of appointments). The nonparametric analysis identified a statistically significant moderate positive correlation between self-reported meaningfulness in rehabilitation and the flourishing aspect of well-being. This raises important questions and suggests that patients' perception of rehabilitation as meaningful warrants further research. This pilot study provides valuable guidance to inform a larger investigation.

The experience of meaningful rehabilitation as perceived by people with chronic pain: A phenomenological study.

BACKGROUND: People with chronic pain may seek rehabilitation to reduce pain and restore productivity and valued roles. Theoretically, a biopsychosocial approach makes rehabilitation more meaningful, however, the limited research on meaningful rehabilitation predominantly describes the perspective of therapists and researchers. The client's perspective of meaningfulness in rehabilitation is lacking. OBJECTIVE: To investigate the experience of meaningfulness in rehabilitation from the perspective of people with chronic pain. METHODS: Qualitative, semi-structured interviews were conducted with Australian adults who had chronic pain and recent experience of occupational therapy or physiotherapy. Sampling continued until thematic saturation occurred. Transcripts were coded and analyzed using theory-driven and data-driven thematic analysis. RESULTS: Ten participants (four males; six females) were interviewed. Pain histories ranged from nine months to 20+ years, with conditions such as fibromyalgia or trauma. Three themes from a prior concept analysis were upheld, and a further three data-driven themes emerged. Results indicate that people with chronic pain seek a "genuine connection"; from a therapist who is "credible"; and can become a "guiding partner", and they find rehabilitation meaningful when it holds "personal value"; is "self-defined"; and relevant to their sense of "self-identity". CONCLUSIONS: The genuine connection and guiding partnership with a credible therapist, that is sought by people with chronic pain, may be at odds with aspects of contemporary rehabilitation. Client-defined meaningfulness is an important construct to engage clients in treatment and improve work and other occupational outcomes for people with chronic pain.

Perceived injustice in injured workers: analysis of public responses to an injured worker who took Workers' Compensation Board employees hostage.

INTRODUCTION: Injured workers' perceived injustice can contribute to retaliatory, aggressive actions. Research also shows a relationship between persistent pain, anger and aggressive, maladaptive coping. AIMS: We took the unique opportunity afforded by a workers compensation board (WCB) hostage taking incident to address four questions: (i) What contemporary values, beliefs, and potential behaviours about the WCB system are reflected in the online postings of other claimants (or family members of claimants) in response to the hostage taking incident? (ii) To what degree do the narratives of people who posted online (PWP) in response to this incident, demonstrate the theme of perceived injustice and support retaliatory actions? (iii) How accurate is the information relayed by PWP about the WCB system where the hostage taking occurred? (iv) What is the quality and the public utility of the information this WCB makes available to the public through on-line posting? METHODS: We thematically analysed comments posted on a national news website in response to the hostage-taking. We focused on posted narratives from people who stated that they had personal involvement with WCB. We also assessed the accuracy of the comments about WCB made in these narratives against the information available on the WCB website. A standardized assessment tool was used to determine the readability and accessibility of the WCB website. FINDINGS: Emergent themes were: retribution, perceived systemic mistreatment, justice/injustice, empathy, disbelief, and loss. There were many inaccurate beliefs about the Workers' Compensation Board. The overall quality of readability and accessibility of the website was low. CONCLUSION: Narratives indicated perceived procedural injustice attributed to a flawed and uncaring compensation system. Inaccurate beliefs about WCB and poor quality of the public website may have contributed to suffering, miscommunication and perceptions of unjust, systemic mistreatment. Findings support a relationship between perceived injustice and aggressive retaliatory action.

Return-to-Work Following Occupational Rehabilitation for Long COVID: Descriptive Cohort Study.

