St. Joseph's Care Group

Low back pain (LBP) is a common and disabling condition that is costly for health systems and society. Interprofessional primary care models may improve care quality and reduce this burden. This protocol and analysis plan communicates the methods for a cluster randomized trial with the following objectives: (1) evaluate the effectiveness of a physiotherapist-led (PT-led) primary care model for LBP at improving disability (primary outcome), pain intensity, quality of life, global rating of change, patient satisfaction, and adverse events compared with usual physician-led primary care; and (2) determine the impact of the PT-led primary care model for LBP on the health care system and society (health care access, health care use, missed work, cost-effectiveness). Both objectives are evaluated over a 1-year period. A multimethod process evaluation is embedded to assess model implementation, mechanisms, perspectives of patients and providers, and contextual influences. This study is a cluster randomized controlled trial with 20 primary care practices (clusters) in Canada, randomized 1:1 to a PT-led or usual physician-led primary care model for LBP. Adults seeking care from their primary care team for LBP are recruited over 1 year. Data collection occurs at baseline, 6 weeks, and 3, 6, 9, and 12 months. Effectiveness will be analyzed using linear mixed regression. The process evaluation analysis will include: descriptive and comparative analyses to assess implementation; descriptive and mediation analyses to assess potential mechanisms; qualitative interpretive description to understand experiences and perspectives of patients, PTs, and other health professionals; and mixed methods to determine contextual influences on implementation. Recruitment of primary care sites (clusters) was completed in June 2023, following delays related to the COVID-19 pandemic. Cluster randomization occurred in July 2023. Recruitment of patient participants began in October 2023 and concluded in November 2024 (n=739). The final self-reported patient data was collected on November 25, 2025. Extraction of electronic health record data is scheduled for completion on December 19, 2025. Data analysis will be conducted in accordance with the study protocol and analysis plan and will begin once all data collection activities are complete. No interim analyses have been performed. The results of this trial will provide evidence for knowledge users to determine whether a PT-led primary care model for LBP is effective and should be adopted more widely. Knowledge users have identified the impact of the new model of care on disability, quality of life, and cost-effectiveness as key evidence needed to inform key decision-making. The multimethod process evaluation will provide critical evidence to interpret trial results and inform future scale and spread of this model of care if effective. ClinicalTrials.gov NCT04287413; https://clinicaltrials.gov/study/NCT04287413. DERR1-10.2196/89004.

Abstract In the Democratic Republic of Congo (DRC) unsafe abortion claims thousands of lives every year. Under the 2018 Maputo protocol ratification, officials are implementing abortion services, yet abortion stigma contributes to delays in access to care. A recognized approach, person-centred care, can improve the quality and access to care in DRC. The aim of this study was to understand the experiences of women who received an abortion with midwives, nurses or physicians recently trained in comprehensive abortion care (CAC) using person-centred approaches in the capital city of Kinshasa. A qualitative design with semi-structured interviews captured the complexity and richness of twenty-five women who accessed CAC with trained healthcare providers. Participants were interviewed two weeks post-abortion. The analysis was thematic and applied person-centred abortion care frameworks. Participants emphasized the importance of emotional and psychological support from healthcare providers, and care that was empathetic, informative, reassuring and rapport building over time. They valued services tailored to their needs including care delivered virtually or outside of traditional clinical settings before, during, and after the abortion process. Relational continuity across the care journey, was central to their experiences and helped reduce feelings of isolation and stigma. Person-centred abortion care approaches can be expanded to explore how the care process, particularly the nexus between healthcare provider and client, shapes the overall experience. In DRC this includes prioritizing programs to support continuity of healthcare provider, and community-based care including the option for abortion self-management.

Determining cognitive fitness to drive is challenging. A previous study used serial trichotomization with five cognitive tests to determine whether drivers should continue driving, undergo further evaluation, or stop driving. To examine agreement between serial trichotomization and fitness-to-drive determinations made by occupational therapists. Drivers referred for cognitive screens completed all tests used in the previous study. Occupational therapists provided fitness-to-drive recommendations (safe, indeterminate, or unsafe) using all clinical information available. We examined the agreement between the tests' results (using cut points from the previous study) and occupational therapists' recommendations. Outpatient neurology program at a chronic care and rehabilitation hospital. 279 clients (M age = 66.35 yr; SD = 13.25). Tests included the Trail Making Tests A and B, the Clock Drawing Test (CDT), the Montreal Cognitive Assessment, and the Motor-Free Visual Perception Test, using a road test as the gold standard. The previous study used dual cut points with 100% sensitivity and specificity to reduce false positives and false negatives. Weighted κs ranged from .03 (95% confidence interval [CI] [-.01, .08]) for the CDT to .54 (95% CI [.46, .62]) for the Trail Making Test, Part B. Although the agreement between serial trichotomization and the final recommendations was moderate (κ = .59; 95% CI [.50, .67]), serial trichotomization appeared useful for identifying unsafe drivers. These results remind us of the variability inherent in stand-alone cognitive tests, even within a serial trichotomization framework, and the importance of clinical judgement and road tests in decision making about driving. Plain-Language Summary: It can be challenging for occupational therapists to accurately determine a client's cognitive fitness to drive. Many occupational therapists lack the time, have limited training, or do not have access to comprehensive driving evaluation tools. A serial testing approach can support occupational therapists in assessing a client's cognitive fitness to drive. This study used an approach based on a series of five cognitive tests to determine whether a client should continue driving, undergo further evaluation, or stop driving. The series of tests were used to classify drivers as safe, indeterminate, or unsafe. In principle, a driver would take the second test only if the driver was classified as indeterminate on the basis of first test, and so on. By applying the tests in sequence, few drivers should remain classified as indeterminate at the end of the series of tests. This serial approach has the potential to streamline the decision-making process for occupational therapists by classifying the more extreme unsafe cases while still providing an accurate assessment of cognitive fitness to drive.

