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To advance the understanding of perceived social isolation among persons with spinal cord injury (SCI), the objectives of the present study were to explore: (1) experiences of perceived social isolation and (2) factors that contribute to perceived social isolation. Interpretive description qualitative methodology was used to conduct semi-structured interviews with 30 individuals with SCI from across Ontario (Canada) from November 2016 to August 2017. Data were analyzed using thematic analysis. Participants identified disruption to social networks that seemed to impact perceived social isolation. Five major themes were identified: (1) impact on structure and frequency of social network; (2) importance of feeling heard; (3) importance of employment, hobbies, and sports; (4) need to improve physical accessibility and built environment; and (5) individual characteristics. Changes in quality of social networks, rather than size, contributed to greater feelings of perceived social isolation. The built environment, maintenance of employment, hobbies, and sports, social media, and technology use, as well as individual traits, were also found to impact perceived social isolation. Future research should focus on the development of programs to help maintain or improve social network quality for persons with SCI to minimize the impact of perceived social isolation. Perceived social isolation, resulting from physical and environmental barriers, is a challenge that is faced by many individuals who are living in the community with a spinal cord injury (SCI). Rehabilitation and community programs should utilize an individualized approach to find solutions to challenges faced by this population to prevent the effects of perceived social isolation. Education on how to adapt to changes in social network, together with the provision of access to peer-to-peer support groups, and SCI specific return to work or leisure programs, is recommended as an essential component of rehabilitation. [ABSTRACT FROM AUTHOR]

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

To compare the attitudes and preferences of persons with spinal cord injury/dysfunction (SCI/D) and healthcare providers regarding prescription medications, over-the-counter medications, and natural health products (NHPs). A qualitative study involving semi-structured interviews with healthcare providers (n = 32) and persons with SCI/D (n = 19) in Canada. Inductive descriptive and interpretive analyses were conducted using data display matrices and a constant comparative approach. Participants described differing perceptions of therapeutic benefits based on medication type, with shared attitudes about the therapeutic benefits of prescription medications and differing views about the effectiveness of NHPs. Despite the perceived effectiveness of prescription medications, persons with SCI/D preferred to avoid them due to concerns about side effects, safety, and stigma. Persons with SCI/D were often concerned about the long-term safety of prescription medications, whereas providers focused more on medication-related addictions. Participants discussed stigma relating to prescription medications, NHPs, and medicinal marijuana. Healthcare providers and persons with SCI/D described different attitudes about and preferences for pharmacotherapeutic products, contributing to challenges in optimizing medication management. Strategies to improve medication management include shared decision-making to incorporate patient preferences into care plans and explicit discussions about long-term medication safety. Further, steps are needed to combat the stigma associated with medication use. Following a person-centered approach to shared decision-making, prescribers should initiate explicit conversations about patient medication preferences, short and long-term prescription medication side effects, and alternative treatment options. Regarding prescription medication safety, persons with spinal cord injury/dysfunction focused on the long term impact of medications, while providers focused on medication-related addictions, highlighting a disconnect that should be discussed during initiation, continuation, or discontinuation of a medication. Providers should be mindful of the stigma associated with taking multiple prescription medications, including medicinal marijuana, as well as the stigma associated with over-the-counter medications and natural health products. Providers could benefit from education about spinal cord injury/dysfunction-specific prescription medications and could benefit from increased education about natural health products. [ABSTRACT FROM AUTHOR]

To explore the attitudes, beliefs and experiences pertaining to the management of prescribed and unprescribed medications among community-dwelling adults with spinal cord injury/dysfunction (SCI/D) in Ontario, Canada. In-depth semi-structured interviews were conducted by telephone. Each interview was audio-recorded, transcribed verbatim and analyzed using inductive thematic analysis. Of the 19 participants, 11 were male and 8 were female, with an age range from 36 to 76 years; 14 participants had traumatic SCI and 5 had non-traumatic spinal cord dysfunction. All but three participants were taking five or more medications, including prescription medications, over-the-counter medications and natural health products. The three main themes identified were: disruptive nature of medications, fear of negative outcomes and self-management: playing a critical role. Medication management is a complex, multifaceted and non-linear process. Persons with SCI/D described experiences with medication-taking that are not well understood by current medication management frameworks. Thus, it is essential to broaden our lens and situate persons with SCI/D medication-taking experiences within self-management frameworks to allow for a more comprehensive and reflective understanding of their experiences. Based on the findings from this study, recommendations for future research, practice and policy have been suggested. Persons with spinal cord injury/dysfunction identified numerous challenges and concerns with medication use post-injury. Educational medication management programs should be implemented post-discharge to improve the state of knowledge around medications (indication, side effects, strategies for taking medications) and how to optimize medication management. In order to optimize experiences and outcomes, there is a need for explicit and ongoing discussions around medication management between persons with spinal cord injury/dysfunction and their healthcare providers. [ABSTRACT FROM AUTHOR]

