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BackgroundHip fractures among older adults remain a public concern. Consequences of a hip fracture include the subsequent decline in function and mobility for the older adult, and an increased burden placed upon their caregivers and the health care system. The consequences may be more challenging if an older adult also has a compromised cognitive reserve. Although rehabilitation programs have proven effective, the best practices and resources required to maintain the gains in function and mobility, to negate diminution of effect, and to enable this patient population to continue living at home are currently unknown. ObjectiveThe objective of this study is to develop a systematic review protocol focused on identifying the evidence and evaluating the effectiveness of post discharge rehabilitation programs for older adults with a cognitive impairment following a hip fracture. MethodsThe search strategy will include a combination of text words and subject headings relating to the concepts of cognitive impairment, dementia, delirium, cognitive reserve, and hip fractures. Searching various databases will identify peer-reviewed journal articles. There will be two independent reviewers who will screen the titles and abstracts to determine which articles comprise a rehabilitation intervention within a community setting prior to being included for a full article review. A data extraction form and an evidence and quality checklist will be used during the full article data analysis and synthesis. It is expected that there will be a paucity of studies that focus on post discharge rehabilitation interventions for older adults with cognitive impairment following a hip fracture, and few studies that use the same or similar outcome measures. However, if possible, a meta-analysis will be conducted on studies that used similar outcome methods. ResultsThis review will synthesize knowledge focusing on activities to maintain and restore function in older adult patients with cognitive impairment once they have completed their active rehabilitation program and return home. A synthesis of the findings will be conducted to determine which components of the interventions identified were the most advantageous to the patient population. The results will be used to develop a multi-faceted post discharge rehabilitation intervention aimed at enabling older adults to return and remain living at home after a hip fracture. ConclusionsThe aim of this systematic review is to generate results that can be used to create interventions that focus on the care necessary to enable older adults to remain living at home post discharge from acute or inpatient rehabilitation care for a hip fracture. With the support and contributions by our associated knowledge users, this systematic review will be used to help inform procedures and policies to facilitate the necessary care and resources required by our patient population.

Reducing sedentary behavior (SB) in individuals with chronic obstructive pulmonary disease (COPD) is being increasingly recognized as a novel health target. Understanding healthcare professionals (HCPs) behavior that influences a reduction in SB in this population could facilitate achieving this target. To explore the determinants of behavior related to HCPs targeting a reduction in SB in people with COPD. We used a qualitative semi-structured interview approach informed by the Theoretical Domains Framework (TDF). Sixteen HCPs were interviewed. Interview transcripts were mapped against the relevant TDF domain(s) and then higher order themes were generated. Directed content analysis resulted in mapping 949 quotes to the TDF domains with environmental context and resources being the most coded domain. Three higher order themes were identified: 1) HCPs need more knowledge on reducing SB; 2) Strategies suggested to include in pulmonary rehabilitation (PR) to reduce SB; and 3) Barriers to adding SB to PR. Domains of environmental context and resources, knowledge, social/professional role and identity, reinforcement, social influences, skills and beliefs about capabilities were relevant to the study population to reduce SB in people with COPD. Knowledge of SB varied across participants. This study provided information on potential behavioral targets for future interventions that involve HCPs and aim to reduce SB among people with COPD. [ABSTRACT FROM AUTHOR]

Abstract Pulmonary rehabilitation is a cornerstone intervention for controlling respiratory symptoms in people with chronic respiratory diseases. Chronic cough affects up to 90% of people with chronic respiratory diseases, however, it is currently unknown whether chronic cough is assessed and/or managed in pulmonary rehabilitation. This study aimed to determine if and how chronic cough is assessed and managed in pulmonary rehabilitation. This was a cross-sectional study. Pulmonary rehabilitation programs in Canada were identified via online websites. A representative from each program was invited to complete an online survey including the following topics: program demographics, assessment and management practices, and barriers and facilitators. Of 133 programs contacted, 31 returned a completed survey (23% response rate). Approximately half (52%) of respondents reported enrolling patients with chronic cough. Of those, 45% reported assessing and 62% reported intervening in chronic cough. Inadequate knowledge of assessment and management techniques was commonly identified to be a barrier and increased education was suggested as a possible facilitator. Based on pulmonary rehabilitation programs that responded to our survey, chronic cough is a prevalent symptom; however, it is scarcely assessed and managed. A need for structured education and the use of standardised strategies were reported as facilitators to the assessment and management of chronic cough in pulmonary rehabilitation. [ABSTRACT FROM AUTHOR]

