Background: The study protocol for this project aims to advance ecologically valid measures of communication function in older adults with hearing loss (HL). In Canada, 77% of those 60–69 years old and 94% of individuals over 70 have HL. HL is associated with cognitive decline and is a modifiable risk factor for dementia. Individuals with hearing loss and dementia find it difficult to participate in conversations. Objectives: The objectives of this study are to (1) evaluate conversation accuracy and efficiency using a joint problem-solving communication task in older adults with a range of cognitive abilities and hearing loss profiles with familiar and unfamiliar listeners, (2) examine the relationship between objective measures of a standardized self-report instrument of communication effectiveness in everyday life. Method: The study will enroll 60 English-speaking participants 60 years and older with mild to moderate hearing loss and no more than mild-moderate cognitive impairment. Participants will complete the Diapix communication task, a joint problem-solving task to examine communication efficiency and effectiveness between two conversation partners (familiar and unfamiliar). Stimuli and partner familiarity will counterbalance conditions. Statistical analyses will explore the relationships among demographics, hearing status, cognitive variables, communication accuracy, and efficiency. Impact: This study addresses a critical gap in understanding how hearing loss and cognitive impairment interact to influence conversation difficulties in older adults. The result will inform the development of clinical assessment tools for clinicians to assess conversation difficulties more accurately.
Dysarthria refers to a group of neurogenic speech disorders characterized by abnormalities regarding the strength, speed, steadiness, tone, accuracy, or range of movements that are required for resonatory, phonatory, respiratory, articulatory, or prosodic aspects of speech production. Dysarthria can adversely affect the intelligibility and/or naturalness of one’s speech. Furthermore, people with dysarthria report reduced communicative participation, which refers to how a communication disorder impacts one’s ability to participate in daily activities involving communication. The use of Patient Reported Outcome Measures (PROMs) in the assessment of dysarthria allows for the inclusion of the patient's perspective related to the impact of dysarthria. However, the range of PROMs currently available for assessing this diverse clinical population is not well understood, nor is it clear how these outcome measures align with the International Classification of Functioning, Disability, and Health (ICF) framework, which offers a comprehensive model for conceptualizing health and disability. A scoping review exploring PROMs used in the assessment of adults with dysarthria, categorized according to the ICF conceptual framework will provide insights into 1) which domains of the ICF are most commonly measured in research and clinical practice and 2) whether there are any gaps or limitations in capturing the full range of experiences for individuals with acquired dysarthria. This will further aid to identify trends in PROM use and highlight areas where future research could expand or refine PROM development for this clinical population.
Dyslexia is a learning disorder, affecting approximately 7% of the population, and is characterized by difficulties in word recognition, processing, and spelling. Structural and functional brain abnormalities have been noted in those with dyslexia, resulting in deficits in higher order cognitive abilities, such as task sequencing, information processing, and memory. These may pose significant challenges to health management abilities, such as recall of information, dosing medications, or following treatment regimens. Furthermore, adults with dyslexia often experience poorer social determinants of health which increases risk for adverse health outcomes. Health literacy—another critical determinant of health—requires proficiency in reading, numeracy, communication, and decision-making, areas where individuals with dyslexia frequently face deficits. Despite these connections and widespread prevalence research examining the relationship between dyslexia and health is almost non-existent. This paper aims to improve our understanding of if dyslexia impacts health-management abilities, as defined by treatment non-adherence and poor health literacy in adults. A survey-based design will be employed with two participant groups—those with dyslexia and those without—completing validated questionnaires assessing health literacy and medication adherence. A simulation component will further evaluate participants’ ability to accurately follow treatment protocols, such as interpreting prescription labels or changing wound dressings. By identifying disparities in health management, my study can guide professionals in developing better interventions to assist individuals with dyslexia, dismantling systemic barriers and reducing negative health outcomes, while fostering a more equitable healthcare system
Background: The essence of human connection lies in communication. For individuals with Parkinson’s Disease (PD), their ability to communicate can be limited due to a motor speech disorder called hypokinetic dysarthria. Speech therapy plays a crucial role in communication management while supporting the independence of individuals with PD. Research Objective: The aim of this scoping review is to synthesize that available literature regarding the perceptions and experiences of people with PD and hypokinetic dysarthria about the benefits, challenges, and outcomes of speech therapies. Methods: A qualitative scoping review will be conducted to explore and map the existing literature on communication challenges faced by individuals with Parkinson’s Disease, particularly focusing on the impact of hypokinetic dysarthria. This review will identify key themes in current research, and evidence-based interventions, with the aim of providing insights that can inform future studies and improve speech therapy practices for people with PD. Future Applications: This research challenges paradigms in rehabilitation sciences by utilizing a qualitative health research framework to understand how speech therapy interventions effect this clinical population. The review will further highlight any gaps in the existing literature and offer recommendations for improving clinical practice and patient-centered care for people with PD. Communication can look differently for everyone, thus this research will identify the branches of speech therapy to optimize the health and care of individuals with PD and hypokinetic dysarthria.
