A case study of using community-based consensus methods to facilitate shared decision-making among a spinal cord injury network.

Spinal cord injury (SCI) research and policy decisions are rarely made in partnership with people with SCI, making them less relevant, applicable, and used by those whom the decisions are intended to support. Across disciplines, consensus methods have been promoted as a viable solution for supporting shared research and policy-based decision-making. In this paper, we describe a partnered approach between academic researchers and the Ontario SCI Alliance, a non-profit, SCI community mobilization network to co-develop and co-disseminate a community-based consensus exercise. The community-based consensus exercise included two modified Delphi surveys and one in-person retreat. The partnership's goal with this exercise was to facilitate shared decision-making for the development of their upcoming strategic plan. We then interviewed partners and participants from the Delphi and in-person retreat to discuss successes, challenges, and lessons learned from the exercise. Survey 1 was disseminated to over 2,500 members of the Ontario SCI community and received 374 responses (276 coming from people with SCI). Survey 2 had 118 responses, with 87 coming from people with SCI. The retreat had 73 attendees, including people with SCI, family/friends of people with SCI, clinicians, researchers, and SCI community and research organization staff/volunteers. The retreat included a presentation of the survey results, a clinician/researcher panel, and externally-facilitated working groups. All survey responses and retreat materials were synthesized. Using the synthesized feedback, the Ontario SCI Alliance was able to implement several changes for the Ontario SCI community, including higher-quality primary care experiences (reduced wait times, more accessible examining rooms), the development of a wound care strategy with the Ontario government, and an advocacy campaign for public coverage for catheters and urinary care supplies. From the five interviews conducted, five themes were co-constructed regarding the successes, challenges, and lessons learned from the exercise: (1) Inclusion, Diversity, Equity, and Accessibility; (2) Partnership; (3) Design Considerations; (4) Transparency and Clarity in Communication; and (5) Sustainability. Findings from this community case study demonstrate the feasibility of conducting a community-level consensus exercise among an equity-deserving group while providing detailed guidance for how to ensure future research and policy-based decision-making is shared across diverse knowledge users.

Creative nonfiction approach to explore peer mentorship for individuals with spinal cord injury.

PURPOSE: Research has examined peer mentorship to understand how it may help people with spinal cord injury (SCI) adapt and thrive. We still lack an in-depth understanding of the perspectives of SCI peer mentors and mentees on their dyadic relationship. This study was to explore the dyadic interactions and relationships between SCI peer mentors and mentees in a peer mentorship program delivered at a rehabilitation center. RESEARCH METHOD: Between 2016 and 2017, we recruited two dyads of peer mentor and mentee with SCI (N = 4). Each participant completed three one-on-one interviews (N = 12). Data were analyzed using a creative nonfiction approach. RESULTS: Three unique dialogical stories were developed. Story 1 (A slow and steady start) described how mentors took a mentee-centered approach in building the relationship. Story 2 (Mentorship and friendship: negotiating the "grey zone") highlighted how mentees and mentors experienced challenges in navigating the boundaries between mentorship and friendship. Story 3 (The "endless" job for mentor) showcased how the relationship could enter a phase in which it could affect mentors' well-being. CONCLUSIONS: The stories highlighted important attributes to the relationships between SCI mentors and mentees. Considerations were suggested for community-based SCI organizations to integrate peer mentorship into rehabilitation settings, including optimizing mentorship introductions and matching, defining mentors' role explicitly, and building support systems for mentors. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Delivery of a community-based peer mentorship program for people with spinal cord injury at a rehabilitation center.

Introduction: Community-based spinal cord injury (SCI) organizations deliver peer mentorship programs in rehabilitation settings. Little is known on how these programs are delivered through the collaboration between community-based SCI organizations and rehabilitation institutions. This study aimed to identify barriers, facilitators, and collaboration processes within a SCI peer mentorship program provided by a community-based organization at a rehabilitation center. Methods: A qualitative case study design was applied. Seven participants were recruited, including two mentees, two mentors, one program director of the community-based SCI organization, and two healthcare professionals of the rehabilitation center. Each participant completed a one-on-one interview. Data were analyzed inductively and deductively based on the Consolidated Framework for Implementation Research (CFIR). Results: Ten factors were identified to influence the delivery of the peer mentorship program, including nine CFIR constructs. Successful delivery of the program required strong, collaborative inter-professional relationships between health professionals and community organizational staff (e.g., peer mentors) as facilitators; whereas potential cost, minimal patient needs, and limited mentor resources were found to be barriers. Engaging health professionals by initiating communications, reflecting and evaluating the program collectively with health professionals were important collaboration processes for the community-based organization to maintain effective partnership with the rehabilitation center. Discussion: The collaboration processes and strategies to addressing/leveraging the barriers and facilitators may inform evidence-based practice to establish and optimize the delivery of SCI peer mentorship programs in various rehabilitation settings.

