GF Strong Rehabilitation Centre

Intermittent catheterization (IC) remains the standard of care for patients who are unable to empty their bladder. However, incomplete bladder emptying and urinary tract infections (UTIs) can persist, leading to complications such as recurrent infections, episodes of hospitalizations, and decreased quality of life. The Micro-hole Zone Technology (MHZT) catheter (Luja™) represents an innovative catheter design that aims to address known mechanical risk factors for UTI by minimizing flow-stops, mucosal microtrauma, and residual urine, all key contributors to infection risk. A scoping literature search was performed in PubMed and Google Scholar to identify all preclinical, clinical, and patient-reported outcome (PRO) studies evaluating the MHZT catheter (Luja). To contextualize its performance, findings were systematically compared with conventional two-eyelet catheters (CEC) across the same endpoints. The co-primary endpoints were (1) frequency of flow-stops and (2) residual urine volume at first flow-stop (RV1). Secondary endpoints included intracatheter pressure peaks, haematuria, and PRO measures related to comfort, ease of use, and perceived completeness of bladder emptying. Preclinical studies demonstrated significantly fewer flow stop with the MHZT (0% vs. up to 80% with CEC), markedly reduced residual volume at first flow-stop (mean 3.6 ± 3.9 mL vs. 38.1 ± 26.7 mL; p < 0.001) and lower intraluminal pressure peaks (− 42 ± 11 vs. − 132 ± 7 mbar; p < 0.001). From summarized data across randomized controlled trials (n > 250), catheterizations with Luja resulted in zero flow-stops and complete emptying at first flow-stop (RV1 < 10 mL) > 87% of the times compared to approximately 50% for CEC. PRO data from > 3,400 users indicated improved confidence in complete emptying, easier use and less worry for UTIs. By triangulating evidence across preclinical, clinical, and PRO studies, this review demonstrates that the MHZT/Luja catheter significantly improves bladder drainage compared with conventional designs, reducing flow-stops, residual urine, and urothelial trauma. Given that infection remains one of the most frequent IC complications, Luja offers a promising approach to lowering UTI risk factors. Enhanced user experience and confidence in complete emptying further support its potential clinical benefit.

Introduction Bien que la prescription sociale constitue un courant de plus en plus important en faveur de la santé globale et de la société, aucune étude Delphi n’a déterminé quels résultats sont essentiels à évaluer. Notre objectif était de faire émerger un ensemble de résultats fondamentaux en fonction des commentaires de divers groupes d’utilisateurs susceptibles d’être concernés par la prescription sociale (aînés de 60 ans et plus) ou de personnes pouvant avoir une influence sur elle (comme les fournisseurs ou les chercheurs). Méthodologie Conformément aux lignes directrices normalisées pour les études Delphi, nous avons élaboré une enquête en ligne à deux cycles en ciblant les perspectives canadiennes. Nous avons demandé aux participants d’évaluer 21 résultats comme « cruciaux » (7 à 9 sur une échelle de 9 points), « importants mais non cruciaux » (4 à 6 points) ou « sans importance » (1 à 3 points). Nous présentons une description du sous-groupe de résultats obtenus du point de vue des aînés et de leurs familles et amis. Résultats Le premier cycle a été complété par 74 personnes relevant de 10 groupes d’utilisateurs et le second par 52 personnes relevant de 8 groupes d’utilisateurs (taux de rétention de 70 %). Les évaluations entre les cycles ont été généralement uniformes. Sept résultats ont atteint le seuil de résultat « crucial ». Aucun résultat n’a été exclu. Les résultats cruciaux portaient sur la santé mentale, le fonctionnement physique et social et le bien-être. Les participants ont formulé des commentaires sur les facteurs contextuels (ressources, prestation de soins, etc.) et les facteurs liés à l’équité Conclusion Cette étude a permis de faire émerger sept résultats cruciaux à prendre en compte dans les évaluations en matière de recherche et d’interventions portant sur la prescription sociale. Les recherches futures devraient porter sur la manière dont les facteurs contextuels et personnels ont une influence sur les résultats et elles devraient définir des outils précis (questionnaires, tests axés sur le rendement) pour évaluer chaque résultat. Définir quels résultats sont importants est un processus continu qui nécessite des mises à jour régulières dans la mesure où ces résultats sont susceptibles de changer en fonction de l’évolution de la prescription sociale et d’autres facteurs.

