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Background The evaluation of Patient Reported Outcomes Measurement Information System (PROMIS) computerized adaptive test (CAT) in adults with systemic lupus erythematous (SLE) is an emerging field of research. We aimed to examine the test–retest reliability and construct validity of the PROMIS CAT in a Canadian cohort of patients with SLE. Methods Two hundred twenty-seven patients completed 14 domains of PROMIS CAT and seven legacy instruments during their clinical visits. Test–retest reliability of PROMIS was evaluated 7–10 days from baseline using intraclass correlation coefficient (ICC (2; 1)). The construct validity of the PROMIS CAT domains was evaluated against the commonly used legacy instruments, and also in comparison to disease activity and disease damage using Spearman correlations. A multitrait-multimethod matrix (MMM) approach was used to further assess construct validity comparing selected 10 domains of PROMIS and SF-36 domains. Results Moderate to excellent reliability was found for all domains (ICC [2;1] ranging from lowest, 0.66 for Sleep Disturbance and highest, 0.93 for the Mobility domain). Comparing seven legacy instruments with 14 domains of PROMIS CAT, moderate to strong correlations (0.51–0.91) were identified. The average time to complete all PROMIS CAT domains was 11.7 min. The MMM further established construct validity by showing moderate to strong correlations (0.55–0.87) between select PROMIS and SF-36 domains; the average correlations from similar traits (convergent validity) were significantly greater than the average correlations from different traits. Conclusions These results provide evidence on the reliability and validity of PROMIS CAT in SLE in a Canadian cohort.

Background. Individuals or persons who live with a disability (PWD) can experience unique financial occupation challenges. Financial education programs can address some challenges. Purpose. The aim of this study was to describe and critically appraise current financial education programs for PWD in Canada. Method. This environmental scan framed by scoping review methods included a critical appraisal of Canadian programs’ online content and provider consultations. Researchers used four search methods to identify programs, interviewed service providers from four Canadian programs, and thematically analyzed interview transcripts. Findings. Researchers identified 134 programs; 50 (37.3%) included services. The online content of only 26 (19%) programs explicitly addressed accessibility; 106 (79%) programs’ content was at least college reading level. The qualitative results include three themes: (a) individualized approach, (b) “getting the word out”, and (c) service growth. Implications. There are financial education programs specific to PWD in Canada. Accessibility, individualization, advocacy, and development are needed.

Introduction At least 38% of patients with Systemic Lupus Erythematosus (SLE) experience cognitive impairment (CI). Patients report CI impacts their health-related quality of life (HRQoL) and social role participation. Objectives To synthesize and critically appraise the quantitative literature on the relationship of CI to HRQoL and social role participation in individuals with SLE. Methods Six electronic databases were searched in December 2018 and June 2020 by an information specialist. Two reviewers independently completed all screening phases and data extraction; a third reviewer resolved disagreements. The Mixed Methods Appraisal Tool was used to critically appraise the quality of included studies. Data has been synthesized and analyzed descriptively to present evidence on the relationship of CI to HRQoL and social role participation. Results A total of 7182 references were identified and screened, with 14 articles included. Four of the included articles investigated the relationship between CI and HRQoL and all identified a negative relationship. Ten of the 14 studies investigated CI and social role participation, eight identified a negative relationship. There was heterogeneity of measures used between studies to examine CI, HRQoL, and social role participation. As such, results were interpreted descriptively and could not be pooled for meta-analysis. Conclusion The presence of CI is negatively related to HRQoL and social role participation in patients with SLE. Healthcare professionals should be aware of this relationship so that it can be addressed in clinical practice. Further research, using consistent methods of quantifying CI, HRQoL and social role participation, is needed to enable data pooling.

