Pub Date : 2024-03-25DOI: 10.3389/fresc.2024.1308062
Anna Katalifos, M. Elsabbagh, A. Yusuf, Sakiko Yamaguchi, Julie Scorah, Nicola Wright, M. Steiman, Andy Shih, K. Shikako
The UNICEF-WHO Global Report on Developmental Delays, Disorders, and Disabilities is an ongoing initiative aimed at increasing awareness, compiling data, providing guidance on strengthening health systems, and engaging country-level partners. Data from its caregiver survey assessing impacts of the COVID-19 pandemic showed that half of youths with developmental delays and disabilities (DDDs) and their caregivers struggled to cope, with a significant portion reporting a lack of supports and difficulty managing the worsening of the child's symptoms in isolation. Governments created service strategies supporting vulnerable groups. Little is known about the alignment between COVID-19 policies for persons with disabilities and their lived experiences. Contextualizing caregivers’ experiences can promote the development of tailored public supports for these families following a public health crisis.Online survey data were collected from June-July 2020, leading to a convenience sample of caregivers of youth with DDDs across Canada. Respondents answered two open-ended questions regarding challenges and coping strategies during the pandemic. We conducted a thematic analysis of responses using inductive coding on NVivo software. Overarching codes derived from the dataset were contextualized using an analysis of provincial policies published during the pandemic. Parallels with these policies supported the exploration of families’ and youths’ experiences during the same period.Five hundred and seventy-six (N = 576) participants answered open-ended questions. Barriers to coping included family mental health issues, concerns about the youths’ regression, challenges in online schooling, limited play spaces, and managing physical health during quarantine. Environmental barriers encompassed deteriorating family finances, loss of public services, and a lack of accessible information and supports. In contrast, caregivers reported coping facilitators, such as family time, outdoor activities, and their child's resilience. Environmental facilitators included community resources, public financial supports, and access to telehealth services. Few COVID-19 policies effectively addressed caregiver-identified barriers, while some restrictions hindered access to facilitators.Prioritizing needs of families of youths with DDDs during public health emergencies can significantly impact their experiences and mental health. Enhancing financial benefits, providing telehealth services, and creating inclusive public play spaces are priority areas as we navigate the post-pandemic landscape.
{"title":"Alignment of Canada's COVID-19 policy response with barriers and facilitators for coping reported by caregivers of youth with developmental delays, disorders, and disabilities","authors":"Anna Katalifos, M. Elsabbagh, A. Yusuf, Sakiko Yamaguchi, Julie Scorah, Nicola Wright, M. Steiman, Andy Shih, K. Shikako","doi":"10.3389/fresc.2024.1308062","DOIUrl":"https://doi.org/10.3389/fresc.2024.1308062","url":null,"abstract":"The UNICEF-WHO Global Report on Developmental Delays, Disorders, and Disabilities is an ongoing initiative aimed at increasing awareness, compiling data, providing guidance on strengthening health systems, and engaging country-level partners. Data from its caregiver survey assessing impacts of the COVID-19 pandemic showed that half of youths with developmental delays and disabilities (DDDs) and their caregivers struggled to cope, with a significant portion reporting a lack of supports and difficulty managing the worsening of the child's symptoms in isolation. Governments created service strategies supporting vulnerable groups. Little is known about the alignment between COVID-19 policies for persons with disabilities and their lived experiences. Contextualizing caregivers’ experiences can promote the development of tailored public supports for these families following a public health crisis.Online survey data were collected from June-July 2020, leading to a convenience sample of caregivers of youth with DDDs across Canada. Respondents answered two open-ended questions regarding challenges and coping strategies during the pandemic. We conducted a thematic analysis of responses using inductive coding on NVivo software. Overarching codes derived from the dataset were contextualized using an analysis of provincial policies published during the pandemic. Parallels with these policies supported the exploration of families’ and youths’ experiences during the same period.Five hundred and seventy-six (N = 576) participants answered open-ended questions. Barriers to coping included family mental health issues, concerns about the youths’ regression, challenges in online schooling, limited play spaces, and managing physical health during quarantine. Environmental barriers encompassed deteriorating family finances, loss of public services, and a lack of accessible information and supports. In contrast, caregivers reported coping facilitators, such as family time, outdoor activities, and their child's resilience. Environmental facilitators included community resources, public financial supports, and access to telehealth services. Few COVID-19 policies effectively addressed caregiver-identified barriers, while some restrictions hindered access to facilitators.Prioritizing needs of families of youths with DDDs during public health emergencies can significantly impact their experiences and mental health. Enhancing financial benefits, providing telehealth services, and creating inclusive public play spaces are priority areas as we navigate the post-pandemic landscape.","PeriodicalId":507590,"journal":{"name":"Frontiers in Rehabilitation Sciences","volume":" 27","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140385008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-20DOI: 10.3389/fresc.2024.1345505
Riley C. Sheehan, Michael Vernon
There is a need to be able to accurately evaluate whether an injured service member is able to return to duty. An effective assessment would challenge and measures physical and cognitive performance in a military-relevant context. Current assessments are lacking in one or more of these aspects. The simulation and data capture abilities of virtual reality systems are promising for use as the basis of multidimensional assessments. The team has previously developed a military-specific assessment in the Computer Assisted Rehabilitation Environment (CAREN) called the Readiness Evaluation During simulated Dismounted Operations (REDOp). Due to notable limitations in the original assessment, we have developed the next iteration, REDOp2. The assessment is able to challenge and measure a broader range of physical and cognitive performance domains in a more streamlined fashion. While limited to facilities with a CAREN, REDOp2 has the potential to provide an effective tool for highly trained and experienced wounded service members that require thorough assessment prior to returning to duty to ensure the safety of the team and mission. This methods paper describes the specific limitations in REDOp, how they were addressed in REDOp2, and suggested next steps to prepare the assessment for implementation.
