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Additional file 1: Table A. Our initial list of behavioural change techniques (BCTs), mapped to each relevant theoretical domains framework (TDF) domain for A) Patients, B) Health professionals, and C) Arthritis therapists with either a confirmed link or inconclusive evidence for a link according to the Theory and Technique Tool (https://theoryandtechniquetool.humanbehaviourchange.org/) (70). Those in bold font indicates the BCTs selected in the research process as potentially operationalizable and feasible.

Additional file 2: Table B. Interview Guide: Patients with Diabetes and Osteoarthritis. Table C. Interview Guide: Physicians and Diabetes Educators. Table D. Interview Guide: Arthritis Therapists.

Additional file 2: Table B. Interview Guide: Patients with Diabetes and Osteoarthritis. Table C. Interview Guide: Physicians and Diabetes Educators. Table D. Interview Guide: Arthritis Therapists.

Physical disabilities have various etiologies, including but not limited to, traumatic injuries (i.e., spinal cord injury, limb loss), nervous system disorders (i.e., Parkinson’s Disease), and autoimmune diseases (Multiple Sclerosis) [1]. Due to the dramatic and sometimes sudden changes in function and ability following the adult-onset of a physical disability, it is not surprising to see that people struggle with anxiety and depression[2-5]. A critical phase for the recovery of patients with a physical disability is treatment provided while patients first receive care, either as hospital inpatients (acute care, rehabilitation) or through ambulatory models of care. During this phase, there is often an emphasis placed on restoring physical function to ensure that patients can regain independence to return home and to subsequently be able to participate in their community, which often makes mental health concerns secondary [6-8]. Consequently, the types of available mental health services are often dependent on and limited by financial and human resource constraints, which can impact the provision of adequate mental health care [9]. One potentially cost-effective approach to providing mental health supports is group therapy [10-12] . There is some preliminary evidence on the efficacy of group therapy approaches for patients with medical illness [13] as well as those with motor and functional impairments caused by limb loss [14] and traumatic brain injury[15]. Importantly, group therapy aligns with a stepped-care delivery approach, allowing for less resource-intensive interventions initially, moving to higher intensity interventions if required [16]. This service delivery approach offers an innovative way to optimize the balance between outcomes and resource utilization in mental healthcare[17-18]. However, further evidence is required to demonstrate its feasibility, acceptability, potential efficacy and implementability for those with physical disabilities[16] To help advance knowledge regarding the implementation of group therapy within hospital settings for patients with physical disability, the proposed scoping review will address the following research question: What is known about the implementation of psychosocial groups in patients with physical disabilities to address depression and/or anxiety? To date, no scoping review has summarized the main characteristics of an existing group therapy program for persons with disabilities (i.e., duration, frequency, facilitator characteristics, etc.) nor the main factors that may influence implementation. As a result, the present scoping review will provide important insights on how to effectively design and implement a model of group therapy for adults with physical disabilities, which practitioners and policy-makers can refer to in order to develop their own programs.

To understand how people with major limb amputation experience the transition in care from inpatient rehabilitation to the community. A qualitative study was conducted using semi-structured interviews. Individuals were eligible if they had undergone a major lower limb amputation and had been discharged from inpatient rehabilitation to the community within one to twelve months. Interviews explored participants’ experiences and factors associated with the transition in care. The interviews were audio-recorded, transcribed, and thematically analyzed. Nine individuals with major lower limb amputation participated. Five themes were identified to describe the transition in care experience: (a) Preparedness: differing experiences during inpatient rehabilitation; (b) Challenges with everyday tasks: “everything has to be thought out”; (c) Importance of coping strategies; “gradually you accept it more and more” (d) Importance of support and feeling connected; “if I needed anything, they’re right there” and (e) Not everyone has access to the same resources: “left to your own devices”. The identified themes concurrently influenced the transition from inpatient rehabilitation to the community. Common challenges during the initial transition were identified. Areas of improvement within inpatient rehabilitation included individualized care, discussions surrounding expectations, and better access to ongoing community support.Implication for rehabilitationTransition in care are difficult and vulnerable times for people with major lower limb amputation, especially when transitioning home following inpatient rehabilitation.Rehabilitation should prepare individuals for completing meaningful tasks in the home and community.Access to ongoing support in the community in the form of practical and emotional support can ease the challenges of transitioning home. Transition in care are difficult and vulnerable times for people with major lower limb amputation, especially when transitioning home following inpatient rehabilitation. Rehabilitation should prepare individuals for completing meaningful tasks in the home and community. Access to ongoing support in the community in the form of practical and emotional support can ease the challenges of transitioning home.