BACKGROUND: Emerging evidence suggests that worldwide, between 30% and 50% of those who are infected with COVID-19 experience long COVID (LC) symptoms. These symptoms create challenges with return-to-work (RTW) in a high proportion of individuals with LC. To tailor rehabilitation programs to LC sequelae and help improve RTW outcomes, more research on LC rehabilitation program outcomes is needed. OBJECTIVE: This study describes the characteristics and outcomes of workers who participated in an LC occupational rehabilitation program. METHODS: A cohort study was conducted. Descriptive variables included demographic and occupational factors as well as patient-reported outcome measures (PROMs, ie, the Fatigue Severity Scale [FSS], the Post-COVID Functional Scale [PCFS], the 36-item Short Form Health Survey [SF-36], the Pain Disability Index [PDI], the pain Visual Analogue Scale [VAS], the 9-item Patient Health Questionnaire [PHQ-9], the 7-item Generalized Anxiety Disorder Questionnaire [GAD-7], and the Diagnostic and Statistical Manual for Mental Disorders Fifth Edition [DSM-5] posttraumatic stress disorder [PTSD] checklist [PCL-5]). The main outcome variable was the RTW status at discharge. Descriptive statistics were calculated. Logistic regression examined predictors of RTW. RESULTS: The sample consisted of 81 workers. Most workers were female (n=52, 64%) and from health-related occupations (n=43, 53%). Only 43 (53%) individuals returned to work at program discharge, with 40 (93%) of these returning to modified duties. Although there were statistically significant improvements on the pain VAS (mean 11.1, SD 25.6, t31=2.5, P=.02), the PDI (mean 9.4, SD 12.5, t32=4.3, P<.001), the FSS (mean 3.9, SD 8.7, t38=2.8, P=.01), the SF-36 PCS (mean 4.8, SD 8.7, t38=-3.5, P=.001), the PHQ-9 (mean 3.7, SD 4.0, t31=5.2, P<.001), and the GAD-7 (mean 1.8, SD 4.4, t22=1.8, P=.03), there were no significant improvements in the PCFS, the overall mental component score (MCS) of the SF-36, or on the PCL-5. The availability of modified duties (odds ratio [OR] 3.38, 95% CI 1.26-9.10) and shorter time between infection and admission for rehabilitation (OR 0.99, 95% CI 0.99-1.00) predicted RTW even when controlling for age and gender. CONCLUSIONS: Workers undergoing LC rehabilitation reported significant but modest improvements on a variety of PROMs, but only 43 (53%) returned to work. Outcomes would likely improve with increased availability of modified duties and timelier rehabilitation. Additional research is needed, including larger observational cohorts as well as randomized controlled trials to evaluate the effectiveness of LC rehabilitation.

Risk Factors for Developing Concurrent Posttraumatic Stress Injury After Work-Related Musculoskeletal Injury: A Case-Control Study.

OBJECTIVE: This study aimed to study risk factors for developing concurrent posttraumatic stress injury (PTSI) among workers experiencing work-related musculoskeletal injury (MSI). METHODS: A case-control study was conducted using workers' compensation data on injured workers undergoing rehabilitation programs for concurrent MSI and PTSI (cases) and MSI only (controls). A variety of measures known at the time of the compensable injury were entered into logistic regression models. RESULTS: Of the 1948 workers included, 215 had concurrent MSI and PTSI. Concurrent MSI and PTSI were predicted by type of accident (adjusted odds ratio [OR], 25.8), experiencing fracture or dislocation fracture or dislocation (adjusted OR, 3.7), being public safety personnel (adjusted OR, 3.1), and lower level of education (adjusted OR, 1.9). CONCLUSIONS: Experiencing a concurrent PTSI diagnosis with MSI after work-related accident and injury appears related to occupation, type of accident, and educational background.

A critical review of interventions addressing ageist attitudes in healthcare professional education.

BACKGROUND: As the population ages, the demand for health care services will increase. Evidence suggests that the pervasive negative societal beliefs regarding aging and older persons are also found among occupational therapy students and practitioners. These attitudes can negatively affect healthcare service provision. PURPOSE: To determine the strength of the evidence regarding educational interventions used to modify ageist values and beliefs of health care professionals. METHODS: A critical review of the literature was undertaken to evaluate methodological quality of relevant outcome studies. FINDINGS: . Of the fifteen studies meeting the inclusion criteria one was rated as "strong" evidence, and the remainder lacked methodological rigour. Such results make it difficult to decide the usefulness of including educational interventions in health care curricula to negate ageism. IMPLICATIONS: Research specific to occupational therapy is required as our unique frames of reference and theoretical models to guide practice may preclude generalizability of research from other professional groups.

Cross-Sectional Survey of Sleep Practices of Australian University Students.

