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Background: Irrespective of where nurses work, they may provide care to individuals with substance use disorders. Unfortunately, some nurses may not understand how to work with these individuals and stigmatisation may occur. Aim: To explore how to provide effective care for these individuals. Method: A qualitative descriptive study examining helpful interventions for individuals with substance use disorders through interviewing four substance abuse specialist nurses. Findings: Findings consider person-centred care, such as how to create a therapeutic relationship with individuals with substance use disorders, empowerment of these individuals and providing hope, and employing a holistic approach. Conclusion: Nurses may encounter individuals with substance use disorders and may benefit from knowledge of how best to intervene. [ABSTRACT FROM AUTHOR]

This study sought to understand athletic therapists' perspectives on the psychological challenges athletes experience during injury recovery and to assess their perceived level of preparedness in addressing these challenges. Using an online survey, 49 certified athletic therapists from across Canada reported they are aware of the psychological challenges facing injured athletes and believe they play a role in assisting injured athletes in their psychological recovery. However, the results indicated that athletic therapists do not feel adequately prepared to provide this support and recommended more exposure to content related to psychological aspects of injury in their education. [ABSTRACT FROM AUTHOR]

Purpose: Identify patient subgroups with different functional outcomes after SCI and study the association between functional status and initial ISNCSCI components. Methods: Using CART, we performed an observational cohort study on data from 675 patients enrolled in the Rick-Hansen Registry(RHSCIR) between 2014 and 2019. The outcome was the Spinal Cord Independence Measure (SCIM) and predictors included AIS, NLI, UEMS, LEMS, pinprick(PPSS), and light touch(LTSS) scores. A temporal validation was performed on data from 62 patients treated between 2020 and 2021 in one of the RHSCIR participating centers. Results: The final CART resulted in four subgroups with increasing totSCIM according to PPSS, LEMS, and UEMS: 1)PPSS < 27(totSCIM = 28.4 ± 16.3); 2)PPSS ≥ 27, LEMS < 1.5, UEMS < 45(totSCIM = 39.5 ± 19.0); 3)PPSS ≥ 27, LEMS < 1.5, UEMS ≥ 45(totSCIM = 57.4 ± 13.8); 4)PPSS ≥ 27, LEMS ≥ 1.5(totSCIM = 66.3 ± 21.7). The validation model performed similarly to the original model. The adjusted R-squared and F-test were respectively 0.556 and 62.2(P-value <0.001) in the development cohort and, 0.520 and 31.9(P-value <0.001) in the validation cohort. Conclusion: Acknowledging the presence of four characteristic subgroups of patients with distinct phenotypes of functional recovery based on PPSS, LEMS, and UEMS could be used by clinicians early after tSCI to plan rehabilitation and establish realistic goals. An improved sensory function could be key for potentiating motor gains, as a PPSS ≥ 27 was a predictor of a good function. IMPLICATIONS FOR REHABILITATION: After a traumatic Spinal Cord Injury (SCI), early neurological examination using the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) is recommended to determine initial injury severity and prognosis. This study identified three initial ISNCSCI components defining four subgroups of SCI patients with different expectations in functional outcomes, namely the initial pinprick sensory score, the Lower Extremity Motor Score, and the Upper Extremity Motor Score. Clinicians could use these subgroups early after tSCI to plan rehabilitation and set realistic therapeutic goals regarding functional outcomes. In clinical practice, careful and accurate assessment of pinprick sensation early after the SCI is crucial when predicting function or stratifying patients based on the expected function. [ABSTRACT FROM AUTHOR]

The Clubhouse model of psychosocial rehabilitation supports individuals with mental health challenges using a person centered and recovery-oriented approach. Clubhouses around the world have been found to be effective in supporting their member's recovery. However, there is a lack of multi-site and longitudinal studies on the Clubhouse model. Therefore, the purpose of the present study was to longitudinally assess the psychosocial outcomes of Clubhouse members across six accredited Clubhouses in Canada. Due to the COVID-19 pandemic occurring midway through the study, a secondary aim was to assess the impact of the pandemic on the psychosocial outcomes of Clubhouse members. A total of 462 Clubhouse members consented to participate in the study. Members completed a questionnaire battery every 6 months over a 2-year period (five data points total). The last three data points were collected during the COVID-19 pandemic. Psychosocial outcomes included mental health symptoms, substance use, community integration, and satisfaction with life, and were analyzed using multilevel growth models. The results indicated that satisfaction with life and psychological integration increased over the study period, while mental health symptoms, substance use, and physical integration decreased. Examining Clubhouse participation, length of Clubhouse membership and frequency of Clubhouse use predicted higher life satisfaction, lower substance use, and fewer mental health symptoms over the study period. The results of the present study provide invaluable insight into the psychosocial impact of Clubhouses on Canadian Clubhouse members, particularly during COVID-19. [ABSTRACT FROM AUTHOR]

The 2016 Alberta wildfires resulted in widespread destruction of property and displacement of residents. Research aimed to identify the roles and responsibilities of social work practitioners and human service professionals in long-term disaster recovery. This article presents the findings from interviews, focus groups, and a survey with a total of 140 participants in Alberta, Canada. Implications for disaster social work planning, and response and recovery efforts in Canada and internationally, will inform the development of programs and policies to support and make visible the contribution of social workers and human service professionals in long-term disaster recovery. [ABSTRACT FROM AUTHOR]

Background: As nonsuicidal self‐injury (NSSI) has become an increasing public health concern, the last few years have seen the emergence of efforts to address NSSI recovery. Although many recovery efforts adopt a medical view of self‐injury and focus on cessation of the behaviour, recovery can mean many different things to different people. In this study, we provide initial empirical validation of the self‐injury recovery framework, by assessing whether different recovery profiles exist. Methods: Our sample comprised 733 participants with lived experience of NSSI (M age = 24.54, sd = 6.39). Participants completed self‐report measures of constructs related to NSSI recovery and NSSI characteristics. Results: Using latent profile analysis, we identified six unique profiles reflecting differences in thoughts/urges to self‐injure, self‐efficacy, social support, optimism, coping, underlying adversities, perceptions of scarring, disclosure, resilience and self‐compassion. Multivariate analyses of variance confirmed these profiles differed according to NSSI characteristics such as frequency of NSSI, a self‐assessment of recovery, the desire to self‐injure or avoid self‐injury and the number of people disclosed to. Limitations: A homogenous sample and cross‐sectional design limit generalisability of our findings across populations and across time. Conclusions: Our findings reinforce that recovery can take many different forms, with different factors being relevant to different individuals. Adopting a person‐centred approach that centres an individual's lived experience and emphasises what is important to them in the recovery process offers opportunities for more empathic responses to self‐injury and better outcomes for individuals who self‐injure. [ABSTRACT FROM AUTHOR]

Objective: We investigated if theta burst stimulation could enhance recovery by reducing key symptoms when implemented acutely post fracture in participants with an isolated upper limb fracture. Methods/Design: This was a pilot study with a randomized matched pair, sham-controlled, participant-blind design of a 10-day prolonged continuous theta burst stimulation protocol. Two main groups were included: I) participants with isolated upper limb fracture receiving active theta burst stimulation and II) patients with isolated upper limb fracture receiving SHAM/placebo. Another group (III) of healthy individuals was the reference group. Disability and pain intensity were collected through questionnaires (disabilities of the Arm, Shoulder, and Hand as well as numerical rating scale (NRA)) at three time points (baseline; 72 hrs after intervention, 3 mos after injury). Group III completed the baseline assessment. Results: Seventy-nine participants were enrolled. Individuals in the ACTIVE and SHAM groups had similar baseline measures. For disability, the interaction between intervention and time approached significance (F = 2.33; P = 0.11), whereas it was significant for pain (F = 3.42; P = 0.04). At 3 mos after injury, the ACTIVE group reported reduced disability (F = 4.71; P = 0.04) and pain (F = 5.84; P = 0.02) at 3 mos after injury compared to the SHAM group, with clinical measures from ACTIVE group being like controls. Conclusions: In isolated upper limb fracture patients, a 10-day theta burst stimulation intervention implemented acutely posttraumatic had beneficial effects on symptoms of functional recovery and pain at 3 mos after trauma. [ABSTRACT FROM AUTHOR]