{"title":"Development of a multidimensional military readiness assessment","authors":"Riley C. Sheehan, Michael Vernon","doi":"10.3389/fresc.2024.1345505","DOIUrl":"https://doi.org/10.3389/fresc.2024.1345505","url":null,"abstract":"There is a need to be able to accurately evaluate whether an injured service member is able to return to duty. An effective assessment would challenge and measures physical and cognitive performance in a military-relevant context. Current assessments are lacking in one or more of these aspects. The simulation and data capture abilities of virtual reality systems are promising for use as the basis of multidimensional assessments. The team has previously developed a military-specific assessment in the Computer Assisted Rehabilitation Environment (CAREN) called the Readiness Evaluation During simulated Dismounted Operations (REDOp). Due to notable limitations in the original assessment, we have developed the next iteration, REDOp2. The assessment is able to challenge and measure a broader range of physical and cognitive performance domains in a more streamlined fashion. While limited to facilities with a CAREN, REDOp2 has the potential to provide an effective tool for highly trained and experienced wounded service members that require thorough assessment prior to returning to duty to ensure the safety of the team and mission. This methods paper describes the specific limitations in REDOp, how they were addressed in REDOp2, and suggested next steps to prepare the assessment for implementation.","PeriodicalId":507590,"journal":{"name":"Frontiers in Rehabilitation Sciences","volume":"37 S163","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140224464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-19DOI: 10.3389/fresc.2024.1220427
Prasad A. Tendolkar, Oluwaseun Ibironke, G. Marchesi, A. De Luca, Valentina Squeri, Karen J. Nolan, R. Pilkar, K. Karunakaran
Traumatic brain injury (TBI) impairs sensory–motor functions, with debilitating consequences on postural control and balance, which persist during the chronic stages of recovery. The Timed Up and Go (TUG) test is a reliable, safe, time-efficient, and one of the most widely used clinical measures to assess gait, balance, and fall risk in TBI patients and is extensively used in inpatient and outpatient settings. Although the TUG test has been used extensively due to its ease of performance and excellent reliability, limited research has been published that investigates the relationship between TUG performance and quantitative biomechanical measures of balance. The objective of this paper was to quantify the relationship between biomechanical variables of balance and the TUG scores in individuals with chronic TBI. Regression models were constructed using six biomechanical variables to predict TUG scores. The model that conservatively removed gait speed (i.e., TUG-1/GS) gave the best results, achieving a root-mean-square error of ∼±2 s and explaining over 69% of the variability.
