Research Award Winner – First Place
A RANDOMIZED CONTROLLED TRIAL TO TEST THE EFFECTS OF THE SCI GET FIT TOOLKIT ON PHYSICAL ACTIVITY BEHAVIOR AND COGNITIONS IN ADULTS WITH SPINAL CORD INJURY: A PRELIMINARY ANALYSIS
Kelly Arbour-Nicitopoulos1,2, Shane Sweet3, Marie-Eve Lamontagne4, Amy Latimer-Cheung2,5
1University of Toronto, 2SCI Action Canada, 3McGill University, 4CIRRIS-IRDPQ, 5Queen's University
Background/Objective: SCI Action Canada has developed a SCI Get Fit Toolkit, an evidence-informed physical activity (PA) resource for Canadian adults with spinal cord injury (SCI). The purpose of this study was to evaluate the effects of the toolkit on self-efficacy, intentions, planning, and PA behavior in a sample of Canadian adults with SCI.
Methods/Overview: Participants were randomized to one of the two conditions: experimental (n = 19) or control (n = 20). Participants with both conditions completed online social-cognitive (i.e. self-efficacy, intentions, and planning) and PA behavior questionnaires at four timepoints (i.e. baseline, 24 hours post-baseline, 1 week post-baseline, 1 month post-baseline). At 24 hours post, exposure to either the toolkit (experimental condition) or the SCI Physical Activity Guidelines (control condition) occurred. Preliminary analyses were conducted using the baseline to 1-week post-timepoint to determine the effects of the experimental manipulation on the measured outcomes: a 2 (condition) × 3 (time: baseline, 24-hour post, and 1-week post) analysis of variance for self-efficacy and intentions; a 2 (condition) × 2 (time: baseline, 1-week post) for planning; a one-way analysis of covariance on PA, controlling for between-condition differences on baseline values. Due to the small sample, effect sizes (i.e. partial η2 (η)) were reported and emphasized. Three separate 2 (condition) × 2 (time (e.g. 24-hour post, 1-week post)), post hoc analyses were conducted where necessary.
Results: Of the 39 participants recruited, 20 (M age = 48.50 years ± 9.26; 60% quadriplegia; 80% male; 60% French-speaking) completed all three assessment periods. Analyses indicated moderate- to large-sized effects for the time × condition interaction of planning (P = 0.09, η = 0.16) and self-efficacy (P = 0.15, η = 0.10), respectively. In comparison to the control condition, the experimental condition reported greater PA planning from baseline to 1-week post and greater PA self-efficacy from 24-hour post to 1-week post. After controlling for baseline levels, a medium- to large-sized effect of condition was found for PA behavior (P = 0.18, η = 0.13), indicating that PA behavior was greater at 1-week post for the experimental versus the control condition. No difference over time by condition was found for intentions.
Conclusions: Our preliminary analyses suggest that the SCI Get Fit Toolkit appears to be more effective than the guidelines alone for increasing planning, self-efficacy, and PA behavior among a sample of adults with SCI.
Acknowledgments: Granting Agency/Funding Source: Ontario Neurotrauma Foundation and the Provincial Rehabilitation Research Network Ontario/Quebec Inter-Provincial Partnership grant.
Award Winner Research – Second Place
RECOVERY OF TRUNK MUSCLE STRENGTH IN TRAUMATIC AND NON-TRAUMATIC SPINAL CORD INJURED INPATIENTS DURING REHABILITATION
Sylvie M. Nadeau1,2,3, Molly C. Verrier4,5, Cyril Duclos1,2,3, Dany Gagnon1,2,3, Sharon Gabison4,5, Audrey Roy2
1Centre de Recherche Interdisciplinaire en Réadaptation (CRIR), 2Institut de Réadaptation Gingras-Lindsay-de-Montréal (IRGLM), 3Université de Montréal, 4University of Toronto, 5Toronto Rehabilitation Institute – UHN
Background/Objective: Trunk function is important in individuals with spinal cord injury (SCI) whether they are walkers or manual wheelchair users. It is important to document the recovery of the trunk strength muscle in order to inform sensorimotor and mobility rehabilitation. The specific aim of this study was to quantify, for the first time, the natural course of recovery of trunk muscle strength in traumatic (TSCI) and non-traumatic SCI (NTSCI) during inpatient rehabilitation.
