Recommendations for Canada's National Action Plan to End Gender-Based Violence: perspectives from leaders, service providers and survivors in Canada's largest city during the COVID-19 pandemic. / Recommandations pour le Plan d'action national pour mettre fin à la violence fondée sur le genre : points de vue de dirigeants, de fournisseurs de services et de survivantes dans la plus grande ville du Canada pendant la pandémie de COVID-19.

INTRODUCTION: The Canadian government has committed to a national action plan (NAP) to address violence against women (VAW). However, a formalized plan for implementation has not been published. Building on existing recommendations and consultations, we conducted the first formal and peer-reviewed qualitative analysis of the perspectives of leaders, service providers and survivors on what should be considered in Canada's NAP on VAW. METHODS: We applied thematic analysis to qualitative data from 18 staff working on VAW services (11 direct support, 7 in leadership roles) and 10 VAW survivor participants of a community-based study on VAW programming during the COVID-19 pandemic in the Greater Toronto Area (Ontario, Canada). RESULTS: We generated 12 recommendations for Canada's NAP on VAW, which we organized into four thematic areas: (1) invest into VAW services and crisis supports (e.g. strengthen referral mechanisms to VAW programming); (2) enhance structural supports (e.g. invest in the full housing continuum for VAW survivors); (3) develop coordinated systems (e.g. strengthen collaboration between health and VAW systems); and (4) implement and evaluate primary prevention strategies (e.g. conduct a gender-based and intersectional analysis of existing social and public policies). CONCLUSION: In this study, we developed, prioritized and nuanced recommendations for Canada's proposed NAP on VAW based on a rigorous analysis of the perspectives of VAW survivors and staff in Canada's largest city during the COVID-19 pandemic. An effective NAP will require investment in direct support organizations; equitable housing and other structural supports; strategic coordination of health, justice and social care systems; and primary prevention strategies, including gender transformative policy reform.

Longitudinal mixed methods study assessing caregivers of seniors across diverse populations: research protocol.

BACKGROUND: Canada's aging population is increasing, along with the number of caregivers providing support to seniors. Caregiving is a taxing responsibility that often results in loneliness and distress. Creating awareness of available supports for caregivers is essential for their health and to provide the best support to the care recipients. This study aims to better understand and improve the caregiving experience for caregivers from diverse ethnic communities and the LGBTQI2S+ communities. The goal is to improve the well-being and resilience of caregivers and optimize outcomes for care recipients by delivering educational workshops that resemble the design of existing workshops currently offered by the participating social service agency. Content will be adapted based on identified participant learning needs. These workshops will be offered to the English-speaking community, diverse newcomer ethnic groups and the LGBTQI2S+ community. METHODS: This mixed-methods, longitudinal study includes two streams of caregivers; Stream One consists of English-speaking caregivers and care recipients while Stream Two includes individuals from the Afghan, Iranian, Somali-, Tamil- and Spanish-speaking populations and those belonging to LGBTQI2S+ communities. Each stream has two phases; Phase One includes needs assessments using focus groups and semi-structured interviews with caregivers and care recipients while Phase Two includes a pre-test post-test evaluation of educational workshops. The anticipated sample size for Phase One is 30 caregivers from the English-speaking community, 150 from the five linguistic/cultural communities combined and 30 from the LGBTQI2S+ group. For Phase Two, we plan to recruit 250 caregivers from the English-speaking community, 250 from the five linguistic/cultural communities, and 50 from the LGBTQI2S+ group. DISCUSSION: To provide caregivers with optimal support, we must acknowledge the caregivers and care recipients from diverse communities. Currently, at least two focus groups have been conducted with caregivers from each of the seven targeted groups and workshops have begun for all communities. Recruitment has been a challenge for all groups, but our team continues to conduct outreach with caregivers and will use our learning to inform the delivery of educational caregiver workshops.

Facilitators of and Barriers to Providing Access to Community-Based Exercise Programmes for Adults with Post-Stroke Aphasia from the Perspective of Programme Representatives.

