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ObjectivesThis project used a systematic and integrated knowledge translation (IKT) approach to co-create theory- and evidence-based best practices for physical activity counseling for adults with spinal cord injury (SCI).MethodsGuided by the IKT Guiding Principles, we meaningfully engaged research users throughout this project. A systematic approach was used. An international, multidisciplinary expert panel (n = 15), including SCI researchers, counselors, and people with SCI, was established. Panel members participated in two online meetings to discuss the best practices by drawing upon new knowledge regarding counselor-client interactions, current evidence, and members’ own experiences. We used concepts from key literature on SCI-specific physical activity counseling and health behavior change theories. An external group of experts completed an online survey to test the clarity, usability and appropriateness of the best practices.ResultsThe best practices document includes an introduction, the best practices, things to keep in mind, and a glossary. Best practices focused on how to deliver a conversation and what to discuss during a conversation. Examples include: build rapport, use a client-centred approach following the spirit of motivational interviewing, understand your client’s physical activity barriers, and share the SCI physical activity guidelines. External experts (n = 25) rated the best practices on average as clear, useful, and appropriate.ConclusionWe present the first systematically co-developed theory- and evidence-based best practices for SCI physical activity counseling. The implementation of the best practices will be supported by developing training modules. These new best practices can contribute to optimizing SCI physical activity counseling services across settings.

Study design: Guided by the 4-step process outlined in the Consensus-based Standards for the selection of health Measurement INstruments (COSMIN) guideline, multiple methodologies were used: Delphi, literature reviews, ratings with consensus, think-aloud, and test-retest. Objectives: The purpose of this study was to develop and test a spinal cord injury (SCI) peer support evaluation tool that meets the needs of community-based SCI organizations in Canada. Setting: Peer support programs for people with SCI delivered by community-based SCI organizations. Methods: This research was co-constructed with executives and staff from SCI community-based organizations, people with SCI, researchers, and students. Given the multiple steps of this study, sample size and characteristics varied based on each step. Participants included people with SCI who received peer support (mentees) or provided peer support (mentors/supporters) and staff of community-based organizations. Results: In step 1, the 20 most important outcomes for SCI peer support were identified. In step 2 and 3, the 97 items were identified to assess the outcomes and by using rating and multiple consensus methodologies 20 items, one to assess each outcome, were selected. In step 4, content and face validity and test-retest reliability were achieved. The resulting SCI Peer Support Evaluation Tool consists of 20 single-item questions to assess 20 outcomes of SCI peer support. Conclusion: Through a systematic process, the SCI Peer Support Evaluation Tool is now ready to be implemented to assess outcomes of SCI peer support programs delivered by community-based SCI organizations.

The Physical Activity Recall Assessment for People with SCI (PARA-SCI) has demonstrated the best test-retest reliability and validity of self-report measures of leisure-time physical activity (LTPA) for adults with SCI. However, the absence of internal consistency reliability data has been raised as a concern. Internal consistency is relevant only for unidimensional measures. In other populations, LTPA is known to be a multidimensional construct, evaluated with multidimensional measures. We tested for unidimensionality through secondary analysis of PARA-SCI data (n = 703). Cronbach’s α was 0.227. Principal components analysis showed two components/dimensions (‘Moderate and Heavy Intensity LTPA’ and ‘Mild Intensity LTPA’) explained 73% of the variance. Binary logic crosstabulation produced no discernible patterns of behavioural interrelatedness across LTPA intensities. Together, these data demonstrate the multidimensionality of LTPA and the PARA-SCI is not unidimensional. Internal consistency should not be a criterion for evaluating LTPA questionnaires for use in studies of people with SCI.

Children and youth with disabilities (CYD) are more likely to experience poor mental health compared to non-disabled peers. Disability type may impact mental health outcomes; however, a more comprehensive understanding of mental health outcomes in CYD with diverse disability types is needed. This study examined the mental health status of CYD. Parents of 473 CYD completed a survey including a measure of mental health indicators. Approximately 72% of the sample had above average total difficulties scores. Boys scored higher than girls on the hyperactivity subscale, and those with comorbid disabilities scored the highest on total difficulties. Overall, the results indicate CYD experience mental health challenges at rates well above population norms. Research exploring interventions that may buffer these effects is warranted.