Reducing endocrine metabolic disease risk in adults with chronic spinal cord injury: strategic activities conducted by the Ontario-Quebec RIISC team.

PURPOSE: The Rehabilitation Interventions for Individuals with a Spinal Cord Injury in the Community (RIISC) team aimed to develop and evaluate innovative rehabilitation interventions to identify endocrine metabolic disease (EMD) risk, intending to reduce the frequency and severity of EMD related morbidity and mortality among adults living with chronic spinal cord injury or disease (SCI/D). MATERIALS AND METHODS: An interprovincial team from Ontario and Quebec reviewed available EMD literature and evidence syntheses and completed an inventory of health services, policies and practices in SCI/D care. The review outcomes were combined with expert opinion to create an EMD risk model to inform health service transformation. RESULTS: EMD risk and mortality are highly prevalent among adults with chronic SCI/D. In stark contrast, few rehabilitation interventions target EMD outcomes. The modelled solution proposes: 1) abandoning single-disease paradigms and examining a holistic perspective of the individual's EMD risk, and 2) developing and disseminating practice-based research approaches in outpatient community settings. CONCLUSIONS: RIISC model adoption could accelerate EMD care optimization, and ultimately inform the design of large-scale longitudinal pragmatic trials likely to improve health outcomes. Linking the RIISC team activities to economic evaluations and policy deliverables will strengthen the relevance and impact among policymakers, health care providers and patients.

Living with a spinal cord injury or disease (SCI/D) increases endocrine metabolic disease (EMD) risk.EMD-related outcomes include fracture; type II diabetes; and cardiovascular disease (myocardial infarction, sudden cardiac death and stroke), directly contributing to higher morbidity and mortality.Single-disease paradigms are not the ideal strategy to address multimorbidity contexts experienced in SCI/D.Practice-based research could be an alternative/adjunct to randomized control trials at generating evidence on current and emerging rehabilitation approaches.

Physical activity is for everyone: a call to action for education and knowledge mobilisation to optimise the continuum of services for people with mobility disabilities in Québec, Canada.

Approximately 2.7 million Canadians live with mobility disabilities. There is scientific documentation describing the importance of physical activity for maintaining or increasing functional capacity, which can support mobility and enhance social participation for people with mobility disabilities. However, numerous barriers continue to restrict participation in community-based physical activity for people with mobility disabilities. It is critical to address these barriers now. A consensus activity was conducted to identify challenges and solutions to overcome the barriers to physical activity promotion among people with mobility disabilities in Quebec, Canada. Three challenges were identified: (1) better services and communication continuum between research, clinical and community organisations, (2) enhanced knowledge mobilisation between research, clinical and community settings and (3) more education for healthcare professionals and community knowledge users regarding mobility and physical activity. Research priorities should focus on developing, testing and implementing existing interventions and programmes to ensure accessible physical activity and to facilitate participation in community settings for people with mobility disabilities.

IKT Guiding Principles: demonstration of diffusion and dissemination in partnership.

