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Purpose: The R ehabilitation I nterventions for I ndividuals with a S pinal Cord Injury in the C ommunity (RIISC) team aimed to develop and evaluate innovative rehabilitation interventions to identify endocrine metabolic disease (EMD) risk, intending to reduce the frequency and severity of EMD related morbidity and mortality among adults living with chronic spinal cord injury or disease (SCI/D)., Materials and Methods: An interprovincial team from Ontario and Quebec reviewed available EMD literature and evidence syntheses and completed an inventory of health services, policies and practices in SCI/D care. The review outcomes were combined with expert opinion to create an EMD risk model to inform health service transformation., Results: EMD risk and mortality are highly prevalent among adults with chronic SCI/D. In stark contrast, few rehabilitation interventions target EMD outcomes. The modelled solution proposes: 1) abandoning single-disease paradigms and examining a holistic perspective of the individual's EMD risk, and 2) developing and disseminating practice-based research approaches in outpatient community settings., Conclusions: RIISC model adoption could accelerate EMD care optimization, and ultimately inform the design of large-scale longitudinal pragmatic trials likely to improve health outcomes. Linking the RIISC team activities to economic evaluations and policy deliverables will strengthen the relevance and impact among policymakers, health care providers and patients.

Background: Early discharge of frail older adults from post-acute care service may result in individuals' reduced functional ability to carry out activities of daily living, and social, emotional, and psychological distress. To address these shortcomings, the Montreal West Island Integrated University Health and Social Services Centre in Quebec, Canada piloted a post-acute home physiotherapy program (PAHP) to facilitate the transition of older adults from the hospital to their home. This study aimed to evaluate: (1) the implementation fidelity of the PAHP program; (2) its impact on the functional independence, physical and mental health outcomes and quality of life of older adults who underwent this program (3) its potential adverse events, and (4) to identify the physical, psychological, and mental health care needs of older adults following their discharge at home., Methods: A quasi-experimental uncontrolled design with repeated measures was conducted between April 1st, 2021 and December 31st, 2021. Implementation fidelity was assessed using three process indicators: delay between referral to and receipt of the PAHP program, frequency of PAHP interventions per week and program duration in weeks. A battery of functional outcome measures, including the Functional Independence Measure (FIM) and the Patient-Reported Outcomes Measurement Information System (PROMIS) Global-10 scale, as well as fall incidence, emergency visits, and hospitalizations were used to assess program impact and adverse events. The Patient's Global Impression of Change (PGICS) was used to determine changes in participants' perceptions of their level of improvement/deterioration. In addition, the Camberwell Assessment of Need for the Elderly (CANE) questionnaire was administered to determine the met and unmet needs of older adults., Results: Twenty-four individuals (aged 60.8 to 94 years) participated in the PAHP program. Implementation fidelity was low in regards with delay between referral and receipt of the program, intensity of interventions, and total program duration. Repeated measures ANOVA revealed significant improvement in FIM scores between admission and discharge from the PAHP program and between admission and the 3-month follow-up. Participants also reported meaningful improvements in PGICS scores. However, no significant differences were observed on the physical or mental health T-scores of the PROMIS Global-10 scale, in adverse events related to the PAHP program, or in the overall unmet needs., Conclusion: Findings from an initial sample undergoing a PAHP program suggest that despite a low implementation fidelity of the program, functional independence outcomes and patients' global impression of change have improved. Results will help develop a stakeholder-driven action plan to improve this program. A future study with a larger sample size is currently being planned to evaluate the overall impact of this program., Clinical Trial Registration: Retrospectively registered NCT05915156 (22/06/2023)., (© 2024. The Author(s).)

Background: Health human resources are scarce worldwide. In occupational therapy (OT), physical therapy (PT), and speech-language pathology (S-LP), attrition and retention issues amplify this situation and contribute to the precarity of health systems., Objective: To investigate the phenomena of attrition and retention with OTs, PTs and S-LPs who stayed in, or left their profession., Methods: Cultural-historical activity theory provided the theoretical scaffolding for this interpretive description study. We used purposeful sampling (maximum variation approach) to recruit OTs, PTs, and S-LPs from Quebec, Canada. Individual interviews were conducted with 51 OTs, PTs, and S-LPs from Quebec, Canada, in English or French (2019-2020). Inductive and deductive approaches, and constant comparative techniques were used for data analysis., Results: Six themes were developed: 1) characteristics of work that made it meaningful; 2) aspects of work that practitioners appreciate; 3) factors of daily work that weigh on a practitioner; 4) factors that contribute to managing work; 5) relationships with different stakeholders that shape daily work; and 6) perceptions of the profession. Meaningfulness was tied to participants' sense that their values were reflected in their work. Factors outside work shaped participants' work experiences. Recurrent negative experiences led some to leave their profession., Conclusion: Findings underscore a critical need to address contributing factors to attrition and retention which are essential to ensuring the availability of OTs, PTs and SLPs for present and future rehabilitation needs.

Objectives: Low back pain (LBP) is one of the main expenditure items for health systems. Data on the economic impact of LBP are uncommon from the patient perspective. The aim of this study was to estimate the economic impact of work disability related to chronic LBP from the patient perspective., Methods: We conducted a cross-sectional analysis from patients aged over 17 years suffering from non-specific LBP for at least 3 months. Systematic medical, social and economic assessments were collected: pain duration and intensity; functional disability with the Quebec Back Pain Disability Scale (0-100); quality of life with the Dallas Pain Questionnaire; job category; employment status; duration of work disability due to LBP, and income. Factors associated with loss of income were identified by multivariable logistic regression analysis., Results: We included 244 workers (mean age 43 ± 9 years; 36% women); 199 patients had work disability, including 196 who were on sick leave, 106 due to job injury. Three were unemployed due to layoff for incapacity. The mean loss of income for patients with work disability was 14% [SD 24, range -100 to 70] and was significantly less for patients on sick leave due to job injury than on sick leave not related to job injury (p < 0.0001). On multivariable analysis, the probability of loss of income with LBP was about 50% less for overseers and senior managers than workers or employees (odds ratio 0.48 [95% confidence interval 0.23-0.99])., Conclusion: Work disability due to LBP resulted in loss of income in our study. The loss of income depended on the type of social protection and job category. It was reduced for patients on sick leave related to work injury and for overseers and senior managers., Competing Interests: Declaration of Conflicting Interests The Authors declares no conflict of interest, (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Objective: The main objective of this study was to examine secular trends in body mass, body height and body mass index (BMI) from measured rather than self-reported values between 1972 and 2017., Methods: A total of 4500 students (males = 51%) were selected from a stratified sampling. The age range varied between 6.0 and 17.9 years. The sample came from 24 elementary schools and 12 high schools located in six urban cities from the province of Québec. All the tests selected were based on standardized procedures that are recognized as valid and reliable. Standardization and modeling of smoothed percentile curves for each variable for both sexes were produced., Results: Regional variations between youth from the province of Québec and those from all other Canadian provinces confirm the relevance of using data specific to the target population. Comparisons with the 1972 and 1982 data show an important increase in body mass (~ 7 kg, i.e. 16.4%) and BMI (~ 1.4 kg·m -2 , i.e. 19.9%) with minor change in body height (~ 1.8 cm, i.e. 3.9%). Youth from low-income backgrounds (p = 0.001) as well as those living in large urban cities (p = 0.002) see their probability of developing overweight or obesity greatly increase (low-income = 2.1 times; large urban cities = 1.3 times). However, overweight and obesity rates seem to have stabilized at around 21% since 2004., Conclusion: This study provides up-to-date data on factors that contribute to the prevalence of overweight and obesity in youth in urban settings of Québec, and will be instrumental in guiding public health strategies designed to optimize growth outcomes., (© 2023. The Author(s) under exclusive license to The Canadian Public Health Association.)

