Patient Perspectives on Transitions from Acute to Community-Based Physiotherapy Care Following Total Knee Replacement Surgery Within the Context of a Bundled Care Model.

Purpose: Research on fiscal implications of the bundled care (BC) model exist; however, patient-perceived experiences are less well known. As BC expands in Ontario, this study aims to examine these experiences with physiotherapy care within the total knee replacement (TKR) BC programme. Methods: Qualitative cross-sectional study design. Semi-structured one-on-one telephone interviews were conducted with eight patients four to six weeks post-TKR. Thematic analysis was used. Results: This exploratory study identified three themes across the care journey that patients perceived as influencing their physiotherapy experiences: timely access to physiotherapy care, quality of physiotherapy care, and patient outcomes. Communication, clinical support, and social support were sub-themes. Conclusions: Patients' overall experiences with BC physiotherapy were positive. Areas for improvement included coordination of postoperative physiotherapy and return-to-work support. Patients valued group settings and were interested in meeting previous TKR patients. Health system planners are advised to consider incorporating patient experiences when evaluating and developing BC programmes to achieve patient-centred outcomes.

Objectif : il existe des recherches sur les conséquences budgétaires du modèle des faisceaux de soins (FS), mais les expériences perçues par les patients sont moins connues. Puisque le FS se généralise en Ontario, la présente étude vise à examiner ces expériences dans le contexte des soins physiothérapiques au sein du programme de FS de l'arthroplastie totale du genou (ATG). Méthodologie : étude transversale qualitative. Les chercheurs ont effectué des entrevues téléphoniques individuelles semi-structurées auprès de huit patients, de quatre à six semaines après une ATG. Ils ont utilisé une analyse thématique. Résultats : cette étude exploratoire a permis de faire ressortir trois thèmes dans le parcours des soins que les patients perçoivent comme influents sur leurs expériences de la physiothérapie : l'accès rapide aux soins de physiothérapie, la qualité de ces soins et l'issue des patients. Les sous-thèmes de la communication, du soutien clinique et du soutien social ont également été dégagés. Conclusions : les expériences globales des patients à l'égard de la physiothérapie des FS étaient positives. Les secteurs à améliorer incluaient la coordination de la physiothérapie postopératoire et le soutien au retour au travail. Les patients aimaient les contextes de groupe et s'intéressaient à rencontrer des patients qui avaient déjà subi une ATG. Les planificateurs du système de santé sont invités à envisager d'intégrer les expériences des patients lorsqu'ils évaluent et développent des programmes de FS pour obtenir des résultats axés sur les patients.

Aotearoa New Zealand Deaf women's perspectives on breast and cervical cancer screening.

AIMS: Since the introduction of both cervical and breast screening programmes in Aotearoa New Zealand, mortality rates have dropped. Both screening programmes track women's engagement, but neither capture the level of engagement of Deaf women who are New Zealand Sign Language users or their experiences in these screening programmes. Our paper addresses this knowledge deficit and provides insights that will benefit health practitioners when providing screening services to Deaf women. METHODS: We used qualitative interpretive descriptive methodology to investigate the experiences of Deaf women who are New Zealand Sign Language users. A total of 18 self-identified Deaf women were recruited to the study through advertisements in key Auckland Deaf organisations. The focus group interviews were audiotaped and transcribed. The data was then analysed using thematic analysis. RESULTS: Our analysis indicated that a woman's first screening experience may be made more comfortable when staff are Deaf aware and a New Zealand Sign Language interpreter is used. Our findings also showed that when an interpreter is present, extra time is required for effective communication, and that the woman's privacy needs to be ensured. CONCLUSION: This paper provides insights, as well as some communication guidelines and strategies, which may be useful to health providers when engaging with Deaf women who use New Zealand Sign Language to communicate. The use of New Zealand Sign Language interpreters in health settings is regarded as best practice, however their presence needs to be negotiated with each woman.

A qualitative photo-elicitation study exploring the impact of falls and fall risk on individuals with subacute spinal cord injury.

