Understanding uncertainty in young-onset Parkinson disease.

Objectives Individuals living with young-onset Parkinson's disease compose a rare subtype of a disease typically associated with older age. Situated within a large grounded theory study exploring information behavior, this paper describes the core category of the theory, i.e. uncertainty. Methods Data were collected with 39 individuals living with young-onset Parkinson's disease who took part in in-depth interviews, focus groups and/or an online discussion board. Fourteen autobiographies written by individuals living with young-onset Parkinson's disease were also used as data sources. Results Through experiencing young-onset Parkinson's disease, participants were confronted with uncertainty along two main lines. First, they experienced uncertainty with respect to their identities as young- and middle-aged adults, deviating from the idealized age-graded life path marked out within their socio-cultural context. Second, they experienced uncertainty with respect to their functioning, as the heterogeneous nature of Parkinson's progression meant that it would not be possible to chart how their disease would change over time. This uncertainty was associated with feelings of lost control over their lives and increased grief. Discussion With a deeper appreciation for how uncertainty is experienced in the lives of those with young-onset Parkinson's disease, health professionals may be better prepared to discuss these issues with patients and provide support and resources.

Exploring use of the ICF in health education.

PURPOSE: Currently, little is known regarding use of the International Classification of Functioning, Disability and Health (ICF) in health education applications. Therefore, this review sought to examine the scope of work that has been conducted regarding the application of the ICF in health education. METHODS: A review of the current literature related to use of the ICF in health education programs was conducted. Twelve electronic databases were searched in accordance with a search protocol developed by a health sciences librarian. In total, 17,878 records were reviewed, and 18 articles met the criteria for inclusion in this review. RESULTS: Current evidence regarding use of the ICF in healthcare education revealed that program and participant properties can be essential facilitators or barriers to successful education programs. In addition, gaps in comprehensive outcome measurement were revealed as areas for future attention. Educational applications of the ICF are very much a work in progress as might be expected given the ICF's existence for only a little over a decade. CONCLUSIONS: To advance use of the ICF in education, it is important to incorporate the measurement of both knowledge acquisition and behavior change related to ICF-based programs. Ultimately, widespread implementation of the ICF represents not only a substantial opportunity but also poses a significant challenge.

Assessing quality of life in relation to physical activity participation in persons with spinal cord injury: a systematic review.

BACKGROUND: Physical activity (PA) participation in persons with spinal cord injury (SCI) holds a number of benefits for quality of life (QOL) but there is a need to better understand conceptual and measurement issues. OBJECTIVE: To evaluate the appropriateness of outcome measurement tools to assess QOL in relation to PA in persons with SCI. METHODS: A systematic literature review was conducted using PubMed and CINAHL databases to identify studies that used a QOL measurement tool and assessed PA or employed a PA intervention to determine a relationship between PA and QOL. RESULTS: Thirteen articles met the inclusion criteria. Within the 13 articles, 9 different QOL outcome measurement tools were used; two objective measures (Short Form-36 [SF-36] and Quality of Well-being [QWB]) and 7 subjective measures (Perceived QOL [PQoL], Satisfaction with Life Scale [SWLS], QOL Index SCI Version III, Life Satisfaction [LISAT], QOL Feedback, QOL Profile: Physical and Sensory Disabilities Version [QOLP-PSD] and Subjective QOL [SQOL]). The PQoL was the most commonly used tool (4 studies) and was used in 2 of the 3 randomized controlled trials. Twelve of the studies demonstrated a positive effect of PA on QOL. CONCLUSIONS: Outcome measurement tool selection should be guided by the specific purpose of the data collection activity as well as the context under which the tool will be used (e.g., setting, population, etc.). Therefore, different tools may rightfully be selected to assess the same construct when considering different circumstances-however, these considerations should be balanced by the evidence and demonstrated prior utility of potential tools.

Perspectives on prevention, assessment, and rehabilitation of low back pain in WORK.

INTRODUCTION: The aim of this review was to describe the low back pain (LBP) knowledge base developed in WORK and to discuss its relevance to current perspectives in the broader literature on LBP and employment. METHOD: A scoping review of the literature in WORK on LBP and employment was conducted using published articles from 1990-2009. Articles were organized into geographical regions and summarized for contributions to the domains of WORK: prevention, assessment, and rehabilitation. Methodological accordance of the articles was also assessed. RESULTS: Fifty articles were extracted and organized into contributions from authors within North America (n=34) and outside North America (n=16). In total there were 26 prevention, 7 assessment, and 12 rehabilitation articles in this review. Five articles were also classified as 'understanding' articles. More than half of the articles retrieved employed quantitative methodology. CONCLUSIONS: WORK has contributed a broad realm of publications to the knowledge base on LBP and employment. Two thirds of the articles were contributed from authors within North America, with a greater emphasis on prevention. This article highlights the similarities and differences in the international knowledge base in the management of LBP in WORK. Future directions for research are elaborated drawing on current perspectives of two experts on the management of LBP.

A systematic review of multidisciplinary outcomes in the management of chronic low back pain.

OBJECTIVE: Previous research has provided an inconsistent message as to the effectiveness of multidisciplinary programs to improve employment outcomes in clients with Chronic Low Back Pain (CLBP). The primary aims of this review were to: 1) update the evidence for the multidisciplinary treatment of CLBP to improve employment outcomes 2) assess what knowledge supports occupational therapy as contributing to a multidisciplinary approach in the treatment of CLBP. PARTICIPANTS: Working-age adults experiencing CLBP who took part in controlled trials evaluating multidisciplinary programs between July 1998 and July 2009. METHODS: Updated guidelines provided by the Cochrane Collaboration Back Review Group (BRG) were used to perform a systematic review to identify, appraise, and synthesize research evidence relevant to our research questions. RESULTS: Twelve unique articles were found, after a database search and citation tracking, only two of which were high quality. Our findings suggest that there is still conflicting evidence for the effectiveness of multidisciplinary programs to improve employment outcomes in CLBP. CONCLUSIONS: The results are discussed with reference to current methodological limitations found in the literature. Furthermore, occupational therapists were found to be underutilized in the included studies and future multidisciplinary programs should take advantage of the wide range of skills that occupational therapists can contribute in this practice area.

Social support for physical activity and perceptions of control in early Parkinson's disease.

PURPOSE: The purpose of this article is to investigate how social support influences physical activity participation, as perceived by men and women in the early stages of Parkinson's disease (PD). It will also address how this perceived support interacts with perceptions of control to influence this participation. METHOD: Three women and four men with early PD completed a background questionnaire and participated in individual semi-structured interviews. The World Health Organisation's International Classification of Functioning, Disability and Health (ICF) model was used as a framework to develop questions related to the environmental factors examined. Phenomenology was employed in the analysis of interview transcripts. RESULTS: Three main types of support (instrumental, emotional, informational) were provided to participants, and each of these had a positive influence on physical activity participation. In addition to this support, participants reported personally participating in exercise as a means to help control the progression of PD. CONCLUSIONS: This is believed to be the first study looking at factors influencing physical activity participation in PD. Issues related to support for exercise from physicians and organisational issues of support groups for PD are discussed. Directions for future research are provided, which should aid in the identification of strategies to increase physical activity levels in those with PD.