INTRODUCTION: Integrated knowledge translation (IKT) is a partnered approach to research that aims to ensure research findings are applied in practice and policy. IKT can be used during diffusion and dissemination of research findings. However, there is a lack of understanding how an IKT approach can support the diffusion and dissemination of research findings. In this study, we documented and described the processes and outcomes of an IKT approach to diffusing and disseminating the findings of consensus recommendations for conducting spinal cord injury research. METHODS: Communication of the IKT Guiding Principles in two phases: a diffusion phase during the first 102 days from the manuscript's publication, followed by a 1147 day active dissemination phase. A record of all inputs was kept and all activities were tracked by monitoring partnership communication, a partnership tracking survey, a project curriculum vitae, and team emails. Awareness outcomes were tracked through Google Analytics and a citation-forward search. Awareness includes the website accesses, the number of downloads, and the number of citations in the 29 month period following publication. RESULTS: In the diffusion period, the recommendations were viewed 60 times from 4 different countries, and 4 new downloads. In the dissemination period, the recommendations were viewed 1109 times from 39 different countries, 386 new downloads, and 54 citations. Overall, during dissemination there was a 17.5% increase in new visitors to the website a month and a 95.5% increase in downloads compared to diffusion. CONCLUSION: This project provides an overview of an IKT approach to diffusion and dissemination. Overall, IKT may be helpful for increasing awareness of research findings faster; however, more research is needed to understand best practices and the the impact of an IKT approach on the diffusion and dissemination versus a non-partnered approach.

Often, research findings do not get to the people, groups, and/or institutions who could benefit from the findings. Two ways to help move research into practice more efficiently are to: (1) work in partnership with people who may benefit most from the research findings, and (2) share and communicate the findings of research beyond scientists. However, little is known about how to work in partnership while sharing the results of a research study. Therefore, this project demonstrates how a research partnership can work while promoting the results of their research project. Overall, working in partnership while sharing research findings may further help to ensure the research results are shared with those who could benefit from those findings.

Strategies to improve access to physical activity opportunities for people with physical disabilities.

Community-based physical activity opportunities have been shown to help adults with physical disabilities improve their participation in daily activities and reduce social isolation. Despite the known benefits, substantial barriers and challenges inhibit accessibility to these physical activity opportunities. To facilitate the co-construction of strategies to overcome accessibility issues pertaining to community-based physical activity opportunities. In total, 45 individuals with physical disabilities, patients at a rehabilitation hospital, staff members of disability organizations, staff of local or provincial government agencies/departments, kinesiologists, occupational therapists, graduate students, and peer mentors participated in one of four World Cafés held in their respective cities. World Café is a methodology for fostering collaborative, solution-focused conversation that aims to solve problems through collective intelligence. Participants were divided into groups of three to four people and invited to engage in evolving rounds of discussions responding to prompts about accessibility to physical activity in their communities. Transcripts were analyzed using content analysis. In total, 17 strategies were identified, addressing 5 areas: representation and visibility (e.g., prioritize hiring people with a disability), finances (e.g., reduce direct costs for participants), connection and social support (e.g., foster social networks that provide informational support), education and programming (e.g., enhance awareness of existing services and resources), and government programs and policies (e.g., enforce accessibility standards for indoor and outdoor spaces). The findings of this study provide strategies and practical applications for community programs and governments to consider for increasing access to physical activity opportunities for people with physical disabilities.

Adults living with physical disabilities experience numerous benefits (e.g., greater social connection and ability to complete everyday tasks) from participation in community-based physical activities. Despite the known benefits of physical activity for adults with physical disabilities, accessibility to community-based physical activity opportunities remain limited in Canada. The purpose of this study was to facilitate conversations among members of the disability and physical activity communities and co-develop strategies to improve access to community-based physical activity opportunities. In total, 45 participants in 3 Canadian cities were divided into small groups to engage in evolving rounds of discussions responding to access to physical activity in their communities. Altogether, 17 strategies targeting 5 areas related to accessibility were developed. The five areas included representation and visibility (e.g., prioritize hiring people with a disability), finances (e.g., reduce direct costs for participants), connection and social support (e.g., foster social networks that provide informational support), education and programming (e.g., enhance awareness of existing services and resources), and government programs and policies (e.g., enforce accessibility standards for indoor and outdoor spaces). The findings of this study provide practical strategies that community organizations and governments can implement to improve access to community-based physical activity opportunities for people with physical disabilities.

Examining long-term motivational and behavioral outcomes of two physical activity interventions.

