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Introduction Evidence of the effect of comorbid spinal cord injury (SCI) on cognitive outcome of persons undergoing rehabilitation following newly diagnosed traumatic brain injury (TBI) is limited. We conducted a population-based study to investigate this effect. Objective Cognitive outcomes in patients with TBI with and without a comorbid SCI were compared in a population-based cohort study. Setting/participants Adult patients diagnosed with TBI were identified and followed for one year through provincial health administrative data; those who entered inpatient rehabilitation were studied. Design A retrospective matched cohort study using the National Rehabilitation Reporting System data of all acute care and freestanding rehabilitation hospitals in Ontario, Canada. Main measures The exposure was a comorbid SCI in patients with diagnosed TBI. Exposed patients were matched to unexposed (TBI-only) on sex, age, injury severity, and income, in a ratio of one to two. Gain differences in the cognitive subscale of the Functional Independence Measure were compared between exposed and unexposed patients using multivariable mixed linear model, controlling for comorbidity propensity score, gains in motor function, and rehabilitation care indicators. Results Over the first year post injury, 12,750 (0.84%) of all TBI patients entered inpatient rehabilitation, of whom 1,359 (10.66%) had a comorbid SCI. A total of 1,195 exposed patients (65.4% male, mean age 50.9 ±20.6 for males and 61.8±21.8 for females) were matched to 2,390 unexposed patients. Controlling for confounding, exposed patients had lower cognitive gain (beta,-0.43; 95% CI [-0.72, -0.15]), for both males (beta -0.39; 95% CI [-0.75, -0.03]) and females (beta, -0.51; 95% CI [-0.97, -0.05]) patients. The adverse effects of comorbid SCI were driven largely by lower gains in problem solving and comprehension. Conclusions Adult patients with TBI and comorbid SCI showed a lower cognitive domain response to inpatient rehabilitation than patients with TBI alone. Identifying patients at risk for worse cognitive outcomes may facilitate development of targeted strategies that improve cognitive outcomes. Level III Retrospective Study. This article is protected by copyright. All rights reserved.

OBJECTIVE: This systematic review aimed to describe the burden and risk factors of work-related traumatic brain injury (wrTBI) and evaluate methodological quality of existing literature on wrTBI. METHODS: A search of electronic databases (MEDLINE, EMBASE, PsycINFO, and CINAHL) was conducted to identify articles published between 1980 and 2013 using a combination of terms for work, TBI, and epidemiology, without geographical limitations. RESULTS: Ninety-eight studies were included in this review, of which 24 specifically focused on wrTBI. In general, male workers, those in the youngest and oldest age groups, and those working in the primary (e.g., agriculture, forestry, mining) or construction industries were more likely to sustain wrTBI, with falls being the most common mechanism of injury. CONCLUSIONS: This review identified workers at highest risk of wrTBI, with implications for prevention efforts. Future research of better methodological quality is needed to provide a more complete picture of the epidemiology of wrTBI. Am. J. Ind. Med. © 2015 Wiley Periodicals, Inc. Language: en

The Daily Cognitive Communicative and Sleep Profile (DCCASP) is a seven-item instrument that captures daily subjective sleep quality, perceived mood, cognitive, and communication functions. The objective of this study was to evaluate the reliability and validity of the DCCASP. The DCCASP was self-administered daily to a convenience sample of young adults (n = 54) for two two-week blocks, interspersed with a two-week rest period. Afterwards, participants completed the Pittsburgh Sleep Quality Index (PSQI). Internal consistency and criterion validity were calculated by Cronbach's α coefficient, Concordance Correlation Coefficient (CCC), and Spearman rank (rs) correlation coefficient, respectively. Results indicated high internal consistency (Cronbach-s α = 0.864−0.938) among mean ratings of sleep quality on the DCCASP. There were significant correlations between mean ratings of sleep quality and all domains (rs=0.38–0.55, p

