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Background/Objective: The purpose of this study was to investigate the impact of the COVID-19 pandemic on mortality rates in a community-dwelling spinal cord injury (SCI) population in Ontario. Methods: Using health administrative databases, monthly mortality rates were evaluated pre-pandemic, during the pandemic, and post-pandemic from March 2014 to May 2024. Data were stratified by sex, injury etiology, and mental health status. Group differences were evaluated using t-tests. Autoregressive integrated moving average (ARIMA) models evaluated the pandemic's impact on mortality rates. Results: A significant increase of 21.4% in mortality rates during the pandemic was found for the SCI cohort. With the exception of the traumatic group, all subgroups also experienced a significant increase in mortality rates (males: 13.9%, females: 31.9%, non-traumatic: 32.3%, mental health diagnoses: 19.6%, and mental health diagnoses: 29.4%). During the pandemic, females had a significantly higher mortality rate than males. The non-traumatic group had higher mortality rates than the traumatic group at all time periods. Individuals with mental health diagnoses had higher mortality rates than those without at the pre-pandemic and pandemic periods. Conclusions: The variation in mortality rates across groups highlights inequitable access to medical care in the SCI population, with further research and interventions needed. [ABSTRACT FROM AUTHOR]

Persons with disabilities experience numerous barriers to healthcare access including vaccine accessibility. The purpose of this study was to determine COVID-19 vaccine uptake in the spinal cord injury and disease (SCI/D) population of Ontario and identify potential factors influencing C OVID-19 vaccine uptake. This was a retrospective closed-cohort study using administrative health data on individuals with SCI/D of traumatic and non-traumatic causes to examine the monthly number of COVID-19 vaccine doses received between December 2020 and December 2023. Logistic regression analysis was used to examine the potential association between socio-demographic, clinical, and neighbourhood characteristics with initial COVID-19 vaccine receipt and booster dose uptake. By the end of the observation period in December 2023, 82.9% received the full two-dose coverage and 65.6% received at least one additional booster dose in a cohort of 3574 individuals with SCI/D. SCI/D individuals showed a comparable COVID-19 vaccine uptake percentage to the general population. Sociodemographic, clinical, and neighbourhood characteristics were associated with COVID-19 vaccine uptake in the SCI/D population, including age, type of injury, number of comorbidities, mental health history, and neighbourhood characteristics such as income. Further investigation is necessary to determine the causation effects of these relationships with vaccine uptake to address health equity concerns. [ABSTRACT FROM AUTHOR]

BackgroundGlobally, 1 in 3 adults live with multiple chronic conditions. Thus, effective interventions are needed to prevent and manage these chronic conditions and to reduce the associated health care costs. Teaching effective self-management practices to people with chronic diseases is one strategy to address the burden of chronic conditions. With the increasing availability of and access to the internet, the implementation of web-based peer support programs has become increasingly common. ObjectiveThe purpose of this scoping review is to synthesize existing literature and key characteristics of web-based peer support programs for persons with chronic conditions. MethodsThis scoping review follows the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) extension for scoping reviews guidelines. Studies were identified by searching MEDLINE, CINAHL, Embase, PsycINFO, and the Physiotherapy Evidence Database. Chronic diseases identified by the Public Health Agency of Canada were included. Our review was limited to peer support interventions delivered on the web. Peers providing support had to have the chronic condition that they were providing support for. The information abstracted included the year of publication, country of study, purpose of the study, participant population, key characteristics of the intervention, outcome measures, and results. ResultsAfter duplicates were removed, 12,641 articles were screened. Data abstraction was completed for 41 articles. There was a lack of participant diversity in the included studies, specifically with respect to the conditions studied. There was a lack of studies with older participants aged ≥70 years. There was inconsistency in how the interventions were described in terms of the duration and frequency of the interventions. Informational, emotional, and appraisal support were implemented in the studied interventions. Few studies used a randomized controlled trial design. A total of 4 of the 6 randomized controlled trials reported positive and significant results, including decreased emotional distress and increased health service navigation, self-efficacy, social participation, and constructive attitudes and approaches. Among the qualitative studies included in this review, there were several positive experiences related to participating in a web-based peer support intervention, including increased compassion and improved attitudes toward the individual’s chronic condition, access to information, and empowerment. ConclusionsThere is limited recent, high-level evidence on web-based peer support interventions. Where evidence exists, significant improvements in social participation, self-efficacy, and health-directed activity were demonstrated. Some studies incorporated a theoretical framework, and all forms of peer support—emotional, informational, and appraisal support—were identified in the studies included in this review. We recommend further research on web-based peer support in more diverse patient groups (eg, for older adults and chronic conditions outside of cancer, cardiovascular disease, and HIV or AIDS). Key gaps in the area of web-based peer support will serve to inform the development and implementation of future programs.

Background: Individuals with spinal cord injuries or disease (SCI/D) require frequent healthcare services. The COVID-19 pandemic may have impacted healthcare. Furthermore, due to secondary health conditions and comorbidities persons with SCI/D are at increased risk of experiencing severe symptoms or outcomes if infected with the COVID-19 virus. It is unclear to what extent research has investigated the pandemic and virus impacts on the SCI/D population. Objective: To identify and summarize what is reported in the literature on the impact the COVID-19 virus and pandemic had on healthcare, health outcomes, and experiences in the adult SCI/D population. Methods: Electronic databases and grey literature were searched for articles that included an adult population with a SCI/D and investigated the impact the COVID-19 virus and pandemic had on healthcare-related outcomes and experiences. Articles were double screened, and data were extracted, and synthesized to provide a descriptive summary of the findings. Results: Twenty-four studies were included in this review with eight qualitative, fifteen quantitative, and one mixed methods study. Sixteen studies investigated healthcare utilization/access; nine investigated care delivery, nine investigated patient outcomes, and eight investigated patient experiences, with multiple studies spanning different categories of investigation. The pandemic was detrimental to healthcare utilization, access, and outcomes, but no studies quantified these changes. Virtual care was well-received by the SCI/D population to maintain continuity of care. The SCI/D population had issues with maintaining caregiving support. It was unclear if the COVID-19 virus infection impacted individuals with SCI/D differently than the general population. Conclusions: This scoping review found the pandemic negatively impacted multiple aspects of healthcare in individuals with SCI/D, however further investigation on health outcomes is required. More research, particularly large-scale quantitative studies, investigating healthcare access, utilization, and delivery, as well as patient outcomes and experiences is needed to improve care in the SCI/D population post-pandemic onset. [ABSTRACT FROM AUTHOR]