Purpose: Individuals with post-stroke aphasia (PSA) engage in inadequate levels of physical activity (PA), hindering physical and psychosocial recovery. The purpose of this study was to identify the extent to which community-based exercise programmes (CBEPs) in the Greater Toronto Area (GTA) are accessible to adults living with PSA and the characteristics of such programmes from the perspective of CBEP representatives. Methods: A cross-sectional, Web-based survey was administered to representatives of CBEPs open to adults post-stroke in the GTA to identify the CBEPs' relevant characteristics and perceived facilitators of and barriers to accessibility. Results: A total of 17 eligible CBEP representatives completed the survey, for a response rate of 32%. The most commonly used exercise instructors were personal trainers (8; 47%). Of the 17 eligible CBEP representatives, 10 (59%) identified a lack of qualified personnel as the main barrier to providing access to adults with PSA. Verbal strategies were among the most commonly used methods of communication with adults with PSA (16; 94%), and written material was the least used (5; 29%). Conclusion: Understanding the common facilitators of and barriers to providing adults with PSA access to CBEPs will assist programme developers to improve the accessibility of CBEPs and facilitate PA in this population.

Objectif : les personnes souffrant d'aphasie après un accident vasculaire cérébral (AAVC) ne font pas assez d'activité physique (AP), ce qui nuit à leur rétablissement physique et psychosocial. La présente étude visait à déterminer l'accessibilité des programmes d'exercices communautaires (PEC) du Grand Toronto (GT) pour les adultes atteints d'un AAVC, ainsi que les caractéristiques de ces programmes selon des représentants de PEC. Méthodologie : les représentants des PEC ouverts aux adultes après un AVC du GT ont reçu un sondage transversal en ligne pour connaître les caractéristiques des PEC ainsi que les incitatifs et les obstacles perçus à l'accessibilité. Résultats : au total, 17 représentants des PEC admissibles ont rempli le sondage, ce qui constitue un taux de réponse de 32 %. Les moniteurs d'exercices les plus sollicités étaient des entraîneurs personnels (8, 47 %). Parmi les 17 représentants des PEC admissibles, dix (59 %) soulignaient la pénurie de personnel qualifié comme le principal obstacle à l'accès pour les adultes atteints d'AAVC. Les stratégies verbales étaient les modes de communication les plus utilisés auprès des adultes atteints d'AAVC (16, 94 %), et les documents écrits étaient les moins utilisés (5, 29 %). Conclusion : s'ils comprennent les incitatifs et les obstacles courants à l'accès aux PEC pour les adultes atteints d'AAVC, les développeurs de programmes seront mieux en mesure d'améliorer l'accessibilité des PEC et de favoriser l'AP au sein de cette population.

The impact of a community re-engagement cue to action trigger tool on re-engaging in activities post-stroke: a mixed-methods study.

OBJECTIVES: This study evaluated the guided use of the Community Re-engagement Cue to Action Trigger Tool (CRCATT), a patient-mediated question prompt list, and its impact on self-reported re-engagement in activities post-stroke. METHODS: A multi-site, single-blind randomized controlled study in which 77 persons with stroke participated from three rehab organizations in Toronto, Canada. Of the 77 participants, a total 57 within the two groups completed the study and Reintegration to Normal Living Index (mailed response questionnaire) and a sub-set of all participants participated in qualitative interviews. Data collection occurred 3-4 months after enrollment. Quantitative responses were analyzed in SPSS (Chicago, IL, USA) for descriptive frequencies and differences between groups. Qualitative responses were analyzed using an inductive approach with thematic analytic procedures. RESULTS: No between group differences were observed due to small sample size. A multi-variable regression model including age, gender, level of education, treatment group, and language, suggests those with higher education are more likely to participate in activities. Interview analysis revealed participants' ability to recover and re-engage is influenced by an interplay of the CRCATT with external factors. These factors include social support, interactions with providers, and ability to access information. CONCLUSION: The CRCATT was perceived as a useful tool as it assisted persons with stroke to take a more self-directed role in their care by asking relevant questions and anticipating their needs. The tool complemented the external factors that persons with stroke draw on to support recovery and participate in activities post-stroke.

A feasibility and pilot randomized controlled trial of the "Timing it Right Stroke Family Support Program".

