Allyson Jones

Chronic disease self-management for individuals with stroke, multiple sclerosis and spinal cord injury

Purpose. The purpose of this study was to explore the experience of people with neurological conditions who take the chronic disease self-management (CDSM) programme. The CDSM programme is used to teach skills to manage chronic conditions, and prevent secondary conditions. Few studies have explored the use of the CDSM programme with people with neurological conditions, in spite of the long standing and sometimes unpredictable nature of those conditions. Method. This qualitative study explored the experience of people with stroke, multiple sclerosis (MS) and spinal cord injury (SCI) who participated in the CDSM programme. We completed individual interviews using a semi-structured interview guide with 22 individuals with stroke, MS and SCI. Results. Five categories emerged from the interview discussions including: (1) pre-programme influences; (2) group; (3) factors affecting learning opportunities; (4) workshop content and (5) outcomes. Conclusions. The results of this study provide insights regarding the optimal way to present the CDSM programme to people with neurological conditions.

Economic Evaluation for Assistive Technology Policy Decisions

Economic evaluation analysis comprises a set of tools that are used to assess alternative health technologies, including assistive technologies. Health technology assessment is a set of concepts that are used to evaluate technologies and to make policy recommendations. This article presents an exposition of each of these areas: the tools that are used to conduct an economic evaluation, how these tools fit in to the larger policy-related analysis of health technology assessment, and how these tools can be used in the assistive technology field.

Geographic and Temporal Distribution of Mortality Rates for Multiple Sclerosis in Canada, 1965–1994

Statistics Canada data were used to calculate multiple sclerosis (MS) mortality rates per 100,000 population in the Canadian provinces from 1965 to 1994. For the period 1965–1994, the highest average annual MS mortality rates were in Quebec (4.4) and Ontario (3.9), while the Western Provinces had an intermediate rate (2.1) and the Atlantic Provinces had the lowest rate (1.2). Female mortality rates exceeded male rates in each of the four regions. Average annual MS mortality rates in Canada overall fluctuated during the past 30 years, with rates of 3.4 in 1965–1969, 4.2 in 1970–1974, 3.2 in 1975–1979, 2.3 in 1980–1984, 2.8 in 1985–1989 and 3.9 in 1990–1994. Female mortality rates exceeded male rates during each 5-year period. The highest mortality rates for both genders were in the 65 years plus age group. Rates in the under 45 years age group have remained stable, while rates in both the 45–64 and 65 years plus age groups have fluctuated. There is no apparent relationship between prevalence and mortality rates among the Canadian provinces.

The efficacy of pre-operative home visits for total hip replacement clients.

Background. There is increasing realization among health care administrative decision makers and service providers that we must measure the true value of expensive services by demonstrating the achievement of identified goals. Purpose. The objective of this study was to determine whether clients who received the home-based intervention for a hip arthroplasty would result in a more timely discharge home from hospital. Method. Two hundred and eight clients receiving a total hip replacement at two acute care hospitals comprised the sample. One hospital included the more costly home-based pre-operative teaching by an occupational therapist as part of its protocol while the other provided comparative occupational therapy intervention within its hospital based pre-admission clinic. Discharge disposition and length of hospital stay were measured. Results. Though no significant difference in either of these outcomes was found, a number of issues were raised indicating the complexity of resource allocation to this client population and the importance of the qualitative dimensions of care. Practice Implications. The location for pre-operative teaching for total hip replacements was not found to impact the length of hospital stay nor whether clients are discharged directly home.

Commonalities and differences in the implementation of models of care for arthritis: key informant interviews from Canada

BackgroundTimely access to effective treatments for arthritis is a priority at national, provincial and regional levels in Canada due to population aging coupled with limited health human resources. Models of care for arthritis are being implemented across the country but mainly in local contexts, not from an evidence-informed policy or framework. The purpose of this study is to examine existing models of care for arthritis in Canada at the local level in order to identify commonalities and differences in their implementation that could point to important considerations for health policy and service delivery.MethodsSemi-structured key informant interviews were conducted with 70 program managers and/or care providers in three Canadian provinces identified through purposive and snowball sampling followed by more detailed examination of 6 models of care (two per province). Interviews were transcribed verbatim and analyzed thematically using a qualitative descriptive approach.ResultsTwo broad models of care were identified for Total Joint Replacement and Inflammatory Arthritis. Commonalities included lack of complete and appropriate referrals from primary care physicians and lack of health human resources to meet local demands. Strategies included standardized referrals and centralized intake and triage using non-specialist health care professionals. Differences included the nature of the care and follow-up, the role of the specialist, and location of service delivery.ConclusionsCurrent models of care are mainly focused on Total Joint Replacement and Inflammatory Arthritis. Given the increasing prevalence of arthritis and that published data report only a small proportion of current service delivery is specialist care; provision of timely, appropriate care requires development, implementation and evaluation of models of care across the continuum of care.

Rehabilitation Research for Older Adults: Outcomes of a Knowledge Translation and Network Engagement Event

In this article, we describe a knowledge translation symposium focused on rehabilitation research for older adults. The symposium consisted of presentations on rehabilitation research, followed by roundtable discussions designed to solicit perspectives of public stakeholders. Eighty-eight people attended the event, most with backgrounds in health care service provision. The participants evaluated the event and provided feedback on research topics related to rehabilitation of older adults. Lessons learned from this event may be useful in the design of future knowledge translation symposia and to facilitate involvement of public stakeholders in design, implementation, and dissemination of rehabilitation research for older adults.