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This study aimed to inform a measurement approach for older persons who wish to engage in active living such as participating in a walking program. The Patient Generated Index, an individualized measurement approach, and directed and summative content analyses were carried out. A sample size of 204 participants (mean age 75 years; 62% women) was recruited; it generated 934 text threads mapped to 460 unique categories within 45 domains with similarities and differences for women and men. The Capability, Opportunity, Motivation, and Behaviors Model best linked the domains. The results suggest that older persons identify the need to overcome impaired capacity, low motivation, and barriers to engagement to live actively. These are all areas that active living programs could address. How to measure the outcomes of these programs remains elusive.

The seventh edition of the Canadian Stroke Best Practice Recommendations for Rehabilitation and Recovery following Stroke includes a new section devoted to the provision of virtual stroke rehabilitation. This consensus statement uses Grading of Recommendations, Assessment, Development and Evaluations methodology and Appraisal of Guidelines for ResearchEvaluation II principles. A literature search was conducted using PubMed, Embase, and Cochrane databases. An expert writing group reviewed all evidence and developed recommendations, as well as consensus-based clinical considerations where evidence was insufficient for a recommendation. All recommendations underwent internal and external review. These recommendations apply to hospital, ambulatory care, and community-based settings where virtual stroke rehabilitation is provided. This guidance is relevant to health professionals, people living with stroke, healthcare administrators, and funders. Recommendations address issues of access, eligibility, consent and privacy, technology and planning, training and competency (for healthcare providers, patients and their families), assessment, service delivery, and evaluation. Virtual stroke rehabilitation has been shown to safely and effectively increase access to rehabilitation therapies and care providers, and uptake of these recommendations should be a priority in rehabilitation settings. They are key drivers of access to high-quality evidence-based stroke care regardless of geographical location and personal circumstances in Canada.

While underutilized, poststroke administration of the 10-m walk test (10mWT) and 6-minute walk test (6MWT) can improve care and is considered best practice. We aimed to evaluate provision of a toolkit designed to increase use of these tests by physical therapists (PTs).In a before-and-after study, 54 PTs and professional leaders in 9 hospitals were provided a toolkit and access to a clinical expert over a 5-month period. The toolkit comprised a guide, smartphone app, and video, and described how to set up walkways, implement learning sessions, administer walk tests, and interpret and apply test results clinically. The proportion of hospital visits for which each walk test score was documented at least once (based on abstracted health records of ambulatory patients) were compared over 8-month periods pre- and post-intervention using generalized mixed models.Data from 347 and 375 pre- and postintervention hospital visits, respectively, were analyzed. Compared with preintervention, the odds of implementing the 10mWT were 12 times greater (odds ratio [OR] = 12.4, 95% confidence interval [CI] 5.8, 26.3), and of implementing the 6MWT were approximately 4 times greater (OR = 3.9, 95% CI 2.3, 6.7), post-intervention, after adjusting for hospital setting, ambulation ability, presence of aphasia and cognitive impairment, and provider-level clustering. Unadjusted change in the percentage of visits for which the 10mWT/6MWT was documented at least once was smallest in acute care settings (2.0/3.8%), and largest in inpatient and outpatient rehabilitation settings (28.0/19.9% and 29.4/23.4%, respectively).Providing a comprehensive toolkit to hospitals with professional leaders likely contributed to increasing 10mWT and 6MWT administration during inpatient and outpatient stroke rehabilitation.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A390 ).

Purpose: Pelvic health physiotherapy involves sensitive practices including internal assessment and treatment of the pelvic floor. Pelvic health physiotherapy education is not standardized in Canada, which may lead to diverse experiences. The purpose of this study was to explore the education and practice experiences of pelvic health physiotherapists in Canada. Method: This descriptive qualitative study used semi-structured interviews with physiotherapists providing pelvic health services in Canada and a reflexive thematic analysis approach. Results: Based on interviews with 20 pelvic health physiotherapists (19 women and one man) from six provinces, we identified four themes: the right fit, managing vulnerability, the holistic nature of pelvic health physiotherapy, and entering pelvic health physiotherapy requires thoughtful consideration. Participants described pelvic health physiotherapy as the right fit for themselves personally and professionally. The clinical practice involved managing their patients, and their own vulnerability and taking a holistic and biopsychosocial approach to treating patients with pelvic health conditions. Participants described the importance of mentorship and a supportive clinical environment when entering the field. Conclusions: This study provides an understanding of pelvic health physiotherapists’ experiences, which can help to guide the advancement of pelvic health physiotherapy education and practice supports in Canada.

BackgroundCommunity-based exercise programs delivered through healthcare-community partnerships (CBEP-HCPs) are beneficial to individuals with balance and mobility limitations. For the community to benefit, however, these programs must be sustained over time.PurposeTo identify conditions influencing the sustainability of CBEP-HCPs for people with balance and mobility limitations and strategies used to promote sustainability based on experiences of program providers, exercise participants, and caregivers.MethodsUsing a qualitative collective case study design, we invited stakeholders (program providers, exercise participants, and caregivers) from sites that had been running a CBEP-HCP for people with balance and mobility limitations for ≥4 years; and sites where the CBEP-HCP had been discontinued, to participate. We used two sustainability models to inform development of interview guides and data analysis. Qualitative data from each site were integrated using a narrative approach to foster deeper understanding of within-organization experiences.ResultsTwenty-nine individuals from 4 sustained and 4 discontinued sites in Ontario (n = 6) and British Columbia (n = 2), Canada, participated. Sites with sustained programs were characterized by conditions such as need for the program in the community, presence of secure funding or cost recovery mechanisms, presence of community partners, availability of experienced and motivated instructors, and the capacity to allocate resources towards program marketing and participant recruitment. For sites where programs discontinued, diminished participation and/or enrollment and an inability to allocate sufficient financial, human, and logistical resources towards the program affected program continuity. Participants from discontinued sites also identified issues such as staff with low motivation and limited experience, and presence of competing programs within the organization or the community. Staff associated the absence of referral pathways, insufficient community awareness of the program, and the inability to recover program cost due to poor participation, with program discontinuation.ConclusionSustainability of CBEP-HCPs for people with balance and mobility limitations is influenced by conditions that exist during program implementation and delivery, including the need for the program in the community, and organization and community capacity to bear the program's financial and resource requirements. Complex interactions among these factors, in addition to strategies employed by program staff to promote sustainability, influence program sustainability.