Methods/Overview: Forty-two individuals (42 years old; SD: 16), including 25 TSCI and 17 NTSCI (American Spinal Injury Association (ASIA) Impairment Scale (AIS) from A to D) were evaluated at rehabilitation admission (T1) and discharge (T2). Maximal isometric muscle strength was measured in the sitting position, in right and left lateral flexion, anterior flexion, and extension of the trunk, using a hand-held dynamometer affixed to a rigid frame. Maximal strength values were normalized to body mass. Statistical analyses (analysis of variances and paired t-tests) were used to assess the effects of time (T1 vs. T2), direction (four), and type of lesion (TSCI vs. NTSCI) on the trunk strength outcome measures, while the level of association between the values for each direction were examined using Pearson's correlation coefficients.
Results: As a group, participants with SCI increased static trunk strength during inpatient rehabilitation in each direction tested except extension. However, differences existed between TSCI and NTSCI with the former showing greatest increases. Static trunk strength (r = 0.57–0.90) upon admission were inter-correlated. Thus, the individuals who are strong in one direction were strong in all directions. Static trunk strength values in extension were nearly double those of the other directions. As expected, for the individuals with a traumatic etiology, the strength results of individuals who walked (ASIA D) were greater than those of the wheelchair users and strength values correlated with the ASIA motor score.
Conclusions: Further analysis of the data will determine whether the recovery of trunk muscle strength is a predictor of trunk function and postural control in individuals with SCI.
Acknowledgments: Craig H. Neilsen Foundation.
Award Winner Research – Third Place
SPINAL CORD INJURY AND CARDIOVASCULAR DISEASE: A NATIONAL HEALTH STUDY ON RISK AND MECHANISMS
Jacquelyn Cragg1, Vanessa Noonan2, Andrei Krassioukov1, G. B. John Mancini1, Luc Noreau3, David Patrick1, Jaimie Borisoff4
1University of British Columbia, 2Rick Hansen Institute, 3Université de Laval, 4British Columbia Institute of Technology
Background/Objective: Previous evidence demonstrates that individuals with spinal cord injury (SCI) are at a significantly higher risk of heart disease and stroke. In addition to the physical disability caused by SCI, there may be other factors that contribute to this heightened risk. For example, repetitive and significant blood pressure fluctuations from extremely low during episodes of orthostatic hypotension (OH) to extreme elevations due to episodes of autonomic dysreflexia (AD), which are typical and unique to SCI, could contribute to vascular injury, and consequently contribute to this excess risk. However, this hypothesis has never been formally tested. Thus, the primary aim of this study was to examine the relationship between AD and OH with cardiovascular disease (CVD). A secondary aim of the study was to examine the relationship between SCI-specific factors (injury level, completeness of injury, and time since injury) and traditional risk factors (sex, age, and diabetes) with CVD.
Methods/Overview: A total of 1109 individuals with chronic traumatic SCI (>1 year post-injury) participated in our self-report cross-sectional Canada-wide survey (mean age: 48.3 ± 13.4 years; 70% male; mean time since injury: 18.5 ± 13.2 years).
Results: The adjusted odds of CVD among individuals with frequent OH was 2.79 times those without frequent OH (95% confidence interval: 1.09–6.53). There was no significant relationship between AD and CVD. Diabetes was associated with a significantly increased odds of CVD. Interestingly, sex, age, time since injury, AIS grade, and completeness of injury were not significantly associated with CVD.
Conclusions: Some factors that are strong predictors of CVD outcomes in the general population are not associated with CVD outcomes among individuals with SCI; other factors impart similar risk among subjects with SCI compared with non-SCI subjects; others, including OH, impart significantly higher risk for CVD. Overall, these findings suggest that there may be a shift in the relative contribution of traditional risk factors among individuals with SCI. This will be an important consideration for management of CVD risk among these individuals.
Acknowledgments: J. Cragg is supported by a University of British Columbia Killam Doctoral Award.
Award Winner Research – Fourth Place
ADULTS WITH SPINAL CORD INJURY WHO REPORT A NEED FOR PEER SUPPORT
Shane Sweet1, Kathleen A. Martin Ginis2, Luc Noreau3,4, Jean Leblond4
1McGill University, 2McMaster University, 3Université Laval, 4CIRRIS
Background/Objective: Peer support programs are widely offered in Canada. However, we still do not know the profiles of adults with spinal cord injury (SCI) who need these programs. The purpose of this study was to identify the characteristics of adults with SCI who reported a peer support need.