BACKGROUND: Individuals living with chronic spinal cord injury or disease (SCI/D) are at an increased risk of falling. However, little is known about the impact of falls and fall risk in the subacute phase of SCI/D, despite this being a time when fall prevention initiatives are delivered. Hence, we explored the impact of falls and fall risk in individuals with subacute SCI/D as they transitioned from inpatient rehabilitation to community living. METHODS: This qualitative photo-elicitation study used an inductive thematic analysis. Eight individuals (7 male) undergoing inpatient rehabilitation at a Canadian tertiary rehabilitation hospital due to a new SCI/D participated. Six months following discharge, photo-elicitation interviewing was used to understand the impact of falls and fall risk. Over 7-14 days, participants completed a photo-assignment that involved taking photographs in response to questions, such as what increases/decreases your likelihood of falling? A semi-structured interview followed, in which participants described their photographs and discussed their experiences with falls, fall risk and fall prevention training. RESULTS: Four themes were identified. 1) Risk factors and strategies identified through lived experience. Participants discovered their fall risk factors and fall prevention strategies through "trial and error". 2) Influences on the individual's perception of their fall risk. Prior experience with falls, including falls experienced by themselves as well as friends and family, influenced their perception of fall risk. 3) Experiencing life differently due to increased fall risk. A high fall risk reduced participation, increased negative emotions and decreased independence and quality of life. 4) Falls training in rehabilitation can be improved. Prior experiences with falls training varied; however, participants expressed a desire for comprehensive and individualized training. CONCLUSION: Although participants' experiences with falls and fall prevention varied, falls and the risk of falling can have a significant impact on the first year of living with a SCI/D.

Access to and engagement with cervical and breast screening services for women with disabilities in Aotearoa New Zealand.

PURPOSE: To describe access to and engagement with cervical and breast screening services for women who are Deaf or live with a physical or sensory disability in Aotearoa New Zealand (NZ). METHOD: We carried out an online survey on a convenience sample of 84 women. Tests of association were undertaken between socio-demographics and cervical and breast screening; and between disability type, and health outcomes and barriers to screening respectively. Participants also reported specific barriers to screening. RESULTS: Living without family/partner and unemployment were associated with never having a cervical smear. Non-English preferred language, and urban residence were related to lower levels of breast self-examination; having insufficient income was related to never having a mammogram. Disability type was not related to either smear or mammogram on eligibility, uptake ever, or uptake timeframe. A higher proportion of those with multiple disability types experienced service environment barriers to having a cervical smear. Specific barriers to screening covered accessibility, service environment, and information. CONCLUSIONS: This study, unique in Aotearoa, provides insights into disabled women's access to and engagement with screening services and suggests factors that may inhibit or facilitate participation. Women with multiple disabilities may be disadvantaged in the seeking and delivery of screening.Implications for rehabilitationRehabilitation and other practitioners need to be attuned to how women living with multiple disabilities may be disadvantaged in the seeking of, and, more importantly, the delivery of breast or cancer screening.Practitioners need to discuss with disabled women what supports or resources they need to have screening procedures, and to advocate for these supports for their clients.Practitioners need to ensure accessibility that encompasses the whole screening journey from the initial invitation to the obtaining of results.For practitioners to be able to provide equitable service delivery, the government and institutional policies and procedures that are developed must take into consideration the multiple needs of women living with disabilities.

Cardiopulmonary Exercise Testing in Stroke Rehabilitation: Benefits and Clinical Utility Perceived by Physiotherapists and Individuals with Stroke.

Purpose: The purpose of this study was to understand the perceived benefits and clinical utility of cardiopulmonary exercise testing (CPET) from the perspectives of physiotherapists and patients and to explore the factors that influence adopting CPET in a stroke rehabilitation setting. Method: A qualitative descriptive study was conducted. Physiotherapists (n = 6) participated in a focus group to discuss the use of CPET in practice. Patients (n = 8) who had completed CPET during stroke rehabilitation participated in a semi-structured interview to explore their experiences. Thematic analysis was performed. Results: CPET increased the physiotherapists' confidence in prescribing exercise, especially for medically complex patients. Ongoing medical management early post-stroke was a barrier to referral. Physiotherapists expressed decreased confidence in interpreting test results. Consultation with local experts facilitated the use of CPET. Patients described how CPET increased their confidence to participate in exercise. They desired more information before and after CPET to better understand the purpose and results and their relation to their rehabilitation goals. Conclusions: Both physiotherapists and patients described the benefit of having CPET available to support them as they participated in exercise in a stroke rehabilitation setting. Physiotherapists would benefit from having educational tools to support their interpretation and application of test results, and patients would benefit from improved communication and education to support their understanding of the relevance of CPET to their rehabilitation goals. Future research should explore these findings in other stroke rehabilitation settings.