Introduction: Stroke is a leading cause of morbidity and mortality worldwide, placing an immense burden on patients and the health system. Timely access to rehabilitation services can improve stroke survivors' quality of life. The use of standardised outcome measures is endorsed for optimising patient rehabilitation outcomes and improving clinical decision-making. This project results from a provincially mandated recommendation to use the fourth version of the Mayo-Portland Adaptability Inventory (MPAI-4) to measure changes in social participation of stroke survivors and to maintain commitment to evidence-informed practices in stroke care. This protocol outlines the implementation process of the MPAI-4 for three rehabilitation centres. The objectives are to: (a) describe the context of MPAI-4 implementation; (b) determine clinical teams' readiness for change; (c) identify barriers and enablers to implementing the MPAI-4 and match the implementation strategies; (d) evaluate the MPAI-4 implementation outcomes including the degree of integration of the MPAI-4 into clinical practice and (e) explore participants' experiences using the MPAI-4., Methods and Analysis: We will use a multiple case study design within an integrated knowledge translation (iKT) approach with active engagement from key informants. Each case is a rehabilitation centre implementing MPAI-4. We will collect data from clinicians and programme managers using mixed methods guided by several theoretical frameworks. Data sources include surveys, focus groups and patient charts. We will conduct descriptive, correlational and content analyses. Ultimately, we will analyse, integrate data from qualitative and quantitative components and report them within and across participating sites. Results will provide insights about iKT within stroke rehabilitation settings that could be applied to future research projects., Ethics and Dissemination: The project received Institutional Review Board approval from the Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal. We will disseminate results in peer-reviewed publications and at local, national and international scientific conferences., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

The published literature shows a lack of methods to evaluate the patterns and extent of decomposition of human remains and to estimate the post-mortem interval (PMI) in humid, continental (Dfb) climates such as Quebec. The aim of this study was to address this gap in the current knowledge base by providing the first observations from human corpses studied under controlled conditions in Quebec. A 12-month study was conducted at the site for Research in Experimental and Social Thanatology; the first human taphonomy facility in Canada. Six human donors with known time of death were deposited across spring (n = 1), summer (n = 3), and autumn (n = 2) 2021. The lack of suitability of the total body score method to evaluate the extent of decomposition at the facility prompted the development of a new scoring system based on the macromorphoscopic changes observed. The scoring system was applied to the donors to evaluate decomposition throughout seasons. All donors followed comparable decomposition trajectories, regardless of the season of deposition. Eighty-five percent of taphonomic patterns appeared in the first 25 experimental days or 5000 Kelvin accumulated degree days (350 ADD). Extensive desiccation of tissues was observed at a median of 21 experimental days across donors, resulting in a plateau within decomposition with no extensive skeletonization. To the authors' knowledge, this is the first published report of experimentally observed desiccation in such a form in a Dfb climate. This study provides new data on the types of decomposition patterns to expect in forensic investigations in southern Quebec and comparable climates., (© 2023 American Academy of Forensic Sciences.)

Background: Shoulder pain is difficult to diagnose and treat with half of those affected still symptomatic six months after initial consultation. This may be explained by primary care management not conforming to evidence-based practice. This survey evaluated physiotherapists (PTs) and family physicians' (FPs) knowledge and appropriateness of care in shoulder pain management., Methods: A survey sent to PTs and FPs in the province of Quebec, Canada presented four clinical vignettes with cases of rotator cuff (RC) tendinopathy, acute full-thickness RC tear, adhesive capsulitis and traumatic anterior glenohumeral instability. Respondents indicated diagnosis, indications for imaging, specialists' referrals, and choice of treatments. Answers were compared to recommendations from clinical practice guidelines (CPGs). Participants' responses were compared between types of providers with Fisher's exact test., Results: Respondents (PTs = 175, FPs = 76) were mostly women with less than ten years of experience. More than 80% of PTs and 84% of FPs correctly diagnosed cases presented. Despite this practice not being recommended, more FPs than PTs recommended an imaging test in the initial management of RC tendinopathy (30% compared to 13%, p = 0.001) and adhesive capsulitis (51% compared to 22%, p = 0.02). For full-thickness RC tear and shoulder instability, up to 72% of FPs and 67% of PTs did not refer to a specialist for a surgical opinion, although recommended by CPGs. For RC tendinopathy, 26% of FPs and 2% of PTs (p < 0.001) would have prescribed a corticosteroid infiltration, which is not recommended in the initial management of this disorder. For adhesive capsulitis, significantly more FPs (76%) than PTs (62%) (p < 0.001) suggested an intra-articular corticosteroid infiltration, as recommended by CPGs. For all presented vignettes, up to 95% of family physicians adequately indicated they would refer patients for physiotherapy. In prioritizing rehabilitation interventions, up to 42% of PTs did not consider active exercises as a priority and up to 65% selected passive modalities that are not recommended for all shoulder pain vignettes., Conclusions: Most FPs and PTs were able to make adequate diagnoses and select appropriate treatments for shoulder pain, but practices opposed to evidence-based recommendations were chosen by several respondents. Further training of FPs and PTs may be needed to optimize primary care management of different shoulder disorders., (© 2023. The Author(s).)

Background: Clinical research coordinators (CRCs) facilitate the interaction between researchers and knowledge users in rehabilitation centres to promote and sustain evidence-informed practices. Despite their presence in rehabilitation settings in Quebec for over 20 years, little is known about their profiles and knowledge translation (KT) activities nor how they can best enact their role. This study explored CRCs' roles and perspectives on the barriers, enablers, and strategies for improving KT activities in rehabilitation settings., Methods: We conducted a multi-centre, participatory sequential mixed methods study. In the descriptive quantitative phase, we collected data via an online survey to determine CRCs' role in research and KT. In the subsequent qualitative phase, we conducted an in-person focus group to elicit CRCs' perspectives regarding factors influencing their work in KT, and potential solutions for overcoming these challenges. We used a descriptive and an inductive content analysis approach for the data analysis. The data synthesis was inspired by the Promoting Action on Research Implementation in Health Services framework., Results: All nine CRCs from five partner health regions of a large rehabilitation research centre agreed to participate in the study. The data suggest that CRCs are like knowledge brokers and boundary spanners. As information managers, linkage agents and facilitators, CRCs play a pivot role in diffusion, dissemination, synthesis and tailoring of knowledge to improve evidence informed practices and quality of care in rehabilitation. The factors influencing CRCs' KT activities are mostly linked to the context such as the receptivity of the organization as well as the lack of time and resources, and limited understanding of their roles by stakeholders. Two main suggestions made to enhance CRCs' contribution to KT activities include the harmonisation of expectations between the large research centre and their partner health regions, and better promotion of their role to clinical and research teams., Conclusions: This study provides valuable insights into the scope of CRCs' role. The results shed light on the challenges that they face and potential solutions to overcome them. The knowledge generated in this study can be used to implement this role with similar duties in rehabilitation settings or other health care domains., (© 2023. The Author(s).)

The vast majority of people living in long-term care facilities (LTCFs) are octogenarians (i.e., in Québec, 57.4% of the residents are age 85 or older, 26.2% are between age 75 and 84, 10.7% are between age 65 and 74, and 5.7% are below age 65 (1)), who are affected by a great loss of physical or cognitive autonomy due to illnesses and are unable to maintain their independence, safety and mobility at home. For the majority of them, their last living environment will be a LTCF. Moreover, the annual turnover in LTCFs is one-third of all residents (2) while the average length of stay is 823 days (1). Therefore the main challenges for caregivers in LTCFs are the maintenance of functional capacities and preventing patients from becoming bedridden and isolated. Measuring the level of autonomy and functional capacities is therefore a key element in the care of institutionalized people. Several validated tools are available to quantify the degree of dependence and the functional capacities of older people living in long-term care facilities. This narrative review aims to present the characteristics of the specific population living in long-term care facilities and describe the most widely used and validated tools to measure their level of autonomy and functional capacities., Competing Interests: The authors declare that they have no conflicts of interest.

