An Advanced Clinician Practitioner in Arthritis Care (ACPAC) Maintains a Positive Patient Experience While Increasing Capacity in Rheumatology Community Care.

PURPOSE: This study describes patient care experiences of solo-rheumatologist and co-managed care models utilizing an Advanced Clinician Practitioner in Arthritis Care-trained Extended Role Practitioner (ACPAC-ERP) in three community rheumatology practices. MATERIALS AND METHODS: Patients with inflammatory arthritis (IA) were assigned to care provided by one of three (2 senior, 1 early-career) community-based rheumatologists (usual care), or an ACPAC-ERP (co-managed care) for the 6-months following diagnosis. Patient experiences were surveyed using validated measures of patient satisfaction (Patient Doctor Interaction Scale-PDIS), global ratings of confidence and satisfaction, referral patterns, disease activity (RADAI) and self-perceived disability (HAQ-Disability) as well as demographic information. Practice capacity was evaluated 18-months prior to, and across, the study period. RESULTS: Of 55 participants (mean age 56.6 years, 61.8% female), 33 received co-managed care. Most participants were diagnosed with rheumatoid arthritis (65.5%) with a median symptom duration of 1.1 years. At 6-months, patients from both models of care were equally satisfied in terms of the information provided (usual care 4.6 vs co-managed care 4.7/5=greater satisfaction), rapport with health-care provider (4.6 vs 4.6/5) and having needs met (4.7 vs 4.5/5). Overall satisfaction was high (87.2 vs 85.3/100=completely satisfied) as was confidence in the system by which care was received (85.0 vs 82.1/100=completely confident). Usual care patients reported higher perceived disability than co-managed patients (HAQ-Disability 0.5 vs 0.2/3=unable to do). Significant differences in overall RADAI score (p=0.014) were found between the two models. The senior rheumatologist, with a previously saturated practice, attained a 37% capacity increase for new patients utilizing the co-managed care model. CONCLUSION: The ACPAC-ERP model was equivalent to the solo-rheumatologist model with regard to patient experience and satisfaction. A co-management model utilizing a highly trained ACPAC-ERP can increase capacity in community rheumatology clinics for patients newly diagnosed with IA while maintaining confidence and satisfaction with their care.

Impact of pharmacist intervention on completion of recombinant zoster vaccine series in a community pharmacy.

OBJECTIVES: The objectives of this study were to analyze the impact a pharmacist phone call has played on patients completing the 2-dose shingles vaccine series and to explore the effect that patient cost has on the second dose administration. METHODS: A retrospective cohort study design was used to evaluate whether patients who had a pharmacist phone call intervention were more likely to return for their second recombinant zoster vaccine (RZV) dose than patients who did not have a pharmacist phone call intervention. In addition, the impact of immunization cost on series completion was analyzed. The study evaluated the SHINGRIX call lists from 10 randomly selected pharmacies within a large pharmacy chain. The percentage of patients who received the call intervention and their second RZV dose was compared with the percentage of patients who did not receive the intervention yet returned for their second dose of RZV. A chi-square test of independence analyzed the relationship between the 2 variables. An odds ratio (OR) was calculated to determine the relationship between payment data and second dose return status. RESULTS: The relationship between pharmacists' phone calls and patients' return for the second dose vaccination was statistically significant (P < 0.05). Based on payment data, the relationship between the cost of the first dose to the patient and the second dose vaccination was not statistically significant (OR 0.6703; 95% CI 0.4153-1.082). CONCLUSION: A higher percentage of patients received their second RZV dose if they spoke with a pharmacist. Based on the results of this study, a pharmacist's intervention may affect completion rates of the RZV series more than cost.

Measuring Advanced/Extended Practice Roles in Arthritis and Musculoskeletal Care in Canada.