ABSTRACTLeisure-time physical activity (LTPA) participation involves two dimensions: quantity and quality. Research has been undertaken to explore strategies for increasing the quantity of LTPA among ambulators with spinal cord injury (SCI). Yet, no studies have been conducted to examine the quality of LTPA participation among ambulators with SCI, which may be important for well-being, health, and maintaining participation. Thus, the purpose of this study was to explore conditions and elements involved in positive and negative quality LTPA experiences. Semi-structured interviews were conducted with 22 ambulators with SCI. Using pragmatism and integrated knowledge translation as guiding approaches, the data were thematically analysed. Following inductive coding, the Quality Participation Framework and the Quality Parasport Participation Framework were employed for deductively coding the elements and conditions associated with LTPA experiences, respectively. Three principal themes were identified which provide broad insights for LTPA among ambulators with SCI: ableism, feeling sidelined, and effects of SCI. These themes capture conditions that fostered a positive or negative quality PA experience, including: three intrapersonal, five social, four programme, and one physical condition(s). Elements identified in the Quality Participation Framework were also related to both positive and negative quality LTPA experiences. This study provides insight on how LTPA is uniquely experienced by ambulators with SCI, including conditions and elements that influence quality participation. Self-determination theory may be useful to inform the design of behavioural interventions due to its alignment with the Quality Participation Framework. Behavioural interventions should employ behaviour change techniques to target conditions and elements of LTPA participation.

ContextIndonesia, Japan, Korea, Thailand.ObjectiveTo culturally validate and translate the Scientific Exercise Guidelines for Adults with Spinal Cord Injury (SEG-SCI) for use in four Asian countries.DesignSystematic ReviewParticipantsN/AMethodsA systematic review was conducted to identify all published English- and local-language studies conducted in Indonesia, Japan, Korea, and Thailand, testing the effects of exercise training interventions on fitness and cardiometabolic health in adults with acute or chronic SCI. Protocols and results from high-quality controlled studies were compared with the SEG-SCI. Forward and backward translation processes were used to translate the guidelines into Bahasa Indonesian, Japanese, Korean and Thai languages.ResultsFifteen studies met the review criteria. At least one study from each country implemented exercise prescriptions that met or exceeded the SEG-SCI. Two were controlled studies. In those two studies, relative to control conditions, participants in exercise conditions achieved significant improvements in fitness or cardiometabolic health outcomes only when the exercise intervention protocol met or exceeded the SEG-SCI. During the language translation processes, end-users confirmed that SEG-SCI language and terminology were clear.ConclusionClinical researchers in Indonesia, Japan, Korea and Thailand have implemented exercise protocols that meet or exceed the SCI-SEG. Results of high-quality studies align with the SEG-SCI recommendations. Based on this evidence, we recommend that the SEG-SCI be adopted in these countries. The cultural validation and translation of the SEG-SCI is an important step towards establishing consistent SCI exercise prescriptions in research, clinical and community settings around the world.

Regular leisure time physical activity (LTPA) has beneficial health effects in people with spinal cord injury (SCI). Yet, participation in LTPA is low, and little is known about changes many years after injury.

Study design: Multi-centre randomized clinical trial. Objectives: (1) compare the effects of arm-cycle ergometry (ACET) and body weight supported treadmill training (BWSTT) on quality of life (QOL) and intermediary variables in individuals with spinal cord injury (SCI); (2) examine correlations between baseline measures, and changes in physical activity, QOL, and intermediaries. Setting: Hospital-based research institutes (Vancouver, Toronto) and University-based exercise program (Hamilton). Methods: 35 participants with motor-complete SCI above T6 completed baseline assessments of physical activity, life satisfaction, independence, autonomy, positive and negative affect, and pain. Twenty-eight participants were randomized to 72 sessions of ACET (n= 14) or BWSTT (n= 14) with measures repeated following 36 sessions, 72 sessions, and 6-months post-intervention. Results: Neither intervention significantly impacted QOL. Pain was reduced in ACET compared to BWSTT (interaction effect p= 0.022) and was significantly less at 72 sessions vs. baseline in the ACET group (p= 0.009). At baseline, QOL was positively correlated with independence, autonomy, and positive affect and negatively correlated with negative affect (all p< 0.05). Following BWSTT, changes in moderate-vigorous physical activity correlated with changes in QOL (r= 0.87, p= 0.010). Following ACET, changes in autonomy and independence were positively correlated with changes in QOL (both r> 0.64, p< 0.048). Conclusions: Contrary to previous studies, there was no benefit of either intervention on measures of QOL. The social context of exercise may be important for improving QOL. However, individuals may benefit more from active (ACET) than passive (BWSTT) exercise modalities through reduced pain. Exercise interventions that improve autonomy and independence may lead to improvements in QOL.