Objectif : comprendre les avantages perçus et l'utilité clinique de l'épreuve d'effort cardiorespiratoire (ÉECR) du point de vue des physiothérapeutes et des patients et explorer les facteurs qui influent sur l'adoption de l'ÉECR dans un milieu de réadaptation après un accident vasculaire cérébral (AVC). Méthodologie : étude descriptive qualitative. Les physiothérapeutes (n = 6) ont participé à un groupe de travail pour discuter de l'utilisation de l'ÉECR dans la pratique. Les patients (n = 8) qui ont effectué une ÉECR pendant la réadaptation après un AVC ont participé à une entrevue semi-structurée pour explorer leurs expériences. Une analyse thématique a suivi. Résultats : l'ÉECR donne confiance aux physiothérapeutes qui prescrivent de l'exercice, particulièrement pour les patients qui éprouvent des problèmes de santé complexes. La prise en charge médicale continue peu après un AVC était un obstacle à une demande de consultation. Les physiothérapeutes exprimaient leur manque de confiance à interpréter les résultats de l'ÉECR. La consultation d'experts locaux les incitait à utiliser l'ÉECR. Les patients ont expliqué que l'ÉECR leur donnait confiance à participer aux exercices. Ils souhaitaient recevoir plus d'information avant et après l'ÉECR, afin de mieux comprendre la raison d'être, les résultats et leur lien avec les objectifs de réadaptation. Conclusion : les physiothérapeutes et les patients ont décrit les avantages de disposer de l'ÉECR pour les aider dans le cadre des exercices effectués en réadaptation après un AVC. Les physiothérapeutes profiteraient d'outils de formation pour les aider à interpréter et appliquer les résultats, et les patients profiteraient de meilleures communications et d'une meilleure éducation pour mieux comprendre la pertinence de l'ÉECR dans l'atteinte de leurs objectifs de réadaptation. Les prochaines recherches devraient explorer ces résultats dans d'autres milieux de réadaptation après un AVC.

Capturing the psychosocial impacts of falls from the perspectives of wheelchair users with spinal cord injury through photo-elicitation.

PURPOSE: While the physical consequences of falls among wheelchair users with spinal cord injury have previously been examined, the psychosocial impacts remain understudied. Here, we explored the psychosocial impacts of falls and risk of falling from the perspectives of wheelchair users with spinal cord injury. MATERIALS AND METHODS: Twelve wheelchair users (aged 41.8 ± 12.5 years; median 17.5 (range 3-44) years post-spinal cord injury) with traumatic spinal cord injury captured photographs of how falls and the risk of falling impacted their recreation/leisure and paid/volunteer work activities. Participants then engaged in photo-elicitation interviews to discuss the content depicted in the photographs. Interviews were analyzed using a thematic analysis. RESULTS: Two main themes emerged: (1) The varying concern about falling: While some participants experienced a high concern, others were not concerned about falling in their daily activities. The level of concern about falling varied among participants over time and across situations. (2) Fear, falling, and limitations: Falls could impact daily activities, parenting, work, leisure/recreation, and lead participants to want a life without a constant risk of falling. CONCLUSIONS: Falls have a significant psychosocial impact for some, but not all participants. Clinicians should explore whether and to what extent falls/fall risk have a lasting psychosocial impact, and work with individuals to create strategies that may reduce negative psychosocial impacts.IMPLICATIONS FOR REHABILITATIONThis study highlighted that falls can have a significant psychosocial impact on the lives of some wheelchair users with spinal cord injury.Since a wheelchair user's concern of falls may change overtime, clinicians are encouraged to have ongoing dialogue about every wheelchair user's level of concern about falls.If a wheelchair user expresses a high concern of falls, clinicians are encouraged to provide appropriate supports and resources for individuals to continue engaging in meaningful activities.

