Publications by authors named "Marie-France Dubois"

75 Publications

Correction to: CONECT-6: a case-finding tool to identify patients with complex health needs.

BMC Health Serv Res 2021 Apr 9;21(1):321. Epub 2021 Apr 9.

Department of Family Medicine and Emergency Medicine, University of Sherbrooke, 3001 12e Avenue N, Sherbrooke, QC, J1H 5H3, Canada.

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http://dx.doi.org/10.1186/s12913-021-06216-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8034114PMC
April 2021

CONECT-6: a case-finding tool to identify patients with complex health needs.

BMC Health Serv Res 2021 Feb 17;21(1):157. Epub 2021 Feb 17.

Department of Family Medicine and Emergency Medicine, University of Sherbrooke, 3001 12e Avenue N, Sherbrooke, QC, J1H 5H3, Canada.

Background: Early identification of patients with chronic conditions and complex health needs in emergency departments (ED) would enable the provision of services better suited to their needs, such as case management. A case-finding tool would ultimately support ED teams to this end and could reduce the cost of services due to avoidable ED visits and hospitalizations. The aim of this study was to develop and validate a short self-administered case-finding tool in EDs to identify patients with chronic conditions and complex health needs in an adult population.

Methods: This prospective development and initial validation study of a case-finding tool was conducted in four EDs in the province of Quebec (Canada). Adult patients with chronic conditions were approached at their third or more visit to the ED within 12 months to complete a self-administered questionnaire, which included socio-demographics, a comorbidity index, the reference standard INTERMED self-assessment, and 12 questions to develop the case-finding tool. Significant variables in bivariate analysis were included in a multivariate logistic regression analysis and a backward elimination procedure was applied. A receiver operating characteristic (ROC) curve was developed to identify the most appropriate threshold score to identify patients with complex health needs.

Results: Two hundred ninety patients participated in the study. The multivariate analysis yielded a six-question tool, COmplex NEeds Case-finding Tool - 6 (CONECT-6), which evaluates the following variables: low perceived health; limitations due to pain; unmet needs; high self-perceived complexity; low income; and poor social support. With a threshold of two or more positive answers, the sensitivity was 90% and specificity 66%. The positive and negative predictive values were 49 and 75% respectively.

Conclusions: The case-finding process is the essential characteristic of case management effectiveness. This study presents the first case-finding tool to identify adult patients with chronic conditions and complex health needs in ED.
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http://dx.doi.org/10.1186/s12913-021-06154-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7891167PMC
February 2021

Multimodal physical therapy versus topical lidocaine for provoked vestibulodynia: a multicenter, randomized trial.

Am J Obstet Gynecol 2021 02 18;224(2):189.e1-189.e12. Epub 2020 Aug 18.

Department of Community Health Sciences, Faculty of Medicine and Health Sciences, Université de Sherbrooke and Research Center on Aging, Sherbrooke, QC, Canada.

Background: Provoked vestibulodynia is the most common subtype of chronic vulvar pain. This highly prevalent and debilitating condition is characterized by acute recurrent pain located at the entry of the vagina in response to pressure application or attempted vaginal penetration. Although physical therapy is advocated as a first-line treatment for provoked vestibulodynia, evidence supporting its efficacy is scarce.

Objective: The purpose of this study was to establish the efficacy of multimodal physical therapy compared with topical lidocaine, a frequently used first-line treatment.

Study Design: We conducted a multicenter, parallel-group, randomized clinical trial in women diagnosed as having provoked vestibulodynia recruited from the community and 4 Canadian university hospitals. Women were randomly assigned (1:1) to receive either weekly sessions of physical therapy or overnight topical lidocaine (5% ointment) for 10 weeks. Randomization was stratified by center using random permuted blocks from a computer-generated list managed by an independent individual. Physical therapy entailed education, pelvic floor muscle exercises with biofeedback, manual therapy, and dilation. Assessments were conducted at baseline, posttreatment, and 6-month follow-up. Outcome assessors, investigators, and data analysts were masked to allocation. The primary outcome was pain intensity during intercourse evaluated with the numeric rating scale (0-10). Secondary outcomes included pain quality (McGill-Melzack Pain Questionnaire), sexual function (Female Sexual Function Index), sexual distress (Female Sexual Distress Scale), satisfaction (numeric rating scale of 0-10), and participants' impression of change (Patient Global Impression of Change). Intention-to-treat analyses were conducted using piecewise linear-growth models.

Results: Among 212 women who were recruited and randomized, 201 (95%) completed the posttreatment assessment and 195 (92%) completed the 6-month follow-up. Multimodal physical therapy was more effective than lidocaine for reducing pain intensity during intercourse (between-group pre-post slope difference, P<.001; mean group postdifference, 1.8; 95% confidence interval, 1.2-2.3), and results were maintained at 6-month follow-up (mean group difference, 1.8; 95% confidence interval, 1.2-2.5). The physical therapy group also performed better than the lidocaine group in all secondary outcomes (pain quality, sexual function, sexual distress, satisfaction, and participants' impression of change) at posttreatment and 6-month follow-up. Moreover, the changes observed after physical therapy were shown to be clinically meaningful. Regarding participants' impression of change, 79% of women in the physical therapy group reported being very much or much improved compared with 39% in the lidocaine group (P<.001).

Conclusion: The findings provide strong evidence that physical therapy is effective for pain, sexual function, and sexual distress and support its recommendation as the first-line treatment of choice for provoked vestibulodynia.
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http://dx.doi.org/10.1016/j.ajog.2020.08.038DOI Listing
February 2021

Persistent frequent emergency department users with chronic conditions: A population-based cohort study.

PLoS One 2020 12;15(2):e0229022. Epub 2020 Feb 12.

Département de médecine de famille et de médecine d'urgence, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, Quebec, Canada.

Background: Frequent emergency department users are patients cumulating at least four visits per year. Few studies have focused on persistent frequent users, who maintain their frequent user status for multiple consecutive years. This study targets an adult population with chronic conditions, and its aims are: 1) to estimate the prevalence of persistent frequent ED use; 2) to identify factors associated with persistent frequent ED use (frequent use for three consecutive years) and compare their importance with those associated with occasional frequent ED use (frequent use during the year following the index date); and 3) to compare characteristics of "persistent frequent users" to "occasional frequent users" and to "users other than persistent frequent users".

