Perspectives of inpatient rehabilitation clinicians on the state of manual wheelchair training: a qualitative analysis.

PURPOSE: The purpose of this study was to identify clinician knowledge regarding manual wheelchair (MWC) training in an inpatient rehabilitation (IPR) setting, identify current MWC education provided to new manual wheelchair users (MWUs), and determine how MWC training resources can be developed or modified to promote use among IPR clinicians. METHODS: Semi-structured interviews were conducted with 20 licenced IPR clinicians who work with MWUs. Using a traditional qualitative research design, researchers completed open, data-driven coding of interview transcripts. Overarching themes were determined through content analysis. RESULTS: Participants included 12 physical therapists, six occupational therapists, one physical therapy assistant, and one occupational therapy assistant. Five themes emerged from the interviews: (1) clinician knowledge, education, and experience (2) current training content (3) training environment, (4) desired programme components (5) barriers to implementation. Participants reported receiving minimal education in school and from their employers on training MWUs. While clinicians expressed the importance of MWU education, they used varying training approaches with little standardization. Participants identified that training protocols for IPR are beneficial if they are quick, straightforward, and flexible. CONCLUSIONS: While MWC training occurs during IPR stays, it appears to be inconsistent across facilities, clinicians, and patients, with varying degrees of adherence to evidence-based practices. This is likely due to limited feasibility and awareness of existing MWC training resources. Clinician input gathered from these interviews provides information for how to best integrate MWC training programmes into the rehabilitative process. Findings may inform the development and assessment of more clinically feasible MWC training protocols. Implications for RehabilitationNew manual wheelchair users must learn numerous wheelchair-related skills in order to participate in everyday life activities.Manual wheelchair education for new users during inpatient rehabilitation is often inconsistent across facilities, clinicians, and patients, with varying degrees of adherence to existing evidence-based practices.Systematic challenges often act as a barrier to the implementation of more comprehensive, structured manual wheelchair training protocols.Manual wheelchair training resources must be concise, flexible, customisable, and easy to follow in order to promote increased implementation among inpatient rehabilitation clinicians.

An observational study of personal and environmental factors associated with attendance at a community-based adaptive fitness center for adults with physical disabilities.

BACKGROUND: Regular exercise has many benefits for adults with physical disabilities (AwPD). Despite these benefits, significant barriers to participating in exercise exist for AwPD. Community-based adaptive fitness centers promote exercise for AwPD by minimizing barriers. Research has yet to clearly examine the personal and environmental factors associated with enrollment and attendance rates of AwPD in community-based adaptive fitness centers. OBJECTIVE: The purpose of our study was to explore personal and environmental factors associated with AwPD and their attendance at a community-based adaptive fitness center once enrolled. METHODS: Individuals aged 18-85 with a physical disability interested in exercising were referred to a community-based adaptive fitness center. At initial assessment, participants completed demographics, health, barriers to exercise, and exercise self-efficacy (ESE) surveys. Following initial assessment, participant visits to the fitness center were tracked for six months. RESULTS: Of 106 participants, 27 never visited the facility after initial assessment, and the remaining participants with six months of attendance data (n = 67) averaged 14.9 (SD = 14.2) visits. Correlation results showed a negative curvilinear relationship between number of visits and years living with disability (rs = -0.24, p < 0.05), with higher attendance associated with more recent diagnosis. Logistic and stepwise regressions showed that ESE score (ß = 0.107, p = 0.026) was the only significant predictor of attending the fitness center once enrolled. CONCLUSIONS: This study demonstrates the importance of understanding personal and environmental factors and assessing ESE for AwPD who are newly enrolled in a community-based adaptive fitness center.

Impact of the COVID-19 Pandemic on Psychosocial Health of Persons With Spinal Cord Injury: Investigation of Experiences and Needed Resources.

Background: Emerging evidence suggests that the COVID-19 pandemic has been accompanied by increased rates of depression and social isolation. However, we do not yet understand how the COVID-19 pandemic has affected the psychosocial health of people with spinal cord injury (PwSCI), a population that is already at risk of experiencing mental health conditions. Objectives: The aims of the study were to (1) examine the impact of the pandemic on the psychosocial health of PwSCI and (2) investigate the experiences of PwSCI and resources they reported needing during the peak of the pandemic. Methods: A cross-sectional survey with closed- and open-ended questions was administered to 51 PwSCI. Participants were included if they had an SCI, were 18 years or older, lived in St. Louis, Missouri, and surrounding areas, and understood English. Results: Canonical correlation showed a significant association between financial security, food insecurity, and personal assistance service use and adverse psychosocial health outcomes (p < .001). Participants reported interest in resources related to COVID-19 precautions for wheelchair users as well as home exercise programming and financial assistance with utilities. Finally, qualitative analysis revealed four major themes: (1) mental health during the pandemic, (2) financial concerns and reduced access to personal assistance services, (3) feelings of social isolation prior to the pandemic, and (4) local and national authorities' handling of the pandemic. Conclusion: PwSCI are impacted by the COVID-19 pandemic and reported a variety of resource needs. These findings may inform service providers, support systems, and organizations to better support PwSCI during times of crisis.