OBJECTIVE: Examine feasibility of conducting a randomized controlled trial of the Timing it Right Stroke Family Support Program (TIRSFSP) and collect pilot data. DESIGN: Multi-site mixed method randomized controlled trial. SETTING: Acute and community care in three Canadian cities. SUBJECTS: Caregivers were family members or friends providing care to individuals who experienced their first stroke. INTERVENTION: The TIRSFSP offered in two formats, self-directed by the caregiver or stroke support person-directed over time, were compared to standard care. MAIN MEASURES: Caregivers completed baseline and follow-up measures 1, 3 and 6 months post-stroke including Centre for Epidemiological Studies Depression, Positive Affect, Social Support, and Mastery Scales. We completed in-depth qualitative interviews with caregivers and maintained intervention records describing support provided to each caregiver. RESULTS: Thirty-one caregivers received standard care (n=10), self-directed (n=10), or stroke support person-directed (n=11) interventions. We retained 77% of the sample through 6-months. Key areas of support derived from intervention records (n=11) related to caregiver wellbeing, caregiving strategies, patient wellbeing, community re-integration, and service delivery. Compared to standard care, caregivers receiving the stroke support person-directed intervention reported improvements in perceived support (estimate 3.1, P=.04) and mastery (estimate .35, P=.06). Qualitative caregiver interviews (n=19) reflected the complex interaction between caregiver needs, preferences and available options when reporting on level of satisfaction. CONCLUSIONS: Preliminary findings suggest the research design is feasible, caregivers' needs are complex, and the support intervention may enhance caregivers' perceived support and mastery. The intervention will be tested further in a large scale trial.

Getting on with the rest of your life following stroke: a randomized trial of a complex intervention aimed at enhancing life participation post stroke.

OBJECTIVE: To enhance participation post stroke through a structured, community-based program. DESIGN: A controlled trial with random allocation to immediate or four-month delayed entry. SETTING: Eleven community sites in seven Canadian cities. SUBJECTS: Community dwelling persons within five years of stroke onset, cognitively intact, able to toilet independently. INTERVENTIONS: Evidence-based program delivered in three 12-week sessions including exercise and project-based activities, done as individuals and in groups. MAIN MEASURES: Hours spent per week in meaningful activities outside of the home and Reintegration to Normal Living Index; Stroke-Specific Geriatric Depression Scale, Apathy Scale, gait speed, EuroQuol EQ-5D, and Preference-Based Stroke Index. All measures were transformed to a scale from 0 to 100. Assessments prior to randomization, after the first session at three months, six months, 12 months, and 15 months. RESULTS: A total of 186 persons were randomized. The between-group analysis showed no disadvantage to waiting and so groups were combined and a within-person analysis was carried out at three time points. There were statistically significant increases in all study outcomes on average over all persons. Over 45% of people met or exceeded the pre-specified target of a three hour per week increase in meaningful activity and this most often took a full year of intervention to achieve. Greatest gains were in satisfaction with community integration (mean 4.78; 95% CI: 2.01 to 7.55) and stroke-specific health-related quality of life (mean 4.14; 95% CI: 2.31 to 5.97). CONCLUSIONS: Community-based programs targeting participation are feasible and effective, but stroke survivors require time to achieve meaningful gains.

Randomized clinical trial of the Timing it Right Stroke Family Support Program: research protocol.

BACKGROUND: Family caregivers provide invaluable support to stroke survivors during their recovery, rehabilitation, and community re-integration. Unfortunately, it is not standard clinical practice to prepare and support caregivers in this role and, as a result, many experience stress and poor health that can compromise stroke survivor recovery and threaten the sustainability of keeping the stroke survivor at home. We developed the Timing it Right Stroke Family Support Program (TIRSFSP) to guide the timing of delivering specific types of education and support to meet caregivers' evolving needs. The objective of this multi-site randomized controlled trial is to determine if delivering the TIRSFSP across the stroke care continuum improves caregivers' sense of being supported and emotional well-being. METHODS/DESIGN: Our multi-site single-blinded randomized controlled trial will recruit 300 family caregivers of stroke survivors from urban and rural acute care hospitals. After completing a baseline assessment, participants will be randomly allocated to one of three groups: 1) TIRSFSP guided by a stroke support person (health care professional with stroke care experience), delivered in-person during acute care and by telephone for approximately the first six to 12 months post-stroke, 2) caregiver self-directed TIRSFSP with an initial introduction to the program by a stroke support person, or 3) standard care receiving the educational resource "Let's Talk about Stroke" prepared by the Heart and Stroke Foundation. Participants will complete three follow-up quantitative assessments 3, 6, and 12-months post-stroke. These include assessments of depression, social support, psychological well-being, stroke knowledge, mastery (sense of control over life), caregiving assistance provided, caregiving impact on everyday life, and indicators of stroke severity and disability. Qualitative methods will also be used to obtain information about caregivers' experiences with the education and support received and the impact on caregivers' perception of being supported and emotional well-being. DISCUSSION: This research will determine if the TIRSFSP benefits family caregivers by improving their perception of being supported and emotional well-being. If proven effective, it could be recommended as a model of stroke family education and support that meets the Canadian Stroke Best Practice Guideline recommendation for providing timely education and support to families through transitions. TRIAL REGISTRATION: ClinicalTrials.gov: NCT00958607.

