Mélanie Levasseur

Is social participation associated with quality of life of older adults with physical disabilities

Purpose: To explore the relationships between subjective quality of life and social participation of older adults with physical disabilities. Method: A cross-sectional design was used with a convenience sample of 46 people aged 60 to 90 living in the community. Subjective quality of life was estimated with the Quality of Life Index and social participation with the Assessment of Life Habits. Results: Only a weak relationship was found between total scores of quality of life and social participation. Interpersonal relationships, responsibilities, fitness and recreation were the categories of social participation most associated with quality of life. Social roles were more associated with quality of life than daily activities. Finally, satisfaction with the accomplishment of life habits was also more associated with quality of life than the performance itself. Conclusions: The importance of social participation in regard to the quality of life of older persons with physical disabilities living in the community is partially supported by these findings. Other studies are needed to clarify how social participation influences quality of life in this population.

‘Optimal’ participation: A reflective look

Purpose. There is mounting interest by professionals working in the rehabilitation sciences related to the concept of participation, especially given the increasing numbers of individuals worldwide living with chronic illnesses. It is now internationally agreed that participation level is influenced by both personal and environmental factors. The question arises as to the meaning of ‘optimal’ participation. The main objective of this article is to provide a reflective look at the concept of participation and the meaning of ‘optimality’ for individuals with and without disability and to explore both in relation to response shift. Method. Similarities in definitions of participation are first examined. Normal participation level is discussed leading to an ‘optimal’ level based on normality. Cases are used to illustrate normality as well as how ‘optimal’ participation can be achieved through a transition period despite disabilities caused by a health condition such as a stroke. Results. ‘Optimal’ participation would rely on a perfect fit between an individuals reality (how activities and roles are actually realised) and expectations of how activities and roles should be accomplished. A transition period, including a response shift, following an acute event or onset of a chronic condition can lead to an optimal participation level despite persisting disabilities. Conclusions. A better understanding of the meaning of optimal participation and its association to response shift is important to clinical practice. Interventions aimed at optimizing participation through assisting clients who are experiencing a response shift can then be designed to maximize participation and concomitantly, quality of life in those with chronic health conditions.

Subjective Quality-of-Life Predictors for Older Adults with Physical Disabilities.

Levasseur M, Desrosiers J, St-Cyr Tribble D: Subjective quality-of-life predictors for older adults with physical disabilities. Am J Phys Med Rehabil 2008;87: 830-841. Objectives:To study changes in quality of life (QOL) and to explore predictors of QOL of community-dwelling older adults with physical disabilities. Design:A 2-yr longitudinal study involved a convenience sample of 49 people with physical disabilities aged 60–94 yrs. QOL was estimated twice at a 2-yr interval with the Quality of Life Index, which includes four domains: health and functioning, socioeconomic, psychological/spiritual, and family. The potential predictors evaluated at baseline were health condition, activity, participation (level and satisfaction), personal factors, and environmental factors (obstacles and facilitators). Results:No change over time in QOL mean score was observed (mean: −0.41; SD: 2.5; 95% confidence interval: −1.1 to 0.30; P = 0.25). However, about half the participants had a clinically significant change (either increase or decrease). Greater satisfaction with participation in social roles and fewer obstacles in the physical environment were identified as the best predictors (R2 = 0.27; P = 0.001) of better QOL. Greater participation in daily activities, fewer obstacles in the physical environment, and greater satisfaction with participation in social roles were found to be the best predictors (R2 = 0.49; P < 0.001) of high health and functioning QOL. Finally, increased QOL score over the 2-yr period was best predicted by initial lower socioeconomic QOL and activity level perceived as unstable (R2 = 0.27; P = 0.001). Conclusions:QOL is partially explained by participation and environmental factors. These factors may be positively modified and thus may warrant special attention in health interventions. Identified predictors of QOL changes over time need to be considered in intervention studies.