Background: Between 2022 and 2023, rates of opioid-related deaths in Ontario increased from 16.9 to 17.4 per 100,000 people. While current response measures to the opioid crisis involve a harm reduction approach, there lacks a comprehensive, ethical examination of Ontario’s harm reduction policies and practices, to determine to what extent, and for whom, the province’s response is ‘just’ or ‘equitable.’ This is important, since social factors (e.g., housing) intersect with harm reduction and are pivotal aspects of health equity. Accordingly, an applied ethics analysis is particularly needed, to determine to what extent, if any, Ontario’s harm reduction response equitably supports individuals who use substances throughout the province. Objective: To elucidate how equity is conceptualized and reflected under Ontario’s current harm reduction guidelines and practices; to evaluate Ontario’s current harm reduction practices from a feminist-relational ethics perspective, to account for intersectional aspects of health equity (e.g., socio-economic status, housing, etc.); and to articulate, and argue for, a concrete account—and application—of equitable harm reduction in Ontario, using the opioid crisis as a guiding example. Proposed Methods: Guided by a feminist-relational ethics lens and paradigmatically grounded in critical theory, this study will involve a qualitative document analysis of Ontario’s harm reduction guidelines and practices using public health and policy documents. Future Applications: This ethical analysis will offer a coherent framework for implementing equitable harm reduction in Ontario, thus offering insights to policymakers for how best to organize community mental health, addictions, and social service supports.
Background: HIV-related stigma poses barriers to reducing transmission risks, accessing preventive services, and achieving positive health outcomes for men who have sex with men (MSM) in Canada. Stigma manifests through healthcare discrimination, internalized negative beliefs, and the expectation of rejection, deterring MSM from seeking testing and treatment. Despite interventions such as educational programs, trust-building initiatives, and PrEP promotion, critical gaps remain in addressing stigma related to sexuality, race, and healthcare discrimination while providing tailored mental health support. This research aims to examine the influence of stigma types on HIV transmission risk, prevention, and treatment outcomes among MSM living with HIV in Canada through a scoping review of health-related literature. The hypothesis posits that various stigma types differentially impact these health outcomes. Eligible studies include original, peer-reviewed articles conducted in Canada, involving MSM and exploring stigma types related to HIV outcomes, published in English, and using quantitative, qualitative, or mixed methods. Searches will be conducted across PubMed, CINAHL, PsychInfo, Scopus, and Web of Science using tailored keywords. Articles will be systematically screened, with a PRISMA flowchart illustrating selection. Data will be synthesized to identify patterns and relationships across stigma types and health outcomes. Findings will inform targeted interventions and policies, addressing stigma’s impact on HIV transmission and health among MSM. Knowledge mobilization strategies, including stakeholder engagement and policy recommendations, will ensure the research benefits communities, healthcare providers, and policymakers, advancing health equity for MSM in Canada.
Background: Communicative participation (CP), defined as ""taking part in situations where knowledge, ideas, or feelings are exchanged,"" is critical to understanding the impact of communication disorders. Despite increasing recognition of CP within the International Classification of Functioning, Disability, and Health (ICF), limited research explores CP in individuals with velopharyngeal insufficiency (VPI) resulting from cleft palate. VPI impairs nasal closure during speech, leading to hypernasality and unclear speech, which can profoundly affect daily communication tasks. Existing literature primarily focuses on speech outcomes without addressing their impact on CP. This scoping review aims to examine how speech outcomes in adults with VPI are measured and whether these assessments consider CP. Objectives: To review how speech outcomes in adults with VPI are measured, identify addressed ICF domains, and establish a literature base for understanding CP in adults with VPI. Methods: This scoping review will follow the Levac and Arksey & O’Malley frameworks, using a systematic search strategy developed with a research librarian. It will include peer-reviewed studies published in English involving adults (≥18 years) with VPI or cleft palate and those reporting speech outcomes. Two independent reviewers will screen studies, extract data on outcome measures, and identify themes related to CP. The data will be synthesized and mapped to ICF domains. Consideration of sex and gender will ensure inclusivity across diverse populations. Significance: Findings will highlight research gaps, informing future studies on CP in VPI and advancing knowledge of psychosocial outcomes. Results will be disseminated via presentations and publications.
