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There is a profoundly troubling history of research being done on Indigenous peoples without regard for their priorities and accompanying calls to decolonize health research. Storytelling methods can privilege Indigenous voices in research. Indigenous people’s knowledge systems have existed for millennium, where knowledge is produced and shared through stories. Our collaborative team of Indigenous and non-Indigenous researchers, and Indigenous Elders, patients, healthcare providers, and administrators, conducted a participatory, scoping review to examine how storytelling has been used as a method in Indigenous health research on Turtle Island (North America), Australia, and Aotearoa (New Zealand). We searched key databases and online sources for qualitative and mixed-methods studies that involved Indigenous participants and used storytelling as a method in health research. Reviewers screened abstracts/full texts to confirm eligibility. Narrative data were extracted and synthesized. An intensive collaboration was woven throughout and included gatherings incorporating Indigenous protocol, Elders’ teachings on storytelling, and sharing circles. We included 178 articles and found a diverse array of storytelling approaches and adaptations, along with exemplary practices and problematic omissions. Researchers honoured Indigenous ways of knowing, being, and doing through careful preparation and community engagement to do storywork, inclusion of Indigenous languages and protocols, and Indigenous initiation and governance. Storytelling centered Indigenous voices, was a culturally relevant and respectful method, involved a healing process, and reclaimed Indigenous stories. But it could result in several challenges when researchers did not meaningfully engage with Indigenous peoples. These findings can guide respectful storytelling research that bridges divergent Indigenous and Western knowledge systems, to decolonize health research.

PurposeThis is a study protocol to co-create with knowledge users a core outcome set focused on middle-aged and older adults (40 years+) for use in social prescribing research.MethodsWe will follow the Core Outcome Measures in Effectiveness Trials (COMET) guide and use modified Delphi methods, including collating outcomes reported in social prescribing publications, online surveys, and discussion with our team to finalize the core outcome set. We intentionally center this work on people who deliver and receive social prescribing and include methods to evaluate collaboration. Our three-part process includes: (1) identifying published systematic reviews on social prescribing for adults to extract reported outcomes; and (2) up to three rounds of online surveys to rate the importance of outcomes for social prescribing. For this part, we will invite people (n = 240) who represent the population experienced in social prescribing, including researchers, members of social prescribing organizations, and people who receive social prescribing and their caregivers. Finally, we will (3) convene a virtual team meeting to discuss and rank the findings and finalize the core outcome set and our knowledge mobilization plan.ConclusionTo our knowledge, this is the first study designed to use a modified Delphi method to co-create core outcomes for social prescribing. Development of a core outcome set contributes to improved knowledge synthesis via consistency in measures and terminology. We aim to develop guidance for future research, and specifically on the use of core outcomes for social prescribing at the person/patient, provider, program, and societal-level.

BackgroundDespite the importance of their perspectives, end users (eg, patients, caregivers) are not typically engaged by academic researchers in the development of mobile health (mHealth) apps for perioperative cardiac surgery settings. ObjectiveThe aim of this study was to describe a process for and the impact of patient engagement in the development of an mHealth app that supports patient and caregiver involvement with enhanced recovery protocols during the perioperative period of cardiac surgery. MethodsEngagement occurred at the level of consultation and took the form of an advisory panel. Patients who underwent cardiac surgery (2017-2018) at St. Boniface Hospital (Winnipeg, Manitoba) and their caregivers were approached for participation. A qualitative exploration determined the impact of patient engagement on the development (ie, design and content) of the mHealth app. This included a description of (1) the key messages generated by the advisory panel, (2) how key messages were incorporated into the development of the mHealth app, and (3) feedback from the developers of the mHealth app about the key messages generated by the advisory panel. ResultsThe advisory panel (N=10) generated 23 key messages to guide the development of the mHealth app. Key design-specific messages (n=7) centered around access, tracking, synchronization, and reminders. Key content-specific messages (n=16) centered around medical terms, professional roles, cardiac surgery procedures and recovery, educational videos, travel, nutrition, medications, resources, and physical activity. This information was directly incorporated into the design of the mHealth app as long as it was supported by the existing functionalities of the underlying platform. For example, the platform did not support the scheduling of reminders by users, identifying drug interactions, or synchronizing with other devices. The developers of the mHealth app noted that key messages resulted in the integration of a vast range and volume of information and resources instead of ones primarily focused on surgical information, content geared toward expectations management, and an expanded focus to include caregivers and other family members, so that these stakeholders may be directly included in the provision of information, allowing them to be better informed, prepare along with the patient, and be involved in recovery planning. ConclusionsPatient engagement may facilitate the development of a detail-oriented and patient-centered mHealth app whose design and content are driven by the lived experiences of end users.

