"Navigating chaos": Urban, Rural, and Remote Patient Experiences in Accessing Healthcare with Indigenous and Non-Indigenous Perspectives of Living with Chronic Low Back Pain.

Background: Healthcare access for chronic low back pain is complex and should consider not only the health system, but patient care seeking experiences as well. People who live in rural and remote communities and/or identify as being Indigenous may often encounter additional barriers to accessing care for chronic low back pain; thus, these contexts must be considered to fully understand barriers and facilitators. Aims: The aim of this study was to understand care-seeking experiences of people living with chronic back pain in Saskatchewan and determine unique experiences facing urban, rural, remote, and/or Indigenous peoples. Methods: Thirty-three participants with chronic low back pain completed a preliminary survey followed by individual semistructured interviews. Participants were categorized as urban, rural, or remote including Indigenous status. A qualitative interpretive research approach with inductive thematic analysis was employed. Results: Three overarching themes were identified with the following subthemes: (1) healthcare access challenges: challenges to accessing care, challenges within the health system, and challenges leading to self-directed management/coping strategies; (2) healthcare access facilitators: funded care, participant education and knowledge, patient-provider communication, and care closer to home; and (3) participant recommendations for improved care provision: coordination of care, integrative and holistic care, and patient-centered care and support. Rural and remote participants highlighted travel as a main barrier. Indigenous participant experiences emphasized communication with healthcare providers and past experiences influencing desire to access care. Conclusion: Participants identified a range of challenges and facilitators as well as recommendations for improving access to care for chronic low back pain, with unique barriers for rural, remote, and Indigenous participants.

Contexte: L'accès aux soins de santé pour la lombalgie chronique est complexe et devrait tenir compte non seulement du système de santé, mais aussi des expériences de recherche de soins des patients. Les personnes vivant dans des communautés rurales et éloignées et/ou qui s'identifient comme autochtones font souvent face à des obstacles supplémentaires pour accéder aux soins pour la lombalgie chronique; il faut donc tenir compte de ces contextes pour bien comprendre les obstacles et les facilitateurs.Objectifs: L'objectif de cette étude était de comprendre les expériences de recherche de soins des personnes vivant avec une lombalgie chronique en Saskatchewan et de déterminer les expériences uniques d'accès aux soins auxquelles sont confrontées les personnes vivant en milieu urbain, rural, éloigné et/ou ayant un statut d'autochtone.Méthodes: Trente-trois participants souffrant de lombalgie chronique ont répondu à un questionnaire préliminaire suivi d'entretiens individuels semi-structurés. Les participants ont été catégorisés comme vivant en milieu urbain, rural, éloigné, incluant ceux ayant un statut d'autochtone. Une approche de recherche qualitative interprétative avec une analyse thématique inductive a été utilisée.Résultats: Trois thèmes principaux ont été répertoriés avec les sous-thèmes suivants : (1) difficultés d'accès aux soins de santé : difficultés pour accéder aux soins, difficultés au sein du système de santé et difficultés conduisant à des stratégies de gestion et d'adaptation autonomes; (2) facilitateurs de l'accès aux soins de santé : financement des soins, éducation et connaissances des participants, communication entre le patient et le prestataire de soins et proximité des soins par rapport au domicile et (3) recommandations des participants pour l'amélioration de la prestation des soins : la coordination des soins, les soins intégrés et holistiques, les soins et le soutien centrés sur le patient. Les participants des régions rurales et éloignées ont souligné que les déplacements constituaient un obstacle majeur. Les expériences des participants autochtones ont mis l'accent sur la communication avec les prestataires de soins de santé et les expériences passées qui influencent le désir d'accéder aux soins.Conclusion: Les participants ont répertorié un ensemble de difficultés, de facilitateurs et de recommandations pour améliorer l'accès aux soins pour les lombalgies chroniques, qui présente des obstacles uniques pour les participants vivant en milieu rural et éloigné et les participants autochtones.

Healthcare Access Challenges and Facilitators for Back Pain Across the Rural-Urban Continuum in Saskatchewan, Canada: Cross-Sectional Results From a Provincial-Wide Telephone Survey.