Background: Spending time in and connecting with nature has been shown to have positive benefits across multiple health outcomes, including for children and youth. Nature prescriptions (Nature Rx) may support sustained well-being among adolescents and involve recommendations from health care providers (HCPs) and social workers to spend more time in nature. Nature Rx are increasingly implemented in Canada, including at the Children’s Hospital, London Health Sciences Centre (CH-LHSC) in London, Ontario. However, there is a lack of resources to support effective implementation of Nature Rx for adolescent health and well-being. Purpose: To co-design and test a Nature Rx toolkit and education module for health and social providers at the CH-LHSC. Methods: This is a two-phase qualitative study. Phase One will be co-designing a Nature Rx, including a Nature Rx script and template, population-specific case studies, and an online education module. Participants will engage in five online co-design consultations with a stakeholder design committee, comprised of five mental health providers, five social workers, and three Youth Advisory Board members from CH-LHSC. Phase Two will be a 6-week implementation of the toolkit for health and social providers at five paediatric clinics. Health and social providers will participate in in-depth, semi-structured interviews or focus groups to explore their experiences and perspectives of the toolkit as a resource and the feasibility of the toolkit in practice. Expected Outcomes: The toolkit has the potential to be implemented as a long-term resource in practice to support nature prescribing for adolescent health and well-being.
Background: Most care for persons living with dementia is provided by family caregivers (FCs), who often feel unprepared to address the symptoms of dementia and experience psychological, social, and physical health challenges. These challenges frequently go unrecognized by healthcare professionals, and this population displays more unmet needs and lower service use than other caregivers. Caregiver identity theory posits that the caregiver career is dynamic, differs by cultural experiences, and is classified by transitory phases. Interventions that aim to support FC needs sometimes produce trivial outcomes due to providing a standardized approach for all FCs or neglecting to consider and support the current caregiver phase. Objectives: I will review tailored interprofessional interventions for FCs to assess: 1) whether FC’s needs are met; 2) which elements can be personalized to FC’s unique needs and how; and 3) examine the outcomes of tailored interventions for FCs. Proposed Methods: Six databases (CINAHL, PsycInfo, SCOPUS, Medline, Embase, Cochrane Library) were searched. The Joanna Briggs Institute methodology for scoping reviews will be followed. Future Applications/Directions: Scoping review results will reveal the outcomes of providing interventions developed for a specific phase of the FC career. Review findings will evidence the outcomes of including tailored elements within interventions and will help address the heightened rate of unmet needs for FCs."
Background: Post-COVID condition (PCC) is defined as COVID-19 for symptoms at least 12 weeks following the acute infection. The most prevalent symptom is fatigue, affecting 72% of Canadians with PCC. This fatigue can have a significant impact on affected individuals’ quality of life and ability to work, yet a comprehensive treatment has not yet been established. A clinical team at Parkwood Institute have developed a rehabilitation program called COVIDEx, and the aim of this study is to evaluate the effectiveness of COVIDEx in reducing PCC-related fatigue. Methods: Adults with PCC-related fatigue will be recruited from the Post-Acute COVID-19 outpatient program at Parkwood Institute. Participants will be randomized to participate in the COVIDEx program or usual care twice per week for eight weeks. Fatigue will be evaluated using transcranial magnetic stimulation (TMS) and qualitative interviews. At baseline, and each follow-up sessions throughout the program, participants will receive single-pulse TMS to their primary motor cortex following a fatiguing exercise. The TMS elicits motor-evoked potentials (MEPs). MEP amplitudes decrease with increased fatigue. Individuals will also participate in qualitative interviews to gauge their opinions of the intervention, recovery goals, and perceptions of how their symptoms are changing over time. Anticipated Results: We hypothesize that completion of the COVIDEx program will result decreased fatigue, observed quantitatively as an increase in MEP amplitudes at each follow-up session. Additionally, we anticipate that the interviews will provide us with insight regarding intervention acceptability, barriers/facilitators to study completion, and patient perceptions of changes in symptoms throughout the course of the program.