Purpose: Cognitive fatigue is commonly reported and described as disabling by patients recovering from neurological conditions including stroke. However, cognitive fatigue is usually underdiagnosed among stroke survivors which leads to a lack of specific treatments for this condition. Therefore, the aim of this study was to explore post-stroke cognitive fatigue as it is experienced by stroke survivors. Methods: This qualitative research followed the principles of descriptive phenomenology within a constructivist paradigm. Individual semi-structured interviews were conducted with stroke survivors experiencing post-stroke cognitive fatigue recruited through the Heart and Stroke Foundation, the Canadian Partnership for Stroke Recovery, and social media posts. Data were analyzed through inductive content analysis. Results: Eleven stroke survivors participated. The analysis revealed five themes illustrating the experience and descriptions of post-stroke cognitive fatigue: (1) characteristics, (2) aggravating factors, (3) management, (4) effect of cognitive fatigue on daily life, and (5) social awareness and support. Conclusion: This study highlights the complexity of post-stroke cognitive fatigue. Cognitive fatigue becomes more evident after discharge; therefore, clinicians should consistently screen for it and provide proper education to the patients and their carers. IMPLICATIONS FOR REHABILITATION: Cognitive fatigue is a complex phenomenon that can negatively affect the daily life of stroke survivors. Sensory-overloaded environments, emotional distress, poor sleep, and engaging in complex cognitive tasks can trigger post-stroke cognitive fatigue. More education on the concept of cognitive fatigue should be provided to healthcare providers to be able to identify and manage this symptom properly. [ABSTRACT FROM AUTHOR]

Introduction: In 2019, our center attempted to transition all partial nephrectomies (PNs) to robotic-assisted laparoscopic PN (RALPN). The purpose of this study was to compare RALPN outcomes to laparoscopic PN (LPN) and open PN (OPN) at our institution, as there is limited literature from Canadian centers. Methods: In this single-center, two-surgeon, retrospective cohort study, we compared RALPN outcomes during the early phase of our robotics program to OPN and LPN performed just before the introduction of RALPN. Results: A total of 106 patients underwent OPN, 83 LPN, and 82 RALPN during the study period. Median RALPN RENAL score was 7 vs. 6 for LPN (p<0.05) and 8 for OPN (p=0.10). Median RALPN length of stay (LOS) was two days vs. three and four days for LPN and OPN (p<0.05), respectively. OPN median procedure time was 104 minutes vs. 94 and 82 minutes for LPN and RALPN (p<0.05), respectively. Median OPN operating room (OR) time was 160 minutes vs. 150 and 146 minutes for LPN and RALPN (p<0.05), respectively. There were no significant differences in intraoperative (p=0.92) or postoperative complications rates (p=0.47). RALPN warm ischemia time (WIT) was 17 minutes vs 14.5 and 15 minutes for OPN and LPN (p<0.05), respectively. Median RALPN estimated blood loss (EBL) was 165 ml vs. 250 ml for OPN (p<0.05) and 125 ml for LPN (p=0.15). Conclusions: Although patients who underwent RALPN had longer WIT, they had similar rates of complications, required less total OR time, and had shorter procedure time and LOS compared with OPN and LPN despite similar RENAL score compared to OPN and greater score than LPN. [ABSTRACT FROM AUTHOR]

To understand experiences and perceptions on non-pharmacological treatment of vertebral fractures and virtual-care from the perspective of care professionals' (HCPs) We conducted semi-structured interviews with 13 HCPs within Canada (7 F, 6 M, aged 46 ± 12 years) and performed a thematic and content analysis from a post-positivism perspective. Two themes were identified: acuity matters when selecting appropriate interventions; and roadblocks to receiving non-pharmacological interventions. We found that treatment options were dependent on the acuity/stability of fracture and were individualized accordingly. Pain medication was perceived as important, but non-pharmacological strategies were also considered helpful in supporting recovery. Participants discussed barriers related to the timely identification of fracture, referral to physiotherapy, and lack of knowledge among HCPs on how to manage osteoporosis and vertebral fractures. HCPs reported positive use of virtual-care, but had concerns related to patient access, cost, and comprehensive assessments. HCPs used and perceived non-pharmacological interventions as helpful and selected specific treatments based on the recency of fracture and patient symptoms. HCPs' also believed that virtual-care that included an educational component, an assessment by a physiotherapist, and an exercise group was a feasible alternative, but concerns exist and may require further evaluation. Non-pharmacological strategies in combination with pain medication may be a more effective strategy to support recovery than pain medication alone but should be informed by fracture acuity and patient symptoms. To improve access to physiotherapy and other non-pharmacological treatment options during the acute or chronic management of vertebral fractures, it may be worthwhile to explore the effectiveness and feasibility of virtual-care. [ABSTRACT FROM AUTHOR]

While the field of recovery science has burgeoned over the past two decades, little research has considered the experiences of university students in recovery from addiction, particularly in Canada. Addressing this gap, using a recovery capital framework, 16 qualitative interviews were conducted to explore students' meanings, experiences, and barriers/facilitators to recovery from problematic substance use and/or behaviors. Reflexive thematic analysis revealed three main themes: 1. multiple recovery pathways and identities; 2. stigma and disclosure; and 3. proximity to campus community and resources. Recommendations to create more recovery-friendly campuses are provided. [ABSTRACT FROM AUTHOR]

Background: Previous research has shown that nostalgia for the pre-addicted self can motivate people living with addiction to engage in behavior change. Objective: Herein, we explored nostalgia for the addictive behavior—labeled addiction-related nostalgia (ARN)—among people in recovery from engaging in addictive behavior. We tested the novel idea that ARN is positively associated with ambivalence about recovery. We also hypothesized that ARN may counteract the positive influence of optimism on individuals' commitment to recovery. Results: In two studies involving individuals in recovery from a gambling (Study 1; N=301) or alcohol use disorder (Study 2; N=604), ARN was linked to increased ambivalence about recovery, while optimism was associated with decreased ambivalence. As expected, the interaction between optimism and ARN revealed that nostalgia either eliminated (Study 1) or reduced (Study 2) the negative relation between optimism and ambivalence. Conclusions: These findings underscore the challenges posed by ARN in the recovery process and emphasize the importance of interventions that address and mitigate its impact while considering the moderating role of optimism. [ABSTRACT FROM AUTHOR]

Objective: To investigate the association between psychosocial factors and physician clearance to return to play (RTP) in youth ice hockey players after sport-related concussion. Design: Prospective cohort study, Safe to Play (2013-2018). Setting: Youth hockey leagues in Alberta and British Columbia, Canada. Participants: Three hundred fifty-three ice hockey players (aged 11-18 years) who sustained a total of 397 physician-diagnosed concussions. Independent Variables: Psychosocial variables. Main Outcome Measures: Players and parents completed psychosocial questionnaires preinjury. Players with a suspected concussion were referred for a study physician visit, during which they completed the Sport Concussion Assessment Tool (SCAT3/ SCAT5) and single question ratings of distress and expectations of recovery. Time to recovery (TTR) was measured as days between concussion and physician clearance to RTP. Accelerated failure time models estimated the association of psychosocial factors with TTR, summarized with time ratios (TRs). Covariates included age, sex, body checking policy, days from concussion to the initial physician visit, and symptom severity at the initial physician visit. Results: Self-report of increased peer-related problems on the Strengths and Difficulties Questionnaire (TR, 1.10 [95% CI, 1.02-1.19]), higher ratings of distress about concussion outcomes by participants (TR, 1.06 [95% CI, 1.01-1.11]) and parents (TR, 1.05 [95% CI, 1.01-1.09]), and higher parent ratings of distress about their child’s well-being at the time of injury (TR, 1.06 [95% CI, 1.02-1.09]) were associated with longer recovery. Conclusions: Greater pre-existing peer-related problems and acute distress about concussion outcomes and youth well-being predicted longer TTR. Treatment targeting these psychosocial factors after concussion may promote recovery. [ABSTRACT FROM AUTHOR]

