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Tang GH, Thachil J, Bowman M, Bekdache C, James PD, Sholzberg M. Patient-centered care in von Willebrand disease: are we there yet? Expert Rev Hematol 2023; 16:641-649. [PMID: 37581602 DOI: 10.1080/17474086.2023.2243386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 07/28/2023] [Indexed: 08/16/2023]
Abstract
INTRODUCTION Von Willebrand Disease is the most common inherited bleeding disorder. Paradoxically, affected individuals are often misdiagnosed and experience substantial diagnostic delay. There are sex-specific health disparities in VWD rooted in the stigmatization of vaginal bleeding, which leads to symptom dismissal, lack of timely access to care and lower health-related quality of life. AREAS COVERED Following the core elements of patient-centered care - respect for patient preferences, values, and needs, we describe the current state of VWD care. Challenges of diagnostic delay, serial misrecognition of abnormal bleeding, and symptom dismissal are barriers that disproportionately affect women with VWD. These negative effects are further amplified in individuals living in low- and middle-income countries. We describe the importance of coordinated multidisciplinary care, as well as the need for patient education and empowered self-advocacy. EXPERT OPINION While tremendous work has been done to improve the diagnosis and management of VWD, timely and high-quality research is urgently needed to address care gaps. Systemic changes such as resource investment, dedicated research funding for novel treatment modalities, and effective knowledge translation strategies to address structural barriers are needed to facilitate effective patient-centered care for VWD.
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Affiliation(s)
- Grace H Tang
- Hematology-Oncology Clinical Research Group, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Jecko Thachil
- Department of Hematology, Manchester University Hospitals, Manchester, UK
| | - Mackenzie Bowman
- Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Carine Bekdache
- Hematology-Oncology Clinical Research Group, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Paula D James
- Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Michelle Sholzberg
- Department of Medicine and Laboratory Medicine & Pathobiology, St. Michael's Hospital, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
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Doroszkiewicz H, Sierakowska M. Usability of the COPE Index in the assessment of subjective caregiving burden of family caregivers of older people: A cross-sectional Study. J Clin Nurs 2021; 31:3110-3119. [PMID: 34811836 DOI: 10.1111/jocn.16138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 09/13/2021] [Accepted: 11/10/2021] [Indexed: 11/29/2022]
Abstract
AIM The aim of the study was to evaluate the usability of the COPE Index in the assessment of subjective caregiving burden of family caregivers providing care for older people in their home environment. METHODS A cross-sectional study was conducted among 110 family caregivers. The criterion of including caregivers in the study was their provision of care at home for an older person who needed and received regular long-term nursing care in their home environment. The study was carried out using the COPE Index questionnaire in assessing the situation of family caregivers. The study was reported according to the STROBE checklist. RESULTS The mean result of assessment of negative impact of care in the studied group of caregivers was 16.5 ± SD 3.0, positive impact of care - 10.4 ± SD 2.8 and the quality of support - 9.2 ± SD 1.8. A higher level of caregiving burden was found in 58.2% caregivers. The vast majority of the caregivers were women (83.6%). The care was most often provided by the elderly people's children (51.0%), less often by spouses (17.0%), siblings (10.0%), grandchildren (10.0%) and paid caregivers (10.0%). CONCLUSION The COPE Index proved to be a useful instrument for routine application in home environment to identify care deficits. Greater caregiving burden of family caregivers of disabled older persons was associated with a higher number of nights devoted to care, growing limitations on professional life, choice to provide care, the caregiver's emotional state, the lack of support in the caregiving role, support from family members and the state of cognitive functions of the care recipient. RELEVANCE TO CLINICAL PRACTICE This study may help identify and characterise the profile of family caregivers who are at risk of caregiving burden, and can be used to apply well-designed activities aimed at reducing their suffering and providing them support.