BackgroundUse of standardized tools to assess balance and mobility limitations is a recommended practice in stroke rehabilitation. The extent to which clinical practice guidelines (CPGs) for stroke rehabilitation recommend specific tools and provide resources to support their implementation is unknown.PurposeTo identify and describe standardized, performance-based tools for assessing balance and/or mobility and describe postural control components challenged, the approach used to select tools, and resources provided for clinical implementation, in CPGs for stroke.MethodsA scoping review was conducted. We included CPGs with recommendations on the delivery of stroke rehabilitation to address balance and mobility limitations. We searched seven electronic databases and grey literature. Pairs of reviewers reviewed abstracts and full texts in duplicate. We abstracted data about CPGs, standardized assessment tools, the approach for tool selection, and resources. Experts identified postural control components challenged by each tool.ResultsOf the 19 CPGs included in the review, 7 (37%) and 12 (63%) were from middle- and high-income countries, respectively. Ten CPGs (53%) recommended or suggested 27 unique tools. Across 10 CPGs, the most commonly cited tools were the Berg Balance Scale (BBS) (90%), 6-Minute Walk Test (6MWT) (80%), Timed Up and Go Test (80%) and 10-Meter Walk Test (70%). The tool most frequently cited in middle- and high-income countries was the BBS (3/3 CPGs), and 6MWT (7/7 CPGs), respectively. Across 27 tools, the three components of postural control most frequently challenged were underlying motor systems (100%), anticipatory postural control (96%), and dynamic stability (85%). Five CPGs provided information in varying detail on how tools were selected; only 1 CPG provided a level of recommendation. Seven CPGs provided resources to support clinical implementation; one CPG from a middle-income country included a resource available in a CPG from a high-income country.ConclusionCPGs for stroke rehabilitation do not consistently provide recommendations for standardized tools to assess balance and mobility or resources to facilitate clinical application. Reporting of processes for tool selection and recommendation is inadequate. Review findings can be used to inform global efforts to develop and translate recommendations and resources for using standardized tools to assess balance and mobility post-stroke.Systematic Review Registrationhttps://osf.io/, identifier: 10.17605/OSF.IO/6RBDV.

PURPOSE Reactive balance training (RBT) aims to improve reactive balance control. However, because RBT involves clients losing balance, clinicians may view that it is unsafe or not feasible for some clients. We aimed to explore how clinicians implement RBT to treat balance and mobility issues. MATERIALS AND METHODS Physiotherapists and kinesiologists across Canada who reported that they include RBT in their practices were invited to complete telephone interviews about their experiences with RBT. Interviews were transcribed verbatim, and analysed using a deductive thematic analysis. RESULTS Ten participants completed telephone interviews, which lasted between 30-60 min. Participants primarily worked in a hospital setting (inpatient rehabilitation (n = 3); outpatient rehabilitation (n = 2)), and were treated clients with neurological conditions (n = 5). Four main themes were identified: 1) there is variability in RBT approaches; 2) knowledge can be a barrier and facilitator to RBT; 3) reactive balance control is viewed as an advanced skill; and 4) RBT experience builds confidence. CONCLUSIONS Our findings suggest a need for resources to make clinical implementation of RBT more feasible.Implications for rehabilitationTrust between the therapist and client improves self-efficacy and feelings of apprehension/fear when conducting reactive balance training.Being creative and improvising with equipment that is readily available in clinics enables reactive balance training, without the need for high-tech equipment.Clinicians should consider using standardized tools with reactive balance control components, such as the Balance Evaluation Systems Test or Performance Oriented Mobility Assessment, to assess balance control.

Background Considerable progress has been made to advance the field of knowledge translation to address the knowledge-to-action gap in health care; however, there remains a growing concern that misalignments persist between research being conducted and the issues faced by knowledge users, such as clinicians and health policy makers, who make decisions in the health care context. Integrated knowledge translation (IKT) is a collaborative research model that has shown promise in addressing these concerns. It takes advantage of the unique and shared competencies amongst researchers and knowledge users to ensure relevance of the research process and its outcomes. To date, core competencies have already been identified to facilitate training in knowledge translation more generally but they have yet to be prioritized for IKT more specifically. The primary aim of this study was to recruit a group of researchers and knowledge users to identify and prioritize core competencies for researchers and knowledge users to engage with IKT. Methods We recruited health care knowledge users (KUs) and researchers with experience and knowledge of IKT for a quantitative, cross-sectional study. We employed a modified Delphi approach consisting of three e-survey rounds to establish consensus on competencies important to IKT for KUs and researchers based on mean rating of importance and agreement between participants. Results Nineteen (73%) of the initial 26 participants were researchers (response rate = 41% in the first round; retention in subsequent rounds > 80%). Participants identified a total of 46 competencies important for IKT (18 competencies for KUs, 28 competencies for researchers) under 3 broad domains. Technical research skills were deemed extremely important for researchers, while both groups require teamwork and knowledge translation skills. Conclusions This study provides important insight into distinct and overlapping IKT competencies for KUs and researchers. Future work could focus on how these can be further negotiated and contextualized for a wide range of IKT contexts, projects and teams. Greater attention could also be paid to establishing competencies of the entire team to support the research co-production process.

BACKGROUND Electronic knowledge resources are readily available and typically target different audiences, including health professionals and the public, that is, those with lived experience and their relatives. The knowledge-to-action framework, in combination with the information assessment method (IAM), considering both the value-of-information construct and the conceptual model of acquisition-cognition-application, can be used to support the evaluation process of such resources. As an example, Stroke Engine is an evidence-based knowledge translation resource in stroke rehabilitation (assessments and interventions) for health professionals and students as well as individuals who have sustained a stroke and their relatives. According to Google Analytics, the website is perused >10,000 times per week. OBJECTIVE With the overall aim to improve the content available on Stroke Engine, we documented Stroke Engine users’ perceptions of situational relevance, cognitive impact, intention to use, and expected patient and health benefits regarding the information consulted. METHODS A web-based survey anchored in the IAM was made available via an invitation tab. The IAM is a validated questionnaire that is designed to assess the value of information. Sociodemographic characteristics were also collected, and a space for free-text comments was provided. Descriptive statistics were used, and thematic analysis was used for the free-text comments. RESULTS The sample consisted of 6634 respondents. Health professionals (3663/6634, 55.22%) and students (2784/6634, 41.97%) represented 97.18% (6447/6634) of the total responses. The remaining 2.82% (187/6634) of the responses were from individuals who had sustained a stroke (87/6634, 1.31%) and their relatives (100/6634, 1.51%). Regarding situational relevance, assessments (including selecting, obtaining, and interpreting results from a test) was the main topic searched by health professionals (1838/3364, 54.64%) and students (1228/2437, 50.39%), whereas general information on stroke rehabilitation was the top-ranked topic for nearly two-thirds of the individuals with stroke (45/76, 59%) and their relatives (57/91, 63%). Cognitive impact was characterized by learning something new. Intention to use was high (4572/6379, 71.67%) among the respondents and varied in context (eg, refine a topic, research, class assignments, teaching, and education). Respondents commented on ways to improve content. Expected patient and health benefits such as improvement in health and well-being was the top-ranked category for all 4 subgroups, followed by the avoidance of unnecessary or inappropriate treatment for health professionals (183/623, 29.4%) and a feeling of being reassured for individuals with stroke (26/75, 35%) and their relatives (28/97, 29%). CONCLUSIONS Valuable feedback on Stroke Engine was obtained in terms of its accessibility, relevance for informational needs and retrieval, accuracy, and applicability; however, of utmost importance is the potential implementation of its evidence-based content in clinical practice and the perceived expected impact on patients, their relatives, and their health professionals. The feedback received allowed for corrections and the identification of key topics for further development.