BackgroundMore than 12% of the world’s population and more than 1 million Canadians use walking aids to support mobility. Unsafe use of walking aids due to a lack of training may lead to injuries and an increased risk of falls. A novel interactive video-based feedback mobile app to train walking aid fitting and safe use, called ICanWALK (Improving Canadians’ Walking Aid Skills, Learning, and Knowledge), was recently developed.ObjectiveThe primary objective of this study is to explore the efficacy of the walking aid skills training app on the balance confidence of walking aid users. The secondary objective is to explore the influence of the mobile app on mobility and knowledge of walking aid users.MethodsA 2-site single-blind pragmatic randomized controlled trial is proposed. A total of 52 adults who use walking aids will be recruited through clinical and community organizations. Participants will complete measures of balance confidence (Activities-specific Balance Confidence scale; the primary outcome), mobility (6-Minute Walk Test and Timed Up and Go test), walking aid skills (Walking Aids Skills Test, WAST), and knowledge of and confidence in walking aid fit and use (self-reported questionnaire) at baseline (T1). Participants will then be randomly assigned to the experimental (ICanWALK app) or attention-matched control group (breathing activity app) and will complete two 20-minute sessions interacting with the assigned app. Participants will be reassessed 2 to 4 days after the intervention (T2) and again 4 weeks later (T3). Analysis of covariance will be performed for primary and secondary outcomes by using SPSS software.ResultsThe study protocols were approved by the institutional review boards of both recruitment sites in 2023 and 2024. A feasibility study was conducted from 2023 to 2024 across the 2 sites. As of November 2025, participant recruitment is ongoing and expected to conclude in December 2026. To date, 26 individuals have been enrolled and have successfully completed all 3 assessment time points: T1, T2, and T3.ConclusionsUsing a video-based feedback training approach, a novel app is hypothesized to improve balance confidence, mobility, and knowledge of and confidence in walking aid fitting and use. This structured educational program for fitting and training of walking aids may improve balance confidence. Better walking aid fitting and use may improve mobility, especially for older adults, thereby increasing independence and social participation. Establishing efficacy is an important first step before exploring how the ICanWALK app may be used by walking aid users and clinicians in clinical and community settings.Trial RegistrationClinicalTrials.gov NCT05347875; https://clinicaltrials.gov/study/NCT05347875International Registered Report Identifier (IRRID)DERR1-10.2196/71060

Public transportation is fundamental for people with disabilities to access meaningful opportunities. However, their access to public transit is still limited, partly due to the policies establishing the accessibility requirements of public transportation services. We conducted a policy scan analysis of the local, provincial/state, and federal public transportation policies in Canada and the United States. With this scan, we analyzed the policies’ aims, the definition of disabilities, and the content of those policies. The policy analysis revealed that the definition of disability was inconsistent across jurisdictions, creating a discrepancy between those who have access to accessible transport and those who do not. The analysis also showed that policies in the United States and Canada mainly focused on the built environment, the adaptations of vehicles, and the provision of services. In contrast, only a few policies covered social accessibility, such as interaction with the staff, which underscores a significant policy gap and suggests the need for more training requirements in the policies. Funding to transport agencies for people with disabilities was also a missing piece highlighted in this comparative analysis, particularly in Canada. Policymakers need to develop funding mechanisms to ensure a better implementation of accessibility in services and infrastructure.

Older adults living in hospitals and long-term care (LTC) settings often lack opportunities for meaningful social engagement and interaction with the outside world, particularly due to mobility disabilities and frailty. Immersive virtual reality (VR) technologies have shown potential to overcome these barriers by virtually connecting individuals with nature, familiar environments, and cultural experiences, thereby promoting well-being and social engagement. However, existing research primarily utilizes head-mounted displays (HMDs) and involves healthy community-dwelling participants, limiting relevance for people living with dementia in care settings such as hospitals and LTC. This qualitative study protocol outlines the use of a non-HMD immersive technology tailored for people living with dementia in hospital and LTC settings. Employing wall projections and motion sensors, the intervention is specifically designed for accessibility among people living with dementia in hospitals and LTC environments. Guided by the Collaborative Action Research (CAR) approach, the study comprises three phases: Plan, Implement, and Evaluate. Focus groups, interviews, and ethnographic observations will be conducted to collect data. Thematic analysis will identify key themes related to feasibility, acceptability, and user experiences. Findings will inform the equitable design and implementation of future immersive technologies in dementia care settings.

ObjectiveRehabilitation is important for regaining mobility poststroke. Clinical practice guidelines suggest a high number of repetitive stepping activities to optimize subacute recovery especially when undertaken at intensities that challenge cardiovascular fitness. However, adherence to these guidelines is unclear. The objective of this study was to quantify aerobic minutes and step number in usual care inpatient stroke rehabilitation unit physical therapy sessions across Canada and identify characteristics of participants who met guideline aerobic intensity minutes at a session midpoint in their rehabilitation.MethodsTo gain insight into usual care, we analyzed cross-sectional data from the usual care arm of the Walk ‘n Watch implementation trial; trial sites included Canadian rehabilitation units that were not typically involved in research studies. To be included, medically stable patients were admitted for inpatient stroke rehabilitation, and able to take > 5 steps with a maximum of one person assisting. We assessed a midpoint physical therapy session with a wrist-based heart monitor (aerobic minutes) and ankle-based step counter (step number). Means, histograms, and correlations between aerobic minutes (> 40% heart rate reserve) and steps were calculated.ResultsThere were 166 participants (69 females, age 69 standard deviation (SD)12 years) with stroke (138 Ischemic/ 27 Hemorrhagic) included. Participants had a mean of 10(SD11) aerobic minutes and 985(SD579) steps. The relationship between step number and aerobic minutes was negligible (R2 = 0.003). More participants with ≥20 aerobic minutes in a session were male, with lower 6 Minute Walk Test distance, and have a subcortical stroke location.ConclusionThe number of steps has increased, but aerobic minutes has not changed and remains extremely low compared to published reports in the past several years. Given that increasing activity levels are critical for stroke recovery, further investigation into the potential barriers to achieving targets set by guidelines is recommended.Trial registrationClinicalTrials.gov NCT04238260

