Manon Guay

Performance of the ‘Unaffected’ Upper Extremity of Elderly Stroke Patients

BACKGROUND AND PURPOSE The main objective of this study was to compare the sensorimotor performance of the unaffected upper extremity (UE) of elderly stroke patients with that of healthy elderly people. METHODS The group of stroke patients was composed of 43 hemiplegic/paretic subjects who had had a cerebrovascular accident at least 6 months earlier. They were > or = 60 years old, were right-handed before the stroke, had visual perception within normal limits, and showed no major cognitive impairments. A group of 43 healthy subjects matched for dominance, age, and sex was used for comparison. The main parameters of the performance of the unaffected UE of the stroke subjects and of the same side of the healthy subjects were measured with valid, reliable instruments. Some variables potentially related to the unaffected UE were also measured: affected UE motor function, functional independence, length of time since the stroke, self-perceived health status, activity level, and hand anthropometry. RESULTS Statistical analyses showed significant deficits in the unaffected UE of hemiplegic/paretic subjects compared with normal subjects with regard to the following parameters: gross manual dexterity, fine manual dexterity, motor coordination, global performance, and kinesthesia (P < .01 to P < .0001). No significant clinical or statistical difference was found for grip strength (P < .81), static and moving two-point discrimination (P = .21 and P = .12), or touch/pressure threshold (P < .91). CONCLUSIONS Many factors (frequency of use of the unaffected hand, sensorimotor interaction tasks, severity of the deficits in corticifugal projections, and deficits in postural stabilization) could interact to provide the clinical picture obtained in the present study.

Exponential Increases in the Prevalence of Disability in the Oldest Old: A Canadian National Survey

Background: As most studies generally treat all 85+ year-olds as a homogeneous group, little is known about the specific disabilities of the oldest old population, those aged 90 and older. Objective: To estimate age-specific prevalence of disability in activities of daily living for older Canadians, including the oldest old, those aged 90 and older. Methods: Cross-sectional national survey with a representative sample of noninstitutionalized Canadians aged between 50 and 104 years old (n = 28,406). Disability was self-reported and defined as needing assistance to perform self-care and domestic life activities. Results: The prevalence of disability increased with age, and the rise appeared exponential when considering the oldest old. At age 90, the highest estimated rates of disability were reported for housekeeping (50%), shopping (45%) and transportation (44%), and 21% reported requiring assistance for washing themselves. Compared to the 85-89 age group, the estimated proportion of people reporting disability in the 95+ age group approximately triples for self-care activities and doubles for domestic life activities. Conclusion: Even if we knew that disability increases with age, we can now state that it increases at an accelerated rate beyond age 85. Grouping people aged 85+ into one category leads to substantial underestimates of disability in the oldest old. Accurate estimates are necessary for adequate allocation of care and rehabilitation resources for a rapidly expanding age group.

Can home health aids using the clinical algorithm Algo choose the right bath seat for clients having a straightforward problem

Objective: To determine if Algo, a clinical algorithm to select bathing equipment for ‘straightforward’ cases, guides home health aides in selecting the appropriate bath seat. Design: Criterion validity study. Setting: Community home care. Subjects: Eight home health aides used Algo with community-dwelling older adults having a straightforward problem. Main measures: Their bath-seat recommendations were compared with those proposed by an occupational therapist (OT), which were considered as the gold standard. In order to determine a clinically acceptable threshold of agreement between the recommendations, a subgroup of community-dwelling elderly people was assessed a third time by another OT. Results: Half of the clients (74/143) for whom bathroom assessments were requested qualified as potentially straightforward cases after triage and were visited at home by a home health aide using Algo. In 84% of cases (95% confidence interval (CI) = [75, 93]), the non-OTs using Algo identified a seat that would enable these older adults to bathe according to their preferences, abilities and environment, as confirmed by the gold standard OT. Moreover, this appropriateness rate did not statistically differ from that obtained when comparing another OT to the gold standard. Conclusion: Algo guides non-OTs toward a bath seat that meets the needs of community-dwelling older adults in the majority of cases.