Background:The use of an effective antimicrobial preoperative skin preparation solution is essential in preventing infections after surgery, but the findings in the literature regarding efficacy are not necessarily applicable to surgery involving the hip. The purpose of the present study was twofold: 1) to examine the native bacteria on the skin at the hip and 2) to determine the efficacy of 2 surgical skin preparation solutions at eliminating bacteria from the hip site in patients undergoing total hip arthroplasty.Methods:We conducted a prospective randomized controlled trial in consecutive adult patients who underwent primary total hip arthroplasty at a single institution from October 2014 to December 2015. Each patient was randomly allocated to be treated with 1 of 2 commonly used surgical skin preparation solutions: ChloraPrep (2% chlorhexidine gluconate and 70% isopropyl alcohol) or DuraPrep (0.7% iodophor and 74% isopropyl alcohol). Aerobic and anaerobic samples were obtained for culture before skin preparation, immediately after skin preparation and after skin closure.Results:Full data were obtained for 105 patients: 54 in the ChloraPrep group and 51 in the DuraPrep group. Staphylococcus epidermidis, Corynebacterium and Micrococcus luteus were the organisms most commonly isolated from the hip before skin preparation. Positive bacterial culture results were obtained in 50 patients (93%) in the ChloraPrep group and 48 patients (94%) in the DuraPrep group. Immediately after skin preparation, the overall proportion of positive culture results was significantly lower in the DuraPrep group than the ChloraPrep group (14% v. 35%, adjusted relative risk 0.40, 95% confidence interval 0.18–0.85). After wound closure, there was no significant difference in the rate of positive culture results between the 2 groups.Conclusion:DuraPrep was more effective than ChloraPrep at eliminating skin flora at the hip initially on application, but the 2 solutions were equally effective at the time of closure. Further study with larger samples is required to identify any influence of skin preparation solution on the incidence of prosthetic joint infection.

We examined the positive association between perceived community age-friendliness and self-reported quality of life for older adults. A total of 171 participants, aged 77–96 years, completed a mail-in questionnaire package that included measures of health (SF-36 Physical), social participation (Social Participation Scale), community age-friendliness (Age-Friendly Survey [AFS]), and quality of life (WHO Quality of Life). Hierarchical regression models including age, gender, driving status, finances, health, social participation, and AFS scores explained 8 to 21 per cent of the variance in quality of life scores. Community age-friendliness was a statistically significant variable in all models, accounting for three to six and a half per cent of additional variance in quality of life scores. Although the proportion of variance explained by age-friendliness was small, our findings suggest that it is worthwhile to further investigate whether focused, age-friendly policies, interventions, and communities could play a role towards successful and healthy aging.

Abstract: Ethical practice compels evaluators to obtain informed consent from evaluation participants. When those participants are minors, parental consent is routinely sought. However, seeking parental consent may not be appropriate in all evaluation contexts. This practice note presents one context (mental health services research in rural Canada) where seeking parental consent for youths’ participation in research was considered unethical and unfeasible. We present a two-step “capacity-to-consent” protocol that we developed to obtain consent from youth participants. This protocol offers an ethical and feasible alternative to seeking parental consent for youth. The implications for evaluation practice are discussed.

Rationale Improving end-of-life care (EOLC) in long-term care (LTC) homes requires quality measurement tools that assess families' satisfaction with care. This research adapted and pilot-tested an EOLC satisfaction measure (Canadian Health Care Evaluation Project (CANHELP) Lite Questionnaire) for use in LTC to measure families' perceptions of the EOLC experience and to be self-administered. Methods and Results Phase 1. A literature review identified key domains of satisfaction with EOLC in LTC, and original survey items were assessed for inclusiveness and relevance. Items were modified, and one item was added. Phase 2 The revised questionnaire was administered to 118 LTC family members and cognitive interviews were conducted. Further modifications were made including reformatting to be self-administered. Phase 3 The new instrument was pilot-tested with 134 family members. Importance ratings indicated good content and face validity. Cronbach's alpha coefficients (range: .88–.94) indicated internal consistency. Conclusion This research adapted and pilot-tested the CANHELP for use in LTC. This paper introduces the new, valid, internally consistent, self-administered tool (CANHELP Lite Family Caregiver LTC) that can be used to measure families' perceptions of and satisfaction with EOLC. Future research should further validate the instrument and test its usefulness for quality improvement and care planning.

Driving is a complex activity that, for many older adults, is a primary means of mobility. Driving draws upon multiple cognitive, sensory, and physical systems to operate the vehicle and navigate the roadway environment safely. It follows that when one of these systems is impaired, driving safety may be hindered. Individuals with mild cognitive impairment (MCI) are impaired in at least one cognitive domain, which may, depending on the nature of their deficit, make them at increased risk for collision. Research indicates that memory, executive functions, and attention are all associated with driving performance. While a number of assessment instruments are available to aid professionals’ decisions related to fitness to drive, health professionals must strike a balance between safety and mobility when making this determination. This chapter discusses the components of the driving task, the impact of an MCI diagnosis on driving fitness, methods to assess drivers with MCI, and strategies to promote continued mobility among adults who have ceased driving.

Most older adults will eventually have to stop driving. Readiness for this transition helps to reduce some of the adverse effects associated with driving cessation. To measure this readiness, Meuser et al. (2011) developed the Assessment of Readiness for Mobility Transition (ARMT) tool, and reported that it correlates with facets of mental health and personality, and self-reported physical function.