Abstract Background Randomized controlled trials (RCTs) are rigorous scientific research designs for evaluating intervention effectiveness. However, implementing RCTs in a real-world context is ...challenging. To develop strategies to improve its application, it is essential to understand the strengths and challenges of this design. This study thus aimed to explore the strengths, challenges, and strategies for improving the implementation of a pragmatic multicenter, prospective, two-arm RCT evaluating the effects of the Personalized Citizen Assistance for Social Participation ( Accompagnement-citoyen Personnalisé d’Intégration Communautaire : APIC; weekly 3-h personalized stimulation sessions given by a trained volunteer over a 12-month period) on older adults’ health, social participation, and life satisfaction. Methods A multiple case study was conducted with 14 participants, comprising one research assistant, seven coordinators, and six managers of six community organizations serving older adults, who implemented the APIC in the context of a RCT. Between 2017 and 2023, qualitative data were extracted from 24 group meetings, seven semi-directed interviews, emails exchanged with the research team, and one follow-up document. Results Aged between 30 and 60 (median ± SIQR: 44.0 ± 6.3), most participants were women from organizations already offering social participation interventions for older adults and working with the public sector. Reported strengths of this RCT were its relevance in assessing an innovative intervention to support healthy aging, and the sharing of common goals, expertise, and strategies with community organizations. Challenges included difficulties recruiting older adults, resistance to potential control group assignments, design complexity, and efforts to mobilize and engage volunteers. The COVID-19 pandemic lockdown and health measures exacerbated challenges related to recruiting older adults and mobilizing volunteers and complicated delivery of the intervention. The strategies that mostly overcame difficulties in recruiting older adults were reducing sample size, simplifying recruitment procedures, emphasizing the health follow-up, extending partnerships, and recognizing and supporting volunteers better. Because of the lockdown and physical distancing measures, the intervention was also adapted for remote delivery, including via telephone or videoconferencing. Conclusion Knowledge of the strengths and challenges of pragmatic RCTs can contribute to the development of strategies to facilitate implementation studies and better evaluate health and social participation interventions delivered under real-life conditions. Trial registration NCT03161860; Pre-results. Registered on May 22, 2017.
Introduction
Urinary incontinence (UI) is one of the most prevalent health concerns in women age 65 and over. The recommended first-line treatment for UI is individual pelvic floor muscle training ...(PFMT). However, healthcare systems worldwide are unable to meet the demand for this resource-intensive approach. Recently, the Group Rehabilitation Or IndividUal Physiotherapy (GROUP) trial showed that group-based PFMT was not inferior to individual PFMT to treat UI in older women, despite using fewer resources. This study aims to assess the feasibility, acceptability and effects on UI-related symptoms and associated quality of life (QoL) of an online adaptation of the GROUP program (teleGROUP) for UI in older women.
Methods and analysis
This pilot study will involve the recruitment of 32 older women with UI. Participants’ attendance to online sessions, adherence to weekly home exercises, and side effects, in addition to the physiotherapist's fidelity to the program delivery will be collected to evaluate the program's feasibility. Participants’ dropout rates, reasons for dropout, satisfaction and usability scores will be collected to evaluate the program's acceptability for participants. A survey will evaluate the program's acceptability for the physiotherapists. Additionally, at the end of the study, qualitative semi-structured interviews and focus groups will investigate further feasibility and acceptability. To measure the effects of teleGROUP, number of weekly leakages and percentage reduction will be the primary outcomes.
Background: This study examined the implementation outcomes (program reach, fidelity, adaptations, responsiveness) of a peer-led program for older adults with fear of falling —Vivre en Équilibre ...(VEE). Method: VEE was implemented in six independent-living residences for older adults in Quebec (Canada) as part of an effectiveness study. Implementation outcomes were documented using attendance sheets, peer leaders’ logbooks, observation sheets, and phone-administered questionnaires. Qualitative interviews were also conducted with peer leaders, activity coordinators of residences, and a subsample of program participants. Results: The program reached 71 participants who generally corresponded to the program’s target population. Peer leaders delivered the program with moderate to high fidelity but adapted some elements. Responsiveness was good, as reflected by a high attendance rate (91%) and respondents’ satisfaction levels. Conclusion: Findings revealed that VEE was well implemented, suggesting that it can be successfully delivered by peer leaders.
It is recommended that sexuality be addressed at all transition points along the continuum in stroke rehabilitation. However, little is known about needs specific to the subacute phase. (1) Explore ...priorities and needs of individuals who have had a stroke regarding sexuality in the subacute phase of stroke rehabilitation, according to both clients and clinicians; (2) Explore clinicians’ perceptions of their professional roles with regard to sexuality rehabilitation after stroke. This qualitative study involved a convenience sample composed of five clients and 15 clinicians. Clinicians were asked to implement an interview guide to assess their clients’ need to address sexuality during rehabilitation. Following implementation, data was collected through individual interviews (n = 6) and focus groups (n = 3). Verbatim were partially co-coded (15%) and analyzed by two independent assessors through a thematic analyzis. The mean age of the five clients (3 female, 2 male) was 67.0 years-old (S.D. 4.6) and clinicians included a psychologist and occupational, physical and speech language therapists. Three themes emerged: (1) Sexuality: a secondary priority, (2) Clients’ needs: just talk about it!, and (3) professional roles. Clients and clinicians considered sexuality as important, but a secondary priority to be addressed after more basic activities of daily living. Needs varied among clients regarding sexuality and clinicians shared their respective contribution to the issue while emphasizing interdisciplinarity. This study is among the first to identify priorities and needs related to sexuality for clients in subacute phase of stroke rehabilitation and their clinicians.
