Understanding the Changing Health Care Needs of Individuals Aging With Spinal Cord Injury.

Background: Individuals over age 65 are projected to account for over 20% of the general population by 2030. This trend is reflected in an increase in the age of individuals sustaining traumatic spinal cord injury (SCI). Based on current evidence, there is concern regarding the needs of older individuals aging with SCI and current health care services. Research is limited regarding factors that contribute to health status and treatment outcomes associated with aging 5 or more years post SCI. Objective: The purpose of this qualitative study was to explore changing health care needs of individuals aging with SCI and their caregivers and to identify the environmental supports and barriers to achieving long-term health and treatment outcomes. Methods: This was a phenomenological study utilizing semi-structured interviews. Inclusion criteria were age greater than 60 years old and 5 years post SCI. Between October 2014 and January 2016, 41 individuals with SCI and eight caregivers participated in the semi-structured interviews. Emergent themes and quotations were noted and analyzed using established methods. Triangulation was used to establish rigor and trustworthiness. Results: Data analysis of the interviews revealed four themes (health literacy, health services, changes with age, and environment) and 10 subthemes. Conclusion: Rehabilitation programs should consider the health literacy of older individuals with SCI and their caregivers. Similarly, these programs should be designed to allow them to identify and utilize resources in solving barriers to everyday participation. Further investigation is required to examine the macro-environmental influences (systems and policies) on the changing health care needs of individuals aging with SCI.

Building International Sustainable Partnerships in Occupational Therapy: A Case Study.

Occupational therapy practitioners frequently identify opportunities for international practice. The World Health Organization and the World Federation of Occupational Therapists have encouraged occupational therapists to address transnational issues, social inclusion, and equal access to opportunities grounded in meaningful occupation (WFOT, 2012). This case study describes a partnership between two U.S. schools of occupational therapy and a Cuban community based pediatric clinic. It examines the dynamics that have sustained the partnership despite political, economic, and logistical barriers. The literature is scrutinized to show how this case study fits into other accounts of collaborative international partnerships. Particularly, it investigates structural and institutional conditions that shape international sustainable partnerships. In doing so, we answer the following questions: (1) Under which circumstances do international partnerships emerge and flourish? (2) What structural and institutional conditions shape international sustainable partnerships? And (3) How do partners perceive and experience the bilateral international partnership? It also discusses and illustrates the foundations and development of international partnerships that succeed. Through the use of a case study we illustrate the development of this partnership. Finally, we consider the next steps of this particular sustainable and collaborative international partnership.

Culturally responsive care in occupational therapy: an entry-level educational model embedded in service-learning.

OBJECTIVE: This study focuses on the design of an entry-level educational model of culturally responsive care in occupational therapy embedded in service-learning (CRCOT-SL) that is perceived as clear, relevant, evidence-based, and useful by occupational therapy educators. The purpose of the model is to guide OT educators in teaching students to enable occupational participation and social inclusion in cross-cultural encounters. METHOD: The design consisted in defining the areas of the model and the components of each area, and articulating the learning process embedded in service-learning. A formative evaluation of CRCOT-SL was then performed using survey methods to collect feedback from 30 OT educators regarding the clarity, relevance, evidence-based constructs, and usefulness of CRCOT-SL. RESULTS: CRCOT-SL was perceived to be clear, relevant, evidence-based, and useful to 81.5% of the OT educators who participated in the study. Minor modifications to the model were completed based on the educator's feedback. CONCLUSIONS: CRCOT-SL is intended to respond not only to the dynamic, multicultural, and diverse environments in which practitioners currently practice but to the future needs of a global community facing social, political, economic, and environmental issues that will continue to affect dramatically people's living conditions and occupational needs.

Reliability and validity of the capabilities of upper extremity test (CUE-T) in subjects with chronic spinal cord injury.