IntroductionPrevious social prescribing work highlights a range in the types and number of outcomes used in published studies. We aimed to describe social prescribing outcome core areas and instruments to build capacity for future research and program evaluation. MethodsThis was a modified umbrella review following standard guidelines. We registered the study and searched multiple databases (all languages and years); inclusion criteria were peer-reviewed publications containing outcomes for self-described social prescribing for adults aged 18 years and older. The last search date was 9 July 2023. From the included systematic reviews, we identified primary studies using the same inclusion criteria. For primary studies, we sorted extracted outcomes and instruments into six core areas using a published taxonomy. We located information on instruments’ description and measurement properties and conducted two rating rounds for (1) the quality of systematic reviews and (2) reporting of instruments in primary studies. We conducted a narrative synthesis of reviews, primary studies and outcomes (PROSPERO 2023 CRD42023434061). ResultsWe identified 10 systematic reviews and 33 primary studies for inclusion in our review. Outcomes covered most core taxonomy areas, with an emphasis on psychosocial factors (e.g. well-being) and less emphasis on cognition, physical activity, and caregivers and volunteers. We noted few studies provided detailed information on demographic data of participants or measurement properties of instruments. ConclusionThis synthesis provides an overview and identifies knowledge gaps for outcomes and instruments used in social prescribing interventions. This work forms the basis of our next step of identifying social prescribing–related outcomes that matter most across interested parties, such as individuals providers and decision makers.

IntroductionLes travaux dont on dispose sur la prescription sociale montrent une grande variété, au sein des études publiées, dans les types de résultats et leur nombre. Nous avons entrepris de décrire les grands thèmes et les instruments associés aux résultats de la prescription sociale, dans l’objectif de renforcer la capacité de recherche et d’évaluation des programmes. MéthodologieCette étude est une métarevue modifiée, réalisée selon des lignes directrices normalisées. Nous avons enregistré l’étude et effectué des recherches dans plusieurs bases de données (toutes langues et années confondues). Les publications incluses devaient avoir été évaluées par les pairs et devaient rendre compte des résultats d’une intervention auprès d’adultes de 18 ans et plus qualifiée de prescription sociale dans la publication elle-même. La période de recherche s’étend jusqu’au 9 juillet 2023. Nous avons sélectionné, dans les revues systématiques retenues, les études primaires qui répondaient à ces mêmes critères d’inclusion. En ce qui concerne les études primaires, nous avons trié les résultats et les instruments extraits en fonction de six grands thèmes provenant d’une taxonomie publiée. Nous avons trouvé l’information relative à la description et aux propriétés de mesure des instruments et mené deux rondes d’évaluation concernant 1) la qualité des revues systématiques et 2) la présentation de données en lien avec les instruments dans les études primaires. Nous avons fait une synthèse narrative des revues, des études primaires et des résultats (PROSPERO 2023 CRD42023434061). RésultatsDix revues systématiques et 33 études primaires ont répondu aux critères d’inclusion de notre revue. Les résultats couvrent la plupart des grands thèmes de la taxonomie, en particulier les facteurs psychosociaux (comme le bien-être) et, dans une moindre mesure, la cognition, l’activité physique, ainsi que les aidants naturels et les bénévoles. Nous avons constaté que peu d’études fournissaient des données détaillées sur les caractéristiques sociodémographiques des participants ou sur les propriétés de mesure des instruments. ConclusionNotre synthèse brosse une vue d’ensemble des résultats et des instruments qui sont utilisés dans les interventions de prescription sociale et cerne également les lacunes des connaissances en la matière. Ce travail jette les bases de la prochaine étape de notre démarche : la sélection des résultats associés à la prescription sociale qui comptent le plus pour les parties intéressées, notamment les usagers, les prestataires et les décideurs.