Developed in California to enable community-dwelling older adults to maintain healthy and meaningful activities, Lifestyle Redesign
is a well-known cost-effective preventive occupational therapy ...intervention. The impact of a newly adapted French version on older French-Canadians was, however, unknown.
To explore the influence of Lifestyle Redesign on older French-Canadians' health, social participation, leisure, and mobility.
A mixed-methods design included a preexperimental component (questionnaires administered before and after the intervention and 3 and 6 mo postintervention) and an exploratory descriptive qualitative clinical study. Individual semidirected interviews were digitally audiotaped and transcribed, then underwent thematic content analysis using mix extraction grids.
Community.
Sixteen volunteers (10 women) aged 65-90 yr (mean = 76.4, standard deviation = 7.6), 10 without and 6 with disabilities. Inclusion criteria were age ≥65 yr, normal cognitive functions, residence in a conventional or senior home, and French speaking.
French-Canadian 6-mo version of Lifestyle Redesign.
Health, social participation, leisure, and mobility were measured using the 36-item Short Form Health Survey, Social Participation Scale, Leisure Profile, and Life-Space Assessment, as well as a semistructured interview guide.
The French-Canadian Lifestyle Redesign had a beneficial effect on participants' mental health (p = .02) and interest in leisure (p = .02) and, in those with disabilities, social participation (p = .03) and attitudes toward leisure (p = .04). Participants reported positive effects on their mental health, leisure, mobility, and social participation, including frequency and quality of social interactions, and indicated that having an occupational routine fostered better health. None of the participants reported no effect.
The translated and culturally adapted Lifestyle Redesign is a promising occupational therapy intervention for community-dwelling older French-Canadians.
This study sheds light on the influence of the French-Canadian version of the intervention not only on older adults' health and social participation but also on their leisure activities and life-space mobility, two important outcomes not addressed in previous Lifestyle Redesign studies. Moreover, this study provides an in-depth understanding of the Lifestyle Redesign experience of French-Canadian older adults with and without disabilities, including participants with significant communication and mobility disabilities.
Musculoskeletal disorders (MSKDs) are the most common causes of disabilities for older adults. The aim of this systematic review and meta-analysis is to assess the effectiveness of multimodal ...interventions including exercise rehabilitation for older adults with chronic MSKDs.
A literature search was conducted up to February 2019 in 5 bibliographical databases to identify randomized controlled trials (RCTs) that compared multimodal interventions including exercise rehabilitation with usual medical care or no intervention. Randomized controlled trials were assessed with the Cochrane risk-of-bias tool. Meta-analyses were performed and pooled mean differences (MDs) or standardized mean differences (SMDs) were calculated.
Sixteen RCTs (n = 2322 participants) were included. One RCT was considered at low risk of bias, 8 had some concerns of bias, and 7 had a high risk of bias. Participants suffered from hip or knee osteoarthritis (OA) (n = 12 RCTs), low back pain (LBP) (n = 2 RCTs) and generalized chronic pain (GCP) (n = 2 RCTs). Multimodal interventions were significantly more effective than usual care to decrease pain (visual analog scale, out of 10 points) in the short term, MD: -0.71 (95% confidence interval CI -1.08 to -0.34, n = 900), and in the long term: MD: -0.52 (95% CI -0.98 to -0.05, n = 575), but these differences are not considered clinically important. In terms of disabilities, multimodal interventions were also significantly more effective than usual care. The SMDs were -0.47 (95% CI -0.61 to -0.34, n = 903) and -0.29 (95% CI -0.46 to -0.13, n = 568) for OA trials in the short and long terms, respectively, and -0.47 (95% CI -0.81 to -0.12, n = 211) for LBP and GCP trials in the short term. The magnitude of these effects may be considered as small to moderate.
Multimodal intervention including exercise rehabilitation combined with usual medical care is an efficacious therapeutic option to reduce disabilities in older adults with chronic MSKDs. A significant but not clinically important effect was observed for pain. The most beneficial component of the multimodal interventions in terms of education, exercises, or medication remains to be determined.