Methods/Overview: A database of 1549 Canadian adults with SCI allows the analysis of 13 needs for services favoring community integration in relation with socioeconomic and type of lesion variables. In this study, the peer support need was examined according to if it exists or not, and when it exists, whether it is met or unmet. Two recursive partitioning analyses with a classification tree were conducted in R to identify the strongest association between peer support and 11 variables: age, sex, education, marital status, city/urban, severity of injury (ASIA scale), years since injury, event, type of SCI, manual wheelchair use, and number of unmet needs among the 12 other categories.
Results: Five groups were differentiated on the peer support need outcome according to the number of unmet needs, education, severity, and type of SCI. Approximately 58% of individuals in Group 1 and 37% in Group 2 reported a need for peer support. The profiles of Groups 1 and 2 are: having 4 unmet needs and, either, a university degree (Group 1, n = 114) or not (Group 2, n = 381). The profiles of the three other groups include having < 4 unmet needs and, either, tetraplegia and ASIA A, B, or C (Group 3, n = 329), paraplegia and ASIA A, B, or C (Group 4, n = 487), or ASIA D (Group 5, n = 238). Approximately 33%, 22%, and 14% of individuals reported a peer support need in Groups 3, 4, and 5, respectively. When the analysis is limited to the 464 adults who reported a peer support need, three groups are differentiated on the basis of the number of unmet needs: <3 (Group A, n = 204), 3 or 4 (Group B, n = 120), and 5 or more (Group C, n = 140). Approximately 85, 59, and 24% (60% overall) indicated that their peer support need was met.
Conclusions: This study is the first to describe the characteristics of adults with SCI who report a need for peer support and whether that need is met. Adults with many unmet SCI needs and with tetraplegia appear to report a greater peer support need. Peer support programs could use this information to target adults who report needing their service.
Acknowledgments: Rick Hansen Institute, grant number: 2010-03, Ontario Neurotrauma Foundation, grant number: 2010-RHI-SURVEY-812.
Student Award Winner – First Place
THE “ABCS OF AD”: A PILOT TEST OF AN ONLINE EDUCATIONAL MODULE TO INCREASE USE OF THE AUTONOMIC DYSREFLEXIA CLINICAL PRACTICE GUIDELINES AMONG PARAMEDIC AND NURSE TRAINEES
Jennifer R. Tomasone1, Wayland Pulkinnen2, Kathleen A. Martin Ginis1, Jinshu Yang3,4, Andrei Krassioukov3,4
1McMaster University, 2Georgian College, 3University of British Columbia, 4ICORD
Background/Objective: Despite the availability of evidence-based resources and clinical practice guidelines (CPGs), tremendous gaps in autonomic dysreflexia (AD) knowledge and practice persist among healthcare professionals. A free online educational module, the “ABCs of AD”, was developed to improve knowledge of the AD-CPGs among emergency care personnel, including paramedics and nurses. The purpose of the current pilot study was to examine short-term changes in paramedic and nurse trainees' knowledge of, and social cognitions towards using, the AD-CPGs following participation in the “ABCs of AD” module.
Methods/Overview: Trainees were recruited from their educational institutions. Prior to and following their viewing of the “ABCs of AD” module, participants (n = 34) completed online questionnaires assessing their knowledge of and Theory of Planned Behavior social cognitions for using the AD-CPGs. Participants were also asked to report the amount of time they spent viewing the module and which sections of the module they completed.
Results: From pre- to post-training, paired samples t-tests revealed significant increases in participants AD knowledge scores (M ± SDpre = 9.00 ± 2.46, M ± SDpost = 12.03 ± 4.07, P < 0.001; d = 0.84).
Conclusions: Since the purpose of educational modules is to impart new knowledge, it is not surprising that significant increases were seen in participants' AD knowledge scores from pre- to post-training. However, knowledge alone is insufficient for clinical behavior change; as such, social cognitive determinants of behavior should be explicitly targeted in future iterations of the module so that emergency personnel adopt and implement the AD-CPGs. To increase viewers' processing of content, the “ABCs of AD” module would benefit from the inclusion of additional educational strategies, such as interactive quizzes, to engage viewers for longer durations and for all module sections.
Acknowledgments: Granting Agency/Funding Source (Grant Number): (1) Ontario Neurotrauma Foundation (2012-ONF-RHI-MT-949); (2) Canadian Institutes of Health Research (2011-CIHR-260877).