OBJECTIVE: Our objective was to characterize Canadian workforce attributes of extended role practitioners (ERPs) in arthritis care. METHODS: We used an exploratory, mixed-methods study that was based on the Canadian Rheumatology Association's Stand Up and Be Counted Rheumatologist Workforce Survey (2015). An anonymous online survey was deployed to groups of non-physician health care professionals across Canada who potentially had post-licensure training in arthritis care. Demographic and practice information were elicited. Qualitative responses were analyzed using grounded theory techniques. RESULTS: Of 141 respondents, 91 identified as practicing in extended role capacities. The mean age of ERP respondents was 48.7; 87% were female, and 41% of ERPs planned to retire within 5 to 10 years. Respondents were largely physical or occupational therapists by profession and practiced in urban/academic (46%), community (39%), and rural settings (13%). Differences in practice patterns were noted between ERPs (64.5%) and non-ERPs (34.5%), with more ERPs working in extended role capacities while retaining activities reflective of their professional backgrounds. Most respondents (95%) agreed that formal training is necessary to work as an ERP, but only half perceived they had sufficient training opportunities. Barriers to pursuing training were varied, including personal barriers, geographic barriers, patient-care needs, and financial/remuneration concerns. CONCLUSION: To our knowledge, no previous studies have assessed the workforce capacity or the perceived need for the training of ERPs working in arthritis and musculoskeletal care. Measurement is important because in these health disciplines, practitioners' scopes of practice evolve, and ERPs integrate into the Canadian health care system. ERPs have emerged to augment provision of arthritis care, but funding for continuing professional development opportunities and for role implementation remains tenuous.

Patient and caregiver experience in the transition from hospital to home - brainstorming results from group concept mapping: a patient-oriented study.

BACKGROUND: Improving the quality of care for patients who return home after a hospital stay is an international priority; however, few jurisdictions have engaged broadly with patients and caregivers to understand what most affects their experience transitioning home. We performed Ontario-wide group concept mapping, beginning with a brainstorming phase, to understand patient and caregiver priorities in the transition. METHODS: We used group concept mapping to engage patients and caregivers who had lived experience transitioning from hospital to home in Ontario in the previous 3 years. We report on the first phase, brainstorming, conducted over 10 weeks beginning Jan. 11, 2018 via an online survey or facilitated group discussion. Participants responded to a single focal prompt: "When leaving the hospital for home, some thing(s) that affected the experience were: ____." The study team identified recurrent concepts and overarching themes. Patients and caregivers informed the study design, recruitment and data interpretation. RESULTS: In all, 665 people (263 patients [39.5%], 352 caregivers [52.9%] and 50 people who were both patient and caregiver [7.5%]) participated in brainstorming online, and 71 people participated in 1 of 8 group discussions. Participants identified 6 key areas affecting their experience of transition from hospital to home: home and community care, the discharge process, medical follow-up after discharge, medications, patient and caregiver education, and the kindness and caring of the health care team in hospital. Most notable were challenges with the timeliness, sufficiency, reliability and consistency of publicly funded home care services. INTERPRETATION: Patients and caregivers from across Ontario noted a range of issues affecting their experience transitioning from hospital to home, particularly the quality and sufficiency of publicly funded home care. Our findings will be used to inform a provincial quality standard on the transition from hospital to home.

Patient and caregiver priorities in the transition from hospital to home: results from province-wide group concept mapping.

BACKGROUND: Patients and caregivers often face significant challenges when they are discharged home from hospital. We sought to understand what influenced patient and caregiver experience in the transition from hospital to home and which of these aspects they prioritised for health system improvement. METHODS: We conducted group concept mapping over 11 months with patients-and their caregivers-who were admitted to a hospital overnight in the last 3 years in Ontario, Canada and discharged home. Home included supportive housing, shelters and long-term care. Participants responded to a single focal prompt about what affected their experience during the transition. We summarised responses in unique statements. We then recruited participants to rate each statement on a five-point scale on whether addressing this gap should be a priority for the health system. The provincial quality agency recruited participants in partnership with patient, community and healthcare organisations. Participation was online, in-person or virtual. RESULTS: 736 participants provided 2704 responses to the focal prompt. Unique concepts were summarised in 52 statements that were then rated by 271 participants. Participants rated the following three statements most highly as a gap that should be a priority for the health system to address (in rank order): 'Not enough publicly funded home care services to meet the need', 'Home care support is not in place when arriving home from hospital' and 'Having to advocate to get enough home care'. The top priority was consistent across multiple subgroups. CONCLUSIONS: In a country with universal health insurance, patients and caregivers from diverse backgrounds consistently prioritised insufficient public coverage for home care services as a gap the health system should address to improve the transition from hospital to home.

Patient engagement in the development of best practices for transitions from hospital to home: a scoping review.