Methods: This is a retrospective cohort study using Quebec administrative databases. All adult patients who visited the emergency department in 2012, diagnosed with chronic conditions, and living in non-remote areas were included. Patients who died in the three years following their index date were excluded. The main outcome was persistent frequent use (≥4 visits per year during three consecutive years). Potential predictors included sociodemographic characteristics, physical and mental comorbidities, and prior healthcare utilization. Odds ratios were computed using multivariable logistic regression.

Results: Out of 297,182 patients who visited ED at least once in 2012, 3,357 (1.10%) were persistent frequent users. Their main characteristics included poor socioeconomic status, mental and physical comorbidity, and substance abuse. Those characteristics were also present for occasional frequent users, although with higher percentages for the persistent user group. The number of previous visits to the emergency department was the most important factor in the regression model. The occasional frequent users' attrition rate was higher between the first and second year of follow-up than between the second and third year.

Conclusions: Persistent frequent users are a subpopulation of frequent users with whom they share characteristics, such as physical and mental comorbidities, though the former are poorer and younger. More research is needed in order to better understand what factors can contribute to persistent frequent use.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0229022PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7015381PMC
May 2020

Risk of Frequent Emergency Department Use Among an Ambulatory Care Sensitive Condition Population: A Population-based Cohort Study.

Med Care 2020 03;58(3):248-256

PRIMUS Research Group, Centre de recherche du Centre hospitalier universitaire de Sherbrooke (CRCHUS).

Background: A small fraction of patients use a disproportionately large amount of emergency department (ED) resources. Identifying these patients, especially those with ambulatory care sensitive conditions (ACSC), would allow health care professionals to enhance their outpatient care.

Objective: The objectives of the study were to determine predictive factors associated with frequent ED use in a Quebec adult population with ACSCs and to compare several models predicting the risk of becoming an ED frequent user following an ED visit.

Research Design: This was an observational population-based cohort study extracted from Quebec's administrative data.

Subjects: The cohort included 451,775 adult patients, living in nonremote areas, with an ED visit between January 2012 and December 2013 (index visit), and previously diagnosed with an ACSC but not dementia.

Measures: The outcome was frequent ED use (≥4 visits) during the year following the index visit. Predictors included sociodemographics, physical and mental comorbidities, and prior use of health services. We developed several logistic models (with different sets of predictors) on a derivation cohort (2012 cohort) and tested them on a validation cohort (2013 cohort).

Results: Frequent ED users represented 5% of the cohort and accounted for 36% of all ED visits. A simple 2-variable prediction model incorporating history of hospitalization and number of previous ED use accurately predicted future frequent ED use. The full model with all sets of predictors performed only slightly better than the simple model (area under the receiver-operating characteristic curve: 0.786 vs. 0.759, respectively; similar positive predictive value and number needed to evaluate curves).

Conclusions: The ability to identify frequent ED users based only on previous ED and hospitalization use provides an opportunity to rapidly target this population for appropriate interventions.
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http://dx.doi.org/10.1097/MLR.0000000000001270DOI Listing
March 2020

Comparing the attitudes of four groups of stakeholders from Quebec, Canada, toward extending medical aid in dying to incompetent patients with dementia.

Int J Geriatr Psychiatry 2019 07 29;34(7):1078-1086. Epub 2019 Apr 29.

VUB-UGhent End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB), Brussels, Belgium.

Objective: The Canadian province of Quebec has recently legalized medical aid in dying (MAID) for competent patients who satisfy strictly defined criteria. The province is considering extending the practice to incompetent patients. We compared the attitudes of four groups of stakeholders toward extending MAID to incompetent patients with dementia.

Methods: We conducted a province-wide postal survey in random samples of older adults, informal caregivers of persons with dementia, nurses, and physicians caring for patients with dementia. Clinical vignettes featuring a patient with Alzheimer's disease were used to measure the acceptability of extending MAID to incompetent patients with dementia. Vignettes varied according to the stage of the disease (advanced or terminal) and type of request (written or oral only). We used the generalized estimating equation (GEE) approach to compare attitudes across groups and vignettes.

Results: Response rates ranged from 25% for physicians to 69% for informal caregivers. In all four groups, the proportion of respondents who felt it was acceptable to extend MAID to an incompetent patient with dementia was highest when the patient was at the terminal stage, showed signs of distress, and had written a MAID request prior to losing capacity. In those circumstances, this proportion ranged from 71% among physicians to 91% among informal caregivers.

Conclusion: We found high support in Quebec for extending the current MAID legislation to incompetent patients with dementia who have reached the terminal stage, appear to be suffering, and had requested MAID in writing while still competent.
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http://dx.doi.org/10.1002/gps.5111DOI Listing
July 2019

Case management in primary care for frequent users of healthcare services with chronic diseases and complex care needs: an implementation and realist evaluation protocol.

BMJ Open 2018 11 25;8(11):e026433. Epub 2018 Nov 25.

Sturgeon Lake First Nation, Sturgeon Lake, Saskatchewan, Canada.

Introduction: Significant evidence in the literature supports case management (CM) as an effective intervention to improve care for patients with complex healthcare needs. However, there is still little evidence about the facilitators and barriers to CM implementation in primary care setting. The three specific objectives of this study are to: (1) identify the facilitators and barriers of CM implementation in primary care clinics across Canada; (2) explain and understand the relationships between the actors, contextual factors, mechanisms and outcomes of the CM intervention; (3) identify the next steps towards CM spread in primary care across Canada.

Methods And Analysis: We will conduct a multiple-case embedded mixed methods study. CM will be implemented in 10 primary care clinics in five Canadian provinces. Three different units of analysis will be embedded to obtain an in-depth understanding of each case: the healthcare system (macro level), the CM intervention in the clinics (meso level) and the individual/patient (micro level). For each objective, the following strategy will be performed: (1) an implementation analysis, (2) a realist evaluation and (3) consensus building among stakeholders using the Technique for Research of Information by Animation of a Group of Experts method.