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Purpose: We aimed to elicit patients' views of research priorities related to pulmonary rehabilitation (PR). Method:We used a modified nominal group technique in which participants with chronic lung conditions who had completed PR attended one of five meetings during which they generated ideas, discussed them with the group, and prioritized their top three topics. Afterward, they completed member checking and satisfaction questionnaires. Results:Fourteen participants (mean age 71 years) prioritized 25 topics, which included music as a motivator, education about the reason for various assessments and exercises, and ongoing patient assessment and follow-up. Most participants "totally agreed" that the summarized topics matched what they thought was important in PR research (75%) and that the meeting was a positive experience (100%). Participants indicated that the findings of this study accurately reflected their priorities. Conclusions:Individuals who have completed PR may have questions about programme components including assessment, treatment, and strategies for promoting motivation. To inform future research projects and identify knowledge translation needs, we will distribute a questionnaire to a larger sample of former PR patients to further prioritize the 25 topics identified in the meetings. Objectif : connaître les points de vue des patients sur les priorités de la recherche en réadaptation pulmonaire (RP). Méthodologie : les chercheurs ont utilisé une technique de groupe nominale modifiée selon laquelle les participants atteints d'une pneumopathie chronique qui ont effectué une RP ont assisté à l'une des cinq rencontres pour générer des idées, en parler en groupe et prioriser leurs trois thèmes principaux. Ils ont ensuite rempli les questionnaires de vérification et de satisfaction des membres. Résultats : quatorze participants (d'un âge moyen de 71 ans) ont priorisé 25 thèmes, qui incluaient la musique comme élément motivateur, l'éducation sur la raison des diverses évaluations et des divers exercices ainsi que l'évaluation et le suivi continus des patients. La plupart des participants étaient « totalement d'accord » avec le fait que les thèmes résumés correspondaient à ce qu'ils considéraient comme important en recherche sur la RP (75 %) et que la rencontre était une expérience positive (100 %). Les participants ont indiqué que les résultats de cette étude étaient un reflet exact de leurs priorités. Conclusions : les personnes qui ont effectué la RP peuvent avoir des questions sur les éléments du programme, y compris l'évaluation, le traitement et les stratégies pour promouvoir la motivation. Afin d'éclairer les projets de recherche et de déterminer les besoins en application des connaissances, les chercheurs distribueront un questionnaire à un plus grand échantillon d'anciens patients en RP afin de mieux prioriser les 25 thèmes établis pendant les rencontres. [ABSTRACT FROM AUTHOR]

Background and Purpose: The Physical Therapy Competence Assessment for Airway Suctioning (PT‐CAAS) is a recently developed measure to assess the clinical competence of physiotherapists who perform airway suctioning with adults. The purpose of this study was to assess the inter‐rater and intra‐rater reliability of the PT‐CAAS. Methods: Scoring rules were developed through expert consultation. Reliability was then assessed using nine videos of suctioning performed in a simulated learning environment. A repeated measures design was used, with two replicate sets of measurements made by each participant for all videos. Data were analyzed using a repeated measures model for the concurrent assessment of inter‐rater and intra‐rater reliability. Participants were physiotherapists with suctioning experience. Results: Twenty physiotherapists completed initial scoring and re‐scoring for all nine videos; their data were included in the analysis. Intraclass correlation coefficients (ICCs) for inter‐rater reliability ranged from 0.569 [lower one‐sided 95% confidence interval (CI): 0.395; standard error of measurement (SEM): 0.963] for infection control to 0.759 (lower one‐sided 95% CI: 0.612; SEM: 0.722) for post‐suctioning assessment and care. The inter‐rater ICC for overall performance was 0.752 (lower one‐sided 95% CI: 0.602; SEM: 0.660). ICCs for intra‐rater reliability ranged from 0.759 (lower one‐sided 95% CI: 0.197; SEM 0.721) for infection control to 0.860 (lower one‐sided 95% CI: 0.544; SEM: 0.550) for post‐suctioning assessment and care. The intra‐rater ICC for overall performance was 0.867 (lower one‐sided 95% CI: 0.559; SEM: 0.483). Discussion: Evidence of moderate to good inter‐rater and good intra‐rater reliability was found; however, the results should be interpreted with caution given the wide CIs and relatively large SEMs. Improved assessor training and assessments of reliability using a larger sample size are recommended. [ABSTRACT FROM AUTHOR]