OBJECTIVE: To examine possible impacts of two theory-based interventions - "Enhancing quality of life through exercise: A tele-rehabilitation approach (TEQ) and Active Living Lifestyles for individuals with SCI who use Wheelchair (ALLWheel)" - 12-18 months post-intervention on the satisfaction of psychological needs and motivation for leisure-time physical activity (LTPA), LTPA participation, and participation experience. DESIGN: A mixed-methods follow-up study. SETTING: Community. PARTICIPANTS: Sixteen TEQ and six ALLWheel participants completed questionnaires and a semi-structured interview, 12-18 months after completing the interventions. INTERVENTION: TEQ intervention participants received a weekly LTPA counseling session with a trained kinesiologist through videoconferencing for 8 weeks. ALLWheel participants interacted with a peer mentor who provided LTPA counseling using smartphones for 10 weeks. OUTCOME MEASURES: The Psychological Need Satisfaction in Exercise, and the Treatment Self-Regulation Questionnaire were used as primary outcome measures. The LTPA barrier self-efficacy scale, the Measure of Experiential Aspects of Participation, and the 7-day LTPA Questionnaire for Adults with SCI were used as secondary outcome measures. A coding framework was created and deductive thematic analyses were used to analyze the qualitative data. RESULTS: Medium to large effects were found for autonomous motivation (TEQ), competence (TEQ and ALLWheel), and barrier self-efficacy (TEQ and ALLWheel). LTPA remained higher for the TEQ intervention group compared to the control group at follow-up, while an increase in moderate-to-vigorous LTPA was found in ALLWheel participants. CONCLUSION: Community-based tele-rehabilitation and virtual rehabilitation approaches, informed by theory, may assist adults with SCI in implementing LTPA over the long term.

Investigating the peer Mentor-Mentee relationship: characterizing peer mentorship conversations between people with spinal cord injury.

PURPOSE: This study aimed to: (1) develop a coding manual to characterize topics discussed and conversation techniques used during peer mentorship conversations between people with spinal cord injury (SCI); (2) assess the reliability of the manual; and (3) apply the manual to characterize conversations. MATERIALS/METHODS: The study was conducted in partnership with three Canadian provincial SCI organizations. Twenty-five phone conversations between SCI peer mentors and mentees were audio-recorded and transcribed verbatim. Ten transcripts were inductively analyzed to develop a coding manual identifying topics and techniques used during the conversations. Inductive technique codes were combined and deductively linked to motivational interviewing and behaviour change techniques. Two coders independently applied the coding manual to all transcripts. Code frequencies were calculated. RESULTS: The coding manual included 14 topics and 31 techniques. The most frequently coded topics were personal information, recreational programs, and chronic health services for mentors and mentees. The most frequently coded techniques were giving personal information, social smoothers, and closed question for mentors; and giving personal information, social smoothers, and sharing perspective for mentees. CONCLUSION: This research provides insights into topics and techniques used during real-world peer mentorship conversations. Findings may be valuable for understanding and improving SCI peer mentorship programs.Implications for RehabilitationSCI peer mentorship conversations address a wide range of rehabilitation topics ranging from acute care to living in the community.Identification of the topics discussed, and techniques used in SCI peer mentorship conversations can help to inform formalized efforts to train and educate acute and community-based rehabilitation professionals.Identifying commonly discussed topics in SCI peer mentorship conversation may help to ensure that peer mentors are equipped with the necessary knowledge and resources, or the development of those resources be prioritized.Developing a method to characterize the topics discussed and techniques used during SCI peer mentorship conversations may aid in designing methods to evaluate how rehabilitation professionals provide support to people with SCI.

Couples' experiences with sexuality after spinal cord injury.

PURPOSE: To explore sexuality after spinal cord injury (SCI) from the perspectives of individuals with SCI and their romantic partners. METHODS: A sample of 8 Canadian adults with SCI (6 men, 2 women) and their partners participated in this study (N = 16). Semi-structured dyadic and individual interviews were conducted, discussions surrounding sexuality and intimacy were extracted, and a qualitative description of the interview data was performed using thematic analysis. RESULTS: Three major themes were identified: the changing definition of sex; emotions; and practical support. Couples' conversations around the changing definition of sex after SCI addressed the taboo topic of sexuality and the importance of communication between couples, peers, and healthcare providers. Emotions included fears of losing intimacy, embarrassment in managing bladder and bowel interference, and acceptance in balancing being a romantic partner and a caregiver. Finally, couples reported challenges accessing practical support including medical interventions and sexual health nurses, but saw value in peer mentorship programs. CONCLUSION: Couples explored a changing definition of sex following SCI that was complicated by the taboo nature of discussing sexuality, experienced a range of emotions throughout the recovery process, and had difficulties navigating the healthcare system for appropriate support.IMPLICATIONS FOR REHABILITATIONHealthcare professionals should promote discussion and provide support for sexuality following SCI, but during initial rehabilitation may be too early.Healthcare providers should prepare people with SCI and their partners for the inevitable trial-and-error process involved in sexual rehabilitation.Rehabilitation professionals could direct couples to SCI peer mentorship programs to help normalize the experiences and emotions of sexual rehabilitation.