Award Winner Student – Second Place
POSTURAL CONTROL IN INDIVIDUALS WITH SPINAL CORD INJURY: WHAT DO WE KNOW ABOUT ASSESSMENTS AND REHABILITATION INTERVENTIONS?
Jenny Quach, Chris Alappat, Heather Flett, Kristina Guy, Molly C. Verrier
Toronto Rehabilitation Institute – UHN
Background/Objective: The control of posture against external forces such as gravity and perturbations is crucial for performing activities of daily living and maintaining functional independence in individuals with spinal cord injury (SCI). The study of postural control provides insight into the ability to perform functional tasks such as sitting, standing, transferring, and walking. Research in this area such as modeling studies are used to design rehabilitative strategies to improve postural control after injury. The purpose of this review is to identify key themes and potential gaps in the current research and practice being conducted regarding the control of posture in the SCI population.
Methods/Overview: A search of published academic literature was performed using the online databases: MEDLINE, EMBASE, CINAHL, and PsychINFO. The search, focused on postural control in the SCI population, was limited to humans, articles in English, and studies from 2003 to 2013. Title and abstracts of the articles were assessed and relevant articles were selected from the initial search results. The overall themes and outcomes of the research were identified and an organizational framework was developed to summarize the current state of postural control research in SCI.
Results: Of the 1235 sources found, 118 studies met the determined criteria and were ultimately included in this review. Studies describing laboratory assessment techniques (n = 54), clinical measures (n = 21), and rehabilitative interventions (n = 43) were used to construct three emerging themes. The general themes were: (1) quantifying/assessing aspects of postural control, (2) developing measures of postural control, and (3) developing interventions for postural control, all specific to the SCI population. Specific aspects of postural control research in SCI were neuroprosthetics (n = 16), orthotics (n = 8), and locomotor training (n = 7). Details of the studies in these specific areas will be presented.
Conclusions: Currently, a large portion of studies investigating postural control is comprised of laboratory measures; however, future research should begin to translate laboratory findings to the clinical setting. A limitation of doing so may be that studies in SCI research are limited in their power to generalize results to the entire SCI population due to the heterogeneity in subjects causing small sample sizes. Further research is needed in exploring valid and reliable clinical measures, cost-effective interventions, and more sophisticated neuroprostheses.
Acknowledgments: Granting Agency/Funding Source: Craig H. Neilsen Foundation Grant Number: 164422.
Award Winner Student – Third Place
THE USE OF PERSONAL INFORMATION TECHNOLOGY BY PERSONS WITH SPINAL CORD INJURY
Andrew Mattar1, Hitzig Sander1,2, McGillivray Colleen1,2
1University of Toronto, 2Toronto Rehabilitation Institute – UHN
Background/Objective: Previous work has shown that information technology (IT) has positive effects on health and wellbeing in persons with chronic health conditions. It is likely that IT is beneficial for persons living with spinal cord injury (SCI), but this has so far been unexplored.
Methods/Overview: Semi-structured interviews were conducted in persons with SCI (N = 10), who live in the community and identify themselves as frequent or daily users of IT. Qualitative content analysis was used to identify the ways that personal IT is used by persons with SCI.
Results: Ten themes related to IT use were identified: (1) modifications allowing access to IT; (2) convenience of IT and its perceived value; (3) IT as a scheduler/planner; (4) challenges; (5) contributions of IT to participation; (6) access to information; (7) influence of IT on wellbeing; (8) IT as a connector; (9) issues of IT acquisition; and (10) desires for future devices/technology.
Conclusions: Overall, IT use allows people with SCI to better understand their condition, enables participation in the community, and benefits wellbeing. Despite these benefits, persons with SCI describe skepticism about the reliability and applicability of the health information they find online.
Acknowledgments: Support provided by the Toronto Rehabilitation Institute, which receives funding under the Provincial Rehabilitation Research Program from the Ministry of Health and Long-Term Care in Ontario.