Study design: Type II hybrid effectiveness-implementation trial protocol. Objectives: To (1) evaluate the implementation of coordinated physical activity (PA) coaching delivered by physiotherapists and spinal cord injury (SCI) peers during the transition from in-hospital care to living in a community (implementation objective) and (2) assess the effect of coaching on PA behaviour and psychosocial predictors among people with SCI (effectiveness objective). Setting: Rehabilitation hospital and home/community settings in British Columbia, Canada. Methods: Implementation objective: PA coaches (physiotherapists and SCI peers) receive an implementation intervention including training, monitoring, feedback, and champion support. A Theoretical Domains Framework-based questionnaire is collected at baseline, post-training, 2, and 6 months follow-up and semi-structured interviews conducted at 6 months. Effectiveness objective: Using a quasi-experimental design, 55 adults with SCI are allocated to intervention (PA coaching, n= 30) or control (usual care, n= 25) groups. Participants in the intervention group are referred by physiotherapists to receive 11 SCI peer-delivered PA coaching sessions in the community. Control participants received usual care. Questionnaires assessing PA behaviour and psychosocial predictors are administered at baseline, 2-months, 6-months, and 1-year. Semi-structured interviews are conducted to assess intervention satisfaction at 6 months. Analyses include one-way (implementation objective) and two-way (effectiveness objective) repeated measures ANCOVAs for questionnaire-reported outcomes and thematic content analysis for interview data. Data are summarised using the reach effectiveness adoption implementation maintenance (RE-AIM) framework. Ethics and dissemination: The University of British Columbia Clinical Research Ethics Board approved the protocol (#H19-02694), clinicaltrials.gov registration NCT04493606. Documentation of the adoption process will inform implementation in future sites.

Study design: Cross-sectional construct validation study. Objectives: To test the construct validity of the Leisure Time Physical Activity Questionnaire for People with Spinal Cord Injury (LTPAQ-SCI) by examining associations between the scale responses and cardiorespiratory fitness (CRF) in a sample of adults living with spinal cord injury (SCI). Setting: Three university-based laboratories in Canada. Methods: Participants were 39 adults (74% male; Mage: 42 ± 11 years) with SCI who completed the LTPAQ-SCI and a graded exercise test to volitional exhaustion using an arm-crank ergometer. One-tailed Pearson’s correlation coefficients were computed to examine the association between the LTPAQ-SCI measures of mild-, moderate-, heavy-intensity and total minutes per week of LTPA and CRF (peak volume of oxygen consumption [V̇O2peak] and peak power output [POpeak]). Results: Minutes per week of mild-, moderate- and heavy-intensity LTPA and total LTPA were all positively correlated with V̇O2peak. The correlation between minutes per week of mild intensity LTPA and V̇O2peakwas small-medium (r= 0.231, p= 0.079) while all other correlations were medium-large (rs ranged from 0.276 to 0.443, ps < 0.05). Correlations between the LTPAQ-SCI variables and POpeakwere also positive but small (rs ranged from 0.087 to 0.193, ps > 0.05), except for a medium-sized correlation between heavy-intensity LTPA and POpeak(r= 0.294, p= 0.035). Conclusions: People with SCI who report higher levels of LTPA on the LTPAQ-SCI also demonstrate greater levels of CRF, with stronger associations between moderate- and heavy-intensity LTPA and CRF than between mild-intensity LTPA and CRF. These results provide further support for the construct validity of the LTPAQ-SCI as a measure of LTPA among people with SCI.

