Perceptions of physical activity among individuals with limb loss: A qualitative study.

OBJECTIVES: Individuals with lower-limb amputations (LLA) often have deficits in balance and community walking ability. As a result, people with LLA are often sedentary. The aim of this study was to explore perceptions of physical activity from the perspective of people with LLA. METHODS: A qualitative descriptive study situated within an interpretive research paradigm was conducted. Semistructured interviews were held by telephone or in person with adults living with major LLAs recruited from rehabilitation hospitals and advertisements on social media. Individuals were included if they were age 18 years and older with a major LLA. Purposive sampling was used to ensure variation by sex, cause, and level of amputation. RESULTS: Thirty-three people with LLA participated (22 men/11 women; median age 63 years). The majority of individuals had a unilateral, transtibial amputation (∼50% dysvascular LLA). Three main themes were developed to characterize participants' perceptions of physical activity: (1) physical activity is perceived as important but can be challenging after amputation; (2) physical activity has physical and mental health benefits; and (3) physical activity is a means to maintain independence and engagement in community and social life. CONCLUSIONS: Obtaining the perspectives of individuals with LLA about physical activity helps us understand how they think about it, what motivates them, and how we can optimize physical activity levels. Future research is needed to evaluate the effectiveness of interventions to enhance physical activity in this population.

Use of virtual reality for the management of phantom limb pain: a systematic review.

PURPOSE: To summarize the research on the effectiveness of virtual reality (VR) therapy for the management of phantom limb pain (PLP). METHODS: Three databases (SCOPUS, Ovid Embase, and Ovid MEDLINE) were searched for studies investigating the use of VR therapy for the treatment of PLP. Original research articles fulfilling the following criteria were included: (i) patients 18 years and older; (ii) all etiologies of amputation; (iii) any level of amputation; (iv) use of immersive VR as a treatment modality for PLP; (v) self-reported objective measures of PLP before and after at least one VR session; (vi) written in English. RESULTS: A total of 15 studies were included for analysis. Fourteen studies reported decreases in objective pain scores following a single VR session or a VR intervention consisting of multiple sessions. Moreover, combining VR with tactile stimulation had a larger beneficial effect on PLP compared with VR alone. CONCLUSIONS: Based on the current literature, VR therapy has the potential to be an effective treatment modality for the management of PLP. However, the low quality of studies, heterogeneity in subject population and intervention type, and lack of data on long-term relief make it difficult to draw definitive conclusions.IMPLICATION FOR REHABILITATIONVirtual reality (VR) therapy has emerged as a new potential treatment option for phantom limb pain (PLP) that circumvents some limitations of mirror therapy.VR therapy was shown to decrease PLP following a single VR session as well as after an intervention consisting of multiple sessions.The addition of vibrotactile stimuli to VR therapy may lead to larger decreases in PLP scores compared with VR therapy alone.

Reporting of Rehabilitation Outcomes in the Traumatic Lower Limb Amputation Literature: A Systematic Review.

OBJECTIVE: To synthesize the outcomes reported in the rehabilitation and community literature for adults with traumatic lower limb amputation (LLA). DATA SOURCES: The search strategy was conducted in 3 databases (Medline, EMBASE, and CINAHL) from inception to April 2022. STUDY SELECTION: To be eligible, articles could be of any design but were required to have at least 50% adult individuals with traumatic LLA and had to report on interventions and outcomes in either a rehabilitation or community setting. DATA EXTRACTION: The extracted outcomes were classified using Dodd's framework, which is designed for organizing research outcomes. Heterogeneity was observed in the outcome measures (OMs) used for evaluation. Two reviewers independently conducted the data extraction, which was verified by a third reviewer. DATA SYNTHESIS: Of the 7,834 articles screened, 47 articles reporting data on 692 individuals with traumatic LLA, met our inclusion criteria. Four core areas encompassing 355 OMs/indicators were identified: life effect (63.4%), physiological/clinical (30.1%), resource use (5.1%), and adverse events (1.4%). Physical functioning (eg, gait, mobility) was the most frequently reported outcome domain across studies, followed by nervous system outcomes (eg, pain) and psychiatric outcomes (eg, depression, anxiety). Domains such as global quality of life and role/emotional functioning were seldomly reported. CONCLUSION: The study provides a list of outcome indicators explicitly published for adults with traumatic LLA, highlighting inconsistent reporting of outcome indicators. The lack of a standardized set of OMs is a barrier to performing meta-analyses on interventions, preventing the identification of effective care models and clinical pathways. Developing a core outcome set that includes OMs relevant to the needs of the traumatic LLA population may address these issues.