OBJECTIVES: To explore the extent of patient engagement in the development of best practice reports related to transitions from hospital to home. DESIGN: Scoping review. DATA SOURCES: Electronic databases (MEDLINE, EMBASE, CINAHL, Scopus, Trip Database, DynaMed Plus and Public Health Plus) and multiple provincial regulatory agency and healthcare organisation websites. ELIGIBILITY CRITERIA: We included best practice reports related to the transition from hospital to a long-term care facility, community dwelling or rehabilitation centre. We included documents disseminated in English between 1947 and 2019. DATA EXTRACTION AND SYNTHESIS: Two independent reviewers screened for eligibility and one extracted and analysed data using a data extraction tool we developed based on established patient engagement frameworks. Only records actively engaging patients were analysed (n=11). The methodological quality of actively engaging patients was assessed using domain 2 (item 5) of stakeholder involvement from the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool. RESULTS: The search yielded 1921 citations of which 23 met the inclusion criteria and were included for narrative synthesis. These were disseminated between 1995 and 2019, with 18 (78%) published after 2010. Most were conducted in North America (USA 43%, Canada 22%), Europe (UK 30%) and Australia (4%). Eleven (48%) actively involved patients, of which only two involved patients across all stages of development. Most involved patients through direct or indirect consultation. The mean AGREE II domain 2 item 5 score (of those that actively engaged patients) was 5.9 out of 7. CONCLUSIONS: Only half of existing best practice reports related to the transition from hospital to home actively involved patients in report development. However, the extent of patient engagement has been increasing over time. More organisations should strive to engage patients throughout the best practice development process and provide patients with opportunities for shared leadership.

A Systematic Review and Standardized Comparison of Available Evidence for Outcome Measures Used to Evaluate Proximal Humerus Fracture Patients.

OBJECTIVES: To summarize and appraise any patient-reported or clinician-measured outcome measures based on their measurement properties in proximal humerus fracture patients. DATA SOURCES AND STUDY SELECTION: MEDLINE, EMBASE, and CINAHL were searched from January 2000 to August 2018 to identify all studies of proximal humerus fracture patients that reported a measurement property evaluation of an outcome measure. DATA EXTRACTION AND SYNTHESIS: Quality appraisal of each measure was completed using the Evaluating the Measurement of Patient-Reported Outcomes (EMPRO) tool. The EMPRO takes into account all studies of each measure, and the overall score is transformed linearly to a range of 0 (lowest) to 100 (best). RESULTS: Eleven instruments were identified. Intended concepts of the instruments included clinician-measured shoulder function, patient-reported function or disability, and patient-reported general health state. Only the Disabilities of the Arm, Shoulder and Hand (DASH), Oxford Shoulder Score, Constant Score, University of California, Los Angeles Shoulder Score, and EuroQol 5 Dimension (EQ5D) were evaluated in more than 1 study. The Shoulder Function Index (SFINX), DASH, and EQ5D had the highest EMPRO scores (80, 66, and 58, respectively). The SFINX and DASH consistently scored among the top 3 instruments for each attribute. CONCLUSIONS: Evidence on the measurement properties of outcome measures for proximal humerus fracture patients is limited. With the available evidence, the SFINX is recommended as a clinician-measured functional outcome measure, the DASH as a patient-reported functional outcome measure, and the EQ5D as a general health status measure.

An advanced clinician practitioner in arthritis care can improve access to rheumatology care in community-based practice.

OBJECTIVE: To facilitate access and improve wait times to a rheumatologist's consultation, this study aimed to 1) determine the ability of an advanced clinician practitioner in arthritis care (ACPAC)-trained extended role practitioner (ERP) to triage patients with suspected inflammatory arthritis (IA) for priority assessment by a rheumatologist and 2) determine the impact of an ERP on access-to-care as measured by time-to-rheumatologist-assessment and time-to-treatment-decision. MATERIALS AND METHODS: A community-based ACPAC-trained ERP triaged new referrals for suspected IA. Patients with suspected IA were booked to see the rheumatologist on a priority basis. Diagnostic accuracy of the ERP to correctly identify priority patients; the level of agreement between ERP and rheumatologist (Kappa coefficient and percent agreement); and the time-to-treatment-decision for confirmed cases of IA were investigated. Retrospective chart review then compared time-to-rheumatologist-assessment and time-to-treatment-decision in the solo-rheumatologist versus the ERP-triage model. RESULTS: One hundred twenty-one patients were triaged. The ERP designated 54 patients for priority assessment. The rheumatologist confirmed IA in 49/54 (90.7% positive predictive value [PPV]). Of the 121 patients, 67 patients were designated as nonpriority by the ERP, and none were determined to have IA by the rheumatologist (100% negative predictive value [NPV]). Excellent agreement was found between the ERP and the rheumatologist (Kappa coefficient 0.92, 95% CI: 0.84-0.99). In the ERP-triage model, time-from-referral-to-treatment-decision for patients with IA was 73.7 days (SD 40.4, range 12-183) compared with 124.6 days (SD 61.7, range 26-359) in the solo-rheumatologist model (40% reduction in time-to-treatment-decision). CONCLUSION: A well-trained and experienced ERP can shorten the time-to-Rheumatologist-assessment and time-to-treatment-decision for patients with suspected IA.