The assessment for living with aphasia: reliability and construct validity.

The Assessment for Living with Aphasia (ALA) is a pictographic, self-report measure of aphasia-related quality-of-life. Research was undertaken to assess test-re-test reliability, construct validity, and the ability to discriminate aphasia severity. The ALA was administered to 101 participants with aphasia on two occasions. Test-re-test reliability was evaluated using intra-class correlations and internal consistency using Cronbach's alpha. Three reference measures were administered to assess construct validity. A focus group reported on ease of administration and face validity. Analysis identified 15 out of 52 rated items for elimination. For the remaining items, test-re-test reliability was excellent for the total score (ICC = .86) and moderate-to-strong for a priori domains adapted from the WHO ICF (.68-.83). Internal consistency was acceptable-to-high. Significant correlations were observed between the ALA and reference tests (SAQOL-39, .72; p < .001; VASES, .62, p = .03; BOSS CAPD, -.69; p = .008). The language impairment domain discriminated between all aphasia severity groups, while mild aphasia was different from moderate and severe aphasia in participation and total scores. The ALA was reportedly easy to administer and captured key aspects of the experience of living with aphasia. Results suggest acceptable test-re-test reliability, internal consistency and construct validity of the ALA.

Implementation of Mental Health Huddles on Dementia Care Units.

Client-responsive behaviours occur commonly among residents in long-term care (LTC) settings; direct-care staff, however, receive little education, support, or opportunities to discuss and collaborate on managing such behaviours. Our participatory action project introduced mental health huddles to support staff in discussing and managing client-responsive behaviours in long-term care. This research project engaged direct-care staff (e.g., personal support workers, registered practical nurses, housekeeping staff, and registered nurses) in learning how to use these huddles. Staff workers used huddles as a forum to stay informed, review work, problem solve, and develop person-centered action plans. Fifty-six huddles occurred over a 12-week period; two to seven direct-care staff participated in each huddle. Focus groups indicated improved staff collaboration, teamwork, support, and communication when discussing specific responsive behaviours. Huddles provided LTC staff with the opportunity to collaborate and discuss strategies to optimize resident care. Further research on how huddles affect resident care outcomes is needed.

Barriers to and Facilitators of Access and Participation in Community-Based Exercise Programmes from the Perspective of Adults with Post-stroke Aphasia.

PURPOSE: To explore communication-related experiences with accessing and participating in community-based exercise programmes from the perspective of adults with post-stroke aphasia. METHODS: Adults with mild to severe post-stroke aphasia were recruited from the Aphasia Institute (AI), Toronto, Canada, for a qualitative descriptive study using semi-structured, in-depth one-on-one interviews. Participants were asked to identify facilitators of, barriers to, and strategies for joining and participating in exercise programmes. Interview data were analyzed using conventional content analysis. RESULTS: Ten adults with mild (40%), moderate (40%), or severe (20%) aphasia participated in this study. The majority of participants were men (60%) aged 60-69 years (40%). Participants experienced a combination of communication, environmental, and personal facilitators of and barriers to accessing and participating in community-based exercise programmes. Strategies to enhance participation can be applied at both programme and individual levels. CONCLUSIONS: Findings may inform clinical practice and programming to optimize access to and participation in community-based exercise programmes for adults with post-stroke aphasia.