Background: Graduate students face high stress levels due to factors including criticism-related pressures, social isolation, financial precarity, and the continuing toll of COVID-19. PhD student satisfaction has also steadily declined over the past seven years. These ongoing and escalating concerns highlight the need for an updated synthesis of relevant stress-management interventions for graduate students. Objective: The purpose of this systematic review was to provide a synthesis of stress reduction interventions available to graduate students since Stillwell and colleagues’ 2017 review. Participants: Graduate students in North America. Methods: Eligible studies: (1) were peer-reviewed and published between 2016–2024; (2) involved master’s, doctoral, professional, or post-graduate students; (3) assessed interventions to reduce stress; (4) gauged participants’ perceived stress levels pre- and post-intervention; and (5) were conducted in North America. JBI critical appraisal tools were used to assess risk of bias among included studies. Results: Thirty studies (representing 2,024 students) were included and the majority utilized individual-level interventions. Mindfulness was the most frequently offered intervention component (n = 13), although a wide range of intervention components, and often multiple components, were offered including behavioural change strategies and yoga. Twelve studies demonstrated significant reductions in perceived stress, six of which offered virtual interventions and four were embedded into the course curriculum. Implications: The findings suggest that mindfulness-based interventions, virtual stress reduction interventions, as well as those embedded within academic courses can positively impact perceived stress among graduate students. However, further research is needed to identify the most effective approaches.
Background: The rising prevalence of total hip arthroplasty (THA) underscores the need to improve outcomes and address co-occurring low back pain (LBP). While patient-reported outcome measures (PROMs) are standard, their limitations highlight the need for outcomes to evaluate change. Physical measures of spinopelvic alignment and physical functioning may add valuable insights. This study examined the association of these measures with PROMs after THA and their interplay in the presence of LBP. Methods: A systematic review (PROSPERO: CRD42023412744), examined cross-sectional and longitudinal studies from electronic databases, grey literature, and key journals up to 31/5/2024. Two reviewers independently evaluated eligibility, extracted data, and assessed risk-of-bias (RoB) using the NIH tool. Owing to heterogeneity, a narrative synthesis was conducted using GRADE to determine overall quality. Results: 51 studies (53 articles) were included: 8 low, 23 moderate, and 20 high RoB. Current evidence, although of very low-quality, suggests no cross-sectional association between walking speed and function short term after surgery and between light-intensity physical activity and patient-reported physical activity medium term. Similarly, evidence suggests no longitudinal association between change in Timed-Up-and-Go with change in pain and function, and change in Stair-Climb-Test (SCT) with change in pain and function in the short-term, and between change in SCT with change in function medium-term. Other findings were inconsistent. Four LBP studies were heterogeneous and it was not possible to synthesize findings. Conclusion: Findings support no association or inconsistent findings between physical measures with PROMs, with limited studies investigating LBP. An adequately powered low-RoB study is required.
Introduction: Multiple psychological factors have been proposed to influence pain and disability in musculoskeletal disorders. The overall objective of this paper was to better understand the relative importance of positive and negative psychological factors as determinants of pain and function/disability, reported by patients presenting for care of upper extremity musculoskeletal problems. Methods: This was a single-center retrospective cohort design of The Hand and Upper Limb Centre (HULC), that provide specialty care to patients with a variety of upper limb extremity disorders. The core outcomes of interest extracted include patient demographics, pain (1 of 3 joint specific PROM) and function/disability (SANE for all patients and 1 of 3 joint specific PROM). All outcome measures were expressed on a common metric of 0-100%. A Pearson correlation analysis and a standard and backwards multivariate linear regression analysis was conducted on SPSS. Results: The association between individual psychological factors and pain was low to moderate (0.07-0.54), and negligible to low with the SANE (-0.04 to -0.28), and a joint specific disability PROM (0.03-0.43) for overall patients.Baseline Prognostic Negative Sub-scale scores and Baseline Prognostic Positive Sub-scale scores were significantly correlated to Upper Extremity Pain, the SANE, and Upper Extremity Disability. Our linear regression highlighted that sex (R2 = 0.26) had the largest effect on Upper Extremity Pain, while age had the largest effect on Upper Extremity Function (R2 = 0.21). Discussion/Conclusions: Patients Negative and Positive Prognostic Sub-scale scores are associated with Upper Extremity Pain, the SANE, and Upper Extremity Disability scales.