Transitions across care settings can be stressful for trauma patients, and when poorly executed, can lead to poor outcomes. Early physical medicine and rehabilitation (PM&R) consults in acute care settings can optimize the continuum of care for trauma patients, but there is a need for additional insight on its impact. This study aimed to better understand how early PM&R consults influence the continuum of care between acute and rehabilitation trauma settings. Four focus groups were conducted with 21 trauma acute care and rehabilitation staff, and data were analyzed via content analysis. The main themes identified were: (1) patient-level considerations (i. readiness for rehab [mental health]; ii. patient education and expectations for rehab); (2) clinical-team considerations (i. physiatry role clarity and role limitations; ii. access and accuracy of information; iii. departmental silos); and (3) system-level considerations (i. occupancy and discharge pressures; ii. inter-facility coordination and patient flow). Although both acute and rehabilitation care staff find early PM&R consults as being important to support the recovery of trauma patients, there is a need for greater role clarity of the physiatrist across settings and a more refined implementation approach to better meet the communication needs of clinical staff. Early physical medicine and rehabilitation consults are seen by acute care and rehabilitation front-line staff as valuable for optimizing the continuum of trauma care. There is a lack of clarity on the role of physiatrists among acute care and rehabilitation clinical staff. The physiatrist plays an important role to help prepare trauma patients for rehabilitation. For patients with complex physical and/or mental health challenges, the physiatrist can also serve as an advocate for access to rehabilitation services. [ABSTRACT FROM AUTHOR]

Compared to other patient population groups, the field of amputation research in Canada lacks cohesion largely due to limited funding sources, lack of connection among research scientists, and loose ties among geographically dispersed healthcare centres, research institutes and advocacy groups. As a result, advances in clinical care are hampered and ultimately negatively influence outcomes of persons living with limb loss. To stimulate a national strategy on advancing amputation research in Canada, a consensus-workshop was organized with an expert panel of stakeholders to identify key research priorities and potential strategies to build researcher and funding capacity in the field. A modified Delphi approach was used to gain consensus on identifying and selecting an initial set of priorities for building research capacity in the field of amputation. This included an anonymous pre-meeting survey (N = 31 respondents) followed by an in-person consensus-workshop meeting that hosted 38 stakeholders (researchers, physiatrists, surgeons, prosthetists, occupational and physical therapists, community advocates, and people with limb loss). The top three identified research priorities were: (1) developing a national dataset; (2) obtaining health economic data to illustrate the burden of amputation to the healthcare system and to patients; and (3) improving strategies related to outcome measurement in patients with limb loss (e.g. identifying, validating, and/or developing outcome measures). Strategies for moving these priorities into action were also developed. The consensus-workshop provided an initial roadmap for limb loss research in Canada, and the event served as an important catalyst for stakeholders to initiate collaborations for moving identified priorities into action. Given the increasing number of people undergoing an amputation, there needs to be a stronger Canadian collaborative approach to generate the necessary research to enhance evidence-based clinical care and policy decision-making. Limb loss is a growing concern across North America, with lower-extremity amputations occurring due to complications arising from diabetes being a major cause. To advance knowledge about limb loss and to improve clinical care for this population, stronger connections are needed across the continuum of care (acute, rehabilitation, community) and across sectors (clinical, advocacy, industry and research). There are new surgical techniques, technologies, and rehabilitation approaches being explored to improve the health, mobility and community participation of people with limb loss, but further research evidence is needed to demonstrate efficacy and to better integrate them into standard clinical care. [ABSTRACT FROM AUTHOR]