Key informants' perspectives on implementing caregiver programs in an organized system of stroke care.

PURPOSE: Family caregivers provide essential support to individuals recovering after experiencing a stroke. Although clinical guidelines recommend the provision of caregiver education and support, these guidelines have not been implemented into standard clinical practice. The objective of this study was to gain insight from key informants-affiliates of a regional stroke system-to identify organization and system level barriers and facilitators associated with implementing stroke caregiver programs. METHODS: Twelve key informants were interviewed. Informants discussed their experiences with and perceptions of caregiver programs. They also identified barriers and facilitators to implementing caregiver programs. Interview data were analyzed using inductive thematic analysis. RESULTS: Three themes were generated: (1) lack of consensus on the need for caregiver education and support programs as part of the health care system; (2) a collaborative process is needed to engage stakeholders and identify champions (3) stakeholders need different types of evidence in support of implementation. CONCLUSIONS: This study provides initial insight into the potential barriers and facilitators needed to develop and implement stroke caregiver programs. Further exploration of these topics can inform caregiver program development and their implementation into stroke systems of care.IMPLICATIONS FOR REHABILITATIONRehabilitation research needs to demonstrate that caregivers are a unique group in need of support from the health care system.Rehabilitation research needs to contribute to the evidence that caregiver programs can improve patient, caregiver, and health system outcomes.Researchers can enhance caregiver program implementation through collaboration between researchers, stakeholders, and system change champions starting with program development.

Factors that influence the risk of falling after spinal cord injury: a qualitative photo-elicitation study with individuals that use a wheelchair as their primary means of mobility.

INTRODUCTION: Falls are a concern for wheelchair users with spinal cord injury (SCI). Falls can negatively impact the physical and psychological well-being of fallers. To date, the perspectives of wheelchair users with lived experiences of SCI on the contributors to falls has been understudied. Information about factors that influence fall risk would guide the development of effective fall prevention strategies. OBJECTIVES: To gain a comprehensive understanding of the factors that influenced the risk of falling as perceived by wheelchair users with SCI. DESIGN: A qualitative study using photo-elicitation interviews. SETTING: A Canadian SCI rehabilitation hospital and the participants' home/community environments. PARTICIPANTS: Twelve wheelchair users living in the community with chronic SCI. METHODS: Participants captured photographs of situations, places or things that they perceived increased and decreased their risk of falling. Semistructured photo-elicitation interviews were conducted to discuss the content of the photographs and explore perceptions of fall risk factors. A hybrid thematic analysis and the Biological, Behavioural, Social, Economic, and Environmental model were used as a framework to organise/synthesise the data. RESULTS: Overall, the findings indicated that the risk of falling was individualised, complex and dynamic to each person's life situation. Four main themes were revealed in our analysis: (1) Falls and fall risk caused by multiple interacting factors; (2) Dynamic nature of fall risk; (3) Single factors were targeted to reduce falls and fall-related injuries; and (4) Fall prevention experiences and priorities. CONCLUSIONS: Each wheelchair user encountered numerous fall risk factors in their everyday lives. Information from this study can be used to set priorities for fall prevention. Fall prevention initiatives should consider a wheelchair user's fall risks in a holistic manner, acknowledging that a person's current situation, as well as anticipating their fall risks and fall prevention needs, will change over time.

Getting on with life: a qualitative evaluation of an independent living skills education program for people with physical disabilities.