Community-based programmes can support healthcare systems by delivering preventive services and health promotion. This study aimed to determine the nature, range, and extent of theoretical models that guide the development of linkages between healthcare settings and community programmes. A scoping review guided by the Joanna Briggs Institute methodology and the PRISMA-ScR was conducted. Four databases (MEDLINE, EMBASE, CINAHL and PsycINFO) were searched on August 8, 2020. Two reviewers independently screened articles by title and abstract and divided the remaining articles for full-text screening. Articles that described the development of a theoretical model to guide the establishment of linkages between healthcare settings and community programmes, were peer-reviewed, and in English, were included. Articles that solely applied linkage models were excluded. One reviewer extracted data on study and model characteristics (e.g. model purpose, model components and relationships between components from the included articles). Categorical data were summarised using frequencies and percentages. Conventional content analysis was used for variables that had lengthier descriptions and variable terminology. The search identified 8926 records. Six articles describing six unique models were included in the review. Of the four models that described intended users, three (75%) identified primary care. Healthcare settings were identified in all models, with three (50%) focusing on primary care. Models used two or more linkage strategies: (1) agreeing on sharing resources, staff, and information, (2) coordinating services and referral processes, (3) planning and evaluation, (4) leadership, policies, and funding, (5) boundary spanning and (6) brokering. All models used the linkage strategy of agreeing on sharing resources, staff, and information. Findings provide important considerations for healthcare and community programme providers planning linkages. Future research should investigate the role and characteristics of community programmes in linkages, and linkages with other types of healthcare settings.

Objective Guidelines recommend task-oriented training and the use of standardized assessments to improve stroke-related mobility deficits. However, the German outpatient physical therapy prescription catalogue does not include these recommendations resulting in a possible gap between guideline recommendations and clinical practice. Therefore, the purpose of this study was to describe physical therapy practice patterns of stroke-related mobility deficits in the outpatient setting exemplified by the states Baden-Württemberg and Thuringia. Methods Using an online survey, physical therapists treating people with stroke in outpatient settings in Baden-Württemberg and Thuringia were recruited. The questionnaire was developed using a multi-step procedure. Using a case vignette and open-ended questions, preferred evaluation and treatment methods were assessed. Data were analyzed using content analysis and descriptive statistics. Results Data from 63 physical therapists were included in the analysis. Answers to the open questions showed a wide range of different citations. Of 186 citations on evaluation methods, 28 (15,1 %) were classified as “standardized assessments”, while 158 citations (84,9 %) were classified as “basic physical therapy evaluation (non-standardized)”. Standardized assessments were cited by 25% of participants. Of 182 citations on treatment methods, 69 (35,2%) were classified as “traditional therapies”. These traditional therapies were cited by 81 % of participants. Task-oriented training was not cited. Discussion Despite the small sample size our data confirm the insufficient guideline use in German physical therapy and contribute results on practice patterns in outpatient stroke settings. These results will be used to initiate theory-based implementation strategies aiming to optimize physical therapy for people with stroke.

Purpose: Reactive balance is a critical consideration for mobility and fall avoidance, but is under-assessed among physiotherapists. The objective of this study was to explore factors influencing physiotherapist perceptions about measuring reactive balance upon completion of a 12-month theory-based, multi-component intervention to increase use of a measure of reactive balance.Methods: A qualitative descriptive approach was used. Semi-structured interviews were conducted with 28 physiotherapists treating adults with balance impairment in three urban Canadian rehabilitation hospitals that participated in the intervention. Interviews explored perceptions of reactive balance measurement and perceived changes in clinical behavior. Thematic analysis involved multiple rounds of coding, review and discussion, theme generation, and interpretation of findings through individual analysis and team meetings.Findings: Participants expressed contrasting views about integrating reactive balance measurement in their practice, despite consistent acknowledgement of the importance of reactive balance for function. Three themes were identified highlighting factors that mediated perceptions about measuring reactive balance: patient characteristics; trust between physiotherapist and patient; and the role of physiotherapist fear.Conclusions: The findings highlight that decision making for measuring reactive balance in rehabilitation settings is complex. There is a need for additional work to facilitate long-term implementation of clinical reactive balance measurement, such as refining patient criteria for administration, ensuring sufficient time to establish a trusting relationship, and developing and testing strategies to address physiotherapist fear.IMPLICATIONS FOR REHABILITATIONReactive balance is important for falls prevention and mobility, but is under-assessed among physiotherapists.This study identified three factors that influenced uptake of reactive balance measurement among physiotherapists in rehabilitation settings: patient characteristics; trust between physiotherapist and patient; and the role of physiotherapist fear.Knowledge of the identified factors may assist with design and use of reactive and other balance measurements.Strategies aimed at developing trusting relationships between physiotherapist and patient along with addressing physiotherapist fear could facilitate the uptake of clinical reactive balance measurement.

BACKGROUND: Improving walking capacity is a key objective of post-stroke rehabilitation. Evidence describing the quality and protocols of standardized tools for assessing walking capacity can facilitate their implementation. OBJECTIVE: To synthesize existing literature describing test protocols and measurement properties of distance-limited walk tests in people post-stroke. METHODS: Electronic database searches were completed in 2017. Records were screened and appraised for quality. RESULTS: Data were extracted from 43 eligible articles. Among the 12 walk tests identified, the 10-metre walk test (10mWT) at a comfortable pace was most commonly evaluated. Sixty-three unique protocols at comfortable and fast paces were identified. Walking pace and walkway surface, but not walkway length, influenced walking speed. Intraclass correlation coefficients for test-retest reliability ranged from 0.80–0.99 across walk tests. Measurement error values ranged from 0.04–0.40 and 0.06 to 0.20 for the 10mWT at comfortable and fast and paces, respectively. Across walk tests, performance was most frequently correlated with measures of strength, balance, and physical activity (r = 0.26-0.8, p

Background and purpose Aerobic exercise is a recommended part of stroke best practices; yet, access to aerobic exercise programs within stroke rehabilitation remains limited and inconsistent. The purpose of this scoping review was to describe the nature and extent of barriers and facilitators to aerobic exercise implementation with adults post-stroke as reported by health care professionals. Methods MEDLINE, EMBASE, Web of Science, CINAHL, PsycINFO, and AMED Allied and Complementary Medicine were searched from inception to October 16, 2019. Research studies that examined health care professionals' barriers and facilitators to aerobic exercise implementation in adults post-stroke were included. Two reviewers independently conducted title and abstract screening, full-text evaluation, data extraction, and quality appraisal. The Theoretical Domains Framework was used to map the identified barriers or facilitators and to analyze and interpret the results. Results Four studies were included in the review. All studies involved surveys conducted among physical therapists and reported barriers related to "environmental context and resources" (eg, lack of equipment, time, staff), insufficient "knowledge" and "skills" (eg, safe aerobic exercise prescription and implementation), "beliefs about capabilities" (eg, uncertainty about exercise intensity and screening tools), and professional role and identity (eg, aerobic exercise not a priority). Access to and continued education in structured aerobic exercise programs and safety monitoring were identified facilitators. Discussion and conclusions Some of the identified barriers could be overcome with modeling and training in best practice, while others may require interventions targeting organizational environment and leadership. Future knowledge translation interventions should target the identified barriers and facilitators to implementing aerobic exercise.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A312).