Objective To examine the extent, scope, and methodological quality of rehabilitation scoping reviews. Data Sources A comprehensive list of scoping reviews conducted in the broader health field (inception to July 2014), with a further update of that list (up to February 2017) using similar methods, including searching 9 electronic databases. Study Selection Articles were included if they were scoping reviews within rehabilitation. Established review methods were used including (1) a PubMed filter detecting rehabilitation content and (2) title-and-abstract screening by 2 independent reviewers applied sequentially to articles from the existing list of scoping reviews and to the updated search results. Full-text articles were reviewed by 1 reviewer, with discrepancies resolved by another after pilot screening with > 80% agreement. Remaining discrepancies were resolved by external experts. Data Extraction Two independent reviewers used piloted and standardized data extraction forms. Data Synthesis We screened 1823 records, including 992 full texts, to identify 251 rehabilitation-related scoping reviews. Rehabilitation scoping reviews had an exponential yearly increase since 2008 (r2=0.89; P Conclusions The increasing popularity of scoping reviews in rehabilitation has not been met by high standards in methodological quality. To increase the value of rehabilitation scoping reviews, rehabilitation stakeholders need to use existing methodological standards for the conduct, reporting, and appraisal of scoping reviews.

ObjectivesTo examine for latent patterns of SLE disease activity trajectories that associate with specific latent patterns of health-related quality of life (HRQoL; Medical Outcomes Study Short Form-36), and to determine baseline predictors of class membership.MethodsIn this retrospective longitudinal inception cohort of 222 SLE adults over 10 years, trajectories of three outcomes were studied jointly: Short Form-36 physical (PCS) and mental (MCS) component summaries and adjusted mean SLEDAI-2000 (AMS). Group-based joint trajectory modelling was used to model latent classes; univariable and multivariable analyses were used to identify predictors of class membership.ResultsFour latent classes were identified: Class 1 (C1) (24%) had moderate AMS, and persistently low PCS and MCS; C2 (26%) had low AMS, moderate PCS and improved then worsened MCS; C3 (38%) had moderate AMS, and persistently high PCS and MCS; and C4 (11%) had high AMS, moderate-low PCS and improving MCS. Baseline older age was associated with lower HRQoL trajectories. Higher AMS trajectories did not associate with a particular pattern of HRQoL trajectory. A higher prevalence of fibromyalgia (44% in C1) was associated with worse HRQoL trajectories. Disease manifestations, organ damage and cumulative glucocorticoid were not differentially distributed across the latent classes.ConclusionHigh disease activity did not necessarily associate with low HRQoL. More patients with worse HRQoL trajectories had fibromyalgia. Older age at diagnosis increased the probability of belonging to a class with low HRQoL trajectories. The care of SLE patients may be improved through addressing fibromyalgia in addition to disease activity.

Objectives To systematically review and synthesize literature on 1) the overall prevalence of depression and anxiety in SLE patients in identified studies, and 2) the pooled prevalence per metrics of depression and anxiety in adult SLE patients. Methods This review used (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) PRISMA guidelines and in-depth searches in four databases (1954-2016; Ovid-based Medline, Embase, PsycINFO and CINAHL) to identify articles on the prevalence of depression and/or anxiety in adult SLE patients. Included studies were critically appraised and analyzed. The prevalence of depression and anxiety was studied for all included studies, and whenever possible, pooled prevalence (PP) was determined for more commonly used metrics. Statistical and publication bias was assessed using funnel plots. Result A total of 3103 references were identified, 226 were selected for detailed review and 72 were included in the final analysis. Overall Prevalence The depression PP, obtained from 69 studies representing 23,386 SLE patients, was 35.0% (95% CI: 29.9%-40.3%). The anxiety PP, obtained from 38 studies representing 4439 SLE patients, was 25.8% (95% CI: 19.2%-32.9%). Prevalence per metrics used The more commonly used instruments included the Centre for Epidemiological Studies - Depression (CES-D), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Hospital Anxiety and Depression Scales (HADS-A/D), and Hamilton Rating Scales for Depression/Anxiety (HAM-D/A)]. The CES-D was utilized in 13 studies including 1856 SLE patients; depression PP was 41.5% (95% CI: 35.1%-48.1%). The BDI was utilized in 14 studies including 1355 SLE patients and the BAI in 3 studies including 489 patients; depression PP was 39.9% (95% CI: 31.1%-49.1) and anxiety PP was 38.4% (95% CI: 34.2%-42.8%). The HADS-D was utilized in 14 studies including 1238 SLE patients and the HADS-A in 12 studies including 1099 patients respectively; it's depression PP was 24.4% (95% CI: 19.1%-30.1%) and anxiety PP was 38.3% (95% CI: 29.1%-47.9%). The HAM-D was utilized in 4 studies including 267 SLE patients and the HAM-A in 4 studies including 213 patients respectively; its depression PP was 40.0% (95% CI: 23.0%-59.0%) and anxiety PP was 39.0% (95% CI: 32.0%-45.0%). Conclusion There was high variability in the prevalence of depression and anxiety, ranging from 8.7%-78.6% and 1.1%-71.4%, respectively. This could be attributed to the lack of consistency in the metrics used and its definition for depression and anxiety in SLE. Studies that used a specific metric, such as the CES-D, BDI or HAM-D, yielded similar depression prevalence. The HADS-D had the lowest prevalence. All metrics of anxiety yielded similar anxiety prevalence.