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Introduction: The reliability, minimal detectable change (MDC), and construct validity of the evidence-based practice confidence (EPIC) scale were evaluated among physical therapists (PTs) in clinical practice. Methods: A longitudinal mail survey was conducted. Internal consistency and test-retest reliability were estimated using Cronbach's alpha and the intraclass correlation coefficient (ICC), respectively. The ICC was used to compute the MDC. We evaluated construct validity by testing hypotheses that EPIC scores would be positively associated with education level and frequency of searching, reading, and using research literature in clinical decision making. Results: At baseline, 275 PTs completed the EPIC scale and validity questionnaire and 187 completed the scale at retest (mean retest interval = 16 days). Internal consistency was 0.89 (95% confidence interval 0.86 to 0.91; N = 275). The ICC for test-retest reliability was 0.89 (95% confidence interval 0.85 to 0.91; N = 187). The MDC[subscript 95] was 4.1 percentage points meaning that a change in an individual's score must be greater than 4.1 percentage points to exceed the limits of measurement error. The mean EPIC score was significantly higher among PTs holding a Masters or doctoral degree compared to those holding a bachelor's degree or diploma, and among PTs reporting searching online, reading, and using the research literature in clinical decision making 6 or more times compared to 0 to 5 times in a typical month. Discussion: Results provide evidence of excellent test-retest reliability and acceptable construct validity and minimal measurement error on repeated administration of the EPIC scale. The scale is recommended for use among PTs in clinical practice. Validation of the EPIC scale in other health professional groups is warranted. (Contains 4 tables.)

Therapists play a key role in delivering fall prevention/management education to individuals with spinal cord injury/disease, yet their perspectives on this topic remain understudied. Here, we described the perspectives of physical and occupational therapists who routinely provided rehabilitation to patients with spinal cord injury/disease on: (1) how fall risk was assessed, (2) what fall prevention education, interventions or strategies were provided, and (3) opportunities to improve fall risk assessment and the delivery of fall prevention education, strategies and interventions. Twenty-one therapists completed an individual interview or focus group that was analyzed using an inductive thematic analysis. Four main themes were identified: (1) policy and procedures impact practice (i.e., policy and procedures positively and negatively impact practice), (2) assessing and managing fall risk/falls in patients with spinal cord injury/disease (i.e., discipline-specific roles in fall risk assessments and fall management processes in rehabilitation), (3) fall prevention and management education (i.e., helicopter therapists and challenges with fall prevention and management education), (4) building insight into fall risk and management (e.g., building insight into fall risk for patients and therapists). This study revealed opportunities to improve the delivery of fall prevention education and training to individuals with spinal cord injury/disease. Fall prevention education should be initiated in spinal cord injury rehabilitation and then reinforced in community rehabilitation. Barriers and challenges faced by therapists when delivering fall prevention and management education/training in spinal cord injury rehabilitation include their perceptions of a patient's readiness to receive fall prevention education, short length of stay in rehabilitation, organization's expectations of zero falls and a lack of spinal cord injury-specific fall prevention resources. Therapists who work in spinal cord injury rehabilitation may benefit from information about fall risk factors encountered by individuals with spinal cord injury/disease in the community. [ABSTRACT FROM AUTHOR]

Introduction: Several differences have been reported between male and female patients with stroke in clinical and sociodemographic features, treatment, and outcomes. Potential effects in the inpatient rehabilitation population are unclear. Objective: To evaluate the differences between male and female patients in discharge functional status, length of stay, and discharge home after inpatient rehabilitation for stroke. Design: Retrospective, population-based cohort study. Setting: Inpatient rehabilitation centers in Ontario, Canada. Participants: Male (N = 10,684) and female (N = 9459) patients discharged from acute care between September 1, 2012 and August 31, 2017, with a diagnosis of stroke and subsequently admitted to inpatient rehabilitation. Exposure Variable: Female sex. Main Outcome Measures: Discharge Functional Independence Measure (FIM) score, length of stay, and discharge home. Results: Female patients had a lower functional status at discharge (mean FIM score 94.1 vs. 97.8, p < .001) and a lower proportion were discharged home (81.1% vs. 82.9%, p = .001). Female and male patients had similar rehabilitation length of stay (mean 31.8 vs. 31.7 days, p = .90). In the adjusted analyses, there was no difference in discharge functional status between male and female patients (FIM score β -.20 [95% confidence interval [CI] - 0.64 to 0.25]). Female patients had a mean length of stay 2% shorter (0.98 [95% CI 0.96-0.99]) and a higher odds of discharge home (odds ratio [OR] 1.14 [95% CI 1.05-1.24]). Conclusions: There were no clinically significant sex differences in outcomes after inpatient rehabilitation for stroke. Observed sex disparities in the general stroke population may not be directly applicable to individuals undergoing inpatient rehabilitation. [ABSTRACT FROM AUTHOR]