To describe objective social disconnectedness and perceived social isolation post-spinal cord injury/dysfunction (SCI/D), and to examine associations among social disconnectedness and social isolation by sociodemographic and clinical characteristics. A telephone-based questionnaire was administered to 170 community dwelling individuals with a SCI/D. Social disconnectedness was measured by social network size, composition, and frequency of contact. Social isolation was measured using the revised three item UCLA Loneliness Scale. Of the 170 participants, the majority were men (n = 136, 80%), had a traumatic injury (n = 149, 87.6%), and had incomplete tetraplegia (n = 58, 34%). The mean network size was 3.86 (SD = 2.0) of a maximum seven. The mean loneliness score for the sample was 4.93 (SD = 1.87). Factors associated with lower feelings of loneliness included being married, living with a higher proportion of network members, and being employed. Size of networks was not significantly associated with feelings of loneliness. This study highlights the vulnerability for perceived social isolation among persons with SCI/D. The size of network does not seem to matter as much as the frequency and quality of social interactions. Findings reinforce the complexity of social disconnectedness and the importance in understanding the various indicators of social disconnectedness as they relate to social isolation. Social relationships have been shown to be a vital component of optimal health and well-being. Individuals with a spinal cord injury/dysfunction are faced with a number of challenges in developing and maintaining social relationships and community participation. Rehabilitation professionals should encourage opportunities for social inclusion, employment and community participation to optimize health and well-being for this population. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this scoping review was to map the scope of the literature on polypharmacy among individuals with spinal cord injury or dysfunction (SCI/D). Material and methods: Five electronic databases were searched for literature published between January 1990 and July 2018. The following keywords were searched using Boolean operators, wild cards, proximity operators and truncations: spinal cord injuries, multiple medications, polypharmacy. The initial search identified 1,459 articles; 1,098 remained after deduplication. Following the title and abstract screen, 81 full-texts were reviewed, and 18 met all of the eligibility criteria for inclusion in the review. Results: Of the 18 studies identified, less than half defined polypharmacy. Definitions varied in the types and number of medications. Older age, higher level of injury and greater severity of injury were factors related to polypharmacy. Negative clinical outcomes, such as drug-related problems and bowel complications were identified. Conclusions: This scoping review identified a paucity of research on polypharmacy post-SCI/D, highlighting a need for future research. To improve the state of knowledge, there is a need to better understand factors and clinical outcomes related to polypharmacy in persons with SCI/D and to explore experiences of persons with SCI/D, caregivers and clinicians relating to polypharmacy. Prescribers should be aware of the factors and negative clinical outcomes related to polypharmacy and spinal cord injuries/dysfunction, especially for patients with higher level and more severe injuries. Prescribers should work with their patients with spinal cord injuries/dysfunction to avoid inappropriate polypharmacy and to integrate appropriate alternatives to medications. Optimizing medication management should be a significant focus of spinal cord injury/dysfunction rehabilitation and research in order to develop targeted interventions that improve patient outcomes. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this scoping review was to explore the literature on experiences and perspectives of patients with hip fractures and their caregivers during transitions in care. Methods: Seven databases were searched for studies published between 1 January 2000 and 3 July 2018. Grey literature was also searched. Results: Eleven articles met the inclusion criteria. The scoping review found that patients and caregivers encounter several challenges during care transitions including the following: lack of information sharing, role confusion and disorganized discharge planning. Common suggestions reported in the literature for improving care transitions were: increasing written communication, offering a patient representative role, using technology for knowledge dissemination and increasing geriatrician involvement. Conclusions: The results of this scoping review provide a useful foundation from which to build strategies to address challenges such as lack of information sharing, role confusion and disorganized discharge planning experienced by patients and caregivers during care transitions. Further research needs to explore the development of strategies to promote patient-centered care especially during discharge from an acute care facility. Encourage health care providers to collaborate with patients with hip fracture and caregivers on decision-making about rehabilitation and recovery goals, discharge planning and safe patient transfer. Assess the needs of patients with hip fracture and caregivers before, during and after a care transition to deliver patient and family-centered care across multiple care settings. Provide patients with hip fracture and caregivers standardized information-exchange tools to increase timely, accurate exchange of information during care transitions. Encourage formal discussions about roles and responsibilities in the transitions in care process among patients with hip fracture, caregivers and health care providers. [ABSTRACT FROM AUTHOR]