{"title":"Relationship between Timed Up and Go performance and quantitative biomechanical measures of balance","authors":"Prasad A. Tendolkar, Oluwaseun Ibironke, G. Marchesi, A. De Luca, Valentina Squeri, Karen J. Nolan, R. Pilkar, K. Karunakaran","doi":"10.3389/fresc.2024.1220427","DOIUrl":"https://doi.org/10.3389/fresc.2024.1220427","url":null,"abstract":"Traumatic brain injury (TBI) impairs sensory–motor functions, with debilitating consequences on postural control and balance, which persist during the chronic stages of recovery. The Timed Up and Go (TUG) test is a reliable, safe, time-efficient, and one of the most widely used clinical measures to assess gait, balance, and fall risk in TBI patients and is extensively used in inpatient and outpatient settings. Although the TUG test has been used extensively due to its ease of performance and excellent reliability, limited research has been published that investigates the relationship between TUG performance and quantitative biomechanical measures of balance. The objective of this paper was to quantify the relationship between biomechanical variables of balance and the TUG scores in individuals with chronic TBI. Regression models were constructed using six biomechanical variables to predict TUG scores. The model that conservatively removed gait speed (i.e., TUG-1/GS) gave the best results, achieving a root-mean-square error of ∼±2 s and explaining over 69% of the variability.","PeriodicalId":507590,"journal":{"name":"Frontiers in Rehabilitation Sciences","volume":"43 S11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140228976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-18DOI: 10.3389/fresc.2024.1303094
S. Dahl, E. C. Arntzen, Britt Normann
Physical activity (PA) is often reduced in people with MS (pwMS), even when disability is low. Understanding the perspectives of pwMS on interventions aiming to improve PA is important to inform the development of such services. The aim of this study was to explore the experiences of pwMS participating in an outdoor, high-intensity and balance exercise group intervention.This qualitative study was nested within an RCT exploring a novel intervention integrating sensorimotor exercises with high-intensity intervals of running/walking. Individual, in-depth interviews with the intervention group (n = 15; 12 women, 3 men; age 38–66; EDSS score 0–3.5) were conducted postintervention (mean days = 14), analyzed using a phenomenological-inspired approach with systematic text condensation, and interpreted based on enactive theory.Four categories were generated: (1) Exploration of one's own physical abilities: Challenging one's own limits was perceived by all participants to improve movement performance and/or intensity level. Such bodily changes engendered strong positive feelings. Some negative consequences of high-intensity training were described, increasing a feeling of loss. (2) New insights and beliefs: Participants experienced enhanced beliefs in their own capabilities, which they integrated in activities outside the intervention. (3) An engaging environment: The group setting was perceived as supportive, and the outdoor environment was perceived as stimulating activity. (4) Professional leadership, tailoring and co-creation of enjoyment: Physiotherapist-led, individualized interactions were regarded as necessary to safely revisit prior activities, such as running. Co-creating enjoyment facilitated high-intensity training and intervention adherence.High-intensity training combined with detailed exercises in a physiotherapy outdoor group was perceived to create meaningful bodily changes and enhance PA and prospects for both PA and life. Importantly, however, some negative experiences were also reported from the high-intensity training. Enactive theory allowed for the illumination of new perspectives: the importance of embodiment for self-efficacy and of tailored physiotherapy and an outdoor-group environment for exploring one's own limits to physical capabilities. These aspects should inform future exercise interventions in pwMS with low disability.
{"title":"The meaningfulness of exploring one's own limits through interactions and enjoyment in outdoor high-intensity physiotherapy for people with multiple sclerosis: a qualitative study","authors":"S. Dahl, E. C. Arntzen, Britt Normann","doi":"10.3389/fresc.2024.1303094","DOIUrl":"https://doi.org/10.3389/fresc.2024.1303094","url":null,"abstract":"Physical activity (PA) is often reduced in people with MS (pwMS), even when disability is low. Understanding the perspectives of pwMS on interventions aiming to improve PA is important to inform the development of such services. The aim of this study was to explore the experiences of pwMS participating in an outdoor, high-intensity and balance exercise group intervention.This qualitative study was nested within an RCT exploring a novel intervention integrating sensorimotor exercises with high-intensity intervals of running/walking. Individual, in-depth interviews with the intervention group (n = 15; 12 women, 3 men; age 38–66; EDSS score 0–3.5) were conducted postintervention (mean days = 14), analyzed using a phenomenological-inspired approach with systematic text condensation, and interpreted based on enactive theory.Four categories were generated: (1) Exploration of one's own physical abilities: Challenging one's own limits was perceived by all participants to improve movement performance and/or intensity level. Such bodily changes engendered strong positive feelings. Some negative consequences of high-intensity training were described, increasing a feeling of loss. (2) New insights and beliefs: Participants experienced enhanced beliefs in their own capabilities, which they integrated in activities outside the intervention. (3) An engaging environment: The group setting was perceived as supportive, and the outdoor environment was perceived as stimulating activity. (4) Professional leadership, tailoring and co-creation of enjoyment: Physiotherapist-led, individualized interactions were regarded as necessary to safely revisit prior activities, such as running. Co-creating enjoyment facilitated high-intensity training and intervention adherence.High-intensity training combined with detailed exercises in a physiotherapy outdoor group was perceived to create meaningful bodily changes and enhance PA and prospects for both PA and life. Importantly, however, some negative experiences were also reported from the high-intensity training. Enactive theory allowed for the illumination of new perspectives: the importance of embodiment for self-efficacy and of tailored physiotherapy and an outdoor-group environment for exploring one's own limits to physical capabilities. These aspects should inform future exercise interventions in pwMS with low disability.","PeriodicalId":507590,"journal":{"name":"Frontiers in Rehabilitation Sciences","volume":"350 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140232749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-15DOI: 10.3389/fresc.2024.1336115