Quality of life following non-dysvascular lower limb amputation is contextualized through occupations: a qualitative study.

PURPOSE: To understand how persons with non-dysvascular lower limb amputation (LLA) use occupations to contextualize their quality of life (QoL). METHODS: A qualitative study using an interpretative description approach was conducted. Analysis of the interviews was guided by an occupational perspective, which considers the day-to-day activities that are important to an individual. RESULTS: Twenty adults with an adult-acquired non-dysvascular amputation (e.g., trauma, cancer or infection) were interviewed. Following thematic analysis, two main themes were developed: (1) sense of self expressed through occupations; and (2) sense of belonging with others influenced by occupations. Participants expressed the way they felt about themselves through their activities and placed high value on whether they could participate in certain occupations. Participants also described how their sense of belonging was changed through the context of their changing occupations. CONCLUSION: The findings from this work can be leveraged by clinicians and researchers alike to improve care for this population. Rehabilitation programs should consider interventions and programming that help to restore occupations or develop new ones given the importance placed on occupations by persons with non-dysvascular LLA.

Quality of life is affected following non-dysvascular lower limb amputation due to physical, mental and psychosocial changes.Occupations (or day-to-day activities) are important components of quality of life for persons with lower limb amputation.Rehabilitation professionals should take into account the influence that occupations have on how persons with lower limb amputation perceive themselves when developing interventions and programming for this population.The influence occupations have on sense of belonging should also be considered by rehabilitation professionals when developing these interventions and programs for persons with non-dysvascular lower limb amputation.

Qualitative needs assessment for the development of a smart thumb prosthesis.

PURPOSE: To critically explore experiences following thumb amputation and delineate elements of an ideal thumb prosthesis from the end user perspective. METHODS: A qualitative study was undertaken with end user stakeholder groups, which included persons with a thumb amputation, rehabilitation professionals, and prosthetists. Analysis proceeded in line with conventional content analysis. RESULTS: Six patients with traumatic thumb amputation and eight healthcare providers (HCPs) were interviewed. Six themes were identified. The first theme discussed the impact of losing a thumb upon function, occupational activities, and mental wellbeing. The second theme reflected the idiosyncratic nature of thumb amputees, including their goals and nature of injury. The third theme stressed the costs associated with obtaining a thumb prosthesis. The fourth theme explored patient frustration and causes of device abandonment. Theme five summarized opinions on currently available thumb prostheses, and theme seven was the ideal design for a thumb prosthetic, including sensory elements and materials. CONCLUSIONS: Representative data from stakeholders mapped the current status of thumb prostheses. Preferences for an ideal thumb prosthesis included a simple, durable design with the ability to oppose, grasp, and sense pressure. Affordable cost and ease of fit emerged as systemic objectives.

Provides insight into the experiences of individuals following thumb amputation.Identifies challenges that may lead to prosthetic abandonment so that these can be considered and addressed by rehabilitation professionals.Identifies positive elements and preferred materials in current prosthetics so that rehabilitation professionals may incorporate these more frequently.

Improving hand therapy delivery during care transitions in multisystem trauma patients.