Objet : Explorer les expériences de communication liées à l'accès et à la participation à des programmes d'exercices communautaires vécues par des adultes atteints d'aphasie à la suite d'un accident vasculaire cérébral (AVC). Méthodes : Une étude descriptive qualitative a été menée au moyen d'entrevues individuelles approfondies semi-structurées. Des adultes atteints d'aphasie légère à grave à la suite d'un AVC ont été recrutés au sein de l'Aphasia Institute de Toronto, au Canada. On a demandé aux participants d'indiquer les éléments facilitant leur inscription et leur participation à des programmes d'exercices, de même que les obstacles et les stratégies habilitantes. On a eu recours à l'analyse de contenu traditionnelle. Résultats : Dix adultes atteints d'aphasie légère (40 %), modérée (40 %) ou grave (20 %) ont participé à l'étude. La majorité des participants étaient des hommes (60 %) âgés de 60 à 69 ans (40 %). Les participants ont fait l'expérience d'un ensemble d'éléments facilitant la communication, de facilitateurs environnementaux et personnels, et d'obstacles à l'accès et à la participation aux programmes d'exercices communautaires. Les stratégies visant à améliorer la participation sont autant applicables aux programmes qu'aux personnes. Conclusions : Les constatations peuvent éclairer la pratique clinique et l'élaboration des programmes afin d'optimiser l'accès et la participation aux programmes d'exercices communautaires des adultes atteints d'aphasie à la suite d'un AVC.

The effect of walking on cardiorespiratory fitness in adults with knee osteoarthritis.

Walking programs alone or in combination with behavioral interventions have proven effective at improving quality of life among older adults with osteoarthritis (OA). It is unclear, however, whether the combination of both of these treatments is more effective at improving cardiorespiratory fitness in older adults with knee OA than a walking program alone or than unsupervised self-directed walking. In this study, we assessed cardiorespiratory fitness with 3 programs: a structured supervised community-based aerobic walking program with a behavioral intervention (WB; n = 41); a supervised program of walking only (W; n = 42); and an unsupervised self-directed walking program (n = 32). We measured maximal oxygen uptake (V̇O2peak), exercise test duration, and workload, heart rate, and ventilation at maximum aerobic capacity in older adults with knee OA after 6 months of WB, W, or self-directed walking. Overall, V̇O2peak improved by 4% in female walkers (+0.9 ± 2.5 mL O2·kg(-1)·min(-1); p < 0.001) and 5% in male walkers (+1.3 ± 2.7 mL O2·kg(-1)·min(-1); p < 0.001), and the change in fitness was similar with all 3 walking interventions. In conclusion, low- to moderate-intensity walking may improve and (or) prevent decrements in cardiorespiratory fitness in older adults with OA. This response was comparable in supervised walkers with and without a behavioral intervention and in unsupervised self-directed walkers.

Development of supportive services for frontotemporal dementias through community engagement.

The effect of early onset frontotemporal dementias (FTD) on spouses and children is profound, requiring different types of support services from pre-existing Alzheimer's disease interventions already in place. This article explores how the needs of families living with FTD resulted in three programme initiatives developed at Baycrest (an academic health sciences centre focused on ageing, in Toronto, Canada) to meet the needs of this population. These included an Internet-based videoconferencing support group for spouses, a website that provides support and counsel for children and their parents, and an adult day programme designed for FTD patients. The strength of these interventions is that services were developed with involvement of stakeholders in FTD care from the start, to deal with gaps in services in a sustainable way.

The implementation of a community-based aerobic walking program for mild to moderate knee osteoarthritis: a knowledge translation randomized controlled trial: part II: clinical outcomes.