Despite emerging evidence on cost-related nonadherence (CRNA) to prescription medications, there is little conceptualization and exploration of this phenomenon with respect to disability. Specifically, there is a gap in the literature that explores factors influencing medication cost–adherence relationship among individuals living with a disability. To advance research on and policy for CRNA to medications among people with disabilities, we need a framework that can contribute towards guiding solutions to this problem. We examined the applicability of Piette and colleagues' existing model for CRNA to the context of people with disabilities and suggested an adapted model (CRNA to medications for persons with disability [CRNA-d]) that can provide a more specific conceptualization of CRNA with respect to disability. The adapted CRNA-d model depicts that CRNA to prescription medications with respect to disability is a dynamic and multifaceted phenomenon, determined by various socioeconomic, disability-related, medication-related, prescriber-related, and system-related factors. We discuss how higher susceptibility to health complications, barriers to income and employment, additional health care costs, the complexity of medical regimens, limited access to physician services, and other policy-related factors increase the risk of persons with disabilities to face cost-related barriers to fulfill their necessary medications. [ABSTRACT FROM AUTHOR]

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Introduction: Falls among older adults are common, and frequently result in injuries such as hip fractures. Following a hip fracture, patients experience numerous transitions in care between providers and across sectors. These transitions have been noted as a vulnerable time for patients and families, with the potential for poor health outcomes, readmission to hospital, medication errors, decreased satisfaction, and confusion. Despite being known as a challenging and vulnerable time, there are limited recommendations on how to improve transitions in care for older adults with hip fracture. Objectives and Methods: The objective of this qualitative study was to explore recommendations for improving transitions in care for older adults with hip fracture from the perspectives of patients, caregivers, healthcare providers, and decision-makers. To achieve this objective, we conducted indepth, semi-structured interviews with all participants. Follow-up interviews were conducted with patients and caregivers as they transitioned along their care journey. All interviews were audiorecorded for transcription. The transcripts were coded by three team members and descriptive and interpretive approaches were used to analyze the data. Patients were involved as participants and are involved as co-leaders in the next phase of research. Results: A total of 48 participants (15 patients, 15 healthcare providers, 10 caregivers, and 8 decision-makers) took part in 66 interviews between August 2018 and July 2019. Recommendations to improve transitions were based within three main categories: (1) hospital-based recommendations; (2) community-based recommendations; and (3) cross-sectoral based recommendations. Hospital-based recommendations included improving communication between hospital providers and between providers and families, increasing staffing levels, and treating patients and families with respect. Community-based recommendations included identifying atrisk individuals early and increasing community-based prevention and educational programs. Cross-sectoral based recommendations were grounded in enhanced system navigation through the introduction of care navigators. Conclusions: We identified the importance of integrated care for older adults with hip fracture, with an enhanced focus on the integration of community-based providers (primary care). The recommendations outlined have the potential to improve experiences within the hospital, in the community, and during care transitions for older adults with hip fracture. Implications for applicability/transferability, sustainability, and limitations: The majority of patient and caregiver participants were English-speaking and White. It is possible that individuals who speak English as a second language or who are from different ethnic/cultural backgrounds have differing experiences and therefore, additional recommendations on how to improve care transitions. This requires future research. [ABSTRACT FROM AUTHOR]