Objective: Clarifying the distinctions between art-based creative activities in the domains of occupational therapy and art therapy in the context of stroke rehabilitation, while also describing the effects of art-based creative activities on stroke rehabilitation. Design: Scoping review. Data source: A systematic search was performed in nine databases (Web of Science, PubMed, EMBASE, Cochrane Library, CINAHL and four Chinese database) from their inception to December 2023. Review methods: The study included randomized and non-randomized controlled trials involving art-based creative activities, as well as qualitative research providing detailed intervention measures. The study focused on stroke patients, with primary outcomes related to patients' physiological recovery, psychological well-being, ADL, etc. Data extraction included information on intervention strategies and study results. Results: Seventeen studies were included, extracting six similarities and differences in creative activity between two domains. Creative activities were observed to have positive impacts on daily living activities, limb motor function, fine motor ability, and emotional well-being in stroke patients. Conclusion: Creative activities, whether in occupational therapy or art therapy, involve providing participants with tangible crafting materials for the creation of artistic works. Future stroke rehabilitation practices should tailor activities and intervention focus based on patients' rehabilitation needs, preferences, and cultural background. The current comprehensive analysis provides initial support for the potential positive role of creative activities in stroke rehabilitation, but further in-depth research is needed to confirm their effectiveness. [ABSTRACT FROM AUTHOR]

Context: Best practice guidelines for the recovery and return to work (RTW) of people with mental disorders recommend access to the services of an interdisciplinary team combining pharmacological, psychological and work rehabilitation interventions. In the Canadian context, primary healthcare services are responsible for providing these services for people with common mental disorders, such as depressive or anxiety disorders. However, not everyone has easy access to these recommended primary healthcare services, and previous studies suggest that multiple personal, practice‐related and organizational factors can influence the patient's journey. Moreover, previous studies documented that family physicians often work in silos and lack the knowledge and time needed to effectively manage by themselves patients' occupational health. Thus, the care and service trajectories of these patients are often suboptimal and can have important consequences on the person's recovery and RTW. Objective and Population Studied: Our study aimed to gain a better understanding of the patient journeys and the factors influencing their access to and experience with primary healthcare services while they were on sick leave due to a common mental disorder. Methods: A descriptive qualitative research design was used to understand and describe these factors. Conventional content analysis was used to analyze the verbatim. Results: Five themes describe the main factors that influenced the patient's journey of the 14 participants of this study: (1) the fragmented interventions provided by family physicians; (2) patients' autonomy in managing their own care; (3) the attitude and case management provided by the insurer, (4) the employer's openness and understanding and (5) the match between the person's needs and their access to psychosocial and rehabilitation services. Conclusions: Our findings highlight important gaps in the collaborative practices surrounding the management of mental health‐related sick leave, the coordination of primary healthcare services and the access to work rehabilitation services. Occupational therapists and other professionals can support family physicians in managing sick leaves, strengthen interprofessional and intersectoral collaboration and ensure that patients receive needed services in a timelier manner no matter their insurance coverage or financial needs. Patients of Public Contribution: This study aimed at looking into the perspective of people who have lived or are currently experiencing a sick leave related to a mental health disorder to highlight the factors which they feel hindered their recovery and RTW. Additionally, two patient partners were involved in this study and are now engaged in the dissemination of the research results and the pursuit of our team research programme to improve services delivered to this population. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has had a profound impact on the academic work environment. Studies have documented cross-sectional associations between COVID-related stress and mental health symptoms in university faculty and staff. However, longitudinal studies that can establish temporal associations are needed. Further, it is important to determine if relations to mental health symptoms are driven by worries about COVID-19 (i.e., perceptions of stress) or actual impacts of COVID-19 across domains of health, job, and relationships. The present study included 100 faculty and 265 staff at a medium-sized Canadian University who completed an adapted version of the electronic U-Flourish well-being survey at two time points (October, 2020 and March, 2021). Cross-lagged panel modeling provided evidence that levels of COVID-19 worries and COVID-19 impacts at baseline significantly positively predicted follow-up levels of anxiety over and above baseline levels. Further, baseline levels of anxiety were positively associated with follow-up levels of COVID-19 worries, but not with follow-up COVID-19 impacts. In contrast, none of the cross-lagged associations with depressive symptoms were significant. We suggest from these results that post-COVID-19 mental health recovery can be promoted by academic leadership in two main ways. First, reducing the impact of COVID-19 on anxiety could be achieved through strategies that enhance individuals' sense of control and predictability in their environment, including clear, consistent, and consolidated communication. Second, reducing worry about COVID-19 for faculty and staff with preexisting mental health symptoms might be achieved by broadening access to mental health support. [ABSTRACT FROM AUTHOR]

In the area of addiction, Canada has been in a public health crisis since 2016. Addiction takes a toll on an individual's self-worth and identity. In this narrative literature review, the distinct nature of spirituality was addressed. Next, individualized conceptualizations of spirituality were outlined. Subsequently, the importance of fellowship in addiction recovery was detailed. Next, the significance of being of service was presented. Meaningful and authentic spirituality were discussed in the context of recovery identity. Lastly, spirituality as a personal journey is described. A narrative literature review of 70 manuscripts published between 1999 and 2021 was undertaken to determine multiple approaches to treating addiction recovery in the context of spiritual development. An understanding of spirituality can inform counsellors regarding spiritual development in addiction recovery. Implications for counselling include a roadmap to support clients developing an individualized spiritual connection and operating as a functional system. [ABSTRACT FROM AUTHOR]

Objectives Children living with a tracheostomy have among the most complex medical care needs in Canada. The focus of this study was to gain a contemporary understanding of key aspects of these children's medical journeys. Methods We conducted a qualitative constructivist grounded theory study using semi-structured focus groups with parents whose children are living in the community with a tracheostomy. Parents were recruited from the Stollery Children's Hospital Tracheostomy Clinic, which serves a geographically wide and diverse population. Results Three focus groups were completed, including a total of 12 participants. Key themes leading up to tracheostomy related to contextual understanding, experiences of inclusion, and perceptions of proportionality. Parents discussed the preparedness for how a tracheostomy would affect their child, their own involvement in recovery, and the education needed for their child's medical care. Navigating hospital units related to inconsistencies in care, accommodations of families' needs, and confidence in care received. Finally, living in the community was the focus of much of the participants' discussions including coping with system-related issues, limited homecare and medical support, cost of care, and connections with the broader community of parents of children with complex medical needs. All themes encircled the family's deeply felt responsibility to care for their child. Conclusions From both patient- and family-centered care perspectives, there exist individual and systemic issues related to the care delivery for children with a tracheostomy. It is in particular in the community where there is a severe deficiency of support afforded to these children and their families. [ABSTRACT FROM AUTHOR]