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Affiliation(s)
| | - Matylda Sierakowska
- Department of Integrated Medical Care Medical, University of Bialystok, Bialystok, Poland
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Jabłoński MJ, García-Torres F, Zielińska P, Bułat A, Brandys P. Emotional Burden and Perceived Social Support in Male Partners of Women with Cancer. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17124188. [PMID: 32545445 PMCID: PMC7344620 DOI: 10.3390/ijerph17124188] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 05/31/2020] [Accepted: 06/08/2020] [Indexed: 12/31/2022]
Abstract
Background: The aim of this study was to describe the correlations between the psychosocial burden on male caregivers and their perception of social support, as well as distress, anxiety, and depression among their partners in the first six months after a cancer diagnosis. Methods: A cross-sectional, longitudinal and observational study was conducted on a group of 61 couples, with the use of Zarit Burden Interview (ZBI), Caregiver Burden Scale (CBS), Berlín Social Support Scales (BSSS), Hospital Anxiety and Depression Scale (HADS) and Distress Thermometer (DT). Statistical analysis was performed using Statistica v.13. Results: A strong positive correlation between the ZBI and CBS, as well as between support-seeking and the emotional involvement of male partners, was documented. The negative correlation between the lack of instrumental support and a much greater burden on caregivers, in emotional, social, and family life was documented. The level of distress, anxiety, and depression, as well as family problems reported by female patients, were positively correlated with the male caregiver′s burden. A demographic analysis showed significant relationships between the number of offspring and the negative health indicators of patients and their partners. Implications: The obtained results encourage deeper reflection on the need to improve the availability of instrumental support for male caregivers and support for families with an oncological ill parent in caring for minor children, and to maintain the social activity of the caregiver.
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Affiliation(s)
- Marcin J. Jabłoński
- Institute of Psychology, Faculty of Philosophy, Jesuit University Ignatianum in Krakow, 31-501 Kraków, Poland;
| | - Francisco García-Torres
- Department of Psychology, University of Cordoba, 14071 Cordoba, Spain
- IMIBIC Health Research Institute, Reina Sofía University Hospital of Cordoba, 14004 Cordoba, Spain
- Correspondence: ; Tel.: +34-957-218-847; +34-646-545-104
| | - Paulina Zielińska
- The Maria Skłodowska Curie Memorial Cancer Centre and Institute of Oncology (MCMCC) branch in Krakow, 31-115 Kraków, Poland; (P.Z.); (A.B.); (P.B.)
| | - Alicja Bułat
- The Maria Skłodowska Curie Memorial Cancer Centre and Institute of Oncology (MCMCC) branch in Krakow, 31-115 Kraków, Poland; (P.Z.); (A.B.); (P.B.)
| | - Piotr Brandys
- The Maria Skłodowska Curie Memorial Cancer Centre and Institute of Oncology (MCMCC) branch in Krakow, 31-115 Kraków, Poland; (P.Z.); (A.B.); (P.B.)
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Overcash J, Fugett S, Tan A, Ginther J, Williams N. Strain Among Caregivers of Older Adults Diagnosed With Breast Cancer. Oncol Nurs Forum 2019; 46:E185-E201. [PMID: 31626615 DOI: 10.1188/19.onf.e185-e201] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To illustrate the predictors of strain among caregivers of older adults diagnosed with breast cancer. SAMPLE & SETTING This study involved 39 women diagnosed with breast cancer who were aged 69 years or older, receiving any type of treatment, and seeking an initial assessment in a geriatric oncology program at a large cancer center in the midwestern United States and their caregivers. METHODS & VARIABLES This cross-sectional study evaluated relationships among the variables of caregiver strain, age, employment status, patient characteristics, and patient scores on the comprehensive geriatric assessment. Bivariate statistics and logistic regression models were used. RESULTS Increasing age of the caregiver was associated with less caregiver strain. Caregivers employed part-time experienced greater strain than those employed full-time. IMPLICATIONS FOR NURSING Nurses must assess for strain in caregivers of individuals diagnosed with cancer, particularly if they are younger and employed part-time. Caregivers of depressed patients should be assessed for strain and offered support.