Background. Little is known about the financial management occupations of people living with brain injury, despite the importance of these to adult autonomy. Purpose. This work aims to develop a conceptual framework for financial management after adulthood acquired brain injury. Method. This qualitative study used grounded theory methods. Data included semistructured interviews of 10 adults living with brain injury and two close others who assist with financial management occupations. Analysis included initial and focused coding, memo writing, constant comparison, theoretical sampling of questions, and member checking. Findings. The Financial Management Activity Process conceptual framework describes a complex action process. This includes accounting for factors influencing financial choices and actions, and identifying and using a trusted personalized process, including using financial management strategies aligned with the constraints of factors. Implications. This conceptual framework may be useful to assessment and intervention development. It highlights the between-person and between-activity variability in financial management processes and strategy use.

Background Cognitive impairment is a common and frequently under-recognized complication of chronic kidney disease (CKD). Although there is extensive literature on cognitive interventions that can ameliorate cognitive impairment or associated negative outcomes in the general literature, the breadth and characteristics of cognitive interventions that have been studied in people with CKD are currently unclear. The objective of this scoping review is to identify and describe the literature on cognitive interventions for adults with CKD, including end-stage kidney disease (ESKD). Methods A scoping review following Joanna Briggs Institute methodology will be conducted. With assistance from an information specialist, we will search 5 electronic databases (MEDLINE [OVID], EMBASE, PsycINFO, Cochrane Central Register of Controlled Trials, and CINAHL Plus) using search terms that represent the target population (CKD) and concept (cognition), and conduct backward citation searching for additional literature. Eligible sources will be primary research studies (quantitative or qualitative) that investigate any intervention targeting cognition in adults (≥ 18 years) with CKD or ESKD, including those treated with dialysis. We will extract data about characteristics of interventions (e.g., type, underlying theory, design, location, and provider), populations (e.g., stage of CKD, age, sex, and type of cognitive impairment), and studies (e.g., authors, location, design, and reported findings). Article screening and data extraction will be performed by two to three reviewers. Data will be analyzed using descriptive statistics and narrative syntheses to characterize the literature on cognitive interventions for people with CKD. Discussion This study will provide a comprehensive overview of the cognitive interventions that have been studied for people with CKD. It will help identify research gaps within this population (e.g., types of interventions that have yet to be investigated; best practices in cognition research that have not been implemented) and inform the direction of future research in this field.

Clinicians, researchers, and outcome stakeholders have the crucial, albeit difficult, task of quantifying when a person or group experiences important change or difference on any given outcome measure, often in response to a specific intervention. The minimal clinically important difference (MCID) provides this quantified value of change/difference for a measure. There are many methods for MCID derivation, which can result in multiple values for the same measure. Thus, it is important for potential users of MCID values to be aware of the nuances of MCID development and cautions for interpreting values. This review outlines MCID-related definitions, methods, and guidelines.