High-quality hand therapy is critical to maximising functional capacity and optimising overall outcomes following hand injuries. Therapy delivery requires clear communication between surgeons and occupational therapists. At Sunnybrook Health Sciences Centre (SHSC), Canada's largest tertiary care centre, suboptimal communication is a significant barrier to efficient hand therapy delivery in acute multisystem trauma patients. A baseline audit at SHSC found that 41% of hand therapy orders required clarification and 35% of patients waited over 24 hours before their order was fulfilled. In many cases, communication errors created unacceptably long delays that were suspected by surgeon stakeholders to impede patient outcomes. This highlighted an opportunity for investigation and system improvement.Using process mapping methodology, we outlined standard process involved in patient care and identified barriers to successful communication. We collaborated with key stakeholders to codesign a standardised template for care orders. We aimed to improve order clarity and consistency with the goal of reducing the incidence of clarification and delays.Postimplementation, the percentage of hand therapy orders requiring clarification was decreased to 24%. The number of patients waiting over 24 hours for therapy was also reduced; however, further investigation is required to verify this finding. In addition, essential order components were more consistently and comprehensively included. Next steps of this work include expanding the use of the order template outside of the multisystem trauma population and improving the communication of hand therapy at discharge from hospital.

Physician engagement in organisational patient safety through the implementation of a Medical Safety Huddle initiative: a qualitative study.

BACKGROUND: Efforts to increase physician engagement in quality and safety are most often approached from an organisational or administrative perspective. Given hospital-based physicians' strong professional identification, physician-led strategies may offer a novel strategic approach to enhancing physician engagement. It remains unclear what role medical leadership can play in leading programmes to enhance physician engagement. In this study, we explore physicians' experience of participating in a Medical Safety Huddle initiative and how participation influences engagement with organisational quality and safety efforts. METHODS: We conducted a qualitative study of the Medical Safety Huddle initiative implemented across six sites. The initiative consisted of short, physician focused and led, weekly meetings aimed at reviewing, anticipating and addressing patient safety issues. We conducted 29 semistructured interviews with leaders and participants. We applied an interpretive thematic analysis to the data using self-determination theory as an analytic lens. RESULTS: The results of the thematic analysis are organised in two themes, (1) relatedness and meaningfulness, and (2) progress and autonomy, representing two forms of intrinsic motivation for engagement that we found were leveraged through participation in the initiative. First, participation enabled a sense of community and a 'safe space' in which professionally relevant safety issues are discussed. Second, participation in the initiative created a growing sense of ability to have input in one's work environment. However, limited collaboration with other professional groups around patient safety and the ability to consistently address reported concerns highlights the need for leadership and organisational support for physician engagement. CONCLUSION: The Medical Safety Huddle initiative supports physician engagement in quality and safety through intrinsic motivation. However, the huddles' implementation must align with the organisation's multipronged patient safety agenda to support multidisciplinary collaborative quality and safety efforts and leaders must ensure mechanisms to consistently address reported safety concerns for sustained physician engagement.

Characteristics and healthcare utilization of COVID-19 rehabilitation patients during the first and second waves of the pandemic in Toronto, Canada.

The objective of this study is to describe the healthcare utilization, and clinical and sociodemographic features of a cohort of 74 coronavirus disease 2019 (COVID-19) patients admitted to a tertiary rehabilitation hospital in Toronto, Canada. A retrospective chart review was performed using 74 charts from patients admitted to a COVID-19 rehabilitation unit between 11 April 2020 and 30 April 2021. Measures of central tendency, SDs, interquartile ranges, frequencies, and proportions were calculated to analyze clinical and sociodemographic data. A total of 74 patients were included in this study, including 33 males and 41 females. The mean age was 72.8 years, with Wave 1 patients being younger than Wave 2 patients. Sixty-six percent of total patients experienced hypertension. Mean functional independence measure score across both waves was 78 at admission and 100 at discharge. Mean length of stay was 14.6 days in Wave 1 and 18.8 days in Wave 2. This study represents some of the first data on the characteristics and outcomes of COVID-19 patients admitted to inpatient rehabilitation in Toronto, Canada across the initial waves of the COVID-19 pandemic.

Patients, Caregivers, and Healthcare Providers' Experiences with COVID Care and Recovery across the Care Continuum: A Qualitative Study.

