French cross-cultural adaptation of the Organizational Readiness for Implementing Change (ORIC).

BACKGROUND: Organizational readiness is a factor known to influence the predisposition of individuals within an organization to change. Based on Weiner's organizational theory, the "Organizational Readiness for Implementing Change" (ORIC) questionnaire was developed and validated to measure organizational readiness in healthcare contexts. However, no such tools allow French-speaking organizations to measure this concept. The objectives of this study were to (1) conduct a French cultural adaptation of the ORIC questionnaire, and (2) initiate the study of its psychometric properties. METHODS: (1) Cross-cultural adaptation and translation processes were first conducted with the methodologies of Beaton, Vallerand and Massoubre. (2) Subsequently, internal consistency was documented by calculating Cronbach's alpha and inter-item and item-to-scale correlations. The study of construct validity was initiated with a confirmatory factor analysis. RESULTS: A French 10-item scale named the Réceptivité organisationnelle à l'implantation d'un changement (ROIC) was developed and pretested by 125 occupational therapists working in Quebec homecare services. Cronbach's alpha values for the 2 item subscales show satisfactory internal consistency (Commitment: α = 0.84 and Efficacy: α = 0.86). Inter-item correlations revealed that the ROIC's items are moderately related to each other while item-to-total scale correlations pinpoint items that accounts for variance and influence internal consistency. Confirmatory factor analysis allowed the initiation of a substantial documentation of ROIC's model fit with the original version (CFI = 0.89, TLI = 0.85, SRMR = 0.08, and RMSEA = 0.12). CONCLUSIONS: The ROIC is a new theory-based and translated questionnaire that can be used to rigorously document the organizational readiness of French organizations. The ROIC has the potential to support members of different organizations in the identification of subsequent efforts for the implementation of a change.

Costs of a home-based rehabilitation program for older adults after lower limb orthopedic surgery: a pilot study.

Little is known about the cost of home-based rehabilitation programs in Quebec, Canada. The objective of this pilot project was to test a cost estimation methodology in the context of rehabilitation services delivered at home and to provide preliminary data on the costs for lower limb orthopedic surgery patients. This pilot study examined a short-term home care program for adults, aged 65 and over who returned home after lower limb surgery and required rehabilitation services. Efficacy was determined as the functional autonomy changes between admission and discharge from home rehabilitation program, as measured by the functional autonomy measurement system (SMAF). Costs of professionals, including direct and indirect time related to the intervention, were also determined in order to document cost-effectiveness of the program. Eighteen subjects were recruited. From those, 14 had complete data available for the analysis. The result shows that costs related to the combined natural improvement and the effect of the home-based rehabilitation program were CAN dollars 419 per unit of change of functional autonomy. The results of this pilot study confirm the feasibility of the cost estimation methodology for a home-based rehabilitation program.

Functional autonomy measurement system: development of a social subscale.

The purpose of this study was to develop a subscale assessing social functioning for the functional autonomy measurement system (SMAF). The development of this new dimension was based on consultations (focus groups and nominal groups) of experts from different health care disciplines in Quebec, Canada, and France. Two interrater reliability studies were carried out with older people presenting a loss of functional autonomy and living either in an institution or at home. With the focus groups, the experts clarified the definition of social functioning and identified the factors involved. The nominal groups were used to construct a subscale composed of six items. The results of the first interrater reliability study showed a mean agreement percentage of 60% for the subscale and an intraclass correlation coefficient (ICC) of 0.70 (CI: 0.57-0.80). The results of the second interrater reliability study showed higher coefficients with an agreement percentage of 74% for the subscale and an ICC of 0.83 (CI: 0.61-0.93). These preliminary results demonstrate that the new social functioning subscale has good reliability, but more studies are needed to show its validity. The new SMAF, including the social functioning subscale, should help clinicians and researchers to obtain a comprehensive profile of functional autonomy. It could also contribute to the improvement of health care for older people.

Predictors of handicap situations following post-stroke rehabilitation.