Sleep insufficiency is often associated with the life of a university student, yet it is well known that inadequate sleep can have a negative impact on physical and mental health and be detrimental to cognitive skills for learning. The aim of this study was to replicate a Canadian study to survey university student sleep practices, the way in which students address any sleep issues, and the students' preferred method to receive targeted sleep information. METHODS: An anonymous on-line survey was promoted to all enrolled students at one Australian University in August 2017. RESULTS: In total, 601 students responded to the survey. One third indicated that they had insufficient sleep (less than 6.5 hrs). Almost two thirds reported a perception of not getting sufficient sleep. There was a significant association between the reported number of sleep hours, and the perception of high-quality sleep. Strategies to get to sleep included the use of social media which is counter to best practice in sleep hygiene. CONCLUSION: The study supports the need for education about sleep health coupled with stress management to better the demands of student life.

Effectiveness of Hand Self-Shiatsu to Promote Sleep in Young People with Chronic Pain: a Case Series Design.

BACKGROUND: Sleep problems exist for up to 30% of young people, and increase in the case of those with chronic pain. Because exclusive pharmacological management of sleep problems for children with pain is contraindicated, the development of appropriate non-pharmacological sleep interventions is a significant, largely unmet, need. PURPOSE: This study examined whether the application of a standardized hand self-shiatsu (HSS) intervention within a population of young people with chronic pain would be associated with improved objectively and subjectively measured sleep. SETTING: The Pain Management Clinic of the Stollery Children's Hospital Hospital, a large tertiary care centre in Edmonton, Alberta and the University of Alberta. RESEARCH DESIGN: Sixteen young adults, aged 17 to 27, were recruited for a case series study. The intervention involved participants self-applying a standardized hand shiatsu protocol. Participants wore an actigraph for one week at baseline before learning the HSS technique, and then at four- and eight-week follow-up. At the same measurement points they completed validated self-report measures of their sleep quality and daytime fatigue. Each participant also completed a sleep log to supplement the actigraphy data and to collect their general impressions of the HSS experience. Data were analyzed with SPSS 23 software, using Freidman's test for analysis of variance. RESULTS: The objective data did not support the hypothesis that this standardized HSS protocol improves objectively measured sleep. However, standardized self-report measures demonstrated statistically significant improvement in perceived sleep disturbance (chi-squared test [χ2] = 8.034, p = .02), sleep-related impairment (χ2 = 7.614, p = .02), and daytime fatigue as measured by the PROMIS Fatigue SF 8-a (χ2 = 12.035, p = .002), and the Flinder's Fatigue Scale (χ2 = 11.93, p = .003). Qualitative sleep log information indicated wide-spread endorsement of HSS for the management of sleep difficulties. CONCLUSION: Contrary to objective findings, self-report data support the technique of HSS to improve sleep. Participants' comments reflected an overall high level of acceptance and appreciation for the HSS technique. Results highlight the importance of expanding the theory and practice related to sleep measurement to better integrate the qualitative domain.

An eHealth insomnia intervention for children with neurodevelopmental disorders: Results of a usability study.

BACKGROUND: Sleep problems, particularly insomnia, are highly prevalent in children with neurodevelopmental disorders (NDD) and can negatively affect health and development. eHealth interventions may increase access to evidence-based care for insomnia for children with NDD, as programs are rare in most communities. Better Nights, Better Days (BNBD) is an online, parent-implemented intervention for pediatric insomnia in typically developing 1- to 10-year-olds. AIMS: The present study examined whether parents of children with NDD perceived the original BNBD to be usable, acceptable, and feasible, and what modifications might be necessary to adapt it for children with NDD. METHODS AND PROCEDURES: Twenty Canadian parents/caregivers of children aged 4-10 years with NDD and insomnia implemented the BNBD intervention with their children, and completed usability questionnaires. Questionnaire data were analyzed quantitatively (descriptive statistics) and qualitatively (thematic analysis). OUTCOMES AND RESULTS: Participants reported the intervention to be usable, useful, acceptable, and feasible. Several modifications were suggested to make the intervention more appropriate and acceptable for use with children with NDD. CONCLUSIONS AND IMPLICATIONS: Results support a largely transdiagnostic approach to treating sleep in children with NDD, and will inform the development of BNBD for Children with Neurodevelopmental Disorders (BNBD-NDD).

Barriers and facilitators to treating insomnia in children with autism spectrum disorder and other neurodevelopmental disorders: Parent and health care professional perspectives.

