Content analysis of the Measure of the Quality of the Environment by linkage with the International Classification of Functioning, Disability and Health.

BACKGROUND: This study explores the linkage between the Measurement of Environmental Quality (MQE) and the International Classification of Functioning, Disability, and Health (ICF). Stemming from the Human Development Model-Disability Creation Process (HDM-DCP), MQE enhances understanding of how environmental quality impacts disability development across diverse socio-cultural contexts. Integrating MQE with ICF expands the perspective on disability formation beyond HDM-DCP, encompassing ICF's functioning approach. OBJECTIVE: To link the MQE with the concepts and categories of the ICF. METHODS: Two health professionals with adequate taxonomic knowledge of the ICF performed the initial linkage, which was based on updated standardized rules considering all hierarchical levels of the ICF. Linkage agreement between the first two assessors was measured using the Kappa (k) coefficient and respective 95% confidence intervals. In the absence of a consensus between the two assessors (k > 0.60), a third assessor was consulted to make the arbitrary decision of the final categories linked to the MQE. RESULTS: Insufficient agreement between the two assessors was found for the linkage process (k = 0.52; p < 0.001), requiring the final decision from the third assessor. At the end of the process, 26 ICF categories were linked to the main concepts (MC) measured by the 26 items of the short version of the MQE. Ten ICF categories were linked to the additional concepts (AC) measured by the MQE. Moreover, the MQE addresses the five domains of the ICF component "environmental factors," with a predominance of the "services, systems and policies" domain (MC = 45.8% and AC = 40%). CONCLUSION: The linkage of the concepts measured by the MQE to ICF categories enabled mapping the content of the MQE, identifying it as a promising tool for measuring environmental factors in accordance with ICF percepts.

Advancing social inclusion of people with disabilities through awareness and training activities: A collaborative process between community partners and researchers.

OBJECTIVE: The main objectives were to 1) search and map current disability awareness and training activities in Quebec, Canada, 2) collectively reflect on these practices, and 3) develop a five-year strategic plan. METHODS: We used an integrated knowledge translation approach whereby researchers and community partners were involved in all stages. This project consisted of two sequential phases: 1) an environmental scan (web review and interview) of current practices, and 2) a reflection process with an external expert-facilitator in social transformation. Outcome results and process data are reported. RESULTS: We identified 129 activities (71 training, 58 awareness) from 39 organizations (from 123 organizations initially invited). A wide range of characteristics were collected for each activity which allowed for the identification of gaps. The working group met seven times in one year to discuss results from phase 1 and co-create a five-year strategic plan. Main priorities are 1) the development of a methodology for measuring collective impact and 2) content synchronization of activities. CONCLUSION: Involvement of partners and researchers enabled a concerted and efficient approach to the development of a five-year strategic plan. PRACTICE IMPLICATIONS: A transition committee led by partners will ensure implementation and sustainability of the plan across the province.

Integration of the social environment in a mobility ontology for people with motor disabilities.

BACKGROUND: Our contemporary understanding of disability is rooted in the idea that disability is the product of human-environment interaction processes. People may be functionally limited, but this becomes a disability only when they engage with their immediate social and physical environments. Any attempt to address issues of mobility in relation to people with disabilities should be grounded in an ontology that encompasses this understanding. PURPOSE: The objective of this study is to provide a methodology to integrate the social and physical environments in the development of a mobility ontology for people with motor disabilities (PWMD). METHODS: We propose to create subclasses of concepts based on a Nature-Development distinction rather than creating separate social and physical subclasses. This allows the relationships between social and physical elements to be modelled in a more compact and efficient way by specifying them locally within each entity, and better accommodates the complexities of the human-environment interaction as well. Based on this approach, an ontology for mobility of PWMD considering four main elements - the social and physical environmental factors, human factors, life habits related to mobility and possible goals of mobility - is presented. CONCLUSIONS: We demonstrate that employing the Nature-Development perspective facilitates the process of developing useful ontologies, especially for defining the relationships between the social and physical parts of the environment. This is a fundamental issue for modelling the interaction between humans and their social and physical environments for a broad range of applications, including the development of geospatial assistive technologies for navigation of PWMD. Implications for rehabilitation The proposed perspective may actually have much broader interests beyond the issue of disability - much of the interesting dynamics in city development arises from the interaction between human-developed components - the built environment and its associated entities - and natural or organic components. The proposed approach facilitates the process of developing useful ontologies, especially for defining the relationships between the social and physical parts of the environment. This is a fundamental issue for modeling the interaction between human -specially people with disabilities -and his social and physical environments in a broad range of domains and applications, such as Geographic Information Systems and the development of geospatial assistive technologies for navigation of people with disabilities, respectively.