Ethics And Dissemination: This study, which received ethics approval, will provide innovative knowledge about facilitators and barriers to implementation of CM in different primary care jurisdictions and will explain how and why different mechanisms operate in different contexts to generate different outcomes among frequent users. Consensual and prioritised statements about next steps for spread of CM in primary care from the perspectives of all stakeholders will be provided. Our results will offer context-sensitive explanations that can better inform local practices and policies and contribute to improve the health of patients with complex healthcare needs who frequently use healthcare services. Ultimately, this will increase the performance of healthcare systems and specifically mitigate ineffective use and costs.
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http://dx.doi.org/10.1136/bmjopen-2018-026433DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6254422PMC
November 2018

Quebec physicians' perspectives on medical aid in dying for incompetent patients with dementia.

Can J Public Health 2018 12 27;109(5-6):729-739. Epub 2018 Aug 27.

Research Centre on Aging, University Institute of Geriatrics of Sherbrooke, 1036 South Belvedere Street, Sherbrooke, QC, Canada.

Objectives: To elicit Quebec physicians' attitudes towards extending medical aid in dying (MAiD) to incompetent patients and to compare the attitudes of family physicians to those of other medical specialists.

Methods: We conducted a postal survey among physicians caring for patients with dementia. We used hypothetical vignettes to elicit their attitudes towards MAiD and continuous deep sedation (CDS) to relieve suffering at end of life. Two patients were depicted in the vignettes: one with cancer eligible for MAiD and one with dementia. The generalized estimating equation approach was used to investigate factors associated with attitudes, including the stage of the illness (advanced vs terminal dementia) and the presence or absence of a prior written request.

Results: A total of 136 physicians out of 653 returned the questionnaire. Physicians favoured CDS over MAiD for relieving suffering in the cancer vignette (93% vs 79%; p = 0.002). In advanced dementia, 45% of physicians supported giving the patient access to MAiD with a written request and 14% without such request. At the terminal stage of dementia, these proportions increased to 71% and 43%, respectively (p < 0.001), reaching 79% and 52% among family physicians. Support for CDS in terminal dementia was lower than in end-stage cancer (68% vs 93%; p < 0.001) and equal to MAiD with a written request (68% vs 71%; p = 0.623).

Conclusion: Many Quebec physicians support extending MAiD to incompetent patients with dementia to relieve suffering at the terminal stage. This finding will inform current deliberations as to whether MAiD should be extended to these patients.
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http://dx.doi.org/10.17269/s41997-018-0115-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6964547PMC
December 2018

Case Management in Primary Care for Frequent Users of Health Care Services: A Mixed Methods Study.

Ann Fam Med 2018 05;16(3):232-239

Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean, Québec, Canada.

Purpose: This study aimed to evaluate the effects of the V1SAGES case management intervention (Vulnerable Patients in Primary Care: Nurse Case Management and Self-management Support) for frequent users of health care services with chronic disease and complex care needs on psychological distress and patient activation.

Methods: We used a 2-phase sequential mixed methods design. The first phase was a pragmatic randomized controlled trial with intention-to-treat analysis that measured the effects of the intervention compared with usual care on psychological distress and patient activation before and after 6 months. The second phase had a qualitative descriptive design and entailed thematic analysis of in-depth interviews (25 patients, 6 case management nurses, 9 health managers) and focus groups (8 patients' spouses, 21 family physicians) to understand stakeholders' perceived effects of the intervention on patients.

Results: A total of 247 patients were randomized into the intervention group (n = 126) or the control group (n = 121). Compared with usual care, the intervention reduced psychological distress (odds ratio = 0.43; 95% CI, 0.19-0.95, = .04), but did not have any significant effect on patient activation ( = .43). Qualitative results suggested that patients and their spouses benefitted from the case management intervention, gaining a sense of security, and stakeholders noted better patient self-management of health.

Conclusions: Together, our study's quantitative and qualitative results suggest that case management reduces psychological distress, making patients and caregivers feel more secure, whereas impact on self-management is unclear. Case management is a promising avenue to improve outcomes among frequent users of health care with complex needs.
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http://dx.doi.org/10.1370/afm.2233DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5951252PMC
May 2018

Effect of personalised citizen assistance for social participation (APIC) on older adults' health and social participation: study protocol for a pragmatic multicentre randomised controlled trial (RCT).

BMJ Open 2018 03 31;8(3):e018676. Epub 2018 Mar 31.

Aix-Marseille University, Marseille, France.

Introduction: The challenges of global ageing and the growing burden of chronic diseases require innovative interventions acting on health determinants like social participation. Many older adults do not have equitable opportunities to achieve full social participation, and interventions might underempower their personal and environmental resources and only reach a minority. To optimise current practices, the (APIC), an intervention demonstrated as being feasible and having positive impacts, needs further evaluation.

Methods And Analysis: A pragmatic multicentre, prospective, two-armed, randomised controlled trial will evaluate: (1) the short-term and long-term effects of the APIC on older adults' health, social participation, life satisfaction and healthcare services utilisation and (2) its cost-effectiveness. A total of 376 participants restricted in at least one instrumental activity of daily living and living in three large cities in the province of Quebec, Canada, will be randomly assigned to the experimental or control group using a centralised computer-generated random number sequence procedure. The experimental group will receive weekly 3-hour personalised stimulation sessions given by a trained volunteer over the first 12 months. Sessions will encourage empowerment, gradual mobilisation of personal and environmental resources and community integration. The control group will receive the publicly funded universal healthcare services available to all Quebecers. Over 2 years (baseline and 12, 18 and 24 months later), self-administered questionnaires will assess physical and mental health (primary outcome; version 2 of the 36-item Short-Form Health Survey, converted to SF-6D utility scores for quality-adjusted life years), social participation (Social Participation Scale) and life satisfaction (Life Satisfaction Index-Z). Healthcare services utilisation will be recorded and costs of each intervention calculated.

Ethics And Dissemination: The Research Ethics Committee of the has approved the study (MP-31-2018-2424). An informed consent form will be read and signed by all study participants. Findings will be published and presented at conferences.

Trial Registration Number: NCT03161860; Pre-results.
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http://dx.doi.org/10.1136/bmjopen-2017-018676DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5884338PMC
March 2018

Are Informal Caregivers of Persons With Dementia Open to Extending Medical Aid in Dying to Incompetent Patients? Findings From a Survey Conducted in Quebec, Canada.