Perceived factors influencing hospital-based primary care clinic referrals to community health medical nutrition therapy: An exploratory study.

Primary care clinics provide an array of diagnostic and clinical services that assist patients in preventing the onset or managing acute and chronic conditions. Some chronic conditions such as high blood pressure, high cholesterol, and type 2 diabetes require primary care professionals to seek additional medical intervention from registered dieticians. This study explored beliefs, attitudes, and practices of medical and administrative professionals in primary care clinics encountering patients who are potential candidates for ongoing nutrition education or counselling. Five focus groups with primary care providers and clinical staff (n = 24) were conducted to identify perceived intra-organisational factors influencing initiation of community health medical nutrition therapy (MNT) referrals. Lack of clarity regarding community health dieticians' role in chronic disease management was the primary finding for the absence of MNT referrals. Insurance-imposed constraints, perceived patient readiness to change, and service inaccessibility were revealed as barriers that influence referrals to both community health and specialty care dieticians. This study underscores the importance of identifying organisational and interpersonal barriers that influence the initiation of community health MNT referrals. Understanding these barriers can create stronger interprofessional collaboration between primary care providers and community health dieticians.

Exploring Proxy Measures of Mutuality for Strategic Partnership Development: A Case Study.

Partnerships between academic and clinical-based health organizations are becoming increasingly important in improving health outcomes. Mutuality is recognized as a vital component of these partnerships. If partnerships are to achieve mutuality, there is a need to define what it means to partnering organizations. Few studies have described the elements contributing to mutuality, particularly in new relationships between academic and clinical partners. This study seeks to identify how mutuality is expressed and to explore potential proxy measures of mutuality for an alliance consisting of a hospital system and a School of Public Health. Key informant interviews were conducted with faculty and hospital representatives serving on the partnership steering committee. Key informants were asked about perceived events that led to the development of the Alliance; perceived goals, expectations, and outcomes; and current/future roles with the Alliance. Four proxy measures of mutuality for an academic-clinical partnership were identified: policy directives, community beneficence, procurement of human capital, and partnership longevity. Findings can inform the development of tools for assisting in strengthening relationships and ensuring stakeholders' interests align with the mission and goal of the partnership by operationalizing elements necessary to evaluate the progress of the partnership.

Telemedicine delivery of patient education in remote Ontario communities: feasibility of an Advanced Clinician Practitioner in Arthritis Care (ACPAC)-led inflammatory arthritis education program.

OBJECTIVE: Telemedicine-based approaches to health care service delivery improve access to care. It was recognized that adults with inflammatory arthritis (IA) living in remote areas had limited access to patient education and could benefit from the 1-day Prescription for Education (RxEd) program. The program was delivered by extended role practitioners with advanced training in arthritis care. Normally offered at one urban center, RxEd was adapted for videoconference delivery through two educator development workshops that addressed telemedicine and adult education best practices. This study explores the feasibility of and participant satisfaction with telemedicine delivery of the RxEd program in remote communities. MATERIALS AND METHODS: Participants included adults with IA attending the RxEd program at one of six rural sites. They completed post-course program evaluations and follow-up interviews. Educators provided post-course feedback to identify program improvements that were later implemented. RESULTS: In total, 123 people (36 in-person and 87 remote, across 6 sites) participated, attending one of three RxEd sessions. Remote participants were satisfied with the quality of the video-conference (% agree/strongly agree): could hear the presenter (92.9%) and discussion between sites (82.4%); could see who was speaking at other remote sites (85.7%); could see the slides (95.3%); and interaction between sites adequately facilitated (94.0%). Educator and participant feedback were consistent. Suggested improvements included: use of two screens (speaker and slides); frontal camera angles; equal interaction with remote sites; and slide modifications to improve the readability on screen. Interview data included similar constructive feedback but highlighted the educational and social benefits of the program, which participants noted would have been inaccessible if not offered via telemedicine. CONCLUSION: Study findings confirm the feasibility of delivering the RxEd program to remote communities by using telemedicine. Future research with a focus on the sustainability of this and other models of technology-supported patient education for adults with IA across Ontario is warranted.

Does Every Patient Require Imaging after Cervical Spine Trauma? A Knowledge Translation Project to Support Evidence-Informed Practice for Physiotherapists.