Introduction: During the COVID-19 pandemic, discharge timelines were accelerated and patients were moved across the continuum of care, from acute to post-acute care, to relieve the strain in health system capacity. This study aimed to investigate the COVID-19 care pathway from the perspective of patients, caregivers, and healthcare providers to understand their experiences with care and recovery within and across care settings. Methods: A qualitative descriptive study. Patients and their families from an inpatient COVID-19 unit and healthcare providers from an acute or rehabilitation COVID-19 unit were interviewed. Results: A total of 27 participants were interviewed. Three major themes were identified: 1) The perceived quality and pace of COVID-19 care improved from acute care to inpatient rehabilitation; 2) Care transitions were especially distressing; and 3) Recovery from COVID-19 stagnated in the community. Conclusion: Inpatient rehabilitation was viewed as higher quality due to the slower paced care. Care transitions were distressing for stakeholders and enhanced integration between acute and rehabilitation care were suggested to improve patient handover. A lack of rehabilitation access led to recovery stagnating for patients discharged to the community. Telerehab may improve the transition to home and ensure access to adequate rehabilitation and support in the community.

Psychosocial group therapy interventions for patients with physical disabilities: A scoping review of implementation considerations.

OBJECTIVE: Group therapy is an intervention that that has been well-studied in patients with medical illness and shown to optimize patients' wellbeing and mental health resource utilization. However, its implementation and effectiveness have not been adequately studied in those with physical disabilities. This review addresses current gaps by synthesizing the literature to examine implementation considerations in the use of psychosocial group therapy for anxiety and depression in individuals with physical disabilities. METHOD: This review adhered to Arksey and O'Malley's methodological framework and the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews Checklist. Studies were identified through MEDLINE, EMBASE, PSYCINFO, and CINAHL. Included studies were qualitative, quantitative, or mixed methods research on participants with a physical disability, and undergoing psychosocial group therapy to address anxiety/depression. RESULTS: Fifty-five studies were included in the review. The most common physical disabilities were multiple sclerosis (n = 31) and Parkinson's disease (n = 13). Group Cognitive Behavioral Therapy was the most commonly used intervention, facilitated by individuals with formal mental health training. A majority of therapy sessions included cohorts of up to 10 patients, and occurred weekly. Almost half of the studies (n = 27) reported high adherence rates (80%-99%), and a large proportion found group therapy led to improvements in their samples on a range of outcomes. CONCLUSION: Group therapies to address anxiety and depression are diverse, widely used, effective, and well-adhered to. This review may help practitioners develop, implement, and evaluate group programming for individuals with physical disabilities to address anxiety and depression. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Virtual Fracture Care in Long-Term Care Homes Avoiding Emergency Department Visits.

Long-term care residents with suspected fractures as a result of a fall typically transfer to the emergency department (ED) for diagnostic imaging and care. During the COVID-19 pandemic, transfer to the hospital increased the risk of COVID-19 exposure and resulted in extended isolation days for the resident. A fracture care pathway was developed and implemented to provide rapid diagnostic imaging results and stabilization in the care home, reducing transportation and exposure risk to COVID-19. Eligible residents with a stable fracture would receive a referral to a designated fracture clinic for consultation; fracture care is provided in the care home by long-term care staff. Evaluation of the pathway was completed and demonstrated that 100% of residents did not transfer to the ED and 47% of the residents did not transfer to a fracture clinic for additional care.

Health utility in community-dwelling adults with dysvascular lower limb loss.

PURPOSE: Adults with dysvascular lower extremity amputation (LEA) experience a large number of secondary health conditions yet there is a gap in the literature on health utility scores for this population. A health utility score relates to a person's state of well-being, and is a single metric anchored at 0 (death) and 1 (perfect health). This study aimed to provide a descriptive account of health utility scores in community-dwelling adults with dysvascular LEA. METHODS: Participants were adults with dysvascular LEA who were 3 months post-amputation. Data collected included socio-demographic characteristics, the Special Interest Group in Amputee Medicine (SIGAM) grades, the dysvascular conditions scale (DCS), which is a scale developed for this study, and the Short Form-36 (SF-36). SF-6D health utility scores were derived from the SF-36 using a software algorithm. Participants were grouped into low-impact and high-impact groups based on self-reported severity of symptoms using the DCS. Health utility scores were compared between the low-impact and high-impact groups using independent t-tests. RESULTS: A total of 231 participants were enrolled in the study. The mean SF-6D health utility score was 0.689 (0.127). A significant association was found between health utility score and SIGAM grade (p < 0.001, η2 = .09). Health utility was positively associated with age (r = 0.137, p = 0.037) and months post-amputation (r = 0.141, p = 0.032), and negatively associated with DCS severity (r = -0.526, p < 0.001). Health utility scores were lower for participants in the DCS high-impact groups for conditions such as diabetes mellitus, phantom limb pain, musculoskeletal pain, back pain, psychological distress, depression, vision problems, and other pain. CONCLUSION: Cost-utility analyses rely on health utility estimates and our findings provide data for future economic evaluations that may assist policy makers in evidence informed allocation of healthcare resources for this population.

