Constance Lethbridge Rehabilitation Center

Montréal, Canada

Constance Lethbridge Rehabilitation Center

Montréal, Canada
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Scherrer S.-A.,McGill University | Chu Yu Chee J.,McGill University | Vu N.,McGill University | Lu P.,McGill University | And 3 more authors.
Disability and Rehabilitation: Assistive Technology | Year: 2017

Diabetes is a global health concern that can lead to mobility limitations necessitating a wheelchair. However, there are currently no guidelines for wheelchair adjustments tailored to the diabetic population. Purpose: To describe relevant manual wheelchair adjustments for adults with diabetes, and to explore how these adjustments apply to populations living in less-resourced countries. Methods: Semi-structured interviews were conducted with 13 wheelchair experts from five different countries working with adult with diabetes. Interviews were analyzed using the constant comparison method. Results: The most frequently mentioned wheelchair adjustments were related to neuropathies, skin integrity, decreased strength and amputations. Air cushions were preferred for managing seat sores. Lightweight wheelchairs could be advantageous for people with decreased strength and endurance. In less-resourced settings, wheelchair adjustment decisions prioritized durability and low maintenance. Discussion: The recommendation of lightweight wheelchairs for adults with diabetes may be limited by the lack of adjustment possibilities compared to regular weight wheelchairs. In less-resourced settings, prioritizing durability and low maintenance may limit prevention and management of conditions associated to diabetes. Conclusion: This study represents a first step towards the development of guidelines for manual wheelchair adjustments specifically tailored to adults with diabetes, in a global health context.Implications of rehabilitationWhen prescribing manual wheelchairs to persons with diabetes, expert clinicians agree that skin integrity, neuropathies and decreased strength are their primary concerns.Compromises are often necessary when adjusting a wheelchair for a person with diabetes, due to the complexity of their symptoms: same modification can be indicated for one symptom but contraindicated for another.Diabetes prevalence is high in less-resourced settings. There is a need for increased availability of affordable wheelchair equipment that is durable, reliable and adapted to persons with diabetes. © 2017 Informa UK Limited, trading as Taylor & Francis Group

Lafrance M.-E.,Shriners Hospital for Children | Benoit D.,Constance Lethbridge Rehabilitation Center | Benoit D.,McGill University | Dahan-Oliel N.,McGill University | And 2 more authors.
British Journal of Occupational Therapy | Year: 2017

Introduction Occupational therapists are amongst the certified driving rehabilitation specialists providing driving rehabilitation and training. This study aimed at gathering information on driving readiness in adolescents and young adults with physical and/or cognitive impairments related to cerebral palsy and spina bifida to guide the development of a driving readiness program for this clientele. Method A review of the scientific literature was performed. Seventy-four driving rehabilitation specialists across North America were surveyed, of whom eight were subsequently interviewed. Results Learner drivers with cerebral palsy and spina bifida lack the basic skills (such as information processing, visual memory, attention span) for and familiarity with community mobility and self-efficacy, often resulting in a lengthy and difficult learning process for automobile driving. The literature findings were corroborated by a survey and interview of specialized driving rehabilitation therapists. There is a therapist-driven desire to improve pre-requisite skills for driving through a driving readiness program tailored to this population's specific needs. An outline of such a program was developed based on the person-environment-occupation model. Conclusion A driving readiness program may act as an important clinical tool intended to optimize pre-driving skills in adolescents with cerebral palsy or spina bifida in order to facilitate the driving training process and ensure greater community independence in this population. © The College of Occupational Therapists Ltd.

Bartlett S.J.,Johns Hopkins University | Ahmed S.,McGill University | Ahmed S.,Constance Lethbridge Rehabilitation Center
Journal of Clinical Epidemiology | Year: 2017

Background: Patient-centered health care, where we design and deliver care to address the needs and preferences of patients, represents an important paradigm shift. Patient-reported outcomes (PROs) are critical to capture the patient voice, understand how illness and treatments affect people, and establish how well services and treatments address what matters most to patients. Objective: Originally developed for use in research, PROs are now used to monitor individuals and populations, manage care, evaluate services and providers, and inform policy. However, moving PROs beyond research settings incurs considerable methodological, organizational, technological, and ethical considerations. National collaborative networks of researchers, clinicians, patients, and other stakeholders can address these challenges by coordinating development, creating standards for use, sharing costs and delivery platforms, and improving widespread uptake of core sets of measures to better inform health care decisions and improve outcomes. Discussion: We introduce eight papers from researchers, clinicians, patients, and decision makers who participated in deliberations around creating a national network to accelerate the application and harmonized use of PROs in Canada. They offer a snap shot of the strategies that pioneers and innovative thinkers are using to integrate the patient voice into comprehensive care, research, and health policy planning of chronic diseases. © 2017 Elsevier Inc.