BACKGROUND/AIMS: Insomnia is highly prevalent in children with neurodevelopmental disorders (NDDs), yet little research exists on sleep treatment access, utilization, and provision in this population. This study explores barriers and facilitators to access, use, and provision of treatment for sleep problems as experienced by parents of children with NDDs, including Autism Spectrum Disorder (ASD), Attention-Deficit/Hyperactivity Disorder (ADHD), Cerebral Palsy (CP) and Fetal Alcohol Spectrum Disorder (FASD), and health care professionals who work with children with these conditions. METHOD: Transcripts from online focus groups and interviews, conducted separately with parents of children with NDDs (n = 43) and health care professionals (n = 44), were qualitatively analyzed using content analysis for key themes. RESULTS: Barriers included limited access to/availability of treatment, lack of knowledge/training, NDD-specific factors (e.g., symptoms, medications, and comorbidities), parent factors (e.g., capacity to implement treatment, exhaustion), and the challenging, intensive nature of sleep treatment. Facilitators included positive beliefs and attitudes, education, support, and ability to modify treatments for NDD symptoms. Barriers and facilitators were similar across all four NDDs. CONCLUSIONS: Results highlight a need for more education about sleep in NDDs and to develop accessible interventions, as well as the potential of a transdiagnostic approach to sleep treatment in this population.

Mazes, conflict, and paradox: tools for understanding chronic pain.

This article presents an argument for framing chronic pain within a complex adaptive systems (CAS) paradigm. The first aim of this article is to demonstrate how chronic pain can be framed as a CAS and how paradox, one of the core characteristics of a CAS, exists within the chronic pain experience. The second aim is to illustrate how paradox exists at multiple levels within the health care encounter and ongoing experience of chronic pain. Finally, the article will use the example of interactions at the patient/clinician level to illustrate how health care workers' efforts to deal with issues emergent from the range of paradoxes have for the most part been ineffective, and at times harmful, to persons experiencing chronic pain. This article uses the example of chronic pain to explore how the manner in which health care providers and patients recognize and deal with paradoxes can either worsen the pain experience or help generate creative new ways to manage the chronic pain condition. The CAS principles discussed in this article hold application across a range of chronic conditions for which a traditional biomedical paradigm proves insufficient.

Questioning: a critical skill in postmodern health-care service delivery.

Occupational therapists can no longer rely exclusively on biomedical frameworks to guide their practice and facilitate clinical problem-solving. A postmodernist perspective of health and well-being underlines that the illness experience is not a linear, cause-and-effect equation. Rather, life experiences are constructed through a myriad of social, cultural, physical and economic contexts that are highly unique to each individual. In other words, the assumption that 'one-size-fits-all' is as flawed in health care as it is in clothing design. This paper contributes to the growing discussion of health care within the postmodern context of the twenty-first century through first presenting a brief discussion of emerging postmodern thinking and application within the profession, followed by a rationale for the need to scrutinise prevalent modernist assumptions that guide decision-making. Finally, the paper introduces the method of Socratic questioning as a critical tool in successfully carrying out this scrutiny in an empowering and respectful manner for all stakeholders.

Effectiveness of hand self-shiatsu to improve sleep following sport-related concussion in young athletes: a proof-of-concept study.

OBJECTIVE: The prevalence of sport-related concussion (SRC) is high and results in a number of serious health consequences. One area that has received minimal research is the relationship between SRC and sleep. The literature shows that sleep deficiency is a frequent negative consequence of SRC. At the same time, sleep deficiency delays recovery from SRC and contributes added risk of symptom recurrence. A 2014 study of chronic pain patients who learned to apply the complementary and alternative medicine intervention hand self-shiatsu (HSS) had promising, sleep-promoting results that warrant further investigation with other populations. This proof-of-concept study explored the feasibility of HSS as an intervention to promote sleep onset and continuity for young adults with SRC. METHODS: This study employed a prospective case-series design, where participants act as their own controls. Baseline and follow-up data included standardized self-reported assessment tools and sleep actigraphy. RESULTS: Seven athletes, aged between 18 and 25 years, participated in the study. Although statistically significant improvement in actigraphy sleep scores between baseline and follow-up was not achieved, metrics for sleep quality and daytime fatigue showed significant improvement. CONCLUSION: These findings support the hypothesis that HSS has the potential to improve sleep and reduce daytime fatigue in young postconcussion athletes. This pilot study provides guidance to refine research protocols and lays a foundation for further, large-sample, controlled studies.