IntroductionSouth Asian groups experience a higher burden of stroke and poorer functional outcomes after stroke than their White counterparts. However, within the stroke literature, there has been little focus on the unique poststroke needs of the South Asian community and opportunities for community-based services to address these needs.Research questionWhat is the current knowledge base related to the experiences and needs, including unmet needs of people living with stroke and their caregivers from South Asian communities living in high-income countries?AimsThis is a protocol for a review that intends to synthesise existing studies of the poststroke experiences and needs of individuals from South Asian communities to uncover opportunities for community-based resources to address these needs.Methods and analysisThis scoping review methodology will be guided by modified Arksey and O’Malley (2005) and Joanna Briggs Institute frameworks. A search on OVID Medline, OVID Embase, OVID PsycINFO, EBSCO CINAHL, the Cochrane Library, Scopus and Global Index Medicus will be conducted to synthesise existing peer-reviewed literature (all study designs). Grey literature will be searched through detailed hand searching. Literature focusing on the poststroke experiences and needs of South Asian groups impacted by stroke residing in high-income countries will be included. Study descriptors will be extracted (eg, study location, type, methodology). Data will be analysed descriptively and thematically. Team meetings will provide opportunities for peer debriefing, thereby enhancing analytic rigour.Conclusion and implicationsFindings will enhance knowledge of the poststroke experiences and needs of South Asian communities living in high-income countries and identify actionable opportunities for community-based resources to address needs.Ethics and disseminationEthics approval was not required for this scoping review protocol. Community-based organisations will be consulted to provide insights into the analysis and assist with dissemination. Dissemination of findings will also occur through a publication and academic presentations.

Identifying individuals at risk for falls during inpatient stroke rehabilitation can ensure timely implementation of falls prevention strategies to minimize the negative personal and health system consequences of falls.To compare sociodemographic and clinical characteristics of fallers and non-fallers; and evaluate the ability of the Berg Balance Scale (BBS) and Morse Falls Scale (MFS) to predict falls in an inpatient stroke rehabilitation setting.A longitudinal study involving a secondary analysis of health record data from 818 patients with stroke admitted to an urban, rehabilitation hospital was conducted. A fall was defined as having ≥1 fall during the hospital stay. Cut-points on the BBS and MFS, alone and in combination, that optimized sensitivity and specificity for predicting falls, were identified.Low admission BBS score and admission to a low-intensity rehabilitation program were associated with falling (p .05). Optimal cut-points were 29 for the BBS (sensitivity: 82.4%; specificity: 57.4%) and 30 for the MFS (sensitivity: 73.2%; specificity: 31.4%) when used alone. Cut-points of 45 (BBS) and 30 (MFS) in combination optimized sensitivity (74.1%) and specificity (42.7%).A BBS cut-point of 29 alone appears superior to using the MFS alone or combined with the BBS to predict falls.

Introduction: Despite aerobic exercise (AE) testing being a key recommendation for stroke rehabilitation, less than half of physical therapists working with individuals post-stroke perform this practice. Concern for adverse cardiovascular events and inadequate guidance on how to conduct AE testing for individuals with stroke and comorbidity are key barriers. This review aims to describe submaximal AE testing protocols with evidence of safety, defined as less than 11% occurrence of serious adverse events, for people with subacute stroke and comorbidity. Methods: MEDLINE, EMBASE, PsycINFO, CINAHL and SPORTDiscus were searched from inception to October 29, 2020. Published studies that involved submaximal AE testing with individuals with subacute stroke and reported on adverse events during testing were included. Two reviewers independently conducted title and abstract, and full-text screening. One reviewer conducted data extraction, verified by a second reviewer. Results: Sixteen studies involving 595 participants were included. Hypertension (35%), cardiovascular disease (14%) and atrial fibrillation (8%) were the most common cardiovascular comorbidities, while, diabetes (25%), dyslipidemia (23%) and smoking history (11%) were the most common general comorbidities affecting participants with stroke. Evidence of safety for individuals with stroke and comorbidity was found for incremental bicycle (n=5), recumbent stepper (n=3), body weight support treadmill (n=1) and upper extremity ergometer (n=1) protocols; constant load bicycle (n=1) and body weight support treadmill (n=1) protocols; and field (n=10) protocols. Heart rate (95%), blood pressure (82%) and oxygen consumption (72%) monitoring were most frequently done. Test termination criteria based on volition/fatigue (59%) and heart rate (55%) were most commonly reported. Conclusion: A range of submaximal AE testing protocols utilizing diverse exercise modalities can be safely conducted on people with subacute stroke and comorbid conditions that are perceived to increase the risk for serious adverse events. These protocols can be used to guide the development of more specific clinical practice guidelines for conducting AE testing on individuals with stroke and comorbidity.

Objective To compare two methods of knowledge broker support to improve standardized assessment use. Design Two-site cluster randomized trial. Setting Acute rehabilitation hospital. Participants 18 physical therapists. Intervention A 10-month intervention was collaboratively designed with an external knowledge broker and physical therapists to compare full and partial implementation support. The knowledge broker provided education and strategies for implementation to the fully supported group and recommended strategies to the partially supported group that they self-implemented. Measurement Chart audit data documenting frequency of use was extracted at four timepoints. Ten focus groups were conducted to describe factors that influenced use. Focus group data were coded using the Consolidated Framework for Implementation Research and rated as barriers and facilitators for standardized assessment use. Results For the fully supported group, standardized assessment use at initial examination increased from 0% to 58.3% at month 2 and decreased to 17.6% and 11.8% at months 4 and 8–10. For the partially supported group, standardized assessment use increased from 0% to 46% and 50% at month 2 and 4 and decreased to 2.8% at months 8–10. For both groups, early use was seen multiple facilitators. At month 10, barriers included organizational changes that impacted intervention fit. In addition, the fully supported group didn't value the selected standardized assessment and the partially supported group lacked space. Conclusions Knowledge broker support improved both groups standardized assessment use early on, but it was not sustained. The amount of support could not be isolated as factors that influenced use varied by groups.