Background: The Independent Living Movement seeks to promote independence for people living with disabilities by encouraging them to direct their own care. Programs exist that strive to teach individuals the necessary skills to live independently; however, these programs have not been widely researched.Purpose: The purpose of this paper is to explore alumni perceptions of a long-duration, immersive, independent living program and its influence on community independent living.Methods: Nine individuals who had previously attended the Gage Transition to Independent Living program in urban Toronto were interviewed to ascertain their perceptions on the program and how it assisted with independent community living, as well as their feedback for program improvement.Results: Most participants reported a positive impact from the program, and five main themes were developed: (i) referral source and expectations, (ii) perspectives of program and staff, (iii) navigating housing, (iv) benefits to transition and (v) recommendations for program improvement.Conclusions: Independent living skills education programs seem to have a positive impact on the participants who complete them. Further research should target direct comparisons of program models and effect on quality of life as measured by validated constructs.IMPLICATIONS FOR REHABILITATIONIncorporating a life skills component for individuals with physical disabilities can improve their transition to independent living.Skills such as self-advocacy, directing attendant services, and completing instrumental activities of daily living are found to be the most efficacious components taught within an independent living skills program.Greater awareness of independent living skills educational programs are needed amongst healthcare professionals to inform individuals who could benefit from such interventions.

Spinal cord injury rehabilitation and pressure ulcer prevention after the 2005 South Asian Earthquake: a CBR case study from Pakistan.

BACKGROUND: The 2005 South Asian earthquake led to large-scale injuries and disabilities in northern Pakistan, which were dealt with using various approaches. In this regard, a community-based rehabilitation approach was initiated in the Muzaffarabad district of Pakistan in early 2006, focused on preventing complications among persons with Spinal Cord Injury. This case study briefly describes its development, aims and service provision components, in addition to the distribution of injuries from the disaster. Pressure ulcer prevention education, its recall and decrease in prevalence over a year are presented as key outcomes and illuminate the process of implementing rehabilitation in this context. METHODS: This case study presents findings from a larger internal program evaluation in 2010-11. The study design was cross-sectional, to elicit recall of education components and the resulting prevalence of pressure ulcers over the year, in 33 randomly selected persons with Spinal Cord Injury. Outcomes included retention of knowledge about pressure ulcer prevention, practices and reduction in the prevalence of pressure ulcers over the last year. We also conducted a narrative literature review on the types of injuries and complications in the Spinal Cord population from Northern Pakistan. RESULTS: Hospital cohort studies reported "spine" injuries at 5%, while persons with spinal cord injury were identified as the most underserved needing rehabilitation services after the quake. Results from the evaluation of prevention education revealed that all 33 respondents were trained in detection of pressure ulcers, while 32 recalled "danger signs" for which they would seek immediate help. All correctly recalled postural change timings, however, their actual practices differed. Twenty-seven respondents (82%) reported no pressure ulcers over the last year. CONCLUSION: The decrease in pressure ulcer prevalence over the last year in persons with spinal cord injury highlights the strengths of the community-based rehabilitation approach, particularly preventive education in geographically challenging and highly resource constrained settings. The research also begins to fill a critical gap in the present literature as most research is limited to hospital based interventions from the first year of the 2005 earthquake. Implications for Rehabilitation Prevention education for targeting pressure ulcers can be effective in reducing incidence of this important complication in persons with spinal cord injury. Community-based rehabilitation approaches can prove beneficial in post-disaster settings, especially in resource constrained settings and difficult hilly terrain. Rehabilitation programs should consider nutrition interventions to reduce multiple pressure ulcers, especially in lower middle income countries.

Let's Talk about the Talk: Exploring the Experience of Discussing Student Performance at the Mid- and Final Points of the Clinical Internship.

Purpose: The purpose of this study was to explore the experiences of physiotherapy students and clinical instructors (CIs) when discussing student clinical performance at the mid- and final points of clinical internships. The objectives were to identify why performance assessment discussions are valuable, explore the role of each participant throughout the discussion, identify the challenges associated with these discussions, and explore the effect of the standardized assessment tool on the discussion. Methods: This study used a qualitative descriptive design, consisting of student and CI focus groups in the Greater Toronto Area from January to June 2016. Results: All participants (N=29) recognized the importance of having face-to-face performance assessment discussions in a quiet and private space. Students and CIs agreed that the Canadian Physiotherapy Assessment of Clinical Performance helped to structure and focus the discussions. Valuable discussions occurred when students were open minded and self-reflected on their performance and when CIs were honest and used their expertise to guide learning. Other key features included mutual preparedness, two-way feedback that was constructive and tangible, and a goal-setting process. Students described the emotional component of these discussions as being challenging, and CIs found it difficult when a student took a more passive role in the discussion. Conclusions: Our findings indicate that valuable discussions can provide meaningful feedback, strengthen the student-CI relationship, and engage the learner in an ongoing and cumulative learning process that contributes to professional development.

