Marie-Eve Lamontagne

Team consensus concerning important outcomes for augmentative and alternative communication assistive technologies: a pilot study.

Abstract Obstacles to assistive device outcome measurement include a lack of consensus about which outcomes should be evaluated. This article reports a case study of the use of a structured consensus-building approach called Technique for Research of Information by Animation of a Group of Experts (TRIAGE) to develop agreement among key professional team members with regard to outcome measurement. We also describe the changes in key professional team members’ perspectives on outcome measurement over time. Initially, participants expressed preferences for the measurement of about 33 different outcomes. Subsequent discussions and the TRIAGE process led to the choice of the five most important outcomes. Our case study provides evidence that professional team consensus could successfully be reached through the individual reflections and group sharing proposed by the TRIAGE technique. Future research directions include the development of strategies to give prominence to the opinions of individuals who use augmentative and alternative communication (AAC) in the identification of important outcomes, and for aggregating and interpreting data gathered at local, regional, or national levels.

A systematic review of interventions to increase the use of standardized outcome measures by rehabilitation professionals

Objective: To determine the types and effectiveness of interventions to increase the knowledge about, attitudes towards, and use of standardized outcome measures in rehabilitation professionals. Data sources: An electronic search using Medline, EMBASE, PsycINFO, CINAHL, Ergonomics Abstracts, Sports Discus. The search is current to February 2016. Study selection: All study designs testing interventions were included as were all provider and patient types. Two reviewers independently conducted a title and abstract review, followed by a full-text review. Data extraction: Two reviewers independently extracted a priori variables and used consensus for disagreements. Quality assessment was conducted using the Assessment of Quantitative Studies published by the Effective Public Health Practice Group. Data synthesis: We identified 11 studies involving at least 1200 providers. Nine of the studies showed improvements in outcome measure use rates but only three of these studies used an experimental or quasi-experimental design. Eight of the studies used an educational approach in the intervention and three used audit and feedback. Poor intervention description and quality of studies limited recommendations. Conclusions: Increased attention to testing interventions focused on known barriers, matched to behavior change techniques, and with stronger designs is warranted.

Perceptions of traumatic brain injury network participants about network performance.

Background: Networks have been implemented within trauma systems to overcome problems of fragmentation and lack of coordination. Such networks regroup many types of organizations that could have different perceptions of network performance. No study has explored the perceptions of traumatic brain injury (TBI) network participants regarding network performance. Objective: To document the perceptions of TBI network participants concerning the importance of different dimensions of performance and to explore whether these perceptions vary according to organization types. Methodology: Participants of network organizations were surveyed using a questionnaire based on a conceptual framework of performance (the EGIPSS framework). Results: Network organizations reported dimensions related to goal attainment to be more important than dimensions related to process. Differences existed between the perceptions of various types of network organizations for some but not all domains and dimensions of performance. Conclusion: Network performance appears different from the performance of an individual organization and the consideration of the various organizations’ perceptions in clarifying this concept should improve its comprehensiveness and its acceptability by all stakeholders.

Exploring end user adoption and maintenance of a telephone-based physical activity counseling service for individuals with physical disabilities using the Theoretical Domains Framework

Abstract Purpose: In Canada, two counseling services are offered to facilitate physical activity participation among persons with physical disabilities, yet both have encountered concerns related to the recruitment and retainment of clients. The purpose of this paper is to explore factors related to service adoption among nonusers, and the barriers and facilitators to maintaining service participation among adopters. Methods: Individuals who had never enrolled in the services (nonusers, n = 13) as well as current/previous service clients (adopters, n = 26) participated in interviews based on the Theoretical Domains Framework. Transcripts were subjected to deductive thematic analysis according to participant group. Results: Fifteen themes relating to service adoption within 10 of the 12 theoretical domains were identified for nonusers, while 23 themes relating to maintenence of service participation were identified across all 12 theoretical domains for adopters. Conclusions: The findings provide strategies to improve recruitment, adoption, and retention of clients in counseling services and to enhance the experiences of targeted service users. Implications for Rehabiliation Peer support and education for equipment use should be built into physical activity programs to encourage participation among persons with physical disabilities. Programs that encourage physical activity among individuals with disabilities should be designed by practitioners to be responsive to a variety of needs, which are addressed in the program’s advertisements and offerings. The Theoretical Domains Framework is a useful framework for providing valuable insight about clients’ experiences of adoption and maintenance of a behavior change service, suggesting merit in other rehabilitation settings.

