Diana Zidarov

Quality of Life of Persons With Lower-Limb Amputation During Rehabilitation and at 3-Month Follow-Up

OBJECTIVE To describe and compare the quality of life (QOL) of persons with lower-limb amputation (LLA) at admission (T1), discharge (T2), and 3 months after rehabilitation discharge (T3) and to explore the relationships between QOL and demographic and clinical variables including body image. DESIGN Longitudinal case series. SETTING Inpatient rehabilitation facility. PARTICIPANTS Consecutive sample of 19 unilateral persons with LLA (14 men, mean age, 53.4+/-14.6y). INTERVENTION Interdisciplinary rehabilitation. MAIN OUTCOME MEASURES Generic and specific QOL measures and perception of body image at T1, T2, and T3. RESULTS Subjective QOL was relatively high at T1, T2, and T3 (0.87/2, 1.1/2, and 1.0/2, respectively) except for items related to physical functioning. There was no significant change over time for all but 1 QOL satisfaction measure (ability to go outside, P=.024). Prosthesis-related QOL was high at discharge and follow-up. Body-image disturbances were absent over the study period. QOL satisfaction and prosthesis satisfaction were strongly related to lower-limb pain and psychosocial factors (eg, body image). CONCLUSIONS QOL of persons with LLA was high and remained relatively stable during inpatient rehabilitation and 3 months after discharge.

Knowledge translation in physical therapy: from theory to practice

Abstract Purpose: Knowledge translation (KT) has emerged as a concept that can lead to a greater utilization of evidence-based research in systems of care. Despite a rise in KT research, the literature on KT in relation to physical therapy practice is scarce. This article provides physical therapists (PTs) with recommendations that can support the effective implementation of new knowledge and scientific evidence in clinical practice. Method: Recommendations are grounded in the Ottawa Model of Research Use and in the literature in KT in the health professions. Results: A well-established KT process, which is supported by a planning model, is essential to guide the implementation of scientific evidence. Consensus among all stakeholders about what evidence will be implemented must be reached. Context-related barriers and facilitators should be assessed and tailored active and multi-component interventions should be considered. Participation from individuals in intermediary positions (e.g. opinion leaders) supports implementation of KT interventions. Monitoring of the process and assessment of intended outcomes should be performed in order to assess the success of the implementation. Conclusion: Five major recommendations grounded in the Ottawa model are provided that can assist PTs with the complex task of implementing new knowledge in their clinical practice. Implications for Rehabilitation In order to support EBP, knowledge translation interventions can be used to support best practice. Implementation of new knowledge should be guided by a framework or a conceptual model. Consensus on the evidence must be reached and assessment of context-related factors should be done prior to the implementation of any KT intervention. Intervention strategies should be active, multi-component and include individuals with intermediary positions that can facilitate the KT process.

Life Habits and Prosthetic Profile of Persons With Lower-Limb Amputation During Rehabilitation and at 3-Month Follow-Up

OBJECTIVE To assess performance of life habits among persons with lower-limb amputation at admission, at discharge, and 3 months after rehabilitation discharge and describe their prosthetic profile at discharge and follow-up. DESIGN Case series. SETTING Inpatient rehabilitation. PARTICIPANTS Unilateral persons with lower-limb amputation (N=19; 14 men; mean age, 53.4+/-14.6y). INTERVENTION Interdisciplinary rehabilitation. MAIN OUTCOME MEASURES Life habits performance and prosthetic profile. RESULTS In the daily activities subdomain, the lowest performances were observed for mobility and housing at all evaluation times. Within the social role subdomain, employment, recreation, and community life scores were the lowest for the 3 evaluations. Mean scores for all activities of daily living subdomain categories significantly increased (P<.05) during rehabilitation except for personal care and communication. Only community life (social roles subdomain) significantly increased during rehabilitation; life habits remained unchanged after discharge. Fifty-eight percent of patients at discharge versus 68.4% at follow-up used their prosthesis for more than 9 hours a day, and this increased significantly postdischarge (P=.017). Locomotor capability with prosthesis was similarly high at discharge and follow-up. CONCLUSIONS Among persons with lower-limb amputation, social role life habits appear to be more disturbed than those associated with activities of daily living. At discharge, prosthetic wear and locomotor capabilities with prosthesis were high and tended to improve on return to the community.

Evaluating the implementation process of a new telerehabilitation modality in three rehabilitation settings using the normalization process theory: study protocol

ABSTRACT Introducing innovations such as telerehabilitation (TR) into routine care involves complex changes in organizations. This study protocol aims to (1) examine the extent to which a TR platform was implemented as intended in three clinical settings and (2) identify which TR activities were becoming integrated into routine clinical practices, and which factors affect the routine use of the platform. A mixed-method prospective single-case study design with multiple embedded units of analysis will be used. Pre/post-implementation data collection will focus on implementation leaders, clinical champions, upper management, and clinical staff. Qualitative data include semistructured individual interviews with leaders, champions, and upper management as well as focus groups with clinical staff who are users and non-users of the TR platform. Quantitative data include TR use data and TR implementation questionnaires. The consolidated framework for implementation research will be used to analyze the implementation process and normalization process theory will be used to analyze the embedding of TR in routine daily practice. The project is expected to yield evidence regarding which specific TR activities are implemented in day-to-day clinical activities as well as capture threats and opportunities to normalization at a critical moment when it is expected to occur.