BACKGROUND: Osteoarthritis (OA) is the most common joint disorder in the world, as it is appears to be prevalent among 80% of individuals over the age of 75. Although physical activities such as walking have been scientifically proven to improve physical function and arthritic symptoms, individuals with OA tend to adopt a sedentary lifestyle. There is therefore a need to improve knowledge translation in order to influence individuals to adopt effective self-management interventions, such as an adapted walking program. METHODS: A single-blind, randomized control trial was conducted. Subjects (n = 222) were randomized to one of three knowledge translation groups: 1) Walking and Behavioural intervention (WB) (18 males, 57 females) which included the supervised community-based aerobic walking program combined with a behavioural intervention and an educational pamphlet on the benefits of walking; 2) Walking intervention (W) (24 males, 57 females) wherein participants only received the supervised community-based aerobic walking program intervention and the educational pamphlet; 3) Self-directed control (C) (32 males, 52 females) wherein participants only received the educational pamphlet. One-way analyses of variance were used to test for differences in quality of life, adherence, confidence, and clinical outcomes among the study groups at each 3 month assessment during the 12-month intervention period and 6-month follow-up period. RESULTS: The clinical and quality of life outcomes improved among participants in each of the three comparative groups. However, there were few statistically significant differences observed for quality of life and clinical outcomes at long-term measurements at 12-months end of intervention and at 6- months post intervention (18-month follow-up). Outcome results varied among the three groups. CONCLUSION: The three groups were equivalent when determining the effectiveness of knowledge uptake and improvements in quality of life and other clinical outcomes. OA can be managed through the implementation of a proven effective walking program in existing community-based walking clubs. TRIAL REGISTRATION: Current Controlled Trials IRSCTNO9193542.

The implementation of a community-based aerobic walking program for mild to moderate knee osteoarthritis (OA): a knowledge translation (KT) randomized controlled trial (RCT): Part I: The Uptake of the Ottawa Panel clinical practice guidelines (CPGs).

BACKGROUND: The implementation of evidence based clinical practice guidelines on self-management interventions to patients with chronic diseases is a complex process. A multifaceted strategy may offer an effective knowledge translation (KT) intervention to promote knowledge uptake and improve adherence in an effective walking program based on the Ottawa Panel Evidence Based Clinical Practice Guidelines among individuals with moderate osteoarthritis (OA). METHODS: A single-blind, randomized control trial was conducted. Patients with mild to moderate (OA) of the knee (n=222) were randomized to one of three KT groups: 1) Walking and Behavioural intervention (WB) (18 males, 57 females) which included the supervised community-based aerobic walking program combined with a behavioural intervention and an educational pamphlet on the benefits of walking for OA; 2) Walking intervention (W) (24 males, 57 females) wherein participants only received the supervised community-based aerobic walking program intervention and the educational pamphlet; 3) Self-directed control (C) (32 males, 52 females) wherein participants only received the educational pamphlet. One-way analyses of variance were used to test for differences in quality of life, adherence, confidence, and clinical outcomes among the study groups at each 3 month assessment during the 12-month intervention period and 6-month follow-up period. RESULTS: Short-term program adherence was greater in WB compared to C (p<0.012) after 3 months. No statistical significance (p> 0.05) was observed for long-term adherence (6 to 12 months), and total adherence between the three groups. The three knowledge translation strategies demonstrated equivalent long-term results for the implementation of a walking program for older individuals with moderate OA. Lower dropout rates as well as higher retention rates were observed for WB at 12 and 18 months. CONCLUSION: The additional knowledge translation behavioural component facilitated the implementation of clinical practice guidelines on walking over a short-term period. More studies are needed to improve the long-term walking adherence or longer guidelines uptake on walking among participants with OA. Particular attention should be taken into account related to patient's characteristic and preference. OA can be managed through the implementation of a walking program based on clinical practice guidelines in existing community-based walking clubs as well as at home with the minimal support of an exercise therapist or a trained volunteer. TRIAL REGISTRATION: Current Controlled Trials IRSCTNO9193542.

Remote participants' experiences with a group-based stroke self-management program using videoconference technology.

