PurposeAlthough rural and remote residents face general challenges accessing health care in comparison to urban dwellers, care for musculoskeletal conditions like chronic back disorders (CBD) is particularly challenging for rural and remote residents due to lack of access to physical yherapists. Telerehabilitation such as secure videoconferencing offers one solution to this disparity in rural care delivery, but incorporating the perspectives of health practitioners and patients is important when developing new sustainable care models.Patients and methodsThis study investigated the experiences of practitioners and patients during a novel interprofessional model of assessment where an urban-based physical therapist used videoconferencing to virtually join a rural nurse practitioner and a rural patient with CBD. Patient surveys and semi-structured interviews of practitioners and patients were analyzed quantitatively and qualitatively.ResultsMost patients were “very satisfied” (62.1%) or “satisfied” (31.6%) with the overall experience, and “very” (63.1%) or “somewhat (36.9%) confident” with the assessment. Thematic analysis of interviews revealed that this novel assessment method identified: access to care for CBD, effective interprofessional practice, enhanced clinical care for CBD, and technology considerations.ConclusionPatient satisfaction with the telerehabilitation model of care was high. Patients and practitioners reported their experiences were impacted by access to care, interprofessional practice, enhanced care for CBD and technology. These findings will be useful in the development of patient-centered models of care utilizing telehealth strategies.

We postulate that longitudinal growth of myofibrils in adult muscle is characterized by the sequential expression of MyHC isoforms similar to that observed in rapidly growing muscle and that the presence of the neurotransmitter hydrolase AChE at the tapered fiber ends may be related to the retention of neonatal MyHC.

The eleven Indigenous communities served by the File Hills Qu’Appelle Tribal Council (FHQTC) in Saskatchewan, Canada have experienced a progressive reduction in access to physical and occupational therapy services. A community-directed needs assessment facilitated by FHQTC Health Services was undertaken in the summer of 2021 to identify experiences and barriers of community members in accessing rehabilitation services. Sharing circles were conducted according to FHQTC COVID-19 policies; researchers connected to community members via Webex virtual conferencing software. Community stories and experiences were collected via sharing circles and semi-structured interviews. Data was analysed using an iterative thematic analysis approach with NVIVO qualitative analysis software. An overarching theme of culture contextualised five primary themes: 1) Barriers to Rehabilitation Care, 2) Impacts on Family and Quality of Life, 3) Calls for Services, 4) Strength Based Supports, and 5) What Care Should Look Like. Each theme is comprised of numerous subthemes amassed by stories from community members. Five recommendations were developed to enhance culturally responsive access to local services in FHQTC communities: 1) Rehabilitation Staffing Requirements, 2) Integration with Cultural Care, 3) Practitioner Education and Awareness, 4) Patient and Community-Centered Care, and 5) Feedback and Ongoing Evaluation.

Background Back pain is common and costly, with negative impacts on both individuals and the health care system. Rural, remote, and Indigenous populations are at greater risk of experiencing back pain compared to urban and non-Indigenous populations. Potential barriers to health care access among Canadians with chronic back pain (CBP) have been identified; however, no study has used lived experiences of people with CBP to drive the selection, analysis, and interpretation of variables most meaningful to patients. Objective The aims of this study are to (1) engage with rural, remote, and urban Indigenous and non-Indigenous patients, health care providers, and health system decision makers to explore lived experiences among people with CBP in Saskatchewan, Canada; (2) cocreate meaningful indicators of CBP care access and effectiveness; and (3) identify program and policy recommendations to overcome access barriers to CBP care. Methods In phase 1, one-on-one interviews with 30 people with current or past CBP and 10 health care providers residing or practicing in rural, remote, or urban Saskatchewan communities will be conducted. We will recruit Indigenous (n=10) and non-Indigenous (n=20) rural, remote, and urban people. In phase 2, findings from the interviews will inform development of a population-based telephone survey focused on access to health care barriers and facilitators among rural, remote, and urban people; this survey will be administered to 383 residents with CBP across Saskatchewan. In phase 3, phase 1 and 2 findings will be presented to provincial and national policy makers; health system decision makers; health care providers; rural, remote, and urban people with CBP and their communities; and other knowledge users at an interactive end-of-project knowledge translation event. A World Café method will facilitate interactive dialogue designed to catalyze future patient-oriented research and pathways to improve access to CBP care. Patient engagement will be conducted, wherein people with lived experience of CBP, including Indigenous and non-Indigenous people from rural, remote, and urban communities (ie, patient partners), are equal members of the research team. Patient partners are engaged throughout the research process, providing unique knowledge to ensure more comprehensive collection of data while shaping culturally appropriate messages and methods of sharing findings to knowledge users. Results Participant recruitment began in January 2021. Phase 1 interviews occurred between January 2021 and September 2022. Phase 2 phone survey was administered in May 2022. Final results are anticipated in late 2022. Conclusions This study will privilege patient experiences to better understand current health care use and potential access challenges and facilitators among rural, remote, and urban people with CBP in Saskatchewan. We aim to inform the development of comprehensive measures that will be sensitive to geographical location and relevant to culturally diverse people with CBP, ultimately leading to enhanced access to more patient-centered care for CBP. International Registered Report Identifier (IRRID) DERR1-10.2196/42484