Expert consensus for a digital peer-led approach to improving physical activity among individuals with spinal cord injury who use manual wheelchairs.

CONTEXT: Active Living Lifestyles for manual wheelchair users (ALLWheel) uses a digital peer-led approach to incorporate two behavior change theories to address a critical need for leisure-time physical activity (LTPA) programs for individuals with spinal cord injury (iSCI). OBJECTIVE: The objective of this study was to obtain expert opinion and consensus for the ALLWheel program. DESIGN: Mixed-methods (qualitative and quantitative) were used to gather expert opinion and consensus for the ALLWheel program using an action research approach. SETTING: Rehabilitation center. PARTICIPANTS: Experts in SCI and LTPA included iSCI who used manual wheelchairs, healthcare professionals, and community collaborators. PROCEDURES: Two, 90-minute focus groups were conducted and transcribed verbatim, analyzed thematically, and the results were used to create a Delphi survey. Delphi surveys were completed online using consecutive rounds until ≥70% consensus per item was attained. Cumulative percent concordances were calculated to determine consensus. RESULTS: Twelve experts in SCI and LTPA participated in focus groups. Four themes were generated: Need for LTPA programs; Important considerations; Perceptions about peer-coaches; and Feelings about smartphones, which were used to generate the Delphi survey. Consensus on the ALLWheel program was attained in two rounds. CONCLUSIONS: Experts established a need for fun and personalized community-based LTPA programs. Ensuring that healthcare professionals would be involved in the ALLWheel program alleviated safety concerns, and experts agreed there were benefits of peers delivering the program. Experts agreed that the ALLWheel program targeted important psychological factors (i.e. autonomy, relatedness, self-efficacy, and motivation) and affirmed the potential for a potentially large geographic reach.

Participatory co-creation of an adapted physical activity program for adults with moderate-to-severe traumatic brain injury.

Background: Research about using physical activity (PA) to improve health, quality of life, and participation after moderate-to-severe traumatic brain injury (TBI) is receiving growing attention. However, best-practices for maintaining PA participation after TBI have yet to be defined. In this context, a team of researchers and stakeholders with a moderate-to-severe TBI (including program participants and peer mentors) participated in a co-creation process to optimize a 9-month, 3-phased, community-based, adapted PA program named TBI-Health. Purpose: The study aimed to provide a detailed account of the participation in and co-creation of a new TBI-Health Program to enhance sport and exercise participation for adults with moderate-to-severe TBI. Specifically, we carried out an in-depth exploration of the perceived experiences and outcomes of users over one cycle of the program to assist the co-creation process. Methods: An interpretive case study approach was used to explore the experiences and outcomes of the participatory co-creation within and across phases of the TBI-Health program. A purposeful sample of fourteen adults with moderate-to-severe TBI (program participants n = 10; peer mentors n = 4) were involved in audio-recorded focus groups after each program phase. Reflexive thematic analyses within and across the phases identified three higher-order themes. Results: Program Participation included barriers, facilitators, sources of motivation and suggested modifications to optimize the program; Biopsychosocial Changes highlighted perceived physical, psychological, and social outcomes, by self and others, that resulted from program participation; PA Autonomy emphasized transitions in knowledge, sex- and gender-related beliefs, and abilities related to exercise and sport participation. Conclusions: Study findings suggest the TBI-Health program can increase autonomy for and reduce barriers to PA for adults with moderate-to-severe TBI, which results in increased PA participation and important physical, psychological, and social benefits. More research is needed about the TBI-Health program with larger samples.

Lessons Learned From Clinicians and Stroke Survivors About Using Telerehabilitation Combined With Exergames: Multiple Case Study.