Objectif : la présente étude visait à explorer les expériences d'étudiants en physiothérapie et de moniteurs cliniques (MC) lors des discussions sur le rendement clinique des étudiants au milieu et à la fin de leur stage clinique. Les objectifs consistaient à déterminer l'intérêt des discussions sur l'évaluation de rendement, à explorer le rôle de chaque participant à la discussion, à cerner les défis associés à ces discussions et à explorer l'effet de l'outil d'évaluation normalisé sur la discussion. Méthodologie : la présente étude faisait appel à une méthodologie descriptive qualitative, composée de groupes de travail d'étudiants et de MC du Grand Toronto entre janvier et juin 2016. Résultats : tous les participants (n=29) ont convenu de l'importance des discussions d'évaluation du rendement en tête à tête, dans un lieu calme et privé. Les étudiants et les MC conviennent également que l'évaluation de rendement clinique de l'Association canadienne de physiothérapie contribuait à structurer et à orienter les discussions. Des discussions intéressantes avaient lieu lorsque les étudiants étaient ouverts et prêts à tenir une autoréflexion sur leur rendement et lorsque les MC étaient honnêtes et utilisaient leurs compétences pour orienter l'apprentissage. Parmi les autres caractéristiques clés, soulignons une préparation mutuelle, des commentaires bidirectionnels constructifs et tangibles et un processus d'établissement d'objectifs. Les étudiants trouvaient les aspects émotifs de ces discussions exigeants, alors que les MC éprouvaient de la difficulté lorsqu'un étudiant adoptait un rôle plus passif dans la discussion. Conclusions : selon nos observations, des discussions intéressantes peuvent favoriser des commentaires significatifs, renforcer la relation entre l'étudiant et le MC et faire participer l'étudiant à un processus d'apprentissage continu et cumulatif qui contribue à son perfectionnement professionnel.

Relationship between Physical Activity and Fatigue in Adults with Cystic Fibrosis.

Purpose: We examined the relationship between the amount of physical activity and level of fatigue in adults with cystic fibrosis (CF). Method: Participants were recruited from the Toronto Adult Cystic Fibrosis Centre at St. Michael's Hospital. Participants completed the Habitual Activity Estimation Scale, the Multidimensional Fatigue Inventory, and the Depression subscale of the Hospital Anxiety and Depression Scale, in that order. Descriptive statistics and linear and multiple regressions were computed. Results: Over a 6-month period, 51 individuals were approached, and 22 (10 men, 12 women) participated in this study. The participants' median age was 33, and forced expiratory volume in 1 second (FEV1) was 64% predicted. When holding both FEV1 and depression constant, a significant negative correlation was found between total active hours per weekday and general fatigue (ß=-0.735, p=0.03); there was a negative trend between total active hours per weekday and physical fatigue (ß=-0.579, p=0.09). Conclusions: This study is the first to demonstrate that among adults with CF, a higher level of physical activity is associated with a lower level of general and physical fatigue when controlling for lung function and level of depression. Physical activity may be used as a means of mitigating the levels of general and physical fatigue in people with CF.