Telerehabilitation implementation and routine clinical use: Preliminary findings from a case study across three rehabilitation centers

Integrating innovations such as telerehabilitation (TR) into routine clinical care is a complex process. This study aimed to identify the factors which impact on TR implementation and routine use. Methods. A mixed-method prospective single-case study with multiple embedded units of analysis was conducted. Interviews (implementation leaders, clinical champions and upper management) and focus groups with users and non-users of TR were conducted, and TR use was recorded. The Consolidated Framework for Implementation Research and Normalization Process Theory were used to examine factors which impacted on TR implementation and routine use. Results. Over 18 months, 155 TR sessions were carried out by 12 clinicians (6% of potential staff), eight of which continued using TR routinely clinical activities. During implementation, deviations to the intended implementation and unexpected delays impacted on TR use. TR continued to be used for some clinical activities. Facilitators and barriers were related to the intervention, the organisations and the health care context. Discussion. Comprehensive frameworks and theories used in long term studies of TR use can help identify factors which impact on implementation and routine clinical use.

Integrating the perspectives of individuals with spinal cord injuries, their family caregivers and healthcare professionals from the time of rehabilitation admission to community reintegration: protocol for a scoping study on SCI needs

Introduction There is fragmented information about the different needs following a spinal cord injury (SCI). Expressed SCI needs can be met or unmet, they change along the rehabilitation continuum (eg, acute, rehabilitation and reintegration into the community) and can be different for traumatic and non traumatic SCI. The general objective of this scoping study is to evaluate and integrate the needs of individuals with traumatic and non-traumatic SCI, their family caregivers and those reported by rehabilitation professionals from the time of rehabilitation admission to community reintegration. The specific objectives are to: (A) synthesise the needs of individuals with SCI as perceived by themselves, their family caregivers and rehabilitation professionals using two theoretical models, (B) classify needs as met and unmet, (C) explore the evolution of met/unmet needs from the time of rehabilitation admission to community reintegration and (D) provide recommendations to improve SCI care. Methods and analysis (A) identifying the most frequent met and unmet needs reported by adults with traumatic and non-traumatic SCI, their family caregivers and their rehabilitation professionals from the time of rehabilitation admission to community reintegration; (B) identifying relevant studies with a search in electronic databases; (C) charting the data based on categories refined and adjusted with a stakeholder group; (D) collating, summarising and reporting the results using two analytical frameworks (Maslows hierarchical model of human needs and the Ferrans et als model of health-related quality of life) and (E) a stakeholder consultation phase. Ethics and dissemination The results of this scoping study will allow understanding SCI needs from the time of rehabilitation admission to community reintegration from the perspective of different stakeholders. An integrated master report combining the needs of individuals with SCI from the perspectives of different stakeholders from the time of rehabilitation admission to community reintegration will follow the consultation meetings.

Performance and quality indicators for the management of non-cancer chronic pain: a scoping review protocol.

Introduction Chronic pain is a public health problem of epidemic proportion in most countries with important physical, psychological, social and economic consequences. The management of chronic pain is complex and requires an integrated network approach between all levels of the healthcare system and the involvement of several health professionals from different disciplines. Measuring the performance of organisations that provide care to individuals with chronic pain is essential to improve quality of care and requires the use of relevant performance and quality indicators. A scoping review methodology will be used to synthesise the evidence on performance and quality indicators developed for non-cancer chronic pain management across the continuum of care. Methods and analysis The following electronic databases will be searched from 2000 onwards: Cochrane Effective Practice and Organisation of Care (EPOC) Review Group Specialised Register; Cochrane Library; EMBASE; PubMed; CINAHL; PsycINFO; ProQuest Dissertations and Theses. All types of studies will be included if these are concerned with performance or quality indicators in adults with chronic non-cancer pain. In addition, searches will be conducted on provincial, national and international health organisations as well as health professional and scientific associations’ websites. A qualitative descriptive approach will be used to describe characteristics of each indicator. All identified indicators will be classified according to dimensions covered by Donabedian and the Triple Aim frameworks. Ethics and dissemination The scoping review findings will inform the development of a performance measurement system comprising a list of performance indicators with their level of evidence which can be used by stakeholders to evaluate the quality of care for individuals with chronic non-cancer pain at the patient, institutional and system level. The results will be disseminated via several knowledge translation strategies, including 2 stakeholder meetings, publication and presentation at conferences.