BACKGROUND: In Canada, stroke survivors have difficulty accessing community-based rehabilitation services because of a lack of resources. VirTele, a personalized remote rehabilitation program combining virtual reality exergames and telerehabilitation, was developed to provide stroke survivors an opportunity to pursue rehabilitation of their chronic upper extremity (UE) deficits at home while receiving ongoing follow-up from a clinician. OBJECTIVE: We aimed to identify the behavioral and motivational techniques used by clinicians during the VirTele intervention, explore the indicators of empowerment among stroke survivors, and investigate the determinants of VirTele use among stroke survivors and clinicians. METHODS: This multiple case study involved 3 stroke survivors with chronic UE deficits and their respective clinicians (physiotherapists) who participated in the VirTele intervention, a 2-month remote rehabilitation intervention that uses nonimmersive virtual reality exergames and telerehabilitation aimed at improving UE deficits in stroke survivors. Study participants had autonomous access to Jintronix exergames and were asked to use them for 30 minutes, 5 times a week. The VirTele intervention included 1-hour videoconference sessions with a clinician 1 to 3 times a week, during which the clinician engaged in motivational interviewing, supervised the stroke survivors' use of the exergames, and monitored their use of the affected UE through activities of daily living. Semidirected interviews were conducted with the clinicians and stroke survivors 4 to 5 weeks after the end of the VirTele intervention. All interviews were audiorecorded and transcribed verbatim. An abductive thematic analysis was conducted to generate new ideas through a dynamic interaction between data and theory. RESULTS: Three stroke survivors (n=2, 67%, women and n=1, 33%, man), with a mean age of 58.8 (SD 19.4) years, and 2 physiotherapists participated in the study. Five major determinants of VirTele use emerged from the qualitative analyses, namely technology performance (usefulness and perception of exergames), effort (ease of use), family support (encouragement), facilitators (considerations of the stroke survivors' safety as well as trust and understanding of instructions), and challenges (miscommunication and exergame limits). During the VirTele intervention, both clinicians used motivational and behavioral techniques to support autonomy, competence, and connectivity. All these attributes were reflected as empowerment indicators in the stroke survivors. Lessons learned from using telerehabilitation combined with exergames are provided, which will be relevant to other researchers and contexts. CONCLUSIONS: This multiple case study provides a first glimpse into the impact that motivational interviewing can have on adherence to exergames and changes in behavior in the use of the affected UE in stroke survivors. Lessons learned regarding the supportive role caregivers play and the new responsibilities clinicians have when using the VirTele intervention may inform the use of exergames via telerehabilitation. These lessons will also serve as a model to guide the implementation of similar interventions. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/14629.

Rehabilitation of Upper Extremity by Telerehabilitation Combined With Exergames in Survivors of Chronic Stroke: Preliminary Findings From a Feasibility Clinical Trial.

BACKGROUND: Exergames are increasingly being used among survivors of stroke with chronic upper extremity (UE) sequelae to continue exercising at home after discharge and maintain activity levels. The use of virtual reality exergames combined with a telerehabilitation app (VirTele) may be an interesting alternative to rehabilitate the UE sequelae in survivors of chronic stroke while allowing for ongoing monitoring with a clinician. OBJECTIVE: This study aimed to determine the feasibility of using VirTele in survivors of chronic stroke at home and explore the impact of VirTele on UE motor function, quantity and quality of use, quality of life, and motivation in survivors of chronic stroke compared with conventional therapy. METHODS: This study was a 2-arm feasibility clinical trial. Eligible participants were randomly allocated to an experimental group (receiving VirTele for 8 weeks) or a control group (receiving conventional therapy for 8 weeks). Feasibility was measured from the exergame and intervention logs completed by the clinician. Outcome measurements included the Fugl-Meyer Assessment-UE, Motor Activity Log-30, Stroke Impact Scale-16, and Treatment Self-Regulation Questionnaire-15, which were administered to both groups at four time points: time point 1 (T1; before starting the intervention), time point 2 (after the intervention), time point 3 (1 month after the intervention), and time point 4 (T4; 2 months after the intervention). RESULTS: A total of 11 survivors of stroke were randomized and allocated to an experimental or a control group. At the onset of the COVID-19 pandemic, participants pursued the allocated treatment for 3 months instead of 8 weeks. VirTele intervention dose was captured in terms of time spent on exergames, frequency of use of exergames, total number of successful repetitions, and frequency of videoconference sessions. Technical issues included the loss of passwords, internet issues, updates of the system, and problems with the avatar. Overall, most survivors of stroke found the technology easy to use and useful, except for 9% (1/11) of participants. For the Fugl-Meyer Assessment-UE and Motor Activity Log-30, both groups exhibited an improvement in >50% of the participants, which was maintained over time (from time point 3 to T4). Regarding Stroke Impact Scale-16 scores, the control group reported improvement in activities of daily life (3/5, 60%), hand function (5/5, 100%), and mobility (2/5, 40%), whereas the experimental group reported varied and inconclusive results (from T1 to T4). For the Treatment Self-Regulation Questionnaire-15, 75% (3/4) of the experimental group demonstrated an increase in the autonomous motivation score (from T1 to time point 2), whereas, in the control group, this improvement was observed in only 9% (1/11) of participants. CONCLUSIONS: The VirTele intervention constitutes another therapeutic alternative, in addition to conventional therapy, to deliver an intense personalized rehabilitation program for survivors of chronic stroke with UE sequelae. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/14629.