Purpose: This article evaluates, describes, and addresses a gap in British Columbia physiotherapists' knowledge of the decision making required for the diagnostic imaging of patients after traumatic neck injury. Method: An online survey of orthopaedic physiotherapists in British Columbia was undertaken to explore their awareness of, knowledge of, and attitudes toward the Canadian Cervical Spine Rule (C-Spine Rule) and decision making regarding the need for diagnostic imaging in managing patients with traumatic neck injury. The survey included questions about managing clinical scenarios; respondents' awareness, knowledge, and use of a specific clinical decision rule-the C-Spine Rule-and any perceived barriers to using clinical practice guidelines in general and the C-Spine Rule in specific. The survey also included questions about the facilitators of and barriers to using the C-Spine Rule. These data were used to guide development of a tool kit to facilitate use of the rule. Results: Of 889 physiotherapists, 467 (52.5%) completed the survey. Given a scenario in which imaging was indicated according to the C-Spine Rule, 95.2% of the respondents correctly recommended imaging. However, in a scenario in which imaging was not indicated, 42.7% incorrectly recommended it. The barriers to using the guidelines included their perceived rigidity, role limitation, and reliance on clinical judgment. The results indicated a need for, and guided development of, resources to facilitate the use of the C-Spine Rule by British Columbia physiotherapists. Conclusions: We identified a gap in the knowledge of British Columbia physiotherapists in identifying which patients were most likely to require imaging after sustaining a traumatic neck injury. We developed a tool kit to address these barriers. British Columbia physiotherapists have accessed this resource extensively. Evaluating its impact on clinical practice, although desirable, was not feasible.

Objectif : évaluer, décrire et corriger une lacune dans les connaissances des physiothérapeutes de la Colombie-Britannique (C.-B.) sur les prises de décision nécessaires à l'égard de l'imagerie diagnostique après un traumatisme cervical. Méthodologie : les chercheurs ont lancé un sondage en ligne auprès des physiothérapeutes orthopédiques de la C.-B. pour évaluer leurs connaissances et leurs attitudes au sujet des règles canadiennes relatives à la colonne cervicale (RCC) et de la prise de décision entourant la nécessité de procéder à une imagerie diagnostique pour traiter les patients atteints d'un traumatisme cervical. Le sondage comprenait des questions sur la gestion des scénarios cliniques, les connaissances des répondants au sujet d'un outil de décision clinique (les RCC), leur utilisation de cet outil et les obstacles perçus à l'utilisation de guides de pratique clinique en général et des RCC en particulier. Le sondage contenait également des questions sur les incitations et les obstacles à l'utilisation des RCC. Les chercheurs ont utilisé ces données pour orienter l'élaboration d'un outil visant à faciliter le recours à ces règles. Résultats : au total, 467 des 889 physiothérapeutes (52,5 %) ont rempli le sondage. À la lecture d'un scénario où l'imagerie était indiquée d'après les RCC, 95,2 % des répondants ont bien recommandé l'imagerie. Cependant, dans un scénario où l'imagerie n'était pas indiquée, 42,7 % recommandaient l'imagerie à tort. Les obstacles à l'utilisation des lignes directrices incluaient une perception de rigidité, les limites de leur rôle et le fait de se fier au jugement clinique. Les résultats démontraient la nécessité de préparer des ressources pour faciliter l'utilisation des RCC par les physiothérapeutes de la C.-B. et en ont orienté la préparation. Conclusions : les chercheurs ont constaté une lacune dans les connaissances des physiothérapeutes de la C.-B. qui doivent repérer les patients les plus susceptibles d'avoir besoin d'imagerie après un traumatisme cervical. Ils ont préparé un outil pour vaincre ces obstacles. Les physiothérapeutes de la C.-B. ont abondamment consulté cette ressource. Même s'il aurait été souhaitable d'en évaluer les répercussions sur la pratique clinique, il n'a pas été possible de le faire.

A prospective comparison of telemedicine versus in-person delivery of an interprofessional education program for adults with inflammatory arthritis.

