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R - Community Participation

Opportunities Telecommunication technology has the potential to accelerate community participation service delivery. Currently, all E-Scan sites report video conference capability, 92% (11/12) of sites have telehealth facilities, and 75% (9 /12) report clinical personnel with telehealth expertise. In 75% (9/12) of sites, healthcare professionals are able to consult with one another in the community; and 58% (7/12) of sites report the ability to assess and monitor individuals in distant facilities. There is insufficient data regarding the frequency of telehealth implementation or accessibility of telehealth resources. As the pressures on healthcare spending continue, the length of stay during inpatient rehabilitation will likely decrease further, and novel models of care delivery (which allow for cost savings and expanded patient volumes) will be needed. Current telehealth and future technology advancement offers unique opportunities to reframe current care delivery models, and enhance community participation. There is also an opportunity to centralize information using an SCI portal, within the Rick Hansen Institute (www.rickhanseninstitute.org). This could provide individuals with SCI with online information using programs such as SCI-U (www.sci-u.ca), and enable completion of standardized outcome assessments, using the Rick Hansen SCI Registry (RHSCIR, www.rickhansenregistry.org), that would be available to clinicians to monitor community participation. A proposed best practice indicator that encompasses these concepts is described later in this chapter. Outcome Measures Relevant to Community Participation In Canadian rehabilitation centres, there is tremendous variability in the measures used to assess community participation and related concepts, such as environmental factors and quality of life. Below are outcome measures reported in the E-Scan. many resources ARE available to aid clinicians and researchers in develop MENT and evaluat ION OF comunity participation . These include: 1. ParQoL (www.parqol.com) The Canadian-developed Participation and Quality of Life (Par-QoL) Tool-Kit assists clinicians and researchers to identify appropriate outcome measures, to assess the impact of secondary health conditions on participation and quality of life. A detailed description of the three main groups of quality of life, and definitions for the objective and subjective dimensions, is provided on the Par-QoL website. Below is a list of measures commonly used to assess participation, classified according to the boxes covered in Dijkers’ model (Figure 4.0). Figure 4.0 Dijkers’ conceptualization of quality of life. Adapted with permision from Dijkers.9 A prominent feature of the model is the distinction between objective and subjective dimensions of quality of life. Objective measures take into account the ‘societal’ or ‘outsider’ perspective of what constitutes quality of life. Measures, from the objective standpoint, rate quality of life in terms of measurable ‘achievements’ taken to be representative of good quality of life, such as being married, having a job, being educated, having good health, etc. (Figure 4.0 Boxes A and B versus C). Conversely, the subjective standpoint takes the individual or the ‘insider’ viewpoint. In other words, it asks respondents to share ‘how they feel’ about their quality of life. Subjective measures typically ask individuals to rate how satisfied they are with a particular domain in their life, and may even ask them to rank their relative importance to their overall wellbeing (Figure 4.0 Boxes D and E versus C). The above framework also applies to measures of community participation, and can inform which dimensions various participation measures assess. Concepts Relevant to Community Participation Outcome Measure Reported Use of Measure in the 12 Canadian Sites Participation Reintegration to Normal Living Index (RNL)3 Canadian Occupational Performance Measure (COPM)4 Craig Handicap Assessment and Reporting Technique (CHART)5 3/12 (25%) 2/12 (17%) 5/12 (42%) Quality of Life Life Satisfaction Questionnaire 11 (LiSat-11)6 Satisfaction with Life Scale (SWLS)7 4/12 (36%) 3/12 (25%) Environment Craig Hospital Inventory of Environmental Factors (CHIEF)8 1/12 (8%) 188 CAPTURING CAPACITY IN CANADIAN SCI REHABILITATION


R - Community Participation
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