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Affiliation(s)
| | - Susan Fugett
- Ohio State University Comprehensive Cancer Center and the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute
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Caregiving for Older Adults with Limited English Proficiency: Transitioning from Hospital to Home. J Gen Intern Med 2019; 34:1744-1750. [PMID: 31236893 PMCID: PMC6712121 DOI: 10.1007/s11606-019-05119-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 10/26/2018] [Accepted: 04/10/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND Although the family caregiver workforce is increasingly diverse, little is known about culturally and linguistically diverse caregivers and patients for whom they care. Caregiver roles include communicating with health care teams on behalf of patients with language barriers. OBJECTIVE Our objective is to describe characteristics and experiences of caregivers for patients with limited English proficiency (LEP) immediately following hospital discharge. DESIGN Cross-sectional. PARTICIPANTS Primary informal caregivers for Chinese- and Spanish-speaking patients with LEP discharged from a large academic medical center's orthopedic surgery, general surgery, and cardiovascular inpatient floors from June 2012 to August 2013. MAIN MEASURES Bilingual-bicultural research assistants conducted baseline structured interviews with patients or surrogates in the hospital, and 3 weeks after discharge, gathering demographic and health information. They then interviewed by phone informal caregivers, identified by patients, to determine caregiving experiences. KEY RESULTS One hundred fifty-eight caregivers were interviewed post-discharge. Two-thirds (69.0%) were adults caring for parents or grandparents, and 20.9% were spouses or partners. Sixty-nine (43.7%) caregivers had LEP themselves, yet only 12% of patients reported having access to professional interpreters at the time discharge instructions were provided. Ninety percent reported performing three or more caregiving roles for the patient (helping at home, helping with medical decisions, helping with medical forms, helping communicate with medical staff, and talking with doctors about medical care). Forty percent reported moderate/high levels of perceived stress (some, most, or all of the time) caring for the patient. Multivariate regression revealed caregivers for Chinese-speaking patients, and those for patients discharged to another hospital were most likely to report moderate/high levels of perceived stress. CONCLUSION Culturally and linguistically diverse caregivers perform multiple roles caring for patients with LEP, often have LEP themselves, and experience notable levels of stress. These results also demonstrate an opportunity to expand the use of professional interpreters at hospital discharge to avoid communication errors.
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Overcash J, Ford N, Kress E, Ubbing C, Williams N. Comprehensive Geriatric Assessment as a Versatile Tool to Enhance the Care of the Older Person Diagnosed with Cancer. Geriatrics (Basel) 2019; 4:geriatrics4020039. [PMID: 31238518 PMCID: PMC6630523 DOI: 10.3390/geriatrics4020039] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 06/14/2019] [Accepted: 06/20/2019] [Indexed: 12/27/2022] Open
Abstract
The comprehensive geriatric assessment (CGA) is a versatile tool for the care of the older person diagnosed with cancer. The purpose of this article is to detail how a CGA can be tailored to Ambulatory Geriatric Oncology Programs (AGOPs) in academic cancer centers and to community oncology practices with varying levels of resources. The Society for International Oncology in Geriatrics (SIOG) recommends CGA as a foundation for treatment planning and decision-making for the older person receiving care for a malignancy. A CGA is often administered by a multidisciplinary team (MDT) composed of professionals who provide geriatric-focused cancer care. CGA can be used as a one-time consult for surgery, chemotherapy, or radiation therapy providers to predict treatment tolerance or as an ongoing part of patient care to manage malignant and non-malignant issues. Administrative support and proactive infrastructure planning to address scheduling, referrals, and provider communication are critical to the effectiveness of the CGA.
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Affiliation(s)
- Janine Overcash
- The College of Nursing, The Ohio State University, 1585 Neil Ave, Newton Hall, Columbus, OH 43201, USA.
| | - Nikki Ford
- Stephanie Spielman Comprehensive Breast Center, The Ohio State University, 1145 Olentangy River Road, Columbus, OH 43121, USA.
| | - Elizabeth Kress
- Stephanie Spielman Comprehensive Breast Center, The Ohio State University, 1145 Olentangy River Road, Columbus, OH 43121, USA.
| | - Caitlin Ubbing
- Stephanie Spielman Comprehensive Breast Center, The Ohio State University, 1145 Olentangy River Road, Columbus, OH 43121, USA.
| | - Nicole Williams
- Stephanie Spielman Comprehensive Breast Center, The Ohio State University, 1145 Olentangy River Road, Columbus, OH 43121, USA.