Objectif : des chercheurs ont examiné la relation entre la quantité d'activité physique et le taux de fatigue chez des adultes atteints de fibrose kystique (FK). Méthodologie : les chercheurs ont recruté les sujets au sein du centre de FK pour adultes du St. Michael's Hôpital de Toronto. Ils leur ont fait remplir, dans l'ordre, l'échelle d'évaluation de l'activité habituelle, l'inventaire de fatigue multidimensionnelle et la sous-échelle de dépression de l'échelle d'anxiété et de dépression en milieu hospitalier. Ils ont calculé les statistiques descriptives et les régressions linéaires et multiples. Résultats : Sur une période de six mois, les chercheurs ont sollicité 51 personnes, dont 22 (10 hommes) ont participé à l'étude. Ceux-ci avaient un âge médian de 33 ans, et leur volume expiratoire maximal par seconde (VEMS) s'établissait à 64 % de celui prévu. Lorsque le VEMS et la dépression des participants étaient maintenus constants, les chercheurs constataient une corrélation négative significative entre le total des heures d'activité par jour et l'état de fatigue général (ß=­0,735, p=0,03). Ils remarquaient également une tendance négative entre le total des heures d'activité par jour et la fatigue physique (ß=­0,579, p=0,09). Conclusion : la présente étude est la première à démontrer que, chez les adultes atteints de FK, un plus fort taux d'activité s'associe à une diminution de la fatigue générale et physique lors des contrôles de la fonction pulmonaire et de la dépression. Ainsi, l'activité physique peut réduire le taux de fatigue générale et physique chez les personnes atteintes de FK.

Meaning of Staring and the Starer-Staree Relationship Related to Men Living With Acquired Spinal Cord Injuries.

When in public places, many individuals with physical disabilities experience staring. Although staring is typically seen as uncomplicated and something to be "ignored," it has consequences for the person being stared and the staree. Few studies have focused on staring experienced by men following spinal cord injury (SCI). Accordingly, this study explored how adult men with SCI give meaning to the staring from others, the consequences for them, and their responses to the staring and to the starer. Principles of modified grounded theory methods were used to conduct a secondary analysis of interview data for 30 male participants from a larger study of community-dwelling individuals with SCI. Themes revealed through analysis related to context-dependent meanings of staring, negative consequences of staring for some men, and positive opportunities for self-growth and interaction with the public. These findings contribute to a more complex understanding of staring and the relationship between the starer and staree in various social circumstances which can support people living with differences in their public interactions, and improve their quality of life.

Mothering children with developmental disabilities: A critical perspective on health promotion.

We present findings of a qualitative study exploring what constitutes relevant health promotion initiatives for immigrant mothers of children with developmental disabilities. We apply a social ecological approach, with a focus on gender-specific and transformative health promotion, to examine factors impacting mothers' health and wellbeing. Twenty-eight semi-structured and open-ended interviews were conducted with immigrant mothers in the greater Toronto area, Canada. Mothers identified facilitators, challenges, and strategies for their health promotion, providing relevant insights for meaningful intervention. Our findings show that immigrant mothers' health is influenced by intersecting social determinants of health, including migration status, gender, and disability.

Long-Term Health Service Outcomes Among Women With Traumatic Brain Injury.

OBJECTIVES: To (1) assess long-term health care service utilization and satisfaction with health care services among women with traumatic brain injury (W-TBI); (2) examine barriers that prevent W-TBI from receiving care when needed; and (3) understand the perceived supports available for W-TBI. DESIGN: Retrospective cohort study. SETTING: Community. PARTICIPANTS: W-TBI (n=105) 5 to 12 years postinjury and women without TBI (n=105) matched on age, education, and geographic location. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Pre- and postinjury data were collected using a questionnaire administered via a semistructured interview. Questions on health services utilization, satisfaction with and quality of services, barriers to receiving care, and perceived social support were from the Canadian Community Health Survey; additional questions on perceived social support were from another large-scale study of people with moderate to severe brain injury. RESULTS: Compared with women without TBI, W-TBI reported using more family physician and community health services. W-TBI reported that they did not receive care when needed (40%), particularly for emotional/mental health problems. Significantly more W-TBI reported financial and structural barriers. There were no significant differences in reported satisfaction with services between women with and without TBI. CONCLUSIONS: Health service providers and policymakers should recognize the long-term health and social needs of W-TBI and address societal factors that result in financial and structural barriers, to ensure access to needed services.

Being a Woman With Acquired Brain Injury: Challenges and Implications for Practice.