Factors influencing physical activity among individuals with lower limb amputations: a qualitative study.

PURPOSE: The purpose of this study was to explore the barriers and facilitators to physical activity from multiple stakeholder perspectives including individuals with LLA and health professionals. MATERIALS AND METHODS: A qualitative descriptive study situated within an interpretive research paradigm was conducted. Semi-structured interviews were held with individuals with LLA recruited from rehabilitation hospitals in a metropolitan city in Canada. Health professionals with experience in amputation care were recruited from across Canada. Data were analysed using codebook thematic analysis. RESULTS: Thirty-three individuals with LLA and eighteen health professionals participated. Six themes were generated which represent the perceived barriers and facilitators to physical activity. Themes including Informal and Formal Supports, Availability of and Access to Community Resources, and Fit and Function of the Prosthesis were perceived by many individuals as facilitators, while acting as a barrier for others depending on an individual's circumstances. CONCLUSIONS: These findings provide us with a basis of understanding from which we can begin addressing barriers to physical activity for individuals with LLA, in support of developing patient-centred interventions and physical activity programs for this population. IMPLICATIONS FOR REHABILITATIONIrrespective of amputation etiology, individuals who have lower limb amputation experience several barriers to engaging in physical activity.Many system-level barriers to physical activity exist for people with lower limb amputation, which include lack of availability and access to community resources and specialised prostheses conducive to physical activity participation.A participatory approach engaging both patients and rehabilitation professionals can address the patient-provider discordance with respect to a patient's motivation and attitude towards physical activity participation by creating a supportive environment conducive to behaviour change.The development of future, patient-centered interventions, and physical activity programs for individuals with lower limb amputation must consider fear of falling as a prominent barrier to physical activity and devise potential strategies to address this barrier, by setting realistic and actionable goals.

Peer support for traumatic injury survivors: a scoping review.

PURPOSE: Peers are uniquely able to draw on their lived experiences to support trauma survivors' recovery. By understanding the functions and outcomes of peer support and the factors that impact implementation, evidence can be mobilized to enhance its application and uptake into standard practice. As such, we aimed to review the literature on peer support for trauma survivors to: examine the role of peer support in recovery; describe the nature and extent of peer support; Examine the influence of peer support on health and well-being; and identify the barriers and facilitators to developing and implementing peer support. METHODS: Scoping review methodology as outlined by Arksey and O'Malley. RESULTS: Ninety-three articles were reviewed. Peer support was highlighted as an important component of care for trauma survivors and provided hope and guidance for the future post-injury. Most peer support programs were offered in the community and provided one-on-one support from peer mentors using various modalities. Interventions were successful when they involved knowledgeable peer mentors and maintained participant engagement. Prior negative experiences and stigma/privacy concerns deterred trauma survivors from participating. CONCLUSIONS: Peer support fulfills several functions throughout trauma survivors' recovery that may not otherwise be met within existing health care systems. Implications for rehabilitationBy understanding the functions and outcomes and the factors that impact implementation of peer support, evidence can be mobilized to enhance its application and uptake into standard practice.Peers provide trauma survivors with socioemotional support as well as assistance in daily management and life navigation post-injury.Peer support provided hope and guidance for the future after injury and improved self-efficacy amongst trauma survivors.Peer support programs are most likely to be successful when they involve knowledgeable peer mentors, are flexibly delivered, align with organizations' values and priorities, and have adequate resources and funding to support their implementation.

The experiences of patients, family caregivers, healthcare providers, and health service leaders with compassionate care following hospitalization with COVID-19: a qualitative study.