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Stojak Z, Jamiolkowski J, Chlabicz S, Marcinowicz L. Levels of Satisfaction, Workload Stress and Support Amongst Informal Caregivers of Patients Receiving or Not Receiving Long-Term Home Nursing Care in Poland: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16071189. [PMID: 30987053 PMCID: PMC6480023 DOI: 10.3390/ijerph16071189] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 03/19/2019] [Accepted: 03/28/2019] [Indexed: 11/16/2022]
Abstract
The role of informal caregivers was included in the Assumptions of the Long-Term Senior Policy in Poland for 2014–2020. The document acknowledged the necessity of diagnosing the needs of informal caregivers of elderly people and to implement systemic solutions that would enable the provision of assistance for them. In response, this study aimed to describe the situation of caregivers of patients receiving versus patients not receiving Long-Term Home Nursing Care (LTHNC; i.e., a formal program including regular visits by a nurse specializing in home care) in terms of caregiver socio-demographic characteristics, health self-assessment, work overload, satisfaction derived from being a caregiver, and the quality of perceived support. A cross-sectional study was conducted using the Carers of Older People in Europe (COPE) Index in 2015 in the north-eastern part of Poland involving 170 caregivers of patients supported with LTHNC and 86 caregivers of patients staying at home and not receiving LTHNC. We found that caregivers for patients receiving LTHNC were significantly less overloaded with care work than caregivers for patients without LTHNC support (p < 0.001). LTHNC support was also related to the level of satisfaction with providing care: Caregivers for patients receiving LTHNC were significantly more satisfied with performing their role and felt greater support than caregivers for patients without LTHNC (p < 0.001). Our study provides evidence for a positive relationship between LTHNC and the situation of informal caregivers of dependent elderly people at home. A formal program of visits by a nurse specializing in long-term home care may facilitate the provision by caregivers of better informal care to patients staying at home.
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Affiliation(s)
- Zofia Stojak
- The Non-Public Health Care Centre OMNI-MED in Bialystok, 15-054 Bialystok, Poland.
| | - Jacek Jamiolkowski
- Department of Population Medicine and Civilization Diseases Prevention, Medical University of Bialystok, 15-269 Bialystok, Poland.
| | - Slawomir Chlabicz
- Department of Family Medicine, Medical University of Bialystok, 15-054 Bialystok, Poland.
| | - Ludmila Marcinowicz
- Department of Primary Health Care, Medical University of Bialystok, 15-054 Bialystok, Poland.
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Doroszkiewicz H, Sierakowska M, Muszalik M. Utility of the Care Dependency Scale in predicting care needs and health risks of elderly patients admitted to a geriatric unit: a cross-sectional study of 200 consecutive patients. Clin Interv Aging 2018; 13:887-894. [PMID: 29773946 PMCID: PMC5947105 DOI: 10.2147/cia.s159511] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Objective The aim of the study was to evaluate the usefulness of the Polish version of the Care Dependency Scale (CDS) in predicting care needs and health risks of elderly patients admitted to a geriatric unit. Methods This was a cross-sectional study of 200 geriatric patients aged ≥60 years, chronologically admitted to a geriatrics unit in Poland. The study was carried out using the Polish version of the CDS questionnaire to evaluate biopsychosocial needs and the level of care dependency. Results The mean age of the participating geriatric patients was 81.8±6.6. The mean result of the sum of the CDS index for all the participants was 55.3±15.1. Detailed analysis of the results of evaluation of the respondents’ functional condition showed statistically significant differences in the levels of care dependency. Evaluation of the patients’ physical performance in terms of the ability to do basic activities of daily living (ADL) and instrumental ADL (I-ADL) showed statistically significant differences between the levels of care dependency. Patients with high dependency were more often prone to pressure ulcers – 13.1±3.3, falls (87.2%), poorer emotional state – 6.9±3.6, mental function – 5.1±2.8, and more often problems with locomotion, vision, and hearing. The results showed that locomotive disability, depression, advanced age, and problem with vision and hearing are connected with increasing care dependency. Conclusion CDS evaluation of each admitted geriatric patient enables us to predict the care needs and health risks that need to be reduced and the disease states to be improved. CDS evaluation should be accompanied by the use of other instruments and assessments to evaluate pressure ulcer risk, fall risk, and actions toward the improvement of subjective well-being, as well as correction of vision and hearing problems where possible and assistive devices for locomotion.
