Reach, Adoption, and Implementation Strategies of a Telehealth Fall Prevention Program: Perspectives From Francophone Communities Across Canada.

Introduction. A fall may impact a person's physical, emotional, and psychological well-being. Fall prevention programs are being implemented to reduce these negative outcomes. However, linguistic barriers in health services may reduce access to such prevention programs. A telehealth fall prevention program was designed to increase access to such programs in French for Francophone minority communities in Canada. This capacity-building project aimed to support community partners to deliver this telehealth program and document strategies used to reach, adopt, and implement the program within various Francophone and Acadian Minority Communities. Methods. A sequential explanatory mixed methodology was used to document reach, adoption, and implementation strategies and describe the lived experiences of program facilitators and organization representatives. Reach, adoption, and implementation were documented and analyzed descriptively, while lived experiences were analyzed using content analysis following the Consortium Framework for Implementation Research. Results. Twelve organization representatives or program facilitators from eight organizations operating in four different provinces participated in the study. Three themes emerged from the qualitative data on reach and adoption: external context, internal context, and capacity building. Four themes were identified as barriers and facilitators to implementation: level of preparation and time management, interpersonal relations and telepresence, exercise facilitation and safety, and technological problem-solving. Conclusion. Using tailored reach and adoption strategies such as prioritizing provinces with higher proportions of needs and training local community program facilitators may lead to the successful implementation of a new telehealth fall prevention program. Results from this study could potentially inform other primary prevention programs or telehealth program implementation.

What is the diagnostic accuracy of red flags related to cauda equina syndrome (CES), when compared to Magnetic Resonance Imaging (MRI)? A systematic review.

OBJECTIVE: To review and statistically pool available evidence on the diagnostic accuracy of red flags to clinically identify MRI confirmed Cauda Equina Syndrome (CES). STUDY DESIGN: Systematic review. DATA SOURCES: Embase, Scopus, Ovid Medline, Ovid Healthstar, Amed and CINAHL from inception to January 30, 2018 and a grey literature search. INCLUSION CRITERIA: Primary diagnostic studies, published in English; comparing red flags for CES; to Magnetic Resonance Imaging (MRI) as reference standard; in humans; older than 18 years. METHODS: Data extraction, assessment of study quality using a modified QUADAS-2 tool and the use of GRADE to synthesize the results for each test was performed by three independent assessors. Diagnostic accuracy statistics applied to the identified data andpooled analysis performed using Meta-DiSc, version 1.4. Moderator analyses planned for pooled results. RESULTS: Seven studies (total N = 569 participants) were included. Potential signs or symptoms of CES were compared to MRI findings. Diagnostic data could be pooled for reduced anal tone, leg pain, back pain, saddle anaesthesia, urinary retention, urinary incontinence and bowel incontinence from six of seven studies. The pooled sensitivity for the signs and symptoms ranged from 0.19 (95% CI 0.09 to 0.33) to 0.43 (95% CI 0.30 to 0.56) while the pooled specificity ranged from 0.62 (95% CI 0.59 to 0.73) to 0.88 (95% CI 0.85 to 0.92). CONCLUSION: Red flags used to identify potential CES appear to be more specific than sensitive. As such, when these are present, they should be considered justification for prompt diagnostic workup.