Aging with Disability Symptoms and Ability to Participate in, and Satisfaction with, Social Participation among Persons Aged 45-64.

Pain, fatigue, and depression, considered aging with disability (AwD) symptoms, are known to be substantially higher among middle-aged adults with long-term disability compared to their age peers. Participation has been recognized as an important component of health. This cohort survey study reports findings on the relationship between AwD symptoms and ability to participate in, and satisfaction with participation in, social roles and activities using PROMIS measures. Data were collected at three time points from individuals aged 45-64 with an average of two decades of disability duration and primarily living in the state of Missouri, USA. This study reports on Time 1 (T1) and Time 3 (T3), pre- and post-COVID-19 pandemic declaration, respectively. Multiple regressions using both individual AwD symptoms and a composite measure demonstrated that having more pain, fatigue, and depression was associated with worse participation outcomes. Lower physical function scores were also related to lower participation scores, as was being female and living with others, and having more income reduced participation. Better physical health and identifying as African American/Black were associated with higher participation scores. Our findings suggest that AwD symptoms, along with other sociodemographic and health factors, play a substantial role in the social participation outcomes for persons aging with disability and remain consistent over time.

Factors influencing participation among adults aging with long-term physical disability.

BACKGROUND: People aging with long-term physical disability (AwPD) experience barriers to participation and independent living. There are currently limited evidence-based interventions that address issues regarding participation for people AwPD. OBJECTIVE: This study examined factors influencing participation in personal and life activities among people AwPD to inform future interventions. METHODS: A cross-sectional study within an ongoing, community-based cohort study of participation was conducted. A purposive sample of people AwPD aged 45-65, living with a physical disability for at least five years, and who speak English was recruited through disability organizations, aging organizations, and social media. Participants answered open-ended questions about what supports they needed to successfully participate in nine activity categories derived from the Health and Retirement Study participation items (e.g., employment, community leisure). A content analysis was conducted using NVivo to categorize responses, and member checking occurred with four additional people AwPD. RESULTS: A total of 215 participants completed the survey. Eight categories of factors emerged from the data: physical environment factors, social factors, symptoms, economic factors, policy factors, body structure and functions, mental and emotional state, and temporal factors. Participant responses illuminated a combination of environmental and individual factors. Physical effects of disability and accelerated aging, such as pain and fatigue, paired with environmental factors, such as accessibility of transportation, were reported as influencing participation. CONCLUSIONS: People AwPD experience a range of factors that substantially impact their ability to remain independent and participate in society. By identifying barriers to participation, new interventions addressing these barriers may be developed, resulting in more effective service provision, enhanced participation in personal and life activities, and improved health and well-being.

Toward Cultural Competency in Health Care: A Scoping Review of the Diversity and Inclusion Education Literature.

PURPOSE: To explore best practices for increasing cultural competency and reducing health disparities, the authors conducted a scoping review of the existing literature. METHOD: The review was guided by 2 questions: (1) Are health care professionals and medical students learning about implicit bias, health disparities, advocacy, and the needs of diverse patient populations? (2) What educational strategies are being used to increase student and educator cultural competency? In August 2016 and July 2018, the authors searched 10 databases (including Ovid MEDLINE, Embase, and Scopus) and MedEdPORTAL, respectively, using keywords related to multiple health professions and cultural competency or diversity and inclusion education and training. Publications from 2005 to August 2016 were included. Results were screened using a 2-phase process (title and abstract review followed by full-text review) to determine if articles met the inclusion or exclusion criteria. RESULTS: The search identified 89 articles that specifically related to cultural competency or diversity and inclusion education and training within health care. Interventions ranged from single-day workshops to a 10-year curriculum. Eleven educational strategies used to teach cultural competency and about health disparities were identified. Many studies recommended using multiple educational strategies to develop knowledge, awareness, attitudes, and skills. Less than half of the studies reported favorable outcomes. Multiple studies highlighted the difficulty of implementing curricula without trained and knowledgeable faculty. CONCLUSIONS: For the field to progress in supporting a culturally diverse patient population, comprehensive training of trainers, longitudinal evaluations of interventions, and the identification and establishment of best practices will be imperative.