The goals of the present study were to describe the development of the first national longitudinal study of collegiate recovery program (CRP) students; provide an updated characterization of CRP students' demographics, past problem severity, and current recovery-related functioning; and examine the perceived impact of COVID-19 on CRP students' recovery. Universities and community colleges with CRPs across the United States and Ontario, Canada, were invited to partner on this project. Launched in fall 2020, three cohorts of participants were recruited. All participants who completed the baseline survey (N = 334 from 43 CRPs) were invited to complete follow-up surveys. The sample was composed of mostly undergraduate, White, cisgender women averaging 29 years old at baseline. They reported challenging backgrounds, including high levels of polysubstance use, alcohol/substance problem severity, mental health challenges, and involvement with the criminal legal system. Despite such adversity, they evidenced high levels of recovery-related functioning. Recovery capital and quality of life were high. Students reported an average of nearly four years in recovery, with most having between two and four years of abstinence from their primary substance of choice. COVID-19 represented a substantial source of stress for many, impacting some students' abstinence and recovery-related functioning. Results generally parallel findings from the only other national study of CRP students conducted a decade ago, providing a much-needed update and novel insights into CRP students. Findings can inform our understanding of the CRP student population and can be used to tailor CRP design and service offerings to students' backgrounds and needs. [ABSTRACT FROM AUTHOR]

Background: Approximately 15%–25% of clinical pregnancies end in miscarriage, with more than 15,000 miscarriages occurring annually in British Columbia, Canada. Despite the significant rates of loss, research and health care services for pregnancy loss remain scarce in British Columbia. Objectives: This study aimed to (1) aid miscarriage recovery through the identification and sharing of equitable pregnancy loss care practices and supports and (2) present policy recommendations to improve prenatal care guidelines and employment standards for pregnancy loss. Design: This research took a patient-oriented methodological approach alongside people with lived/living experience(s) of miscarriage recovery in British Columbia to evaluate access to health care during pregnancy loss, societal understanding of miscarriage, and treatment options that foreground dignity. Methods: The mixed-methods design of this research included policy research on prenatal care guidelines, policy research on provincial and territorial employment legislation for bereavement leave, semi-structured interviews (n = 27), and a discovery action dialogue (n = 4). Results: The findings of this research demonstrate the need for improved prenatal care guidelines for early pregnancy loss, follow-up care after a miscarriage, mental health screening and supports, and bereavement leave legislation. Conclusion: This article includes recommendations to improve equitable access to pregnancy loss care, bereavement leave legislation, and future research in this area. [ABSTRACT FROM AUTHOR]

Across jurisdictions, the use of 'leverage' to promote adherence to mental health treatment is widespread. However, little research exists on the possible association between the application of leverage and personal recovery. We examined the prevalence of various forms of leverage in a Canadian context and compared these rates with those in other jurisdictions. Additionally, we examined the relationship between two prominent forms of leverage (financial and housing) and the experience of personal recovery. Structured interviews were conducted with people receiving community-based mental health care in Toronto, Canada. Rates of overall leverage in our sample were similar to rates reported in other jurisdictions. Personal recovery was negatively associated with financial leverage but was not associated with housing leverage. Our results highlight the importance of separately examining the relationship of specific forms of leverage and personal recovery and raise questions for future research about the possible effect of financial leverage on recovery. [ABSTRACT FROM AUTHOR]

Objective: This study investigated the moderating role of baseline depressive symptoms on the association between baseline pain severity and time to recovery in individuals with acute grade I-II whiplash-associated disorders. Design: This is a secondary analysis of a randomized controlled trial investigating the effectiveness of a government-regulated rehabilitation guideline for the management of grade I-II whiplash-associated disorders. Participants who completed baseline questionnaires for neck pain intensity and depressive symptoms and follow-up questionnaire on self-reported recovery were included in the analysis. Cox proportional hazards models were built, and hazard rate ratios were reported to describe the association between baseline neck pain intensity and time to self-reported recovery and to assess the effect modification of baseline depressive symptoms. Results: Three hundred three participants provided data for this study. Despite baseline level of depressive symptoms and neck pain intensity being independently associated with delayed recovery, the association between baseline neck pain intensity and time to recovery was not stronger for individuals with significant postcollision depressive symptoms (hazard rate ratio = 0.91; 95% confidence interval = 0.79-1.04) than for those without depressive symptoms (hazard rate ratio = 0.92; 95% confidence interval = 0.83-1.02). Conclusions: Baseline depressive symptoms are not an effect modifier of the association between baseline neck pain intensity and time to self-reported recovery in acute whiplash-associated disorders. [ABSTRACT FROM AUTHOR]

Objective: Little is known about the prognostic value of the Buffalo Concussion Treadmill Test (BCTT) after the acute phase of sport-related concussion (SRC). We examined the added prognostic value of the BCTT performed 10 to 21 days after SRC in children, in addition to participant, injury, and clinical process characteristics on days to recovery. Design: Historical clinical cohort study. Setting: Network of approximately 150 Canadian multidisciplinary primary-care clinics. Participants: 855 children (mean age 14 years, range 6-17 years, 44% female) who presented between January 2016, and April 2019 with SRC. Assessment of risk factors: Participant, injury, and clinical process characteristics, with focus on BCTT exercise intolerance assessed 10 to 21 days after injury. Outcome: Days to clinical recovery. Results: Children who were exercise intolerant experienced an increase of 13 days to recovery (95% CI, 9-18 days). Each additional day between SRC and first BCTT was associated with a recovery delay of 1 day (95% CI, 1-2 days), and prior history of concussion was associated with a recovery delay of 3 days (95% CI, 1-5 days). Participant, injury, and clinical process characteristics, and the first attempt BCTT result explained 11% of the variation in recovery time, with 4% accounted for by the BCTT. Conclusion: Exercise-intolerance assessed 10 to 21 days after SRC was associated with delayed recovery. However, this was not a strong prognostic factor for days to recovery. [ABSTRACT FROM AUTHOR]

Background: Discourse analysis has recently received much attention in the aphasia literature. Even if post‐stroke language recovery occurs throughout the longitudinal continuum of recovery, very few studies have documented discourse changes from the hyperacute to the chronic phases of recovery. Aims: To document a multilevel analysis of discourse changes from the hyperacute phase to the chronic phase of post‐stroke recovery using a series of single cases study designs. Methods & Procedures: Four people with mild to moderate post‐stroke aphasia underwent four assessments (hyperacute: 0–24 h; acute: 24–72 h; subacute: 7–14 days; and chronic: 6–12 months post‐onset). Three discourse tasks were performed at each time point: a picture description, a personal narrative and a story retelling. Multilevel changes in terms of macro‐ and microstructural aspects were analysed. The results of each discourse task were combined for each time point. Individual effect sizes were computed to evaluate the relative strength of changes in an early and a late recovery time frame. Outcomes & Results: Macrostructural results revealed improvements throughout the recovery continuum in terms of coherence and thematic efficiency. Also, the microstructural results demonstrated linguistic output improvement for three out of four participants. Namely, lexical diversity and the number of correct information units/min showed a greater gain in the early compared with the late recovery phase. Conclusions & Implications: This study highlights the importance of investigating all discourse processing levels as the longitudinal changes in discourse operate differently at each phase of recovery. Overall results support future longitudinal discourse investigation in people with post‐stroke aphasia. What This Paper Adds: What is already known on the subject: Multi‐level discourse analysis allows for in‐depth analysis of underlying discourse processes. To date, very little is known on the longitudinal discourse changes from aphasia onset through to the chronic stage of recovery. This study documents multi‐level discourse features in four people with mild to moderate aphasia in the hyperacute, acute, subacute and chronic stage of post‐stroke aphasia recovery. What this paper adds to existing knowledge: The study found that most discourse variables demonstrated improvement throughout time. Macrostructural variables of coherence and thematic units improved throughout the continuum whereas microstructural variables demonstrated greater gains in the early compared to the late period of recovery. What are the potential or actual clinical implications of this work?: This study suggests that multilevel discourse analysis will allow a better understanding of post‐stroke aphasia recovery, although more research is needed to determine the clinical utility of these findings. Future research may wish to investigate longitudinal discourse recovery in a larger sample of people with aphasia with heterogenous aphasia profiles and severities. [ABSTRACT FROM AUTHOR]

