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Study design:Cross-sectional.Objectives:To validate a telephone-administered version of the Modified Fatigue Impact Scale spinal cord injury scores among individuals with a traumatic SCI 6 months post discharge from rehabilitation.Setting:GF Strong Rehabilitation Center in Vancouver, British Columbia, Canada.Methods:Data from 42 participants who were 19-years-old with a confirmed American Spinal Injury Association Impairment Scale classification of A, B, C or D resulting from a traumatic SCI, and 6 months post discharge from rehabilitation were analyzed. The internal consistency was ascertained using Cronbach's alpha. Support for validity was provided by conducting correlations between the 21-item MFIS-SCI and Fatigue Severity Scale curve was constructed. Sensitivity, specificity and likelihood ratios were calculated to assess the diagnostic accuracy.Results:Cronbach's alpha was 0.97. Correlations between the MFIS-SCI and FSS were in the a priori hypothesized direction and magnitude. The area under the ROC curve was 0.78 (95% confidence interval=0.65-0.92). At the optimal cutoff score of 24.5, both the sensitivity and specificity were 0.67. The positive and negative likelihood ratios were 2.03 and 0.49, respectively.Conclusion:There is support for the validity of the MFIS-SCI scores and it should be considered for the comprehensive measurement of the impact of fatigue in persons with a traumatic SCI. [ABSTRACT FROM AUTHOR]

Study design:One-week retest methodological study.Objectives:To assess the reliability and validity of the wheelchair outcome measure (WhOM) in a sample of individuals with spinal cord injury (SCI).Setting:Vancouver, British Columbia, Canada.Methods:The WhOM measures the impact of wheelchair interventions on a user's self-selected participation outcomes. The WhOM was administered to 50 participants on two occasions by the same rater, 1 week apart, to assess test-retest reliability. To determine inter-rater reliability, the WhOM was administered a third time approximately 72 h later by a different rater. Validity was evaluated by correlating scores from the WhOM with scores from the Assessment of Life Habits (LIFE-H).Results:The test-retest intraclass correlation coefficients (ICC2, 2) for the WhOM satisfaction (Sat) and WhOM importance (Impt) × Sat scores were 0.83 (95% confidence interval (CI), 0.72-0.90) and 0.88 (95% CI, 0.79-0.93), respectively. The inter-rater ICC for the WhOM Sat and WhOM Impt × Sat scores were 0.91 (95% CI, 0.85-0.95) and 0.90 (95% CI, 0.83-0.94), respectively. As hypothesized, most scores on the WhOM were fair to moderate (r=0.3-0.5) and positively correlated with scores on the LIFE-H.Conclusion:The WhOM is a new outcome measure that demonstrates good reliability and validity among individuals with SCI. It is designed to assist wheelchair users identify and evaluate the impact of wheelchair interventions on participation level outcomes. The WhOM may be applicable for clinical- or research-oriented purposes. [ABSTRACT FROM AUTHOR]

Study design:Cross-sectional. Objectives: To describe self-identified indoor and outdoor wheelchair-oriented participation outcomes and to report satisfaction with the identified outcomes by people with spinal cord injury (SCI). Setting:Vancouver, British Columbia. Methods:Participation outcomes were identified using the Wheelchair Outcome Measure and classified using the International Classification of Functioning, Disability, and Health (ICF).Results: The average age of the 51 community-dwelling subjects with SCI was 43.7(±10.7) years. Of them, 84% were men, 64% had tetraplegia and 66% used a manual wheelchair. There were 258 indoor and 257 outdoor participation outcomes identified by this sample with most outcomes falling into the ‘community, social, and civil life’ (36.5%), ‘domestic life’ (23.7%) and ‘mobility’ (18%) domains of the ICF. All domains had a mean satisfaction score of 7.1/10 or greater except for the indoor ‘mobility’ domain that had a mean satisfaction score of 6.1/10. Satisfaction scores with performance of the specific participation outcomes ranged from high (10/10) to low (2/10) with most scores falling above 7/10. Conclusion: Community-dwelling people with SCI commonly engage in wheelchair-oriented participation outcomes related to ‘community, social, and civil life’, ‘domestic life’ and ‘mobility’ and tend to be satisfied with their performance of these participation outcomes. This information is useful for clinicians and may help to guide assessment and intervention. [ABSTRACT FROM AUTHOR]

Study design:Longitudinal study.Objectives:To examine the relationship between and predictors of quality of life (QOL) at 3 and 15 months post-rehabilitation discharge using the Disability Creation Process model as an explanatory framework.Setting:Vancouver, Canada.Methods:A consecutive sample of individuals with spinal cord injury (SCI) was enrolled in the study. Data were collected using the Quality of Life Index (QLI) and a variety of personal, participation and environmental instruments. On admission, 197 subjects were recruited, but dropouts and missing values led to the final inclusion of 93 cases in multiple regression models used to identify predictors of QOL at 3 and 15 months post-rehabilitation discharge.Results:Mean QLI group scores did not differ between 3 and 15 months (P=0.85). Regression models accounted for 64% of variance in QLI total scores at 3 months and 70% of variance at 15 months. The main predictors of QOL at 3 months were health competence and mood state. The main predictors of QOL at 15 months were QOL level at 3 months, health competence and family support. At both time points, personal factors explained most of the variance, whereas participation and environmental factors were less significant.Conclusion:Given that health competence, mood state and some environmental factors may be amenable to modification, this study suggests interventions to mediate these variables might improve subjective QOL after SCI. [ABSTRACT FROM AUTHOR]