PURPOSE: This study explored the experiences of patients, caregivers, healthcare providers, and health service leaders of compassion in the care of people hospitalized with COVID-19. MATERIALS AND METHODS: This study is a secondary analysis of qualitative data deriving from primary research data on recommendations for healthcare organizations providing care to people hospitalized with COVID-19. Participants comprised patients with COVID-19 (n = 10), family caregivers (n = 5) and HCPs in COVID-19 units (n = 12). Primary research data were analyzed deductively under the "lens" of compassion, as defined by Goetz. RESULTS: Four interacting themes were found: (1) COVID-19 - to care or not to care? The importance of feeling safe, (2) A lonely illness - suffering in isolation with COVID-19, (3) Compassionate care for people with COVID-19 across the hospital continuum, and (4) Sustaining compassionate care for people hospitalized with COVID-19 - healthcare provider compassion fatigue and burnout. CONCLUSIONS: Compassionate care is not a given for people hospitalized with COVID-19. Healthcare providers must feel safe to provide care before responding compassionately. People hospitalized with COVID-19 experience additional suffering through isolation. Compassionate care for people hospitalized with COVID-19 is more readily identifiable in the rehabilitation setting. However, compassion fatigue and burnout in this context threaten healthcare sustainability.IMPLICATIONS FOR REHABILITATIONHealthcare providers need to feel physically and psychologically safe to provide compassionate care for people hospitalized with COVID-19.People hospitalized with COVID-19 infection experience added suffering through the socially isolating effects of physical distancing.Compassion and virtuous behaviours displayed by healthcare providers are expected and valued by patients and caregivers, including during the COVID-19 pandemic.High levels of compassion fatigue and burnout threaten the sustainability of hospital-based care for people with COVID-19.

Exploring the psychosocial needs of persons with lower extremity amputation and feasibility of internet cognitive behavioural therapy: a qualitative study.

PURPOSE: Following major lower extremity amputation (LEA), patients experience significant emotional distress and are at risk for anxiety and depression. There is a lack of mental health supports for this population, and internet-based cognitive behavioural therapy (iCBT) may be a useful resource to meet this need. The purpose of this study was to use a qualitative approach to explore the mental health needs of LEA patients and to gauge their attitudes of the use of iCBT to help them cope with their amputation. METHODS: Semi-structured qualitative interviews were conducted with inpatients and outpatients with LEA recruited from a major urban rehabilitation hospital. Data were analysed using inductive codebook thematic analysis (TA). RESULTS: Ten interviews were completed with individuals with LEA. The main themes identified were: (1) Fixating on the past; (2) Worry about the future; (3) Unmet mental health needs; (4) Barriers to Mental Health Support; (5) Importance of peer support; and (6) Tailoring iCBT. CONCLUSIONS: Our findings highlight that patients with LEA are open to learning more about iCBT to meet their mental health needs. Key iCBT implementation considerations include taking into account issues of stigma associated with mental health, timing of delivery, levels of digital literacy, online security, and interactive content.IMPLICATIONS FOR REHABILITATIONFollowing lower extremity amputation (LEA), people experience significant emotional distress and are at risk for the development of anxiety and/or depression.Patients with LEA are receptive to an online mental health resource (i.e., internet-based cognitive behavioural therapy [iCBT]) but it needs to be tailored to meet the various mental health needs and digital literacy of the LEA population.The use of an implementation science approach can help identify factors related to the development and potential uptake of an iCBT for patients with LEA.

A qualitative study on stakeholder perceptions of digital prosthetic socket fabrication for transtibial amputations.