Patient Care Award Winner – First Place
THE IMPACT OF BEST PRACTICE IMPLEMENTATION FOR PRESSURE ULCER PREVENTION FOLLOWING SPINAL CORD INJURY IN AN INPATIENT REHABILITATION PROGRAM
Carol Scovil1, Heather Flett1,2, Lan McMillian1, Diane Leber1, Anthony Burns1,2, SCI KMN3,4,5
1Toronto Rehabilitation Institute – UHN, 2University of Toronto, 3Rick Hansen Institute, 4Ontario Neurotrauma Foundation, 5Alberta Paraplegia Foundation
Background/Objective: The SCI Knowledge Mobilization Network (SCI KMN) is a six-center, pan-Canadian collaboration focusing on SCI best practices implementation (BPI). The initial focus of the KMN was the prevention of pressure ulcers (PU) after spinal cord injury (SCI). PUs can affect rehabilitation outcomes and are an ongoing risk for individuals living with SCI. The identified objectives were (1) conduct comprehensive PU risk assessment (RA) using a structured RA tool and complete individualized, inter-professional PU prevention plans (PUPP); and (2) provide structured PU prevention education to patients.
Methods/Overview: The systematic use of implementation science (IS) laid the groundwork for sustainable BPI. Feedback from front-line staff and audits of existing practices identified local strengths, gaps, and required processes and policies that were needed for BPI. Two new tools were introduced: (1) the SCI-specific PU RA scale (SCIPUS); and (2) a new inter-professional RA and PUPP form for use in team rounds. The SCIPUS replaced the Braden scale for RA. The PUPP was created with extensive involvement and feedback from front-line staff, as well as reference to institutional policies and requirements. The PUPP ensures that all PU information is centralized in one location, and pertinent risk factors are clearly identified in team rounds. Both the SCIPUS and PUPP required institutional policy and form approval, training for staff, ongoing coaching and support, regular monitoring, and feedback of data to staff. Comprehensive patient education (including PU prevention and management) was already in place at our site, and was strengthened through the application of adult education principles. A patient survey 2 weeks prior to discharge was implemented to provide feedback on PU education effectiveness.
Results: Following initial implementation, completion rates for PU RA (SCIPUS) and PUPP were 94% (7 months) and 97% (5 months), respectively. Patient education rates, survey results, and PU incidence pre- and post-implementation are currently being abstracted from retrospective chart reviews, to further demonstrate the effectiveness of the BPI.
Conclusions: IS provided a framework for the successful implementation of strategies addressing PU prevention following SCI. Objective metrics include increased completion rates for (1) structured PU RA and (2) inter-professional prevention plans as well as (3) increased patient education rates and satisfaction.
Acknowledgments: Rick Hansen Institute and Ontario Neurotrauma Foundation Grant Number: 2010-RHI-ONF-BPI-832.
Award Winner Patient Care – Second Place
THE EFFECTS OF AQUATIC THERAPY ON MOBILITY FUNCTIONS OF INDIVIDUALS WITH NEUROLOGICAL DISEASES: A SYSTEMATIC REVIEW OF LITERATURE REVEALING GAPS IN EVIDENCE IN SPINAL CORD INJURY (SCI) AQUATIC REHABILITATION
Andresa Marinho Buzelli, Alison Bonnyman, Molly C. Verrier
University of Toronto
Background/Objective: Neurorehabilitation is currently challenged by increased prevalence of neurological disorders and longer life expectancies. Aquatic therapy (AT) is a therapeutic modality used with neurological populations with the goal of achieving optimal functional independence. Despite the use of AT for neurorehabilitation, there is a lack of evidence as to how AT changes mobility functions such as gait and dynamic balance post-neurological injury including spinal cord injury (SCI). The objective of the present study was to summarize evidence on the effects of AT on mobility functions in individuals with neurological diseases.
Methods/Overview: A systematic search was performed using MEDLINE, EMBASE, PsycInfo, CENTRAL, CINAHL, SPORTDiscus, PEDro, PsycBITE, and OT Seeker in combination with a hand-searching of reference lists of selected studies, from inception to April 2013. The search included randomized controlled trials (RCTs) and quasi-experimental studies in all languages. One reviewer screened titles and abstracts of retrieved studies from the search strategy. Two reviewers independently examined the full texts and conducted the study selection, data extraction, and quality assessment. A narrative synthesis of data was applied to summarize information. The Downs and Black scale was used for quality assessment.