OBJECTIVE: The purpose of this article is to synthesize and appraise the evidence regarding the use of oculomotor-based vision assessment to identify and monitor recovery from mild traumatic brain injury (mTBI). Specific objectives are to (1) identify changes in oculomotor-based vision following mTBI; (2) distinguish methods of assessment; (3) appraise the level and quality of evidence; and, if warranted, (4) determine clinical recommendations for assessment. METHODS: A systematic review was undertaken to identify and appraise relevant literature. A search was conducted of 7 databases of peer-reviewed literature from January 1990 to January 2015. Articles were included if study populations were clearly identified as having mTBI and used an assessment of oculomotor-based vision. Articles with pooled data (eg, mTBI and stroke), addressing afferent visual function (eg, visual field deficits) or using single case designs, were excluded. RESULTS: Twenty articles were selected for inclusion. Exploratory findings suggest that measurements of saccades, smooth pursuit, and vergence are useful in detecting changes associated with mTBI. Assessment methods included eye tracker protocols, optometric assessment, and the King-Devick test. CONCLUSION: The strength of this evidence is not yet sufficient to warrant clinical recommendations. Research using rigorous methods is required to develop reliable, valid, and clinically useful assessment protocols. Language: en

Background Cognitive impairment (CI) is a common neurobehavioural manifestation of systemic lupus erythematosus (SLE). In our recent systematic review, the prevalence of CI was 38% (95% CI 33% to 43%) with a wide variation (15%–79%), which may be due to differences in CI definitions and selection of neuropsychological tests across studies. We aim to report the prevalence of CI in a large cohort using a comprehensive battery (CB) of tests in which we operationalized the classification of CI. Methods Consecutive consenting SLE patients, aged 18–65 years, who attended a single center (Jul 2016-Feb 2018) were recruited. Patients were administered a CB that evaluates the major cognitive domains: Manual motor speed and dexterity, simple attention and processing speed, visual-spatial construction, verbal fluency, learning and memory (visuospatial and memory), executive functioning (untimed and timed). Patient scores were compared to a normative sample of age- and gender-matched healthy controls to obtain z-scores. CI was operationalized on the CB as a z-score of ≤−1.5 (as compared to controls) on ≥2 domains or z≤−2.0 on ≥1 domain. Descriptive statistics were used. Results Of the 199 patients (89% female), the mean age at SLE diagnosis was 28.3±10.4 and disease duration at enrolment was 14.3±10.2 years. The prevalence of CI was 37.7% (z≤−1.5 in ≥2 domains) and 49.8% (z≤−2.0 in ≥1 domains). Prevalence of patients with domain z-scores of ≤−1.5 and ≤−2.0 varied from 3.0%–46.2% and 0.5%–25.1% respectively (figure 1). The most affected domain was learning and memory (visuospatial and memory) in 92 (46.2%) patients based on z≤−1.5 on ≥2 subtests and 50 (25.1%) patients based on z≤−2.0 in ≥1 subtest. Conclusion Prevalence of CI using our CB ranged between 37.7%–49.8% (z≤−1.5 in≥2 domains and z≤−2.0 in≥1 domains respectively), which was higher than the pooled prevalence from previous reports of 38%. These differences in CI prevalence across studies could be attributed to different factors including the heterogeneity in patients’ demographics/comorbidities, sample size, the use of different metrics to determine CI, and the lack of a standardized definition of CI. Further studies are required to identify the best definition for CI and its metrics. Acknowledgment This project is funded by the Arthritis Society and the Physicians’ Services Incorporated Foundation.