Alzheimer Dis Assoc Disord 2018 Jul-Sep;32(3):247-254

VUB-UGhent End-of-life Care Research Group, Vrije Universiteit Brussel (VUB), Brussels, Belgium.

Euthanasia is a controversial and complex issue, especially when involving incompetent patients. On December 10, 2015, Quebec became the first Canadian province to give access to medical aid in dying (MAiD) (ie, euthanasia performed by a physician) to competent patients who satisfy strictly defined criteria. Less than 2 years later, Quebec is considering extending MAiD to incompetent patients who made an advance request. With the objective of contributing scientific data to current societal debates, we conducted a survey among 471 informal caregivers of persons with dementia, reached through Alzheimer Societies. We used a series of vignettes featuring a person with Alzheimer disease to investigate respondents' attitudes towards MAiD. The response rate was 69%. Two-thirds [68%; 95% confidence interval, 63%-73%] found it acceptable to extend MAiD to an incompetent patient at an advanced stage of Alzheimer disease who had made a written request while competent, and 91% (95% confidence interval, 87%-94%) found it acceptable at the terminal stage. Self-determination was the most widely endorsed argument in favor of access to MAiD for incompetent patients. Findings suggest strong support among informal caregivers for extending MAiD to incompetent patients, provided they are terminally-ill and had made a written request before losing capacity.
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http://dx.doi.org/10.1097/WAD.0000000000000238DOI Listing
September 2019

Should Medical Assistance in Dying Be Extended to Incompetent Patients With Dementia? Research Protocol of a Survey Among Four Groups of Stakeholders From Quebec, Canada.

JMIR Res Protoc 2017 Nov 13;6(11):e208. Epub 2017 Nov 13.

Vrije Universiteit Brussel, UGhent End-of-Life Care Research Group, Brussels, Belgium.

Background: Alzheimer's disease and related disorders affect a growing number of people worldwide. Quality of life is generally good in the early stages of these diseases. However, many individuals fear living through the advanced stages. Such fears are triggering requests for medical assistance in dying (MAiD) by patients with dementia. Legislation was recently passed in Canada and the province of Quebec allowing MAiD at the explicit request of a patient who meets a set of eligibility criteria, including competence. Some commentators have argued that MAiD should be accessible to incompetent patients as well, provided appropriate safeguards are in place. Governments of both Quebec and Canada are currently considering whether MAiD should be accessible through written requests made in advance of loss of capacity.

Objective: Aimed at informing the societal debate on this sensitive issue, this study will compare stakeholders' attitudes towards expanding MAiD to incompetent patients with dementia, the beliefs underlying stakeholders' attitudes on this issue, and the value they attach to proposed safeguards. This paper describes the study protocol.

Methods: Data will be collected via a questionnaire mailed to random samples of community-dwelling seniors, relatives of persons with dementia, physicians, and nurses, all residing in Quebec (targeted sample size of 385 per group). Participants will be recruited through the provincial health insurance database, Alzheimer Societies, and professional associations. Attitudes towards MAiD for incompetent patients with dementia will be elicited through clinical vignettes featuring a patient with Alzheimer's disease for whom MAiD is considered towards the end of the disease trajectory. Vignettes specify the source of the request (from the patient through an advance request or from the patient's substitute decision-maker), manifestations of suffering, and how close the patient is to death. Arguments for or against MAiD are used to elicit the beliefs underlying respondents' attitudes.

Results: The survey was launched in September 2016 and is still ongoing. At the time of submission, over 850 respondents have returned the questionnaire, mostly via mail.

Conclusions: This study will be the first in Canada to directly compare views on MAiD for incompetent patients with dementia across key stakeholder groups. Our findings will contribute valuable data upon which to base further debate about whether MAiD should be accessible to incompetent patients with dementia, and if so, under what conditions.
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http://dx.doi.org/10.2196/resprot.8118DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5703982PMC
November 2017

Capturing how age-friendly communities foster positive health, social participation and health equity: a study protocol of key components and processes that promote population health in aging Canadians.

BMC Public Health 2017 05 25;17(1):502. Epub 2017 May 25.

Department of Community Health Sciences, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, Quebec, J1H 5N4, Canada.

Background: To address the challenges of the global aging population, the World Health Organization promoted age-friendly communities as a way to foster the development of active aging community initiatives. Accordingly, key components (i.e., policies, services and structures related to the communities' physical and social environments) should be designed to be age-friendly and help all aging adults to live safely, enjoy good health and stay involved in their communities. Although age-friendly communities are believed to be a promising way to help aging Canadians lead healthy and active lives, little is known about which key components best foster positive health, social participation and health equity, and their underlying mechanisms. This study aims to better understand which and how key components of age-friendly communities best foster positive health, social participation and health equity in aging Canadians. Specifically, the research objectives are to: 1) Describe and compare age-friendly key components of communities across Canada 2) Identify key components best associated with positive health, social participation and health equity of aging adults 3) Explore how these key components foster positive health, social participation and health equity METHODS: A mixed-method sequential explanatory design will be used. The quantitative part will involve a survey of Canadian communities and secondary analysis of cross-sectional data from the Canadian Longitudinal Study on Aging (CLSA). The survey will include an age-friendly questionnaire targeting key components in seven domains: physical environment, housing options, social environment, opportunities for participation, community supports and healthcare services, transportation options, communication and information. The CLSA is a large, national prospective study representative of the Canadian aging population designed to examine health transitions and trajectories of adults as they age. In the qualitative part, a multiple case study will be conducted in five Canadian communities performing best on positive health, social participation and health equity.

Discussion: Building on new and existing collaborations and generating evidence from real-world interventions, the results of this project will help communities to promote age-friendly policies, services and structures which foster positive health, social participation and health equity at a population level.
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http://dx.doi.org/10.1186/s12889-017-4392-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5445415PMC
May 2017

Integration of chronic disease prevention and management services into primary care: a pragmatic randomized controlled trial (PR1MaC).

CMAJ Open 2016 Oct-Dec;4(4):E588-E598. Epub 2016 Oct 12.

