THE IMPACT OF TRANSFER SETUP ON THE PERFORMANCE OF INDEPENDENT TRANSFERS

For individuals who rely on wheeled mobility devices (WMD), performing transfers is essential to independence with activities of daily living at home and participation in the community. Transfers are required for getting to and from the device to bed, bath tub, car seat, among others. The United States Access Board develops guidelines and maintains design criteria for the built environment to maximize accessibility to public places. The objective of this study was to analyze the impact of transfer setup on performance of independent transfers. The first aim of the study was to perform an expert review of the current knowledge regarding transfers and the impact of setup. Results showed a consensus among studies that transferring to a higher surface implies greater exertion of the upper limb. Yet, there is no evidence concerning height differences, horizontal distance, and space needed next to the target surface so it can be accessible by a majority of WMD users. The second aim was to compare the current guidelines for amusement park rides with the results obtained by evaluating the impact of setup on transfer performance using a custom-built transfer station. We evaluated community-dwelling WMD users who were able to transfer independently and who represented a broad spectrum of disabilities. We evaluated the impact of height differential, gap, placement of a non removable armrest, and the effect of a grab bar. Results showed that height differentials above and below WMD height, gaps and obstacles pose serious transfer-related accessibility problems for WMD users. Current guidelines for amusement park rides fall short in terms of height recommendations and space available for the WMD and could exclude up to 72% of our sample. The third aim was to evaluate the relationship between functional performance (i.e. upper limb strength and trunk control) and transfer ability in people with spinal cord injury. Results found that trunk stability and gender are significant predictors of transfer ability. Rehabilitation plans should include balance training and core strengthening in addition to upper limb conditioning when teaching transfer skills. Improving transfer ability has the potential to increase community participation and independence among WMD users

DEVELOPMENT, IMPLEMENTATION, AND DISSEMINATION OF A WHEELCHAIR MAINTENANCE TRAINING PROGRAM

Wheelchair breakdowns are one cause of users being injured or stranded, and the incidence of these breakdowns is increasing. Evidence suggests that wheelchair users who routinely maintain their wheelchairs are less likely to be injured. Unfortunately, no structured program exists to promote maintenance, and thus the goal of this dissertation was to develop and evaluate a wheelchair maintenance training program (WMTP). In the US, 62% (n=616) of wheelchair users with spinal cord injury reported needing ≥1 repairs within a six month period, 27.4% experience an adverse consequence, 7.1% did not complete the repairs, and most repairs were completed by a vendor for power wheelchairs and by users themselves for manual wheelchairs. In Indonesia, at a 6-month follow up after receiving a new wheelchair, 34% of participants (n=142) self-reported needing ≥1 repairs. The majority (70%) reported not completing the repairs; also most of the repairs that were completed were done by the user/caregiver. Suggesting that regardless of context/population it is common that repairs are not completed, potentially due to lack of wheelchair maintenance training. The WMTP was designed to educate clinicians to train wheelchair users to perform maintenance. The Wheelchair Maintenance Training Questionnaire (WMT-Q) was developed to assess the impact of the WMTP and reached acceptable test-retest reliability for clinicians (ICC(3,1)>0.498), manual (ICC(3,1)>0.578), and power wheelchair users (ICC(3,1)>0.506). The Wheelchair Maintenance Assessment Tool (W-MAT) was developed to objectively assess maintenance state and reached an intra and interrater reliability for the manual and power W-MATs were ICC(3,1)<0.89 and ICC(2,1)<0.96 and ICC(3,1)< 0.95 and ICC(2,1)<0.93 respectively. Fifteen clinicians received WMTP training resulting in a significant increase in WMT-Q. Preliminary results of power wheelchair users (n=24) randomly assigned to a waitlist control and a training group suggest that the WMTP increased maintenance knowledge and performance. Last, the manual wheelchair content of the WMTP, W-MAT, and WMT-Q were translated to Spanish and the clinicians training adapted online. Forty professionals in Mexico participated and positively evaluated the program. Main contributions of this work include the WMTP, W-MATs, and WMT-Qs, their Spanish translation, and the further understanding on wheelchair repairs

Measuring met and unmet assistive technology needs at the national level: Comparing national database collection tools across eight case countries

The development and implementation of assistive technology policy that meets the needs of citizens is dependent on accurate data collection and reporting of assistive technology use and unmet needs on a national level. This study reviews the methodology from instruments intended to capture national statistics on assistive technology use across eight case countries from varying regions and income levels. Recommendations are provided, which highlight the need for mandatory, census level data collection according to international standards for data collection in the areas of disability and assistive technology

Comparison of seven prognostic tools to identify low-risk pulmonary embolism in patients aged <50 years

publishersversionPeer reviewe

Rates and Predictors of Treatment Failure in Staphylococcus aureus Prosthetic Joint Infections According to Different Management Strategies: A Multinational Cohort Study—The ARTHR-IS Study Group