Background Approximately 38% of adults living with Systemic Lupus Erythematosus (SLE) experience cognitive impairment (CI) that can detrimentally affect employment, disease self-management, and quality of life. Identifying those with SLE related CI is critical, but is difficult to do in busy and resource-limited clinics. The patient-reported 20-item Perceived Deficits Questionnaire (PDQ-20), used to screen for SLE related CI, could be less time and cost-burdensome than other objective instruments. However, there is a dearth of published measurement property evidence for using the PDQ-20 with SLE patients. In adults with Multiple Sclerosis the PDQ-20 is purported to have four factors (subscales): attention/concentration, retrospective memory, prospective memory, and planning/organization. This structure has not been examined in adults with SLE. The purpose of this study is to examine the factor structure and the internal consistency of the PDQ-20 in an SLE cohort. Methods Consecutive SLE patients aged 18–65 years were recruited from a single rheumatology center between July 2016 and March 2018. Patients completed the PDQ-20. Analyses included socio-demographic descriptive analyses and confirmatory factor analyses (CFA) of the purported PDQ-20 four-factor structure. Sample size calculations indicated that a cohort of n=177 was sufficient to perform the CFA (power=0.99). Analysis was completed on returned baseline PDQ-20 data using SAS® software. Results Patient demographics are presented in table 1. There was no missing PDQ-20 data. CFA model fitting was adequate (standardized root mean square residual=0.05; root mean square error of approximation=0.10; Bentler comparative fit index=0.90). All factor loadings were statistically significant (factor loading range 0.55–0.88; all t-value >9.82). All factors highly correlated with each other (correlation range: 0.87–0.97; all p Conclusions The CFA analyses indicate that while the fit of the four-factor model for the PDQ fits, the model could be improved. Particularly concerning is the different factor-pathways for seven items, item 19’s current low item-factor reliability, and the increased correlations between factors. In adult SLE patients, researchers and clinicians should be cautious in interpreting PDQ-20 results using the current four factors (subscales). Further validity analyses, including exploratory factor analyses, are needed.

Financial management skills-that is, the skills needed to handle personal finances such as banking and paying bills-are essential to a person's autonomy, independence, and community living. To date, no comprehensive review of financial management skills instruments exists, making it difficult for clinicians and researchers to choose relevant instruments. The objectives of this review are to: (a) identify all available instruments containing financial management skill items that have been used with adults with acquired cognitive impairments; (b) categorize the instruments by source (i.e., observation based, self-report, proxy report); and (c) describe observation-based performance instruments by populations, overarching concepts measured, and comprehensiveness of financial management items. Objective (c) focuses on observation-based performance instruments as these measures can aid in situations where the person with cognitive impairment has poor self-awareness or where the proxy has poor knowledge of the person's current abilities.Two reviewers completed two systematic searches of five databases. Instruments were categorized by reviewing published literature, copies of the instruments, and/or communication with instrument authors. Comprehensiveness of items was based on nine key domains of financial management skills developed by the authors.A total of 88 discrete instruments were identified. Of these, 44 were categorized as observation-based performance and 44 as self- and/or proxy-reports. Of the 44 observation-based performance instruments, 8 had been developed for acquired brain injury populations and 24 for aging and dementia populations. Only 7 of the observation-based performance instruments had items spanning 6 or more of the 9 financial management skills domains.The majority of instruments were developed for aging and dementia populations, and few were comprehensive. This review provides foundation for future instrument psychometric and clinimetric reviews. It a necessary first step in providing information to support decision making for clinicians and researchers selecting financial management skills instruments.

Objectives To critically appraise the measurement property evidence (ie, psychometric) for 8 observation-based financial management assessment instruments. Data sources Seven databases were searched in May 2015. Study selection Two reviewers used an independent decision-agreement process to select studies of measurement property evidence relevant to populations with adulthood acquired cognitive impairment, appraise the quality of the evidence, and extract data. Twenty-one articles were selected. Data extraction This review used the COnsensus-based Standards for the selection of health Measurement Instruments review guidelines and 4-point tool to appraise evidence. After appraising the methodologic quality, the adequacy of results and volume of evidence per instrument were synthesized. Measurement property evidence with high risk of bias was excluded from the synthesis. Data synthesis The volume of measurement property evidence per instrument is low; most instruments had 1 to 3 included studies. Many included studies had poor methodologic quality per measurement property evidence area examined. Six of the 8 instruments reviewed had supporting construct validity/hypothesis-testing evidence of fair methodologic quality. There is a dearth of acceptable quality content validity, reliability, and responsiveness evidence for all 8 instruments. Conclusions Rehabilitation practitioners assess financial management functions in adults with acquired cognitive impairments. However, there is limited published evidence to support using any of the reviewed instruments. Practitioners should exercise caution when interpreting the results of these instruments. This review highlights the importance of appraising the quality of measurement property evidence before examining the adequacy of the results and synthesizing the evidence.