Département de médecine de famille et de médecine d'urgence (Fortin), Université de Sherbrooke, Sherbrooke, Qué.; Département des sciences de la santé (Chouinard, Dubois), Université du Quebec à Chicoutimi, Chicoutimi, Qué.; Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean (Bélanger), Chicoutimi, Qué.; Département de médecine de famille et médecine d'urgence (Almirall, Bouhali), Université de Sherbrooke, Sherbrooke, Qué.; Facultés de Médecine et sciences de la santé (Sasseville), Université de Sherbrooke, Sherbrooke, Qué.

Background: Chronic disease prevention and management programs are usually single-disease oriented. Our objective was to evaluate an intervention that targeted multiple chronic conditions and risk factors.

Methods: We conducted a pragmatic randomized controlled trial involving patients aged 18-75 years with at least 1 of the targeted chronic conditions or risk factors from 8 primary care practices in the Saguenay region of Quebec, Canada, to evaluate an intervention that included self-management support and patient-centred motivational approaches. Self-management (primary outcome) was evaluated using the Health Education Impact Questionnaire (heiQ). Secondary outcomes included self-efficacy, health-related quality of life, psychological distress and health behaviours.

Results: Three hundred thirty-two patients were recruited and randomly assigned ( = 166 for both intervention and control groups) and evaluated after 3 months. The intervention group showed improvement in 6 of the 8 heiQ domains: health-directed behaviour (relative risk [RR] 1.71, 95% confidence interval [CI] 1.13 to 2.59), emotional well-being (RR 1.73, 95% CI 1.07 to 2.79), self-monitoring and insight (RR 2.40, 95% CI 1.19 to 4.86), constructive attitudes and approaches (RR 2.40, 95% CI 1.37 to 4.21), skill and technique acquisition (RR 1.70, 95% CI 1.14 to 2.53), and health service navigation (RR 1.93, 95% CI 1.08 to 3.47). Improvement was also observed in the Physical Component Summary ( = 0.017) and the Single Index ( = 0.041) of the 12-Item Short Form Health Survey (version 2). The intervention group improved in fruit and vegetable consumption (odds ratio [OR] 2.36, 95% CI 1.41 to 3.95) and physical activity (OR 3.81, 95% CI 1.65 to 8.76). One-year improvement was maintained in the intervention group for several outcomes.

Interpretation: It is possible to implement an intervention integrating chronic disease prevention and management services into primary care settings. We obtained positive and promising results using this intervention. ClinicalTrials.gov, no.: NCT01319656.
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http://dx.doi.org/10.9778/cmajo.20160031DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5173473PMC
October 2016

Promoting Advance Directives for Health Care and Research Through a Single- or MultiSession Intervention: Does it Affect Completion Rates and Content?

J Am Geriatr Soc 2016 10 2;64(10):e81-e83. Epub 2016 Sep 2.

Department of Psychiatry, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada.

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http://dx.doi.org/10.1111/jgs.14327DOI Listing
October 2016

Promoting advance care planning among community-based older adults: A randomized controlled trial.

Patient Educ Couns 2016 11 12;99(11):1785-1795. Epub 2016 May 12.

Research Centre on Aging, University Institute of Geriatrics of Sherbrooke, Sherbrooke, Canada.

Objective: To test an intervention designed to motivate older adults in documenting their healthcare preferences in advance, and to guide proxies in making hypothetical decisions that match those of the older adult.

Methods: The trial involved 235 older adults, of which half were assisted in communicating their wishes to their proxy. Hypothetical vignettes were used at baseline and twice after the intervention to elicit older adults' preferences and assess their proxy's ability to predict them.

Results: By the end of the trial, 80% of older adults allocated to the experimental group had documented their wishes. Changes over time in mean accuracy scores did not differ between groups for any hypothetical situations, except when limiting the sample to dyads that were highly discordant at baseline.

Conclusion: The intervention motivated a large proportion of older adults to express their preferences but had little effect on proxies' ability to predict them.

Practice Implications: Educational tools developed for this study will assist healthcare providers in helping older adults to record their wishes in advance. Clients must be informed of the challenge of making substitute decisions and of the need to discuss the amount of leeway the proxy should have in interpreting expressed wishes.
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http://dx.doi.org/10.1016/j.pec.2016.05.009DOI Listing
November 2016

Randomized clinical trial of multimodal physiotherapy treatment compared to overnight lidocaine ointment in women with provoked vestibulodynia: Design and methods.

Contemp Clin Trials 2016 Jan 18;46:52-59. Epub 2015 Nov 18.

Research Center on Aging, Université de Sherbrooke, Sherbrooke, QC, Canada.

Provoked vestibulodynia (PVD) is a highly prevalent and debilitating condition yet its management relies mainly on non-empirically validated interventions. Among the many causes of PVD, there is growing evidence that pelvic floor muscle (PFM) dysfunctions play an important role in its pathophysiology. Multimodal physiotherapy, which addresses these dysfunctions, is judged by experts to be highly effective and is recommended as a first-line treatment. However, the effectiveness of this promising intervention has been evaluated through only two small uncontrolled trials. The proposed bi-center, single-blind, parallel group, randomized controlled trial (RCT) aims to evaluate the efficacy of multimodal physiotherapy and compare it to a frequently used first-line treatment, topical overnight application of lidocaine, in women with PVD. A total of 212 women diagnosed with PVD according to a standardized protocol were eligible for the study and were randomly assigned to either multimodal physiotherapy or lidocaine treatment for 10weeks. The primary outcome measure is pain during intercourse (assessed with a numerical rating scale). Secondary measures include sexual function, pain quality, psychological factors (including pain catastrophizing, anxiety, depression and fear of pain), PFM morphology and function, and patients' global impression of change. Assessments are made at baseline, post-treatment and at the 6-month follow-up. This manuscript presents and discusses the rationale, design and methodology of the first RCT investigating physiotherapy in comparison to a commonly prescribed first-line treatment, overnight topical lidocaine, for women with PVD.
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http://dx.doi.org/10.1016/j.cct.2015.11.013DOI Listing
January 2016

In-Home Pulmonary Telerehabilitation for Patients with Chronic Obstructive Pulmonary Disease: A Pre-experimental Study on Effectiveness, Satisfaction, and Adherence.