Objective: The COVID-19 pandemic and its associated public health measures may increase the risk for psychological distress among vulnerable older adults. This longitudinal study aimed to identify predictors of psychological distress trajectories among community-dwelling older adults in Quebec, Canada., Methods: The study spanned four time points across 13 months and three waves of the COVID-19 pandemic. The sample included 645 community-dwelling older adults ages 60 years and older in Quebec. Participants completed telephone-based interviews that included the Kessler 6-item Psychological Distress Scale (K6) to assess psychological distress at each time point as well as information on socioeconomic, medical, psychological and COVID-19 related factors. Group-based trajectory modelling was used to identify distinct trajectories of psychological distress across time., Results: Three group-based trajectories of psychological distress were identified: the resilient (50.5%), reactive (34.9%), and elevated distress groups (14.6%). Individuals with mobility issues, insomnia symptoms, COVID-19 related acute stress, general health anxiety, increased loneliness symptoms, and those unable to use technology to see others were more likely to be in the reactive and elevated groups than the resilient group. Those with past mental health problems had uniquely increased odds of being in the reactive group compared to the resilient group. Individuals living in poverty and those who reported taking psychotropic medication had increased odds of being in the elevated distress group compared to the resilient group., Conclusion: These findings characterized distinct trajectories of psychological distress in older adults and identified risk factors for elevated distress levels., (© 2023 John Wiley & Sons Ltd.)

Population history reconstruction, using extant genetic diversity data, routinely relies on simple demographic models to project the past through ascending genealogical-tree branches. Because genealogy and genetics are intimately related, we traced descending genealogies of the Québec founders to pursue their fate and to assess their contribution to the present-day population. Focusing on the female and male founder lines, we observed important sex-biased immigration in the early colony years and documented a remarkable impact of these early immigrants on the genetic make-up of 20th-century Québec. We estimated the immigrants' survival ratio as a proportion of lineages found in the 1931-60 Québec to their number introduced within the immigration period. We assessed the effective family size, EFS, of all immigrant parents and their Québec-born descendants. The survival ratio of the earliest immigrants was the highest and declined over centuries in association with the immigrants' EFS. Parents with high EFS left plentiful married descendants, putting EFS as the most important variable determining the parental demographic success throughout time for generations ahead. EFS of immigrant founders appears to predict their long-term demographic and, consequently, their genetic outcome. Genealogically inferred immigrants' "autosomal" genetic contribution to 1931-60 Québec from consecutive immigration periods follow the same yearly pattern as the corresponding maternal and paternal lines. Québec genealogical data offer much broader information on the ancestral diversity distribution than genetic scrutiny of a limited population sample. Genealogically inferred population history could assist studies of evolutionary factors shaping population structure and provide tools to target specific health interventions., Competing Interests: The authors have declared that no competing interests exist

Introduction: The objective of this study was to characterize the combinations of demographic and socioeconomic characteristics associated to the unwillingness to receive the COVID-19 vaccines during the 2021 Quebec's vaccination campaign., Materials and Methods: In March-June 2021, we conducted an online survey of the participants of the CARTaGENE population-based cohort, composed of middle-aged and older adults. After comparing the vaccinated and unvaccinated participants, we investigated vaccine hesitancy among participants who were unvaccinated. For identifying homogeneous groups of individuals with respect to vaccine hesitancy, we used a machine learning approach based on a hybrid tree-based model., Results: Among the 6,105 participants of the vaccine cohort, 3,553 (58.2%) had at least one dose of COVID-19 vaccine. Among the 2,552 participants, 221 (8.7%) did not want to be vaccinated (91) or were uncertain (130). The median age for the unvaccinated participants was 59.3 years [IQR 54.7-63.9]. The optimal hybrid tree-based model identified seven groups. Individuals having a household income lower than $100,000 and being born outside of Canada had the highest rate of vaccine hesitancy (28% [95% CI 19.8-36.3]). For those born in Canada, the vaccine hesitancy rate among the individuals who have a household income below $50,000 before the pandemic or are Non-retired was of 12.1% [95% CI 8.7-15.5] and 10.6% [95% CI 7.6-13.7], respectively. For the participants with a high household income before the pandemic (more than $100,000) and a low level of education, those who experienced a loss of income during the pandemic had a high level of hesitancy (19.2% [8.5-29.9]) whereas others who did not experience a loss of income had a lower level of hesitancy (6.0% [2.8-9.2]). For the other groups, the level of hesitancy was low of around 3% (3.2% [95% CI 1.9-4.4] and 3.4% [95% CI 1.5-5.2])., Discussion: Public health initiatives to tackle vaccine hesitancy should take into account these socio-economic determinants and deliver personalized messages toward people having socio-economic difficulties and/or being part of socio-cultural minorities., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Jantzen, Maltais and Broët.)

Decomposition of human remains is a complex process impacted by many intrinsic and extrinsic factors. A less-studied extrinsic factor in forensic taphonomy are the scavengers that consume soft and hard tissue. Scavengers physically degrade and remove soft tissue, disperse, and destroy skeletal elements, which can make locating remains challenging. While invertebrate activity has been largely investigated, there is limited quantitative data available on vertebrate activity, particularly in Canada. This study aimed to determine which species (vertebrate and invertebrate) belong to the scavenger guilds in southern Quebec, and their potential taphonomic impact on the decomposition process. Two independent trials were conducted in 2020 using pig carcasses: one during summer in a forest habitat and one during fall in a grassland habitat. Each carcass was placed a minimum 100 m apart in semi-rural land. Vertebrate scavenger activity was recorded by continuous surveillance using trail cameras. Carcasses were also regularly visited to monitor the decomposition process and the activity of invertebrate scavengers. Overall, the vertebrate scavenger guilds included a narrow range of corvids, turkey vultures, coyotes, and skunks. The intensity of vertebrate scavengers was greater in the grassland habitat (fall), while the intensity of invertebrate scavengers was greater in the forest habitat (summer). With the exception of invertebrate scavengers, very few species visited during the fresh stage of decomposition, and the probability of body displacement increased as decomposition progressed. These results identify which scavengers have the greatest taphonomic impact and highlight the importance of incorporating scavenger impact when searching for human remains., (© 2021 American Academy of Forensic Sciences.)

Background: International standards govern the installation of detectable warning surfaces in urban environments. However, the application of these standards at the local level poses many challenges due to contextual differences., Methods: The aim of this qualitative cross-sectional study was to evaluate the usability of detectable warning surfaces installed in Quebec City (Canada) with people with visual impairments. Nineteen participants with various profiles visited two sites where the detectable warning surfaces had been installed. They tested the surfaces as well as adjacent urban facilities following a pedestrian route. They were then interviewed about what they thought of the detectable warning surfaces: their usefulness, messages transmitted, locations chosen, how safe they make users feel, types of environment in which they should be installed, how detectable they are, their advantages and disadvantages, and any desired improvements., Results: Generally, the participants understood the messages transmitted by the warning surfaces and were in favor of their installation. They identified some disadvantages and suggested various improvements., Conclusions: The results of this study provide important information concerning the usability of detectable warning surfaces for partners and stakeholders in Quebec City and also contribute to the international literature in this field.Implications for rehabilitationDetectable warning surfaces increase the readability or use of road infrastructures by people with visual impairments. They make it easier for them to get around independently.This project supports the importance of establishing an effective communication plan, particularly with the aim of clarifying the contexts of implantation and the messages transmitted by the detectable warning surfaces to the people with visual impairments. Training could systematically be offered to them by an orientation and mobility specialist.It is also important to inform and educate the general public and bus drivers about the presence of detectable warning surfaces. Information could be transmitted via some community organizations and the public transit networks.In order to effectively coordinate the implantation process of detectable warning surfaces, communication and consultation between the various stakeholders are essential, including the designers, the municipalities and the concerned government authorities.

Several countries have undertaken social distancing measures to stop SARS-CoV-2 spread. Asymptomatic carriers' prevalence is unknown and would provide essential information on hidden viral circulation. In our cross-sectional study, 1.82% of 330 asymptomatic confined individuals living in the community carried SARS-CoV-2 despite no contact with declared cases, raising concerns about unnoticed transmission., (Crown Copyright © 2020. Published by Elsevier Inc. All rights reserved.)

Preschool-aged bilingual children with autism spectrum disorder (ASD) can keep pace with their monolingual peers with ASD. However, can older children with ASD continue to do so as language demands become greater? Also, can they reach language levels similar to those of neurotypically developing (ND) bilingual children? The current study compares the language abilities of 3 school-aged bilingual children with ASD to those of 2 monolingual peers, and 19 ND bilingual and 12 ND monolingual peers. Using cluster analyses, we found that bilingual children with ASD had similar language to those of monolingual children with ASD and neurotypically developing bilingual and monolingual children. Results suggest that bilingual children with ASD can keep pace with their peers with similar intellectual abilities.