Introduction Virtual care using videoconference links between urban-based physical therapists and nurse practitioners in rural primary care may overcome access challenges and enhance care for rural and remote residents with chronic low back disorders (CBD). The purpose of this study was to evaluate the concordance of this new model of care with two traditional models. Methods In this cross-sectional study design, each of 27 participants with CBD were assessed by: 1) a team of a nurse practitioner (NP) located with a patient, joined by a physical therapist (PT) using videoconferencing (NP/PTteam); 2) in-person PT (PTalone); and 3) in-person NP (NPalone). Diagnostic and management concordance between the three groups were assessed with percent agreement and kappa. Results Overall diagnostic categorization was compared for PTalone versus NPalone and NP/PTteam: percent agreement was 77.8% ( k = 0.474, p = 0.001) and 74.1% ( k = 0.359, p = 0.004), respectively. In terms of management recommendations, the PTalone and NPalone demonstrated strong agreement on “need for urgent surgical referral” (92.6%, k = 0.649 ( p < 0.00) and slight agreement for “refer to primary physician for pharmacology, lab or imaging” (81.5%, k = 0.372 ( p = 0.013). The PTalone and NP/PTteam demonstrated strong agreement on “need for urgent surgical referral” (96.3%, k = 0.649, p = 0.000) and “recommendation for PT follow up” (88.9%, k = 0.664, p = 0.000). Discussion The diagnostic categorization and management recommendations of the team using videoconferencing for CBD were similar to decisions made by an in-person PT. This model of care may provide a method for enhancing access to PT for CBD assessment and initial management in underserved areas.

BackgroundRehabilitation therapies are still in the early stages of development in Honduras. At the present time there are no formal training opportunities in Honduras to support the learning needs of health professionals and healthcare workers who specialize in neurological rehabilitation. Support and development of those delivering rehabilitation services from community engaged academic collaborations outside of Honduras can enhance the learning and knowledge of healthcare workers. The purpose of this study was to evaluate reaction and learning linked to two continuing educational workshops for rehabilitation workers in northern Honduras. MethodsThe study design was a pretest-posttest design. The workshops were conducted in a rehabilitation center and a family support organization located in northern Honduras in September 2017.Faculty from Canada and Colombia, together with health professionals from Honduras, facilitated two workshops. Seventeen participants attended the ‘Acquired brain injury/spinal cord injury workshop’ (adult workshop); 15 attended the ‘Rehabilitation for children with impaired neuromotor development workshop’ (pediatric workshop). Participants completed three questionnaires: sociodemographic, knowledge, and Modified Stages of Learning Questionnaires (MSLQ), and three after: Modified Kirkpatrick, knowledge, MSLQ. ResultsWorkshop participants were physiotherapists, physicians, nurses, educational professionals and other non-physiotherapists. Most agreed that the workshops had positive effects in reaction (engagement, relevance, satisfaction), and learning (skills, attitude, confidence and commitment). Stages of Learning changed from scanning/evaluation to learning/experience (p<0.05) in three out of six topics in the pediatric workshop. Three of the knowledge questions showed important learning effects. ConclusionsWorkshops offered to the neurological rehabilitation healthcare workers in Honduras through an international collaboration resulted in enhanced learning and knowledge of participants. This has the potential to improve quality of care for people with neurological conditions in the region.