The sixth update of the Canadian Stroke Best Practice Recommendations: Rehabilitation, Recovery, and Reintegration following Stroke. Part one: Rehabilitation and Recovery Following Stroke is a comprehensive set of evidence-based guidelines addressing issues surrounding impairments, activity limitations, and participation restrictions following stroke. Rehabilitation is a critical component of recovery, essential for helping patients to regain lost skills, relearn tasks, and regain independence. Following a stroke, many people typically require rehabilitation for persisting deficits related to hemiparesis, upper-limb dysfunction, pain, impaired balance, swallowing, and vision, neglect, and limitations with mobility, activities of daily living, and communication. This module addresses interventions related to these issues as well as the structure in which they are provided, since rehabilitation can be provided on an inpatient, outpatient, or community basis. These guidelines also recognize that rehabilitation needs of people with stroke may change over time and therefore intermittent reassessment is important. Recommendations are appropriate for use by all healthcare providers and system planners who organize and provide care to patients following stroke across a broad range of settings. Unlike the previous set of recommendations, in which pediatric stroke was included, this set of recommendations includes primarily adult rehabilitation, recognizing many of these therapies may be applicable in children. Recommendations related to community reintegration, which were previously included within this rehabilitation module, can now be found in the companion module, Rehabilitation, Recovery, and Community Participation following Stroke. Part Two: Transitions and Community Participation Following Stroke.

Zusammenfassung Hintergrund Die EPIC-Skala (evidence-based practice confidence (EPIC) scale) ist ein Fragebogen zur Selbsteinschatzung, evidenzbasiert arbeiten zu konnen. Die Skala wurde in Kanada fur Gesundheitsberufe entwickelt und basiert auf der Selbstwirksamkeits-Theorie von Bandura. Sie beinhaltet 11 Aussagen zur selbststandigen Organisation und Durchfuhrung von Schritten der evidenzbasierten Praxis (EBP). Ziel dieser Arbeit war es, in einem ersten Schritt die EPIC-Skala in die deutsche Sprache zu ubersetzen, deren Verstandlichkeit im deutschsprachigen Raum zu prufen und die Skala interkulturell anzupassen. Methode Die Ubersetzung erfolgte nach international anerkannten Leitlinien. Nach zwei unabhangigen Ubersetzungen ins Deutsche und zwei unabhangigen Ruckubersetzungen wurden in einer ExpertInnenrunde Unstimmigkeiten vor dem Hintergrund der interkulturellen Verstandlichkeit diskutiert und eine vorlaufige deutsche Version erstellt. Die Verstandlichkeit dieser Version wurde an PhysiotherapeutInnen aus der Schweiz, Osterreich und Deutschland getestet. Die Teilnehmenden wurden uber einen bewussten Stichprobenplan rekrutiert und mit Hilfe eines halbstrukturierten Interviewleitfadens (kognitives Interview) telefonisch befragt. Die mit einem Diktiergerat aufgenommenen Interviews wurden durch zwei Autorinnen unabhangig voneinander nach einem strukturierten Auswertungsschema analysiert. Basierend auf den Interviewergebnissen wurde die finale Version der deutschen Ubersetzung erstellt. Alle Anderungen wurden mit der Autorin der EPIC-Skala abgestimmt. Ergebnisse Sechzehn PhysiotherapeutInnen aus den drei deutsch-sprachigen Landern wurden interviewt. Die demografischen Daten zeigen eine gleichmasige Verteilung des Herkunftslandes, der Altersgruppen, Berufsabschlusse und Berufserfahrung. Die Teilnehmenden gaben an, dass die Skala im Allgemeinen gut verstandlich sei. Gleichzeitig wurde ruckgemeldet, dass (zu) viele wissenschaftliche Begriffe zu Verstandnisschwierigkeiten fuhren oder diese Begriffe zum Teil unbekannt seien. In der Erstellung der finalen Version wurde besonders auf eine Vereinfachung und Kurzung des Satzbaus und auf Paraphrasierungen schwer verstandlicher Begrifflichkeiten geachtet. Auserdem wurden die Instruktionen erganzt, um die zum Teil mangelnde Kenntnis wissenschaftlicher Begrifflichkeiten zu adressieren. Schlussfolgerungen Die EPIC-Skala wurde erfolgreich in die deutsche Sprache ubersetzt und interkulturell angepasst. Die Skala konnte zukunftig eingesetzt werden, um die Selbstwirksamkeit in Bezug zu EBP im Rahmen von Fortbildungsangeboten, Lehrveranstaltungen oder Umfragen zu evaluieren. Vorab sollte die Reliabilitat und Validitat der deutschen Skala unter Einbezug weiterer Gesundheitsberufe untersucht werden.

Background: Stroke-specific protocols for the 10-meter and 6-minute walk tests that include instructions for people with aphasia, accessible walkway lengths, and allow provision of assistance to wa...

Family caregivers provide essential support to individuals recovering after experiencing a stroke. Although clinical guidelines recommend the provision of caregiver education and support, these guidelines have not been implemented into standard clinical practice. The objective of this study was to gain insight from key informants-affiliates of a regional stroke system-to identify organization and system level barriers and facilitators associated with implementing stroke caregiver programs.Twelve key informants were interviewed. Informants discussed their experiences with and perceptions of caregiver programs. They also identified barriers and facilitators to implementing caregiver programs. Interview data were analyzed using inductive thematic analysis.Three themes were generated: (1) lack of consensus on the need for caregiver education and support programs as part of the health care system; (2) a collaborative process is needed to engage stakeholders and identify champions (3) stakeholders need different types of evidence in support of implementation.This study provides initial insight into the potential barriers and facilitators needed to develop and implement stroke caregiver programs. Further exploration of these topics can inform caregiver program development and their implementation into stroke systems of care.IMPLICATIONS FOR REHABILITATIONRehabilitation research needs to demonstrate that caregivers are a unique group in need of support from the health care system.Rehabilitation research needs to contribute to the evidence that caregiver programs can improve patient, caregiver, and health system outcomes.Researchers can enhance caregiver program implementation through collaboration between researchers, stakeholders, and system change champions starting with program development.