Results: Ninety-four articles were obtained for full-text eligibility. Sixteen studies met the specified inclusion criteria: 4 RCTs, 2 non-randomized studies, and 10 before-and-after tests. Individuals with multiple sclerosis, Parkinson's disease, and stroke were the most commonly investigated groups. The most common outcomes reported were gait parameters and the Timed Up and Go Test which showed variable improvement across the studies. Studies had “fair” and “weak” methodological quality. Only two studies had investigated individuals with SCI where one study showed “fair” evidence for increased functional transfers and the other study reported “weak” evidence for increased gait speed after AT.
Conclusions: There is some evidence to support that AT improves mobility functions in adults with neurological conditions. However, for individuals with SCI, there is insufficient evidence to suggest that AT influences mobility functions or other outcomes. A comprehensive approach to explore and evaluate AT as a rehabilitation strategy to improve mobility functions in the SCI population is required prior to recommending AT as a mainstream therapeutic approach.
Acknowledgments: Granting Agency/Funding Source: Canadian Institutes of Health Research through the Vanier Canada Graduate Scholarships.
Award Winner Patient Care – Third Place
THE IMPORTANCE OF “TIME TO SURGERY” FOR TRAUMATIC SPINAL CORD INJURED PATIENTS: RESULTS FROM AN AMBISPECTIVE CANADIAN COHORT OF 949 PATIENTS
Vanessa Noonan1,2, Marcel Dvorak3,2, Charles Fisher2, Brian K. Kwon2, Brian Drew4,5, Michael G. Fehlings6, Jerome Paquet7,8, Henry Ahn6,7, Najmedden Attabib10,11,12, Christopher S. Bailey13, Sean D. Christie12, Neil Duggal14, Joel Finkelstein15, Daryl R. Fourney16, R. John Hurlbert17, Michael G. Johnson18, Jean-Marc Mac-Thiong19,20,21, Stefan Parent19, Eve C. Tsai22,23,24, Nader Fallah1,2, Carly S. Rivers1, RHSCIR Network
1Rick Hansen Institute, 2University of British Columbia, 3Vancouver General Hospital Division of Spine, 4Hamilton General, 5McMaster University, 6University of Toronto, 7Hôpital Enfant-Jésus, 8Laval University, 9St. Michael's Hospital, 10Horizon Health Network, 11Saint John Regional Hospital, 12Dalhousie University, 13Western University, 14London Health Sciences Centre, 15Sunnybrook Health Sciences Centre, 16University of Saskatchewan, 17University of Calgary, 18University of Manitoba, 19Hôpital du Sacré-Coeur de Montréal, 20Hôpital Ste-Justine, 21Université de Montréal, 22The Ottawa Hospital, 23Ottawa Hospital Research Institute, 24University of Ottawa
Background/Objective: The timing of surgery for traumatic spinal cord injury (tSCI) is controversial. Although some recent studies highlight the benefit of surgery within 24 hours of injury, this is not definitive. The objective of this study was to determine current surgical timing for tSCI in Canada and to ascertain whether the timing of surgery influences neurological outcome in patients with tSCI.
Methods/Overview: Ambispective cohort design of tSCI patients who underwent spine surgery within 30 days of injury, recruited to the Rick Hansen National Spinal Cord Injury Registry between 2004 and 2013. Patient demographics, admitting and post-operative neurology, and timing of surgery were collected. Multiple linear and gamma regression were used to determine correlations between times of arrival at the first acute hospital, initial neurological examination, and surgery, as well as to determine if there were differential patterns of recovery dependent on time to surgery and admission neurology (ASIA Injury Scale (AIS) A, B, C, or D). Possible reasons for neurological deterioration over time were also examined.
Results: Nine hundred and forty-nine patients were included in this analysis. The mean/median/range time to surgery for all participants were 60 hours/32 hours/2–705 hours. Participants with AIS A at admission did not demonstrate an effect of time of surgery on change in motor score; however, surgery within 24 hours on AIS B, C, or D increased motor score by almost 7 points.
Conclusions: In participants with tSCI who present with AIS A injuries, the timing of surgery does not appear to influence motor recovery. When the AIS is B, C, or D at admission, surgery within 24 hours of injury is correlated with improved motor score recovery.
Acknowledgments: Rick Hansen Institute, Health Canada.