Jonathan R. Gladish, C. Dearth, Mark D. Beachler, Benjamin K. Potter, Jonathan A. Forsberg, B. Hendershot
For individuals with limb loss, bone-anchored implants create a direct structural and functional connection to a terminal prosthesis. Here, we characterized the mechanical loads distal to the abutment during several functional performance tests in Service members with transfemoral (TF) limb loss, to expand on prior work evaluating more steady-state ambulation on level ground or slopes/stairs.Two males with unilateral TF limb loss and two males with bilateral TF limb loss participated after two-stage osseointegration (24 and 12 months, respectively). Tri-directional forces and moments were wirelessly recorded through a sensor, fit distal to the abutment, during six functional tests: Timed Up and Go (TUG), Four Square Step Test (FSST), Six Minute Walk Test (6MWT), Edgren Side-Step Test (SST), T-Test (TTEST), and Illinois Agility Test (IAT). Additionally, participants performed a straight-line gait evaluation on a 15 m level walkway at a self-selected speed (0.93–1.24 m/s). Peak values for each component of force and moment were extracted from all six functional tests; percent differences compared each peak with respect to the corresponding mean peak in straight-line walking.Peak mechanical loads were largest during non-steady state components of the functional tests (e.g., side-stepping during SST or TTEST, standing up from the ground during IAT). Relative to walking, peak forces during functional tests were larger by up to 143% (anterior-posterior), 181% (medial-lateral), and 110% (axial); peak moments were larger by up to 108% (flexion-extension), 50% (ab/adduction), and 211% (internal/external rotation).A more comprehensive understanding of the mechanical loads applied to bone-anchored implants during a variety of activities is critical to maximize implant survivability and long-term outcomes, particularly for Service members who are generally young at time of injury and return to active lifestyles.
{"title":"Mechanical loading of bone-anchored implants during functional performance tests in service members with transfemoral limb loss","authors":"Jonathan R. Gladish, C. Dearth, Mark D. Beachler, Benjamin K. Potter, Jonathan A. Forsberg, B. Hendershot","doi":"10.3389/fresc.2024.1336115","DOIUrl":"https://doi.org/10.3389/fresc.2024.1336115","url":null,"abstract":"For individuals with limb loss, bone-anchored implants create a direct structural and functional connection to a terminal prosthesis. Here, we characterized the mechanical loads distal to the abutment during several functional performance tests in Service members with transfemoral (TF) limb loss, to expand on prior work evaluating more steady-state ambulation on level ground or slopes/stairs.Two males with unilateral TF limb loss and two males with bilateral TF limb loss participated after two-stage osseointegration (24 and 12 months, respectively). Tri-directional forces and moments were wirelessly recorded through a sensor, fit distal to the abutment, during six functional tests: Timed Up and Go (TUG), Four Square Step Test (FSST), Six Minute Walk Test (6MWT), Edgren Side-Step Test (SST), T-Test (TTEST), and Illinois Agility Test (IAT). Additionally, participants performed a straight-line gait evaluation on a 15 m level walkway at a self-selected speed (0.93–1.24 m/s). Peak values for each component of force and moment were extracted from all six functional tests; percent differences compared each peak with respect to the corresponding mean peak in straight-line walking.Peak mechanical loads were largest during non-steady state components of the functional tests (e.g., side-stepping during SST or TTEST, standing up from the ground during IAT). Relative to walking, peak forces during functional tests were larger by up to 143% (anterior-posterior), 181% (medial-lateral), and 110% (axial); peak moments were larger by up to 108% (flexion-extension), 50% (ab/adduction), and 211% (internal/external rotation).A more comprehensive understanding of the mechanical loads applied to bone-anchored implants during a variety of activities is critical to maximize implant survivability and long-term outcomes, particularly for Service members who are generally young at time of injury and return to active lifestyles.","PeriodicalId":507590,"journal":{"name":"Frontiers in Rehabilitation Sciences","volume":"86 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140238457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rehabilitation programs have been shown to have a positive impact on patients' health and work ability. However, the durability of these effects and the extent to which patients alter their health behaviors remain underexplored. This study is divided into two parts; the first assesses the effectivity of rehabilitation programs for orthopedic patients and the durability of effects. The second part examines psychological determinants of aftercare health behaviors.Study Part 1 employs a longitudinal study design with up to nine measurement occasions encompassing a three-year follow-up period. Treatment is provided as per orthopedic indications through rehabilitation centers. Measures include subjective health, work ability, body weight, and physical activity