Student recovery programs are an emerging trend across university campuses in Canada, yet little is known about the experiences of students who utilize these programs. Canada's first student recovery program launched in 2019, with six additional launching shortly thereafter. The current study offers a first look at the student experience in recovery programs at the first Canadian institutions to offer recovery support on campus. We used qualitative methods to examine individual recovery trajectories, program participation, stigma, barriers to recovery on campus, and the impact of a campus-based recovery program on various areas of their lives. Our findings highlight three main themes: (i) inclusivity and diversity of the programs, (ii) increasing recovery capital and dimensions of well-being, and (iii) reducing barriers to recovery on campus. The results inform how Canadian student recovery programs meet the needs of their students and identify areas for improvement using a recovery-informed lens to center the lived experiences of students in recovery. Findings from this initial study may drive the development of future student recovery programs at Canadian institutions and inform new initiatives by existing programs outside of Canada. [ABSTRACT FROM AUTHOR]

Recovery Colleges are strength-based mental health and well-being learning centers driven by peer support and principles of adult education. This paper examines the outcome of a hospital-based Recovery College in Canada on participants' self-reported well-being, recovery, loneliness, and self-esteem. Using a retrospective pre- and postsurvey design and standardized scales, we collected self-reported data from 32 Recovery College students. The majority (88%) of participants were female and 78% of participants reported to struggle with maintaining positive mental health. Recovery College participation had a significant impact on self-reported connection, mental wellbeing, self-esteem, and personal mental health recovery. [ABSTRACT FROM AUTHOR]

Objective: To understand perceptions on rehabilitation after vertebral fracture, non-pharmacological strategies, and virtual care from the perspective of individuals living with vertebral fractures. Design and setting: We conducted semi-structured interviews online and performed a thematic and content analysis from a post-positivism perspective. Participants: Ten individuals living with osteoporotic vertebral fractures (9F, 1 M, aged 71 ± 8 years). Results: Five themes emerged: pain is the defining limitation of vertebral fracture recovery; delayed diagnosis impacts recovery trajectory; living with fear; being dissatisfied with fracture management; and "getting back into the game of life" using non-pharmacological strategies. Conclusion: Participants reported back pain and an inability to perform activities of daily living, affecting psychological and social well-being. Physiotherapy, education, and exercise were considered helpful and important to patients; however, issues with fracture identification and referral limited the use of these options. Participants believed that virtual rehabilitation was a feasible and effective alternative to in-person care, but perceived experience with technology, cost, and individualization of programs as barriers. [ABSTRACT FROM AUTHOR]

Introduction: During the COVID-19 pandemic, discharge timelines were accelerated and patients were moved across the continuum of care, from acute to post-acute care, to relieve the strain in health system capacity. This study aimed to investigate the COVID-19 care pathway from the perspective of patients, caregivers, and healthcare providers to understand their experiences with care and recovery within and across care settings. Methods: A qualitative descriptive study. Patients and their families from an inpatient COVID-19 unit and healthcare providers from an acute or rehabilitation COVID-19 unit were interviewed. Results: A total of 27 participants were interviewed. Three major themes were identified: 1) The perceived quality and pace of COVID-19 care improved from acute care to inpatient rehabilitation; 2) Care transitions were especially distressing; and 3) Recovery from COVID-19 stagnated in the community. Conclusion: Inpatient rehabilitation was viewed as higher quality due to the slower paced care. Care transitions were distressing for stakeholders and enhanced integration between acute and rehabilitation care were suggested to improve patient handover. A lack of rehabilitation access led to recovery stagnating for patients discharged to the community. Telerehab may improve the transition to home and ensure access to adequate rehabilitation and support in the community. [ABSTRACT FROM AUTHOR]

There are mental and physical deficits associated with COVID-19 infection, particularly among individuals requiring hospitalization. Storytelling is a relational intervention that has been used to help patients make sense of their illness experiences and to share their experiences with others, including other patients, families and healthcare providers. Relational interventions strive to create positive, healing stories versus negative ones. In one urban acute care hospital, an initiative called the Patient Stories Project (PSP) uses storytelling as a relational intervention to promote patient healing, including the development of healthier relationships among themselves, with families and with healthcare providers. This qualitative study employed a series of interview questions that were collaboratively developed with patient partners and COVID-19 survivors. The questions asked consenting COVID-19 survivors about why they chose to tell their stories and to flesh out more about their recovery process. Thematic analyses of six participant interviews resulted in the identification of key themes along a COVID-19 recovery pathway. Patients' stories revealed how survivors progress from being overwhelmed by their symptoms to making sense of what is happening to them, providing feedback to their care providers, feeling gratitude for care received, becoming aware of a new state of normal, regaining control of their lives, and ultimately discovering meaning and an important lesson behind their illness experience. Our study's findings suggest that the PSP storytelling approach holds potential as a relational intervention to support COVID-19 survivors along a recovery journey. This study also adds knowledge about survivors beyond the first few months of recovery. [ABSTRACT FROM AUTHOR]

There is strong research to support integrated and gender-sensitive harm reduction approaches for supporting women, girls, and gender diverse people. For individuals who are pregnant, flexible and integrated treatment approaches may be especially important. In this study, we report on an integrated program in rural Canada designed to support pregnant women, girls, and gender diverse people experiencing substance use and other complex needs. Program data (N = 393) from the 2nd Floor Women's Recovery Centre (2nd Floor) at the Lakeland Centre for Fetal Alcohol Spectrum Disorder (LCFASD) was analyzed with several aims. Study goals were to (1) describe characteristics and needs of clients, (2) identify factors associated with program completion, and (3) for a subset of clients, examine resources, wellbeing, and social and behavioral outcomes after treatment. Clients (Mage = 27.4 years, range 15-64) presented at the 2nd Floor with complex medical and mental health needs, and experiences of significant socioenvironmental adversity. However, almost two-thirds (63.4%) successfully completed the program, which was more likely for clients who had stable housing at intake and a possible or confirmed diagnosis of FASD. After treatment, clients reported high levels of wellbeing, and most were connected to health care and community resources. In the year after program completion, clients who were contacted for follow-up maintained strong connection to resources and reported notable improvements in social and behavioral functioning. Many were working or volunteering, most were in stable home environments, rates of substance use and legal involvement were substantially reduced, and many clients were actively caring for their children. This study offers important findings to inform future research, practice, and policy for supporting health and wellbeing for women, children, families, and communities. [ABSTRACT FROM AUTHOR]

Childhood sexual abuse (CSA) can result in devastating and long lasting consequences. Differences in the nature of the abuse differ for males and females and this difference potentially influences recovery. However, studies of recovery from CSA, especially among men, are relatively few, especially for ethnic minority men. The study explored the lived experience of recovery from CSA among African-Caribbean Black male survivors of CSA living in Canada, the United Kingdom and the United States. The theoretical framework was the transactional model of stress and coping, which proposes that stress is an ongoing transaction between the demands of life and a person's psychological ability to address those demands. The study was qualitative in design, using an interpretive phenomenological approach, involving purposeful sampling, in-depth semi-structured interviews, and interpretive phenomenological analysis of the data informed by a critical race theory lens. The results showed that Black male survivors are situated in unique historical/sociocultural interrelationships that complicate recovery from CSA, including institutional racism and discrimination, restrictive narratives of masculinity, and other cultural norms. These findings can be used to influence policy makers, service providers, and communities, to more effectively support and address the needs of CSA survivors and their affected families. [ABSTRACT FROM AUTHOR]