Fracture liaison services (FLS) have been shown to prevent efficiently subsequent fragility fractures (FF). However, very few studies have examined their implementation in depth. The purpose of this ...research was to identify factors influencing the implementation of a FLS at three sites in Quebec, Canada. From 2013 to 2015, individual and group interviews focused on experiences of FLS stakeholders, including implementation committee members, coordinators, and orthopaedic surgeons and their teams. Emerging key implementation factors were triangulated with the FLS patients’ clinico-administrative data. The Consolidated Framework for Implementation Research guided the analysis of perceived factors influencing four intervention outputs: investigation of FF risk (using the FRAX score), communication with the participant primary care provider, initiation of anti-osteoporosis medications (when relevant), and referral to organized fall prevention activities (either governmental or community based). Among the 454 FLS patients recruited to the intervention group, 83% were investigated for FF risk, communication with the primary care provider was established for 98% of the participants, 54% initiated medication, and 35% were referred to organized fall prevention activities. Challenges related to restricted rights to prescribe medication and access to organized fall prevention activities were reported. FLS coordinator characteristics to overcome those challenges included self-efficacy beliefs, knowledge of community resources, and professional background. This study highlighted the importance of enabling access to services for subsequent FF prevention, consolidating the coordinator’s role to facilitate a more integrated intervention, and involving local leaders to promote the successful implementation of the FLS.
Introduction: Up to 50% of community-dwelling older adults report living with some chronic pain that interferes with their daily functioning and leads to disabilities. Hence, it is crucial to provide ...these individuals with strategies to effectively manage pain. An interdisciplinary approach is warranted considering the numerous factors contributing to pain among older adults. Although several studies have been conducted on various interdisciplinary pain self-management programs, little effort has been made to synthesize knowledge about such programs for older adults. Objective: The objective of this review was to synthesize the characteristics and effects of interdisciplinary chronic pain self-management interventions targeting community-dwelling older adults. Methods: A scoping review was conducted following the steps recommended by Arksey and O’Malley (2005) and Levac et al. (2010). Keyword searches were performed in MEDLINE, CINAHL, EMBASE, and the Cochrane Library. Results: Sixty-six articles were included. Most interventions were based on a cognitive-behavioral group approach and used a combination of modalities, including education and training on the use of self-management strategies. The professionals most frequently involved in group interventions were psychologists, physiotherapists, and occupational therapists. Several benefits of these programs have been reported concerning pain intensity, independence in daily functioning, mental health, and quality of life. Conclusions: Interdisciplinary chronic pain self-management programs appear promising in guiding clinical and rehabilitation interventions for older adults living with chronic pain.
Introduction
Most people who sustain a stroke are likely to experience sexual difficulties during their recovery. However, few people get the opportunity to address sexuality during their ...rehabilitation because of factors related to the organization (e.g., culture), managers (e.g., lack of resources), clinicians (e.g., perceived lack of knowledge, skills, and comfort), and clients (e.g., taboo). A multifactorial program tailored to stakeholders' needs with various complementary interventions is needed to lead to a change of practice in post-stroke sexual rehabilitation.
Objective
To co-design with stakeholders (i.e., people with stroke, partners, clinicians, managers and researchers) a theory-driven multifactorial program to improve post-stroke sexual rehabilitation services.
Methods
This qualitative study will be conducted in four steps using an Intervention Mapping approach and a co-design methodology divided into four phases: (1) exploration; (2) co-design; (3) validation; and (4) development. Persons with stroke, partners, clinicians and managers from five distinct stroke rehabilitation centres in the province of Quebec (Canada), and researchers will be recruited to either participate in an advisory committee or working groups throughout the study. A combination of contributions from three different types of groups (advisory group, Lego® groups, work groups) will be used for data collection. Qualitative data analysis will first be realized by two independent reviewers using the Theoretical Domains Framework, and preliminary results of analysis will be validated with the advisory and working groups.
Conclusion
This study will lead to the co-design of the first theory-driven program intended to optimize post-stroke sexual rehabilitation services.
Background: Recent studies show that fear of falling, a frequent fear of community-dwelling seniors, can have a negative impact on their health and quality of life. When fear of falling is intense, ...it can prompt individuals to limit or avoid certain activities. This activity restriction can lead to premature physical and functional decline and, ultimately, increase the risk for falls. Although activity avoidance/restriction is a common strategy used by seniors to cope with fear of falling, they may use other strategies as well to cope with this fear. However, these other strategies have received little attention to date. Objective: This study aimed at examining and comparing coping strategies used by seniors with and without fear of falling. It also examined if fear of falling is an independent correlate of the use of coping strategies among seniors. Methods: 288 seniors aged 65 years or over and going through the normal aging process were assessed during structured home interviews. Fear of falling was assessed through a single question (Are you afraid of falling?) and a 4-category response scale (never, occasionally, often, very often). Coping strategies used by participants were assessed with the Inventory of Coping Strategies Used by the Elderly. Results: Findings show that seniors with fear of falling use several coping strategies other than activity avoidance/restriction in their daily functioning. Compared with nonfearful seniors, they tend to use a wider range of coping strategies and use them more frequently. Results also indicate that fear of falling is an independent correlate of diversity and frequency of use of behavioral coping strategies. Conclusion: This study suggests that fall prevention practitioners and researchers should document the range and frequency of use of strategies that seniors may employ to cope with fear of falling. These data could help improve interventions and evaluative research in the domain of fall prevention.
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