Background: When compared to the general population, persons with an intellectual disability have lower life expectancy, higher morbidity, and more difficulty finding and obtaining healthcare. Organisational interventions are used to reconfigure the structure or delivery of healthcare services. This is the first update of the original review. Objectives: To assess the effects of organisational interventions of healthcare services for the mental and physical health problems of persons with an intellectual disability. Search methods: For this update we searched CENTRAL, MEDLINE, EMBASE, CINAHL and other databases, from April 2006 to 4 September 2015. We checked reference lists of included studies and consulted experts in the field. Selection criteria: Randomised controlled trials of organisational interventions of healthcare services aimed at improving care of mental and physical health problems of adult persons with an intellectual disability. Data collection and analysis: We employed standard methodological procedures as outlined in the Cochrane Handbook of Systematic Reviews of Interventions, in addition to specific guidance from the Cochrane Effective Practice and Organisation of Care (EPOC) Group. Main results: We identified one new trial from the updated searches. Seven trials (347 participants) met the selection criteria. The interventions varied but had common components: interventions that increased the intensity and frequency of service delivery (4 trials, 200 participants), community‐based specialist behaviour therapy (1 trial, 63 participants), and outreach treatment (1 trial, 50 participants). Another trial compared two active arms (traditional counselling and integrated intervention for bereavement, 34 participants). The included studies investigated interventions dealing with the mental health problems of persons with an intellectual disability; none focused on physical health problems. Four studies assessed the effect of organisational interventions on behavioural problems for persons with an intellectual disability, three assessed care giver burden, and three assessed the costs associated with the interventions. None of the included studies reported data on the effect of organisational interventions on adverse events. Most studies were assessed as having low risk of bias. It is uncertain whether interventions that increase the frequency and intensity of delivery or outreach treatment decrease behavioural problems for persons with an intellectual disability (two and one trials respectively, very low certainty evidence). Behavioural problems were slightly decreased by community‐based specialist behavioural therapy (one trial, low certainty evidence). Increasing the frequency and intensity of service delivery probably makes little or no difference to care giver burden (MD 0.03, 95% CI ‐3.48 to 3.54, two trials, moderate certainty evidence). It is uncertain whether outreach treatment makes any difference for care giver burden (one trial, very low certainty evidence). There was very limited evidence regarding costs, with low to very low certainty evidence for the different interventions. Authors' conclusions: There is very limited evidence on the organisation of healthcare services for persons with an intellectual disability. There are currently no well‐designed studies focusing on organising the health services of persons with an intellectual disability and concurrent physical problems. There are very few studies of organisational interventions targeting mental health needs and the results of those that were found need corroboration. There is an urgent need for high‐quality health services research to identify optimal health services for persons with an intellectual disability and concurrent physical problem.

Background Hospitalisations for ambulatory care-sensitive (ACS) conditions are used as an indicator of access to, and the quality of, primary care. The objective was to identify factors associated with hospitalisations for ACS conditions among adults with an intellectual disability (ID) in the context of a publicly insured healthcare system. Methods This study examined adults with an ID living in a Canadian province between 1999 and 2003 identified from administrative databases. Using 5 years of data for the study population, characteristics of persons hospitalised or not hospitalised for ACS conditions were compared. Using a conceptual model, independent variables were selected and an analysis performed to identify which were associated with hospitalisations for ACS conditions. The correlated nature of the observations was accounted for statistically. Results Living in a rural area [odds ratio (OR) 1.3; 95% confidence intervals (CI) = 1.0, 1.8], living in an area with a high proportion of First Nations people (OR 2.3; 95% CI = 1.3, 4.1), and experiencing higher levels of comorbidity (OR 25.2; 95% CI = 11.9, 53.0) were all associated with a higher likelihood of being hospitalised for an ACS condition. Residing in higher income areas had a protective effect (OR 0.56; 95% CI = 0.37, 0.85). None of the health service resource variables showed statistically significant associations. Conclusions Persons with an ID experience inequity in hospitalisations for ACS conditions according to rurality, income and proportion who are First Nations in a geographic area. This suggests that addressing the socio-economic problems of poorer areas and specifically areas densely populated by First Nations people may have an impact on the number of hospitalisations for ACS conditions. Study strengths and limitations and areas for potential future research are discussed.