Study design: Scoping review of experimental and quasi-experimental studies. Objective: To systematically synthesize research testing the effects of leisure time physical activity (LTPA) interventions on chronic pain and subjective well-being (SWB) among adults with spinal cord injury (SCI). Methods: Literature searches were conducted using multiple databases (Web of Science, Embase, CINAHL, Medline, PsychINFO and SPORTDiscus) to identify studies involving persons with SCI that measured and reported the effects of LTPA interventions on both chronic pain and at least one measure of SWB (e.g., affect, life satisfaction, satisfaction with various life domains). Relevant data were extracted from the studies and synthesized. Results: A total of 3494 articles were screened. Fifteen published articles, consisting of 12 different studies met the review inclusion criteria. Four different patterns of findings were observed regarding the effect of LTPA on chronic pain and SWB outcomes: (1) increased chronic pain, decreased SWB (1 article); (2) decreased chronic pain, improved SWB (12 articles); (3) increased chronic pain, improved SWB (1 article); and (4) unchanged levels of pain, improved SWB (1 article). Conclusions: Results of most articles included in this scoping review suggest that LTPA interventions can reduce chronic pain and improve SWB for persons with SCI. Further research is needed to identify the mechanisms by which LTPA affects pain and SWB, in order to formulate LTPA prescriptions that maximize improvements in these outcomes.

Study designs: Cross-sectional survey, semi-structured interview, and randomized-controlled trial. Objectives: Optimal spinal cord injury (SCI)-specific PA intervention strategies appropriate for the physiotherapist setting are unknown. The purpose of this paper is to describe the rigorous co-development process of a theory-based, physiotherapist-led PA intervention for people with SCI and assess its feasibility for implementation in the rehabilitation setting. Setting: Community. Methods: Co-development of the intervention included (1) a review of the literature; (2) key informant interviews with people with SCI (n= 26); (3) a national online survey of physiotherapists’ barriers, needs, and preferences (n= 239); (4) a review of the evidence and recommendations for the intervention from a stakeholder expert panel (n= 13); and (5) a randomized controlled trial of intervention training and its effects on implementation determinants amongst physiotherapists (n= 20). Results: Almost 300 people with SCI and physiotherapists were engaged in the intervention development process. Optimal intervention delivery should be tailored and include (1) education on safety, PA guidelines, and behaviour change techniques, (2) referral to other peers, local programmes, and health professionals, and (3) adapted exercise prescriptions. Following intervention implementation training, physiotherapists demonstrated stronger tested and perceived knowledge, skills, resources, and confidence for promoting PA to people with SCI, ps < 0.05. Conclusions: This development process serves as an example methodology for using theory to co-create a leisure-time physical activity behaviour change intervention tailored for people with SCI.

Study design: Systematic scoping review. Objectives: The purpose of this project was to conduct a scoping review to understand the amounts, types, correlates, and outcomes of physical activity (PA) participation for ambulators with SCI. Methods: A systematic search was employed among five large databases and two theses/dissertation databases, yielding 3257 articles. Following a two-phase screening process by independent coders, 17 articles were included in the review. Data were charted and summarized, and correlates were coded using the COM-B model. Results: 11 studies were cross-sectional, 5 studies involved an exercise intervention, and 1 study used mixed methods. Overall, ambulators with SCI participated in low levels of PA. The type of PA investigated across all studies was leisure-time PA (e.g., sports, exercise). Psychological and physical capability (e.g., perceived behavioral control, fatigue), social and environmental opportunity (e.g., perceptions of disability, cost), and automatic and reflective motivation (e.g., boredom, intentions) were correlates of PA measured within studies. Exercise intervention studies measured physical (e.g., strength, fitness) and one psychological outcome (i.e., depression). No studies examined the quality of PA experiences. Conclusions: Only leisure-time PA has been investigated among ambulators with SCI, and low levels of leisure-time PA have been reported. Correlates of leisure-time PA can be mapped onto all COM-B model constructs and are potential targets for PA-enhancing interventions. Further investigation is warranted into the physical and psychosocial outcomes across all types of LTPA in addition to understanding the quality of LTPA experiences.