Background: While there is a growing body of literature supporting clinical decision-making for rehabilitation professionals, suboptimal use of evidence-based practices in that field persists. A strategic initiative that ensures the relevance of the research and its implementation in the context of rehabilitation could 1) help improve the coordination of knowledge translation (KT) research and 2) enhance the delivery of evidence-based rehabilitation services offered to patients with physical disabilities. This paper describes the process and methods used to develop a KT strategic initiative aimed at building capacity and coordinating KT research in physical rehabilitation and its strategic plan; it also reports the initial applications of the strategic plan implementation., Methods: We used a 3-phase process consisting of an online environmental scan to identify the extent of KT research activities in physical rehabilitation in Quebec, Canada. Data from the environmental scan was used to develop a strategic plan that structures KT research in physical rehabilitation. Seven external KT experts in health science reviewed the strategic plan for consistency and applicability., Results: Sixty-four KT researchers were identified and classified according to the extent of their level of involvement in KT. Ninety-six research projects meeting eligibility criteria were funded by eight of the fourteen agencies and organizations searched. To address the identified gaps, a 5-year strategic plan was developed, containing a mission, a vision, four main goals, nine strategies and forty-two actions., Conclusion: Such initiatives can help guide researchers and relevant key stakeholders, to structure, organize and advance KT research in the field of rehabilitation. The strategies are being implemented progressively to meet the strategic initiative's mission and ultimately enhance users' rehabilitation services.

Reduced mobility and physical independence of elders has emerged as a major clinical and public health priority with extended life expectancy. The impact of the neuromuscular function on muscle activity and properties has emerged as a critical factor influencing the progress and outcome of muscle changes with aging. However, very little is known about the neuromuscular junctions (NMJs) in humans, in part due to technical constraints limiting the access to healthy, fresh neuromuscular tissue. Here, we describe a method, called Biopsy using Electrostimulation for Enhanced NMJ Sampling (BeeNMJs) that improves the outcome of muscle biopsies. We used local cutaneous stimulation to identify the area enriched with NMJs for each participant at the right Vastus lateralis (VL). The needle biopsy was then performed in proximity of that point. The BeeNMJs procedure was safe for the participants. We observed NMJs in 53.3% of biopsies in comparison with only 16.7% using the traditional method. Furthermore, we observed an average of 30.13 NMJs per sample compared to only 2.33 for the traditional method. Importantly, high-quality neuromuscular material was obtained whereby pre-, postsynaptic, and glial elements were routinely labeled, simultaneously with myosin heavy chain type I. The BeeNMJs approach will facilitate studies of NMJs, particularly in human disease or aging process., (© The Author(s) 2019. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: There is a growing interest among healthcare providers (HCPs) to use Patient Reported Outcome Measures (PROMs) in clinical care. PROMs can help improve patient-care provider communication and may be used to inform the need for interdisciplinary care for Low Back Pain (LBP). However, PROM implementation to support clinical decision-making is complex and requires knowledge translation (KT) interventions that will overcome barriers to using PROMs in interdisciplinary clinical settings., Objectives: to 1) identify potential barriers and enablers to using PROMs in primary care LBP clinical practice from the perspective of healthcare team members, and 2) develop a theory-based tailored KT intervention to facilitate the use of PROMs in interdisciplinary clinical practice., Methods: We invited 25 HCPs working in an interdisciplinary team to complete a self-administered survey designed based on the Theoretical Domain Framework (TDF) to identify the barriers and enablers to using PROM scores in LBP clinical practice. The questionnaire consisted of 30 questions rated on a 5-point Likert scale (quantitative) and included open-ended questions (qualitative). Quantitative and qualitative data were analysed to estimate the frequency of barriers and enablers. Findings were then reviewed by a panel of four KT experts who mapped behaviour change techniques to barriers identified that informed the design of a KT intervention., Results: Eighteen HCPs responded to the survey. Factors identified as likely to restrict the use of PROM scores included knowledge, skills, social/professional role and identity, goals, decision processes, beliefs about consequences, environmental context and resources, behavioural regulation, and social influence. A multi-component evidence-based KT intervention was proposed by the panel of experts to address these barriers: a training workshop; educational materials; and use of PROM score reports to HCPs that were all delivered by an opinion leader., Conclusion: The routine use of PROMs in clinical practice may optimize the quality of LBP care and improve patients' outcomes. The proposed multi-component KT intervention is expected to be an effective strategy to increase HCPs' ability to integrate PROMs into clinical decision-making and to engage patients in their care.

Background: Few fire departments in Québec have a diversified health promotion programme. Yet, many allow firefighters to physically train during working hours., Aims: To compare the weekly physical activity (PA) level and cardiovascular health indicators of firefighters who physically train on duty to those who do not., Methods: Participants underwent a cardiovascular health assessment and completed an online questionnaire., Results: One hundred and five full-time male firefighters participated in the study. Two groups were formed: firefighters who physically train while on duty (E, n = 64) and firefighters who do not (NoE, n = 41). Following statistical adjustments, off-duty weekly PA was not different between the two groups (E: 239 ± 224 versus NoE: 269 ± 249 min, P = 0.496); however, total weekly PA was higher (P = 0.035) in E (381 ± 288 min) than in NoE (274 ± 200 min). A difference was also observed in obesity prevalence measured with waist circumference (E: 9% versus NoE: 27%, P = 0.026) and in physical inactivity prevalence (E: 0% versus NoE: 27%, P < 0.001). After statistical adjustments, E firefighters have a significantly lower waist-to-height ratio than NoE firefighters (E: 0.51 ± 0.05 versus NoE: 0.54 ± 0.05, P = 0.017)., Conclusions: Results show that firefighters who physically train while on duty have a higher total PA level on a weekly basis and have better cardiovascular health indicators. Our findings suggest that fire services should promote physical training while on duty to improve firefighters' cardiovascular health., (© The Author(s) 2020. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Adolescence is a crucial time in the development and maintenance of lifestyle habits. Interventions to improve health-related behaviors are important, including those that can contribute to an increase in physical activity (PA). During adolescence, PA typically decreases with age, particularly in girls. The FitSpirit program offers services that help Canadian schools from Quebec and Ontario implement PA interventions for adolescent girls. This study aimed to evaluate changes in participants' PA levels and lifestyle habits (sedentary time, sleep duration and eating habits) and to assess whether these changes depended on adherence to the Canadian 24-Hour Movement Guidelines and Canada's Food Guide recommendations at enrollment. At the time of FitSpirit registration (between December 2018 and March 2019) and in May/June 2019, 73 participants answered online questionnaires. The participants reported improvements, with an increase in the number of days with PA and a decrease in daily consumption of sweets. The greatest changes were observed in those who did not adhere to the Canadian recommendations before enrollment and who significantly increased their number of days with PA and their consumption of fruits and vegetables, and decreased their screen time. In conclusion, participation in FitSpirit improved several health behaviors among adolescent girls, particularly those who did not comply with the Canadian recommendations at enrollment.