Study design:A systematic review.Objectives:To review and assess the psychometric properties of depression and anxiety instruments used with populations with spinal cord injury (SCI).Setting:Vancouver, Canada.Methods:Electronic databases were searched for papers reporting psychometric properties of depression and anxiety instruments. Pre-established criteria were used to assess the psychometric properties.Results:Thirteen papers reporting on the psychometric properties of 13 depression and anxiety instruments are used in this review, and include BDI, BSI, CESD-20, CESD-10, DASS-21, GHQ-28, HADS, Ilfeld-PSI, MEDS, PHQ-9, PHQ-9-Short, SCL-90-R, and the Zung SRS. Reliability data are available for 10 instruments, and validity results are available for 12 instruments. Evidence spanned the spectrum of evaluation criteria varying from poor to excellent. Responsiveness data are generally lacking.Conclusion:Given that the reliability and validity findings range for the most part from adequate to excellent, and the large amount of work to develop cutoff scores specific for populations with SCI, at present there is no need to develop SCI-specific instruments. As psychometric properties of one measure do not clearly stand out, it is difficult to recommend the use of one over another. Overall, more psychometric data are needed, and if the instruments are to be used to evaluate treatment outcomes or change over time, responsiveness data are also required. Administering the instruments in tandem with each other and with clinical diagnostic interviews would provide valuable information, as would comparison of results to normative data specific to individuals with SCI. [ABSTRACT FROM AUTHOR]

Study design:A systematic search of the literature.Objectives:To critically review instruments that assess participation in persons with spinal cord injury (SCI).Setting:Vancouver, British Columbia.Methods:Four electronic databases (MEDLINE/PubMed, CINAHL, EMBASE and PsychInfo) were searched for studies published between 1980 and March 2008. Instruments were included if information was published in English in at least one peer-reviewed journal on its measurement properties (reliability, validity and responsiveness) in a sample that included adults with SCI. Instruments were evaluated using criteria proposed for disability outcome measures.Results:Six instruments were included: Craig Handicap Assessment and Reporting Technique (CHART); Impact on Participation and Autonomy Questionnaire (IPA); Assessment of Life Habits Scale (Life-H); Occupational Performance History Interview; Physical Activity Recall Assessment for People with Spinal Cord Injury; and Reintegration to Normal Living Index. Evidence supporting the reliability of the instruments was reported for four of the six instruments and was adequate. Validity was assessed in all the instruments. Only the Life-H and CHART have been compared with each other. No evidence on responsiveness was available.Conclusion:The instruments differ in how participation is operationalized. Currently, the CHART that measures objective aspects of participation has the most evidence supporting its measurement properties. More evidence is becoming available for instruments such as the IPA, which consider the person's perspective. It is important to determine what information about participation is required before selecting an instrument.Sponsorship:Rick Hansen Foundation, Ontario Neurotrauma Fund.Spinal Cord (2009) 47, 435–446; doi:10.1038/sc.2008.171; published online 24 February 2009 [ABSTRACT FROM AUTHOR]

Background:Depression is common after spinal cord injury (SCI), yet it can be difficult and costly to diagnose. Screening tools such as the Center for Epidemiological Studies Depression scale (CESD) can assist with case identification; however, insufficient knowledge of their measurement properties exists to use them in the SCI population.Objectives:To assess the reliability and validity of the CESD-20 and the CESD-10.Setting:Tertiary care centre in Vancouver, British Columbia, Canada.Methods:A 2-week retest study of 47 individuals with traumatic SCI. Subjects 19, who had their SCI for 1 year and had American Spinal Injury Association Impairment scale ranking of A or B. Short Form-36 (SF-36) subscales and a visual analogue scale for fatigue (VAS-F) were used to assess validity using Pearson's correlations coefficients. Internal consistency was assessed using Cronbach's alpha, retest reliability was assessed using intraclass correlation coefficients (ICCs) and Bland–Altman plots. Normative data are presented based on key demographic and clinical factors.Results:Cronbach's alpha was 0.91 and 0.86 and retest reliability was ICC=0.87 (95% confidence interval (CI) 0.79–0.93) and ICC=0.85 (95% CI 0.75–0.92) for the CESD-20 and CESD-10, respectively. Minimal bias was evident based on the Bland–Altman plots. The strongest correlations were with outcomes representing mental health (r=−0.71), vitality (r=−0.60) and the VAS-F (r=0.57). The weakest correlation was with the physical function score of the SF-36 (r=−0.37).Conclusion:The CESD-20 and CESD-10 are quick and easy to use. This study provides evidence in support of the reliability and validity.Spinal Cord (2008) 46, 287–292; doi:10.1038/sj.sc.3102127; published online 2 October 2007 [ABSTRACT FROM AUTHOR]