Purpose: Varying stakeholders have highlighted how recovery-oriented mental health services such as youth mental health services have traditionally focused on supporting individual resources to promote recovery (e.g., agency) to the exclusion of addressing structural issues that influence recovery (e.g. poverty). One response to this criticism has been work helping people with mental health problems recover a sense of citizenship and sense of belonging in their communities. Work on citizenship has yet to influence youth mental healthcare in Canada's provinces and territories. This paper aims to highlight ways that youth mental healthcare can better help youth recover a sense of citizenship. Design/methodology/approach: The arguments described in this paper were established through discussion and consensus among authors based on clinical experience in youth mental health and an understanding of Canada's healthcare policy landscape, including current best practices as well as guidelines for recovery-oriented care by the Mental Health Commission of Canada. Findings: Here, this study proposes several recommendations that can help young with mental health problems recover their sense of citizenship at the social, systems and service levels. These include addressing the social determinants of health; developing a citizenship-based system of care; addressing identity-related disparities; employing youth community health workers within services; adapting and delivering citizenship-based interventions; and connecting youth in care to civic-oriented organizations. Originality/value: This paper provides the first discussion of how the concept of citizenship can be applied to youth mental health in Canada in multiple ways. The authors hope that this work provides momentum for adopting policies and practices that can help youth in Canada recover a sense of citizenship following a mental health crisis. [ABSTRACT FROM AUTHOR]

Introduction: Patients discharged following hospitalization for COVID‐19 require clear discharge protocols, information resources and communications to adequately prepare them to safely and successfully transition from hospital to home. Our study focuses on the patients' transition to recovering at home including their hospital discharge preparation and hospital experiences. Methods: A qualitative descriptive study design involved interviewing patients who had been hospitalized for COVID‐19 in one urban Alberta, Canada centre. Purposive sampling was used to select patients from a centralized COVID‐19 hospital patient database stratified by month between March 2020 and February 2021. Other inclusion criteria (e.g., sex and age) were also considered. Semi‐structured interviews with patients were recorded, transcribed and analysed using thematic analysis. Data sufficiency and saturation were determined. Results: Twelve patients shared their lived experiences and recovery journey from COVID‐19. Themes were reported under three main areas as framed by the study aim—the current status of patients recovering at home, including the supports they used to manage; their discharge process and preparation to go home; and their various hospital‐related experiences. Suggestions for improving aspects of the patient journey were also captured. Conclusion: Findings provided details of the needs, information gaps and what matters most to patients when they are recovering from COVID‐19 at home, including their preparation to safely and successfully transition from hospital to home (i.e., feeling well prepared to go home, including being adequately assessed and having clear discharge protocols and communication). Key learnings were applied to improve or develop patient discharge and transition resources. Patient or Public Contribution: A patient/family advisor and patient experience partners were involved throughout the study, codeveloping all aspects, from the study design to the reporting and application of the findings. Leading into the study, patient experiences and feedback regarding the home from hospital recovery journey informed multiple aspects, including the codevelopment of the interview guide. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to assess the feasibility of delivering Art skill-based Rehabilitation Training (ART), a novel upper limb motor training program, to patients with stroke as an adjunct to standard care in an inpatient setting. Design: Feasibility study. Setting: Inpatient stroke rehabilitation unit at a university hospital. Participants: Thirty-eight patients admitted to a stroke rehabilitation unit with upper limb motor impairment were enrolled in the ART program facilitated by trained non-healthcare professionals between December 2017 and June 2021. Intervention: The ART program included nine, one-hour sessions of supervised tracing and freehand drawing tasks completed with both hands. This program was intended to be delivered at a frequency of three times per week over a duration of 3 weeks or for the length of inpatient stay. Main outcome measures: Feasibility outcomes included ART program adherence, acceptability, and safety. Results: Thirty-two (84%) participants with subacute stroke completed the ART program and 30 (79%) were included in the study analysis. Participants completed 93–100% of the ART tasks in a median [IQR] of 8 [6–10] ART sessions over a median [IQR] duration of 15 [7–19] days. ART program facilitators effectively provided upper limb assistance to patients with more severe upper limb impairments. Adherence and acceptability were high and no study-related adverse events occurred. Conclusion: The ART program was feasible to deliver and highly acceptable to patients with stroke. Further research is warranted to explore the impact of ART on upper limb sensorimotor function and use. [ABSTRACT FROM AUTHOR]

Background: To address the growing concerns over poor mental health experienced by adults with intellectual disabilities due to the COVID‐19 pandemic, a national virtual mental health course was delivered and evaluated. Methods: This mixed methods study utilized both qualitative and quantitative assessments. Participants were 27 adults with intellectual disabilities who participated in the 6‐week course. Participants completed measures of self‐efficacy and well‐being at three time points and qualitative satisfaction measures at post and follow‐up. Results: Attendance was high and the course was feasible and acceptable to participants. Positive changes related to mental health self‐efficacy were detected (p =.01), though mental well‐being did not improve. Conclusion: The study provided evidence for the feasibility and value of the course for this population. Future research should examine how virtual courses could support the population in terms of pandemic recovery and how courses may work for individuals who are less independent. [ABSTRACT FROM AUTHOR]

Background. Adolescents experience rapid changes and are more vulnerable for developing substance use problems than other age groups. Many studies have focused on the trajectories of adolescent substance use frequencies, rather than symptoms. Objective. The present study examined the trajectory of substance use disorder symptoms, particularly beginning in early adolescence and within a Canadian context. Methods. Data were drawn from a Canadian longitudinal project, in which a province-wide survey was administered to students across three biennial waves starting in grades 7-8. The final sample was comprised of 765 adolescents (baseline Mage = 12.73, SD = 0.67, 49.7% female, 57.6% White). Latent class analysis was conducted to identify substance use disorder symptom classes based on participants' responses on a substance use disorder screener across the three waves. Group differences tests were also computed to examine if the substance use classes differed in participants' demographics. Results. Four classes were identified, labelled as low stable (n = 538, 70.3%), deteriorating (n = 169, 22.1%), recovered (n = 12, 1.6%), and high-risk relapse (n = 46, 6.0%) substance use. Among the demographic variables, non-White ethnicity, both parents being born outside of Canada, and parents' completion of post-secondary education were significantly associated with a less severe substance use class. Conclusions. Results fill a gap in the evidence on the trajectory of symptoms of substance use disorder among adolescents, using a Canadian sample, an area of limited study. Results highlight an at-risk group (i.e., high-risk relapse class) that warrants further tailored prevention and intervention efforts. [ABSTRACT FROM AUTHOR]

Objectives: Supporting women and girls who are pregnant and experiencing substance use challenges is a high priority for researchers, clinicians, and policymakers. Complementary therapies (CTs) can be effective forms of treatment in some contexts and populations; however, research on the use of CTs in substance use recovery with pregnant women and girls is scarce. To fill this gap, we conducted a mixed methods study using survey data collected at a women's recovery center in Canada. Our objectives were to describe CTs provided at the program; identify what CTs are perceived by participants as most/least positive; and explore factors that may impact participant experiences with CTs. Methods: We analyzed feedback responses from 255 women and girls (M age = 27.5 years, range 15–64) using Pearson chi-square tests, logistic regression, and inductive content analysis. Results: The most frequently provided CTs were yoga, energy-related activities (e.g. reiki, reflexology), and meditation. Among the most common CTs, participants provided the highest endorsements for massage and physical activity, and the lowest endorsements for yoga and drumming. Across CTs, whether participants looked forward to an activity contributed significantly to whether they found it helpful, would like to do it again, and planned to continue engaging in the activity after leaving the program. Four broad contextual factors were identified that may impact experiences and perspectives about CTs: (1) goodness of fit, (2) self-awareness, (3) growth, and (4) healing and holistic wellbeing. Conclusions: This study provides novel evidence on the potential impacts of CTs in substance use treatment for pregnant women and girls, and important contextual factors to consider when implementing these approaches. [ABSTRACT FROM AUTHOR]