Background: Hypertension guidelines recommend moderate-intensity continuous training (MICT) for the primary or secondary prevention of hypertension. However, alternative modalities, such as high-intensity interval training (HIIT) on dry land or in water, have been studied less widely., Aim: To assess chronic blood pressure (BP) response to a 2-week training programme involving six sessions of either MICT or HIIT performed on dry land or HIIT performed in an immersed condition, in participants with baseline office systolic/diastolic BP (SBP/DBP)≥130/85mmHg., Methods: We randomly assigned 42 individuals (mean age 65±7 years; 52% men) with baseline office SBP/DBP≥130/85mmHg to perform six 24-minute sessions on an ergocycle (three times a week for 2 weeks) of either MICT on dry land, HIIT on dry land or HIIT in a swimming pool, and assessed BP responses using 24-hour ambulatory BP monitoring., Results: While 2-week MICT and HIIT on dry land modified none of the 24-hour average haemodynamic variables significantly, immersed HIIT induced a significant decrease in 24-hour BP (SBP -5.1±7.3 [P=0.02]; DBP -2.9±4.1mmHg [P=0.02]) and daytime BP (SBP -6.2±8.3 [P=0.015]; DBP -3.4±4.0mmHg [P=0.008]), and slightly improved 24-hour and daytime pulse wave velocity (PWV) (24-hour PWV -0.17±0.23m/s [P=0.015]; daytime PWV -0.18±0.24m/s [P=0.02])., Conclusion: HIIT on an immersed stationary ergocycle is an innovative method that should be considered as an efficient non-pharmacological treatment of hypertension. As such, it should now be implemented in a larger cohort to study its long-term effects on the cardiovascular system., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)

Background and O bjectives: Language-induced grip force modulation (LGFM) can be used to better understand the link between language and motor functions as an expression of embodied language. However, the contribution of each brain hemisphere to LGFM is still unclear. Using six different action verbs as stimuli, this study evaluated the grip force modulation of the left hand in a unimanual task to characterize the left and right hemispheres' contributions. Materials and Methods: Left-hand LGFM of 20 healthy and consistently right-handed subjects was evaluated using the verbs "to write", "to hold", "to pull" (left-lateralized central processing actions), "to draw", "to tie", and "to drive" (bihemispheric central processing actions) as linguistic stimuli. The time between the word onset and the first interval of statistical significance regarding the baseline (here as reaction time, RT) was also measured. Results: The six verbs produced LGFM. The modulation intensity was similar for the six verbs, but the RT was variable. The verbs "to draw", "to tie", and "to drive", whose central processing of the described action is bihemispheric, showed a longer RT compared to the other verbs. Conclusions: The possibility of a given manual action being performed by the left hand in consistent right-handers does not interfere with the occurrence of LGFM when the descriptor verb of this action is used as a linguistic stimulus, even if the possibility is remote. Therefore, LGFM seems to mainly rely on the left hemisphere, while a greater activation of the right hemisphere in action processing appears to slow the increase in LGFM intensity., Competing Interests: The authors declare no conflicts of interest.

What do policing leaders think and know of forensic science? Beyond crime scene investigators or detectives, how do police senior managers perceive the role, utility and limitations of forensic science? Very few empirical studies have addressed the issue. Forensic scientsts should be concerned about the perception that law enforcement senior managers have of their discipline for two reasons. First, strategic and financial decision-makers are obviously key players in the overall administration and provision of forensic science, either as a supervisor, money provider or as a customer. Second, literature has highlighted that other actors involved in forensic science underestimate the scope and possibilities offered by forensic science, hence limiting its exploitation and potential. Following interviews with 18 police senior managers from Quebec (Canada), this study shows that they generally restrict forensic science to a reactive discipline whose role and utility is to identify offenders and support the Court. This understanding of forensic science, like that of many others including a significant share of forensic scientists, differs from the perception of other police activities in modern law enforcement agencies where proactive action is sought. Considering these findings and the growing body of literature which calls for forensic science to connect more tightly with policing and security, we advocate a more extensive education of police leaders regarding the scope of forensic science., (Copyright © 2019 The Chartered Society of Forensic Sciences. Published by Elsevier B.V. All rights reserved.)

Background: Obesity is known to be associated with poor mental health. Studies suggested that multimorbidity might explain the consequences of obesity on mental health. The objective of the present study was to examine to what extent physical multimorbidity and the severity of obesity were associated with mental health and with mental disorders., Methods: Cross-sectional study including a weighted representative sample of individuals in obesity from the province of Quebec included in the 2013-2014 Canadian Community Health Survey (N=1315) and test of the replicability of the association in the three previous cycles (2011-2012, N=1180; 2009-2010, N=1166; 2007-2008, N=1298)., Results: Adjusted logistic regressions showed that when obesity classes and physical multimorbidity were considered, the latter was preferentially associated with poor perceived mental health (OR 3.58, 95% CI 2.07 to 6.22), psychological distress (OR 3.71, 95% CI 2.14 to 6.42), major depressive episode (OR 5.16, 95% CI 2.92 to 9.13), mood disorders (OR 2.31, 95% CI 1.41 to 3.78) and anxiety disorders (OR 2.46, 95% CI 1.46 to 4.16). The same associations were confirmed in the previous cycles. Obesity class was only associated with stress (OR 2.05, 95% CI 1.36 to 3.07), but this association was not confirmed in the other cycles. Both physical multimorbidity and severe obesity were associated with mental multimorbidity., Conclusion: Among people with obesity, physical multimorbidity is preferentially associated with poor mental health/disorders. There is an existence of a somatic-mental multimorbidity which should be assessed and prevented in the management of obesity., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

To document the cardiovascular health profile of Québec police officers (PO). Participants answered an online questionnaire evaluating the presence of cardiovascular disease (CVD) risk factors and symptoms. Two thousand, ninety-nine (2,099) male (age: 40.8 ± 9.2 years) and 756 female (age: 37.9 ± 7.9 years) PO participated in this study. The prevalence of obesity (body mass index ≥30 kg/m 2 ) and diagnosed hypertension was respectively 21.1, and 14.3% in male and 7.3 and 4.1% in female PO. According to 2013 American College of Sports Medicine guidelines, 27.0 and 48.0% of male and 12.1 and 56.7% of female PO were categorized as being at moderate and high CVD risk, respectively. These findings suggest that Québec police departments should help PO to adopt and maintain a healthy lifestyle to decrease CVD risk.

Background: The unique perspectives of patients and caregivers on their experiences as users of rehabilitation services help identify areas for improvement for the continuum from acute care to community integration., Objective: This study reports perceptions of persons with stroke and their caregivers in an existing continuum of stroke care, social services, and rehabilitation in the Province of Quebec., Methods: A total of 10 focus groups were held, 5 with persons with stroke (n = 37, mean age 59.6 years (SD = 11.6); 21 men) and 5 others with caregivers (n = 31; mean age 58.8 years (SD = 15.1); 8 men). Discussions were transcribed and were the object of thematic content analysis using Nvivo., Results: Participants expressed their general satisfaction toward the care received in inpatient, hospital, and rehabilitation settings. The information received about acute care, however, was deemed insufficient and fragmented, and access of rehabilitation services was often perceived to be difficult. In the community integration phase of the continuum, most participants stated that they had experienced poor accessibility to services of any kind., Conclusions: Persons with stroke and their relatives' perspectives about the services that they obtained throughout the rehabilitation continuum vary importantly according to the services examined. Adopting a continuum perspective is helpful to target priorities for improvement.

Background: Female firefighters are in the minority in the Québec firefighter population and worldwide. To our knowledge, no study has focused on cardiovascular risk factors in female firefighters, and further research in this area is needed to evaluate and reduce the risk of on-duty sudden cardiac death., Aims: To evaluate the prevalence of cardiovascular disease (CVD) risk factors in female firefighters in Québec., Methods: A cross-sectional study using an online questionnaire to evaluate lifestyle and CVD risk factors and symptoms., Results: Forty-one female firefighters (age: 38.2 ± 9.9 years) participated in this study, representing ~7% of all female Québec firefighters. The prevalence of obesity (body mass index ≥ 30 kg/m2), hypertension, dyslipidaemia, type 2 diabetes mellitus, smoking and physical inactivity was 12% (95% confidence interval [CI] 4-26%), 5% (95% CI 0.6-19%), 5% (95% CI 0.6-19%), 3% (95% CI 0.1-14%), 14% (95% CI 5-29%) and 62% (95% CI 5-7%), respectively. Among survey participants, 76% (59-88%) had moderate to high CVD risk according to the 2013 American College of Sports Medicine guidelines. Eighty-two per cent of participants did not meet the National Fire Protection Association's required cardiorespiratory fitness standard of 12 metabolic equivalents., Conclusions: A high proportion of female firefighters in this study were at moderate to high risk of CVD. These findings suggest that they would benefit from healthy lifestyle initiatives.

Objective: We aimed to document the prevalence of cardiovascular disease (CVD) risk factors and symptoms in Québec firefighters., Methods: Seven hundred and seventy-nine (779) male firefighters (age: 41.6 ± 10.4 years; body mass index [BMI]: 28.0 ± 3.6 kg/m) answered an online questionnaire evaluating lifestyle and the presence of CVD risk factors and symptoms., Results: The prevalence of obesity (BMI is more than or equal to 30 kg/m), diagnosed hypertension, diagnosed dyslipidemia, and diagnosed type 2 diabetes mellitus was respectively 23.6%, 12.2%, 17.4%, and 1.7%. Among survey participants, 34.5% were categorized as moderate and 43.6% as high CVD risk, according to American College of Sports Medicine guidelines., Conclusions: A high proportion of Québec firefighters are at moderate to high risk of CVD. These findings suggest that Québec fire departments should help all firefighters to adopt and maintain a healthy lifestyle.