Study design: Protocol for a pragmatic randomized controlled trial (the Exercise guideline Promotion and Implementation in Chronic SCI [EPIC-SCI] Trial). Primary objectives: To test if home-/community-based exercise, prescribed according to the international SCI exercise guidelines, significantly reduces chronic bodily pain in adults with SCI. Secondary objectives: To investigate: (1) the effects of exercise on musculoskeletal and neuropathic chronic pain; (2) if reduced inflammation and increased descending inhibitory control are viable pathways by which exercise reduces pain; (3) the effects of chronic pain reductions on subjective well-being; and (4) efficiency of a home-/community-based exercise intervention. Setting: Exercise in home-/community-based settings; assessments in university-based laboratories in British Columbia, Canada. Method: Eighty-four adults with chronic SCI, reporting chronic musculoskeletal or neuropathic pain, and not meeting the current SCI exercise guidelines, will be recruited and randomized to a 6-month Exercise or Wait-List Control condition. Exercise will occur in home/community settings and will be supported through behavioral counseling. All measures will be taken at baseline, 3-months and 6-months. Analyses will consist of linear mixed effect models, multiple regression analyses and a cost–utility analysis. The economic evaluation will examine the incremental costs and health benefits generated by the intervention compared with usual care. Ethics and dissemination: The University of British Columbia Clinical Research Ethics Board approved the protocol (#H19–01650). Using an integrated knowledge translation approach, stakeholders will be engaged throughout the trial and will co-create and disseminate evidence-based recommendations and messages regarding the use of exercise to manage SCI chronic pain. Trial registration: ClinicalTrials.gov identifier NCT04160858.

Study design: Knowledge translation (KT) study. Objectives: To demonstrate how to use systematic, community-engaged methods to (1) translate the international scientific spinal cord injury (SCI) exercise guidelines into community and clinical practice guidelines, and (2) develop supporting resources. Setting: Canada. Methods: An expert panel of SCI researchers and stakeholders translated the guidelines and developed a supporting resource, using a KT process guided by an adapted version of the Appraisal of Guidelines, Research and Evaluation (AGREE) II Instrument. Pilot tests with end-users were conducted throughout. Results: The panel recommended (1) the two scientific exercise guidelines be combined and presented in a single message titled “The Canadian SCI physical activity guidelines”; (2) development of an online supporting resource, with educational and motivational information presented in “layers” to address the needs and preferences of diverse end-users. The top layer presents and explains the Canadian SCI physical activity guidelines. The deeper layers include information on benefits, overcoming barriers, activity examples, safety tips, and links to existing resources. Interviews with adults with SCI (n= 8) and survey-data from end-users (n= 90) showed that the guidelines and supporting resource were perceived as clear, useful, and appropriate. Conclusion: Using community-engaged methods, the two scientific SCI exercise guidelines were combined into one single physical activity guideline message. This KT process provides a template for groups in other countries to translate the scientific SCI exercise guidelines to their local settings using a similar systematic, community-engaged approach. Sponsorship: Rick Hansen Institute; Social Sciences and Humanities Research Council of Canada.

Paralympic athletes with SCI report significantly greater neuropathic pain intensity than recreational athletes with SCI, but also higher levels of positive affect and well-being. Neither pain catastrophizing, pain coping, nor positive affect and well-being significantly moderated the relationship between athlete status (i.e., Paralympic or recreational athlete) and neuropathic pain intensity.Significant, positive correlations were observed between total weekly moderate-intensity exercise and neuropathic pain. No significant correlations were observed between frequency of heavy-intensity exercise and neuropathic pain .

Even though university students with disabilities are less active than their peers without disabilities, there is scarce knowledge on the predictors of physical activity (PA) in this population.

Health and recreation practitioners play an important role in promoting and supporting leisure time physical activity (LTPA) among persons with physical disabilities (PWPD), yet many practitioners lack training and education to provide the basic knowledge, skills, and resources necessary.1Little is known about existing LTPA information and training resources for health and recreation practitioners and there has been no known systematic effort to identify existing resources.