Identifying Characteristics of ‘Straightforward Cases’ for which Support Personnel Could Recommend Home Bathing Equipment:

Introduction: The general consensus is that an occupational therapist should carry out the assessment for recommending home bathing equipment. Nevertheless, in response to a shortage of human resources, home-care occupational therapists in Quebec, Canada, frequently transfer the clinical task of recommending bathing equipment to support personnel in ‘straightforward cases’. However, there is no consensus on what constitutes such cases, and clinicians lack information on how to define a straightforward case. Objective: To characterise ‘straightforward cases’ when recommending bathing equipment in home-care occupational therapy. Design: The RAND/UCLA Appropriateness Method, combining a literature review with a three-round survey and one focus group meeting of nine occupational therapists. Results: Eight characteristics required for describing straightforward cases for bathing equipment recommendations were identified. They cover the three dimensions of the Canadian Model of Occupational Performance and Engagement: the occupation, the person, and the persons home environment. Conclusion: The literature review and collective opinion of experienced occupational therapists made it possible to agree on a common language to describe straightforward cases for bathing equipment. The characteristics identified will, it is hoped, support the critical thinking of clinicians deciding whether or not to transfer the task of recommending bathing equipment to support personnel.

Exploring support needed by home health aides in choosing bathing equipment: New challenges for occupational therapy collaboration

UNLABELLED In Quebec (Canada), home health aides are gradually being involved in choosing bathing equipment for community-dwelling clients with bathing difficulties, a task traditionally performed by occupational therapists. OBJECTIVE This article explores the support home health aides want in assuming this clinical task. PARTICIPANTS Three home health aides having previously intervened with clients with bathing difficulties. METHODS Home health aides were first observed while performing an assessment, followed by an in-depth individual interview. RESULTS Results indicate that participants wish to be trained to acquire further knowledge about bathing equipment and learn to use a tool that would guide and document their observations. They sought partnership with a designated occupational therapist, who would be available to answer questions and assess clients with a complex clinical situation. CONCLUSIONS These results suggest that needs of home health aides are not currently met and highlight clinical as well as organizational implications.

Development of Algo, a clinical algorithm for non–occupational therapists selecting bathing equipment: Développement de l’Algo, un algorithme clinique conçu à l’intention du personnel non-ergothérapeute pour faciliter la sélection de l’équipement au bain

Background. In Quebec, occupational therapy guidelines allow non–occupational therapists, such as home health aides, to select bathing equipment for “straightforward” cases of clients living at home as long as the aides use a decision-making tool. Purpose. Our aim was to develop a tool that met the common needs of Quebec’s health and social services centres (HSSCs), which involve home health aides in selecting bathing equipment for home-dwelling clients. Method. We followed an ongoing iterative process involving a literature review as well as (a) a synthesis of 40 in-house tools, (b) feedback from 10 occupational therapists (two questionnaires and one focus group), (c) pretests, and (d) translation. Findings. Algo is a clinical algorithm constituting a visual map of the logical steps to follow when selecting bathing equipment for straightforward cases. Algo is a series of yes/no questions dealing with occupation, person, and environment. Implications. Algo, rooted in evidence and regulatory board guidelines, is available to HSSCs involving non-occupational therapists in selecting bathing equipment. Description. Selon l’Ordre des ergothérapeutes du Québec (OEQ), le personnel non-ergothérapeute (p. ex. auxiliaire) peut identifier l’équipement qui facilite la réalisation de l’hygiène corporelle à la condition que ce personnel dispose d’un outil d’aide à la décision. But. Développer un outil qui tend à répondre aux besoins communs des Centre de santé et des services sociaux (CSSS) qui engagent l’auxiliaire dans le choix de l’équipement pour l’hygiène des « cas simples » vivant à domicile. Méthodologie. Processus itératif incluant une recension des écrits et (a) la mise en commun de 40 outils maison, (b) la consultation de 10 ergothérapeutes (deux questionnaires et un groupe de discussion focalisée), (c) des prétests et (d) la traduction. Résultats. L’Algo est une carte graphique des étapes logiques à suivre lors d’un « cas simple » de choix d’équipement pour l’hygiène. L’Algo comprend une suite de questions (oui/non) qui abordent l’occupation, la personne et l’environnement. Conséquences. L’Algo, un outil enraciné dans les données probantes et les lignes directrices de l’OEQ, est maintenant disponible aux CSSS qui ont recours au personnel non-ergothérapeute pour la sélection de l’équipement au bain.