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Affiliation(s)
| | - Matylda Sierakowska
- Department of Integrated Medical Care, Medical University of Bialystok, Bialystok, Poland
| | - Marta Muszalik
- Department and Clinic of Geriatrics, Nicolaus Copernicus University, Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
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Guay C, Auger C, Demers L, Mortenson WB, Miller WC, Gélinas-Bronsard D, Ahmed S. Components and Outcomes of Internet-Based Interventions for Caregivers of Older Adults: Systematic Review. J Med Internet Res 2017; 19:e313. [PMID: 28928109 PMCID: PMC5627044 DOI: 10.2196/jmir.7896] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 07/11/2017] [Accepted: 07/11/2017] [Indexed: 12/02/2022] Open
Abstract
Background When trying to access interventions to improve their well-being and quality of life, family caregivers face many challenges. Internet-based interventions provide new and accessible opportunities to remotely support them and can contribute to reducing their burden. However, little is known about the link existing between the components, the use of behavior change techniques, and the outcomes of these Internet-based interventions. Objective This study aimed to provide an update on the best available evidence about the efficacy of Internet-based interventions for caregivers of older adults. Specifically, the components and the use of behavior change techniques and how they impact on the efficacy of the intervention were sought. Methods A systematic review searched primary source studies published between 2000 and 2015. Included studies were scored with a high level of evidence by independent raters using the GRADE criteria and reported caregiver-specific outcomes about interventions delivered through the Internet for caregivers of people aged 50 years and older. A narrative synthesis identified intervention components (eg, content, multimedia use, interactive online activities, and provision of support), behavior change techniques, and caregiver outcomes (eg, effects on stressors, mediators, and psychological health). The risk of bias within the included studies was assessed. Results A total of 2338 articles were screened and 12 studies describing 10 Internet-based interventions were identified. Seven of these interventions led to statistically significant improvements in caregiver outcomes (eg, reducing depression or anxiety, n=4). These efficacious interventions used interactive components, such as online exercises and homework (n=4) or questionnaires on health status (n=2) and five of them incorporated remote human support, either by professionals or peers. The most frequently used behavior change techniques included in efficacious interventions were provision of social support (n=6) and combinations of instructions to guide behavior change and barrier identification (n=5). The design and aim of the included studies did not permit determining exactly which component and/or behavior change technique was more efficacious in producing positive outcomes in caregivers. The risk for selection bias was low for all the studies, and low to high for performance, detection, and attrition biases. Conclusions In sum, Internet-based interventions that incorporate professional and social support, and provide instructions to change behavior and problem solve in an interactive manner appear to lead to positive outcomes in caregivers. Studies isolating the specific effect of components are needed to improve our understanding of the underlying mechanism of action.
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Affiliation(s)
- Cassioppée Guay
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, QC, Canada
| | - Claudine Auger
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, QC, Canada
| | - Louise Demers
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada.,Centre de recherche de l'Institut universitaire de gériatrie de Montréal, Montreal, QC, Canada
| | - W Ben Mortenson
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,GF Strong Rehabilitation Center, Vancouver, BC, Canada.,International Collaboration on Repair Discoveries, Vancouver, BC, Canada
| | - William C Miller
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,GF Strong Rehabilitation Center, Vancouver, BC, Canada
| | - Dominique Gélinas-Bronsard
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, QC, Canada
| | - Sara Ahmed
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, QC, Canada.,School of Physical and Occupational Therapy, Faculty of Medicine, McGill University Health Centre, Clinical Epidemiology, McGill University, Montreal, QC, Canada
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