Education Award Winner – First Place
INNOVATIVE ELECTRONIC SPINAL CORD INJURY EDUCATION FOR PRIMARY CARE PHYSICIANS: ACTIONABLE NUGGETS™ ON SKILLSCRIBE
Karen Smith, Mary Ann McColl, Alice Aiken, Danielle Naumann
Queens University
Background/Objective: Actionable Nuggets™ is an approach that has been developed to address the issue of knowledge translation for specialized populations in primary care. The first set of Nuggets addressed the healthcare issues of individuals with spinal cord injury (SCI). Individuals with SCI often represent a low percentage of the patients in any one primary care practice but have very high potential for morbidity. Primary care physicians are unlikely to attend continuing education events that facilitate the care of only a few patients in their practice. The Actionable Nuggets™ were developed to address this gap. This tool consisted of a series of 20 visually attractive postcards that were time-released through conventional mail. Participating physicians received one per week and completed brief learning activities in order to gain education and knowledge on the common conditions experienced by individuals with SCI. In the evaluation phase of the mailed version of Nuggets, primary care physicians expressed an interest in having an electronic version. This phase of research shares the development of an electronic version of Actionable Nuggets™ and the novel software platform developed.
Methods/Overview: This poster describes the development of an e-learning tool based on the educational principles of the Actionable Nuggets™. Pre- and post-test knowledge scores and qualitative evaluation interviews demonstrate the effectiveness of the information and the KT tool.
Results: Preliminary comparison of pre- and post-test results indicates significant increases in knowledge on best practices for SCI following the intervention. Analysis of qualitative data suggest that the tool supports principles of adult learning and best practice for medical education curriculum design leading to changes to practice.
Conclusions: Actionable Nuggets™ delivered using a convenient electronic medium, with time-released content and interactive testing has the potential to improve the care of specialized populations in primary care. This research will share the results of the use of this tool for SCI care.
Acknowledgments: SEAMO Educational Grant Queens University.
Award Winner Education – Second Place
MOVING FROM THE E-SCAN ATLAS TO ACTION: DEVELOPMENT OF A SCI REHABILITATION MANIFESTO
B. Catharine Craven1, Christina Balioussis1, Molly C. Verrier1, Jane T. Hsieh2,3, Erin Cherban4, Vanessa Noonan4, Dalton Wolfe2,3
1Toronto Rehabilitation Institute – UHN, 2Lawson Health Research Institute, 3Parkwood Hospital, 4Rick Hansen Institute
Background/Objective: Although translation of research findings into actions is a desired and laudable goal, few investigators or clinicians succeed. Our aim was to ensure that the recommendations derived from the E-Scan Atlas become translated into actions effecting necessary changes in spinal cord injury (SCI) rehabilitation research, practice, and policy.
Methods/Overview: The E-Scan Atlas, published in October 2012 (http://www.rickhanseninstitute.org/sci-resource/publications-60/escan), identified gaps in SCI rehabilitation services, as well as priority areas for focusing efforts and funding. In October 2013, a 2-day consensus meeting of 25 national and international SCI experts, consumers, and stakeholders was held to extend the national dialog regarding Canadian SCI rehabilitation priorities. Three foci were addressed at the meeting: optimizing cardiovascular, musculoskeletal, and skin integrity following SCI. Participants formed working groups to address current and emerging Canadian capacity and brainstorm on key issues for each focus point. A draft SCI rehabilitation “Manifesto” was developed at the meeting, and finalized collaboratively by the E-scan Investigative Team, the meeting participants, and a professional writer. “Manifesto” was operationally defined as: “A published verbal declaration of the intentions, motives, or views of the issuer, be it an individual, group, political party or government. A manifesto usually accepts a previously published opinion or public consensus and/or promotes a new idea with prescriptive notions for carrying out changes the author(s) believe should be made”.
Results: The manifesto identifies four goals: reducing ER visits and unnecessary hospital admissions for pressure ulcers, heart disease, and fracture by 50% for individuals with SCI; reducing the incidence and prevalence of persons with SCI impacted by pressures ulcers, heart disease, and fracture; facilitating access to evidence-based rehabilitation therapies for these conditions; and creating a national and universal diagnostic and management dataset to support these activities. The Rehabilitation Manifesto prescribes specific actions by which these goals can be achieved, and tailors each action to the audience(s) or stakeholders best suited to address each one.
Conclusions: The SCI Rehabilitation Manifesto provides clear directives that can enable a variety of stakeholders, clinicians, researchers, and policy makers to bridge the gap between research and action, leading to evolution in SCI rehabilitative care by the year 2020.
Acknowledgments: Ontario Neurotrauma Foundation Grant Number: 2013-KM-ONF-ESC-977.