"This program should come with a warning sign!": Mental wellness in occupational therapy and physical therapy students.

Objectives: To measure and compare distress in entry-level masters occupational therapy (OT) and physical therapy (PT) students; to evaluate distress levels relative to existing data; and to explore factors that cause stress, effects of stress, and coping strategies. Participants: Ninety-eight OT and PT students (75 females, 23 males) from two cohorts at a Canadian university. Methods: Sequential mixed-methods including questionnaires and inductive analysis of focus group discussions. Results: OT and PT students from one cohort reported higher levels of stress, anxiety and/or depression compared to the following academic year and compared to undergraduate and general population samples. The overall theme was the unrelenting tug of war between school and other aspects of students' lives. Factors related to academic workload negatively affected mental health. Coping strategies included physical activity, strategic selection of peers, and modifying expectations. Conclusions: Wellness in OT and PT students is an important concern that deserves attention.

Managing Knee Osteoarthritis: The Effects of Body Weight Supported Physical Activity on Joint Pain, Function, and Thigh Muscle Strength.

OBJECTIVE: To determine the effect of a 12-week lower body positive pressure (LBPP)-supported low-load treadmill walking program on knee joint pain, function, and thigh muscle strength in overweight patients with knee osteoarthritis (OA). DESIGN: Prospective, observational, repeated measures investigation. SETTING: Community-based, multidisciplinary sports medicine clinic. PATIENTS: Thirty-one patients aged between 55 and 75 years, with a body mass index ≥25 kg/m and mild-to-moderate knee OA. INTERVENTION: Twelve-week LBPP-supported low-load treadmill walking regimen. MAIN OUTCOME MEASURES: Acute knee joint pain (visual analog scale) during full weight bearing treadmill walking, chronic knee pain, and joint function [Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire] during normal activities of daily living, and thigh muscle strength (isokinetic testing). Appropriate methods of statistical analysis were used to compare data from baseline and follow-up evaluation. RESULTS: Participants reported significant improvements in knee joint pain and function and demonstrated significant increases in thigh muscle strength about the degenerative knee. Participants also experienced significant reductions in acute knee pain during full weight bearing treadmill walking and required dramatically less LBPP support to walk pain free on the treadmill. CONCLUSIONS: Data suggest that an LBPP-supported low-load exercise regimen can be used to significantly diminish knee pain, enhance joint function, and increase thigh muscle strength, while safely promoting pain-free walking exercise in overweight patients with knee OA. These findings have important implications for the development of nonoperative treatment strategies that can be used in the management of joint symptoms associated with progressive knee OA in at-risk patient populations. CLINICAL RELEVANCE: This research suggests that LBPP-supported low-load walking is a safe user-friendly mode of exercise that can be successfully used in the management of day-to-day joint symptoms associated with knee OA, helping to improve the physical health, quality of life, and social well-being of North America's aging population.

Advancing the use of theory in occupational therapy: a collaborative process.

BACKGROUND: Theory is important to the growth and evolution of occupational therapy. However, use of theory remains challenging for many therapists. PURPOSE: The aim was to develop a process that occupational therapists could apply to advance theory in practice. METHOD: Based on a review of the literature and using a qualitative instrumental case study design, 18 student occupational therapists and eight fieldwork educators completed online modules on the theory advancement concepts generated from the literature, wrote journals, and/or participated in online discussions during fieldwork. Following fieldwork, educators were interviewed and students participated in focus groups exploring their experiences. Directed content analysis was used to analyze the data. FINDINGS: Based on the data collected, we developed the Theory Advancement Process (TAP). The TAP is composed of four primary contexts, a climate of collaborative relationships with four key elements, and four essential processes. IMPLICATIONS: The TAP presents a collaborative process for students, faculty, and therapists to work together to advance the use of theory in practice.

Development of a computer-based clinical decision support tool for selecting appropriate rehabilitation interventions for injured workers.