Telemed J E Health 2015 Nov 15;21(11):870-9. Epub 2015 Jun 15.

1 Research Centre on Aging, University Institute of Geriatrics of Sherbrooke, University of Sherbrooke , Sherbrooke, Quebec, Canada .

Background: Pulmonary rehabilitation (PR) has proven effective in improving exercise tolerance and quality of life in patients with chronic obstructive pulmonary disease (COPD). In Canada, however, there are insufficient rehabilitation services. New strategies such as telerehabilitation must be deployed to increase accessibility. This study aims to investigate the effect of telerehabilitation on exercise tolerance and quality of life and to document patient satisfaction and adherence.

Materials And Methods: Twenty-six patients with moderate to very severe COPD participated in this pre-/postintervention study. They received 15 in-home teletreatment sessions over 8 weeks via videoconference from a service center to their home. Education was provided via self-learning health capsules. Assessments were carried out twice before (T0 and T1; 8 weeks apart) and immediately after the intervention (T2). Primary outcome measures were changes in exercise tolerance (6-min walk test [6MWT] and cycle endurance test [CET]) and quality of life (Chronic Respiratory Questionnaire [CRQ]).

Results: There were significant improvements between pre- and postintervention (T2-T1) on the 6MWT (32 m; p<0.001), CET (41 s; p=0.005), and three of four CRQ domains (dyspnea [p<0.001], fatigue [p=0.002], and emotion [p=0.002]). Improvements in the CET and fatigue during the 8-week intervention period were greater than changes over 8 weeks of maturation (T1-T0) (p=0.004 and 0.02, respectively). Participants' satisfaction and adherence rate with telerehabilitation were very high.

Conclusions: Using telehealth technology to deliver in-home PR is a feasible and practical solution for patients with moderate to very severe COPD. The telerehabilitation program was associated with beneficial effects on exercise tolerance and quality of life and was well received by users.
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http://dx.doi.org/10.1089/tmj.2014.0198DOI Listing
November 2015

Are improvements maintained after in-home pulmonary telerehabilitation for patients with chronic obstructive pulmonary disease?

Int J Telerehabil 2014 29;6(2):21-30. Epub 2015 Jan 29.

RESEARCH CENTRE ON AGING, UNIVERSITY INSTITUTE OF GERIATRICS OF SHERBROOKE, UNIVERSITÉ DE SHERBROOKE, SHERBROOKE, QUEBEC, CANADA.

This study investigated if improvements can be maintained over 24 weeks when in-home pulmonary telerehabilitation is combined with asynchronous self-management education for Chronic Obstructive Pulmonary Disease (COPD). Twenty-three community-living elders with moderate to very severe COPD participated in a pre/post-intervention study. Over 8 weeks, they had access to self-learning capsules on self-management, received 15 in-home teletreatment sessions and were encouraged to gradually engage in unsupervised sessions. Participants were assessed before the intervention (T1), immediately after the intervention (T2), and 6 months later (T3). Outcome measures were (1) exercise tolerance (6-minute walk test [6MWT]), Cycle Endurance Test [CET]), and (2) quality of life (Chronic Respiratory Questionnaire [CRQ]). Although there were significant improvements after 8 weeks of pulmonary telerehabilitation on the 6MWT, CET and three of four CRQ domains, none of these improvements were maintained after 6 months and scores returned to their baseline values (all p values > 0.05 when comparing T3 with T1). While pulmonary telerehabilitation is possible and has a positive impact on patients with moderate to very severe COPD, improvements were not maintained in the long-term even when physical therapy was accompanied by self-management education.
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http://dx.doi.org/10.5195/ijt.2014.6156DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4353006PMC
May 2015

An exploration of factors associated with post-traumatic stress in ER nurses.

J Nurs Manag 2016 Mar 31;24(2):174-83. Epub 2015 Mar 31.

Département de psychologie, Faculté des lettres et sciences humaines, Université de Sherbrooke, Sherbrooke, QC, Canada.

Background: Emergency room (ER) nurses are frequently exposed to traumatic events (TE) at work. These events can lead to symptoms of post-traumatic stress disorder (PTSD).

Aim: The goal of the present study was to describe the factors associated with PTSD symptoms.

Methods: A cross-sectional descriptive correlational design was used. The sample consisted of 35 nurses from an ER in Québec (Canada). Data were collected through self-administered questionnaires.

Results: TEs presenting a grief component (e.g. intentional injury to a child and patient suicide) are positively associated with peritraumatic distress (PD) in the days after the event. PD is positively associated with PTSD symptoms. Two personality traits (neuroticism and extraversion) should also be considered. Neuroticism is positively associated with PD whereas extraversion is negatively associated with PD and PTSD symptoms.

Conclusion: The results are consistent with the literature, but some of these results are new to nurses. They suggest that in this population, TEs in the ER represent 'red flags'. Their occurrence should mobilise support structures. PD and its personality traits are also key factors to consider.

Implication For Nursing Management: To provide adequate support for nurses, ER managers should be on the alert for these conditions. Interventions should be adapted to these findings.
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http://dx.doi.org/10.1111/jonm.12294DOI Listing
March 2016

Environmental Factors Associated With Social Participation of Older Adults Living in Metropolitan, Urban, and Rural Areas: The NuAge Study.

Am J Public Health 2015 Aug 17;105(8):1718-25. Epub 2015 Feb 17.

Mélanie Levasseur, Alan A. Cohen, Marie-France Dubois, Mélissa Généreux, and Hélène Payette are with the Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec. Lucie Richard is with the Institut de Recherche en Santé Publique, Université de Montréal, Montréal, Québec. France-Hélène Therrien is with the University Institute of Geriatrics of Sherbrooke, Québec.

Objectives: We compared the social participation of older adults living in metropolitan, urban, and rural areas, and identified associated environmental factors.

Methods: From 2004 to 2006, we conducted a cross-sectional study using an age-, gender-, and area-stratified random sample of 1198 adults (aged 67-82 years). We collected data via interviewer-administered questionnaires and derived from Canadian censuses.