Background: There is a paucity of studies using administrative health data to examine the epidemiology, health care utilization, and outcomes for non-traumatic spinal cord dysfunction (NTSCD). Objective: The purpose of this study is to characterize discrete NTSCD cohorts using decision algorithms with Canadian health administrative databases. Method: Data were provided by the Canadian Institute for Health Information that included all acute care hospital, day surgery, ambulatory, and inpatient rehabilitation records of patients with neurological impairment between April 1, 2004 and March 31, 201 1. Diagnostic codes for neurological impairment and NTSCD etiology were used to identify cases and classify 3 NTSCD groups (most likely, probable, and possible). Logistic regression identified factors related to inpatient rehabilitation admission within 7 days of discharge among the preferred group. Results: The most likely NTSCD group (n = 6,362) was significantly older and had a greater proportion of women ard individuals with cauda equina lesions compared to the other 2 NTSCD groups (probable [n = 2,777] and possible [n = 1 1,1 79]; ps < .001). Factors associated with the likelihood of an inpatient rehabilitation admission included being older (odds ratio [OR], 1.01; 95% Cl, 1.00-1.01), being female (OR, 1.18; 95% Cl, 1.06-1.32), having paraplegia diagnosis compared to cauda equina |OR, 1.24; 95% Cl, 1.09-1.41), residing in an urban area compared to a rural area (OR, 1.34; 95% Cl, 1.13-1.58), having degenerative etiology compared to other (OR, 1.59; 95% Cl, 1.41-1.80), and having an MRI on record compared to not (OR = 1.57; 95% Cl, 1.39-1.76). Conclusion: Administrative data allow for ongoing surveillance of a population in a relatively cost-effective manner. Advancing our knowledge of NTSCD epidemiology, health outcomes, and system performance can inform policy and system planning. [ABSTRACT FROM AUTHOR]

Background: Administrative health data, such as the hospital Discharge Abstract Database (DAD), can potentially be used to identify patients with non-traumatic spinal cord dysfunction (NTSCD). Algorithms utilizing administrative health data for this purpose should be validated before clinical use. Objective: To validate an algorithm designed to identify patients with NTSCD through DAD. Method: DAD between 2006 and 2016 for Southern Alberta in Canada were obtained through Alberta Health Services. Cases of NTSCD were identified using the algorithm designed by the research team. These were then validated by chart review using electronic medical records where possible and paper records where electronic records were unavailable. Measures of diagnostic accuracy including sensitivity, specificity, and positive and negative predictive values and 95% confidence intervals (CI) were computed. Results: Two hundred and eighty cases were identified to have both the administrative codes for neurological impairments and NTSCD etiology. Twenty-eight cases were excluded from analysis as 5 had inadequate medical record information, 17 had traumatic spinal cord injury, and 6 were considered "other" non-spinal cord conditions. Measures of diagnostic accuracy that were computed were sensitivity 97% (95% CI, 94%-98%), specificity 60% (95% CI, 47%-73%), positive predictive value (PPV) 92% (95% CI, 88%-95%), and negative predictive value (NPV) 80% (95% CI, 65%-90%). The most prevalent etiologies were degenerative (36.9%), infection (19.0%), oncology malignant (15.1%), and vascular (10.3%). Conclusion: Our algorithm has high sensitivity and PPV and satisfactory specificity and NPV for the identification of persons with NTSCD using DAD, though the limitations for using this method should be recognized. [ABSTRACT FROM AUTHOR]

Background: The lack of consensus on the best methodology for identifying cases of non-traumatic spinal cord dysfunction (NTSCD) in administrative health data limits the ability to determine the burden of disease and provide evidence-informed services. Objective: The purpose of this study is to develop an algorithm for identifying cases of NTSCD with Canadian health administrative databases using a case-based approach. Method: Data were provided by the Canadian Institute for Health Information that included all acute care hospital and day surgery (Discharge Abstract Database), ambulatory (National Ambulatory Care Reporting System), and inpatient rehabilitation records (National Rehabilitation Reporting System) of patients with neurological impairment (paraplegia, tetraplegia, and cauda equina syndrome) between April 1, 2004 and March 31, 2011. The approach to identify cases of NTSCD involved using a combination of diagnostic codes for neurological impairment and NTSCD etiology. Results: Of the initial cohort of 23,703 patients with neurological impairment, we classified 6,362 as the "most likely NTSCD" group (had a most responsible diagnosis or pre-existing diagnosis of NTSCD and diagnosis of neurological impairment); 2,777 as "probable NTSCD" defined as having a secondary diagnosis of NTSCD, and 11,179 as "possible NTSCD" who had no NTSCD etiology diagnoses but neurological impairment codes. Conclusion: The proposed algorithm identifies an inpatient NTSCD cohort that is limited to patients with significant paralysis. This feasibility study is the first in a series of 3 that has the potential to inform future research initiatives to accurately determine the incidence and prevalence of NTSCD. [ABSTRACT FROM AUTHOR]