To disentangle the key steps of the return to work (RTW) process and offer clearer recovery-focused and sustainable RTW for people on sick leave due to common mental disorders (CMDs). This participatory research involves two large Canadian organizations. In each organization, we established an advisory committee composed of RTW stakeholders. We collected information in semi-structured interviews from RTW stakeholders (n = 26) with each member of the advisory committee in each organization, as well as with employees who had recently experienced CMDs. The interviews examined the RTW process for employees on sick leave due to CMDs as well as RTW stakeholders' perceptions of barriers and facilitators. A thematic approach was used to synthesize the data, following which, results were discussed with the two advisory committees to identify solutions considering key RTW steps. Ten common key steps within the three RTW phases emerged from the semi-structured interviews with RTW stakeholders and discussions with the two advisory committees: 1) At the beginning of sickness absence and involvement of disability management team (phase 1), we found 3 steps (e.g., taking charge of the file), 2) during the involvement in treatment rehabilitation with health professionals and preparation of the RTW (phase 2), 4 steps (e.g., RTW preparation), and finally 3) the RTW and follow-up (phase 3) consists of 3 steps (e.g., gradual RTW). A participatory study involving RTW stakeholders helped identify 10 common key steps within three phases to support RTW sustainability of people with CMDs. Future research will need to address how RTW coordinators intervene in the RTW process of employees with CMDs within these steps. Rehabilitation professionals will benefit from a detailed description of the RTW process (10 steps spread out over 3 RTW phases), allowing them to standardize it while adopting a personalized approach for the employee on sick leave. Rehabilitation professionals are informed of stakeholders' role and actions required in the RTW process; as such the communication between RTW stakeholders should be improved. RTW coordinators will be able to tailor more precisely their intervention, considering the detailed RTW process and RTW stakeholders' role and actions, and thus will become the pivot occupational health specialists for the RTW process. [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is Available in the Text. Objective: To document the occurrence and recovery outcomes of sports-related concussions (SRCs) presenting to the Emergency Department (ED) in a community-based sample. Design: A prospective observational cohort study was conducted in 3 Canadian hospitals. Setting: Emergency Department. Patients: Adults (≥17 years) presenting with a concussion to participating EDs with a Glasgow Coma Scale score ≥13 were recruited. Interventions: Patient demographics (eg, age and sex), clinical characteristics (eg, history of depression or anxiety), injury characteristics (eg, injury mechanisms and loss of consciousness and duration), and ED management and outcomes (eg, imaging, consultations, and ED length of stay) were collected. Main outcome measures: Patients' self-reported persistent concussion symptoms, return to physical activity status, and health-related quality of life at 30 and 90 days after ED discharge. Results: Overall, 248 patients were enrolled, and 25% had a SRC. Patients with SRCs were younger and reported more physical activity before the event. Although most of the patients with SRCs returned to their normal physical activities at 30 days, postconcussive symptoms persisted in 40% at 90 days of follow-up. After adjustment, there was no significant association between SRCs and persistent symptoms; however, patients with concussion from motor vehicle collisions were more likely to have persistent symptoms. Conclusion: Although physically active individuals may recover faster after a concussion, patients returning to their physical activities before full resolution of symptoms are at higher risk of persistent symptoms and further injury. Patient–clinician communications and tailored recommendations should be encouraged to guide appropriate acute management of concussions. [ABSTRACT FROM AUTHOR]

This single‐arm, repeated measures study investigated the impact caregiver trauma history may have on treatment response following an intensive, 2‐day Emotion Focused Family Therapy (EFFT) caregiver workshop. Caregivers (n = 243) completed questionnaires regarding their child's emotion regulation and clinical symptoms, as well as their own childhood trauma history (i.e., exposure to various forms of child maltreatment), caregiver self‐efficacy and caregiver blocks (e.g., fears) to support their child's treatment and recovery. Questionnaires were administered prior to and immediately following the workshop and again 4, 8 and 12 months later. At baseline, caregivers who reported experiences of childhood maltreatment demonstrated more blocks compared with caregivers who did not (B = 6.35, SE = 2.62, p < 0.05). Results indicated that caregivers with and without maltreatment histories reported similar, significant gains in their child's total difficulties (B = 0.64, SE = 0.41, p = 0.12) and emotional negativity and lability (B = 0.51, SE = 0.48, p = 0.29) at 12‐month post‐workshop. Caregivers with maltreatment histories reported greater improvements in caregiver blocks (B = 5.15, SE = 1.34, p < 0.001) and child emotion regulation (B = 0.90, SE = 0.18, p < 0.001) than caregivers without maltreatment histories. They also report less, but still significant, improvement in parental self‐efficacy (B = −0.68, SE = 0.26, p < 0.01) when compared with caregivers without maltreatment histories. Findings suggest that EFFT workshops may be an acceptable and effective trans‐diagnostic intervention for families presenting with complex histories, including caregiver exposure to childhood maltreatment. [ABSTRACT FROM AUTHOR]

Activity-based therapy (ABT) is a restorative approach that promotes neurological recovery below the level of injury in individuals with spinal cord injury or disease (SCI/D). This study sought to understand how ABT and its associated technologies were being used in community-based facilities across Canada. One to two participants from ten community-based ABT facilities completed a semi-structured interview that queried types of technologies or techniques used in ABT, and barriers and facilitators to providing ABT for individuals with SCI/D. Interviews were audio-recorded and transcribed verbatim, and analyzed using an interpretive description approach to identify themes and categories. The overarching theme that emerged was that ABT in the community is a client-centered approach characterized by variety in techniques, clinicians, and clientele. The researchers identified three categories within this theme: characteristics of ABT in the community, perceived challenges, and a need for advocacy. Participants advocated for earlier implementation, increased education, and reduced costs of ABT to address the challenges with implementation and accessibility. The use of ABT and its associated technologies varied across participating community-based facilities in Canada, despite a consistent focus on client goals and well-being. Addressing system-level limitations of ABT may improve implementation and accessibility in Canada. Activity-based therapy (ABT) is a group of interventions targeting recovery of sensory and motor function below the level of injury in individuals with spinal cord injury or disease (SCI/D). ABT in the community emphasizes a client-centered approach and is characterized by variety in techniques, clinicians, and clientele. Participants advocated that earlier implementation, reduced costs, and increased education will help overcome barriers to providing ABT, ultimately assisting to facilitate neurorecovery in individuals with SCI/D. Challenges in implementation, accessibility, and knowledge of ABT exist, highlighting a need to explore and address system-level limitations in Canada. [ABSTRACT FROM AUTHOR]

We assessed the relationship between tobacco smoking and immunologic and virologic response among people living with HIV (PLWH) initiating combination antiretroviral therapy (cART) in the Canadian HIV Observational Cohort (CANOC). Positive immunologic and virologic response, respectively, were defined as ≥50 cells/mm3 CD4 count increase (CD4+) and viral suppression ≤50 copies/mL (VL+) within 6 months of cART initiation. Using multinomial regression, we examined the relationship between smoking, immunologic, and virologic response category. Model A adjusted for birth sex, baseline age, enrolling province, and era of cohort entry; models B and C further adjusted for neighbourhood level material deprivation and history of injection drug use (IDU), respectively. Among 4267 individuals (32.7%) with smoking status data, concordant positive (CD4+/VL+) response was achieved by 64.2% never, 66.9% former, and 59.4% current smokers. In the unadjusted analysis, current smoking was significantly associated with concordant negative response (odds ratio [OR] 1.85, 95% confidence interval [CI] 1.40–2.45). Similarly, models A and B showed an increased odds of concordant negative response in current smokers (adjusted OR [aOR] 1.78, 95% CI 1.32–2.39 and 1.74, 95% CI 1.29–2.34, respectively). The association between current smoking and concordant negative response was no longer significant in model C (aOR 1.18, 95%CI 0.85–1.65). [ABSTRACT FROM AUTHOR]