PURPOSE: Many stroke survivors have to cope with impairments and disabilities that may result in the occurrence of handicap situations. The purpose of the study was to explore bio-psycho-social predictors of handicap situations six months after discharge from an intensive rehabilitation programme. METHODS: At discharge from a rehabilitation programme, participants were evaluated with instruments measuring motor, sensory, cognitive, perceptual, affective and psychosocial impairments and disabilities that may play a role in the development of handicap. Some other demographic and clinical variables, and those related to rehabilitation, were also collected. Six months later, they were re-assessed in their own environment in order to document their handicap level with the Assessment of Life Habits (LIFE-H). RESULTS: One hundred and thirty-two stroke patients participated in the discharge evaluation and 102 of them also participated in the handicap measurement. Relationships between handicap level and impairments and disabilities were all statistically significant. Multiple regression analyses indicated that affect, lower extremity co-ordination, length of stay in rehabilitation, balance, age and comorbidity at the end of an intensive rehabilitation programme are the best predictors of handicap situations six months later (adjusted R(2): 68.1%). CONCLUSIONS: In spite of its exploratory nature, this study revealed that, among a substantial number of personal characteristics, some were more related to a handicap measure and have greater predictive value. Other studies should be carried out to validate these findings and to consider more environmental factors in order to better understand factors related to the development of handicap situations.

Coping with the consequences of a stroke.

BACKGROUND AND PURPOSE: Having a stroke constitutes a major life event which engenders some types of adaptation in order to try to resume to a "normal" life. The objectives of this study were (1) to explore the type of coping strategies used following a stroke; (2) to verify if coping strategies change over time, and (3) to verify if the coping strategies used are related to age, gender, actualization of potential, handicap level and depression. METHODS: A convenience sample of 76 participants who had had a stroke was recruited upon discharge from a functional intensive rehabilitation unit. Data were collected 2 weeks later and 6 months later in their own home. Coping strategies were measured using a modified version of the Ways of Coping Questionnaire. Actualization of potential was measured using the Measure of the Actualization of Potential and handicap level was quantified with the LIFE-H. Finally, the Beck Depression Inventory was used to evaluate the presence of depressive symptoms. CONCLUSION: The results suggest that long after the end of an intensive rehabilitation programme, some coping strategies might be more effective in dealing with the consequences of a stroke whereas others might be related to some form of inadaptation. However, the results should be treated with caution. More research on coping following a stroke using mixed methodologies is needed.

Association between personal and environmental factors and the occurrence of handicap situations following a stroke.

BACKGROUND AND PURPOSE: Little is known about the potential role of environmental factors in the handicap creation process following a stroke. The objective of this study was to explore the presence of a relationship between environmental factors and the occurrence of handicap following a stroke, taking into consideration age and the level of impairments and disabilities. METHODS: This is a cross-sectional study where data were collected 6 months after discharge from an intensive functional rehabilitation unit. A convenience sample of 51 participants was recruited at the time of their admission to the rehabilitation unit for rehabilitation post-stroke. Perceived influence of environmental factors was measured using the Measure of the Quality of the Environment (MQE). Handicap situations were measured with the Assessment of Life Habits (LIFE-H). Impairments and disabilities comprised six domains (cognition, perception. depression, communication, sensorimotor function and comorbidity) assessed using a variety of measuring tools from which a composite score was derived. RESULTS: Fifty-one participants aged 40-97 years old took part in this study. Perceived obstacles in the environment, together with age and the level of impairments and disabilities, explained 58.9% of the variation in the LIFE-H (handicap level). Taken alone, the perceived obstacles (total score) explained 6.2%. The perceived facilitators (total score) in the environment were not found to be related to the presence of handicap situations. CONCLUSION: Increased level of impairments and disabilities. advanced age and perceived barriers in the physical and social environment contribute to the handicap creation process following a stroke.

Effect of type II diabetic peripheral neuropathy on gait termination in the elderly.

AIMS/HYPOTHESIS: Healthy elderly people can have difficulties in precisely terminating gait due to age-related decline. Diabetes mellitus accelerates the neurodegenerative process, which results in an additional decline in motor control. This biomechanical study investigated goal-oriented gait termination in healthy elderly and elderly diabetic subjects. The trajectories of the centre of pressure and the centre of mass during the gait termination process were analysed in particular. It was hypothesised that the pathology results in an unstable gait termination, expressed in larger overshoots of the centre of pressure and the centre of mass than in healthy control subjects. METHODS: A total of 15 subjects with Type II (non-insulin-dependent) diabetes mellitus with impaired foot sensitivity due to polyneuropathy (median, 66 years) were matched according to age, gender and body mass index with 15 healthy elderly subjects (median, 67 years). The participants walked at their own pace along the walkway and stopped in front of a marked stopping line while kinetic and kinematic data were recorded. RESULTS: The diabetic subjects approached the stopping line more slowly (p = 0.002) than the healthy elderly subjects. They also exhibited a weaker maximal braking force (p = 0.011) and a prolonged relative time to develop this force (p = 0.023). Despite this slower motion, the centre of pressure overshoots were larger in the diabetic subjects than in the healthy elderly (p = 0.027). CONCLUSION/INTERPRETATION: The results show differences between healthy elderly and diabetic subjects during easy goal-oriented stopping tasks. Changes in gait termination parameters and the increased overshoots in particular document the pathology-related decline in postural stability.