Evaluation of the acceptability, feasibility and effectiveness of two methods of involving patients with disability in developing clinical guidelines: study protocol of a randomized pragmatic pilot trial

BackgroundDespite growing interest in the importance of, and challenges associated with the involvement of patient and population (IPP) in the process of developing and adapting clinical practice guidelines (CPGs), there is a lack of knowledge about the best method to use. This is especially problematic in the field of rehabilitation, where individuals with disabilities might face many barriers to their involvement in the guideline development and adaptation process. The goal of this pilot trial is to document the acceptability, feasibility and effectiveness of two methods of involving patients with a disability (traumatic brain injury) in CPG development.Methods/DesignA single-blind, randomized, crossover pragmatic trial will be performed with 20 patients with traumatic brain injury (TBI). They will be randomized into two groups, and each will try two alternative methods of producing recommendations; a discussion group (control intervention) and a Wiki, a webpage that can be modified by those who have access to it (experimental intervention). The participants will rate the acceptability of the two methods, and feasibility will be assessed using indicators such as the number of participants who accessed and completed the two methods, and the number of support interventions required. Twenty experts, blinded to the method of producing the recommendations, will independently rate the recommendations produced by the participants for clarity, accuracy, appropriateness and usefulness.DiscussionOur trial will allow for the use of optimal IPP methods in a larger project of adapting guidelines for the rehabilitation of individuals with TBI. Ultimately the results will inform the science of CPG development and contribute to the growing knowledge about IPP in rehabilitation settings.Trial registrationClinical trial KT Canada 87776.

Life habits performance of individuals with brain injury in different living environments.

Background: Little is known about variations in social participation among individuals with traumatic brain injury (TBI) living in different environments. Objective: To examine the social participation of individuals with moderate-to-severe TBI across various living arrangements. Methods: One hundred and thirty-six individuals with moderate-to-severe TBI, living either in natural settings (e.g. home), intermediate settings (e.g. group homes or foster families) or structured settings (e.g. nursing home or long-term care facilities) and requiring daily assistance, were interviewed using the LIFE-H tool, which measures the level of difficulty and the assistance required to carry out life habits and resulting social participation. Participation in six categories of life habits pertaining to Activities of Daily Living and five categories pertaining to Social Roles were examined. Results: The level of difficulty and the assistance required to carry out the life habits and the overall level of social participation were associated with living arrangements. Participation scores in Activities of Daily Living varied across living arrangements while Social Roles scores did not. Conclusion: Living arrangements (such as intermediate settings) may better support social participation in individuals with TBI. There is a need to further study the issue of living arrangements as they seem to facilitate the performance of life habits, which impacts the social participation of individuals with TBI.

Analysis of the strengths, weaknesses, opportunities and threats of the network form of organization of traumatic brain injury service delivery systems

Networks are an increasingly popular way to deal with the lack of integration of traumatic brain injury (TBI) care. Knowledge of the stakes of the network form of organization is critical in deciding whether or not to implement a TBI network to improve the continuity of TBI care. Goals of the study: To report the strengths, weaknesses, opportunities, and threats of a TBI network and to consider these elements in a discussion about whether networks are a suitable solution to fragmented TBI care. Methods: In-depth interviews with 12 representatives of network organization members. Interviews were qualitatively analyzed using the EGIPSS model of performance. Results: The majority of elements reported were related to the networks adaptation to its environment and more precisely to its capacity to acquire resources. The issue of value maintenance also received considerable attention from participants. Discussion: The network form of organization seems particularly sensitive to environmental issues, such as resource acquisition and legitimacy. The authors suggest that the network form of organization is a suitable way to increase the continuity of TBI care if the following criteria are met: (1) expectations toward network effectiveness to increase continuity of care are moderate and realistic; (2) sufficient resources are devoted to the design, implementation, and maintenance of the network; (3) a networks existence and actions are deemed legitimate by community and organization member partners; and (4) there is a good collaborative climate between the organizations.