Abstract Background There is a complicated and exploitative history of research with Indigenous peoples and accompanying calls to meaningfully and respectfully include Indigenous knowledge in healthcare. Storytelling approaches that privilege Indigenous voices can be a useful tool to break the hold that Western worldviews have within the research. Our collaborative team of Indigenous and non-Indigenous researchers, and Indigenous patients, Elders, healthcare providers, and administrators, will conduct a critical participatory, scoping review to identify and examine how storytelling has been used as a method in Indigenous health research. Methods Guided by two-eyed seeing, we will use Bassett and McGibbon’s adaption of Arksey and O’Malley’s scoping review methodology. Relevant articles will be identified through a systematic search of the gray literature, core Indigenous health journals, and online databases including Scopus, MEDLINE, Embase, CINAHL, AgeLine, Academic Search Complete, Bibliography of Native North Americans, Canadian Reference Centre, and PsycINFO. Qualitative and mixed-methods research articles will be included if the researchers involved Indigenous participants or their healthcare professionals living in Turtle Island (i.e., Canada and the USA), Australia, or Aotearoa (New Zealand); use storytelling as a research method; focus on healthcare phenomena; and are written in English. Two reviewers will independently screen titles/abstracts and full-text articles. We will extract data, identify the array of storytelling approaches, and critically examine how storytelling was valued and used. An intensive collaboration will be woven throughout all review stages as academic researchers co-create this work with Indigenous patients, Elders, healthcare professionals, and administrators. Participatory strategies will include four relational gatherings throughout the project. Based on our findings, we will co-create a framework to guide the respectful use of storytelling as a method in Indigenous health research involving Indigenous and non-Indigenous peoples. Discussion This work will enable us to elucidate the extent, range, and nature of storytelling within Indigenous health research, to critically reflect on how it has been and could be used, and to develop guidance for the respectful use of this method within research that involves Indigenous peoples and settlers. Our findings will enable the advancement of storytelling methods which meaningfully include Indigenous perspectives, practices, and priorities to benefit the health and wellbeing of Indigenous communities. Systematic review protocol registration Open Science Framework ( https://osf.io/rvf7q )

Background: Musculoskeletal trauma at midlife and beyond imposes significant impact on function and quality of life: Rehabilitation is key to support early and sustained recovery. There are frequent barriers to attending in-person rehabilitation that may be overcome by the recent advances in technology (telerehabilitation). Therefore, we conducted a systematic review of published evidence on telerehabilitation as a delivery mode for adults and older adults with musculoskeletal trauma. Methods: We followed established guidelines for conducting and reporting systematic reviews. We searched the following databases up to June 23, 2018: Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, Embase, Google Scholar, MEDLINE (Ovid and PubMed), PsycINFO, and SportDiscus. We included publications across all available years and languages for community-dwelling adults (50 years and older) with musculoskeletal trauma; and interventions using the following delivery modes: Apps, computer, telephone, videophone, videoconference, webcam, webpage, or similar media. Results: Six studies met the inclusion criteria: Five studies for hip fracture (n = 260) and one study for proximal humeral fracture rehabilitation (n = 17). Four of the studies used telephone as the delivery mode, one used computer and another used video-conferencing. Two of the studies were pre-post with no comparator group, and the remaining four studies were randomized controlled trials with low or unclear risk of bias. Studies established some modes of remote delivery as feasible, but the generalizability of the findings were limited. Two studies observed significant between-group differences (favoring the intervention) for physical activity, quality of life, and self-efficacy. Conclusion: Very few studies exist that tested the effect of telerehabilitation for recovery after musculoskeletal trauma later in life. Given the global burden imposed by musculoskeletal trauma, this review underscores an important gap in clinical knowledge.