The recovery paradigm is increasingly being adopted within mental health services internationally, to support a process of personal change for affected individuals, with the aim of living a satisfying, hopeful, contributing life within the limitations of mental illness. In efforts to assist the process of recovery, Recovery Education Centres (REC), offering recovery supports through education rather than traditional service models, have been widely implemented; there is limited evidence to date with respect to the experiences and outcomes of disadvantaged populations, such as people experiencing homelessness, with recovery education. This study used qualitative methods to explore the perspectives and experiences of service users and providers of the Supporting Transitions and Recovery (STAR) Learning Centre in Toronto, Canada, focused on supporting the process of recovery for individuals with histories of homelessness. Between July 2017 and June 2018, semistructured interviews with 20 service users, one key informant, and a focus group comprising eight current and former REC staff and volunteers were conducted to explore opportunities to better tailor the curriculum, and key programmatic features, to the needs of the population. Interviews were analysed using inductive thematic analysis. Most participants described favourable experiences with the REC and suggested adding more challenging course content (n = 10) and increasing delivery options (n = 8), highlighting the diversity of participant needs. Others described the importance of improving accessibility through geographic expansion, offering transit subsidies, and using innovative media. In addition, the importance of delivering more courses in partnership with community partners, to maximise reach and impact, was also highlighted (n = 15). This study underscores the importance of engaging service users and providers, including peers, in ongoing adaptations to best serve the target populations. The expertise and lived experience of these key stakeholders offer a unique lens, supporting the process of recovery, through co‐production of curriculum content and joint program planning and improvements. Findings can inform REC development for disadvantaged populations and potentially enhance recovery outcomes for those experiencing multiple barriers to recovery. [ABSTRACT FROM AUTHOR]

Aim: To use positive deviance to identify actionable processes of care that may improve outcomes and experience from the perspectives of prolonged intensive care unit (ICU) stay survivors and family members. Design: Prospective qualitative interview study in two geographically distant settings: Canada (2018/19) and the United Kingdom (2019/20). Methods: Patient and family participant inclusion criteria comprised: aged over 18 years, ICU stay in last 2 years of over 7 days, able to recall ICU stay and provided informed consent. We conducted semi‐structured in‐person or telephone interviews. Data were analysed using a positive deviance approach. Results: We recruited 29 participants (15 Canadian; 14 UK). Of these, 11 were survivors of prolonged ICU stay and 18 family members. We identified 22 actionable processes (16 common to Canadian and UK participants, 4 Canadian only and 2 UK only). We grouped processes under three themes: physical and functional recovery (nine processes), patient psychological well‐being (seven processes) and family relations (six processes). Most commonly identified physical/functional processes were regular physiotherapy, and fundamental hygiene and elimination care. For patient psychological well‐being: normalizing the environment and routines, and alleviating boredom and loneliness. For family relations: proactive communication, flexible family visiting and presence with facilities for family. Our positive deviance analysis approach revealed that incorporation of these actionable processes into clinical practice was the exception as opposed to the norm perceived driven by individual acts of kindness and empathy as opposed to standardized processes. Conclusion: Actionable processes of care important to prolonged ICU stay survivors and family members differ from those frequently used in ICU quality improvement (QI) tools. Impact: Our study emphasizes the need to develop QI tools that standardize delivery of actionable processes important to patients and families experiencing a prolonged ICU stay. As the largest healthcare professional group, nurses can play an essential role in leading this. [ABSTRACT FROM AUTHOR]

The objective of this study was to validate an automated self-administered 24-hour dietary recall web application (R24W) against recovery biomarkers for sodium, potassium and protein intakes and to identify individual characteristics associated with misreporting in a sample of 61 men and 69 women aged 20–65 years from Québec City, Canada. Each participant completed 3 dietary recalls using the R24W, provided two 24-hour urinary samples and completed questionnaires to document psychosocial factors. Mean reported intakes were 2.2%, 2.1% and 5.0% lower than the urinary reference values, respectively, for sodium, potassium and proteins (significant difference for proteins only (p = 0.04)). Deattenuated correlations between the self-reported intake and biomarkers were significant for sodium (r = 0.48), potassium (r = 0.56) and proteins (r = 0.68). Cross-classification showed that 39.7% (sodium), 42.9% (potassium) and 42.1% (proteins) of participants were ranked into the same quartile with both methods and only 4.8% (sodium), 3.2% (potassium) and 0.8% (proteins) were ranked in opposite quartiles. Lower body esteem related to appearance was associated with sodium underreporting in women (r = 0.33, p = 0.006). No other individual factor was found to be associated with misreporting. These results suggest that the R24W has a good validity for the assessment of sodium, potassium and protein intakes in a sample of French-speaking adults. Novelty: The validity of an automated self-administered 24-hour dietary recall web application named the R24W was tested using urinary biomarkers. According to 7 criteria, the R24W was found to have a good validity to assess self-reported intakes of sodium, potassium and proteins. [ABSTRACT FROM AUTHOR]

Objective: Train drivers are regularly involved in railway critical incidents (CI) and critical incident management and support protocols (CIMSPs) have been developed to support them. This study describes the impact of CIs and evaluates the effectiveness of CIMSPs. Methods: We interviewed 74 train drivers 1 week, 1, 3, and 6 months after a CI. We performed Linear growth model analyses to describe recovery paths and the effect of CIMSPs, considering the effect of CI complexity, proximity to victims, social support, self-assessment of health, use of resources, and attribution of responsibility. Results: CIs have a significant negative impact on train drivers. Recovery paths can be explained by the level of implementation of CIMSPs, and other contributing factors. Conclusions: CIMSPs are effective in reducing the negative impact of CIs and should be implemented rigorously by employers. [ABSTRACT FROM AUTHOR]

Background: Methadone treatment is one of the opioid substitution therapies (OSTs) used to manage opioid use disorder (OUD). Clients on methadone treatment experience a high attrition rate from OST programs due to diverse barriers such as access to methadone treatment, treatment modality, transportation, and stigma. Methods: The aim of this project is to explore the experiences and perspectives of clients on methadone treatment who had previously dropped out of an OST program. We used an explorative qualitative design to interview 22 participants currently receiving methadone treatment at a clinic in a small city in western Canada. Results: Four phases designated as critical moments in their lives were identified from their narratives: 1) pre-addiction phase; 2) early substance use; 3) first methadone treatment; and 4) methadone treatment failure and reenrollment. Conclusion: Understanding clients' experiences on OST treatment and presenting them temporally on a prevention-rehabilitation continuum expands possibilities for community-based interventions focussing on the individual, their family, and the community on substance use prevention, harm reduction activities, and supported treatment and recovery. [ABSTRACT FROM AUTHOR]

Support from caregivers is an important element of mental health recovery. However, the mechanisms by which social support influences the recovery of persons with depressive, anxiety, or bipolar disorders are less understood. In this study, we describe the social support mechanisms that influence mental health recovery. A cross-sectional qualitative study was undertaken in Québec (Canada) with 15 persons in recovery and 15 caregivers—those having played the most significant role in their recovery. A deductive thematic analysis allowed for the identification and description of different mechanisms through a triangulation of perspectives from different actors. Regarding classic social support functions, several of the support mechanisms for mental health recovery were identified (emotional support, companionship, instrumental support, and validation). However, informational support was not mentioned. New mechanisms were also identified: presence, communication, and influence. Social support mechanisms evoke a model containing a hierarchy as well as links among them. [ABSTRACT FROM AUTHOR]