Background:Health care providers (HCPs) are preferred sources of physical activity (PA) information; however, minimal research has explored HCPs’ knowledge of spinal cord injury (SCI) PA guidelines, and no research has examined HCP trainees’ PA guideline knowledge.Objective:The current study explored HCPs’ and trainees’ initial knowledge of PA guidelines for both adults with SCI and the general population, and the utility of an event-based intervention for improving this knowledge.Methods:Participants (HCPs n = 129; trainees n = 573) reported guideline knowledge for both sets of guidelines (SCI and general population) immediately after, one-month, and six-months following the intervention. Frequencies determined guideline knowledge at each timepoint, while chi-squared tests examined differences in knowledge of both guidelines, as well as knowledge differences in the short- and long-term.Results:Results demonstrated that HCPs and trainees lack knowledge of PA guidelines, particularly guidelines for adults with SCI. The results further suggest that a single event-based intervention is not effective for improving long-term guideline knowledge.Conclusion:Suggestions are made for future research with the aim of improving interventions that target HCP and HCP trainees’ long-term guideline knowledge for adults with SCI and the general population.

Study Design: This is a cross-sectional study. Objectives: To describe the association between cardiovascular risk factors (body mass index (BMI), waist circumference (WC), blood pressure, blood glucose and lipids) and leisure time physical activity (LTPA) in older adults with long-term spinal cord injury (SCI). Setting: Community settings, southern Sweden. Methods: Data from the baseline data collection of the Swedish Aging with Spinal Cord Injury Study (SASCIS) (n = 123, 71% men, injury levels C1-L5, American Spinal Injury Association Impairment Scale A-D, mean age 63 years, mean time since injury 24 years). Data were collected through home interviews, assessments and blood samples. The Physical Activity Recall Assessment for People with SCI was used to assess LTPA. Associations were investigated using multivariable linear regression analyses adjusted for age, gender, level and severity of injury, cause of injury, time since injury and tobacco use. Results: More minutes per day of moderate-to-heavy LTPA were significantly associated with a lower BMI (Beta = −0.31; p= 0.001) and a lower WC (Beta = −0.24; p= 0.009). More minutes per day of total LTPA (mild intensity or greater) were associated with a higher systolic blood pressure (Beta = 0.27; p= 0.041) among participants with tetraplegia. No other significant associations between the cardiovascular risk factors and total LTPA were found. Conclusion: Participation in daily LTPA is associated with better cardiovascular health with regard to BMI and WC in older adults with long-term SCI. Further studies are needed to establish the specific amount of activity needed to obtain positive health effects in this group and the directional causality of the associations. Sponsorship: Not applicable.

ObjectiveYoung adulthood is an important transitional life phase where careers are established. Young adults with chronic disabling health conditions are underrepresented in the labour market. Our study aims to examine the effectiveness of work-focused interventions that support the labour market transition of young adults with chronic disabling health conditions; and to examine whether the effectiveness of work-focused interventions differ across work transition phase (eg, preparation, entry and sustaining work, employment advancement) and disability type.MethodsA systematic review of articles published between January 1990 and July 2018 was conducted. Medline, EMBASE and PsycInfo were searched, and titles/abstracts and full texts of articles were reviewed for eligibility. Relevant articles were appraised for methodological quality. A best evidence synthesis was applied to medium-quality/high-quality studies to develop recommendations.Results5816 articles were identified; 10 articles were relevant and of moderate–high methodological quality. Six intervention categories were identified which focused on young adults with mental health or intellectual/learning disabilities (n=3) and addressed employment preparation (n=10) and/or work entry (n=9). No interventions addressed at-work issues or career advancement. Strong evidence existed for tailored supported employment (SE) interventions having a positive impact on preparation and entry into competitive employment. Also, moderate evidence existed for the positive impact of SE on preparation and entry into competitive employment for young adults with mental health conditions.ConclusionsTailored SE is recommended to foster preparation and entry into the labour market. Evidence-based interventions are needed to facilitate sustained work and career advancement of young adults living with different disabling health conditions.