PURPOSE: To develop a classification algorithm and accompanying computer-based clinical decision support tool to help categorize injured workers toward optimal rehabilitation interventions based on unique worker characteristics. METHODS: Population-based historical cohort design. Data were extracted from a Canadian provincial workers' compensation database on all claimants undergoing work assessment between December 2009 and January 2011. Data were available on: (1) numerous personal, clinical, occupational, and social variables; (2) type of rehabilitation undertaken; and (3) outcomes following rehabilitation (receiving time loss benefits or undergoing repeat programs). Machine learning, concerned with the design of algorithms to discriminate between classes based on empirical data, was the foundation of our approach to build a classification system with multiple independent and dependent variables. RESULTS: The population included 8,611 unique claimants. Subjects were predominantly employed (85 %) males (64 %) with diagnoses of sprain/strain (44 %). Baseline clinician classification accuracy was high (ROC = 0.86) for selecting programs that lead to successful return-to-work. Classification performance for machine learning techniques outperformed the clinician baseline classification (ROC = 0.94). The final classifiers were multifactorial and included the variables: injury duration, occupation, job attachment status, work status, modified work availability, pain intensity rating, self-rated occupational disability, and 9 items from the SF-36 Health Survey. CONCLUSIONS: The use of machine learning classification techniques appears to have resulted in classification performance better than clinician decision-making. The final algorithm has been integrated into a computer-based clinical decision support tool that requires additional validation in a clinical sample.

Reflections on the professionalization of occupational therapy: time to put down the looking glass.

BACKGROUND: Many changes have occurred in occupational therapy and its environment during the last 50 years. Despite major advances, occupational therapy is not well-known by the general public and concern remains about its professional status. PURPOSE: To review "professionalization," and relate it to occupational therapy through reflection on major changes and critical events; to analyze the current status of occupational therapy; and to make suggestions for change. KEY ISSUES: Professionalization is a dynamic, ongoing process; occupational groups achieve professional status through recognition by society, not by meeting a set list of criteria. A framework for professionalization allows examination of constraints on occupational autonomy and weighing of issues affecting internal and external dynamics. Application of the framework identified that occupational therapy in Canada today is mostly focused on its internal dynamic. IMPLICATIONS: To maintain and advance its professional status, occupational therapy must focus to the external dynamic to improve its recognition by the general public.

Pathways to translating experiential knowledge into mental health policy.

OBJECTIVE: This research explored the pathways through which the experiential knowledge of people who need and use mental health and social housing services (citizen-users) gains access to policymaking. METHODS: Qualitative instrumental case study methodology focused the study on the policy field of mental health and social housing in Manitoba, Canada. Data collection included interviews with 21 key informants from four policy actor groups: citizen-users, service providers, advocacy organization representatives, and government officials. Relevant policy-related documents were also reviewed. Data were analyzed using inductive qualitative methods. RESULTS: Key informants described diverse pathways through which the experiential knowledge of citizen-users has been communicated to policy decision makers. Pathways have involved direct discourse between citizen-users and decision makers. Alternatively, indirect pathways were ones in which experiential knowledge was translated by other policy actors. Informants identified factors that could influence the integrity of the indirect pathways: the length and complexity of the pathways, the motivations and interests of the translators, and strategies to enhance the pathways. The pathways could be strengthened by developing the culture, leadership, knowledge, skills and attitudes supportive of engaging citizen-users and by accurately translating their experiential knowledge. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: If citizen-users are to be included in policymaking in a recovery-oriented mental health system, action must be taken to enhance the pathways through which their experiential knowledge reaches policymaking processes. Service providers, advocacy organization representatives and government officials can all take action to promote social policymaking that is informed by citizen-users' ideas and experiences.

Experiences with using a pushrim-activated power-assisted wheelchair for community-based occupations: a qualitative exploration.

BACKGROUND: Occupational therapists strive to engage individuals in occupation and enhance community access through wheelchair prescription. Previous research with pushrim-activated, power-assisted wheelchairs identifies a reduction in the physical demands of manual wheelchair propulsion but limited evidence exists regarding user evaluation in context. PURPOSE: This study explored the experience of using a power-assisted wheelchair in the community. METHODS: Eight individuals who used both a power and manual device participated in focus groups after trialing a power-assist wheelchair for three weeks. Data were analyzed using a qualitative description approach. FINDINGS: Three themes emerged from our analysis: relative advantages and disadvantages; environmental factors that affect accessibility; and evaluation of mobility device. IMPLICATIONS: Participants perceived the power-assist as improving performance and accessibility compared with the manual wheelchair, increasing the potential scope of occupations and environments, but not replacing their power mobility device. Sufficient time for adjustment of both user and device was important.