Introduction: Guidelines have improved the management of prosthetic joint infections (PJI). However, it is necessary to reassess the incidence and risk factors for treatment failure (TF) of Staphylococcus aureus PJI (SA-PJI) including functional loss, which has so far been neglected as an outcome. Methods: A retrospective cohort study of SA-PJI was performed in 19 European hospitals between 2014 and 2016. The outcome variable was TF, including related mortality, clinical failure and functional loss both after the initial surgical procedure and after all procedures at 18 months. Predictors of TF were identified by logistic regression. Landmark analysis was used to avoid immortal time bias with rifampicin when debridement, antibiotics and implant retention (DAIR) was performed. Results: One hundred twenty cases of SA-PJI were included. TF rates after the first and all surgical procedures performed were 32.8% and 24.2%, respectively. After all procedures, functional loss was 6.0% for DAIR and 17.2% for prosthesis removal. Variables independently associated with TF for the first procedure were Charlson >= 2, haemoglobin 30 kg/m(2) and delay of DAIR, while rifampicin use was protective. For all procedures, the variables associated with TF were haemoglobin < 10 g/dL, hip fracture and additional joint surgery not related to persistent infection. Conclusions: TF remains common in SA-PJI. Functional loss accounted for a substantial proportion of treatment failures, particularly after prosthesis removal. Use of rifampicin after DAIR was associated with a protective effect. Among the risk factors identified, anaemia and obesity have not frequently been reported in previous studies. [GRAPHICS]

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Assistive Technology Use and Provision During COVID-19: Results From a Rapid Global Survey

Background: The coronavirus disease 2019 (COVID-19) pandemic has impacted all segments of society, but it has posed particular challenges for the inclusion of persons with disabilities, those with chronic illness and older people regarding their participation in daily life. These groups often benefit from assistive technology (AT) and so it is important to understand how use of AT may be affected by or may help to mitigate the impacts of COVID-19. Objective: The objectives of this study were to explore the how AT use and provision have been affected during the initial stages of the COVID-19 pandemic, and how AT policies and systems may be made more resilient based on lessons learned during this global crisis. Methods: This study was a rapid, international online qualitative survey in the 6 United Nations (UN) languages (English, French, Spanish, Russian, Arabic, Mandarin Chinese) facilitated by extant World Health Organization (WHO) and International Disability Alliance networks. Themes and subthems of the qualitative responses were identified using Braun and Clarke’s 6-phase analysis. Results: Four primary themes were identified in in the data: Disruption of Services, Insufficient Emergency Preparedness, Limitations in Existing Technology, and Inadequate Policies and Systems. Subthemes were identified within each theme, including subthemes related to developing resilience in AT systems, based on learning from the pandemic. Conclusion: COVID-19 has disrupted the delivery of AT services, primarily due to infection control measures resulting in lack of provider availability and diminished one-to-one services. This study identified a need for stronger user-centred development of funding policies and infrastructures that are more sustainable and resilient, best practices for remote service delivery, robust and accessible tools and systems, and increased capacity of clients, caregivers, and clinicians to respond to pandemic and other crisis situations

Assistive Technology Use and Provision During COVID-19:Results From a Rapid Global Survey

Background: The coronavirus disease 2019 (COVID-19) pandemic has impacted all segments of society, but it has posed particular challenges for the inclusion of persons with disabilities, those with chronic illness and older people regarding their participation in daily life. These groups often benefit from assistive technology (AT) and so it is important to understand how use of AT may be affected by or may help to mitigate the impacts of COVID-19. Objective: The objectives of this study were to explore the how AT use and provision have been affected during the initial stages of the COVID-19 pandemic, and how AT policies and systems may be made more resilient based on lessons learned during this global crisis. Methods: This study was a rapid, international online qualitative survey in the 6 United Nations (UN) languages (English, French, Spanish, Russian, Arabic, Mandarin Chinese) facilitated by extant World Health Organization (WHO) and International Disability Alliance networks. Themes and subthemes of the qualitative responses were identified using Braun and Clarke’s 6-phase analysis. Results: Four primary themes were identified in in the data: Disruption of Services, Insufficient Emergency Preparedness, Limitations in Existing Technology, and Inadequate Policies and Systems. Subthemes were identified within each theme, including subthemes related to developing resilience in AT systems, based on learning from the pandemic. Conclusion: COVID-19 has disrupted the delivery of AT services, primarily due to infection control measures resulting in lack of provider availability and diminished one-to-one services. This study identified a need for stronger user-centred development of funding policies and infrastructures that are more sustainable and resilient, best practices for remote service delivery, robust and accessible tools and systems, and increased capacity of clients, caregivers, and clinicians to respond to pandemic and other crisis situations