Background: Chronic back pain is a common musculoskeletal disorder, disproportionately affecting rural and Indigenous people. Saskatchewan has a relatively high proportion of rural and Indigenous residents; therefore, understanding barriers and facilitators to accessing healthcare are needed to improve healthcare service delivery. Methods: A provincial-wide telephone survey explored experiences and perceived healthcare access barriers and facilitators among 384 Saskatchewan residents who experienced chronic low back pain. Chi-squared tests were performed to determine if people who lived in urban versus rural areas differed in the proportion who had accessed services from various healthcare practitioners. T-test and Mann-Whitney U analyses were conducted to determine differences between urban and rural, and Indigenous and non-Indigenous respondents. Results: Of 384 residents surveyed, 234 (60.9%) reported living in a rural location; 21 (5.5%) identified as Indigenous. Wait times (47%), cost (40%), travel (39%), and not knowing how to seek help (37%) were the most common barriers for Saskatchewan residents seeking care, with travel being the only barrier that was significantly different between rural and urban respondents (P ⩽ .001). Not knowing where to go to access care or what would help their low back pain (P = .03), lack of cultural sensitivity (P = .007), and comfort discussing problems with health care professionals (P = .26) were greater barriers for Indigenous than non-Indigenous participants. Top facilitators (>50% of respondents) included publicly funded healthcare, locally accessible healthcare services, and having supportive healthcare providers who facilitate referral to appropriate care, with urban respondents considering the latter 2 as greater facilitators than rural respondents. Telehealth or virtual care (P = .013) and having healthcare options nearby in their community (P = .045) were greater facilitators among Indigenous participants compared to non-Indigenous respondents. Conclusions: Rural, urban, Indigenous, and non-Indigenous people report overlapping and unique barriers and facilitators to accessing care for chronic low back pain. Understanding perceived access experiences will assist in developing more effective care models for specific communities or regions.

Experiences of Health Care Access Challenges for Back Pain Care Across the Rural-Urban Continuum in Canada: Protocol for Cross-sectional Research.

BACKGROUND: Back pain is common and costly, with negative impacts on both individuals and the health care system. Rural, remote, and Indigenous populations are at greater risk of experiencing back pain compared to urban and non-Indigenous populations. Potential barriers to health care access among Canadians with chronic back pain (CBP) have been identified; however, no study has used lived experiences of people with CBP to drive the selection, analysis, and interpretation of variables most meaningful to patients. OBJECTIVE: The aims of this study are to (1) engage with rural, remote, and urban Indigenous and non-Indigenous patients, health care providers, and health system decision makers to explore lived experiences among people with CBP in Saskatchewan, Canada; (2) cocreate meaningful indicators of CBP care access and effectiveness; and (3) identify program and policy recommendations to overcome access barriers to CBP care. METHODS: In phase 1, one-on-one interviews with 30 people with current or past CBP and 10 health care providers residing or practicing in rural, remote, or urban Saskatchewan communities will be conducted. We will recruit Indigenous (n=10) and non-Indigenous (n=20) rural, remote, and urban people. In phase 2, findings from the interviews will inform development of a population-based telephone survey focused on access to health care barriers and facilitators among rural, remote, and urban people; this survey will be administered to 383 residents with CBP across Saskatchewan. In phase 3, phase 1 and 2 findings will be presented to provincial and national policy makers; health system decision makers; health care providers; rural, remote, and urban people with CBP and their communities; and other knowledge users at an interactive end-of-project knowledge translation event. A World Café method will facilitate interactive dialogue designed to catalyze future patient-oriented research and pathways to improve access to CBP care. Patient engagement will be conducted, wherein people with lived experience of CBP, including Indigenous and non-Indigenous people from rural, remote, and urban communities (ie, patient partners), are equal members of the research team. Patient partners are engaged throughout the research process, providing unique knowledge to ensure more comprehensive collection of data while shaping culturally appropriate messages and methods of sharing findings to knowledge users. RESULTS: Participant recruitment began in January 2021. Phase 1 interviews occurred between January 2021 and September 2022. Phase 2 phone survey was administered in May 2022. Final results are anticipated in late 2022. CONCLUSIONS: This study will privilege patient experiences to better understand current health care use and potential access challenges and facilitators among rural, remote, and urban people with CBP in Saskatchewan. We aim to inform the development of comprehensive measures that will be sensitive to geographical location and relevant to culturally diverse people with CBP, ultimately leading to enhanced access to more patient-centered care for CBP. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/42484.