More stringent exhaust emissions regulation of IC engines requires more detailed investigation of the aftertreatment and conversion processes of the exhaust flow. Here, we present three independent laser absorption spectrometers for the measurement of mole fractions and temperature during EGR, SCR aftertreatment and at the tail pipe end.

A mobile exhaust gas measuring TDLAS-system was tested on public roads. It is capable of in-situ detection of CO2 and H2O, using multi-pass cells at the tailpipe end, while electronic is located inside the car.

Impaired self-awareness related to acquired brain injury (ABI-ISA) can result in limitations in daily living activities and community participation. We hypothesise that with the appropriate interventions, outcomes for adults with ABI-ISA can be enhanced. The objectives of the study were to describe and examine critically the non-pharmacological intervention literature and to identify intervention elements that optimise everyday living outcomes in adults with ABI-ISA. Two reviewers selected articles and extracted data using five databases, a review protocol, and systematic review standards (i.e., Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Assessing the Quality and Applicability of Systematic Reviews (AQASR)). Included studies reported quantitative activity and participation intervention outcomes for people with stated or measured ABI-ISA, and the methodological quality of randomised controlled trials (RCT) was rated using the Physiotherapy Evidence Database scale (PEDro). Seventeen articles discussing 15 unique intervention studies were found, including two RCTs of good methodological quality. All studies reported improvements on measures of everyday living, utilised interventions with multiple therapeutic elements, and used various forms of external feedback. Evidence supports the use of intervention protocols including elements of experiential practice, external feedback, Socratic guided discussion, and metacognitive strategy training.

Safe patient handling (SPH) and positioning is a worldwide health care issue in both developed and developing countries. It is important for all caregivers and patients but especially for palliative care and oncology patients. While there is a wide breadth of curriculum available in developed countries, little information is available about how to teach SPH and positioning in a developing country where resources are very limited.This article describes the process and recommendations used by a Canadian multidisciplinary health professional team in developing SPH curriculums for palliative care communities in Nepal. Educational materials were developed to teach SPH to a group of health care professionals at a palliative care conference in Bhaktapur, Nepal, in addition to a number of other settings within the Kathmandu Valley area.Current barriers toward future development of SPH in Nepal are defined and discussed. The SPH curriculums that have been created are provided and specific recommendations are outlined. There is a dearth of research to guide SPH education in developing countries. SPH change requires long-term support and curriculums that are culturally sensitive and contextually appropriate.

A new generation of blood glucose meters is now available for use by people with diabetes and health professionals, but little independent evaluation data is available. Previous models are prone to a variety of errors. We compared the accuracy, precision and features of the six latest meters available in Australia as of 1996. Meters studied were the Mini-Accutrend and Advantage (Boehringer Mannheim), Precision QID and Companion 2 (MediSense), Glucometer Elite (Bayer) and Lynx (National Diagnostic Products). We measured the blood glucose levels of 50 people with diabetes with these meters, and compared them to a reference method (YSI glucose analyser). Error grid analysis confirmed that accuracy of all meters was sufficient for their intended use as patient monitors. Precision was assessed using 25 samples from control solutions provided for each meter, and the coefficient of variation calculated. Improvements in strip and meter technology in some models have increased ease of use and reduced the likelihood of user error. This study, when considered with individual preferences for various features and price should assist patients in choosing a new blood glucose meter.

OBJECTIVE. This pilot study explored the experiences of brain injury survivors after a change in financial management (FM) independence. METHOD. Using a qualitative descriptive design, 6 participants with acquired brain injury were recruited from a community brain injury organization and participated in semistructured interviews. Data were analyzed using thematic analysis. RESULTS. Three themes emerged from the interviews: (1) trajectory of FM change, involving family members as key change agents; (2) current FM situation, involving FM strategies such as automatic deposits and restricted budgets; and (3) the struggle for control, in which survivors desired control while also accepting supports for FM. CONCLUSION. This study identifies some of the challenges brain injury survivors face in managing their finances and the adjustment associated with a loss of FM independence. Occupational therapists should be aware of clients’ experiences when supporting them through a change in independence.

