Can we quickly and thoroughly assess pain with the PACSLAC-II? : a convergent validity study in long-term care residents suffering from dementia.

Abstract : A previous study found that the modified version of the Pain Assessment Checklist for Seniors with Limited Ability to Communicate (PACSLAC-II) is a valid tool to assess pain in elderly individuals suffering from dementia and who are unable to communicate verbally. The primary objective of this study was to confirm the convergent validity of the PACSLAC-II using direct evaluation of long-term care residents in real-life situations, using two other well-validated pain assessment scales (i.e., PACSLAC and Pain Assessment in Advanced Dementia [PAINAD]). A secondary objective was to document and compare the time required to complete and score each assessment scale. During two potentially painful procedures (i.e., transfer/mobilization), 46 long-term care residents (mean age = 83 ± 10 years) suffering from dementia were observed by three independent evaluators, each using one of the assessment scales (randomly assigned). Correlational analyses and analysis of variance were used to evaluate the association between each scale and to compare scoring time. The PACSLAC (r = 0.61) and the PAINAD (r = 0.65) were both moderately associated with the PACSLAC-II (all p values < .001). The PAINAD's average scoring time (63 ± 19 seconds) was lower than the PACSLAC-II's (96 ± 2 seconds), which was lower than the PACSLAC's (135 ± 53 seconds) (all p values < .001). These results suggest that the PACSLAC-II is a valid tool for assessing pain in individuals with dementia. The time required to complete and score the PACSLAC-II was reasonable, supporting its usefulness in clinical settings

Study of the knowledge translation process of Algo in homecare services in Quebec

Disponible depuis 2013, l’Algo (pour algorithme clinique) est un outil d’aide à la décision destiné aux membres des équipes interprofessionnelles des services de soutien à domicile (SSAD) ayant recours au chevauchement des compétences afin d’encadrer la sélection d’aides techniques aux soins d’hygiène corporelle pour les personnes ayant des incapacités physiques vivant à domicile. Cette thèse a pour objectif d’étudier le processus d’application des connaissances de cet algorithme décisionnel développé, puis déployé, au sein d’une approche d’application des connaissances intégrée, dans les SSAD des Centres intégrés [universitaires] de santé et de services sociaux du Québec. Cette thèse vise spécifiquement à 1) identifier le niveau d’utilisation de l’Algo dans les SSAD québécois; 2) identifier et décrire les caractéristiques relatives au processus d’application des connaissances de l’Algo et 3) dégager les orientations de facilitation à favoriser pour la suite de son intégration. Le niveau d’utilisation (variable dépendante) fut opérationnalisé avec les stades de Knott et Wildavsky et les caractéristiques liées à son utilisation (variables indépendantes), à l’aide du modèle opérationnel integrated-Promoting Action on Research Implementation in Health Services. Une étude transversale corrélationnelle (n=125; obj. 1 et 2) et une étude de cas multiples (cas : SSAD composé minimalement d’un(e) ergothérapeute, d’un(e) gestionnaire et d’un(e) intervenant(e) non-ergothérapeute; n=5; obj. 2 et 3), menées respectivement avec un devis mixte concomitant niché, ont permis de documenter les caractéristiques de la connaissance, des destinataires et du contexte. Près de la moitié des ergothérapeutes sondés (48%) ont atteint l’un des sept stades d’utilisation de l’Algo en 2015. Bien que les caractéristiques de l’outil (ex. approche intégrée, clarté, convivialité) constituent des facilitateurs à l’initiation de son utilisation (stades 1 à 3), les défis rencontrés par les intervenants dans les SSAD, en termes de collaboration, de ressources, de réceptivité, de pouvoir et de mécanismes d’intégration d’un changement, nuisent au déploiement d’efforts et à son implantation (stades 4 à 7). Pour la suite du processus d’application des connaissances de l’Algo, sa valeur ajoutée devra être clarifiée pour chaque groupe d’intervenants impliqués. L’augmentation du soutien initial auprès des utilisateurs de l’outil et de l’implication des ergothérapeutes dans la sélection des mécanismes d’intégration du changement seront souhaitables afin de pérenniser son implantation. Enfin, la sensibilisation des décideurs au besoin de revoir le mode d’évaluation de la performance sera nécessaire afin de soutenir le chevauchement des compétences dans les équipes interprofessionnelles des SSAD du Québec.Abstract: Algo (for clinical algorithm) is a decision-making tool, available since 2013, for members of interdisciplinary homecare service teams using skill mix to guide the selection of bathing equipment for people with physical disabilities living at home. This thesis is an in-depth study of the application process of this algorithm developed, and deployed, within an integrated knowledge translation approach, in homecare services within the Centres intégrés [universitaires] de santé et de services sociaux in Quebec. More specifically, this thesis aims to 1) identify the level of utilization of Algo in homecare services in Quebec; 2) identify and describe the characteristics related to the knowledge translation process of Algo; and 3) pinpoint facilitation orientations to favor further integration. The level of utilization (dependent variable) was operationalized with Knott and Wildavsky's stages and the characteristics related to its use (independent variables), using the integrated-Promoting Action on Research Implementation in Health Services operational model. A cross-sectional correlational study (n=125, obj. 1-2) and a multiple case study (case: an occupational therapy department of a homecare service comprised of a least an occupational therapist, a manager and a non-occupational therapist) with a concomitant nested mixed design (n=5, obj. 2-3) documented the characteristics of innovation, recipients and context. Nearly half the occupational therapists surveyed (48%) achieved one of the seven stages of utilization of Algo in 2015. Although the characteristics of the tool (e.g., integrated approach, clarity, conviviality) are facilitators at the initiation of its use (stages 1 to 3), the challenges faced by homecare services’ stakeholders in terms of collaboration, resources, responsiveness, power and mechanisms to integrate change impede the deployment of efforts and its implementation (stages 4 to 7). For the continuation of the integrated knowledge translation process of Algo, its added value should be clarified for each stakeholder group involved. Initial support for users and the involvement of occupational therapists in the selection of mechanisms to integrate change should be increased to perpetuate its implementation. Decision-makers will have to be sensitized to the need for a revised performance evaluation model to support skill mix in the interdisciplinary teams of homecare services