Can we associate the hours of clinical services at the rehabilitation outcomes? The case of the visual impairment rehabilitation program.

The purpose of this study was to determine the effects on the elderly of clinical interventions by professionals from a visual impairment rehabilitation program, more specifically, the effects on their daily life and the extent to which such interventions encourage social participation. In accordance with the conceptual framework of the Disability Creation Process, the clinical results of a population study group of 100 persons with various types of visual impairment enrolled in a rehabilitation program were analyzed as per the intensity of the clinical interventions (eg, hours of clinical services provided and dispensed by professionals). The results of the study tend to show that the hours of services accorded to a patient positively contribute to the progression of his or her Functional Global Profile as per the rehabilitation outcomes progression measures. In contrast, age and the spreading of services negatively contribute. The contributions of the study are innovative for assessing clinical effectiveness. For instance, the understanding of the relationship between the measurement of a patient's clinical results and the services that he or she has received should help us improve the practices and methods used in visual impairment rehabilitation.

The Caring-Disability Creation Process model: a new way of combining 'Care' in nursing and 'Rehabilitation' for better quality of services and patient safety.

In an effort to continuously improve the quality of the services provided to persons in rehabilitation and patient safety, this article presents a model for the development of a Caring-Disability Creation Process that combines two elements that, in the past, have often been separated: care in nursing and rehabilitation. This new model and its underlying concepts introduce to a comprehensive approach in the recognition of the added value of caring by the contribution of rehabilitation nurses making an optimal development of the individual's potential and achieving successful social participation.

[Connecting nursing and rehabilitation: can a caring-disability creation process model of practice make the difference?]. / Allier le soin infirmier et la réadaptation: un modèle de pratique caring-processus de production du handicap peut-il faire la difference?

The Disability Creation Process (DCP) model governs for several years rehabilitation setting in Quebec. In a perspective of humanization of care, the philosophy of Human Caring was recently implanted as a nursing model at a centre of rehabilitation of this province. Are these two models of practice compatible? Can we construct a common integrator model? In an aim of continuous improvement of the quality of the services of the persons in rehabilitation, the present article develops Caring-DCP model which could ally two perspectives which are been often separated, cares and rehabilitation.

Measuring participation in children with disabilities using the Assessment of Life Habits.

The objectives of this study were: (1) to examine the psychometric properties of the Assessment of Life Habits (LIFE-H) for children; and (2) to draw a profile of the level of participation among children of 5 to 13 years of age with various impairments. The research team adapted the adult version of the LIFE-H in order to render it more appropriate for the daily life experiences of children. Content validity was verified by an expert panel of 29 people, made up of parents, paediatric clinicians, and researchers. Reliability and construct validity of the LIFE-H for children (interview-administered form) was tested during an experiment that comprised three sessions of interviews with a group of 94 parents of children with disabilities (36 males, 58 females; mean age 8y 10mo [SD 2y 6 mo]; diagnostic groups: cerebral palsy, myelomeningocoele, sensory-motor neuropathy, traumatic brain injury, and developmental delay). Overall, the LIFE-H showed high intrarater reliability with intraclass correlation coefficient values of 0.78 or higher for 10 out of 11 categories. The correlations between the LIFE-H and the tools used in pediatric rehabilitation varied, and categories with similar constructs generally led to higher correlations. The psychometric properties of the LIFE-H are appropriate and its content allows a complete description of participation among children with disabilities.