To examine the need for and availability and use of formal and informal workplace resources and to uncover differences across the life course in adults with arthritis. Focus groups and interviews were conducted with young (aged 18–34 years; n = 7), middle‐aged (35–54 years; n = 13), and older adults (≥55 years; n = 25) with a diagnosis of inflammatory arthritis, osteoarthritis, or other rheumatic disease. Participants were asked about their employment experiences, formal and informal workplace resource needs, and availability and use of workplace resources. Differences based on chronological, functional, psychosocial, organizational, and lifespan dimensions of age were examined. A modified grounded theory approach was used to inductively analyze the data. Young, middle‐aged, and older adult participants required similar workplace resources. Across all participants, scheduling modifications tended to be the most needed workplace resource. In contrast, the perceived availability and use of formal workplace resources differed among participants. Young adult participants and those who were newer to their jobs reported that workplace resources were less available and utilized. Middle‐aged and older adults reported greater availability of workplace resources. Scheduling accommodations and at‐work modifications were the workplace resources that were used most by middle‐aged and older adults, respectively. Similar workplace resources could meet the employment needs of individuals with arthritis across the life course. Attention should be paid to young adults and those who are new to their jobs, because they may perceive more barriers to accessing formal workplace resources and be susceptible to work disability.

To describe the process and outcomes of using a new evidence base to develop scientific guidelines that specify the type and minimum dose of exercise necessary to improve fitness and cardiometabolic health in adults with spinal cord injury (SCI). International. Using Appraisal of Guidelines, Research and Evaluation (AGREE) II reporting criteria, steps included (a) determining the guidelines’ scope; (b) conducting a systematic review of relevant literature; (c) holding three consensus panel meetings (European, Canadian and International) to formulate the guidelines; (d) obtaining stakeholder feedback; and (e) process evaluation by an AGREE II consultant. Stakeholders were actively involved in steps (c) and (d). For cardiorespiratory fitness and muscle strength benefits, adults with a SCI should engage in at least 20 min of moderate to vigorous intensity aerobic exercise 2 times per week AND 3 sets of strength exercises for each major functioning muscle group, at a moderate to vigorous intensity, 2 times per week (strong recommendation). For cardiometabolic health benefits, adults with a SCI are suggested to engage in at least 30 min of moderate to vigorous intensity aerobic exercise 3 times per week (conditional recommendation). Through a systematic, rigorous, and participatory process involving international scientists and stakeholders, a new exercise guideline was formulated for cardiometabolic health benefits. A previously published SCI guideline was endorsed for achieving fitness benefits. These guidelines represent an important step toward international harmonization of exercise guidelines for adults with SCI, and a foundation for developing exercise policies and programs for people with SCI around the world.

Background. Wheelchairs, scooters, and related equipment are essential for the well-being of individuals with limited mobility and impact participation, health, and quality of life.Purpose. Our objective was to identify and evaluate policies governing equipment funding for Canadian adults. We reviewed funding legislation and program documentation for adult Canadians (≥18 years of age) covered by their provincial, territorial, or federal health care plan. Documents were obtained online or through administrative staff. Policy evaluation was guided by the Disability Policy Lens from the Canadian Disability Policy Alliance.Key Issues. Coverage ranges from full funding for all individuals within the jurisdiction to programs limited by strict eligibility criteria. Each jurisdiction defines “disability” or “basic/essential need” differently, contributing to further funding disparities.Implications. Funding policies differ substantially across Canada, resulting in unequal access to equipment dependent on province or territory. We identified eligibility, funding, definitions of mobility, repair and replacement, and prescriber requirement benchmarks that represent policy targets for improved access.

People with disabilities often report restrictions to employment participation. Recent theorising emphasises the need for broadened conceptualisations of participation, incorporating subjective participation experiences.

Changing Minds, Changing Lives, a seminar-mediated behavior change intervention, aims to enhance health care professionals’ (HCPs’) social cognitions for discussing leisure-time physical activity (LTPA) with patients with physical disabilities. This study examines which seminar implementation variables (presenter characteristics, delivery components) predict effectiveness using multilevel modeling. HCP trainees (n= 564) attended 24 seminars and completed Theory of Planned Behavior-based measures for discussing LTPA at pre-, post-, 1-month post-, and 6-months post-seminar. Implementation variables were extracted from presenter-completed questionnaires/checklists. Seminars presented by a HCP predicted positive changes in all cognitions pre-post but negative changes in attitudes and perceived behavioral control (PBC) over follow-up (ps < .05). The number of seminars the presenter had delivered predicted negative changes in attitudes and PBC during follow-up (ps < .001). Inclusion of audiovisual components predicted positive changes in attitudes pre-post (p< .001). Presenter characteristics may be “key ingredients” to educational interventions for HCPs; however, future studies should examine additional implementation variables.