Initiation of clozapine therapy in a patient with preexisting leukopenia: a discussion of the rationale of current treatment options.

Clozapine remains the most effective agent for diminishing or eliminating psychotic symptoms in treatment-resistant patients. However, among such patients, a small percentage (<3.0%) develops clozapine-induced granulocytopenia (CIG). In spite of the fact that lithium and granulocyte colony stimulating factor (G-CSF) have been shown to reverse CIG, many such patients are consigned to treatment with antipsychotic agents that have failed in the past. Apparently, their physicians are not aware that these patients can be salvaged for ongoing clozapine treatment. We report the effectiveness of lithium in reversing CIG in a young man with preexisting mild granulocytopenia. The rapidity of onset of leukocyte depletion is discussed in light of previously hypothesized autoimmune mechanisms of CIG. This case dramatizes the importance of lithium (or G-CSF) augmentation in those patients to maintain clozapine treatment so that their neutropenia can be reversed, and they can continue to benefit from the unique antipsychotic qualities of clozapine.

Involvement of occupational therapy departments in research: a provincial survey.

It is increasingly recognized that research is necessary to advance the practice of occupational therapy. The objective of this study was to determine whether occupational therapy departments in Quebec were commonly involved in research, and whether participation varied with the size of department and type of work setting. Secondly, enablers and barriers to participation in research were identified. A random sample of occupational therapy departments, stratified by size, were surveyed by mail. Participation rate was 74.8% (107/143). Participation in research was noted in half of the departments surveyed (51/107), most frequently as collaborator. Involvement in research was associated (p < .001) with a greater number of therapists in the department. Furthermore, occupational therapy departments in rehabilitation centres and in university hospitals were more likely to participate in research (79% and 90% respectively), whereas participation was lower for long-term care facilities (29%) and community health clinics (38%). When asked to rank factors that may facilitate participation in research, the highest rankings were given to: time allotted to research, research as a priority for administration, adequate financial support, and presence of an occupational therapy researcher and a research centre on site. This survey demonstrates that a number of factors can promote or prevent the realization of research activities within the clinical setting. Strategies are proposed to enhance the integration of research into clinical practice.

Impact of a specific program focusing on the psychological autonomy and actualization of potential of residents in a long term care unit.

In 1996, the Sherbrooke Geriatric University Institute introduced a specific health and services program focusing on actualization of potential and psychological autonomy designed for long term care clients presenting few or no cognitive deficits. Some 30 residents who met specific criteria were moved to the same unit. To determine the impact of this specific program on the residents, a study was done using a quasi-experimental design with a control group. The residents in the experimental and control groups were evaluated three times: at the beginning of the program (1996), 1 year (1997) and 2 years (1998) later. The main variables measured were: actualization of potential, psychological autonomy, psychological well-being, satisfaction with care and services, social relations, and perception of the freedom allowed by the institution in regard to their choices and decisions. The results indicate that the new program had no effect on the residents' psychological autonomy, actualization of potential and social relations. In addition, the residents in the experimental group indicated less well-being and less satisfaction than those in the control group. Despite these negative elements, the experimental residents like being and want to stay together on the same unit but seem somewhat concerned about the program objectives. These results led the research team to propose that the program objectives and activities be reviewed.

Lower limb prosthesis utilisation by elderly amputees.

The goal of prosthetic rehabilitation is to compensate for the loss of a limb by amputation by, in the case of a lower limb, encouraging walking, and to achieve the same level of autonomy as prior to the amputation. However, because of difficulties walking, elderly amputees may use their prosthesis to a greater or lesser degree or simply stop using it during the rehabilitation period. The objective of this research was to study factors such as physical and mental health, rehabilitation, physical independence and satisfaction with the prosthesis to understand why amputees use their prosthesis or not. The sample was composed of 65 unilateral vascular amputees 60 years old or over living at home. The information was collected from medical records, by telephone interview and by mail questionnaire. Prosthesis use was measured by a questionnaire on amputee activities developed by Day (1981). Eighty-one per cent (81%) of the subjects wore their prosthesis every day and 89% of this group wore it 6 hours or more per day. Less use of the prosthesis was significantly related to age, female gender, possession of a wheelchair, level of physical disability, cognitive impairment, poorer self-perceived health and the amputee's dissatisfaction. A multiple regression analysis showed that satisfaction, not possessing a wheelchair and cognitive integrity explained 46% of the variance in prosthesis use.