Background: The increase in overweight and obesity in adolescents and its health-related consequences highlight the need to develop strategies, which could help them adopt healthy eating habits. The objective of this study was to evaluate the impact of an innovative web-based school nutrition intervention (Team Nutriathlon) aimed at promoting the consumption of vegetables and fruit (V/F) and milk and alternatives (M/A) in high school students and to identify facilitators and/or barriers influencing its success., Methods: Ten classes of first and second year secondary students (grades 7 and 8) from the Québec City region were randomized into two groups (control n = 89 and intervention n = 193). Participants in the intervention (Team Nutriathlon) were to increase their consumption of V/F and M/A using an innovative web-based platform, developed for this study, over 6 weeks. The control group followed the regular school curriculum. The number of servings of V/F and M/A consumed by students per day was compared between the two groups before, during, immediately after and 10 weeks after the intervention using a web-based platform. Main outcome measures included V/F and M/A servings and facilitators and/or barriers of program success. Repeated measures linear fixed effects models were used to assess the impact of Team Nutriathlon on V/F and M/A consumption. A P-value of <0.05 was considered significant., Results: Students in the intervention reported a significant increase of 3 servings and 1.8 servings per day of V/F and M/A, respectively, compared to the control group (P < 0.05); however, this was only observed in the short-term. Some factors contributing to the success of Team Nutriathlon included the team aspect of the program, use of the technology and recording results outside of classroom hours., Conclusion: Team Nutriathlon represents an innovative web-based nutrition program which positively impacts V/F and M/A consumption among high school students. Using web-based or technological platforms may help youth adopt healthy eating habits that will have implications later in adulthood; however, further studies are needed to determine their long-term effects., Trial Registration: NCT03117374 (retrospectively registered).

Mobility is important for participation in daily activities and a power wheelchair (PW) can improve quality of life of individuals with mobility impairments. A virtual reality simulator may be helpful in complementing PW skills training, which is generally seen as insufficient by both clinicians and PW users. To this end, specific, ecologically valid activities, such as entering an elevator and navigating through a shopping mall crowd, have been added to the McGill wheelchair (miWe) simulator through a user-centred approach., Purpose: The objective of this study was to validate the choice of simulated activities in a group of newly trained PW users., Methods: We recruited 17 new PW users, who practiced with the miWe simulator at home for two weeks. They then related their experience through the Short Feedback Questionnaire, the perceived Ease of Use Questionnaire, and semi-structured interviews., Results: Participants in general greatly appreciated their experience with the simulator. During the interviews, this group made similar comments about the activities as our previous group of expert PW users had done. They also insisted on the importance of realism in the miWe activities, for their use in training., Discussion: A PW simulator may be helpful if it supports the practice of activities in specific contexts (such as a bathroom or supermarket), to complement the basic skills training received in the clinic (such as driving forward, backward, turning, and avoiding obstacles). Implications for Rehabilitation New power wheelchair users appreciate practicing on a virtual reality simulator and find the experience useful when the simulated diving activities are realistic and ecologically valid. User-centred development can lead to simulated power wheelchair activities that adequately capture everyday driving challenges experienced in various environmental contexts.

Objective: Questionnaires evaluating hearing impairment are available in English but there is a need for French standardised questionnaires for researchers as well as for audiologists and other clinicians. The objective of this study is to describe the translation and validation of four questionnaires that assess different aspects of hearing impairment and handicap among elders with hearing loss, by comparing the main score and psychometric evaluation of original and French-Canadian (FC) versions of the World Health Organization Disability Assessment Scale II (WHO-DAS II), the Screening Test for Hearing Problems (STHP), the Abbreviated Profile of Hearing Aid Benefit (APHAB) and the Measure of Audiologic Rehabilitation Self-Efficacy for Hearing Aids (MARS-HA)., Design: Vallerand method: translation and back-translation by two translators, revision by a committee of experts and pre-tested with five bilingual older participants., Study Sample: Participants (n = 29) were 65 years of age or older including 21 with hearing aids., Results: The psychometric properties (internal consistency, temporal stability after four weeks) indicate good reliability for most of the translated questionnaires and their subscales, especially the WHO-DAS II., Conclusions: The translations in FC of two hearing loss and two hearing aid questionnaires were validated. It is recommended to pursue the demonstration for temporal stability for the STHP.

Background: Musculoskeletal pain, symptoms or injuries are prevalent in the adolescent athlete population as well as in the general adolescent population, and often have significant consequences on their future musculoskeletal health. However, differences between these two populations in regards to their musculoskeletal health are not known and have not yet been explored. Therefore, the main objectives of this study are to 1) compare the 6-month prevalence of musculoskeletal symptoms and their impact on school attendance and reduction in sport or leisure activity between a group of adolescent athletes and a group of control adolescents, and 2) determine if gender has different effects on the prevalence of musculoskeletal symptoms in these two populations., Methods: Among adolescents who participated in the 2012 Québec summer games, 1,865 agreed to participate and constituted the adolescent athletes group (mean age:14.12 ± 1.22). An additional cohort of 707 adolescents from two schools was also recruited to form the comparison control group (mean age: 14.69 ± 1.38). Anthropometric data were collected, and the musculoskeletal 6-month prevalence of symptoms and their related impacts were assessed using the Teen Nordic Musculoskeletal Screening Questionnaire (TNMQ-S). Participants' characteristics as well as symptoms prevalence for the nine anatomical regions as well as their impact on school/work absence and reduction in physical/leisure activities were compared between athletes and control adolescents., Results: When compared to athlete adolescents, significantly more controls had a positive 6-month prevalence of symptoms affecting the neck (48.8% vs 26.3%), upper back (41.3% vs 18.1%) and low back (45.4% vs 35.8%) when compared to athlete. Symptoms affecting the spine led to significantly more school absence and reduction in physical activity in the control group. Controls also showed higher prevalence of shoulder (37.1% vs 28.3%) and wrist/hand (23.8% vs 17.4%) symptoms, while athletes had a higher prevalence of elbow symptoms (8.7% vs 11.4%)., Conclusion: Despite their higher risk of injuries related to high levels of competition or sport participation, adolescent athletes have fewer symptoms affecting the spine than "typical adolescents", and similar prevalence of symptoms affecting the body's extremities. Further investigations are necessary to understand the differences between athletes and non-athletes in regard to disability and long-term complications associated to musculoskeletal pain or symptoms.

We examined gender differences in appetite sensations when exposed to Mediterranean diet (MedDiet) meals and determined whether there are gender differences in the change in the satiating properties of the MedDiet over time. Thirty-eight men and 32 premenopausal women consumed a 4-week isoenergetic MedDiet under controlled conditions. Visual analogue scales were used to measure perceived appetite sensations before and immediately after each meal consumed over the course of one day (Wednesday) of the first and the fourth week of intervention. Women reported greater decreases for desire to eat, hunger, and appetite score than men in response to the consumption of the MedDiet meals (gender-by-meal interactions, resp., P = 0.04, P = 0.048, and P = 0.03). Fullness and prospective food consumption responses did not significantly differ between men and women. Between the first and the fourth week of intervention, premeal prospective food consumption increased with time in men (P = 0.0007) but not in women (P = 0.84; P for gender-by-time interaction = 0.04). These results indicate gender differences in appetite sensations when exposed to the MedDiet. These results may be useful in order to have a better understanding of gender issues for body weight management.