Diabetes-related lower limb amputation (LLA) is a leading cause of disability globally, impacting individuals' physical and mental health, and ultimately their quality of life. Physical activity can reduce risk of chronic disease and mortality while improving quality of life. However, people with LLA often have reduced balance and walking ability resulting in sedentary behaviour. We co-created a physical activity intervention, IMproving Physical Activity through Coaching and Technology following Lower Limb Loss (IMPACT-L3), to support physical activity behaviour change in people with dysvasular LLA. To date, no studies have assessed a peer-led physical activity behaviour change intervention for people with LLA. Prior to launching a large trial, a pilot study is required to assess feasibility and optimize design of a future trial. This pilot study is a parallel group randomized controlled trial (RCT) with an embedded qualitative component. The intervention group will have access to once-weekly virtual peer coaching sessions with a peer trained in brief action planning; web-based physical activity modules; and a wearable activity monitor for 8 weeks. The control group will continue usual care and be offered the intervention at the end of the follow-up period. Data on feasibility will be collected including assessment of process, resource, management and treatment indicators. The proposed primary outcomes will be measured at baseline, post-intervention and one month later: total physical activity counts per day measured by the ActiGraphTM activity monitor and self-efficacy measured by the Self-efficacy for Exercise scale. Secondary measures include patient reported outcome measures of physical activity, mobility, depression, social participation, balance confidence and quality of life. Semi-structured interviews will explore feasibility and acceptability of the intervention to participants and peers. This study will inform the design of a definitive RCT to determine the effectiveness of a peer-led physical activity intervention for people with dysvascular LLA.

Family members of individuals with spinal cord injury often take on caregiving responsibilities, which can lead to caregiver burden. One factor that can mitigate the adverse effects of caregiving, such as caregiver burden, is receiving social support. Caregivers can obtain support from people they meet in person (in-person support) and on social media platforms (online support). The current cross-sectional correlational design study investigated the moderating effect of in-person and online support on the association between relationship quality, caregiver competence, caregiver distress, and caregiver burden (dependent variables). Family caregivers of an individual with spinal cord injury (n = 115) completed an online survey assessing relationship quality, competence, distress, burden, and in-person and online supports. Moderation analyses showed that the negative associations between relationship quality and physical burden (B = -0.58; p = 0.019) and caregiver competence and physical burden (B = -0.73; p = 0.013) were more pronounced at higher levels of online social support. Furthermore, the magnitude of the negative associations between relationship quality and emotional burden (B = -0.52; p < 0.001) and caregiver competence and emotional burden (B = -0.34, p = 0.012) were more pronounced at higher levels of in-person social support. Moderation analyses also revealed that the positive association between distress and social burden (B = 0.47; p = 0.029) and emotional burden (B = 0.26; p = 0.045) were stronger when caregivers reported higher levels of online support. In-person and online support can buffer some aspects of caregiver burden on caregiver well-being. While online support is usually considered beneficial, greater online engagement may contribute to higher levels of burden when the distress is high. It is possible, however, that caregivers who are more distressed engage more with online media to receive support.

Background People with brain injury can have lower resiliency compared to the general public. Yet, resiliency facilitates positive processes to negotiate adversity after brain injury. Therefore, measuring resiliency after a brain injury is important. Objective The review aimed to (1) identify self-report resiliency outcome measures for use with people after acquired brain injury, using the process-based Traumatic Brain Injury Resiliency Model as the guiding conceptual framework, and (2) summarize the psychometric properties of the identified outcome measures and the utility of these measures in clinical rehabilitation. Method The COSMIN guidelines for systematic reviews were followed to ensure appropriate reporting for each measure. Databases CINAHL, EMBASE, Medline, and PsychINFO were searched and independently reviewed by two people. Articles providing data on psychometric properties for measures of resilience for people with brain injury were retrieved. Psychometric properties and clinical utility (number of items, scoring details) were summarized. Results Thirty-two articles were retrieved, including nine measures of resiliency: Acceptance and Action Questionnaire–Acquired Brain Injury, Confidence after Stroke Measure, Connor-Davidson Resilience Scale, Daily Living Self-Efficacy Scale, General Self-Efficacy Scale, Participation Strategies Self-Efficacy Scale, Resilience Scale, Robson Self-Esteem Scale, and the Stroke Self-Efficacy Questionnaire. All measures have acceptable to excellent psychometric properties in accordance with the COSMIN guidelines. Conclusion There are established measures of resiliency in brain injury rehabilitation. Future work may explore use of these measures in a clinical context and implementation of rehabilitation goals for improving resiliency after brain injury.