Enhancement of survival of stored dopaminergic cells and promotion of graft survival by exposure of human fetal nigral tissue to glial cell line--derived neurotrophic factor in patients with Parkinson's disease. Report of two cases and technical considerations.

The authors have studied the ability of glial cell line-derived neurotrophic factor (GDNF) to promote survival of human fetal dopaminergic tissue after a storage period of 6 days and subsequent implantation into the human putamen. The results indicate that GDNF promotes survival of stored dopaminergic cells. Cells stored without GDNF had a 30.1% decrease in survival time compared with those exposed to GDNF. Two patients with Parkinson's disease received bilateral putaminal implants of fetal dopaminergic cells exposed to GDNF for 6 days and showed enhancement of graft survival as assessed by positron emission tomography scanning. A mean increase of 107% in putaminal fluorodopa uptake from baseline values was observed 12 months postgrafting.

Neural transplantation cannula and microinjector system: experimental and clinical experience. Technical note.

The authors present a simple, reliable, and safe system for performing neural transplantation in the human brain. The device consists of a transplantation cannula and microinjector system that has been specifically designed to reduce implantation-related trauma and to maximize the number of graft deposits per injection. The system was evaluated first in an experimental rat model of Parkinson's disease (PD). Animals in which transplantation with this system had been performed showed excellent graft survival with minimal trauma to the brain. Following this experimental stage, the cannula and microinjector system were used in eight patients with PD enrolled in the Halifax Neural Transplantation Program who received bilateral putaminal transplants of fetal ventral mesencephalic tissue. A total of 16 transplantation operations and 64 trajectories were performed in the eight patients, and there were no intraoperative or perioperative complications. Magnetic resonance imaging studies obtained 24 hours after surgery revealed no evidence of tissue damage or hemorrhage. Transplant survival was confirmed by fluorodopa positron emission tomography scans obtained 6 and 12 months after surgery. As neural transplantation procedures for the treatment of neurological conditions evolve, the ability to deliver viable grafts safely will become critically important. The device presented here has proved to be of value in maximizing the number of graft deposits while minimizing implantation-related trauma to the host brain.

[Effect of a multi-strategic group program on performance of the activities of daily living for elderly people with mild cognitive deficits. / Impact d'un programme multi-stratégique de groupe sur le fonctionnement dans les activités de la vie domestique de personnes âgées présentant des déficits cognitifs légers.

OBJECTIVE: The goal of this study was to determine the impact of a group activity program on the level of functioning of a person in instrumental activities of daily living (IADL). This program was specifically designed for people with mild cognitive deficiencies living at home and attending a day centre. METHOD: Using a single subject design of AB type, eleven persons were assigned randomly to a experimental group (n = 7) and to a control group (n = 4). Their cognitive functioning was found to be between the 5th and the 25th percentile on the Modified Mini-Mental State Examination (3MS), which corresponds to stage 3 on the Reisberg Scale. The 18 week long multi-strategic program consisted of two weekly meetings of one and a half hours each. This program included physical exercises, psychomusical techniques, cognitive games and tasks related to IADL. The level of functioning of the subjects in their IADL was measured six times at home using the Assessment of Motor and Process Skills (AMPS), before, during and after the program. FINDINGS: The data derived from each subject were presented as a graphical analysis. Following the application of the program, more of the participants, as compared to the control subjects, improved their functioning in terms of IADL. CONCLUSION: The findings of this study suggest that it would be possible to use coping strategies in the early stages of cognitive deficits.

[Questionnaire on the satisfaction of persons with lower-limb amputations towards their prosthesis: development and validation]. / Questionnaire sur la satisfaction des personnes amputées du membre inférieur face à leur prothèse: développement et validation.

The satisfaction of persons with lower-limb amputations towards their prosthesis constitutes a critical factor in the use of the prosthesis. In order to evaluate a person's satisfaction, the SAT-PRO, a self-administrated questionnaire was developed. The questionnaire includes 15 items developed on the basis of the most significant criteria used by the person when selecting a technical aid. These criteria were measured using an ordinal categorical four-level scale. The validation of the SAT-PRO was established from a sample consisting of 61 people with below-knee or above-knee amputations, aging from 60 years and older. The internal consistency of the instrument is high (Cronback's alpha coefficient is 0.90) and the test-retest reliability coefficient (0.97) indicates a very good consistency of the questionnaire over time. Simple and multiple correlations were used to evaluate construct validity. The degree of use of the prosthesis and the feelings of depression, amongst the measured variables, are the best indicators of the satisfaction of the amputees toward their prosthesis.