Medical record review (MRR) is often used in clinical research and evaluation, yet there is limited literature regarding best practices in conducting a MRR, and there are few studies reporting interrater reliability (IRR) from MRR data. The aim of this research was twofold: (a) to develop a MRR abstraction tool and standardize the MRR process and (b) to examine the IRR from MRR data. This study introduces the MRR-Conduction Model, which was used to implement a MRR, and examines the IRR between two abstractors who collected preinjury medical and psychiatric, incident-related medical and postinjury head symptom information from the medical records of 47 neurologically injured workers. Results showed that the percentage agreement was ≥85% and the unweighted κ statistic was ≥.60 for most variables, indicating substantial IRR. An effective and reliable MRR to abstract medical-related information requires planning and time. The MRR-Conduction Model is proposed to guide the process of creating a MRR.

Purpose: The purpose of this study was to investigate the impact of using a pedometer on time spent walking, in sedentary and overweight adults with type 2 diabetes participating in a coaching intervention. It was hypothesized that participants using a pedometer would spend more time walking than would nonpedometer participants. Method: A sample of 57 men and women with a mean age of 62 years participated in a randomized controlled trial in a community setting. Participants were allocated to either a pedometer and coaching (intervention) group or a coaching-only (control) group. Coaching for both groups involved education, goal setting, and supportive/motivational strategies to increase time spent walking. The duration of the study was 6 months, with blood pressure, glycosylated hemoglobin, anthropometric, and fitness measurements assessed at baseline and at 3-month intervals. Results: A repeated-measures analysis of variance indicated that the coaching-only group spent significantly more time walking than did the pedometer group. However, when an analysis of covariance with all the other variables as covariates was performed, group membership had no influence on time spent walking. Significant reductions in waist circumference and weight were achieved for both groups from baseline to 6 months. Cardiovascular fitness also increased significantly for both groups. Conclusion: The study demonstrated that previously sedentary older adults with type 2 diabetes, supported with a coaching intervention, were able to achieve the physical activity targets known to be beneficial to health. However, using a pedometer added no further benefit. Further research on the impact of specific coaching strategies in diabetes management is warranted.

The primary goal of this study was to identify ethnic differences in battered women's use of health, mental health, and spiritual coping strategies, as well as differences in the perceived helpfulness of each strategy. The authors recruited a sample of 376 African American and Caucasian victims of interpersonal violence from various sites. In comparison with Caucasian women in the sample, African American women were significantly more likely to report using prayer as a coping strategy and significantly less likely to seek help from mental health counselors. The 2 groups did not significantly differ in terms of the extent to which they sought help from clergy or medical professionals. African American women found prayer to be more helpful than did Caucasian women.

Purpose Medical chart or record review (MRR) is commonly used in epidemiological studies. However, there is a dearth of literature summarizing the most methodologically rigorous way to conduct this type of retrospective research. The purpose of this paper is to present a) guidelines concerning the development and implementation of a MRR based on a thorough literature review and b) methodological issues related to MRR within the context of a work-related traumatic brain injury (wrTBI) surveillance and prevention study involving MRR. Methods A comprehensive literature review regarding MRR methodological considerations was conducted. Key words including medical, chart, record, retrospective, review, method(s) and methodology were used within various databases such as Ovid, CINAHL, scholars-portal, PubMed, and Medline. The principles obtained from the literature were applied to a MRR reliability study concerning workers who sustained work related injuries, primarily wrTBI, and who were assessed at a multi-disciplinary neurology service in Ontario, Canada within the years 1998 & 1999. This MRR was designed to abstract variables related to pre-injury and incident related person, occupation and environment factors, and post-injury sequelae related to wrTBI to inform injury prevention strategies. Results The authors developed and utilized a model of MRR methodology, the MRR-Conduction Model, which outlines the relationships between different entities involved in a MRR. These entities include the investigator, the data abstractor(s), the data source, the abstraction tool, and the abstraction manual. Within each entity, guidelines were found that aided in creating a more feasible, effective and reliable MRR. These guidelines and their application to improved MRR reliability will be presented. Conclusion MRR is often perceived as an easy and potentially expedient data collection method however, creating an effective MRR takes planning and time. The MRR-Conduction Model facilitates understanding of the entities and relationships involved in using MRR methodologies.