[The adaptation process of adults who sustained craniocerebral trauma]. / Le processus d'adaptation des adultes présentant des séquelles de traumatisme cranio-cérébral.

BACKGROUND: The adaptation process of adults who had sustained a traumatic brain injury is not well understood. PURPOSE: This qualitative study explores the adaptation process of adults presenting the sequelae of a traumatic brain injury. METHOD: Fifty-three community-dwelling adults with the sequelae of traumatic brain injury participated in an individual interview and answered open-ended questions. RESULTS: The qualitative analysis, inspired by the phenomenological tradition, reports an adaptation process in six stages. The elements which influenced this process as well as the effective coping strategies according to the participant's perception are described. The adaptation process of this clientele is affected primarily by the nature of the cognitive sequelae, as well as the circumstances of the traumatic event. CLINICAL IMPLICATIONS: The realization of significant occupations is one of the key elements of this process, sometimes associated to an important interior transformation from the point of view of personal standards and values.

[Perceived self-efficacy is associated with social participation in adults with traumatic brain injury]. / La perception d'efficacité personnelle comme facteur associé à la participation sociale des adultes ayant subi un traumatisme cranio-cérébral.

BACKGROUND: Identification of the factors facilitating the social participation of adults who have sustained a traumatic brain injury can help occupational therapists with the direction for their interventions. Earlier studies centered on identifying the socio-demographic characteristics and the disabilities associated with social participation. PURPOSE: The aim of this study was to examine the association between perceived self-efficacy, a positive concept derived from social cognitive theory and social participation. METHODS: A cross-sectional and correlational research design was used with 53 adults who sustained a traumatic brain injury between 1995 and 2000 and lived in their natural environment. Two measuring tools were used: a self-administered questionnaire evaluating the perceived self-efficacy and a questionnaire evaluating social participation, administered by an examiner through a face-to-face interview. RESULTS: The results indicate that the perceived self-efficacy explains 40% of the variance of the social participation. PRACTICE IMPLICATIONS: This association suggests that social cognitive theory can constitute a reference model for occupational therapists working with this clientele.

Participation after spinal cord injury: the evolution of conceptualization and measurement.

The increasing life expectancy after spinal cord injury has given social participation a new recognition as one of the ultimate goals of a comprehensive rehabilitation process. Recent evolution of the concept suggests 2 different approaches to document participation after spinal cord injury and a careful appraisal of the related outcome measures is important as discrepancies of results between the 2 approaches can be significant. Literature on objective participation reports a large variability in several dimensions that are particularly influenced by intrinsic factors such as severity of injury and secondary impairments. The direct influence of the environmental factors remains to be demonstrated by empirical studies. There are fewer tools available to evaluate subjective impressions of participation but recent investigations support the importance of taking account of the person's perceived restrictions participation in order to get better understandings of an individual's specific needs and problems. The aim of this article is to present the evolution of the conceptualization and measurement of the two approaches and to describe the level of participation of individuals with SCI.

Toward an explanatory model of social participation for adults with traumatic brain injury.

OBJECTIVE: To identify resiliency factors that could improve social participation for adults with traumatic brain injury. DESIGN: Cross-sectional single measurement, correlational and exploratory study, including quantitative and qualitative data. PARTICIPANTS: Fifty-three community-dwelling people with sequelae of traumatic brain injury, individually interviewed, which included filling out questionnaires and answering open-ended questions. MAIN MEASURES: Social participation, self-efficacy, and positive mental states. RESULTS: Dynamism, self-efficacy, and will account for 51% of the variance in social participation and are the main resiliency factors. Fatigue is one of the sequelae that pose the greatest challenge to self-efficacy and limit social participation. CONCLUSION: Resiliency factors constitute a target for research and intervention for this population.