Burn therapists' opinion on the application and essential characteristics of a burn scar outcome measure.

Comprehensive burn rehabilitation requires the use of an appropriate burn scar outcome measure (BSOM). The literature reports many BSOMs; however, an objective, practical, inexpensive, valid, reliable, and responsive instrument eludes us. A problem in the development of such a measure is disagreement in which scar properties to include. The objective of this study was to determine the burn scar variables that therapists believe should be included in a BSOM. An Internet survey was administered to burn occupational and physical therapists. The response rate was 38.6% (105 surveys). Of the respondents, 38.1% use a BSOM; of those, 75% use the Vancouver Scar Scale. Reasons why respondents do not use a BSOM (61.9%) are because they are not familiar with available measures, have not found one that is clinically practical, or need more training. The majority (95%) believes that using a BSOM is important, and the following BSOM characteristics were reported as important: reliable, valid, quick, easy, and noninvasive. Respondents indicated that the following properties should be included in a BSOM: pliability (96.2%), vascularity (92.4%), height (87.6%), appearance (75.2%), skin breakdown (74.3%), itch (73.3%), surface texture (70.5%), pigmentation (68.6%), and pain (67.6%). This study suggests that using a BSOM is important despite its inconsistent use, and BSOM education may be valuable. The top three agreed-upon properties for inclusion are already incorporated into the most commonly used BSOM-the Vancouver Scar Scale-suggesting that modifications may be reasonable.

Participation in community-based activities of daily living: comparison of a pushrim-activated, power-assisted wheelchair and a power wheelchair.

PURPOSE: The purpose of this study was to evaluate pushrim-activated, power-assisted wheelchair (PPW) performance among dual-users in their natural environment to determine whether the PPW would serve as a satisfactory alternative to a power wheelchair for community-based activities. METHODS: A concurrent mixed methods research design using a cross-over trial was used. The outcome measures used were number of hours reported using the different wheelchairs, Quebec User Evaluation of Satisfaction with assistive Technology (QUEST), Functioning Everyday with a Wheelchair (FEW), Psychosocial Impact of Assistive Devices Scale (PIADS) and Canadian Occupational Performance Measure (COPM). RESULTS: The number of hours spent participating in self-identified activities was not significantly different. Only the Self-Esteem subscale of the PIADS identified a statistically significant difference between the PPW and power wheelchair conditions (p = 0.016). A clinically important difference for Performance and Satisfaction was suggested by the COPM, in favour of the power wheelchair. CONCLUSIONS: Additional knowledge was gained about the benefits of PPW technology. Participants were able to continue participating independently in their self-identified community activities using the PPW, and identified comparable ratings of satisfaction and performance with the PPW and the power wheelchair. For some individuals requiring power mobility, the PPW may provide an alternative to the power wheelchair.

Determination of inter-rater reliability in pediatric burn scar assessment using a modified version of the Vancouver Scar Scale.

The Vancouver Scar Scale is too subjective for our needs and is not culturally sensitive to our Aboriginal clients. The VSS was modified by developing a color scale to aid with vascularity rating. This study was designed to measure the inter-rater reliability of the modified Vancouver Scar Scale (MVSS). Three raters assessed 14 pediatric patients, resulting in a total of 32 scars. Data were analyzed using a Spearman Rank Order Correlation, intraclass correlation coefficient, and the kappa statistic. All subtests were shown to have significant (P < .05) correlations except for the pigmentation subtest. Because the pigmentation subtest has poor reliability, its inclusion in scar assessment should be questioned. Results indicate that only total scores of the MVSS should be used when determining burn scar outcomes because individual subtest scores appear to have little reliability. Further modifications to the MVSS followed by additional research with greater numbers of subjects are warranted.

Training the next generation of researchers in work disability prevention: the Canadian Work Disability Prevention CIHR Strategic Training Program.

INTRODUCTION: There is a need to create, disseminate, and implement new knowledge in the work disability prevention (WDP) field. Training programs attracting high-quality applicants and taking into account the complexity of this emerging field are urgently needed. METHODS: An advanced training program, funded by the Canadian Institutes of Health Research (CIHR), was developed by 24 mentors affiliated with nine different universities. The main objective of this program is to develop transdisciplinary knowledge, skills, and attitudes regarding WDP. This program has been developed for PhD students or post-doctoral fellows already registered full-time in a Canadian or recognized foreign university whose main interest is WDP, regardless of the health problem. RESULTS: Since its implementation, the program received two successive cohorts of 10 students. They were registered in 13 universities in five countries and trained in nine different disciplines. CONCLUSIONS AND SIGNIFICANCES: Appropriate WDP research may save major societal costs attributable to prolonged work disability. The proposed training program will contribute to developing tomorrow's research workforce.

