Telehealth pulmonary rehabilitation: A review of the literature and an example of a nationwide initiative to improve the accessibility of pulmonary rehabilitation.

Several different applications of telehealth technologies have been used in the care of respiratory patients, including telemonitoring, teleconsultations, tele-education, and telehealth-pulmonary rehabilitation (PR). Telehealth technology provides an opportunity to assist in the management of chronic respiratory diseases and improve access to PR programs. While there is inconclusive evidence as to the effectiveness of telemonitoring to reduce healthcare utilization and detection of exacerbations, teleconsultations have been shown to be an effective means to assess patients' disease prior to the initiation of PR, and telehealth PR has been shown to be as effective as institution-based PR at improving functional exercise capacity and health-related quality of life.

Physical activity patterns and clusters in 1001 patients with COPD.

We described physical activity measures and hourly patterns in patients with chronic obstructive pulmonary disease (COPD) after stratification for generic and COPD-specific characteristics and, based on multiple physical activity measures, we identified clusters of patients. In total, 1001 patients with COPD (65% men; age, 67 years; forced expiratory volume in the first second [FEV], 49% predicted) were studied cross-sectionally. Demographics, anthropometrics, lung function and clinical data were assessed.

Promoting Optimal Physical Exercise for Life (PROPEL): aerobic exercise and self-management early after stroke to increase daily physical activity-study protocol for a stepped-wedge randomised trial.

Introduction: Physical exercise after stroke is essential for improving recovery and general health, and reducing future stroke risk. However, people with stroke are not sufficiently active on return to the community after rehabilitation. We developed the Promoting Optimal Physical Exercise for Life (PROPEL) programme, which combines exercise with self-management strategies within rehabilitation to promote ongoing physical activity in the community after rehabilitation.

Reforming Refugee Healthcare in Canada: Exploring the Use of Policy Tools.

Refugee healthcare in Canada has been a controversial and heavily debated topic over the past several years. In this paper, we present a policy analysis of the 2012 Canadian federal government decision to change the criteria and funding of the Interim Federal Health Program (IFHP). The IFHP provides federally funded healthcare coverage for refugees until they gain access to provincially funded health insurance.

Informal caregiving in COPD: A systematic review of instruments and their measurement properties.

Background: Increasing symptoms and activity restriction associated with COPD progression greatly impact on the lives of their informal caregivers, who play a vital role in maintaining their health. An understanding of this impact is important for clinicians to support caregivers and maintain a viable patient environment at home. This systematic review aimed to identify the instruments commonly used to assess informal caregiving in COPD and describe their measurement properties in this population.

Early Rehabilitation for Patients with Hip Fractures: Spreading Change Across the System.

Evidence suggests that patients with hip fractures should begin rehabilitation no later than six days following surgery. The reality is often far different. In an initiative led by the Greater Toronto Area (GTA) Rehab Network, acute care and rehab/complex continuing care hospitals across the GTA have implemented a new early referral process to aid transition of patients from acute care to inpatient rehabilitation as early as possible to improve their outcomes.

Goals Set by Patients Using the Model before Receiving Botulinum Injections and Their Relation to Spasticity Distribution.

Goal Attainment Scaling (GAS) is used to assess functional gains in response to treatment. Specific characteristics of the functional goals set by individuals receiving botulinum toxin type A (BoNTA) injections for spasticity management are unknown. The primary objectives of this study were to describe the characteristics of the goals set by patients before receiving BoNTA injections using the () and to determine whether the pattern of spasticity distribution affected the goals set.

The impact of incline and speed of treadmill on ankle muscle activity in middle-aged adults.

Objective: Additional demands associated with changing walking incline and speed combined with normal aging related changes in muscle recruitment can make walking difficult. This study examined the effects of walking on a treadmill at different inclines and speeds on ankle muscles in healthy middle-aged adults.

Methods: Fifteen healthy subjects (10M/5F) walked on a standard treadmill at three different inclines (0°, 3°, and 6°) and speeds (self-selected, self-selected+20%, self-selected+40%).

"We are all there for the same purpose": Support for an integrated community exercise program for older adults with HF and COPD.

Background: Despite well-established improvements following rehabilitation, functional gains often diminish following discharge.

Objective: To explore the attitudes of older adults with HF and COPD, who have completed rehabilitation, toward community-based exercise maintenance.

Methods: Semi-structured interviews were conducted with 11 individuals with HF or COPD.

Long-Term Functional and Psychosocial Outcomes After Hypoxic-Ischemic Brain Injury: A Case-Controlled Comparison to Traumatic Brain Injury.

Background: Despite the increasing rate of survival from hypoxic-ischemic brain injury (HIBI), there is a paucity of evidence on the long-term functional outcomes after inpatient rehabilitation among these nontrauma patients compared to patients with traumatic brain injury (TBI).