Preuss R.A.,McGill University | Preuss R.A.,Constance Lethbridge Rehabilitation Center
Physical Therapy | Year: 2013

Clinical assessment protocols must produce data that are reliable, with a clinically attainable minimal detectable change (MDC). In a reliability study, generalizability theory has 2 advantages over classical test theory. These advantages provide information that allows assessment protocols to be adjusted to match individual patient profiles. First, generalizability theory allows the user to simultaneously consider multiple sources of measurement error variance (facets). Second, it allows the user to generalize the findings of the main study across the different study facets and to recalculate the reliability and MDC based on different combinations of facet conditions. In doing so, clinical assessment protocols can be chosen based on minimizing the number of measures that must be taken to achieve a realistic MDC, using repeated measures to minimize the MDC, or simply based on the combination that best allows the clinician to monitor an individual patient's progress over a specified period of time. © 2013 American Physical Therapy Association.

Ahmed S.,McGill University | Ahmed S.,Clinical Research | Ahmed S.,Constance Lethbridge Rehabilitation Center | Ware P.,Clinical Research | And 4 more authors.
Journal of Clinical Epidemiology | Year: 2017

Background: Given that the goal of health care systems is to improve and maintain the health of the populations they serve, the indicators of performance must include outcomes that are meaningful to patients. The growth of health technologies provides an unprecedented opportunity to integrate the patient voice into clinical care by linking electronic health records (EHRs) to patient-reported outcome (PRO) data collection. However, PRO data must be relevant, meaningful, and actionable for those who will have to invest the time and effort to collect it. Objective: In this study, we highlight opportunities to integrate PRO data collection into EHRs. We consider how stakeholder perspectives should influence the selection of PROs and ways to enhance engagement in and commitment to PRO implementation. We propose a research and policy agenda to address unanswered questions and facilitate the widespread adoption of PRO data collection into EHRs. Discussion: Building a learning health care system that gathers PRO data in ways that can inform individual patient care, quality improvement, and comparative effectiveness research has the potential to accelerate the application of new evidence and knowledge to patient care. © 2017 Elsevier Inc.

Mayo N.E.,McGill University | Figueiredo S.,McGill University | Ahmed S.,McGill University | Ahmed S.,Constance Lethbridge Rehabilitation Center | Bartlett S.J.,McGill University
Journal of Clinical Epidemiology | Year: 2017

Background: We outline different health outcomes and describe how multiple perspectives can be harnessed to optimize accuracy of key data collected about patients with chronic conditions. The terms health status, health-related quality of life, and quality of life are often used interchangeably without recognizing that they have different meanings, as are the terms used to refer to the different components of function. Although the advantages and limitations of existing frameworks and perspectives are largely understood, greater precision is needed when using health outcome terminology and identifying optimal sources of information. Objective: A refinement of the current taxonomy is proposed to distinguish between patient-reported outcomes and self-report outcomes and expand the concept of clinically reported outcomes to include those assessed by performance and emerging technologies. Discussion: Health outcomes yield important information that can be used to improve the lives of many people. Now is the time to "talk the talk" as part of larger coordinated efforts within and across countries to identify and measure what matters most in health. © 2017 Elsevier Inc.

Woznowski-Vu A.,McGill University | Preuss R.,Constance Lethbridge Rehabilitation Center
Physiotherapy Canada | Year: 2012

Purpose: The aim of the study was to determine the effect of successive repetitions of a measure of hamstring flexibility-the passive unilateral straight leg raise (SLR)-on the reliability of this measure. Method: Ten repetitions of the SLR were performed on nine healthy adults. Measures were quantified using an electromagnetic tracking system and standardized using a handheld dynamometer by stopping the SLR at a set end-point force. The 10 repetitions were analyzed as two blocks of five, and intra-class correlation coefficients-models (2,1) and (3,k)-were calculated for each block of data. Results: ICC values for both models were comparable between the two blocks of data. Conclusion: Previous loading cycles, to a set end-point force, are unlikely to improve the reliability of muscle flexibility assessment in a clinical setting.