behavior. Study Part 2 incorporates a mixed-methods design, involving both quantitative and qualitative assessments. The quantitative component aims to recruit a subsample from Study Part 1 to assess psychological determinants of aftercare health behaviors over 12 to 24 weeks using Ambulatory Assessment. The qualitative component aims to explore the reasons for maintenance and discontinuation of health behaviors and involves a reflexive thematic analysis of interviews with at least 16 individuals, analyzing the differences between those who adopt and those who discontinue their aftercare health behavior.This comprehensive research project may offer insights into the long-term effectivity of rehabilitation programs. Furthermore, it may foster a more profound understanding of the successful incorporation of health-promoting aftercare behaviors, such as physical activity, into everyday life. Therefore, this study may contribute significantly to the evolving field of patient-centered rehabilitation.The trial has been registered at the German Register of Clinical Studies (DRKS) with the registration number: DRKS00032257
{"title":"WiN-Reha—effectiveness and durability of effects of orthopedic rehabilitation programs and the study of psychological determinants of aftercare behaviors: a study protocol","authors":"Katharina Feil, Julian Fritsch, Susanne Weyland, Lena-Marie Rittmann, Detlef Schmidt, D. Jekauc","doi":"10.3389/fresc.2024.1333924","DOIUrl":"https://doi.org/10.3389/fresc.2024.1333924","url":null,"abstract":"Rehabilitation programs have been shown to have a positive impact on patients' health and work ability. However, the durability of these effects and the extent to which patients alter their health behaviors remain underexplored. This study is divided into two parts; the first assesses the effectivity of rehabilitation programs for orthopedic patients and the durability of effects. The second part examines psychological determinants of aftercare health behaviors.Study Part 1 employs a longitudinal study design with up to nine measurement occasions encompassing a three-year follow-up period. Treatment is provided as per orthopedic indications through rehabilitation centers. Measures include subjective health, work ability, body weight, and physical activity behavior. Study Part 2 incorporates a mixed-methods design, involving both quantitative and qualitative assessments. The quantitative component aims to recruit a subsample from Study Part 1 to assess psychological determinants of aftercare health behaviors over 12 to 24 weeks using Ambulatory Assessment. The qualitative component aims to explore the reasons for maintenance and discontinuation of health behaviors and involves a reflexive thematic analysis of interviews with at least 16 individuals, analyzing the differences between those who adopt and those who discontinue their aftercare health behavior.This comprehensive research project may offer insights into the long-term effectivity of rehabilitation programs. Furthermore, it may foster a more profound understanding of the successful incorporation of health-promoting aftercare behaviors, such as physical activity, into everyday life. Therefore, this study may contribute significantly to the evolving field of patient-centered rehabilitation.The trial has been registered at the German Register of Clinical Studies (DRKS) with the registration number: DRKS00032257","PeriodicalId":507590,"journal":{"name":"Frontiers in Rehabilitation Sciences","volume":"92 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140250767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-21DOI: 10.3389/fresc.2024.1302179
K. Clanchy, J. Mitchell, K. Mulholland, E. Jurd, E. Kendall, D. G. Lloyd, D. Palipana, C. Pizzolato, C. Shirota
Early stakeholder engagement is critical to the successful development and translation of rehabilitation technologies, a pivotal step of which is usability testing with intended end-users. To this end, several methods employ end-user feedback to identify usability and implementation issues. However, the process of prioritizing identified issues seldom leverages the knowledge and expertise of the range of stakeholders who will ultimately affect the demand and supply of a device. This paper describes a novel method to prioritize end-user feedback using transdisciplinary stakeholder consultation and address it in subsequent product development. The proposed approach was demonstrated using a case study relating to the development of a novel technology for neural recovery after spinal cord injury.Feedback from five individuals with chronic spinal cord injury was collected during two-hour usability evaluation sessions with a fully functional high-fidelity system prototype. A think-aloud and semi-structured interview protocol was used with each participant to identify usability and acceptability issues relating to the system in a 3-phase approach. Phase 1 involved extracting usability issues from think-aloud and semi-structured interview data. Phase 2 involved rating the usability issues based on their significance, technical feasibility, and implementation priority by relevant internal and external stakeholders. Finally, Phase 3 involved aggregating the usability issues according to design and implementation elements to facilitate solution generation, and these solutions were then raised as action tasks for future design iterations.Sixty usability issues representing nine facets of usability were rated. Eighty percent of issues were rated to be of moderate to high significance, 83% were rated as being feasible to address, and 75% were rated as addressable using existing project resources. Fifty percent of the issues were rated to be a high priority for implementation. Evaluation of the grouped issues identified 21 tasks which were mapped to the product roadmap for integration into future design iterations.This paper presents a method for meaningful transdisciplinary stakeholder engagement in rehabilitation technology development that can extended to other projects. Alongside a worked example, we offer practical considerations for others seeking to co-develop rehabilitation technologies.