Validity of the Assessment of Life Habits in older adults.

OBJECTIVE: To study the construct validity of a participation scale, the Assessment of Life Habits, with older adults having functional limitations. More specifically, the study aimed to verify the ability of the Assessment of Life Habits to discriminate between clienteles in 3 living environments, and to compare participation scores to functional independence scores obtained with the Functional Autonomy Measurement System (Système de mesure de l'autonomie fonctionnelle). DESIGN: Participants were evaluated once with the Assessment of Life Habits and the Functional Autonomy Measurement System. SUBJECTS: Eighty-seven older adults (mean age 78.0 years (8.2)) living in 3 types of environment: own home, private nursing home or long-term care centre. RESULTS: Results suggest that the Assessment of Life Habits scores discriminate between different levels of participation according to the living environments of the participants. The Assessment of Life Habits measures some similar aspects to the Functional Autonomy Measurement System scale but also additional concepts not included in the Functional Autonomy Measurement System. CONCLUSION: This study supports the validity of the Assessment of Life Habits as a participation measure. It suggests the importance of going beyond disability measures to evaluate the overall functioning of older adults correctly.

Measuring social participation: reliability of the LIFE-H in older adults with disabilities.

PURPOSE: Much more attention should be paid to instruments documenting social participation as this area is increasingly considered a pivotal outcome of a successful rehabilitation. The purpose of this study was to document the reliability of a participation measure, the Assessment of Life Habits (LIFE-H), in older adults with functional limitations. METHODS: Eighty-four individuals with physical disabilities living in three different environments were assessed twice with the LIFE-H, an instrument that documents the quality of social participation by assessing a person's performance in daily activities and social roles (life habits). RESULTS: The intraclass correlation coefficients (ICC) computed for intrarater reliability exceeded 0.75 for seven out of the 10 life habits categories. For interrater reliability, the total score and daily activities subscore are highly reliable (ICC

Rasch modeling and the measurement of social participation.

Social participation is the main outcome of physical rehabilitation programs. The aim of this study is to improve the measurement of social participation, using an instrument called the Assessment of Life Habits Scale and the Rasch model. The interval level measurement, the dimensionality and the generalizability of the item hierarchy were verified. The data from a large sample of people with spinal cord injury was analyzed and specific results were compared with expert opinions. The main properties of the instrument were satisfactory and the agreement with expert opinion was high. Principal component analysis showed multidimensionality. The item difficulty hierarchy obtained with spinal cord injury experts was different from the one obtained with traumatic brain injury experts, indicating a different difficulty level of items in relation to each population characteristics. We conclude that the instrument is appropriate for the measurement of social participation and suggest ways to improve the instrument.

[Quality and conditions of the collaboration with the families viewed by the personnel working with psychiatric and traumatic brain injury clients]. / Qualité et conditions de collaboration avec les familles perçues par le personnel de réadaptation en milieu psychiatrique et de déficience physique.

This paper describes the point of view of professionals working with traumatic brain injury (TBI) clients or people with schizophrenic disorders towards their collaboration with clients' families. Four hundred and thirty professionals from 3 different regions in the province of Quebec took part in the study. They were recruited from psychiatric and general hospitals and physical rehabilitation centres. The results of the study point up that conditions for collaboration with families are better for respondents working with TBI clients than for respondents in the psychiatric sector. Furthermore, the results showed that respondents working with TBI clients are significantly more satisfied with their working conditions and the services they deliver and perceive a higher degree of collaboration with families than mental health workers. Another finding of the study is that personnel intervening in an interdisciplinary team reported a higher degree of collaboration with families than respondents working in a multidisciplinary team setting or individually. In the same vein, respondents who received training regarding intervention with families during their practice or during their academic training reported a higher degree of collaboration with their clients' families.