OBJECTIVES: To investigate the effect of cognitive impairment on fatal and nonfatal incident stroke in older adults. DESIGN: A large, national, prospective, population-based study of a representative cohort of older Canadians followed over a 10-year period. SETTING: Secondary analyses were conducted using data from the Canadian Study of Health and Aging, a population-based study of older adults followed prospectively from 1991 to 2001. PARTICIPANTS: Nine thousand four hundred fifty-one adults aged 65 and older who had not previously been diagnosed with stroke at baseline (in 1991). MEASUREMENTS: In addition to known risk factors, the independent contribution of cognitive function (diagnosed in a clinical examination) was examined as a risk for stroke in older adults. RESULTS: Multinomial logistic regression analyses showed that cognitive impairment was associated with twice the odds of fatal incident stroke, controlling for well-established risk factors. CONCLUSION: This study provides further evidence for the need to consider cognitive function in relation to stroke risk in older populations.

Background There is evidence that the primary care provided for persons with an intellectual disability living in the community has been inadequate. Hospitalization rates for ambulatory care sensitive (ACS) conditions are considered an indicator for access to, and quality of, primary care. The objective of this research was to identify ACS conditions that are applicable to persons with an intellectual disability. Materials and Methods We developed and distributed a survey questionnaire using a modified Delphi process. The participants were clinicians with experience working with people with an intellectual disability. Results All eleven conditions that were considered ACS for the general population met the three primary inclusion criteria. Study participants suggested five other conditions of which four met the primary criteria: constipation, gastroesophageal reflux, epilepsy, and schizophrenic disorders. Conclusions There is a very high degree of agreement as to what constitutes an ACS condition for persons with an intellectual disability. The final list has the potential to be used with other populations with cognitive disabilities and outside of Canada.

Background There is evidence that persons with an intellectual disability (ID) face barriers to primary care; however, this has not been extensively studied at the population level. Rates of hospitalisation for ambulatory care sensitive conditions are used as an indicator of access to, and quality of, primary care. The objective of the study was to compare hospitalisation rates for ambulatory care sensitive conditions between persons with and without an ID in a publicly insured population. Methods Persons with an ID were identified among the general population of a Canadian province between 1999 and 2003. Using a list of conditions applicable to persons with an ID, rates of hospitalisations for ambulatory care sensitive conditions for persons with and without an ID were calculated and compared. Regression models were used to adjust for age, sex and place of residence. Hospitalisation rates for specific conditions were also compared, controlling for differences in disease prevalence where possible. Results Persons with an ID were consistently hospitalised for ambulatory care sensitive conditions at a higher rate than persons without an ID. Between 1999 and 2003 the adjusted rate ratio (RR) was 6.1 [95% confidence interval (CI) = 5.6, 6.7]. Rate ratios were highest when comparing persons with, to persons without, an ID between the ages of 30–39 (RR = 13.1; 95% CI = 10.6, 16.2) and among urban area dwellers (RR = 7.0; 95% CI = 6.2, 7.9). Hospitalisation rates for epilepsy and schizophrenic disorders were, respectively, 54 and 15 times higher for persons with compared with persons without an ID. Rate ratios for diabetes and asthma remained significant after controlling for the population prevalence of these diseases. Conclusions The large discrepancy in rates of hospitalisation between persons with and without an ID is an indicator of inadequate primary care for this vulnerable population. Decreasing the number of ambulatory care sensitive condition hospitalisations through specialised outpatient programmes for persons with an ID would potentially lead to better health, improved quality of life and cost savings. Future research should include potentially important factors such as disease severity, socio-economic variables and measures of health service organisation in the analysis. International comparisons of ambulatory care sensitive condition hospitalisation rates could point to the benefits and limitations of the health service policy directions adopted by different countries.