{"title":"Towards co-design of rehabilitation technologies: a collaborative approach to prioritize usability issues","authors":"K. Clanchy, J. Mitchell, K. Mulholland, E. Jurd, E. Kendall, D. G. Lloyd, D. Palipana, C. Pizzolato, C. Shirota","doi":"10.3389/fresc.2024.1302179","DOIUrl":"https://doi.org/10.3389/fresc.2024.1302179","url":null,"abstract":"Early stakeholder engagement is critical to the successful development and translation of rehabilitation technologies, a pivotal step of which is usability testing with intended end-users. To this end, several methods employ end-user feedback to identify usability and implementation issues. However, the process of prioritizing identified issues seldom leverages the knowledge and expertise of the range of stakeholders who will ultimately affect the demand and supply of a device. This paper describes a novel method to prioritize end-user feedback using transdisciplinary stakeholder consultation and address it in subsequent product development. The proposed approach was demonstrated using a case study relating to the development of a novel technology for neural recovery after spinal cord injury.Feedback from five individuals with chronic spinal cord injury was collected during two-hour usability evaluation sessions with a fully functional high-fidelity system prototype. A think-aloud and semi-structured interview protocol was used with each participant to identify usability and acceptability issues relating to the system in a 3-phase approach. Phase 1 involved extracting usability issues from think-aloud and semi-structured interview data. Phase 2 involved rating the usability issues based on their significance, technical feasibility, and implementation priority by relevant internal and external stakeholders. Finally, Phase 3 involved aggregating the usability issues according to design and implementation elements to facilitate solution generation, and these solutions were then raised as action tasks for future design iterations.Sixty usability issues representing nine facets of usability were rated. Eighty percent of issues were rated to be of moderate to high significance, 83% were rated as being feasible to address, and 75% were rated as addressable using existing project resources. Fifty percent of the issues were rated to be a high priority for implementation. Evaluation of the grouped issues identified 21 tasks which were mapped to the product roadmap for integration into future design iterations.This paper presents a method for meaningful transdisciplinary stakeholder engagement in rehabilitation technology development that can extended to other projects. Alongside a worked example, we offer practical considerations for others seeking to co-develop rehabilitation technologies.","PeriodicalId":507590,"journal":{"name":"Frontiers in Rehabilitation Sciences","volume":"10 13","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139958033","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-16DOI: 10.3389/fresc.2024.1276713
Mary Okon, Kei Yen Chan, Shaun T. O’Keeffe
Dysphagia is common in nursing home (NH) residents. Staff may not always be able to access speech and language therapist (SLT) assessments in a timely manner and there are some reports of nurses initiating or changing modified diets in these circumstances.A mixed quantitative and qualitative approach was used to analyse responses to an online anonymized survey of senior nurses working in Irish NHs. They were asked about their experience of delays accessing SLT services and whether they would ever initiate or change modified diets. Respondents were asked if they would give water to a thirsty resident, prescribed mildly thick liquids, who demanded it on a hot day because thickened fluid was not thirst quenching.Of 77 nurses surveyed, 63 (82%) responded. Three quarters reported delays accessing SLT services sometimes or often. Thirty-four (54.0%) would not give the thirsty resident water. About 70% reported that thickened fluids or modified texture diets were started without SLT sometimes or often. A third of respondents would thicken fluids or modify food to a greater extent than previously recommended but very few would make a diet less restrictive. The main themes that emerged from the comments provided were related to the uncertainty and dilemmas created for staff, what mitigating actions they might take in those circumstances and the need for better guidance and better access to SLT services.Delays accessing SLT services are common for Irish NHs, and staff may initiate or change modified diets themselves in these circumstances. The responses suggest a widespread, and unjustified, belief that thicker or more modified is better for those with dysphagia. Clear and accurate guidance, and a better SLT service, is needed for NH staff.