Results: Social participation did not differ across living areas (P = .09), but after controlling for potential confounding variables, we identified associated area-specific environmental variables. In metropolitan areas, higher social participation was associated with greater proximity to neighborhood resources, having a driver's license, transit use, and better quality social network (R(2) = 0.18). In urban areas, higher social participation was associated with greater proximity to neighborhood resources and having a driver's license (R(2) = 0.11). Finally, in rural areas, higher social participation was associated with greater accessibility to key resources, having a driver's license, children living in the neighborhood, and more years lived in the current dwelling (R(2) = 0.18).

Conclusions: To enhance social participation of older adults, public health interventions need to address different environmental factors according to living areas.
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http://dx.doi.org/10.2105/AJPH.2014.302415DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4504331PMC
August 2015

Partners for the optimal organisation of the healthcare continuum for high users of health and social services: protocol of a developmental evaluation case study design.

BMJ Open 2014 Dec 2;4(12):e006991. Epub 2014 Dec 2.

Departement of Family Medicine, Université McGill, Montréal, Québec, Canada.

Introduction: Case management allows us to respond to the complex needs of a vulnerable clientele through a structured approach that promotes enhanced interaction between partners. Syntheses on the subject converge towards a need for a better description of the relationships between programmes and their local context, as well as the characteristics of the clienteles and programmes that contribute to positive impacts. The purpose of this project is thus to describe and evaluate the case management programmes of four health and social services centres in the Saguenay-Lac- Saint-Jean region of Québec, Canada, in order to inform their improvement while creating knowledge on case management that can be useful in other contexts.

Methods And Analysis: This research relies on a multiple embedded case study design based on a developmental evaluation approach. We will work with the case management programme for high users of hospital services of each centre. Three different units of analysis will be interwoven to obtain an in-depth understanding of each case, that is: (1) health and social services centre and local services network, (2) case management programme and (3) patients who are high users of services. Two strategies for programme evaluation (logic models and implementation analysis) will guide the mixed data collection based on qualitative and quantitative methods. This data collection will rely on: (1) individual interviews and focus groups; (2) participant observation; (3) document analysis; (4) clinical and administrative data and (5) questionnaires. Description and comparison of cases, and integration of qualitative and quantitative data will be used to guide the data analysis.

Ethics And Dissemination: The study protocol was approved by the Ethics Research Boards of the four health and social services centres (HSSCs) involved. Findings will be disseminated by publications in peer-reviewed journals, conferences, and policy and practice partners in local and national government.
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http://dx.doi.org/10.1136/bmjopen-2014-006991DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4256534PMC
December 2014

Development of Algo, a clinical algorithm for non-occupational therapists selecting bathing equipment

Can J Occup Ther 2014 10;81(4):237-246

Background: In Quebec, occupational therapy guidelines allow non-occupational therapists, such as home health aides, to select bathing equipment for "straightforward" cases of clients living at home as long as the aides use a decision-making tool.

Purpose: Our aim was to develop a tool that met the common needs of Quebec's health and social services centres (HSSCs), which involve home health aides in selecting bathing equipment for home-dwelling clients.

Method: We followed an ongoing iterative process involving a literature review as well as (a) a synthesis of 40 in-house tools, (b) feedback from 10 occupational therapists (two questionnaires and one focus group), (c) pretests, and (d) translation.

Findings: Algo is a clinical algorithm constituting a visual map of the logical steps to follow when selecting bathing equipment for straightforward cases. Algo is a series of yes/no questions dealing with occupation, person, and environment.

Implications: Algo, rooted in evidence and regulatory board guidelines, is available to HSSCs involving non-occupational therapists in selecting bathing equipment.
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http://dx.doi.org/10.1177/0008417414539643DOI Listing
October 2014

Exponential increases in the prevalence of disability in the oldest old: a Canadian national survey.

Gerontology 2014 7;60(5):395-401. Epub 2014 May 7.

School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Qué., Canada.

Background: As most studies generally treat all 85+ year-olds as a homogeneous group, little is known about the specific disabilities of the oldest old population, those aged 90 and older.

Objective: To estimate age-specific prevalence of disability in activities of daily living for older Canadians, including the oldest old, those aged 90 and older.

Methods: Cross-sectional national survey with a representative sample of noninstitutionalized Canadians aged between 50 and 104 years old (n = 28,406). Disability was self-reported and defined as needing assistance to perform self-care and domestic life activities.

Results: The prevalence of disability increased with age, and the rise appeared exponential when considering the oldest old. At age 90, the highest estimated rates of disability were reported for housekeeping (50%), shopping (45%) and transportation (44%), and 21% reported requiring assistance for washing themselves. Compared to the 85-89 age group, the estimated proportion of people reporting disability in the 95+ age group approximately triples for self-care activities and doubles for domestic life activities.

Conclusion: Even if we knew that disability increases with age, we can now state that it increases at an accelerated rate beyond age 85. Grouping people aged 85+ into one category leads to substantial underestimates of disability in the oldest old. Accurate estimates are necessary for adequate allocation of care and rehabilitation resources for a rapidly expanding age group.
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http://dx.doi.org/10.1159/000358059DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4176936PMC
June 2015

Does regulating private long-term care facilities lead to better care? A study from Quebec, Canada.

Int J Qual Health Care 2014 Jun 15;26(3):330-6. Epub 2014 Apr 15.

Research Centre on Aging, University Institute of Geriatrics of Sherbrooke, Sherbrooke, QC, Canada.

Objective: In the province of Quebec, Canada, long-term residential care is provided by two types of facilities: publicly funded accredited facilities and privately owned facilities in which care is privately financed and delivered. Following evidence that private facilities were delivering inadequate care, the provincial government decided to regulate this industry. We assessed the impact of regulation on care quality by comparing quality assessments made before and after regulation. In both periods, public facilities served as a comparison group.

Design: A cross-sectional study conducted in 2010-12 that incorporates data collected in 1995-2000.

Settings: Random samples of private and public facilities from two regions of Quebec.

Participants: Random samples of disabled residents aged 65 years and over. In total, 451 residents from 145 care settings assessed in 1995-2000 were compared with 329 residents from 102 care settings assessed in 2010-12.

Intervention: Regulation introduced by the province in 2005, effective February 2007.