Introduction We evaluated two modes of delivery of an inflammatory arthritis education program ("Prescription for Education" (RxEd)) in improving arthritis self-efficacy and other secondary outcomes. Methods We used a non-randomized, pre-post design to compare videoconferencing (R, remote using telemedicine) versus local (I, in-person) delivery of the program. Data were collected at baseline (T1), immediately following RxEd (T2), and at six months (T3). Self-report questionnaires served as the data collection tool. Measures included demographics, disorder-related, Arthritis Self-Efficacy Scale (SE), previous knowledge (Arthritis Community Research and Evaluation Unit (ACREU) rheumatoid arthritis knowledge questionnaire), coping efficacy, Illness Intrusiveness, and Effective Consumer Scale. Analysis included: baseline comparisons and longitudinal trends (R vs I groups); direct between-group comparisons; and Generalized Estimating Equations (GEE) analysis. Results A total of 123 persons attended the program (I: n = 36; R: n = 87) and 111 completed the baseline questionnaire (T1), with follow-up completed by 95% ( n = 117) at T2 and 62% ( n = 76) at T3. No significant baseline differences were found across patient characteristics and outcome measures. Both groups (R and I) showed immediate effect (improved arthritis SE, mean change (95% confidence interval (CI)): R 1.07 (0.67, 1.48); I 1.48 (0.74, 2.23)) after the program that diminished over six months (mean change (95% CI): R 0.45 (-0.1, 0.1); I 0.73 (-0.25, 1.7)). For each of the secondary outcomes, both groups showed similar trends for improvement (mean change scores (95% CI)) over time. GEE analysis did not show any meaningful differences between groups (R vs I) over time. Discussion Improvements in arthritis self-efficacy and secondary outcomes displayed similar trends for I and R participant groups.

A user's survey of the clinical application and content validity of the DASH (Disabilities of the Arm, Shoulder and Hand) outcome measure.

STUDY DESIGN: Survey. PURPOSE OF THE STUDY: To elicit feedback on the clinical use and content validity of the Disabilities of the Arm, Shoulder and Hand (DASH) outcome measure from frontline users of the instrument. METHODS: A cross-sectional survey was administered to registered DASH users and inquired about how the DASH was being used and to identify the informational value of items of the DASH (content validity). RESULTS: About 172 completed the survey. One or both of the DASH and/or QuickDASH were consistently (89.5%) being used. About 90% were using it in adults (21-65 years), and at least 70% were using it across the entire extremity, and to a lesser extent, 10% reported using it in isolated neck injuries. Most respondents (66.9%-75.8%) were using the DASH in musculoskeletal (MSK) disorders, with some applying it for other more unique or non-MSK conditions (2.5%-16.6%). All but 1 of the 30 DASH items had at least 10% endorsement as being informative, and 4 items were identified as being problematic by greater than 20%. CONCLUSIONS: The DASH is being used as intended (whole extremity and MSK conditions), and in addition, it is being used in different body regions and diverse conditions. LEVEL OF EVIDENCE: Not applicable (descriptive survey).

A cross-sectional evaluation examining the use of the Achilles tendinopathy toolkit by physiotherapists in British Columbia, Canada.

PURPOSE: To evaluate the awareness and use of the Achilles tendinopathy toolkit (ATT), a knowledge translation (KT) strategy supporting evidence-informed management of midportion Achilles Tendinopathy (AT), by British Columbian physiotherapists (PTs). Secondarily, to assess PTs strategies for AT management by examining the association between exploring the ATT and following best practice in clinical care as recommended by the ATT. METHODS: Members of the Physiotherapy Association of British Columbia (BC) completed an online cross-sectional survey collecting information on demographics; awareness and exposure; perceptions, usability and applicability to clinical practice; knowledge; and attitudes. A clinical vignette assessed if respondents adhered to recommendations made by the ATT. Multi-variable logistic regression examined the association between exploring the ATT and following its recommendations. RESULTS: Of 238 participants, 81% (n = 154) were aware of the ATT and of those 53% (n = 81) explored its contents. Time was the most frequent barrier. Bi-variable analyses showed those who explored the ATT had over double the odds of following the best practice (odds ratio = OR = 2.8; 95% confidence interval = 95% CI = 1.3-6.0). This did not remain significant in the final adjusted model (OR = 2.2; 95% CI = 0.9-5.4). CONCLUSIONS: Evaluation of KT strategies is critical. This study revealed high awareness and moderate use of the ATT. Future work should consider the impact of toolkits on patient outcomes. Implications for Rehabilitation A toolkit is a novel knowledge translation (KT) strategy designed to provide accessibleevidence-informed resources to facilitate best practice by clinicians. The evaluation of the Achilles tendinopathy toolkit (ATT) revealed favourable findingsregarding the impact of this KT strategy on the knowledge and attitudes of British Columbia(BC) PTs and the possibility of a positive impact on best practice in clinical care. This research suggests toolkits are a feasible and meaningful KT strategy to provide clinicianswith valuable synthesized resources that have the potential to benefit patient outcomes.

Reliability and Validity of Cervical Range of Motion and Muscle Strength Testing.