Changes in fall risk and functional status in women aged 50 years and older after distal radius fracture: A prospective 1-year follow-up study.

STUDY DESIGN: Prospective cohort study. INTRODUCTION: Few studies have evaluated the course of recovery after distal radius fracture (DRF) when functional decline and fracture risk may be affected. PURPOSE OF THE STUDY: The purpose of this study was to determine changes in overall functional status over the first year after a DRF in women aged 50 years and older. METHODS: Seventy-eight women were assessed for balance, balance confidence, lower extremity strength, gait speed, fall history, physical activity levels, and self-reported wrist pain and function (Patient-Rated Wrist Evaluation) at weeks 1, 3, 9, 12, 26, and 52 after DRF. Descriptive data were generated for all variables; a 3-way mixed analysis of variance with repeated measures was used to compare differences between participants aged 50-65 years and 65 years and older. RESULTS: There was a significant improvement in functional status measures for both age categories except single-leg balance and fast gait speed, from 1 week after fracture extending up to 1 year after fracture (ranging from 6.1% improvement to 25% improvement, P < .05). There was no significant time × age interaction, as both age groups had the same pattern of recovery; however, there was significantly lower functional status in the older group across all time points. CONCLUSION: Regardless of age, monitoring and addressing functional status including upper limb function, overall strength, balance, confidence, usual gait speed, and physical activity right up to 1 year after fracture is an important consideration for clinicians treating women recovering from DRF. Given the high future fracture risk for these women, identifying functional recovery patterns can help to direct future research and determine preventative strategies.

A Review of the Effects of Physical Therapy on Self-Esteem in Postpartum Women With Lumbopelvic Dysfunction.

This study sought to determine the impact of physical therapy for lumbopelvic dysfunction on self-esteem in postpartum women. Systematic searches were carried out in CINAHL, Embase, PsycINFO, Medline (OVID), Cochrane, and Web of Science by a health sciences librarian using various combinations of subject headings and key words. A dual review process was used first to assess titles and abstracts and then to examine the full text. Conflicts were resolved through discussion or a third reviewer as needed. Dual data extraction was completed using a standardized collection form. Pairs of reviewers met to discuss conflicts. Data quality was assessed using the Cochrane Collaboration's Risk of Bias Tool, the Joanna Briggs Critical Appraisal Tool, and the Critical Appraisal Skills Programme Checklist. Thirteen articles were included in the review. None of the articles assessed self-esteem specifically; however, each article assessed aspects of self-esteem (self-concept, self-efficacy, self-worth, depression, quality of life, general well-being, or physical function). All articles reported improvements in the selected outcome measures compared with baseline; two studies that compared two different physical therapy interventions found no significant differences between the interventions. To our knowledge, there is no literature explicitly evaluating self-esteem in postpartum women following physical therapy intervention for lumbopelvic dysfunction. Low self-esteem is shown to predict depression and anxiety; therefore, interventions that increase self-esteem may be useful in reducing the risk of depression.

Anterior disc derangement with reduction of the temporomandibular joint: a case report.

BACKGROUND: Temporomandibular dysfunction involving anterior disc derangement with or without reduction, secondary to posterior ligament insufficiency is typically managed conservatively with success in a majority of patients. When conservative management fails, the next step in the continuum of care is unclear. Platelet-rich plasma injection combined with a 3-week immobilization period may be effective in treating posterior ligament insufficiency following a period of physical therapy. The result of this case was exceptionally successful, with the patient reporting 100% improvement 6 months post-injection. Prior to this case, we predicted a 20% success rate based on her inability to maintain the effects of conservative management over the long term. CASE PRESENTATION: A 33-year-old white woman presented with temporomandibular dysfunction, which responded to an initial course of physical therapy aimed at restoring the mechanics of her temporomandibular joint, exercise management, and education on self-management strategies. She returned 20 months later and responded well to another course of physical therapy. Despite improvement in pain, range of motion, and mechanics, she continued to present with a reduction click at the end range of opening. The crisp and loud nature of the reduction click indicated a viable posterior ligament and reduction of the anteriorly displaced disc. She opted for platelet-rich plasma injection, provided by a chronic pain specialist with the assistance of a physical therapist. She was immobilized for 3 weeks, followed by a weaning period with reduced posterior support for an additional 5 weeks. Follow-up appointments with a physical therapist occurred at 3 weeks, 8 weeks, and 6 months post-injection. CONCLUSIONS: At 6 months, she reported 100% improvement. Objectively, there was no indication that the disc condyle relationship was disrupted. At 6 months post-platelet-rich plasma injection, preceded by a period of conservative physical therapy management, and followed with appropriate physical therapy follow-up, this individual had complete resolution of her anterior disc derangement with reduction.