INTRODUCTION: Telehealth is an all-inclusive term for the provision of health services using information and communication technology. Videoconference delivery is one form of telehealth whereby a synchronous, two-way audio and visual connection is made between two or more sites. Videoconference is used in remote areas to improve access to healthcare, perform individual clinical assessments and deliver group education. Moving On after Stroke (MOST®) is a group-based, self-management program for stroke survivors and their caregivers, which consists of information sharing, facilitated discussion, goal-setting, and exercise. This program was delivered simultaneously to local participants onsite in Thunder Bay, Canada, and distant participants in smaller, remote communities in Northwestern Ontario using videoconferencing (MOST-Telehealth Remote). The objective of this study was to explore the experiences of remote participants, their perceptions regarding factors that enable or limit videoconference participation, and to obtain suggestions for enhanced delivery of videoconferenced group programs. METHODS: This qualitative study used an interpretive methodology. Semi-structured interviews were conducted in person with remote MOST-Telehealth Remote (MOST-TR) participants within one year post-program. Participants were recruited using purposive sampling and included both male and female stroke survivors and caregivers, those who participated alone and those who participated with others at the remote site. Twenty-seven people were approached, eight declined, and 19 agreed to participate. The average age of participants was 66.2 years (range 48-84). The interviews were transcribed and coded using NVivo v2.0 (www.gsrinternational.com). Data were analyzed for common categories using qualitative descriptive methods. RESULTS: All participants valued access to the program without having to travel long distances. They felt safe in discussions and when exercising with the group across videoconference. Many reported 'feeling as if they were in the same room' but also acknowledged that there were limitations to participating via videoconference. Participants recognized a loss of subtleties in communication and the group facilitators found it difficult to discern whether participants were finding the exercises too difficult or too easy. The videoconference medium also limited participants' ability to privately or informally address concerns. Factors facilitating engagement and participation were similar to factors in face-to-face groups. Additionally, the importance of collaboration with onsite coordinators, volunteers, and other local participants was highlighted. Facilitators have the added responsibility of including all participants more explicitly, especially those offsite. Suggestions to improve group cohesion and participation included a preliminary face-to-face meeting with all participants, implementing technical strategies, and ongoing onsite support. CONCLUSIONS: For MOST-TR participants, videoconference participation was valuable. Addressing the limitations of videoconference connection and enhanced local support may improve the experience for remote participants in small-group, videoconferenced, self-management programs. Using videoconference technology to participate in existing programs greatly increases accessibility for people living in remote areas.

Ottawa panel evidence-based clinical practice guidelines for aerobic walking programs in the management of osteoarthritis.

OBJECTIVE: To update the Evidence-Based Clinical Practice Guidelines (EBCPGs) on aerobic walking programs for the management of osteoarthritis (OA) of the knee. DATA SOURCES: A literature search was conducted using the electronic databases MEDLINE, PubMed, and the Cochrane Library for all studies related to aerobic walking programs for OA from 1966 until February 2011. STUDY SELECTION: The literature search found 719 potential records, and 10 full-text articles were included according to the selection criteria. The Ottawa Methods Group established the inclusion and exclusion criteria regarding the characteristics of the population, by selecting adults of 40 years old and older who were diagnosed with OA of the knee. DATA EXTRACTION: Two reviewers independently extracted important information from each selected study using standardized data extraction forms, such as the interventions, comparisons, outcomes, time period of the effect measured, and study design. The statistical analysis was reported using the Cochrane collaboration methods. An improvement of 15% or more relative to a control group contributes to the achievement of a statistically significant and clinically relevant progress. A specific grading system for recommendations, created by the Ottawa Panel, used a level system (level I for randomized controlled studies and level II for nonrandomized articles). The strength of the evidence of the recommendations was graded using a system with letters: A, B, C+, C, D, D+, or D-. DATA SYNTHESIS: Evidence from 7 high-quality studies demonstrated that facility, hospital, and home-based aerobic walking programs with other therapies are effective interventions in the shorter term for the management of patients with OA to improve stiffness, strength, mobility, and endurance. CONCLUSIONS: The greatest improvements were found in pain, quality of life, and functional status (grades A, B, or C+). A common limitation inherent to the EBCPGs is the heterogeneity of studies included with regards to the characteristics of the population, the interventions, the comparators, the outcomes, the period of time, and the study design. It is strongly recommended to use the Cochrane Risk of Bias Summary assessment to evaluate the methodologic quality of the studies and to consider avenues for future research on how aerobic walking programs would be beneficial in the management of OA of the hip.

Inter-task transfer of meaningful, functional skills following a cognitive-based treatment: Results of three multiple baseline design experiments in adults with chronic stroke.