BACKGROUND AND PURPOSE Although outcome measures are a valuable part of physical therapy practice, there is a gap in routine outcome measurement use by physical therapists (PTs). Knowledge brokers (KBs) are individuals who can collaborate with PTs to facilitate outcome measure use. The purpose of this study was to determine whether an intervention tailored by an external KB, cocreated with the PTs and supported by the supervisor, would increase the use of gait speed by PTs working at an inpatient subacute rehabilitation hospital. METHODS A mixed-methods study was conducted with 11 PTs. The 2-month intervention included education, documentation changes, audit and feedback, goal setting, and organizational support. Use of the 4-meter walk test was measured through chart audits and was self-assessed with the Goal Attainment Scale. Proportions were calculated to determine the number of times gait speed was documented by the PTs both at initial examination (IE) and at discharge. A repeated-measures analysis of variance was used to determine significant differences from baseline (3-month retrospective chart audit), 0 to 2, 2 to 4, 4 to 6, and 6 to 8 months. A Wilcoxon signed rank test was used to determine significant differences in self-reported use on the Goal Attainment Scale month 0 to month 2. Focus groups immediately following the intervention (month 2) and at follow-up (month 9) were used to determine barriers to measuring gait speed and perceptions of the intervention. Open coding was used to identify key themes. A comparison group of per diem PTs was trained by the supervisor between months 4 and 8, using the approach developed by the KB. The comparison group was included as their training may have influenced the experimental groups' outcome. Chart audit data for the comparison group from months 0 to 2, 2 to 4, 4 to 6, and 6 to 8 were reported descriptively. RESULTS AND DISCUSSION Documentation of the 4-meter walk test significantly improved from the 3-month retrospective chart audit at baseline (0% IE, 0% discharge) to months 0 to 2 at IE (mean = 71%, SD = 31 %, F = 9.30, P < .001) and discharge (mean = 66%, SD = 30%, F = 14.16, P < .001) and remained significantly higher at months 6 to 8 follow-up for IE (mean= 63%, SD 21%) and discharge (mean=59%, SD 32%). Eleven PTs participated in the focus group at month 2 and reported that the knowledge translation strategies including documentation changes, environmental cues, and social support helped facilitate their behavior change. Lack of space and the patient's activity limitations were barriers. The PTs significantly improved self-reported use of gait speed using the Goal Attainment Scale from month 0 to month 2 at IE: -2 to 0 (0% use to 50%) (Z = -2.842, P = .004) and discharge: -2 to 1 (0% use to 75%) (Z = -2.448, P = .014). The comparison group increased documented use of gait speed from 0% to 25% at IE and 47% at discharge between months 6 and 8. CONCLUSION The KB, with supervisor support, successfully collaborated with the PTs to tailor an intervention to address local barriers to consistently use the 4-meter walk test. The PTs significantly improved the documented use of gait speed following the intervention. The PTs reported that the intervention facilitated outcome measure use although barriers to using gait speed remained.

Purpose: The purpose of this study was to describe the nature and extent of publications and to evaluate whether lead advisor role and experience, data collection tool, sample size, and research topic predict publication for research projects completed as part of a Canadian Master of Science in Physical Therapy (MScPT) programme. Method: We conducted a quantitative, cross-sectional, retrospective review of projects completed between 2003 and 2015 and confirmed publication status through citations of published work, a literature search, and a survey of advisors. We used descriptive statistics to describe the nature and extent of publications and logistic regression to analyze potential predictor variables. Results: Between 2003 and 2015, 44.5% of the 218 projects completed were associated with at least one peer-reviewed journal publication, and there was a seven-fold increase in annual publication rate. Projects led by a scientist or researcher ([OR] = 3.09; 95% CI: 1.15, 8.35), qualitative projects with 10 or more participants ([OR] 6.22; 95% CI: 1.96, 19.78), and quantitative projects with more than 50 participants ([OR] = 2.29; 95% CI: 1.14, 4.63) were associated with an increased likelihood of publication. Conclusions: MScPT research is published at a moderate rate, and annual publication rates increased between 2003 and 2015. Encouragement to obtain adequate sample sizes and additional support for clinician-led projects may enhance publication rates and, ultimately, bridge gaps in research-to-practice integration.

Background: The long-term consequences of traumatic brain injury can create major barriers to community integration. Peer support represents a sustainable model of support across this transition. The objective of the current study was to determine the feasibility of conducting a randomized controlled trial on the Ontario Brain Injury Association Peer Support Program and the preliminary effectiveness of the program on community integration, mood, health-related quality of life, and self-efficacy, Methods: A pilot feasibility randomized controlled trial with an embedded qualitative component was conducted. Mentees with moderate-to-severe traumatic brain injury (n = 13) were randomized to a weekly intervention or waitlist control group. Interviews were conducted with a subset of mentees and peer mentors (n = 10). Integration of the quantitative and qualitative data was completed using a joint display approach, Results: No statistically significant results were found for community integration, mood, or self-efficacy, however, changes in these outcomes were accompanied by moderate-to-large effect sizes. Within health-related quality of life, the mean pain score of the intervention group was significantly lower than that of the control group at the two-month timepoint but not at completion. Interviews revealed proximal improvements in knowledge, skills, and goals, and identified two domains related to trial acceptability: (1) environmental context and resources, and (2) reinforcement, Conclusions: Given the conceivable importance of proximal improvements in domains such as knowledge, skills, and/or goals for the attainment of more distal outcomes, modifications to the existing Peer Support Program may be warranted. The introduction of program recommendations which promote discussion around particular domains may help facilitate long-term improvements in health outcomes.

BackgroundTo develop a priority-based patient/parent reported outcome measure for children with lower-limb differences (LD) by adapting the Gait Outcomes Assessment List (GOAL) questionnaire.MethodsGuided by a conceptual framework of patient priorities, the GOAL questionnaire was iteratively modified and its sensibility evaluated by field-testing it on children with LD, and their parents. Cognitive interviews were conducted with a subgroup of these children, and an e-survey administered to a multidisciplinary group of health care professionals with expertise in paediatric LD. Findings were integrated to create the final version of the GOAL-LD.ResultsTwenty-five children (9–18 years), 20 parents, and 31 healthcare professionals evaluated the content and sensibility of the GOAL, with an emphasis on the relevance and importance of the items to patients’ health related quality of life (HRQL). This resulted in the retention of 26 of the original 50 items, elimination of 12, modification of 12, and addition of seven new items. The new 45-item GOAL-LD questionnaire was shown to be sensible, and its content deemed important.ConclusionsThe GOAL-LD questionnaire has a high level of face and content validity, and sensibility. It comprehensively captures the HRQL goals and outcomes that matter to children with LD and their parents. Following further psychometric evaluation, the GOAL-LD may serve as a much needed patient and parent reported outcome measure for this population.

Limited community ambulation, defined as independent mobility outside the home, predicts adverse outcomes in older adults. We performed a systematic review and meta-analysis to examine outdoor community ambulation intervention effectiveness in older adults. We searched six databases until October 2021. Studies with an evaluative research objective, older adult population, and outdoor community ambulation interventions were eligible. After reviewing 23,172 records, five studies were included. The meta-analysis found no significant difference in walking endurance and depression outcomes between outdoor community ambulation and comparison interventions. For outcomes not suitable for meta-analysis, studies showed no significant difference in walking activity, anxiety, and general and health-related quality of life, and possible improvements in gait speed and lower extremity function and strength. Most evidence was of low to very low certainty. Considering the limited evidence base, the design, implementation, and evaluation of outdoor community ambulation interventions in older adults should be prioritized in primary research.