Main Outcome Measure: Quality of care measured with the QUALCARE Scale.

Results: After regulation, fewer small-size facilities were in operation in the private market. Between the two study periods, the proportion of residents with severe disabilities decreased in private facilities whereas it remained >80% in their public counterparts. Meanwhile, quality of care improved significantly in private facilities, while worsening in their public counterparts, even after controlling for confounding.

Conclusions: The private industry now provides better care to its residents. Improvement in care quality likely results in part from the closure of small homes and change in resident case-mix.
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http://dx.doi.org/10.1093/intqhc/mzu032DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4041094PMC
June 2014

Maternal, placental and fetal exposure to bisphenol A in women with and without preeclampsia.

Hypertens Pregnancy 2014 Aug 11;33(3):341-8. Epub 2014 Apr 11.

Department of Obstetrics and Gynecology .

Objectives: We aimed to investigate potential association between the exposure of bisphenol A (BPA) and preeclampsia.

Methods: Concentrations of BPA were assessed in 58 pregnancies including 35 normotensive and 23 preeclamptic women, using a highly sensitive gas chromatography-mass spectrometry (GC-MS) method.

Results: BPA was detected in maternal blood, fetal blood and placental tissue; and actual concentrations of BPA were determined. Interestingly, significant accumulation of BPA in the placentas of women with preeclampsia compared to normotensive women has been shown.

Conclusions: This is the first study to highlight a significant correlation between preeclampsia and a high accumulation of BPA in the placenta.
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http://dx.doi.org/10.3109/10641955.2014.892607DOI Listing
August 2014

Tai Chi-based exercise program provided via telerehabilitation compared to home visits in a post-stroke population who have returned home without intensive rehabilitation: study protocol for a randomized, non-inferiority clinical trial.

Trials 2014 Jan 30;15:42. Epub 2014 Jan 30.

Université de Sherbrooke, Sherbrooke, QC, Canada.

Background: The incidence of strokes in industrialized nations is on the rise, particularly in the older population. In Canada, a minority of individuals who have had a stroke actually receive intensive rehabilitation because most stroke patients do not have access to services or because their motor recovery was judged adequate to return home. Thus, there is a considerable need to organize home-based rehabilitation services for everyone who has had a stroke. To meet this demand, telerehabilitation, particularly from a service center to the patient's home, is a promising alternative approach that can help improve access to rehabilitation services once patients are discharged home.

Methods/design: This non-inferiority study will include patients who have returned home post-stroke without requiring intensive rehabilitation. To be included in the study, participants will: 1) not be referred to an Intensive Functional Rehabilitation Unit, 2) have a Rankin score of 2 or 3, and 3) have a balance problem (Berg Balance Scale score between 46 and 54). Participants will be randomly assigned to either the teletreatment group or the home visits group. Except for the delivery mode, the intervention will be the same for both groups, that is, a personalized Tai Chi-based exercise program conducted by a trained physiotherapist (45-minute session twice a week for eight consecutive weeks). The main objective of this research is to test the non-inferiority of a Tai Chi-based exercise program provided via telerehabilitation compared to the same program provided in person at home in terms of effectiveness for retraining balance in individuals who have had a stroke but do not require intensive functional rehabilitation. The main outcome of this study is balance and mobility measured with the Community Balance and Mobility Scale. Secondary outcomes include physical and psychological capacities related to balance and mobility, participants' quality of life, satisfaction with services received, and cost-effectiveness associated with the provision of both types of services.

Study/trial Registration: ClinicalTrials.gov: NCT01848080.
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http://dx.doi.org/10.1186/1745-6215-15-42DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3912257PMC
January 2014

Identifying psychosocial variables for home care services and how to measure them.

Home Health Care Serv Q 2013 ;32(4):197-217

a University of Sherbrooke , Sherbrooke , Quebec , Canada.

A Delphi-type expert consultation founded on the RAND/UCLA Appropriateness method was used to select variables related to older adults and environment characteristics perceived essential in assessing psychosocial needs and that could influence the social work workload in home care services. After two rounds of consultation, the 60 experts reached a consensus on 97 variables out of the 160 considered. A focus group made up of 10 experts identified tools that would allow us to measure the variables in a clinical context. Eighty-three percent of the variables selected could be measured with five instruments identified by the focus group experts.
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http://dx.doi.org/10.1080/01621424.2013.851048DOI Listing
April 2015

Substitute consent practices in the face of uncertainty: a survey of Canadian researchers in aging.

Int Psychogeriatr 2013 Nov 8;25(11):1821-30. Epub 2013 Aug 8.

Department of Community Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada.

Background: In Canada and elsewhere, research policies require researchers to secure consent from a legally authorized representative (LAR) for prospective participants unable to consent. Few jurisdictions, however, offer a clear legislative basis for LAR identification. We investigated Canadian researchers' practices regarding the involvement of decisionally incapacitated participants and tested whether reported practices were associated with (1) researchers' understanding of the law on third-party authorization of research and (2) their comfort with allowing a family member to consent on behalf of an incapacitated relative.

Methods: We surveyed researchers in aging from four Canadian provinces about their practices with prospective participants deemed incapable of consent, their understanding of relevant law, and comfort with family consent for research purposes. Understanding and comfort were measured with research vignettes that briefly described hypothetical studies in which an adult who lacks the capacity to consent was invited to participate.

Results: Many respondents reported soliciting consent from a family member (45.7% for low-risk studies and 10.7% for serious risks studies), even in jurisdictions where such authority is uncertain at law. Researchers' tendency to solicit family consent was associated with their comfort in doing so, but not with their understanding of the law on substitute consent for research.

Conclusions: Findings underscore the need to clarify who may authorize an incapacitated adult's participation in research. Meanwhile, people should inform their relatives of their desire to participate or not in research in the event of incapacity, given researchers' tendency to turn to family for consent, even where not supported by law.
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http://dx.doi.org/10.1017/S1041610213001336DOI Listing
November 2013

Surrogate consent for dementia research: factors influencing five stakeholder groups from the SCORES study.

IRB 2013 Jul-Aug;35(4):1-11

Department of Community Health Sciences, University of Sherbrooke, QC, Canada.

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September 2013