BACKGROUND: Digital residual limb shape capture (three-dimensional [3D] scanning), computer-assisted design (CAD), and computer-assisted manufacturing with 3D printing technology show promise for a completely digital process of fabricating prosthetic sockets for patients with limb loss. The effectiveness and quality of digitally designed 3D-printed lower extremity prosthetic sockets is understudied, and there is lack of data on the patient and prosthetist experiences with this digital workflow. OBJECTIVE: To obtain stakeholder feedback on the feasibility and acceptability of using a completely digital prosthetic fabrication process consisting of 3D scanning, CAD, and 3D printing in a rehabilitation setting for adults with transtibial limb amputations. STUDY DESIGN: Qualitative design. METHODS: Study participants with a transtibial-level amputation were fit with a prosthetic socket fabricated using digital shape capture with a 3D scanner, CAD, and 3D printing in addition to a traditionally handcasted manually fabricated socket. Participants tried on and evaluated both sockets. Semistructured interviews took place after the fitting appointments. A focus group was conducted with prosthetists to obtain their feedback. Audio data were transcribed verbatim, and an inductive content analysis was undertaken. RESULTS: Eleven patient participants and 3 prosthetists identified 4 main themes: 1) openness and enthusiasm for digital prosthetic fabrication; 2) relative advantages of digital fabrication vs. traditional socket fabrication; 3) readiness of the technology used for adoption in practice; and 4) digital prosthetic workflow and 3D printing implementation considerations. CONCLUSIONS: Patients and prosthetists were enthusiastic about digital prosthetic socket fabrication and saw potential advantages over traditional methods. Both patients and prosthetists had concerns about the durability, safety, and aesthetics of the 3D printed sockets in this study. Further studies are needed to optimize digital prosthetic fabrication with 3D printing in prosthetic practice.

Protocol for a stepped wedge cluster randomized quality improvement project to evaluate the impact of medical safety huddles on patient safety.

Introduction: Physician engagement is crucial for furthering patient safety and quality improvement within healthcare organizations. Medical Safety Huddles, which are physician-specific huddles, is a novel way to engage physicians with patient safety and may reduce adverse events experienced by patients. We plan to conduct a multi-center quality improvement (QI) initiative to implement and evaluate Medical Safety Huddles. The primary objective is to determine the impact of the huddles on adverse events experienced by patients. Secondary objectives include assessing the impact of the huddles on patient safety culture and physician engagement, and a process evaluation to assess the fidelity of implementation. Methods: This stepped wedge cluster randomized study will be conducted at four academic inpatient hospitals over 19 months. Each site will adapt Medical Safety Huddles to its own practice context to best engage physicians. We will review randomly selected patient charts for adverse events. Generalized linear mixed effects regression will be used to estimate the overall intervention effect on adverse events. Process measures such as physician attendance rates and number of safety issues raised per huddle will be tracked to monitor implementation adherence. Conclusion: Medical Safety Huddles may help healthcare organizations and medical leaders to better engage physicians with patient safety. The project results will assess the fidelity of implementation and determine the impact of Medical Safety Huddles on patient safety.

Implementation considerations for delivering inpatient COVID rehabilitation: A qualitative study.

RATIONALE: Patients recovering from significant COVID-19 infections benefit from rehabilitation; however, aspects of rehabilitative care can be difficult to implement amidst COVID infection control measures. AIMS AND OBJECTIVES: We used the Consolidated Framework for Implementation Research (CFIR) to evaluate the rapid implementation of a COVID zone in an in-patient rehabilitation hospital at the onset of the first wave of the pandemic. METHODS: Semistructured interviews were conducted with health care providers (n = 12) supporting the COVID zone, as well as with patients (n = 10) who were discharged from the COVID zone and their family caregivers (n = 5). The interviews explored the successes and challenges of working on the unit and the quality of care that was delivered to patients recovering from COVID. RESULTS: Rapid implementation of the COVID zone was supported by champions at the middle-management level but challenged by a number of factors, including: conflicting expert opinions on best infection control practices (outer setting), limited flow of information from senior leaders to frontline staff (inner setting), lack of rehabilitation equipment and understanding of how to provide high quality rehabilitative care in this context (intervention characteristics), willingness and self-efficacy of staff working in the COVID zone (individual characteristics) and lack of time to reflect on and assess effectiveness (process). CONCLUSIONS: While there was an apparent need for rapid implementation of a COVID rehabilitation zone, senior leadership, middle management and frontline staff faced several challenges. Future evaluations should focus on how to adapt COVID rehabilitation services during fluctuating pandemic restrictions, and to account for rehabilitative needs of people recovering from significant COVID infections.