The majority of lower extremity amputations (LEAs) are the result of diabetes or peripheral vascular disease. There is a paucity of literature on individuals’ experiences living with dysvascular LEAs in the community, particularly in Canada. The purpose of this study was to explore the perceptions and experiences of community-dwelling adults living with dysvascular LEA. Semi-structured qualitative interviews were conducted with individuals with a dysvascular LEA recruited from three rehabilitation hospitals. Participants were included if they were English-speaking adults at least three months post-amputation and no longer receiving inpatient rehabilitation. Sampling was purposive to ensure variation by gender, level of amputation, and geographic location. Data were analyzed using an inductive content-analysis approach. Thirty-five interviews were completed with individuals with dysvascular LEA. Study participants portrayed LEA as having an impact on many aspects of their lives, resulting in changes in their mobility, social activities and roles, and psychological wellbeing. Three main factors shaped individuals’ experiences with dysvascular LEA including social support, accessibility, and socioeconomic factors. Our findings highlight the impacts of dysvascular LEA in peoples’ lives. Future research is warranted to explore how community-based interventions and strategies can address the ongoing needs of individuals with dysvascular LEA.Implications for rehabilitationOur findings highlight the long-term impacts of dysvascular lower extremity amputations, which resulted in changes in mobility, social activities and roles, and psychological wellbeing.Participants identified issues in access to community services and resources, including rehabilitation.Mechanisms to identify people at risk for social isolation need to be developed and implemented in rehabilitation centers.Access to ongoing rehabilitation services in the community are needed to optimize mobility outcomes and address ongoing psychological needs. Our findings highlight the long-term impacts of dysvascular lower extremity amputations, which resulted in changes in mobility, social activities and roles, and psychological wellbeing. Participants identified issues in access to community services and resources, including rehabilitation. Mechanisms to identify people at risk for social isolation need to be developed and implemented in rehabilitation centers. Access to ongoing rehabilitation services in the community are needed to optimize mobility outcomes and address ongoing psychological needs.

Semi-structured intial Interview Guides. (DOC 44 kb)

Scripts for obtaining consent. (DOC 45 kb)

Semi-structured follow-up Interview Guides. (DOC 48 kb)

Consent Information Letters. (DOC 326 kb)

To understand what is known about sex and gender differences in quality of life (QoL) and related domains for individuals with an adult acquired lower limb amputation (LLA). A computer-assisted literature search of four online databases was completed. Articles were included if they incorporated sex or gender as part of their data analysis with a focus on QoL-related domains. Data were analyzed using descriptive numerical analysis and thematic analysis. One hundred and eleven articles were included in this review. Women were under-represented across studies, with most of the participants being men. No articles described the inclusion of trans or non-binary persons. Differences by sex or gender were reported by 66 articles. Articles reporting on gender seldom provided descriptions of how gender was defined. Overall, women/females seemed to have worse outcomes in terms of prosthesis-related outcomes, mental health, and return to occupations. Articles included in this review were not clear with how gender was defined. In order for more targeted interventions that account for sex and gender differences, studies need to be more forthcoming about how they use and define gender. Future research should seek to include gender non-conforming participants to identify additional needs.Implications for rehabilitationSex and gender are important constructs that influence outcomes following lower limb amputation.Rehabilitation professionals should consider sex and gender-specific outcomes when tailoring programs to ensure ethical clinical care. Sex and gender are important constructs that influence outcomes following lower limb amputation. Rehabilitation professionals should consider sex and gender-specific outcomes when tailoring programs to ensure ethical clinical care.

Background: Timely access to effective treatments for arthritis is a priority at national, provincial and regional levels in Canada due to population aging coupled with limited health human resources. Models of care for arthritis are being implemented across the country but mainly in local contexts, not from an evidence-informed policy or framework. The purpose of this study is to examine existing models of care for arthritis in Canada at the local level in order to identify commonalities and differences in their implementation that could point to important considerations for health policy and service delivery. Methods: Semi-structured key informant interviews were conducted with 70 program managers and/or care providers in three Canadian provinces identified through purposive and snowball sampling followed by more detailed examination of 6 models of care (two per province). Interviews were transcribed verbatim and analyzed thematically using a qualitative descriptive approach. Results: Two broad models of care were identified for Total Joint Replacement and Inflammatory Arthritis. Commonalities included lack of complete and appropriate referrals from primary care physicians and lack of health human resources to meet local demands. Strategies included standardized referrals and centralized intake and triage using non-specialist health care professionals. Differences included the nature of the care and follow-up, the role of the specialist, and location of service delivery. Conclusions: Current models of care are mainly focused on Total Joint Replacement and Inflammatory Arthritis. Given the increasing prevalence of arthritis and that published data report only a small proportion of current service delivery is specialist care; provision of timely, appropriate care requires development, implementation and evaluation of models of care across the continuum of care.

To understand what is known about sex and gender differences in quality of life (QoL) and related domains for individuals with an adult acquired lower limb amputation (LLA). A computer-assisted literature search of four online databases was completed. Articles were included if they incorporated sex or gender as part of their data analysis with a focus on QoL-related domains. Data were analyzed using descriptive numerical analysis and thematic analysis. One hundred and eleven articles were included in this review. Women were under-represented across studies, with most of the participants being men. No articles described the inclusion of trans or non-binary persons. Differences by sex or gender were reported by 66 articles. Articles reporting on gender seldom provided descriptions of how gender was defined. Overall, women/females seemed to have worse outcomes in terms of prosthesis-related outcomes, mental health, and return to occupations. Articles included in this review were not clear with how gender was defined. In order for more targeted interventions that account for sex and gender differences, studies need to be more forthcoming about how they use and define gender. Future research should seek to include gender non-conforming participants to identify additional needs.Implications for rehabilitationSex and gender are important constructs that influence outcomes following lower limb amputation.Rehabilitation professionals should consider sex and gender-specific outcomes when tailoring programs to ensure ethical clinical care. Sex and gender are important constructs that influence outcomes following lower limb amputation. Rehabilitation professionals should consider sex and gender-specific outcomes when tailoring programs to ensure ethical clinical care.