Predictors of Excessive Daytime Sleepiness in Medical Students: A Meta-Regression.

Excessive daytime sleepiness (EDS) is highly prevalent among medical students and can have serious negative outcomes for both students and their patients. Little is known about the magnitude and predictors of EDS among medical college students. A meta-regression analysis was conducted to achieve these two targets. A systematic search was performed for English-language studies that reported the prevalence of EDS among medical students using the Epworth sleepiness scale (ESS), age, sex, sleep duration and sleep quality as predictive variables. A total of nine observational studies (K = 9, N = 2587) were included in the analyses. Meta-regression analyses were performed using mean age (years), sex (proportion of male subjects), sleep duration (hours/night) and sleep quality index score (continuous scale) as moderators for EDS-with the prevalence of EDS as an outcome variable. An interaction term of sleep duration X sleep quality was created to assess if these two variables simultaneously influenced the outcome variable. Utilizing the ESS, the pooled prevalence of EDS among medical students was 34.6% (95% Confidence Interval (CI) 18.3-50.9%). Meta-regression models of age, sex, sleep duration and sleep quality alone revealed poor predictive capabilities. Meta-regression models of sleep duration-sleep quality interaction revealed results with high statistical significance. The findings from this review contribute supporting evidence for the relationship between sleep duration and sleep quality scores (i.e., sleep duration X sleep quality score) in predicting EDS in medical students.

Factors affecting occupational therapists' decision to join their regional professional association: Facteurs influençant la décision des ergothérapeutes de joindre les rangs de leur association professionnelle régionale.

BACKGROUND: Voluntary occupational therapy organizations fill an important role. However, recruitment and retention can be problematic. Little is known about factors influencing occupational therapists to join/maintain membership in professional associations. PURPOSE: This study investigated factors influencing occupational therapists' decision to join/remain members of their association. METHOD: An electronic survey was carried out and data were analyzed using SPSS software and manual categorization of open-ended comments. FINDINGS: Two hundred and fifty-four therapists responded. Generation of new ideas, opportunities for professional development, self-improvement, maintenance of standards, improvement of the profession, and discounts on equipment/educational opportunities were significant factors in deciding to join the organization. The factors perceived as priorities varied in relation to participants' year of graduation. IMPLICATIONS: More-customized strategies, reflecting priorities that vary during a therapist's career path, may need to be employed to best address recruitment and retention across the range of therapists' needs and goals.

A standardized review of smartphone applications to promote balance for older adults.

BACKGROUND: Balance is one of the risk factors for falls in older adults. The use of smartphone applications (apps) related to health (mHealth) is increasing and, while there is potential for apps to be used as a self-managed balance intervention, many healthcare providers are concerned about the content and credibility of mHealth apps overall. PURPOSE: This study evaluates the quality of balance promoting apps and identifies strengths and areas of concern to assist healthcare providers in recommending these resources. MATERIALS AND METHODS: Balance apps for the general public, offered on the iPhone Operating System (iOS) and Android platforms, were evaluated using the Mobile Application Rating Scale (MARS). RESULTS: Five iOS apps met the inclusion criteria. The mean scores for each of the domains in MARS were: Engagement (3.32), Information (3.7), Functionality (3.8), and Esthetics (3.8). Overall, one app (UStabilize) received a rating of 4.43 in MARS five-point scale, which was considered "good". Other apps in the review demonstrated acceptable quality. CONCLUSIONS: The reviewed balance apps targeted to improve or maintain physical balance were of acceptable quality. Apps address many current issues older adults have to accessing rehabilitation services and, as such, may be particularly useful for this group. Future research should focus on assessing and comparing app efficacy. Development of balance apps for the Android platform is also necessary. Implications for Rehabilitation Given the availability and accessibility of various mHealth apps and the increasing mobile device usage among older adults, mobile apps are a promising avenue for delivering rehabilitation interventions, such as balance training, to older adults. Smartphone apps exist for balance training but overall confidence in health apps within the healthcare community is low and rigorous evaluation is required. A range of apps exist that demonstrate acceptable to good quality and stakeholders should work towards having these apps listed in credible mHealth clearinghouses.