Safety guidelines resulting from the coronavirus disease 2019 pandemic may reduce physical activity participation of older adults, particularly prefrail and frail individuals. The objective was to explore older adults’ experiences with physical activity during the coronavirus disease 2019 pandemic. Using a qualitative descriptive approach, interviews were conducted with 16 older adults. Data were analyzed thematically. Two themes emerged: (a) coming to a standstill and (b) small steps. Participants described that imposed provincial and federal recommendations caused them to reduce their physical activity with negative consequences. As time progressed, participants used emerging public health knowledge about coronavirus disease 2019 to safely increase physical activity. Many participants developed strategies to remain active during the pandemic (e.g., wearing a pedometer, walking outdoors at particular times of day). Findings from this study can better inform the development of programs, clinical practice, and policy for physical activity promotion in older adults during periods of physical distancing and isolation.

Background: To develop a priority-based patient/parent reported outcome measure for children with lower-limb differences (LD) by adapting the Gait Outcomes Assessment List (GOAL) questionnaire. Methods: Guided by a conceptual framework of patient priorities, the GOAL questionnaire was iteratively modified and its sensibility evaluated by field-testing it on children with LD, and their parents. Cognitive interviews were conducted with a subgroup of these children, and an e-survey administered to a multidisciplinary group of health care professionals with expertise in paediatric LD. Findings were integrated to create the final version of the GOAL-LD.Results: Twenty-five children (9-18 years), 20 parents, and 31 healthcare professionals evaluated the content and sensibility of the GOAL, with an emphasis on the relevance and importance of the items to patients’ health related quality of life (HRQL). This resulted in the retention of 26 of the original 50 items, elimination of 12, modification of 12, and addition of seven new items. The new 45-item GOAL-LD questionnaire was shown to be sensible and its content deemed important.Conclusions: The GOAL-LD questionnaire has a high level of face and content validity, and sensibility. It comprehensively captures the HRQL goals and outcomes that matter to children with LD and their parents. Following further psychometric evaluation, the GOAL-LD may serve as a much needed evaluate patient and parent reported outcome measure for this population.

The iWalk study showed that 10-meter walk test (10mWT) and 6-minute walk test (6MWT) administration post-stroke increased among physical therapists (PTs) following introduction of a toolkit comprising an educational guide, mobile app, and video. We describe the use of theory guiding toolkit development and a process evaluation.We used the knowledge-to-action framework to identify research steps; and a guideline implementability framework, self-efficacy theory, and the transtheoretical model to design and evaluate the toolkit and implementation process (three learning sessions). In a before-and-after study, 37 of the 49 participating PTs completed online questionnaires to evaluate engagement with learning sessions, and rate self-efficacy to perform recommended practices pre- and post-intervention. Thirty-three PTs and 7 professional leaders participated in post-intervention focus groups and interviews, respectively.All sites conducted learning sessions; attendance was 50-78%. Self-efficacy ratings for recommended practices increased and were significant for the 10mWT (The approach may help to inform toolkit development to advance other rehabilitation practices of similar complexity.Implications for RehabilitationToolkits are an emerging knowledge translation intervention used to support widespread implementation of clinical practice guideline recommendations.Although experts recommend using theory to inform the development of knowledge translation interventions, there is little guidance on a suitable approach.This study describes an approach to using theories, models and frameworks to design a toolkit and implementation strategy, and a process evaluation of toolkit implementation.Theory-based features of the toolkit and implementation strategy may have facilitated toolkit implementation and practice change to increase clinical measurement and interpretation of walking speed and distance in adults post-stroke.

Introduction Traumatic brain injury (TBI) is estimated to affect 10 million people annually, making it a leading cause of morbidity and mortality worldwide. One cost-effective intervention that has been shown to minimize some of the negative sequelae after TBI is peer support. However, the evidence supporting the benefits of peer support for individuals with TBI is sparse and of low quality. Integrated knowledge translation (iKT) may be one approach to optimizing the evaluation of peer support programs among individuals with TBI. Therefore, the objectives are: (1) To understand key informants’ perspectives of the barriers and facilitators of participating in peer support research and programs among individuals with TBI; (2) to understand key informants’ perspectives on the perceived impacts of peer support programs on individuals with TBI; and, (3) to demonstrate how an iKT approach can inform the development and implementation of a pilot feasibility randomized controlled trial (RCT). Methods A qualitative descriptive approach using one-on-one semi-structured interviews was used. Purposive sampling of 22 key informants included 8 peer support mentors, 4 individuals with TBI who received peer support, 3 caregivers of individuals with TBI, 4 peer support program staff, and 3 academics in peer support and/or TBI. Results There were five main themes related to the barriers and facilitators to participating in peer support research and programs: knowledge, awareness, and communication; logistics of participating; readiness and motivation to participate; need for clear expectations; and matching. There were three main themes related to the perceived impact of peer support: acceptance, community, social experiences; vicarious experience/learning through others: shared experiences, role-modelling, encouragement; and “I feel better.” Discussions with our Research Partner led to several significant adaptations to our trial protocol, including removing the twice/week intervention arm, shortening of the length of trial, and changing the measure for the community integration outcome. Discussion/Conclusion This is the first study to use an iKT approach to inform a trial protocol and the first to assess the barriers and facilitators to participating in peer support research.

Objective Best practice guidelines recommend that aerobic exercise (AEx) be implemented as early as possible poststroke, yet the prescription of AEx remains limited in stroke rehabilitation settings. This study used theoretical frameworks to obtain an in-depth understanding of barriers and enablers to AEx implementation in the stroke rehabilitation setting. Methods A qualitative, descriptive study was conducted. Participants were recruited from 4 stroke rehabilitation settings in Ontario, Canada, that have participated in an implementation study to provide structured AEx programming as part of standard care. Six clinician focus groups (with 19 physical therapists and 5 rehabilitation assistants) and one-to-one interviews with 7 managers and 1 physician were conducted to explore barriers and enablers to AEx implementation. The Theoretical Domains Framework and Consolidated Framework for Implementation Research informed content analysis for clinician and manager perspectives, respectively. Results Barriers specific to resource constraints and health care system pressures, combined with patient goals, led to interventions to improve function being prioritized over AEx. Successful implementation was enabled through an interprofessional approach and team engagement in the planning and implementation process. Health care providers described concerns about patient safety, but confidence and capability for implementing AEx were enabled by education, skill development, use of exercise tests, and consultation with individuals with content expertise. Participants described the development of supportive processes that enabled AEx implementation within team workflows and shared resources. Conclusion Strategies to support implementation of AEx in stroke rehabilitation should incorporate knowledge and skills, the provision of clinical decision-making tools, access to expert consultation, the roles and social influence of the interprofessional team and formal and informal leaders, and supportive processes adapted to the local context. Impact Results from this study will inform the development of a clinical implementation toolkit to support clinical uptake of AEx in the stroke rehabilitation setting.