Differences in Function and Fracture Risk in Postmenopausal Women With and Without a Recent Distal Radius Fracture.

A distal radius fracture (DRF) is commonly the first fracture to occur in early postmenopausal women. The reasons for sustaining a DRF may be related to fall risk, bone fragility, or both. The objective of this study was to compare functional and fracture risk status in postmenopausal women with and without a recent DRF and explore the relationships between function, grip strength, and fracture risk status. Seventy-seven women a ges 50-78 with (n = 32) and without (n = 45) a history of DRF in the past 2 years participated. Balance, timed up and go (TUG), gait velocity, balance confidence, sit to stand, grip strength, and fracture risk were assessed. There was a significant group difference after controlling for physical activity level (Pillai's Trace, p < .05) where women with DRF had poorer outcomes on sit to stand, gait velocity, TUG, and fracture risk status. Grip strength was associated with functional tests, particularly in women with DRF. Women with a recent DRF demonstrated lower functional status and higher fracture risk compared to women without. Grip strength was associated with measures of function and fracture risk, and may complement screening tools for this population.

Falls and Wrist Fracture: Relationship to Women's Functional Status after Age 50.

Women experience a rapid rise in the incidence of wrist fracture after age 50. Accordingly, this study aimed to (1) determine the internal and environmental fall-related circumstances resulting in a wrist fracture, and (2) examine the relationship of functional status to these circumstances. Women aged 50 to 94 years reported on the nature of the injury (n = 99) and underwent testing for physical activity status, balance, strength, and mobility (n = 72). The majority of falls causing wrist fracture occurred outdoors, during winter months, as a result of a slip or trip while walking. Half of these falls resulted in other injuries including head, neck, and spine injuries. Faster walking speed, lower grip strength, and higher balance confidence were significantly associated with outdoor versus indoor falls and slips and trips versus other causes. This study provides insights into potential screening and preventive measures for fall-related wrist fractures in women.

The Relationship of Knee-Extensor Strength and Rate of Torque Development to Sit-to-Stand Performance in Older Adults.

PURPOSE: To investigate the association of knee-extensor strength and power to performance in the 30-second sit-to-stand test (30sSTS) in healthy older adults. METHOD: In a cross-sectional study of 29 healthy older adults aged 60-82 years (12 male, 17 female), hierarchical regression was used to determine the relationship of knee-extensor concentric and eccentric strength, peak rate of torque development (peak RTD) using isokinetic dynamometry, and momentum variables with the number of sit-to-stand repetitions completed in 30 seconds (30sSTSreps). RESULTS: Concentric (180°/s) and eccentric (90°/s) knee-extensor strength were significant independent predictors of 30sSTSreps after controlling for physical activity level, height and weight (adjusted R (2)=0.425, p=0.004; adjusted R (2)=0.427, p=0.004 respectively), as was concentric (90°/s) knee-extensor peak RTD (adjusted R (2)=0.424, p=0.004). Peak linear vertical momentum (PLVM) (adjusted R (2)=0.615, p<0.001) accounted for 36% of the variance. CONCLUSIONS: Generation of PLVM is an important predictor of 30sSTSreps; knee-extensor concentric and eccentric strength and power are associated with improved performance in this common functional task. Focusing on these parameters in exercise interventions may improve functional performance and give insight into specific factors related to success on the test.