A descriptive portrait of human assistance required by individuals with brain injury.

Background: Human assistance is a counterweight to disabilities for people living with a traumatic brain injury (TBI). However, there is no clear description of the human assistance used by this population in relation with specific life habits (LH). Objectives: (1) to describe the proportion of LH performed with human assistance; (2) to explore the characteristics of TBI persons with greater needs for human assistance; (3) to clarify the categories of LH for which persons with TBI need human assistance; and (4) to determine the relationship between the human helper and the person with TBI across different residential settings. Method: One hundred and thirty-six individuals with moderate or severe TBI were interviewed using the LIFE-H. Results: Human assistance is used to perform one out of three LH. A greater need for human assistance was associated with the number of impairments, motor limitation to the upper limbs, hemiplegia and receiving public insurance. Human assistance was used more often to perform LH pertaining to social roles than those pertaining to daily living. Close relatives were the most frequent providers of human assistance regardless of the residential setting. Conclusion: Given the importance of human assistance in TBI, it is essential to support human helpers during and after rehabilitation.

A randomized controlled trial to test the efficacy of the SCI Get Fit Toolkit on leisure-time physical activity behaviour and social-cognitive processes in adults with spinal cord injury

Study Design:Single blind, two-group randomized controlled trial.Objectives:To evaluate the efficacy of the SCI Get Fit Toolkit delivered online on theoretical constructs and moderate-to-vigorous physical activity (MVPA) among adults with SCI.Setting:Ontario and Quebec, Canada.Eligibility:Inactive, English- and French-speaking Canadian adults with traumatic SCI with Internet access, and no self-reported cognitive or memory impairments.Methods:Participants (N=90 Mage=48.12±11.29 years; 79% male) were randomized to view the SCI Get Fit Toolkit or the Physical Activity Guidelines for adults with SCI (PAG-SCI) online. Primary (intentions) and secondary (outcome expectancies, self-efficacy, planning and MVPA behaviour) outcomes were assessed over a 1-month period.Results:Of the 90 participants randomized, 77 were included in the analyses. Participants viewed the experimental stimuli only briefly, reading the 4-page toolkit for approximately 2.5 min longer than the 1-page guideline document. No condition effects were found for intentions, outcome expectancies, self-efficacy, and planning (ΔR2⩽0.03). Individuals in the toolkit condition were more likely to participate in at least one bout of 20 min of MVPA behaviour at 1-week post-intervention compared to individuals in the guidelines condition (OR=3.54, 95% CI=0.95, 13.17). However, no differences were found when examining change in weekly minutes of MVPA or comparing whether participants met the PAG-SCI.Conclusions:No firm conclusions can be made regarding the impact of the SCI Get Fit Toolkit in comparison to the PAG-SCI on social cognitions and MVPA behaviour. The limited online access to this resource may partially explain these null findings.

Social network analysis as a metric for the development of an interdisciplinary, inter-organizational research team

Abstract The development of an interdisciplinary and inter-organizational research team among eight of Canada’s leading emergency, geriatric medicine and rehabilitation researchers affiliated with six academic centers has provided an opportunity to study the development of a distributed team of interdisciplinary researchers using the methods of social network theory and analysis and to consider whether these methods are useful tools in the science of team science. Using traditional network analytic methods, the team of investigators were asked to rate their relationships with one another retrospectively at one year prior to the team’s first meeting and contemporaneously at two subsequent yearly intervals. Using network analytic statistics and visualizations the data collected finds an increase in network density and reciprocity of relationships together with more distributed centrality consistent with the findings of other researchers. These network development characteristics suggest that the distributed research team is developing as it should and supports the assertion that network analysis is a useful science of team science research tool.