OBJECTIVES: To explore the experiences of women with acquired brain injury (ABI) to gain greater insight into their general and sex- and gender-specific health and well-being concerns, and to identify areas for future research. DESIGN: A qualitative pilot study using interpretive description methodology and a sex-and gender-based analysis of data collected through focus groups. SETTING: Community. PARTICIPANTS: A sample of survivors, and formal and informal caregivers of women with ABI (N=16). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Not applicable. RESULTS: Participants identified significant barriers to achieving optimal health and well-being for women survivors of ABI, including a lack of knowledgeable professionals. We identify 3 interrelated themes: (1) experiences shaped by gender norms and roles; (2) experiences influenced by physiological phenomena, including perceived hormone imbalances; and (3) experiences surrounding interpersonal relationships and sexuality. CONCLUSIONS: Post-ABI care should include education about the influences of sex and gender on health and well-being. Acknowledging the impact of gendered roles, and the broader sociopolitical context of gender and disability, is important to develop appropriate services and supports after ABI. Incorporating effective communication strategies between patient and health care professional can also be a potent rehabilitation strategy.

Stressors and Barriers to Services for Immigrant Fathers Raising Children with Developmental Disabilities.

This narrative review examines research on the experiences of immigrant fathers raising children with developmental disabilities, and considers the findings within the Canadian context. Applying Green, Johnson & Adams' (Journal of Chiropractic Medicine, 5(3), 101-117, 2006) methodology, a step-by-step process was followed to conduct the review. Four databases (PsychINFO, PubMed, CINAHL and Sociological Abstracts) were used for the search. A total of 39 articles were found to be relevant after applying the inclusion/exclusion criteria. Also 20 articles from published reference lists and peer-reviewed journal articles, located through Google Scholar, complimented the initial search. Along with House's (1981) four dimensions of social support, an intersectional approach underpinned the analysis of findings. Four themes were identified which included: economic challenges, social influences, cultural influences, and the changing gender roles of fathers. Stressors and barriers to accessing health services in the post-migration setting were examined. Based on the review's findings, the paper recommends 1) addressing income inequality, 2) improving access to health care, social and developmental services, 3) improving cultural-sensitivity of health care, social and developmental services, and 4) increasing participation of fathers. Overall, a more systemic understanding of immigrant fathers' experiences is called for, taking into account their multiple social locations.

A value-based practice model of rehabilitation: consumers' recommendations in action.

The purpose of this paper is to present a model of rehabilitation practice that is based on the recommendations of consumers who used rehabilitation services and have a life-changing physical impairment (spinal cord injury - SCI). This value-based practice model is based on two qualitative studies. The first study developed the framework (social adaptation) for a new practice model based on values. The second study, described in this paper, used the framework to learn about recommendations for change in the rehabilitation process. Participants in the second study were 80 volunteers who live with a SCI in the community, across the province of Ontario, Canada. A snowball strategy was used to recruit interested participants. Participants were involved in face-to-face interviews which included questions on what helped and hindered their initial rehabilitation process, and their recommendations for change. In this paper, we described a model that demonstrates how consumer input is essential in shaping a comprehensive rehabilitation process. The model is based on overarching value statements that express the worthiness of all individuals, the value of the lived experience of disability and the responsibility of the rehabilitation process to enable client autonomy. Four "values in action" are articulated: caring and respect for the individual and his/her personhood; applying the lived experience of disability; fostering autonomy; and promoting hopefulness. These values have been initially described in another paper based on a specific subset of 15 women living with SCI related to body issues during rehabilitation. This paper builds on this value work and we develop key practices for a progressive rehabilitation culture and model, based on the larger study group of 80 participants (men and women with SCI). This value-based model, when integrated with traditional, physical improvement-focused rehabilitation, has the potential to create a more effective process by offering clients better support as they go through the complex process of re-building their lives and making the transition back to the community. Implications for Rehabilitation We suggest that the Values in the Action Rehabilitation Practice Model that emphasized social adaptation be used along side the physical rehabilitation approach to enhance client-based practice. That peers with disabilities work collaboratively with rehabilitation professionals within a culture that acknowledges and reimburses their knowledge and expertise. Rehabilitation professionals learn about the lived experience of disability and systemic issues by being involved in grass-roots community organizations.