Canadian Assessment of Physical Literacy in grades 7-9 (12-16 years): Preliminary validity and descriptive results.

Background: The Canadian Assessment of Physical Literacy (CAPL) accurately and reliably assesses the physical literacy level of young children. However, in preliminary analyses ceiling effects were noted among 183 older children. The purposes of this study were to assess the validity of a modified CAPL designed for older children (CAPL 789) and to offer descriptive results.Methods: CAPL 789 assessed the physical literacy of Canadian children in grades 7-9. Data were collected from schools and recreation facilities in the provinces of Alberta and Ontario (Canada), yielding a new sample of 245 participants (129 girls, 13.7 ± 0.9 years). Descriptive statistics were calculated for all CAPL domains. Age and gender effects were examined to support the validity.Results: Physical competence score (/32) increased with age (F = 4.90, p < 0.05), the means in grades 7-9 being 18.9 ± 3.2, 20.9 ± 4.4 and 21.2 ± 3.4, respectively. Girls scored significantly higher (t = -2.29, p < 0.05) than boys (6.6 ± 1.2 vs 6.3 ± 1.3) in the knowledge assessment (/10).Conclusion: The CAPL 789 was feasible among children from grades 7-9. Additional research is required to establish the psychometric properties in children 12 to 16 years.

Sensitivity, specificity, and reliability of the Get Active Questionnaire for identifying children with medically necessary special considerations for physical activity.

Physical activity is promoted for optimal health but may carry risks for children who require medically necessary activity restrictions. The sensitivity, specificity, and reliability of the Get Active Questionnaire (GAQ) for identifying children needing special considerations during physical activity was evaluated among parents of 207 children aged 3 to 14 years (97 (47%) female, mean age of 8.4 ± 3.7 years). GAQ responses were compared with reports obtained directly from the treating physician (n = 192/207) and information in the medical chart (clinic notes/physician letter, n = 111/207). Parent GAQ responses (either "No to all questions" or "Yes to 1 or more questions") agreed with physician (κ = 0.16, p = 0.003) and medical record (κ = 0.15, p = 0.003) reports regarding the need for special consideration during physical activity (Yes/No). Sensitivity was 71% (20/28) and specificity was 59% (96/164), with few false-negative responses. The GAQ was most effective for rheumatology and cardiology patients. False positives were 29% to 46%, except among chronic pain (80%) and rehabilitation (75%) patients. Test-retest reliability was moderate (Cronbach's α = 0.70) among 57 parents who repeated the GAQ 1 week later. The GAQ effectively identified children not requiring physical activity restrictions and those with medical conditions similar to those of concern among adults. Additional questions from a qualified exercise professional, as recommended for a "Yes" response on the GAQ, should reduce the false-positive burden. Indicating the timeframe of reference for each question and including an option to describe other special considerations (e.g., medication, supervision) are recommended.

Perspectives on Quality of Care in Kidney Transplantation: A Semistructured Interview Study.

BACKGROUND: There is currently no agreement as to what constitutes quality transplant care, and there is a lack of consistency in the approach to assessing transplantation quality. We aimed to ascertain the views of patients, clinicians, and program administrators about quality care for kidney transplant patients. METHODS: Semistructured qualitative interviews were conducted with 20 patients, 17 physicians, and 11 program administrators. Transcripts were analyzed using inductive thematic analysis. RESULTS: We identified 8 themes: access to treatment (standardized transplant referral, lengthy transplant evaluation process, lengthy living donor evaluation); accessibility of services (alternative access options, flexible appointment availability, appropriate amount of follow-up, barriers for accessing care); program resources (comprehensive multidisciplinary care, knowledgeable staff, peer support groups, educational resources, patient navigators/ advocates); communication of information (taking time to answer questions, clear communication about treatment, communication tailored to patients, health promotion and illness prevention); attitude of care providers (positive and supportive attitude, patient centered care); health outcomes (freedom from dialysis, Long-term health, short-term health, fear of infections); patient satisfaction (returning to normal life, patient satisfaction with care); and safety (reducing infection risk, quick response to complications, patient health status on the waitlist). CONCLUSIONS: There is a need to move beyond basic clinical outcomes and focus on increasing ease of access, the patient-provider relationship, and outcomes that are most important to the patients.

Quality Metrics in Solid Organ Transplantation: A Systematic Review.

BACKGROUND: The best approach for determining whether a transplant program is delivering high-quality care is unknown. This review aims to identify and characterize quality metrics in solid organ transplantation. METHODS: Medline, Embase, and Cochrane Central Register of Controlled Trials were searched from inception until February 1, 2017. Relevant full text reports and conference abstracts that examined quality metrics in organ transplantation were included. Two reviewers independently extracted study characteristics and quality metrics from 52 full text reports and 24 abstracts. PROSPERO registration: CRD42016035353. RESULTS: Three hundred seventeen quality metrics were identified and condensed into 114 unique indicators with sufficient detail to be measured in practice; however, many lacked details on development and selection, were poorly defined, or had inconsistent definitions. The process for selecting quality indicators was described in only 5 publications and patient involvement was noted in only 1. Twenty-four reports used the indicators in clinical care, including 12 quality improvement studies. Only 14 quality metrics were assessed against patient and graft survivals. CONCLUSIONS: More than 300 quality metrics have been reported in transplantation but many lacked details on development and selection, were poorly defined, or had inconsistent definitions. Measures have focused on safety and effectiveness with very few addressing other quality domains, such as equity and patient-centeredness. Future research will need to focus on transparent and objective metric development with proper testing, evaluation, and implementation in practice. Patients will need to be involved to ensure that transplantation quality metrics measure what is important to them.