Purpose: To evaluate the effect of comprehensive geriatric management on physical function after hip fracture. Materials and methods: This was a parallel-group 1:1 single-blinded randomized controlled trial. Fifty-three older adults (≥ 65 years) 3 to 12 months after hip fracture were randomized through a web-based system (independent statistical company) into usual care or usual care plus intervention (B4). The B4 group received management by a geriatrician, physical therapist and other health professionals. Outcomes were: Leg (knee extension) and grip strength, timed up and go; and self-report function at baseline, 6 and 12 months (blinded assessment). We estimated between-group differences at 6 and 12 months using linear mixed models, and compared function between groups with a global statistical test (incorporating the five measures). Results: There were no statistically significant differences between groups. For the combined sample, strength on the fractured leg (2.63, 95% CI: 0.86, 4.40 kg) and non-fractured leg (1.36, 95% CI: 0.12, 2.70 kg) were statistically higher than baseline values. Conclusions: There were no between group differences in physical function. Overall, older adults from both groups had small significant improvements in bilateral leg strength at final assessment, but below age-matched normative values.

Abstract Background Walking, and in particular, outdoor walking, is the most common form of physical activity for older adults. To date, no study investigated the association between the neighborhood built environment and physical activity habits of older adults of low SES. Thus, our overarching aim was to examine the association between the neighborhood built environment and the spectrum of physical activity and walking for transportation in older adults of low socioeconomic status. Methods Cross-sectional data were from the Walk the Talk Study, collected in 2012. Participants (n = 161, mean age = 74 years) were in receipt of a rental subsidy for low income individuals and resided in neighbourhoods across Metro Vancouver, Canada. We used the Street Smart Walk Score to objectively characterize the built environment main effect (walkability), accelerometry for objective physical activity, and the Community Healthy Activities Model Program for Seniors (CHAMPS) questionnaire to measure walking for transportation. We used regression analyses to examine associations of objectively measured physical activity [total volume, light intensity and moderate intensity physical activity (MVPA)] and self-reported walking for transportation (any, frequency, duration) with walkability. We adjusted analyses for person- and environment-level factors associated with older adult physical activity. Results Neighbourhood walkability was not associated with physical activity volume or intensity and self-reported walking for transportation, with one exception. Each 10-point increase in Street Smart Walk Score was associated with a 45% greater odds of any walking for transportation (compared with none; OR = 1.45, 95% confidence interval = 1.18, 1.78). Sociodemographic, physical function and attitudinal factors were significant predictors of physical activity across our models. Conclusions The lack of associations between most of the explored outcomes may be due to the complexity of the relation between the person and environment. Given that this is the first study to explore these associations specifically in older adults living on low income, this study should be replicated in other settings.

We used Bland Altman plots to compare agreement between a self-report diary and five different non-wear time algorithms [an algorithm that uses ≥60 min of consecutive zeroes (Troiano) and four variations of an algorithm that uses ≥90 min of consecutive zeroes to define a non-wear period] for estimating community-dwelling older adults’ (n = 106) sedentary behaviour and wear time (min/day) as measured by accelerometry. We found that the Troiano algorithm may overestimate sedentary behaviour and wear time by ≥30 min/day. Algorithms that use ≥90 min of continuous zeroes more closely approximate participants’ sedentary behaviour and wear time. Across the self-report diary vs. ≥90 min algorithm comparisons, mean differences ranged between −4.4 to 8.1 min/day for estimates of sedentary behaviour and between −10.8 to 1.0 min/day for estimates of wear time; all 95% confidence intervals for mean differences crossed zero. We also found that 95% limits of agreement were wide for all comparisons, highlighting the large variation in estimates of sedentary behaviour and wear time. Given the importance of reducing sedentary behaviour and encouraging physical activity for older adult health, we conclude that it is critical to establish accurate approaches for measurement.