Background: Lower limb loss (LLL) is a distressing experience with psychological, physical, and social challenges. Education is needed to enhance the coping skills and confidence of patients to improve LLL outcomes. However, access to rehabilitation services and education is limited outside of urban centers. To address this service gap, we co-created an eHealth platform, called Self-Management for Amputee Rehabilitation using Technology (SMART)., Objectives: First, we will test the effect of SMART and usual care compared with usual care only on walking capacity and confidence among individuals with LLL. Second, we will describe key implementation factors for program delivery and adoption at the person- and provider-level., Methods: This is a Type 1 Effectiveness-Implementation Hybrid Design, mixed-methods, multi-site (British Columbia and Ontario, Canada), parallel, assessor-blinded randomized controlled trial. Participants will include adults with unilateral LLL, during early prosthetic fitting (<2 years after casting for initial prosthesis). Participants in both groups will receive usual care. The experimental group will receive SMART with weekly support sessions from a trained peer mentor for goal setting and action planning for six weeks. Participants will be encouraged to continue using SMART for an additional four weeks. The control group will receive usual care, and weekly social contacts for six weeks. The primary outcome measure is walking capacity operationalized as the performance based Timed Up and Go test. The secondary outcome is walking confidence using the Ambulatory Self-Confidence Questionnaire. Outcome measures will be assessed at baseline, immediately post-intervention, and four weeks follow-up. We will describe key implementation factors (such as, participant experience, intervention adoption, fidelity) throughout the study using questionnaires, semi-structured interviews, and direct observation., Results: No participants have been enrolled., Conclusions: SMART has the potential to provide knowledge and skill development to augment rehabilitation outcomes for adults with LLL., Trial Registration: NCT04953364 in Clinical Trial Registry (https://clinicaltrials.gov/)., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Esfandiari et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Telehealth nursing is a specialized area of nursing practice that has grown in response to the emergence of new technologies and consumer demand for health care services in the community. HealthLinkBC Nursing Services provides symptom triage and health education to residents of British Columbia and Yukon over the phone. Unlike traditional nursing care, telenurses are limited in terms of information they receive from callers. Therefore, there is a need for critical thinking skills to be developed. The purpose of this paper is to describe a participatory approach towards identifying: (1) the factors that affect telehealth nursing practice including critical thinking, and (2) developing a research strategy aimed at identifying the ways in which critical thinking can be supported in a telehealth nursing environment. A HealthLinkBC working group has begun work in developing a definition of critical thinking specific to nursing, identifying future research opportunities and methodologies.

Species of Cryptosporidium and Giardia can infect humans and wildlife and have the potential to be transmitted between these 2 groups; yet, very little is known about these protozoans in marine wildlife. Feces of river otters (Lontra canadensis), a common marine wildlife species in the Puget Sound Georgia Basin, were examined for species of Cryptosporidium and Giardia to determine their role in the epidemiology of these pathogens. Using ZnSO4 flotation and immunomagnetic separation, followed by direct immunofluorescent antibody detection (IMS/DFA), we identified Cryptosporidium sp. oocysts in 9 fecal samples from 6 locations and Giardia sp. cysts in 11 fecal samples from 7 locations. The putative risk factors of proximate human population and degree of anthropogenic shoreline modification were not associated with the detection of Cryptosporidium or Giardia spp. in river otter feces. Amplification of DNA from the IMS/DFA slide scrapings was successful for 1 sample containing > 500 Cryptosporidium sp. oocysts. Sequences from the Cryptosporidium 18S rRNA and the COWP loci were most similar to the ferret Cryptosporidium sp. genotype. River otters could serve as reservoirs for Cryptosporidium and Giardia species in marine ecosystems. More work is needed to better understand the zoonotic potential of the genotypes they carry as well as their implications for river otter health.

The Sexual Health Clinician is a health care specialist who is able to assess the sexual potential of physically disabled persons and assist them in the development of acceptable alternatives in sexual practices. This specialty role was first developed at the Spinal Cord Injury Unit, Shaughnessy Hospital in Vancouver, B.C., Canada, to answer a need of spinal cord injured patients, their partners and family. The opportunity to join the Service arose in May, 1981 following one year as the Senior Occupational Therapist on the Spinal Cord Injury Unit. This paper, which describes the experience of an occupational therapist as a member of the Sexual Health Service, is presented in five brief parts: 1. a background history; 2. a description of the sexual problems of the spinal cord injured and the goals of rehabilitation in this area; 3. the role of the Sexual Health Clinician; 4. the strengths and limitations of Occupational Therapy in this new role; 5. a brief discussion of the the need for a sex-related role and curriculum for students of Occupational Therapy.