Intensity matters: protocol for a randomized controlled trial exercise intervention for individuals with chronic stroke.

RATIONALE: Cardiovascular exercise is an effective method to improve cardiovascular health outcomes, but also promote neuroplasticity during stroke recovery. Moderate-intensity continuous cardiovascular training (MICT) is an integral part of stroke rehabilitation, yet it may remain a challenge to exercise at sufficiently high intensities to produce beneficial adaptations to neuroplasticity. High-intensity interval training (HIIT) could provide a viable alternative to achieve higher intensities of exercise by using shorter bouts of intense exercise interspersed with periods of recovery. METHODS AND DESIGN: This is a two-arm, parallel-group multi-site RCT conducted at the Jewish Rehabilitation Hospital (Laval, Québec, Canada) and McMaster University (Hamilton, Ontario, Canada). Eighty participants with chronic stroke will be recruited at both sites and will be randomly allocated into a HIIT or MICT individualized exercise program on a recumbent stepper, 3 days per week for 12 weeks. Outcomes will be assessed at baseline, at 12 weeks post-intervention, and at an 8-week follow-up. OUTCOMES: The primary outcome is corticospinal excitability, a neuroplasticity marker in brain motor networks, assessed with transcranial magnetic stimulation (TMS). We will also examine additional markers of neuroplasticity, measures of cardiovascular health, motor function, and psychosocial responses to training. DISCUSSION: This trial will contribute novel insights into the effectiveness of HIIT to promote neuroplasticity in individuals with chronic stroke. TRIAL REGISTRATION: ClinicalTrials.gov NCT03614585 . Registered on 3 August 2018.

Exploring the Relationship Between Quality and Quantity of Physical Activity Participation in Community-Based Exercise Programs for Persons With Physical Disabilities.

Community-based exercise programs for persons with disabilities promote greater quantity of leisure-time physical activity (LTPA) participation among their members, perhaps because of the quality experiences fostered by the program. This study aimed to explore the relationship between quality and quantity of physical activity participation in the context of community-based exercise programming and the role that gender plays in this relationship. Adults with physical disabilities (N = 91; Mage = 55, 49 men) from three community-based exercise programs across Canada completed a survey asking about quality participation (Measure of Experiential Aspects of Participation [MeEAP]) and LTPA. Structural equation modeling was used to examine the relationship between MeEAP scores and LTPA. Quality participation was not related to LTPA, even with gender included as a moderator. Men reported higher levels of LTPA and quality participation than women, highlighting gender differences that should be considered when researching and designing exercise programs for individuals with disabilities.

Identifying the outcomes of participating in peer mentorship for adults living with spinal cord injury: a qualitative meta-synthesis.