Objective The iWalk study showed significant increase in use of the 10-Meter Walk Test (10MWT) and 6-Minute Walk Test (6MWT) poststroke following provision of a toolkit. This paper examined the influence of contextual circumstances on use of the toolkit and implementation strategy across acute care and inpatient and outpatient rehabilitation settings. Methods A theory-based toolkit and implementation strategy was designed to support guideline recommendations to use standardized tools for evaluation of walking, education, and goal-setting poststroke. The toolkit comprised a mobile app, video, and educational guide outlining instructions for 3 learning sessions. After completing learning sessions, 33 physical therapists and 7 professional leaders participated in focus groups or interviews. As part of a realist evaluation, the study compared and synthesized site-specific context-mechanism-outcome descriptions across sites to refine an initial theory of how the toolkit would influence practice. Results Analysis revealed 3 context-mechanism-outcomes: (1) No onsite facilitator? No practice change in acute care: Without an onsite facilitator, participants lacked authority to facilitate and coordinate the implementation strategy; (2) Onsite facilitation fostered integration of select practices in acute care: When onsite facilitation occurred in acute care, walk test administration and use of reference values for patient education were adopted variably with high functioning patients; (3) Onsite facilitation fostered integration of most practices in rehabilitation settings: When onsite facilitation occurred, many participants incorporated 1 or both tests to evaluate and monitor walking capacity, and reference values were applied for inpatient and outpatient education and goal setting. Participants preferentially implemented the 10MWT over the 6MWT because set-up and administration were easier and a greater proportion of patients could walk 10 m. Conclusion Findings underscore contextual factors and activities essential to eliciting change in assessment practice in stroke rehabilitation across care settings. Impact This study shows that to foster recommended walking assessment practices, an onsite facilitator should be present to enable learning sessions and toolkit use.

© 2020 John Wiley & Sons, Ltd. Background: Occupational therapy (OT) and physical therapy (PT) programs in Canada have moved to graduate-level entry education to address graduates' readiness for evidence-based practice (EBP). Whether rehabilitation professionals with advanced training in EBP are meeting their responsibilities as evidence-based professionals upon entry into practice and the factors that influence the use of evidence is unclear. The aim of this study was to examine the individual and organizational factors associated with the use of EBP and supporting evidence-based activities among graduates of professional OT and PT master's programs. Methods: A cross-sectional design using a survey of recent graduates of the 29 OT and PT programs in Canada. The survey measured six constructs supportive of EBP (ie, knowledge, attitudes, confidence, organizational resources, actual use of EBP, and evidence-based activities). Analyses consisted of descriptive statistics to characterize the sample and the different variables and ordinal multivariate regression analysis. Results: 257 graduates (15%) completed the survey. Attitudes towards EBP was positively associated both with evidence-based activities (odds ratio = 1.36 with a 95% CI: 1.22 to 1.52) and use of EBP (odds ratio = 1.23 with a 95% CI: 1.12 to 1.36); greater confidence was related to greater use of EBP (OR = 1.12, 95% CI: 1.01 to 1.24); and working in a private practice setting was found to be related to performing more evidence-based activities (odds ratio = 3.15, 95% CI: 1.40 to 7.12). Conclusions: Despite a greater focus on EBP knowledge in these curricula across Canada, knowledge was not related to EBP use nor evidence-based activities upon entry into practice. On the other hand, attitudes, confidence and working in private practice were. University programs should consider curricular strategies that increase the use of EBP, provide opportunities to engage in evidence-based activities with an emphasis on promoting the development of positive attitudes towards EBP and increasing learners' confidence in their ability to be evidence-based professionals.

The aim of this study was to examine the construct and known-groups validity of the total score of five items adapted from the Community Healthy Activities Model Program for Seniors (CHAMPS) questionnaire to measure outdoor walking (CHAMPS-OUTDOORS) in older adults. Data from the baseline assessment of the Getting Older Adult OUTdoors (GO-OUT) trial were used. Construct validity of the CHAMPS-OUTDOORS used objective measures of outdoor walking (accelerometry–GPS), Ambulatory Self-Confidence Questionnaire, RAND-36, 6-min walk test, 10-m walk test, and Mini-Balance Evaluation System Test. For known-groups validity, we compared the CHAMPS-OUTDOORS of those who walked r = .33) and outdoor steps (r = .33) per week measured by accelerometry-GPS, and weakly correlated with Mini-Balance Evaluation System Test score (r = .27). The CHAMPS-OUTDOORS did not distinguish known groups based on crosswalk speed (p = .33). The CHAMPS-OUTDOORS may be used to assess outdoor walking in the absence of accelerometry GPS. Further research examining reliability is needed.

Purpose: To develop a priority-based patient /parent reported outcome measure for children with lower-limb differences (LD) by adapting the Gait Outcomes Assessment List (GOAL) questionnaire. Methods: Guided by a conceptual framework of patient priorities, the GOAL questionnaire was iteratively modified and its sensibility evaluated by field-testing it on children with LD and their parents. Cognitive interviews were conducted with a subgroup of these children, and an e-survey administered to a multidisciplinary group of health care professionals with expertise in paediatric LD. Findings were integrated to create the final version of the GOAL-LD. Results: Twenty-five children, 20 parents, and 31 healthcare professionals evaluated the content and sensibility of the GOAL, with an emphasis on the relevance and importance of the items to patients’ health related quality of life (HRQL). This resulted in the retention of 26 of the original 50 items, elimination of 12, modification of 12, and addition of seven new items. The new 45-item GOAL-LD questionnaire was shown to be sensible and its content deemed important. Conclusion: The GOAL-LD questionnaire has a high level of face and content validity, and sensibility. It comprehensively captures the HRQL goals and outcomes that matter to children with LD and their parents. Following further psychometric evaluation, the GOAL-LD may serve as a much needed patient and parent reported outcome measure for this population.

Background: Healthcare organizations are partnering with recreation organizations to support the delivery of community-based exercise programs for people with balance and mobility limitations. The ...

Objective: To determine the optimal threshold, based on cadence and lifestyle counts per minute, to detect outdoor walking in mobility-limited older adults. Methods: Older adults (N = 25, median age: 77.0 years, interquartile range: 10.5) wore activity monitors during 80 outdoor walks. Walking bouts were identified manually (reference standard) and compared with identification using cadence thresholds (≥30, ≥35, ≥40, ≥45, and ≥50 steps/min) and >760 counts per minute using low frequency extension analysis. Results: Median walking bout duration was 10.5 min (interquartile range 4.8) and median outdoor walking speed was 0.70 m/s (interquartile range 0.20). Cadence thresholds of ≥30, ≥35, and ≥40 steps/min demonstrated high sensitivity (1.0, 95% confidence intervals [0.95, 1.0]) to detect walking bouts; estimates for specificity and positive predictive value were highest for ≥40 steps/min. Conclusion: A cadence threshold of ≥40 steps/min is recommended for detecting sustained outdoor walking in this population.