{"title":"“In Limbo”—use of, and alterations to, modified diets by nursing home staff in the absence of timely specialist support","authors":"Mary Okon, Kei Yen Chan, Shaun T. O’Keeffe","doi":"10.3389/fresc.2024.1276713","DOIUrl":"https://doi.org/10.3389/fresc.2024.1276713","url":null,"abstract":"Dysphagia is common in nursing home (NH) residents. Staff may not always be able to access speech and language therapist (SLT) assessments in a timely manner and there are some reports of nurses initiating or changing modified diets in these circumstances.A mixed quantitative and qualitative approach was used to analyse responses to an online anonymized survey of senior nurses working in Irish NHs. They were asked about their experience of delays accessing SLT services and whether they would ever initiate or change modified diets. Respondents were asked if they would give water to a thirsty resident, prescribed mildly thick liquids, who demanded it on a hot day because thickened fluid was not thirst quenching.Of 77 nurses surveyed, 63 (82%) responded. Three quarters reported delays accessing SLT services sometimes or often. Thirty-four (54.0%) would not give the thirsty resident water. About 70% reported that thickened fluids or modified texture diets were started without SLT sometimes or often. A third of respondents would thicken fluids or modify food to a greater extent than previously recommended but very few would make a diet less restrictive. The main themes that emerged from the comments provided were related to the uncertainty and dilemmas created for staff, what mitigating actions they might take in those circumstances and the need for better guidance and better access to SLT services.Delays accessing SLT services are common for Irish NHs, and staff may initiate or change modified diets themselves in these circumstances. The responses suggest a widespread, and unjustified, belief that thicker or more modified is better for those with dysphagia. Clear and accurate guidance, and a better SLT service, is needed for NH staff.","PeriodicalId":507590,"journal":{"name":"Frontiers in Rehabilitation Sciences","volume":"35 23","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139962431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-16DOI: 10.3389/fresc.2024.1335467
Emily E. Giroux, Peter Athanasopoulos, Shane N. Sweet, Heather L Gainforth
Spinal cord injury (SCI) research and policy decisions are rarely made in partnership with people with SCI, making them less relevant, applicable, and used by those whom the decisions are intended to support. Across disciplines, consensus methods have been promoted as a viable solution for supporting shared research and policy-based decision-making. In this paper, we describe a partnered approach between academic researchers and the Ontario SCI Alliance, a non-profit, SCI community mobilization network to co-develop and co-disseminate a community-based consensus exercise. The community-based consensus exercise included two modified Delphi surveys and one in-person retreat. The partnership's goal with this exercise was to facilitate shared decision-making for the development of their upcoming strategic plan. We then interviewed partners and participants from the Delphi and in-person retreat to discuss successes, challenges, and lessons learned from the exercise. Survey 1 was disseminated to over 2,500 members of the Ontario SCI community and received 374 responses (276 coming from people with SCI). Survey 2 had 118 responses, with 87 coming from people with SCI. The retreat had 73 attendees, including people with SCI, family/friends of people with SCI, clinicians, researchers, and SCI community and research organization staff/volunteers. The retreat included a presentation of the survey results, a clinician/researcher panel, and externally-facilitated working groups. All survey responses and retreat materials were synthesized. Using the synthesized feedback, the Ontario SCI Alliance was able to implement several changes for the Ontario SCI community, including higher-quality primary care experiences (reduced wait times, more accessible examining rooms), the development of a wound care strategy with the Ontario government, and an advocacy campaign for public coverage for catheters and urinary care supplies. From the five interviews conducted, five themes were co-constructed regarding the successes, challenges, and lessons learned from the exercise: (1) Inclusion, Diversity, Equity, and Accessibility; (2) Partnership; (3) Design Considerations; (4) Transparency and Clarity in Communication; and (5) Sustainability. Findings from this community case study demonstrate the feasibility of conducting a community-level consensus exercise among an equity-deserving group while providing detailed guidance for how to ensure future research and policy-based decision-making is shared across diverse knowledge users.
