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


Gogovor A.,McGill University | Auger C.,University of Montréal | Auger C.,The Interdisciplinary Center | Bouvrette-Leblanc L.,Constance Lethbridge Rehabilitation Center | And 9 more authors.
International Journal of Medical Informatics | Year: 2017

Background Self-management can optimize health outcomes for individuals with chronic pain (CP), an increasing fiscal and social burden in Canada. However, self-management is rarely integrated into the regular care (team activities and medical treatment) patients receive. Health information technology offers an opportunity to provide regular monitoring and exchange of information between patient and care team. Objective To identify information needs and gaps in chronic pain management as well as technology features to inform the development of an Internet-based self-management program. Methods Two methods were used. First was a structured literature review: electronic databases were searched up to 2015 with combinations of MeSH terms and text-words such as chronic pain, self-management, self-efficacy, technology, Internet-based, patient portal, and e-health. A narrative synthesis of the characteristics and content of Internet-based pain management programs emerging from the literature review and how they relate to gaps in chronic pain management were completed. Second, four audiotaped focus group sessions were conducted with individuals with chronic pain and caregivers (n = 9) and health professionals (n = 7) recruited from three multidisciplinary tertiary and rehabilitation centres. A thematic analysis of the focus group transcripts was conducted. Results Thirty-nine primary articles related to 20 patient-oriented Internet-based programs were selected. Gaps in CP management included lack of knowledge, limited access to health care, suboptimal care, and lack of self-management support. Overall, 14 themes related to information needs and gaps in care were identified by both health professionals and patients, three were exclusive to patients and five to health professionals. Common themes from the focus groups included patient education on chronic pain care, attitude-belief-culture, financial and legal issues, end-of-program crash, and motivational content. Conclusions Internet-based programs contain automated, communication and decision support features that can address information and care gaps reported by patients and clinicians. However, focus groups identified functionalities not reported in the literature, non-medical and condition- and context-specific information, integration of personal health records, and the role of the different health professionals in chronic pain management were not identified. These gaps need to be considered in the future development of Internet-based programs. While the association between the mechanisms of Internet-based programs’ features and outcomes is not clearly established, the results of this study indicate that interactivity, personalization and tailored messages, combined with therapist contact will maximize the effectiveness of an Internet-based chronic pain program in enhancing self-management. © 2016 Elsevier Ireland Ltd


Ahmed S.,McGill University | Ahmed S.,Constance Lethbridge Rehabilitation Center | Ware P.,McGill University | Visca R.,McGill University | And 17 more authors.
BMC Research Notes | Year: 2015

Background: Seven chronic disease prevention and management programs were implemented across Quebec with funding support from a provincial-private industry funding initiative. Given the complexity of implementing integrated primary care chronic disease management programs, a knowledge transfer meeting was held to share experiences across programs and synthesize common challenges and success factors for implementation. Methods: The knowledge translation meeting was held in February 2014 in Montreal, Canada. Seventy-five participants consisting of 15 clinicians, 14 researchers, 31 knowledge users, and 15 representatives from the funding agencies were broken up into groups of 10 or 11 and conducted a strengths, weaknesses, opportunities, and threats analysis on either the implementation or the evaluation of these chronic disease management programs. Results were reported back to the larger group during a plenary and recorded. Audiotapes were transcribed and summarized using pragmatic thematic analysis. Results and discussion: Strengths to leverage for the implementation of the seven programs include: (1) synergy between clinical and research teams; (2) stakeholders working together; (3) motivation of clinicians; and (4) the fact that the programs are evidence-based. Weaknesses to address include: (1) insufficient resources; (2) organizational change within the clinical sites; (3) lack of referrals from primary care physicians; and (4) lack of access to programs. Strengths to leverage for the evaluation of these programs include: (1) engagement of stakeholders and (2) sharing of knowledge between clinical sites. Weaknesses to address include: (1) lack of referrals; (2) difficulties with data collection; and (3) difficulties in identifying indicators and control groups. Opportunities for both themes include: (1) fostering new and existing partnerships and stakeholder relations; (2) seizing funding opportunities; (3) knowledge transfer; (4) supporting the transformation of professional roles; (5) expand the use of health information technology; and (6) conduct cost evaluations. Fifteen recommendations related to mobilisation of primary care physicians, support for the transformation of professional roles, and strategies aimed at facilitating the implementation and evaluation of chronic disease management programs were formulated based on the discussions at this knowledge translation event. Conclusion: The results from this knowledge translation day will help inform the sustainability of these seven chronic disease management programs in Quebec and the implementation and evaluation of similar programs elsewhere. © 2015 Ahmed et al.


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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