The transfer of skills learned in rehabilitation to new skills in the home has hitherto been notoriously difficult to achieve. The Cognitive Orientation to daily Occupational Performance (CO-OP) treatment approach has been associated with improved performance in people living with stroke, but the specific impact on transfer to untrained skills has not been investigated. The objective of the study was to investigate the capacity of CO-OP treatment to improve performance in both trained and untrained self-selected skills in adults living with stroke. A single case experiment with multiple baselines across skills was conducted, with two replications. The participants self-selected four skills; three were trained using CO-OP; the fourth was not. Using video recording, data points were collected at multiple baselines, during intervention, post-intervention, and at follow-up. The Performance Quality Rating Scale (PQRS) was used by an independent rater to score performances. The two-standard deviation band method was used to determine the significance of improvements. At follow-up, significant performance improvements were seen in all three single case experiments in all trained and untrained skills. A cognitive-based approach was associated with improved performance in trained and untrained skills in three adults with chronic stroke; further controlled research is warranted.

'There's a real plan here, and I am responsible for that plan': participant experiences with a novel cognitive-based treatment approach for adults living with chronic stroke.

PURPOSE: This study was part of a larger mixed methods project aimed at adapting the Cognitive Orientation to daily Occupational Performance (CO-OP) treatment approach, originally designed for children with performance problems, for use with adults with stroke. In CO-OP, the client focuses on learning strategies and skills, rather than on remediating impairments. Therapists use guided discovery to teach cognitive strategy use. The purpose of this study was to explore participants' experiences with the approach. METHOD: Semistructured interviews were conducted with five participants. Transcriptions were coded by two members of the research team. Data analysis was conducted in two distinct phases: Directed content analysis was conducted to apply codes to predetermined categories; Thematic analysis was conducted to allow themes grounded in the data to emerge. RESULTS: Participants reported learning and transferring the strategies taught, and made suggestions for modifications to the approach, such as increasing the number of sessions. One theme emerged, Balancing the need for autonomy with the need for support. CONCLUSIONS: The findings suggest the cognitive strategies were well learned and effectively used. CO-OP was able to provide participants with increased decision-making autonomy, but may require modifications to better support their transition to higher levels of independence.

Validation of the activity inventory of the Chedoke-McMaster stroke assessment and the clinical outcome variables scale to evaluate mobility in geriatric clients.

OBJECTIVE: To evaluate the construct validity of the Activity Inventory of the Chedoke-McMaster Stroke Assessment and the Clinical Outcome Variables Scale (COVS), 2 measures of functional mobility. DESIGN: A retrospective longitudinal study of 24 inpatients (mean age 83 years (standard deviation 7)) on a geriatric rehabilitation unit. PARTICIPANTS: The primary reasons for admission were deconditioning (n=9) and hip fracture (n=7). METHOD: We tested hypotheses that Activity Inventory and COVS scores at admission and discharge, and change scores during hospital stay would correlate. Longitudinal construct validity was also estimated using effect size and standardized response mean. RESULTS: Correlations between scores on each measure ranged from r=0.59-0.93 across subscales and total scales (p<0.01). The effect size of the Activity Inventory and the COVS was 1.53 and 1.43, respectively. The standardized response mean of the Activity Inventory and the COVS was 1.83 and 2.30, respectively. CONCLUSION: Although findings support the validity of both measures, the COVS appears more efficient and sensitive than the Activity Inventory to change in this population. A larger study is needed to confirm these findings.

Exploring a cognitive-based treatment approach to improve motor-based skill performance in chronic stroke: Results of three single case experiments.

PRIMARY OBJECTIVE: Early evidence suggests the use of cognitive strategies has potential to improve skill performance in people living with the effects of stroke, but no specific protocol has been identified. This study aimed to explore the potential of using the Cognitive Orientation to daily Occupational Performance (CO-OP) protocol to improve the functional performance of adults with chronic stroke. RESEARCH DESIGN AND METHODS: A single case experimental design study with two replications was conducted. Three community-dwelling participants were recruited. Each selected three functional goals for the focus of the CO-OP intervention. Multiple video recorded data points were collected at baseline, during intervention, post-intervention and at 1-month follow-up. RESULTS: The nine goals selected varied widely, e.g. using a computer mouse, bicycling and yoga. An independent observer used the observational Performance Quality Rating Scale (PQRS) to rate performances throughout. Using the 2 SD band method to analyse the data, each participant showed significant performance improvements in at least two goals during the course of the intervention and at follow-up. Two participants had an additional goal show significant improvement at follow-up. CONCLUSION: Results provide preliminary evidence that CO-OP is associated with significant performance improvements in self-selected functional goals.