Background: Reproductive coercion and abuse (RCA) is a form of intimate partner violence (IPV) in which one partner threatens the reproductive autonomy of the person with the capacity to be pregnant. 44% of Canadian women who have been in an intimate relationship during their lifetime reported experiencing violence. Women experiencing RCA report having decreased body autonomy. Exposure to RCA is associated with frequent emergency contraception use. Hypothesis/Objectives: This study aims to explore how women experiencing IPV describe their body autonomy from their sexual encounter through the process of obtaining emergency contraception and to understand the strategies used to prevent unwanted pregnancies. It is hypothesized that there is a diminished sense of body autonomy during a sexual experience involving RCA with a renewed sense of body autonomy upon accessing emergency contraception, and that women will describe attempts to prevent their partner from discovering their emergency contraception use. Proposed Methods: This interpretive description study will purposively sample 10 to 20 women with histories of violence from across Canada. Women will be invited to participate through social media advertisements and a pre-established contact list with women’s shelters across Canada. One-hour semi-structured interviews will explore participant’s experience of autonomy over their body from sexual interactions involving RCA to using emergency contraception, and participant’s decision-making and strategies used when obtaining emergency contraception. Future Applications/Directions: This study will contribute to the growing research on women’s health, addressing key gaps in the literature and promoting health and well-being. Findings will be disseminated to identified stakeholders and publications.
Background. In the literature, parents of disabled children are represented as having poorer mental and physical health outcomes due to caregiving1; likewise, disabled children are conceptualized as being burdens on their families. Caregivers in collectivist cultures feel satisfaction from providing care and assign positive value to the duty of caregiving for their disabled children. A vast amount of literature has examined the experiences of caregivers of disabled children, yet almost no research has examined the occupation of caregiving for disabled children among families from collectivist cultures. Study objective. To examine perspectives and experiences of the occupation of caregiving for disabled children among families from collectivist cultures living in the 深夜福利站 diaspora (specifically in a Canadian context). Study design & theoretical framework. This study will be conducted from a critical social science perspective which involves questioning taken-for-granted assumptions under the context of power and social structures Methods. Families from collectivist cultures with a disabled child, from London, Ontario, will be recruited for this study. Family members that identify as caregivers for the child will be interviewed using semi-structured, open-ended questions that will be asked to participants in units. Interviewing participants together can allow participants to co-construct knowledge. Significance. Study results will produce foundational knowledge regarding how families in collectivist cultures value and enact the occupation of caregiving for disabled children. Study results can inform the design and delivery of family support and respite programs in ways that are more responsive to the needs and preferences of families from collectivist cultures.
Background: Active play is critical for young children’s physical, cognitive, social, and emotional development, yet many early childhood educators (ECEs) lack the training needed to support active play effectively. ECEs shape children’s opportunities through role modeling and programming, but insufficient knowledge and confidence limit their ability to create meaningful active play experiences. Hypotheses/Objectives: This study hypothesizes that a co-created professional development intervention will enhance ECEs’ knowledge and self-efficacy related to active play. Secondary objectives include assessing whether the intervention increases active play programming in childcare centres and enhances ECEs’ job satisfaction. Methods: Using a quasi-experimental pre-post design with a waitlist control, 200 childcare centres across Canada will participate in the intervention, which includes a learning module and a community of practice. Data collection involves online surveys at baseline, post-intervention, and 3- and 6-month follow-ups, as well as semi-structured interviews at 6 months. Outcomes will be measured using validated tools to assess knowledge, self-efficacy, and behavioural intentions, along with weekly programming reports and a job satisfaction survey. Quantitative analyses will include linear mixed models and multivariate regression, while qualitative analyses will use thematic and manifest content analysis. Preliminary Results: Data collection is ongoing, with preliminary results expected to demonstrate increased ECE knowledge and self-efficacy, leading to enhanced active play programming. Future Directions/Implications: Findings will inform broader implementation of the intervention, updates to ECE college curricula, and professional development opportunities, ultimately supporting children’s holistic development through active play.
Background: Hearing loss is highly prevalent among older adults and is associated with social isolation, dementia, and mental health concerns. Early intervention is essential to optimize health outcomes and health system efficiency. However, access to audiologists through the current primary healthcare system in Canada is limited, requiring patients to seek out private care options or rely on a referral to otolaryngology to access publicly funded audiology care. In Ontario, the current wait time for an ENT consult is 18 weeks. Alternative models, such as direct-to-audiology and triage-to-audiology care show promising potential in improving access to hearing care and reducing physician workload. Objectives: This study aims to compare the standard care model to direct-to-audiology and triage-to-audiology care models using simulation methods to identify an optimal pathway for hearing care for older adults in Ontario. Methods: Using administrative health data, current workforce, and wait time data, discrete event simulation models will be used to simulate and compare the three models. Discrete event simulation allows for the utilization of a process flowchart that outlines the pathway of patients through the healthcare system. Caseloads related to audiology will be shifted to the audiologist from the ENT physician and family physician for the respective models in order to identify how wait times and patient outcomes are impacted.Future applications/directions: Findings will inform the development of evidence-based policies and future clinical implementation of optimized hearing care models in Ontario.