Kubas, C, Chen, Y-W, Echeverri, S, McCann, S, Denhoed, M, Walker, C, Kennedy, C, and Reid, WD. Reliability and validity of cervical range of motion and muscle strength testing. J Strength Cond Res 31(4): 1087-1096, 2017-Cervical range of motion (ROM) and strength are fundamental measures to assess treatment effectiveness. The JTECH wireless devices provide versatile means of quantifying these measurements. The purpose of this study was to determine intrarater and interrater reliabilities and concurrent validity of the JTECH wireless dual inclinometer and handheld dynamometer. This study included 20 healthy subjects (mean age = 28.7 ± 7.8 years). The directions of ROM movement measured were cervical flexion, extension, lateral flexion, and rotation. Isometric strength was measured for flexion, extension, and lateral flexion. Two testers measured cervical ROM and isometric strength for each subject using the JTECH devices during 2 or 3 sessions to determine reliability. The same ROM and muscle strength movements were measured using the CROM3 and MicroFET2, respectively, to assess concurrent validity. Reliability and validity were analyzed using intraclass correlation coefficient (ICC), along with SEM and minimal detectable change. The results of this study showed that the intrarater reliability of the JTECH inclinometer and dynamometer was moderate to excellent (ICCs (3,1) = 0.53-0.90 and 0.74-0.91, respectively). The interrater reliability of the JTECH inclinometer was moderate to excellent (ICCs (2,3) = 0.69-0.89), whereas the JTECH dynamometer showed excellent interrater reliability (ICCs (2,3) = 0.84-0.88). The JTECH inclinometer and dynamometer showed moderate to excellent concurrent validity (ICCs (3,2) = 0.65-0.91 and 0.91-0.96, respectively). With the ease of use, portability, and ability to record multiple measurements without stopping, these devices can be applied to clinical and research settings.

The patient perspective: arthritis care provided by Advanced Clinician Practitioner in Arthritis Care program-trained clinicians.

OBJECTIVE: To assess patient satisfaction with the arthritis care services provided by graduates of the Advanced Clinician Practitioner in Arthritis Care (ACPAC) program. MATERIALS AND METHODS: This was a cross-sectional evaluation using a self-report questionnaire for data collection. Participants completed the Patient-Doctor Interaction Scale, modified to capture patient-practitioner interactions. Participants completed selected items from the Group Health Association of America's Consumer Satisfaction Survey, and items capturing quality of care, appropriateness of wait times, and a comparison of extended-role practitioner (ERP) services with previously received arthritis care. RESULTS: A total of 325 patients seen by 27 ERPs from 15 institutions completed the questionnaire. Respondents were primarily adults (85%), female (72%), and living in urban areas (79%). The mean age of participants was 54 years (range 3-92 years), and 51% were not working. Patients with inflammatory (51%) and noninflammatory conditions (31%) were represented. Mean (standard deviation) Patient-Practitioner Interaction Scale subscale scores ranged from 4.50 (0.60) to 4.63 (0.48) (1 to 5 [greater satisfaction]). Overall satisfaction with the quality of care was high (4.39 [0.77]), as was satisfaction with wait times (referral to appointment, 4.27 [0.86]; in clinic, 4.24 [0.91]). Ninety-eight percent of respondents felt the arthritis care they received was comparable to or better than that previously received from other health care professionals. CONCLUSION: Patients were very satisfied with and amenable to arthritis care provided by graduates of the ACPAC program. Our findings provide early support for the deployment and integration of ACPAC ERPs into the Ontario health care system and should inform future evaluation at the patient level.

A training program designed to improve interprofessional knowledge, skills and attitudes in chronic disease settings.

For over 25 years, The Arthritis Program (TAP) at Southlake Regional Health Centre has worked within a successful interprofessional model. TAP recognized the need to teach its model and developed The Arthritis Program - Interprofessional Training Program (TAP-ITP). This pilot study evaluated perceptions of 22 TAP-ITP participants related to effectiveness and satisfaction. The study employed a longitudinal survey design and data were collected at the baseline (T1), post-program (T2), and at one year (T3) by use of the following instruments: W(e)Learn Program Assessment; Interprofessional (IP) Learner and Team Contracts; Interprofessional Collaborative Competencies Attainment Survey (ICCAS); Bruyère Clinical Team Self Assessment Scale; and Attitudes Toward Health Care Teams (ATHCT). Data analysis included descriptive, non-parametric and parametric tests. Results indicated participants were very satisfied with TAP-ITP. ICCAS scores revealed statistically significant differences (Wilcoxon rank sum tests) from T1 to T2 in perceptions of IPC competencies (p < 0.05). Paired t-tests for each T1 to post (T2 and T3) scores were all significant (p < 0.05) for each Bruyère subscale and overall scores. For ATHCT, paired t-tests for each T1 to T2 were significant for Quality of Care/Process (p = 0.04) and borderline significant for Physician Centrality scale (p = 0.06). At T3, improvement in both scales was maintained. This pilot study suggests that TAP-ITP improves self-assessed scores of knowledge and skills, as well as attitudes in interprofessional care post-program and sustained at one year.