The objective of this study was to quantify work energy expenditure (EE) in physical education (PE) teachers. Sixty-four (64) physical educators (49 men, 15 women) had their individualized linear function between heart rate (HR) and oxygen consumption measured by laboratory testing. HR was then recorded on 2 different days at work to estimate EE, correlated with a diary of daily tasks. Average absolute EE was low-to-moderate (2.7 ± 1.4 to 4.6 ± 2.5 kcal·min(-1)) and low when expressed in relative values (15.3 ± 6.1% to 24.8 ± 7.6% of VO2max). However, these physical educators often reached very high intensities (from 7.5 ± 7.9% to 23.8 ± 22.3% of work time at 100 bpm and more). PE teaching requires a light-to-moderate EE with more intense periods of physical activity. The variety of tasks performed (office work, supervision and monitoring, mixed participation and active participation) significantly influenced EE., (Copyright © 2014 Elsevier Ltd and The Ergonomics Society. All rights reserved.)

Background: Even if a large proportion of physiotherapists work in the private sector worldwide, very little is known of the organizations within which they practice. Such knowledge is important to help understand contexts of practice and how they influence the quality of services and patient outcomes. The purpose of this study was to: 1) describe characteristics of organizations where physiotherapists practice in the private sector, and 2) explore the existence of a taxonomy of organizational models., Methods: This was a cross-sectional quantitative survey of 236 randomly-selected physiotherapists. Participants completed a purpose-designed questionnaire online or by telephone, covering organizational vision, resources, structures and practices. Organizational characteristics were analyzed descriptively, while organizational models were identified by multiple correspondence analyses., Results: Most organizations were for-profit (93.2%), located in urban areas (91.5%), and within buildings containing multiple businesses/organizations (76.7%). The majority included multiple providers (89.8%) from diverse professions, mainly physiotherapy assistants (68.7%), massage therapists (67.3%) and osteopaths (50.2%). Four organizational models were identified: 1) solo practice, 2) middle-scale multiprovider, 3) large-scale multiprovider and 4) mixed., Conclusions: The results of this study provide a detailed description of the organizations where physiotherapists practice, and highlight the importance of human resources in differentiating organizational models. Further research examining the influences of these organizational characteristics and models on outcomes such as physiotherapists' professional practices and patient outcomes are needed.

Background: Collaboration and interprofessional practices are highly valued in health systems, because they are thought to improve outcomes of care for persons with complex health problems, such as low back pain. Physiotherapists, like all health providers, are encouraged to take part in interprofessional practices. However, little is known about these practices, especially for private sector physiotherapists. This study aimed to: 1) explore how physiotherapists working in the private sector with adults with low back pain describe their interprofessional practices, 2) identify factors that influence their interprofessional practices, and 3) identify their perceived effects., Methods: Participants were 13 physiotherapists, 10 women/3 men, having between 3 and 21 years of professional experience. For this descriptive qualitative study, we used face-to-face semi-structured interviews and conducted content analysis encompassing data coding and thematic regrouping., Results: Physiotherapists described interprofessional practices heterogeneously, including numerous processes such as sharing information and referring. Factors that influenced physiotherapists' interprofessional practices were related to patients, providers, organizations, and wider systems (e.g. professional system). Physiotherapists mostly viewed positive effects of interprofessional practices, including elements such as gaining new knowledge as a provider and being valued in one's own role, as well as improvements in overall treatment and outcome., Conclusions: This qualitative study offers new insights into the interprofessional practices of physiotherapists working with adults with low back pain, as perceived by the physiotherapists' themselves. Based on the results, the development of strategies aiming to increase interprofessionalism in the management of low back pain would most likely require taking into consideration factors associated with patients, providers, the organizations within which they work, and the wider systems.

Background: Despite growing interest in the importance of, and challenges associated with the involvement of patient and population (IPP) in the process of developing and adapting clinical practice guidelines (CPGs), there is a lack of knowledge about the best method to use. This is especially problematic in the field of rehabilitation, where individuals with disabilities might face many barriers to their involvement in the guideline development and adaptation process. The goal of this pilot trial is to document the acceptability, feasibility and effectiveness of two methods of involving patients with a disability (traumatic brain injury) in CPG development., Methods/design: A single-blind, randomized, crossover pragmatic trial will be performed with 20 patients with traumatic brain injury (TBI). They will be randomized into two groups, and each will try two alternative methods of producing recommendations; a discussion group (control intervention) and a Wiki, a webpage that can be modified by those who have access to it (experimental intervention). The participants will rate the acceptability of the two methods, and feasibility will be assessed using indicators such as the number of participants who accessed and completed the two methods, and the number of support interventions required. Twenty experts, blinded to the method of producing the recommendations, will independently rate the recommendations produced by the participants for clarity, accuracy, appropriateness and usefulness., Discussion: Our trial will allow for the use of optimal IPP methods in a larger project of adapting guidelines for the rehabilitation of individuals with TBI. Ultimately the results will inform the science of CPG development and contribute to the growing knowledge about IPP in rehabilitation settings., Trial Registration: Clinical trial KT Canada 87776.

The purposes of this work are to assess the performance of a 2D plastic scintillation detectors array prototype for quality assurance in intensity-modulated radiation therapy (IMRT) and to determine its sensitivity and specificity to positioning errors of one multileaf collimator (MLC) leaf and one MLC leaf bank by applying the principles of signal detection theory. Ten treatment plans (step-and-shoot delivery) and one volumetric modulated arc therapy plan were measured and compared to calculations from two treatment-planning systems (TPSs) and to radiochromic films. The averages gamma passing rates per beam found for the step-and-shoot plans were 95.8% for the criteria (3%, 2 mm), 97.8% for the criteria (4%, 2 mm), and 98.1% for the criteria (3%, 3 mm) when measurements were compared to TPS calculations. The receiver operating characteristic curves for the one leaf errors and one leaf bank errors were determined from simulations (theoretical upper limits) and measurements. This work concludes that arrays of plastic scintillation detectors could be used for IMRT quality assurance in clinics. The use of signal detection theory could improve the quality of dosimetric verifications in radiation therapy by providing optimal discrimination criteria for the detection of different classes of errors.

Objectives: To test the hypotheses that, in comparison with a control group that received standard care, users of manual wheelchairs who also received the French-Canadian version of the Wheelchair Skills Training Program (WSTP) would significantly improve their wheelchair-skills capacity and that these improvements would be retained at 3 months., Design: Multicenter, single-blind, randomized controlled trial., Setting: Three rehabilitation centers in Montréal, Quebec, Canada., Participants: Manual wheelchair users (N=39), a sample of convenience., Intervention: Participants were randomly allocated to the WSTP or control groups. Participants in both groups received standard care. Participants in the WSTP group also received a mean of 5.9 training sessions (a mean total duration of 5h and 36min)., Main Outcome Measures: The French-Canadian version of the Wheelchair Skills Test (WST) (Version 3.2) was administered at evaluation at first time period (baseline) (t1), evaluation at second time period (posttraining) (t2) (a mean of 47d after t1), and at evaluation at third time period (follow-up) (t3) (a mean of 101d after t2)., Results: At t2, the mean ± SD total percentage WST capacity scores were 77.4%±13.8% for the WSTP group and 69.8%±18.4% for the control group (P=.030). Most of this difference was due to the community-level skills (P=.002). The total and subtotal Wheelchair Skills Test scores at t3 decreased by ≤0.5% from the t2 values, but differences between groups at t3, adjusting for t1, did not reach statistical significance (P≥.017 at a Bonferroni-adjusted α level of .005)., Conclusion: WSTP training improves wheelchair skills immediately after training, particularly at the community-skills level, but this study did not show statistically significant differences between the groups at 3 months., (Copyright © 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Purpose: The goal of this study was to describe different components of the food environment in childcare settings., Methods: Visits were made to 33 early childcare centres (CPEs) in the Estrie region of Quebec, Canada. Data were collected between March and July 2008 using a questionnaire based on the Cohen model. The goal of the questionnaire was to collect information about meal organization, menu composition and food preparation methods., Results: Although few CPEs had adopted a food policy, descriptive analyses showed that the food environment in these settings was generally adequate. In 97% of the CPEs, menu planning was performed by the food technician. The meals offered as well as the food preparation methods employed were consistent with the general guidelines of Canada’s Food Guide (CFG). However, a lack of professional training was observed. Furthermore, only 25% of the CPEs offered a snack made up of two food groups., Conclusions: Certain improvements must be made to the food environment in Quebec childcare settings, which underscoresthe need to create and implement a food policy for childcare centres.