La bioéthique selon Van Rensselaer Potter : une perspective pertinente à la réflexion ergothérapique contemporaine

This commentary presents three arguments of Potterian thought from an occupational therapy perspective in order to support reflections on the development of sustainable practices in occupational therapy. In this way, it introduces occupational therapists to a global bioethical perspective that can support them in implementing an ecosystemic approach that respects the environment.Ce commentaire présente trois arguments de la pensée potterienne à partir de la lunette ergothérapique afin de soutenir les réflexions relatives au développement des pratiques durables en ergothérapie. Il permet ainsi d’initier les ergothérapeutes à une perspective de bioéthique globale susceptible de les soutenir dans l’actualisation d’une approche écosystémique respectueuse de l’environnement

Deimplementing Untested Practices in Homecare Services: A Preobservational-Postobservational Design

Introduction. With community-dwelling elders waiting to adapt their bathroom, Health and Social Services Centers in Quebec (Canada) combined human resources through cross-skilling within interdisciplinary teams. To this end, occupational therapists implemented in-house “tools” to support nonoccupational therapists in selecting bathing equipment. However, unknown psychometric properties of those in-house “tools” cast doubt on the quality of service provided to elders. Little is also known about the best processes to use to support the deimplementation of such nonevidence-based practices. This study presents the effect of a knowledge transfer and exchange intervention designed to deimplement in-house “tools” and replace them with an evidence-based tool (Algo). Methods. Censuses were conducted with the 94 Health and Social Services Centers of Quebec providing homecare services, before and after the knowledge transfer and exchange intervention (2009-2013). In 2013, the deimplementation of in-house “tools” and their replacement by Algo were measured with Knott and Wildavsky’s levels of utilization. Results. Cross-skilling within interdisciplinary teams increased between censuses (87% to 98%), as did use of in-house “tools” (67% to 81%). Algo’s uptake started during the knowledge transfer and exchange process as 25 Health and Social Services Centers achieved the first level of utilization. Nonetheless, no Health and Social Services Center deimplemented the in-house “tools” to use Algo. Conclusion. The knowledge transfer and exchange process led to the development of a scientifically sound clinical tool (Algo) and challenged the status quo in clinical settings regarding the use of nonevidence-based practices. However, the deimplementation of in-use practices has not yet been observed. This study highlights the need to act proactively on the deimplementation and implementation processes