OBJECTIVE: To determine the reliability and validity of the capabilities of upper extremity test (CUE-T), a measure of functional limitations, in patients with chronic tetraplegia. DESIGN: Repeated measures. SETTING: Outpatient rehabilitation center. PARTICIPANTS: Fifty subjects (36 male/14 female) with spinal cord injury (SCI) of ≥1-year duration participated. Subjects were 17-81 years old (mean 48.1 ± 18.2); neurological levels ranged from C2 through T6, American Spinal Injury Association Impairment Scale grades A-D. INTERVENTIONS: Not applicable. OUTCOME MEASURES: Intraclass correlation coefficients (ICC), weighted kappa and repeatability values for CUE-T; Spearman correlations of CUE-T with upper extremity motor scores (UEMS), and self-care and mobility portions of the Spinal Cord Independence Measure, vIII (SCIM III). RESULTS: Score ranges for UEMS were 8-50, CUE-T 7-135, self-care SCIM 0-20, and mobility SCIM 0-40. The ICC values for total, right, and left side scores were excellent (0.97-0.98; 95% confidence interval 0.96-0.99). Item weighted kappa values were ≥0.60 for all but five items, four of which were right and left pronation and supination. Repeatability of total score was 10.8 points, right and left sides 6.3 and 6.1 points. Spearman correlations of the total CUE-T with the UEMS and SCIM self-care and mobility scores were 0.83, 0.70, and 0.55 respectively. CONCLUSIONS: The CUE-T displays excellent test-retest reliability, and good-excellent correlation with impairment and capacity measures in persons with chronic SCI. After revising pronation and supination test procedures, the sensitivity to change should be determined.

The health mentors program: three years experience with longitudinal, patient-centered interprofessional education.

Increased emphasis on team care has accelerated interprofessional education (IPE) of health professionals. The health mentors program (HMP) is a required, longitudinal, interprofessional curriculum for all matriculating students from medicine, nursing, occupational therapy, physical therapy, pharmacy, and couple and family therapy. Volunteer lay health mentors serve as educators. Student teams complete four modules over 2 years. A mixed-methods approach has been employed since program inception, evaluating 2911 students enrolled in HMP from 2007 to 2013. Program impact on 577 students enrolled from 2009-2011 is reported. Two interprofessional scales were employed to measure attitudes toward IPE and attitudes toward interprofessional practice. Focus groups and reflection papers provide qualitative data. Students enter professional training with very positive attitudes toward IPE, which are maintained over 2 years. Students demonstrated significantly improved attitudes toward team care, which were not different across programs. Qualitative data suggested limited tolerance for logistic challenges posed by IPE, but strongly support that students achieved the major program goals of understanding the roles of colleagues and understanding the perspective of patients. Ongoing longitudinal evaluation will further elucidate the impact on future practice and patient outcomes.

Development of an objective test of upper-limb function in tetraplegia: the capabilities of upper extremity test.

OBJECTIVE: This study aimed to describe the development, internal consistency, and validity of the Capabilities of Upper Extremity Test (CUE-T) for persons with tetraplegia. DESIGN: This study used a cross-sectional sample of adults with spinal cord injury. CUE-T items and procedures were developed based on the CUE Questionnaire. Thirty adults with complete and incomplete spinal cord injury, neurologic levels C4-T6, were tested on one occasion. Each received upper limb manual muscle testing and the CUE Questionnaire followed by the CUE-T. Raw item scores were converted to a 0-4 scale. Internal consistency was evaluated using Cronbach alpha. Item score distributions were evaluated for ceiling and floor effects. Spearman correlations of total, right, and left CUE-T scores with upper-limb motor scores and international hand classification were performed. RESULTS: There were 23 men and 7 women, with an average age of 44.8 yrs. Twenty subjects had motor complete injuries; 13 had motor levels C4-C6, 13 had between C7 and C8, and 4 were T1 or below. The Cronbach alpha for the CUE-T was 0.96. Item score distributions found ceiling effects for the push/pull items, suggesting that these items were too easy. Correlations of right- and left-sided scores with upper-limb motor scores and international hand classification were strong, with all values greater than or equal to 0.89. CONCLUSIONS: The CUE-T displays good internal consistency and excellent construct validity on preliminary testing. Push/pull tests should be revised to increase difficulty. Reliability and responsiveness should be determined.