{"title":"A case study of using community-based consensus methods to facilitate shared decision-making among a spinal cord injury network","authors":"Emily E. Giroux, Peter Athanasopoulos, Shane N. Sweet, Heather L Gainforth","doi":"10.3389/fresc.2024.1335467","DOIUrl":"https://doi.org/10.3389/fresc.2024.1335467","url":null,"abstract":"Spinal cord injury (SCI) research and policy decisions are rarely made in partnership with people with SCI, making them less relevant, applicable, and used by those whom the decisions are intended to support. Across disciplines, consensus methods have been promoted as a viable solution for supporting shared research and policy-based decision-making. In this paper, we describe a partnered approach between academic researchers and the Ontario SCI Alliance, a non-profit, SCI community mobilization network to co-develop and co-disseminate a community-based consensus exercise. The community-based consensus exercise included two modified Delphi surveys and one in-person retreat. The partnership's goal with this exercise was to facilitate shared decision-making for the development of their upcoming strategic plan. We then interviewed partners and participants from the Delphi and in-person retreat to discuss successes, challenges, and lessons learned from the exercise. Survey 1 was disseminated to over 2,500 members of the Ontario SCI community and received 374 responses (276 coming from people with SCI). Survey 2 had 118 responses, with 87 coming from people with SCI. The retreat had 73 attendees, including people with SCI, family/friends of people with SCI, clinicians, researchers, and SCI community and research organization staff/volunteers. The retreat included a presentation of the survey results, a clinician/researcher panel, and externally-facilitated working groups. All survey responses and retreat materials were synthesized. Using the synthesized feedback, the Ontario SCI Alliance was able to implement several changes for the Ontario SCI community, including higher-quality primary care experiences (reduced wait times, more accessible examining rooms), the development of a wound care strategy with the Ontario government, and an advocacy campaign for public coverage for catheters and urinary care supplies. From the five interviews conducted, five themes were co-constructed regarding the successes, challenges, and lessons learned from the exercise: (1) Inclusion, Diversity, Equity, and Accessibility; (2) Partnership; (3) Design Considerations; (4) Transparency and Clarity in Communication; and (5) Sustainability. Findings from this community case study demonstrate the feasibility of conducting a community-level consensus exercise among an equity-deserving group while providing detailed guidance for how to ensure future research and policy-based decision-making is shared across diverse knowledge users.","PeriodicalId":507590,"journal":{"name":"Frontiers in Rehabilitation Sciences","volume":"31 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139960485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-15DOI: 10.3389/fresc.2024.1266065
Matthias Lukasczik, H-D Wolf, Heiner Vogel
The purpose of this study was to develop a question prompt list (QPL) to support patients undergoing work-related medical rehabilitation in obtaining relevant information and to explore how patients and physicians rate the QPL regarding its usefulness, practicability, and perceived (additional) effort.An initial item pool was assessed by rehabilitation patients (N = 3) in cognitive interviews, rated by physicians and other health professionals (N = 11), and then further modified. The final QPL version (16 items) was used by patients (N = 36) in medical admission interviews in an inpatient medical rehabilitation facility and then evaluated. Physicians evaluated the QPL after each interview with a study participant (N = 6; k = 39 interviews).The QPL was used by 50% of patients who rated its usefulness and comprehensibility positively. Neither the need for information nor satisfaction with the information received was correlated with QPL use. The physicians' assessment showed a positive evaluation regarding the provision of information and structuring of the conversation, but also a higher perceived time expenditure.While initial testing of the QPL in work-related medical rehabilitation as a tool to support patient-provider communication generally showed a favorable evaluation by patients using it and physicians, future research should address its validity and effectiveness.
{"title":"Development and initial evaluation of the usefulness of a question prompt list to promote patients' level of information about work-related medical rehabilitation: a pilot study","authors":"Matthias Lukasczik, H-D Wolf, Heiner Vogel","doi":"10.3389/fresc.2024.1266065","DOIUrl":"https://doi.org/10.3389/fresc.2024.1266065","url":null,"abstract":"The purpose of this study was to develop a question prompt list (QPL) to support patients undergoing work-related medical rehabilitation in obtaining relevant information and to explore how patients and physicians rate the QPL regarding its usefulness, practicability, and perceived (additional) effort.An initial item pool was assessed by rehabilitation patients (N = 3) in cognitive interviews, rated by physicians and other health professionals (N = 11), and then further modified. The final QPL version (16 items) was used by patients (N = 36) in medical admission interviews in an inpatient medical rehabilitation facility and then evaluated. Physicians evaluated the QPL after each interview with a study participant (N = 6; k = 39 interviews).The QPL was used by 50% of patients who rated its usefulness and comprehensibility positively. Neither the need for information nor satisfaction with the information received was correlated with QPL use. The physicians' assessment showed a positive evaluation regarding the provision of information and structuring of the conversation, but also a higher perceived time expenditure.While initial testing of the QPL in work-related medical rehabilitation as a tool to support patient-provider communication generally showed a favorable evaluation by patients using it and physicians, future research should address its validity and effectiveness.","PeriodicalId":507590,"journal":{"name":"Frontiers in Rehabilitation Sciences","volume":"425 19","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139834250","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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