Adoption of Canada's Physical Activity Guide and Handbook for Older Adults: impact on functional fitness and energy expenditure.

This study investigated whether a behaviour change program, based on Canada's Physical Activity Guide and Handbook to Healthy Active Living for Older Adults (Health Canada, 1999a), would elicit greater benefits than adoption of the guide and handbook alone. Fifteen older adults received the guide and accompanying handbook and completed the 8-week behaviour change program (mean age 73.2 +/- 5.2 yrs), while 14 others received only the guide and handbook (mean age 76.8 +/- 10.0 yrs). Functional fitness (lower body strength/endurance, flexibility, agility/dynamic balance) (Rikli and Jones, 1999), and estimated energy expenditure (DiPietro et al., 1993) were measured at baseline and after 8 weeks. Lower body strength/endurance and agility/dynamic balance differed between groups at baseline, p < 0.05. All three functional fitness tests improved in both groups over time, p< 0.05. Estimated energy expended in physical activity increased in both groups over time, p < 0.05; however, there was a significantly greater increase in the behaviour-change group (Group x Time interaction, p < 0.05). Participant response to using the guide and handbook was positive. These results indicate that introduction to Canada's Physical Activity Guide and Handbook to Healthy Active Living for Older Adults leads to benefits, whether or not accompanied by program supports. The group receiving the behaviour change program had a greater increase in energy expenditure, which suggests that such an intervention may ultimately lead to greater health benefits.

Return to work after occupational injury. Family physicians' perspectives on soft-tissue injuries.

OBJECTIVE: To document physicians' views about facilitating factors for and barriers to their helping workers recover after occupational soft-tissue injuries and to ascertain physicians' knowledge and attitudinal barriers to their involvement in return to work. DESIGN: Faxed survey. SETTING: Manitoba family practices and emergency departments. PARTICIPANTS: General practitioners, family physicians, and emergency physicians regularly caring for injured workers. MAIN OUTCOME MEASURES: Physicians' ranking of facilitating factors and barriers, changes to help their involvement in return to work, and their attitudes and knowledge about return to work. RESULTS: Respondents and nonrespondents were demographically similar, 232 physicians (51.3%) responded. Respondents believed the main facilitating factors were physicians' ability to explain the nature and prognosis of injuries to workers (69%) and the willingness of workplaces to accommodate injured workers (26%). The main barriers were workers' misunderstandings and fears about their injuries (70.7%) and non-supportive supervisors and co-workers (20.8%). The most frequently requested change was better workplace job accommodation (48%). Most physicians agreed they had a role in planning return to work and were aware of the effect of job satisfaction, psychosocial elements, and work-related factors. Despite supporting evidence, only one third of physicians stated they would say "try to continue usual activities" to patients with occupational low back pain. CONCLUSION: Most physicians seemed aware of their role in return to work and the effect of occupational factors, but their advice on activity after injury differed from that in practice guidelines.

Return-to-work: The importance of human interactions and organizational structures.

The purpose of this study was to gain insight into stakeholder perspectives on barriers and facilitators for return-to-work (RTW). Qualitative methodology with purposive sampling was employed. A total of 55 participants, representing a wide spectrum of stakeholders and industry, were interviewed in individual or group format. Interview transcripts were coded, categorized according to themes, and placed within a framework which reflected the dynamic interaction of individuals and the structural systems or context of those individuals. Findings indicated that perceived barriers to RTW included delays of all types in processing or delivery of information or treatment, and ineffective communication among stakeholders. Facilitators to RTW included establishment of RTW programs in the workplace, effective communication and teamwork, as well as trust and credibility among stakeholders. The interdependence of organizational structures and human interactions was evident in successful RTW programs which emphasized teamwork, early intervention, and communication. Differing stakeholder perspectives, however, especially on issues such as worker attitudes and participation, must be acknowledged and addressed if more injured workers are to be successful in returning to full employment.