Changing Minds, Changing Lives, a seminar-mediated behavior change intervention, aims to enhance health care professionals' (HCPs') social cognitions for discussing leisure-time physical activity (LTPA) with patients with physical disabilities. This study examines which seminar implementation variables (presenter characteristics, delivery components) predict effectiveness using multilevel modeling. HCP trainees (n = 564) attended 24 seminars and completed Theory of Planned Behavior-based measures for discussing LTPA at pre-, post-, 1-month post-, and 6-months post-seminar. Implementation variables were extracted from presenter-completed questionnaires/checklists. Seminars presented by a HCP predicted positive changes in all cognitions pre-post but negative changes in attitudes and perceived behavioral control (PBC) over follow-up (ps < .05). The number of seminars the presenter had delivered predicted negative changes in attitudes and PBC during follow-up (ps < .001). Inclusion of audiovisual components predicted positive changes in attitudes pre-post (p < .001). Presenter characteristics may be "key ingredients" to educational interventions for HCPs; however, future studies should examine additional implementation variables.

The internet is an important information source for people with disabilities. Unfortunately, little is known about the quality of online leisure time physical activity resources provided for people with physical disabilities.

Context/Objective:Despite the availability of consensus-based resources, first responders and emergency room (ER) health care professionals (HCPs) have limited knowledge regarding autonomic dysreflexia (AD) recognition and treatment. The purpose of this study was to assess the efficacy of “The ABCs of AD” educational seminar for improving HCPs’ short- and long-term knowledge of AD recognition, diagnosis, and management.Design:Multi-center prospective pre, post, and follow-up questionnaire study.Setting:Level I trauma centers with emergency departments in British Columbia, Manitoba, and Ontario.Methods:ER professionals completed measures immediately before and after (n = 108), as well as 3-months following (n = 23), attendance at “The ABCs of AD” seminar.Outcome Measures:AD knowledge test; seminar feedback.Results:Following the seminar, participants had higher ratings of their AD knowledge and had significantly higher AD knowledge test scores (M ± SD pre = 11.85 ± 3.88, M ± SD post = 18.95 ± 2.39, out of 22; P < 0.001, d = 2.21). Most participants believed the seminar changed their AD knowledge, and rated the seminar information as having the potential to influence and change their practice. AD knowledge test scores significantly decreased between post-seminar and 3-month follow-up (M ± SD 3mo = 17.04 ± 3.28; P = 0.004, d = –0.70); however, 3-month scores remained significantly higher than baseline.Conclusion:“The ABCs of AD” seminar improves HCPs’ perceived and actual AD knowledge in the short-term. To enhance knowledge retention in both the short- and long-term, the inclusion of additional active learning strategies and follow-up activities are recommended. The seminar is being translated into an online training module to enhance the dissemination of the AD clinical practice guidelines among first responders, ER staff, and SCI practitioners.

ObjectiveThe present study tested the feasibility of training peers with spinal cord injury (SCI) to learn brief action planning (BAP), an application of motivational interviewing principles, to promote physical activity to mentees with SCI.MethodThirteen peers with SCI attended a half-day BAP workshop. Using a one-arm, pre-, post-test design, feasibility to learn BAP was assessed in terms of peers' (1) BAP and motivational interviewing spirit competence; (2) training satisfaction; and (3) motivations to use BAP as assessed by measures of the theory of planned behavior constructs. Measures were taken at baseline, immediately post-training, and 1 month follow up.ResultsFollowing the training, participants' BAP and motivational interviewing competence significantly increased (P's < 0.05, d's > 2.27). Training satisfaction was very positive with all means falling above the scale midpoint. Participants' perceived behavioral control to use BAP increased from baseline to post (P < 0.05, d = 0.91) but was not maintained at follow up (P > 0.05).ConclusionTraining peers with a SCI to learn to use BAP is feasible.Practical implicationsBAP is a tool that can be feasibly learned by peers to promote physical activity to their mentees.