Interrater reliability of Algo used by non-occupational therapist members of homecare interdisciplinary teams

Abstract Purpose: To determine if non-occupational therapists (non-OTs) with different job titles using Algo, a clinical algorithm for recommending bathroom modifications (e.g., bath seat) for community-dwelling elders in “straightforward” situations, will make clinically equivalent recommendations for standardized clients. Method: Eight non-OTs (three social workers, two physical rehabilitation therapists, two homecare aides and one auxiliary nurse) were trained on Algo and used it with six standardized clients. Bathroom adaptations recommended (one of nine options) by non-OTs were compared to assess interrater agreement using Fleiss adapted kappa. Results: Estimated kappa was 0.43 [0.36; 0.49] qualified as a moderate agreement, according to Landis and Koch’s arbitrary divisions, among the recommendations of non-OTs. However, clinical equivalence is reached, since safety and client needs were met when raters selected two different options (e.g., with or without a seat back). Conclusions: Non-OTs using Algo in the same simulated clinical scenarios recommend clinically equivalent bathroom adaptations, increasing the confidence regarding the interrater reliability of Algo used by non-OT members of homecare interdisciplinary teams Implications for Rehabilitation In homecare services, non-occupational therapists from different health care disciplines (e.g., homecare aides, social workers, physical rehabilitation therapists) may be asked to select assistive devices for the hygiene care of clients living at home. Algo was designed to guide non-occupational therapists in the selection of assistive devices when performed with clients in straightforward cases. This study indicates that non-occupational therapists using Algo recommend similar and acceptable bathroom adaptations to enhance client safety.

Reliability and acceptability of an online decision support system for the self-selection of assistive technologies by older Canadians: a research protocol

Over 1.1 million older Canadians use assistive technologies (ATs) defined as devices that help to improve or maintain the functional capacity or participation of an individual. Rising demands, geographic spread of potential users, and the lack of community rehabilitation services (e.g., occupational therapy) are problematic factors for the provision of ATs. New approaches have to be developed to empower older adults and their caregivers in the self-selection of ATs. Information and communication technologies represent a promising avenue to address this gap. An online decision support system (DSS) for the self-selection of ATs called SmartAssist (available on platforms such as desktop computers, tablets, and smartphones) was developed in the United Kingdom. A study is currently underway to adapt this tool to the Canadian context, validate it and explore its acceptability by potential users and by other stakeholders. This paper will present how the test-retest reliability and the usability of this DSS will be assessed and how its acceptability will be explored.

Cultural adaptation and validation of patient decision aids: a scoping review

In order to promote self-determination, patients have to be actively involved with their care providers in health-care decision making, especially when such decisions involve personal preferences. Decision aids (DAs) are tools that can contribute to patient-centered decision-making processes. To benefit from previous fieldwork and avoid duplicating developmental efforts and producing many similar DAs, the adaptation of existing DAs to new cultural contexts is a resource-saving option. However, there are no guidelines on how to culturally adapt and validate DAs. This study aimed to identify and document existing procedures for the cultural adaptation and validation of patient DAs. A scoping review examined studies conducting cultural adaptation and/or validation of patient DAs. The following databases were searched in February 2016: CINAHL, EMBASE, Medline (Ovid), PASCAL, PsychINFO, and PubMed. From the 13 studies selected, 11 main procedures were identified: appraisal of the original DA, assessment of the new cultural context, translation, linguistic adaptation, cultural adaptation, usability testing, exploration of DA acceptability, test-retest reliability, content validity, construct validity, and criterion validity. A conceptual synthesis of these studies suggests there are four phases in the adaptation/validation process of DAs aimed at: 1) exploring the original DA and the new cultural context, 2) adapting the original DA to the new cultural context, 3) lab testing the preliminary version of the adapted DA, and 4) field testing the adapted DA in a real use context. By facilitating the adaptation and broader implementation of DAs, patients may ultimately be empowered in decision-making processes.

Impact of Changes in Playing Time on Playing-Related Musculoskeletal Pain in String Music Students

BACKGROUND During their training, musicians must develop good work habits that they will carry on throughout their professional career in order to avoid potential chronic health problems, such as musculoskeletal pain. The effect of sudden changes in instrument playing-time on the development of playing-related musculoskeletal pain (PRMP) has not been thoroughly investigated in music students playing bowed string instruments (BSI), even though they are regularly exposed to such changes to perfect their playing skills. OBJECTIVE To explore the association between sudden changes in instrument playing-time and changes in PRMP in BSI players. METHODS A prospective cohort study was completed with BSI students attending a summer music camp offering high-level training. Participants completed a self-administered 23-item questionnaire designed for the study upon arrival at camp (T1) and then 7 days later (T2). RESULTS Ninety-three BSI students (16±4 yrs old) completed the questionnaires, for a 23% response rate. Their playing-time increased by 23±14 hrs between T1 and T2. Complaints in pain frequency (e.g., from never to most of the time) and intensity (19±24 mm on VAS) significantly increased between T1 and T2 and were correlated with an increase in playing-time. CONCLUSION A sudden increase in playing-time, such as that experienced by elite BSI students attending an intensive music camp, was related to an increase in PRMP. However, in this study, changes in pain characteristics were only partly explained by the change in playing-time.