Objective: In 2019, the Society for Enhanced Recovery After Cardiac Surgery (ERAS-CS) published perioperative guidelines to optimize the care of patients undergoing cardiac surgery. For centers with limited capacity, a sequential approach to the implementation of the full guidelines may be more feasible. Therefore, we aimed to explore the priority of implementation of the ERAS-CS guideline recommendations from a patient and caregiver perspective. Methods: Using a modified nominal group technique, individuals who previously underwent cardiac surgery and their caregivers ranked ERAS-CS recommendations within 3 time points (ie, preoperative, intraoperative, and postoperative) and across 2 to 3 voting rounds. Final round rankings (median, mean and first quartile) were used to determine relative priorities. Results: Seven individuals (5 patients and 2 caregivers) participated in the study. Patient engagement tools (2, 2.29, and 1.50), surgical site infection reduction (2, 1.67, and 1.25), and postoperative systematic delirium screening (1, 2.43, and 1.00) were the top-ranked ERAS-CS recommendations in the preoperative, intraoperative, and postoperative time points, respectively. Conclusions: Exploration of patient and caregiver priorities may provide important insights to guide the healthcare team with clinical pathway development and implementation. Further study is needed to understand the impact of the integration of patient and caregiver values on effective and sustainable clinical pathway implementation.

Plain English summary A “scoping review” is a type of study that collects and summarizes published and unpublished research reports to better understand the amount and types of information available on a particular topic. There is a well-known framework for how to conduct a scoping review, which involves six stages. The sixth stage is optional, and involves consulting with people who have an interest in the research results (i.e., people who the research is “about” or who it will affect the most). Very few scoping reviews actually include this stage, potentially due to a lack of practical guidance on how to perform it. For scoping reviews related to health research, it is important to consult or more widely engage patients and caregivers in the scoping review’s conduct because these individuals have a unique type of knowledge that comes from their experience of a health issue, which can yield valuable insights. Therefore, we have designed a scoping review that will identify the ways in which patients and caregivers have been engaged in scoping reviews of health research in the past. We hope to produce recommendations to make it easier for other researchers to engage patients and caregivers in scoping reviews.

The importance and value of engaging patients and the public as co-researchers (i.e., “patient engagement in research”) is becoming more evident, and guiding methods must be available for researchers conducting their work at different points along the engagement spectrum. This article provides a virtual workshop model for integrating patient and public stakeholder perspectives in data analysis and interpretation. The model is based upon a critical reflection on the methods that underlaid the consultation stage of our scoping review on patient and caregiver preferences for cardiac surgery. It involves four virtual workshop sessions held on separate days, each achieving the unique goals of (a) establishing participants’ technological literacy within the virtual platform, (b) obtaining responses to the research question, (c) introducing participant perspectives into research analysis and interpretation, and (d) prioritizing research findings or future research agendas. Further, a description of the considerations related to virtual engagement, including those pertaining to equity, diversity, and inclusion; features of the virtual platform; and roles for the research team are provided. This paper contributes toward a methodological toolkit for patient engagement in research, especially as an adjunct to research with otherwise minimal patient engagement. It also adds to the emerging literature on practical approaches to patient engagement in research as more engagement is occurring virtually.

Abstract Background Cardiac surgery is becoming increasingly common in older, more vulnerable adults. A focus on timely and complete medical and functional recovery has led to the development of enhanced recovery protocols (ERPs) for a number of surgical procedures and subspecialties, including cardiac surgery (ERAS® Cardiac). An element that is often overlooked in the development and implementation of ERPs is the involvement of key stakeholder groups, including surgery patients and caregivers (e.g., family and/or friends). The aim of this study is to describe a protocol for a scoping review of cardiac patient and caregiver preferences and outcomes relevant to cardiac surgery ERPs. Methods Using Arksey and O’Malley’s et al six-stage framework for scoping review methodologies with adaptions from Levac et al. (Represent Interv: 1–18, 2012), a scoping review of existing literature describing patient- and caregiver-identified preferences and outcomes as they relate to care received in the perioperative period of cardiac surgery will be undertaken. The search for relevant articles will be conducted using electronic databases (i.e., the Cochrane Library, Medline, PsycINFO, Scopus, and Embase), as well as through a search of the grey literature (e.g., CPG Infobase, Heart and Stroke Foundation, ProQuest Theses and Dissertations, Google Advanced, and Prospero). Published and unpublished full-text articles written in English, published after the year 2000, and that relate to the research question will be included. Central to the design of this scoping review is our collaboration with two patient partners who possess lived experience as cardiac surgery patients. Discussion This review will identify strategies that can be integrated into ERPs for cardiac surgery which align with patient- and caregiver-defined values. Broadly, it is our goal to demonstrate the added value of patient engagement in research to aid in the success of system change processes.