What interventions improve walking ability in neurogenic claudication with lumbar spinal stenosis? A systematic review.

PURPOSE: To investigate what interventions can improve walking ability in neurogenic claudication with lumbar spinal stenosis. METHODS: We searched CENTRAL, Medline, EMBASE, CINAHL and ICL databases up to June 2012. Only randomized controlled trials published in English and measuring walking ability were included. Data extraction, risk of bias assessment, and quality of the evidence evaluation were performed using methods of the Cochrane Back Review Group. RESULTS: We accepted 18 studies with 1,220 participants. There is very low quality evidence that calcitonin is no better than placebo or paracetamol regardless of mode of administration. There is low quality evidence that prostaglandins, and very low quality evidence that gabapentin or methylcobalamin, improves walking distance. There is low and very low quality evidence that physical therapy was no better in improving walking ability compared to no treatment, oral diclofenac plus home exercises, or combined manual therapy and exercise. There is very low quality evidence that epidural injections improve walking distance up to 2 weeks compared to placebo. There is low- and very low-quality evidence that various direct decompression surgical techniques show similar significant improvements in walking ability. There is low quality evidence that direct decompression is no better than non-operative treatment in improving walking ability. There is very low quality evidence that indirect decompression improves walking ability compared to non-operative treatment. CONCLUSIONS: Current evidence for surgical and non-surgical treatment to improve walking ability is of low and very low quality and thus prohibits recommendations to guide clinical practice.

Nonoperative treatment for lumbar spinal stenosis with neurogenic claudication.

BACKGROUND: Lumbar spinal stenosis with neurogenic claudication is one of the most commonly diagnosed and treated pathological spinal conditions. It frequently afflicts the elderly population. OBJECTIVES: To systematically review the evidence for the effectiveness of nonoperative treatment of lumbar spinal stenosis with neurogenic claudication. SEARCH METHODS: CENTRAL, MEDLINE, CINAHL, and Index to Chiropractic Literature (ICL) databases were searched up to June 2012. SELECTION CRITERIA: Randomized controlled trials published in English, in which at least one arm provided data on nonoperative treatments DATA COLLECTION AND ANALYSIS: We used the standard methodological procedures expected by The Cochrane Collaboration. Risk of bias in each study was independently assessed by two review authors using the 12 criteria recommended by the Cochrane Back Review Group (Furlan 2009). Dichotomous outcomes were expressed as relative risk, continuous outcomes as mean difference or standardized mean difference; uncertainty was expressed with 95% confidence intervals. If possible a meta-analysis was performed, otherwise results were described qualitatively. GRADE was used to assess the quality of the evidence. MAIN RESULTS: From the 8635 citations screened, 56 full-text articles were assessed and 21 trials (1851 participants) were included. There was very low-quality evidence from six trials that calcitonin is no better than placebo or paracetamol, regardless of mode of administration or outcome assessed. From single small trials, there was low-quality evidence for prostaglandins, and very low-quality evidence for gabapentin or methylcobalamin that they improved walking distance. There was very low-quality evidence from a single trial that epidural steroid injections improved pain, function, and quality of life, up to two weeks, compared with home exercise or inpatient physical therapy. There was low-quality evidence from a single trial that exercise is of short-term benefit for leg pain and function compared with no treatment. There was low and very low-quality evidence from six trials that multimodal nonoperative treatment is less effective than indirect or direct surgical decompression with or without fusion. A meta-analysis of two trials comparing direct decompression with or without fusion to multimodal nonoperative care found no significant difference in function at six months (mean difference (MD) -3.66, 95% CI -10.12 to 2.80) and one year (MD -6.18, 95% CI -15.03 to 2.66), but at 24 months a significant difference was found favouring decompression (MD -4.43, 95% CI -7.91 to -0.96). AUTHORS' CONCLUSIONS: Moderate and high-quality evidence for nonoperative treatment is lacking and thus prohibits recommendations for guiding clinical practice. Given the expected exponential rise in the prevalence of lumbar spinal stenosis with neurogenic claudication, large high-quality trials are urgently needed.