To identify positive aspects of caregiving and examine how they are associated with caregiver outcomes.This study used a national sample of caregivers derived from the Canadian Study of Health and Aging (part 2). Two hundred and eighty-nine caregivers caring for seniors living in the community were questioned about their experience of caregiving. Caregivers were asked whether they could identify any positive aspects related to their role, the type of positive aspects and to rate their feelings about caring. Using a conceptual model developed by Noonan and Tennstedt (1997), a staged stepwise multiple regression approach was used factoring the background/contextual variables, stressor variables (3 MS score, ADL limitations), mediator variables (positive aspects of caregiving, number of services used) and outcome variables (depression, burden and self-assessed health measures) into the model.Two hundred and eleven caregivers (73%) could identify at least one specific positive aspect of caregiving. An additional 20 (6.9%) could identify more than one positive aspect. Positive feelings about caring were associated with lower CES-D scores ( p0.001), lower burden scores ( p0.001) and better self assessed health ( p0.001).Clinicians should inquire about the positive aspects of caregiving if they are to fully comprehend the caregiver experience and identify risk factors for negative caregiver outcomes.

Productivity is one of the components of occupational performance in occupational therapy. Thus, work status is an important area to address after head injury. Many studies on long-term outcomes after head injury document return to work post injury but often do not report the nature of employment after injury. The aim of this study was to examine change in vocational status 10 years after head injury and explore participants' perception of how this injury affected career plans. Eighty-three out of 100 subjects were traced 10 years post injury from a large trauma centre in Canada. Of these, 59 agreed to participate in a telephone interview where data on employment were collected. Occupations before and after injury were coded using three indices (Hollingshead Index, Blishen Socioeconomic Index for Occupations, and the Pineo Socioeconomic Classification of Occupations). The study shows that, on average, subjects who are employed before and after injury stay at the same level of vocational status or improve slightly. Younger age (p

This study examined the extent and nature of agreement between the responses of 42 young adults with traumatic brain injury and their informants (family members or friends) on selected outcome measures. A telephone interview was conducted approximately five years post injury with items measuring quality of life, impairment, disability and handicap. Levels of agreement were analysed using kappa and intraclass correlation coefficients. In general, agreement was higher on objective, observable items from all outcome measures such as physical function and productivity. However, there was some disagreement on these items as well as more substantial disagreement on subjective items, so clinicians are cautioned against substituting informant responses for those of TBI clients. These results were similar for mild, more moderate and severely injured clients. Copyright © 1997 Whurr Publishers Ltd.

This paper provides an overview of an innovative course in community occupational therapy. The course emphasises and prepares students for community practice in an environment profoundly affected by ongoing changes in Canada's health and social systems. Its rationale, objectives, structure, and content are outlined. In particular, the paper highlights the in vivo, problem-based component of the course, which centres around community-based fieldwork. A summary of the major results of the evaluation of the course is also presented. Although this course was designed for Canadian occupational therapy students, much of the material presented is potentially useful to educators of occupational therapy students in other countries. Copyright © 1996 Whurr Publishers Ltd.

The aim of this study was to predict leisure time exercise behavior among a group of 62 lower-limb disabled adults. The theory of reasoned action proposed by Fishbein (Fishbein & Ajzen, 1975) provided a framework for the study. Variables measured included the Fishbein model variables, habit, education, disability type, fitness level, and a 7-day follow-up of exercise behavior. Some 35% of the variance in exercise behavior could be explained; intention was the strongest predictor (.31, p less than .05). In comparison, the ability to predict intentions to exercise by using the other variables was quite poor, with only 7% of the variance explained by habit. None of the Fishbein model variables contributed to this prediction. These results indicated the importance of specific factors, such as the strength of the exercise habit and the cause of disability, on exercise behavior.