The purpose of this study was to assess the potential influence of birth quarter on the frequency of physical activity and participation in specific activities during adulthood. We used data from one national and one provincial survey, the 2005 Canadian Community Health Survey and the 1998 Quebec Social and Health Survey (Enquête sociale et de santé du Québec) respectively. We analysed the distribution of participants at each level of practice of a given leisure activity and work-related physical activity. In the Canadian Community Health Survey, a relative age effect was found for participation in soccer in the 25- to 60-year-old population. However, for volleyball, a significant relative age effect was also observed but with over-representation of the last quarters of the year for the whole population and for men aged 12-60 years. In the Quebec Social and Health Survey, significant differences in the frequency of distribution without a relative age effect were revealed for participation in women's ice hockey, work-related physical activity level, and stage of change for physical activity. Overall, the data indicate that the systematic relative age effect reported in other studies for some competitive sports, such as ice hockey and soccer, is not as prevalent in leisure physical activities during adulthood. This may reflect lower competitive selection and attrition in population physical activity compared with competitive sports in younger athletes.

The purpose of the present study was to evaluate the reliability of the oxygen consumption/heart rate (VO(2)/HR) relationship used to estimate energy expenditure during a workday. Before and after a 6-10 h work shift, the VO(2)/HR relationship was measured in 57 workers (28 female, 29 male) in our laboratory. VO(2) was similar before and after the shift at HR of 100 and 125 beats per minute (bpm). However, the VO(2)/HR relation and perceived exertion (RPE) became less accurate after a work shift as VO(2) and RPE were, respectively, increased at HR above 150 and 125 bpm. Increase of RPE for a same exercise intensity was higher in female subjects. Our results suggest good reliability of the VO(2)/HR relationship at HR usually found in workplaces.

The purpose of this study was to describe the traumatology of teaching physical education (PE) and to document the causes and mechanisms of injuries in this occupation. Our sample was composed of 314 physical educators (PEs) teaching at three school levels (primary school, secondary school and college) who responded to a questionnaire survey. The results showed a 0.55 rate of recent lesion per teacher per year (0.65 for women and 0.51 for men). A total of 37.6% of subjects were affected by a lesion during the last year at work. Subjects with a higher weekly frequency of leisure physical activities or endurance activities (five times and more) were less affected by chronic lesions as well as those who frequently practiced aerobic physical activities. Prevalence of chronic injuries was higher in older teachers. Our results confirm that the rate of lesions in this group of workers is high, and that school level and respondent age may influence the rate of lesion and the characteristics of risk factors. In particular, the effect of ageing and teaching specialization on the incidence of occupational problems in PEs warrants further research. Given the relatively high rate of injuries among PE teachers, we suggest that it is necessary to further explore preventive strategies to reduce occupational risk in these workers. In particular, prophylactic physical activity outside of work may represent such a strategy since PEs more active outside their work have lower chronic injury prevalence. PEs gave long periods of standing the highest rating for movements or positions most likely to cause them occupational injuries. It can thus be suggested to find ways to reduce standing position sustained for long periods.

Objective: To reduce the number of transgressions to the rule, the occurrence of violent acts and to prevent injuries, Hockey Québec adopted the Fair-Play Program (FPP). The objective of the present study was to evaluate the effectiveness of the FPP., Methods: 52 Bantam (14-15 years) teams participated in this cohort study. In total, 49 games (13 with the FPP, 36 without FPP) were systematically assessed for transgressions to the rule. Body checking was allowed in all games. Transgressions to the rule data were obtained using a real time observation system in a natural setting, while injury data were collected through a self-administered questionnaire. Data were analysed using generalised linear models with generalised estimating equations accounting for potential team effect., Results: The number of penalties per game was significantly lower (p < 0.01) for games played with the FPP. Overall, no difference was noted in the number of transgressions observed during games played with or without the FPP. Players in leagues where the FPP was used held their opponents more frequently (p < 0.0001). On the other hand, players in leagues without the FPP shoved and hit more (p = 0.05). No difference was noted in the injury rate for games played with or without the FPP., Conclusions: This study showed that the FPP is one of the tools available to help those in the hockey world promote fair play values. Moreover, this project clearly showed the importance of program evaluation and the value of direct observation in a natural setting.

Background: The MOS Social Support Survey was developed for patients who participated in the Medical Outcomes Study (MOS), a two-year study on persons who suffered from chronic illness. There are a number of advantages to using the MOS Social Support Survey, especially with those persons who suffer from chronic illness: it is easy to understand, is relatively short, is multidimensional, can be completed by the patient without assistance and has good psychometric properties., Objective: The goal of this study was to establish a French-Canadian version of the MOS Social Support Survey and to verify its psychometric properties following the cross-cultural translation and validation procedures proposed by Vallerand., Methods: A first draft of the MOS Social Support Survey was achieved by following the back-to-back translation technique. Next, a committee of four bilingual people reviewed and evaluated the preliminary versions of the questionnaire (English and French) to establish a French experimental version. A pre-test was done with 10 francophone persons. The Haccoun method was used to evaluate the construct validity and test-retest reliability, as well as the internal consistency of the questionnaire. The test-retest was performed with 20 students from the School of Languages from Laval University, Sainte-Foy, Quebec. The present research was approved by the ethics committee of the institution., Results: The results showed acceptable internal consistency and good reliability. The psychometric properties were found to be acceptable and comparable with those obtained by Sherbourne and Stewart with the English version., Conclusion: The French-Canadian version of the MOS Social Support Survey should be useful in evaluating social support among patients to allow medical staff to plan rehabilitation programs that would include the necessary consultations and interventions needed to establish a better quality of life for the patient.

This study evaluated intraindividual child-adult and interindividual child-parent relationships of body mass index (BMI) using data from the Trois-Rivières semilongitudinal study of growth and development. Intraindividual correlations between age 12 and 35 years were substantial (r(2) = 36% of variance in women, 30% of variance in men). Interindividual child-parent correlations for mothers and fathers age 36.6 +/- 0.4 and 39.5 +/- 0.4 years, respectively, were very low to low for daughters age 12 years (r = 0.09, NS and 0.34, P < 0.001 vs. father and mother, respectively) but all very low for sons age 12 years (r = 0.07, NS and 0.16, NS vs. father and mother, respectively). A multiple regression analysis predicted adult BMI from the individual's BMI at 10, 11, 12 years plus the maternal and paternal BMIs as calculated from self-reported heights and weights. The BMI at age 12 years was a better predictor of adult BMI than the parental BMI in both men and women (P < 0.001) and multivariate analysis revealed that this index at age 12 years was the sole significant predictor of adult BMI for both men and women. The results from our study do not support the hypothesis that parental BMI is a stronger predictor of adult BMI than childhood BMI. However, useful information for the prediction and prevention of adult overweight can be obtained from the BMI at age 12 years. Our results suggest that environmental influences may be the major factor in the present obesity epidemic., (Copyright 2003 Wiley-Liss, Inc.)

Objectives: The primary objectives were to evaluate the acceptability in France of the Quebec Back Pain Disability Scale (QBPDS) in its original French-language version and to study its correlational validity against indicators of impairment, pain, disability, psychological status, and perceived health status., Material and Methods: Thirty-two patients with chronic low back pain were recruited at the rheumatology outpatient clinic of a French hospital. A physical examination was performed for determination of an impairment score, and scales were completed for pain (visual analog scale and Saint-Antoine Questionnaire), disability (QBPDS and Dallas Scale [DS]), perceived health status (Nottingham Health Profile, NHP), and psychological status (Hospital Anxiety and Depression Scale, HADS)., Results: Acceptability, internal consistency, and content validity of the QBPDS were satisfactory. Investigation of correlational validity showed good agreement with the DPQ (r = 0.755) and NHP (r = 0.739) and fair agreement with the impairment score (r = 0.449), the VAS pain score (r = 0.448), and the HADS score (r = 0.473). The QBPDS showed good discriminating power. Validity of the QBPDS was confirmed., Discussion: Our results confirm the good measurement properties of the original French-language version of the QBPDS in French hospital-clinic patients with chronic low back pain. Comparison of the QBPDS and DPQ in this study shows that the QBPDS is better for evaluating disability, whereas the DPQ evaluates the overall, functional, psychological, and social impact of low back pain.