Associations Between Perceived Proximity to Neighborhood Resources, Disability, and Social Participation Among Community-Dwelling Older Adults: Results From the VoisiNuAge Study

OBJECTIVE To examine the associations between perceived proximity to neighborhood resources, disability, and social participation and the potential moderating effect of perceived proximity to neighborhood resources on the association between disability and social participation in community-dwelling older women and men. DESIGN Cross-sectional. SETTING Community. PARTICIPANTS Older adults (296 women, 258 men). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Data for age, education, depressive symptoms, frequency of participation in community activities, perceived proximity to neighborhood resources (services, amenities), and functional autonomy in daily activities (disability) were collected by means of interviewer-administered questionnaire. RESULTS Greater perceived proximity to resources and lower level of disability were associated with greater social participation for both women (R(2)=.10; P<.001) and men (R(2)=.05; P<.01). The association between disability and social participation did not vary as a function of perceived proximity to neighborhood resources in women (no moderating effect; P=.15). However, in men, greater perceived proximity to neighborhood resources enhanced social participation (P=.01), but only in those with minor or no disability. CONCLUSIONS Future studies should investigate why perceived proximity to services and amenities is associated with social participation in older men with minor or no disabilities and with women overall, but has no association in men with moderate disabilities.

Neighborhood Resources and Social Participation Among Older Adults: Results From the VoisiNuage Study

Objective: This article examined the associations between proximity to selected locations considered to be conducive to social participation, and social participation itself, in urban-dwelling seniors. Methods: A sample of 520 older adults residing in the Montreal area provided reports of social participation and information about health, sociodemographic characteristics, social networks, and perceptions about features of their residential environment. Information about the distance between their home and five locations deemed to be conducive to social participation were obtained from a geographic information system. Results: Analyses showed a significant association between proximity to selected locations and social participation while accounting for individual characteristics and perceptions of neighborhood features (β = 0.37; SE = 0.17; p < 0.05). Discussion: Findings were consistent with contributions highlighting the impact of the built environment on seniors’ health-related behavior. Future work would benefit from the use of longitudinal designs and examinations of social participation through alternate channels.

Health-related and subjective quality of life of older adults with visual impairment

Purpose. To document health-related quality of life (HRQOL) and subjective quality of life (SQOL) and explore their correlates in older adults seeking services for visual impairment (VI). Method. A convenience sample of 64 participants (79.3 ± 5.9 years) with VI was interviewed at home. HRQOL was measured with the Visual Function Questionnaire-25 and SQOL with the Quality of Life Index. The potential correlates were as follows: personal factors (sociodemographic characteristics, co-morbidity, depressive symptoms, activity level), environmental factors (technical aids, social support) and participation in daily activities and social roles (level and satisfaction). Results. Compared to normative data from previous studies of older adults, the participants had lower HRQOL but similar SQOL. Greater level of participation in social roles, higher perceived activity level, use of a writing aid and greater satisfaction with participation in social roles together explained better HRQOL (R2 = 0.66). Fewer depressive symptoms, greater satisfaction with participation in social roles and with social support and fewer co-morbidities together explained better SQOL (R2 = 0.70). Conclusions. HRQOL of older adults with VI is mainly explained by level of participation correlates, while their SQOL is mainly explained by depressive symptoms and satisfaction variables. The results also underscore the importance of social roles for HRQOL and SQOL of this population.

The Patient’s Perspective of in-Home Telerehabilitation Physiotherapy Services Following Total Knee Arthroplasty

This study aimed at exploring patients’ perceptions regarding telerehabilitation services received post total knee replacement. In this qualitative embedded single case study, semi-structured interviews were conducted with five patients who had previously received in-home telerehabilitation post total knee arthroplasty. Participants were asked to reflect on their 8-week rehabilitation process and on their experience with the home telerehabilitation program. Interviews were transcribed and a qualitative thematic analysis was conducted. Six overarching themes emerged from the patients’ perceptions: (1) improving access to services with reduced need for transportation; (2) developing a strong therapeutic relationship with therapist while maintaining a sense of personal space; (3) complementing telerehabilitation with in-person visits; (4) providing standardized yet tailored and challenging exercise programs using telerehabilitation; (5) perceived ease-of-use of telerehabilitation equipment; and (6) feeling an ongoing sense of support. Gaining a better understating of the patient’s experience in telerehabilitation will be essential as programs continue to be developed and implemented.