OBJECTIVE: Peer mentorship is a flagship program utilized by Canadian community-based spinal cord injury (SCI) organizations. Through connecting trained SCI peer mentors with fellow adults with SCI, these programs help adults adapt and thrive following their injury. The objective of this meta-synthesis was to work with SCI community organizations and to identify outcomes of participating in community- or rehabilitation-based peer mentorship programs using an integrated knowledge translation approach. DESIGN: A meta-synthesis of 21 qualitative peer-reviewed studies and 66 community documents was conducted. MAIN OUTCOME MEASURES: A total of 87 outcomes of peer mentorship were identified. RESULTS: The outcomes of peer mentorship were grouped according to six higher-order themes: 1) Independence: enhanced self-sufficiency; 2) Personal growth: positive psychological changes; 3) Activities and participation: greater participation in activities and events; 4) Adaptation: adapting to life with disability; 5) Knowledge: obtaining new information, resources, and opportunities; and 6) Connection: developing and maintaining social relationship. CONCLUSION: The positive nature of the identified outcomes suggests that participating in peer mentorship can promote improved health and quality of life for adults with SCI. Furthermore, the integrated knowledge translation approach helped identify outcomes that were previously not examined within SCI peer mentorship research, thus providing important insight for future research.

Exploring Proximal LGBTQ+ Minority Stressors Within Physical Activity Contexts from a Self-determination Theory Perspective.

BACKGROUND: LGBTQ+ (lesbian, gay, bisexual, transgender, queer, etc.) individuals experience challenges such as discrimination and marginalization (referred to as minority stressors) that are detrimental to their mental and physical health. Specifically, proximal or internalized LGBTQ+ minority stressors may influence motivation for and willingness to participate in physical activity. PURPOSE: To explore whether proximal LGBTQ+ minority stressors relate to the basic psychological needs-motivation-physical activity pathway, as per self-determination theory. METHODS: An online cross-sectional survey was completed by 778 self-identified LGBTQ+ adults. Structural equation modelling analyses were used to examine how proximal LGBTQ+ minority stressors relate to the motivational sequence. RESULTS: Findings support that proximal LGBTQ+ minority stressors are negatively associated with psychological need satisfaction within physical activity (ß = -.36), which in turn is positively associated with autonomous motivation (ß = .53) and reported physical activity participation (ß = .32). Overall, the final model accounted for 13% of variance in need satisfaction (small effect size), 53% of variance in autonomous motivation (moderate-large effect size), and 10% of variance in moderate-to-vigorous physical activity levels (small effect size). CONCLUSIONS: Future research focused on increasing LGBTQ+ participation in physical activity should investigate the effects of (a) reducing proximal LGBTQ+ minority stressors and (b) better supporting LGBTQ+ adults' autonomy, competence, and relatedness within physical activity contexts.

An exploration of the roles and experiences of SCI peer mentors using creative non-fiction.

PURPOSE: Spinal cord injury (SCI) peer mentors are individuals who, through their lived experiences, offer emotional support and empathetic understanding to others living with SCI to foster positive health, independence, and well-being. This study explored SCI peer mentors' perceptions of their roles and experiences. MATERIALS AND METHODS: Six paid or volunteer peer mentors participated in semi-structured interviews. We first explored the data using thematic narrative analysis to identify patterns, themes, and narrative types. Next, we analyzed the narrative types using creative analytical practices to construct and refine the stories. RESULTS: Based on our analysis, we developed two stories from a storyteller perspective to present a snapshot of SCI peer mentors' experiences. The first story focuses on a "discovery" narrative from the point of view of Casey who adopted a person-centered approach to mentoring, focusing their attention on the needs of the mentee. The second story focuses on Taylor's experiences with the "dark" side of peer mentorship, which focuses on the psychological toll of being a SCI peer mentor, from discussions about suicidal thoughts with clients to struggling with burnout. CONCLUSIONS: Results provided insights for support services regarding the importance of supporting the mental health of mentors to ensure they continue delivering high quality mentorship.Implications for rehabilitationPeer mentors need to be educated on the significance of their role in the rehabilitation process and how their interpersonal behaviours can influence their mentees, both positively and negatively.Peer mentors should receive formalized and accessible training to ensure they are equipped with effective mentoring skills, but also providing them with tools to cope with physical, mental, and emotional stressors they may encounter as mentors.There is a need to continue diversifying and improving the types of services provided to SCI peer mentors in addition to one-on-one counselling, such as interactive educational workshops, for peer mentors to learn and practice coping skills, including mindfulness, meditation, and action-planning.As with other paid employees, SCI peer mentors should be trained to recognize when they are feeling depleted and be supported in seeking appropriate care from a health professional to provide quality psychosocial services to others.