Objectives: To compare functional and psychosocial outcomes of patients with HIBI to those of case-matched patients with TBI 4-11 years after brain insult.

Design: Retrospective, matched case-controlled study.

Clinical and psychosocial predictors of exceeding target length of stay during inpatient stroke rehabilitation.

Background: In Ontario, Canada, patients admitted to inpatient rehabilitation hospitals post-stroke are classified into rehabilitation patient groups based on age and functional level. Clinical practice guidelines, called quality-based procedures, recommend a target length of stay (LOS) for each group.

Objectives: The study objective was to evaluate the extent to which patients post-stroke at an inpatient rehabilitation hospital are meeting LOS targets and to identify patient characteristics that predict exceeding target LOS.

Effects of treadmill incline and speed on peroneus longus muscle activity in persons with chronic stroke and healthy subjects.

Objective: To examine the effects of walking at different inclines and speeds on Peroneus Longus (PL) muscle activation and medial gastrocnemius (MG) coactivation with PL in healthy controls and subjects with stroke.

Design: Nineteen persons post-stroke (13M/6F) and fifteen healthy controls (10M/5F) walked on a treadmill at different inclines (0°, 3°, and 6°) and speeds (self-selected, self-selected+20%, self-selected+40%). The electromyographic activity of the PL and MG muscles in the stance phase of gait cycle was measured.

An Innovative Program to Support Internationally Educated Health Professionals and Their Instructors: Role of the Clinical Practice Facilitator.

Introduction: Internationally educated health professionals immigrating to other countries may experience difficulty in clinical practice, due to linguistic and cultural factors. An important element of bridging is the opportunity for internationally educated health professionals to practice in a clinical environment. To support these health professionals and their clinical instructors, a Clinical Practice Facilitator (CPF) role was created.

Long-Term Outcomes and Health Care Utilization after Prolonged Mechanical Ventilation.

Rationale: Limited data are available to characterize the long-term outcomes and associated costs for patients who require prolonged mechanical ventilation (PMV; defined here as mechanical ventilation for longer than 21 d).

Objectives: To examine the association between PMV and mortality, health care utilization, and costs after critical illness.

Methods: Population-based cohort study of adults who received mechanical ventilation in an intensive care unit (ICU) in Ontario, Canada between 2002 and 2013.

Identification of Barriers to Influenza Vaccination in Patients with Chronic Obstructive Pulmonary Disease: Analysis of the 2012 Behavioral Risk Factors Surveillance System.

Introduction: Patients with chronic obstructive pulmonary disease (COPD) are at increased risk for influenza-related morbidity and mortality. Influenza vaccination is known to decrease influenza incidence, severity, hospitalizations, and mortality. Identification of barriers to influenza vaccination among patients with COPD may aid in efforts to increase vaccination rates.

Perspectives of Canadian Final-Year Physiotherapy Students on Cardiorespiratory Physiotherapy as a Career Choice.

To investigate the opinions of final-year Canadian physiotherapy students of cardiorespiratory physiotherapy (CRP) and the factors influencing their decision about whether to pursue a career in CRP. A cross-sectional online survey was completed by final-year Master of Science of Physical Therapy students from three of the largest English-speaking physiotherapy schools in Canada. A total of 120 students responded to the survey (overall response rate was 44%).

Balance confidence and activity of community-dwelling patients with transtibial amputation.

The purpose of this study was to examine the relationship between balance confidence and community-based physical activity. Twenty-two community-dwelling patients with right or left unilateral transtibial amputation who reported no falls in the past 6 mo completed the Activities-Specific Balance Confidence Scale (ABC) and wore a StepWatch Activity Monitor for 7 consecutive d in the community. Subjects were subsequently stratified as low ( <3,000 steps/d) or high (>/=3,000) steps/d) activity groups.

Home-based diabetes self-management coaching delivered by paraprofessionals: A randomized controlled trial.

This study evaluated paraprofessional-led diabetes self-management coaching (DSMC) among 94 clients with type 2 diabetes recruited from a Community Care Access Centre in Ontario, Canada. Subjects were randomized to standard care or standard care plus coaching. Measures included the Diabetes Self-Efficacy Scale (DSES), Insulin Management Diabetes Self-Efficacy Scale (IMDSES), and Hospital Anxiety and Depression Scale (HADS).

The effect of water-based exercises on balance in persons post-stroke: a randomized controlled trial.

Objective: Water-based exercises have been used in the rehabilitation of people with stroke, but little is known about the impact of this treatment on balance. This study examined the effect of water-based exercises compared to land-based exercises on the balance of people with sub-acute stroke.

Methods: In this single-blind randomized controlled study, 32 patients with first-time stroke discharged from inpatient rehabilitation at West Park Healthcare Centre were recruited.