BACKGROUND Back pain is a common and costly problem, with negative impacts on both individuals and the healthcare system. Rural, remote, and Indigenous populations are at greater risk of experiencing back pain compared to urban and non-Indigenous populations. Potential barriers to health care access among Canadians with chronic back pain (CBP) have been identified; however, no known study has used lived experiences of people with CBP to drive the selection, analysis, and interpretation of variables most meaningful to patients. OBJECTIVE 1) Engage with rural, remote, and urban Indigenous and non-Indigenous patients, health care providers, and health system decision makers to explore lived experiences of attempting to access health care among people with CBP in Saskatchewan, Canada; 2) Co-create meaningful indicators of CBP care access and effectiveness; 3) Identify program and policy recommendations to overcome access barriers to CBP care. METHODS Phase 1) One-on-one interviews with 30 people with current or past CBP and 10 health care providers residing or practicing in rural, remote, or urban Saskatchewan communities will be conducted. We will recruit Indigenous (10) and non-Indigenous (20) rural, remote and urban people. Phase 2) Findings from the interviews will inform development of a population-based telephone survey focused on access to health care barriers and facilitators among rural, remote and urban people; this survey will be administered to 383 residents with CBP across Saskatchewan. Phase 3) Phase 1 & 2 findings will be presented to provincial and national policy makers, health system decision makers, health care providers, rural, remote, and urban people with CBP and their communities, and other knowledge users at an interactive end-of-project knowledge translation event. A World Café method will be used to facilitate interactive dialogue designed to catalyse future patient-oriented research and pathways to improve access to CBP care. Patient engagement: People with lived experience of CBP, including Indigenous and non-Indigenous people from rural, remote, and urban communities (i.e. ‘patient partners’) are equal members of the research team for this patient-oriented project. Patient partners are engaged throughout the entire research process and will provide unique knowledge from the patient perspective to ensure more comprehensive collection of data, while shaping culturally appropriate messages and identifying target audiences and methods of sharing findings to knowledge users. RESULTS Participant recruitment began in January 2021. Final results are anticipated in late 2022. CONCLUSIONS This study will privilege CBP patient experiences to better understand current health care use and potential access challenges and facilitators among rural, remote, and urban people living with CBP in Saskatchewan. Our study aims to inform the development of comprehensive measures that will be sensitive to geographical location and relevant to culturally diverse people with CBP, ultimately leading to enhanced access to more patient-centred care for CBP.

Background Children with disability face long wait times for rehabilitation services. Before the COVID-19 pandemic, telehealth adoption was low across pediatric rehabilitation. Owing to the COVID-19 pandemic restrictions, pediatric therapists were asked to rapidly shift to telehealth, often with minimal training. To facilitate the behavior changes necessary for telehealth adoption, provision of appropriate evidence-based training and support is required. However, evidence to support the effective implementation of such training is lacking. The successful real-world implementation of a training intervention and program of support (TIPS) targeting pediatric therapists to enhance the adoption of family-centered telerehabilitation (FCT) requires the evaluation of both implementation and effectiveness. Objective This study aimed to evaluate TIPS implementation in different pediatric rehabilitation settings and assess TIPS effectiveness, as it relates to therapists’ adoption, service wait times, families’ perception of service quality, and costs. Methods This 4-year, pan-Canadian study involves managers, pediatric occupational therapists, physiotherapists, speech-language pathologists, and families from 20 sites in 8 provincial jurisdictions. It will use a multimethod, prospective, hybrid type 3 implementation-effectiveness design. An interrupted time series will assess TIPS implementation. TIPS will comprise a 1-month training intervention with self-paced learning modules and a webinar, followed by an 11-month support program, including monthly site meetings and access to a virtual community of practice. Longitudinal mixed modeling will be used to analyze indicators of therapists’ adoption of and fidelity to FCT collected at 10 time points. To identify barriers and facilitators to adoption and fidelity, qualitative data will be collected during implementation and analyzed using a deductive-inductive thematic approach. To evaluate effectiveness, a quasi-experimental pretest-posttest design will use questionnaires to evaluate TIPS effectiveness at service, therapist, and family levels. Generalized linear mixed effects models will be used in data analysis. Manager, therapist, and family interviews will be conducted after implementation and analyzed using reflective thematic analysis. Finally, cost data will be gathered to calculate public system and societal costs. Results Ethics approval has been obtained from 2 jurisdictions (February 2022 and July 2022); approval is pending in the others. In total, 20 sites have been recruited, and data collection is anticipated to start in September 2022 and is projected to be completed by September 2024. Data analysis will occur concurrently with data collection, with results disseminated throughout the study period. Conclusions This study will generate knowledge about the effectiveness of TIPS targeting pediatric therapists to enhance FCT adoption in pediatric rehabilitation settings, identify facilitators for and barriers to adoption, and document the impact of telehealth adoption on therapists, services, and families. The study knowledge gained will refine the training intervention, enhance intervention uptake, and support the integration of telehealth as a consistent pediatric rehabilitation service option for families of children with disabilities. Trial Registration ClinicalTrials.gov NCT05312827; https://clinicaltrials.gov/ct2/show/NCT05312827 International Registered Report Identifier (IRRID) PRR1-10.2196/40218