[Test-retest and inter-rater reliability of the French version of the Ontario Society of Occupational Therapy (OSOT) Perceptual Evaluation]. / Fidélité test-retest et interjuges de la version française du OSOT Perceptual Evaluation.

This article presents the results of a study conducted to verify the test-retest and inter-rater reliability of the French version of the Ontario Society of Occupational Therapy (OSOT) Perceptual Evaluation. Designed to evaluate the perceptual deficits in patients with brain injuries, this tool uses a 5-points scale (0-4) to measure 18 different tasks. The scores obtained for each task are added to establish a total score. In the early 90s, the instruction manual of the OSOT Perceptual Evaluation was translated in French by a group of occupational therapists from l'Institut universitaire en gériatrie de Sherbrooke. To ensure the reliability of this version, a study was conducted to determine the test-retest reliability and the simultaneous inter-rater reliability. Thirty-two francophone subjects with brain injuries were each evaluated twice by the same therapist to determine the test-retest reliability of this tool. At one of the two encounters, a second therapist completed the score sheet to verify the simultaneous inter-rater reliability. The results show that, despite a few weak kappas' scores for certain tasks, the test-retest reliability and the inter-rater reliability of the total score were excellent (test-retest reliability: intra-class correlation coefficient = 0.93, with a confidence interval of 0.87 to 0.97; and inter-observer reliability: = 0.98, with a confidence interval of 0.97 to 0.99). The findings of this study show that the French version of the OSOT Perceptual Evaluation can therefore be used confidently by francophone occupational therapists.

Age-related changes in upper extremity performance of elderly people: a longitudinal study.

The objective of this research was to study age-related changes in the upper extremity performance of healthy community-dwelling elderly people, by using a longitudinal design. In 1995-1996. gross and fine manual dexterity, global performance, motor coordination, grip strength, tactile recognition, two-point discrimination, touch/pressure threshold, and tactile localization of 264 of the 360 subjects initially evaluated in 1992-1993 were reevaluated by using the same upper extremity measuring instruments. Those who did not participate (n = 96) were found to be significantly different from those who participated in the longitudinal study. Although the survivors were younger, more active, and perceived themselves in better health than the nonparticipants, their upper extremity performance significantly decreased in the 3-year period, with a few exceptions. In general, the decline was related to the initial score but not to age.

Comparison of cross-sectional and longitudinal designs in the study of aging of upper extremity performance.

The purpose of the study was to compare two research designs, namely the cross-sectional design and the longitudinal design, in the context of upper extremity performance and age-related changes. Upper extremity performance of 360 randomly recruited healthy, community-dwelling elderly persons was evaluated with reliable and valid sensori-motor tests. Three years later, survivors (n = 264) were reevaluated with the same tests. In many tests, cross-sectional and longitudinal designs were comparable for estimating the changes in upper extremity performance with age. However, in some tests, the decline with age using a cross-sectional design was underestimated. The upper extremity performance decline observed with the longitudinal design was larger than the decline predicted with the cross-sectional design. The withdrawal and survivor biases related to the longitudinal design and the cohort bias associated with the cross-sectional design may, in part, explain these results.

Isometric grip endurance of healthy elderly men and women.

Grip endurance is one of the important prerequisites for good performance of the upper extremity and hence it is important to evaluate it correctly. However, we know little about normal grip endurance, especially for elderly people. The main objective of this study was to examine the age-related changes in grip isometric endurance of healthy community-dwelling elderly people. Two-hundred and eighty-six subjects aged between 60 and 90, were randomly selected from the electoral list of the city of Sherbrooke, Quebec, Canada. Grip relative isometric endurance was evaluated using the Jamar dynamometer. Isometric grip endurance was estimated by the number of seconds a subject could sustain 50% of his/her maximal voluntary grip strength. Contrary to other upper extremity sensorimotor parameters, no grip isometric endurance difference was found with age, in spite of a slight tendency towards a decrease. The women tended to have better scores than the men and endurance of dominant hand is better than the non-dominant. The stability with age could be explained by muscle fiber composition modifications.

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.