Do rehabilitation professionals need to consider their clients’ health literacy for effective practice?

Objective: To discuss the importance of integrating health literacy into rehabilitation practice. Background: The effectiveness of rehabilitation interventions and clients’ long-term health might depend on various factors, including health literacy. Health literacy is defined as the ability to access, understand, evaluate and communicate information as a way to promote, maintain and improve health in a variety of settings over the life-course. Rehabilitation professionals are often uniformed about and neglect health literacy in their interventions. Method: The scientific and grey literature on health and, more specifically, rehabilitation and health promotion was reviewed. The MEDLINE, OTDBASE, CINAHL, AMED and MANTIS databases were searched by combining the keyword (1) ‘health literacy’ with the keywords (2) ‘rehabilitation’, ‘physical therapy’, ‘occupational therapy’ or ‘health promotion’. Results: Health literacy is one of the foundations of individual health and might have an impact on interventions, the individual and society. All papers addressing both health literacy and rehabilitation (n = 10) specifically mentioned that rehabilitation professionals need to consider their clients’ health literacy. Rehabilitation is particularly linked to health literacy because both stress the importance of (1) capacities, functioning, participation and empowerment of clients; (2) holistic approach; (3) client-centred practice; (4) teaching of information and methods; and (5) access to services and equity issues. Conclusions: Based on these results, we think it is important that rehabilitation professionals be aware of the importance of health literacy and intervene to improve it. The challenge is now to better understand how health literacy influences the effectiveness of rehabilitation and health outcomes.

“Do-Live-Well” A Canadian framework for promoting occupation, health, and well-being

Background. Occupational therapists can bring a unique and valuable perspective to the national dialogue on health promotion. Current approaches have a narrow focus on diet and exercise; a broader focus on occupation has the potential to enrich understanding regarding forces that contribute to health and well-being. Purpose. A new “Do-Live-Well” framework will be presented that is grounded in evidence regarding the links between what people do every day and their health and well-being. Key Issues. Elements of the framework include eight different dimensions of experience and five key activity patterns that impact health and well-being outcomes. Personal and social forces that shape activity engagement also affect the links to health and well-being. Implications. The framework is designed to facilitate individual reflection, community advocacy, and system-level dialogue about the impact of day-to-day occupations on the health and well-being of Canadians.

Integrating health literacy into occupational therapy: findings from a scoping review

Abstract This paper aims to report ways of integrating health literacy into occupational therapy practice. Health literacy is defined as the ability to access, understand, evaluate, and communicate information as a way to promote, maintain, and improve health in various settings over the life-course. A scoping study of the scientific and grey literature on health and, specifically, occupational therapy and health promotion was done from 1980 to May 2010. Five databases were searched by combining key words (i) “health literacy” with (ii) “rehabilitation”, “occupational therapy”, or “health promotion”. Data were extracted from 44 documents: five textbooks, nine reports, and 29 articles. The literature on health literacy needs enhancing in both quantity and quality. Nevertheless, six ways of integrating health literacy into occupational therapy practice were identified (frequency; %): occupational therapists should (i) be informed about and recognize health literacy (27; 61.4), (ii) standardize their practice (10; 22.7), (iii) make information accessible (37; 84.1), (iv) interact optimally with clients (26; 59.1), (v) intervene (29; 65.9) and (vi) collaborate to increase health literacy (21; 47.7). Since health literacy can directly impact on intervention efficacy, further studies are needed on how to integrate health literacy into occupational therapy practice.