Kwok J.C.W.,CHUM Hopital Notre Dame | Gelinas I.,McGill University | Benoit D.,Constance Lethbridge Rehabilitation Center | Chilingaryan G.,Jewish Rehabilitation Hospital
British Journal of Occupational Therapy | Year: 2015

Introduction: The objectives of this study are to determine (1) the ability of the Montreal Cognitive Assessment to predict on-road driving performance in drivers with a neurological condition and elderly drivers with suspected cognitive decline, and (2) the association between the performance on the Useful Field of View and the performance on the Montreal Cognitive Assessment. Method: This study used a retrospective design. Clients were included who had completed the Montreal Cognitive Assessment and the on-road driving evaluation from November 2006 to May 2009 (n =154) in a driving rehabilitation program in the Montreal Area. Total scores on the Montreal Cognitive Assessment, Useful Field of View risk categories, pass or fail outcomes from an on-road evaluation, as well as demographic and clinical characteristics were recorded from participants' medical charts. Results: The Montreal Cognitive Assessment was found to have a sensitivity of 84.5% and a specificity of 50% with a cut-off of ≤25. It was significantly associated with the Useful Field of View risk category. Conclusion: The Montreal Cognitive Assessment could be a valuable screening tool. However, its predictive validity is not strong enough to recommend its use as the sole instrument for identifying unfit drivers. © The Author(s) 2015.

Masse-Alarie H.,Laval University | Masse-Alarie H.,Constance Lethbridge Rehabilitation Center | Beaulieu L.-D.,Laval University | Preuss R.,Constance Lethbridge Rehabilitation Center | And 2 more authors.
Gait and Posture | Year: 2015

Study design: Cross-sectional study of lumbopelvic muscle activation during rapid limb movements in chronic low back pain (CLBP) patients and healthy controls. Introduction: Controversy exists over whether bilateral anticipatory activation of the deep abdominal muscles represents a normal motor control strategy prior to all rapid limb movements, or if this is simply a task-specific strategy appropriate for only certain movement conditions. Objective: To assess the onset timing of the transversus abdominis/internal oblique muscles (TrA/IO) during two rapid limb movement tasks with different postural demands - bilateral shoulder flexion in standing, unilateral hip extension in prone lying - as well as differences between CLBP and controls. Methods: Twelve CLBP and 13 controls performed the two tasks in response to an auditory cue. Surface EMG was acquired bilaterally from five muscles, including TrA/IO. Results: In both groups, 50% of bilateral shoulder flexion trials showed bilateral anticipatory TrA/IO activation. This was rare, however, in unilateral hip extension for which only the TrA/IO contralateral to the moving leg showed anticipatory activation. The only significant difference in lumbo-pelvic muscle onset timing between CLBP and controls was a delay in semitendinosus activation during bilateral shoulder flexion in standing. Conclusion: Our data suggest that bilateral anticipatory TrA/IO activation is a task-specific motor control strategy, appropriate for only certain rapid limb movement conditions. Furthermore, the presence of altered semitendinosus onset timing in the CLBP group during bilateral shoulder flexion may be reflective of other possible lumbo-pelvic motor control alterations among this population. © 2014 Elsevier B.V..

Al Zoubi F.M.,McGill University | Al Zoubi F.M.,Constance Lethbridge Rehabilitation Center | Preuss R.A.,McGill University | Preuss R.A.,Constance Lethbridge Rehabilitation Center
Journal of Applied Biomechanics | Year: 2013

Measuring lumbar spine range of motion (ROM) using multiple movements is impractical for clinical research, because finding statistically significant effects requires a large proportion of subjects to present with the same impairment. The purpose of this study was to develop a single measure representing the total available lumbar ROM. Twenty participants with low back pain performed three series of eight lumbar spine movements, in each of two sessions. For each series, an ellipse and a cubic spline were fit to the end-range positions, measured based on the position of the twelfth thoracic vertebra in the transverse plane of the sacrum. The area of each shape provides a measure of the total available ROM, whereas their center reflects the movements' symmetry. Using generalizability theory, the index of dependability for the area and anterior-posterior center position was found to be 0.90, but was slightly lower for the mediolateral center position. Slightly better values were achieved using the spline-fitting approach. Further analysis also indicated that excellent reliability, and acceptable minimal detectable change values, would be achieved with a single testing session. These data indicate that the proposed measure provides a reliable and easily interpretable measure of total lumbar spine ROM. © 2013 Human Kinetics, Inc.

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