Outdoor Community Ambulation Interventions to Improve Physical and Mental Health in Older Adults: A Systematic Review and Meta-Analysis.

Limited community ambulation, defined as independent mobility outside the home, predicts adverse outcomes in older adults. We performed a systematic review and meta-analysis to examine outdoor community ambulation intervention effectiveness in older adults. We searched six databases until October 2021. Studies with an evaluative research objective, older adult population, and outdoor community ambulation interventions were eligible. After reviewing 23,172 records, five studies were included. The meta-analysis found no significant difference in walking endurance and depression outcomes between outdoor community ambulation and comparison interventions. For outcomes not suitable for meta-analysis, studies showed no significant difference in walking activity, anxiety, and general and health-related quality of life, and possible improvements in gait speed and lower extremity function and strength. Most evidence was of low to very low certainty. Considering the limited evidence base, the design, implementation, and evaluation of outdoor community ambulation interventions in older adults should be prioritized in primary research.

Signs of Inequitable Access: Users of Private Physiotherapy Services Do Not Reflect the Urban Population in Winnipeg, Manitoba.

Purpose: Both private and public funding cover outpatient physiotherapy (PT) in Canada. Knowledge is lacking in who does and does not access PT services, which limits the ability to identify health/access inequities created by current financing structures. This study characterizes the individuals accessing private PT in Winnipeg to better understand whether inequities exist, given the very limited publicly financed PT. Methods: Patients attending PT in 32 private businesses, sampled for geographic variation, completed a survey online or on paper. We compared the sample's demographic characteristics with Winnipeg population data using chi-square goodness-of-fit tests. Results: In total, 665 adults accessing PT participated. Respondents were older and had higher levels of income and education compared to Winnipeg census data (p < 0.001). Our sample included higher proportions of female and White individuals, and lower proportions of Indigenous persons, newcomers, and people from visible minorities (p < 0.001). Conclusions: There are signs that inequities exist in access to PT in Winnipeg; the cohort who access private PT services does not reflect the wider population, which suggests that some segments of the population are not receiving care.

Objectif : un financement tant public que privé couvre les services ambulatoires de physiothérapie au Canada. On ne sait pas qui y a accès ou non, ce qui limite la possibilité de déterminer les iniquités en matière de santé et d'accès attribuables aux structures actuelles de financement. La présente étude caractérise les personnes qui accèdent à des services de physiothérapie privés à Winnipeg, afin de mieux comprendre s'il existe des iniquités, compte tenu des services de physiothérapie très limités qui sont financés par le secteur public. Méthodologie : des patients recevant des services de physiothérapie dans 32 entreprises privées, échantillonnées d'après leur variation géographique, ont rempli un sondage en ligne ou sur papier. Les chercheurs ont comparé les caractéristiques démographiques de l'échantillon aux données populationnelles de Winnipeg au moyen de tests du chi carré pour la qualité de l'ajustement. Résultats : au total, 665 adultes qui avaient accès à des services de physiothérapie ont participé. Ils étaient plus âgés et avaient un revenu et une scolarisation supérieurs aux données du recensement de Winnipeg (p < 0,001). L'échantillon contenait une plus forte proportion de femmes et de personnes blanches, et une plus faible proportion de personnes autochtones, de nouveaux arrivants et de membres des minorités visibles (p < 0,001). Conclusions : il y a des signes d'iniquité d'accès aux services de physiothérapie à Winnipeg. La cohorte qui a accès aux services de physiothérapie privés ne reflète pas l'ensemble de la population, ce qui indique que certains segments de la population ne reçoivent pas de soins.