Using Comprehensive Geriatric Assessment in Identifying Care Goals and Referral Services in a Frailty Intervention Clinic.

The proportion of older adults and frail adults in Canada is expected to rise significantly in upcoming years. Currently, a considerable number of older adults do not actively participate in developing their own care plans; prior research has indicated several benefits of patient engagement in this process. Thus, we conducted a mixed methods study that examined the prevalence of rehabilitation goals and identified these for 305 community dwelling older adults referred to a frailty intervention clinic utilizing Comprehensive Geriatric Assessment (CGA) between 2014 and 2018. Top patient concerns included mobility (84%), services, systems, and policies (51%), sensory functions and pain (50%), and self-care or domestic life (47%). The most common referrals or recommendations for patients included further follow-up with a physician or specialist (36%), referral to an onsite falls prevention clinic (31%), and medication modifications (31%). Based upon these findings, we recommend greater utilization of CGA within a team-based approach to improve patient care by allowing for greater collaboration and shared decision-making by health-care providers. Moreover, CGA can be an effective tool to meet the complex and unique health-care needs of frail patients while incorporating patient goals. This is vitally important considering the predicted growth in the population of frail and/or older patients, as well as the current challenges and shortfalls in meeting the health-care needs of this population.

Growing pains: Lessons learned from a failed mobile mindfulness clinical trial for patients with complex care needs.

This paper discusses lessons learned from a failed clinical trial investigating the use of a mobile application (app) to deliver a mindfulness intervention to middle-aged and older adults receiving services at a rehabilitation hospital in Ontario, Canada. A randomized controlled trial with 82 participants was planned, with the experimental group receiving access to a mindfulness app and a wait-list control group receiving access to the app after 4 weeks; however, the study could not be completed due to low recruitment rates. This implementation failure was considered from the perspective of the PARIHS framework. More specifically, Three key recruitment challenges were identified, and recommendations for future research provided. Firstly, the increasingly complex care needs of the study population appeared to influence eligibility; it would be beneficial for future research to consider adopting strategies to better understand the needs of the target population. Secondly, participants' stage of care and readiness of change likely negatively influenced compliance and retention in this study, and should be assessed in future research. Finally, a lack of clinician integration into the research team negatively impacted recruitment in this study; future studies should consider integrating direct service providers into the research team as this may increase buy-in and referral rates. The challenges and recommendations outlined can inform design and implementation of future studies in this area.

Continuity, transition and participation: preparing clients for life in the community post-stroke.

AIMS: To examine issues of continuity and transition facing clients as they return to life in the community following stroke and the role of rehabilitation in this process. KEY FINDINGS AND IMPLICATIONS: The sudden onset of disability following a stroke represents a major disruption to the continuity of a person's life experience. Rehabilitation has an important role in the transition from the non-disabled to the disabled state however current rehabilitation services and outcomes post-stroke focus on functional recovery rather than on a return to meaningful roles and activities and pay little attention to the transition from the non-disabled to the disabled self. Although some current rehabilitation models address the importance of involvement in a life situation, they do not adequately address issues of the role of the environment, the nature of community, the importance of meaning and choice when thinking about life situations, and change in abilities across the life course. CONCLUSIONS: Models of rehabilitation service delivery need to move to a chronic disease management model that incorporates outcomes that are meaningful to clients, and not the assumed needs or outcomes as defined by rehabilitation professionals.

Assessing the consequences of delisting publicly funded community-based physical therapy on self-reported health in Ontario, Canada: a prospective cohort study.

In early 2005, Canada's most populous province (Ontario) partially delisted publicly funded community-based physical therapy services by restricting the eligibility criteria within designated clinics. The aim of this research was to assess the consequences of this policy decision using a prospective cohort design. In this study, we followed clients before and after delisting in order to assess change in access and self-reported health status. The results indicated that 81 of 113 (71.7%) participants who required physical therapy services continued to receive them after delisting because they remained eligible, were privately insured and/or were able to pay out-of-pocket. Twenty (17.7%) required services but did not receive them because they were uninsured or were not able to pay privately. The remaining participants were discharged at follow-up. Controlling for gender, age, employment and condition, clients who maintained access were 10 times more likely to report very good or excellent health status compared to those who did not receive services (odds ratio: 10.72; 95% confidence interval: 2.20-52.25). Given the association between poor self-reported health status and morbidity and mortality, future research needs to examine the long-term impact to determine the extent to which delisting may be associated with increased utilization of hospitals and family physicians.

The effect of wheelchair use on the quality of life of persons with multiple sclerosis.

SUMMARY This pilot study describes the effect of wheelchair use on the quality of life of persons with multiple sclerosis (MS), and examines the clinical utility of the Psychosocial Impact of Assistive Devices Scale (PIADS) as an outcome measure for use by occupational therapists. Sixteen hospitalized adults with MS were interviewed using the PIADS. Descriptive comparisons of PIADS subscale scores (competence, adaptability, self-esteem) were conducted for participants using different types of wheelchairs, daily versus non-daily wheelchair users, and participants who required different levels of assistance to propel their wheelchairs. Results suggest that using a wheelchair has a positive impact on the quality of life of persons with MS. The PIADS was found to be clinically useful for exploring person-environment interactions and appears to be well suited to the goals and values of occupational therapy. Recommendations for future research and for incorporating the PIADS into occupational therapy practice are discussed.