Objectif : Étudier le lien entre la force et la puissance de l'extenseur du genou et le rendement au cours d'un test assis-debout de 30 secondes (TAD30s) chez des adultes âgés en bonne santé. Méthode : Au cours d'une étude transversale portant sur 29 adultes en bonne santé âgés de 60 à 82 ans (12 hommes, 17 femmes), on a utilisé une régression hiérarchique pour déterminer le lien entre la force concentrique et excentrique de l'extenseur du genou, le taux maximal de production du moment de force (RTD maximal) au moyen de la dynamométrie isokinétique, et les variables de la quantité de mouvement en fonction du nombre de répétitions assis-debout complétées en 30 secondes (répTAD30s). Résultats : La force concentrique (180°/s) et excentrique (90°/s) de l'extenseur du genou constituait un prédicteur indépendant significatif de repTAD30s compte tenu du niveau d'activité physique, de la taille et du poids (R2 rajusté=0,425, p=0,004; R2 rajusté=0,427, p=0,004 respectivement), tout comme l'était le RTD de pointe concentrique (90°/s) de l'extenseur du genou (R2 rajusté=0,424, p=0,004). La quantité de mouvement vertical linéaire de pointe (MVLP) (R2 rajusté=0,615, p<0,001) a représenté 36 % de la variation. Conclusions : La production du MVLP constitue un prédicteur important des répTAD30s. On établit un lien entre la force et la puissance concentriques et excentriques de l'extenseur du genou et une amélioration du rendement dans cette tâche fonctionnelle courante. La concentration de l'attention sur ces paramètres au cours d'intervention basées sur l'exercice peut améliorer le rendement fonctionnel et donner une idée de facteurs particuliers liés à la réussite au test.

Nausea and vomiting perspectives among children receiving moderate to highly emetogenic chemotherapy treatment.

BACKGROUND: Chemotherapy-induced nausea and vomiting (CINV) are common adverse effects, but occurrences among pediatric oncology patients are not well documented. OBJECTIVE: The primary aim was to describe anticipatory, acute, and delayed CINV among children with cancer from the child's, caregiver's, and nurse's perspective. A secondary aim evaluates the correlation of CINV among the child's, caregiver's, and nurse's perspectives. METHODS: CINV perspectives were evaluated before, during, and after a single course of highly or moderately emetogenic chemotherapy. CINV were evaluated among 40 pediatric cancer patients using the Adapted Rhodes Index of Nausea and Vomiting for Pediatrics, among their caregivers using the Adapted Rhodes Index of Nausea and Vomiting for Parents, and among their nurses using the National Cancer Institute Nausea and Vomiting Grading Criteria. RESULTS: CINV were reported by the patient, caregiver, and nurse at all times, with the most frequent reports occurring in the delayed period. Patient's mean total nausea and vomiting scores increased significantly over time. Patient reports of anticipatory, acute, and delayed CINV correlated with caregiver and nurse reports except for anticipatory nausea between the nurse and patient. CONCLUSIONS: CINV occurred throughout the chemotherapy course, with delayed CINV occurring most frequently and with greater severity and distress. Caregiver CINV reports correlated closely with patient reports. IMPLICATIONS FOR PRACTICE: Nurses need to be aware of the frequency, severity, and distress of CINV throughout the chemotherapy regimen. CINV can occur before and after chemotherapy treatment and should be assessed so that appropriate interventions can be implemented.

Interagency Biological Restoration Demonstration (IBRD): a collaborative approach to biological incident recovery.

Following the terrorist attacks in 2001, much time and effort has been put toward improving catastrophic incident response. But recovery--the period following initial response that focuses on the long-term viability of the affected area--has received less attention. Recognizing the importance of being able to recover an area following a catastrophic incident, the Department of Defense, through its Defense Threat Reduction Agency (DTRA), and the Department of Homeland Security, through its Science and Technology Directorate (DHS S&T), created the Interagency Biological Restoration Demonstration (IBRD) program. IBRD was a 4-year program jointly managed and funded by DTRA and DHS S&T, the goal of which was to reduce the time and resources necessary to recover a wide urban area from an intentional release of Bacillus anthracis. Specific program objectives included understanding the social, economic, and operational interdependencies that affect recovery; establishing long-term coordination between the Departments of Defense and Homeland Security; developing strategic recovery/restoration plans; identifying and demonstrating technologies that support recovery; and exercising recovery activities and technology solutions. IBRD has made important first steps toward improving national preparedness in the area biological incident recovery. Specifically, IBRD has helped enhance the efficacy and efficiency of recovering large urban areas by developing consequence management guidance; identifying key S&T capabilities and integrating them with planning and guidance documents; and establishing key relationships across the federal interagency, federal-to-regional, civilian-to-military, and public-to-private stakeholders. Upon completion of IBRD in fall 2010, both DTRA and DHS S&T planned follow-on programs.