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Biomedical subjects

Mary Law

Publications and source records attributed to Mary Law.

At least 19 recordsLinked to original sources
PubMed2006

Defining the effect and mediators of two knowledge translation strategies designed to alter knowledge, intent and clinical utilization of rehabilitation outcome measures: a study protocol [NCT00298727].

BACKGROUND: A substantial number of valid outcome measures have been developed to measure health in adult musculoskeletal and childhood disability. Regrettably, national initiatives have merely resulted in changes in attitude, while utilization remains unacceptably low. This study will compare the effectiveness and mediators of two different knowledge transfer (KT) interventions in terms of their impact on changing knowledge and behavior (utilization and clinical reasoning) related to health outcome measures. METHOD/DESIGN: Physical and occupational therapists (n = 144) will be recruited in partnership with the national professional associations to evaluate two different KT interventions with the same curriculum: 1) Stakeholder-Hosted Interactive Problem-Based Seminar (SHIPS), and 2) Online Problem-Based course (e-PBL). SHIPS will consist of face-to-face problem-based learning (PBL) for 2 1/2 days with outcome measure developers as facilitators, using six problems generated in consultation with participants. The e-PBL will consist of a 6-week web-based course with six generic problems developed by content experts. SHIPS will be conducted in three urban centers in Canada. Participants will be block-allocated by a minimization procedure to either of the two interventions to minimize any prognostic differences. Trained evaluators at each site will conduct chart audits and chart-stimulated recall. Trained interviewers will conduct semi-structured interviews focused on identifying critical elements in KT and implementing practice changes. Interviews will be transcribed verbatim. Baseline predictors including demographics, knowledge, attitudes/barriers regarding outcome measures, and Readiness to Change will be assessed by self-report. Immediately post-intervention and 6 months later, these will be re-administered. Primary qualitative and quantitative evaluations will be conducted 6-months post-intervention to assess the relative effectiveness of KT interventions and to identify elements that contribute to changing clinical behavior. Chart audits will determine the utilization of outcome measures (counts). Incorporation of outcome measures into clinical reasoning will be assessed using an innovative technique: chart-stimulated recall. DISCUSSION: A strategy for optimal transfer of health outcome measures into practice will be developed and shared with multiple disciplines involved in primary and specialty management of musculoskeletal and childhood disability.

Journal Article↗
PubMed2006

Rapamycin disrupts cyclin/cyclin-dependent kinase/p21/proliferating cell nuclear antigen complexes and cyclin D1 reverses rapamycin action by stabilizing these complexes.

Rapamycin and its derivatives are promising anticancer agents, but the exact mechanisms by which these drugs induce cell cycle arrest and inhibit tumor growth are unknown. A biochemical analysis of human mammary tumor cell lines indicated that rapamycin-induced antiproliferative effects correlated with down-regulation of cellular p21 levels and the levels of p21 in cyclin-dependent kinase (Cdk) 2 and 4 complexes. Cyclin D1 overexpression reversed rapamycin action and this reversal correlated with increased levels of cellular p21, higher levels of p21 associated with Cdk2, and stabilization of cyclin D1/Cdk2/p21/proliferating cell nuclear antigen (PCNA) complexes. Experiments using a novel cyclin D1-Cdk2 fusion protein or a kinase-dead mutant of the fusion protein indicated that reversal of rapamycin action required not only the formation of complexes with p21 and PCNA but also complex-associated kinase activity. Similar results were observed in vivo. The rapamycin derivative RAD001 (everolimus) inhibited the growth of mouse mammary tumors, which correlated with the disruption of cyclin D1/Cdk2 complexes. The potential implications of these results with respect to the use of rapamycin derivatives in breast cancer therapy are discussed.

Animals↗
PubMed2006

Patterns of participation in recreational and leisure activities among children with complex physical disabilities.

Children with physical disabilities are at increased risk of limitations to participation in everyday activities. This study describes research examining the participation of children in day-to-day formal and informal activities (excluding mandated academic schooling). Using the Children's Assessment of Participation and Enjoyment (CAPE) measure, data on participation patterns were collected from 427 children (229 males, 198 females; mean age 10 y [SD 2 y 4 mo]; range 6-14 y) with physical limitations and from their families. The primary types of physical disability in the sample included cerebral palsy, spina bifida, acquired brain injury, and musculoskeletal limitations. Findings indicate a broad range of diversity and intensity of participation, with proportionately greater involvement in informal rather than formal activities. Significant differences in participation and enjoyment were found between males and females, and for children more than 12 years of age. Children's participation was less diverse in families reporting lower income, single-parent status, and lower respondent parent education. These findings provide a foundation for an improved understanding of the participation of children with physical disabilities, which can assist families and service providers in planning activities that fit with their child's preferences and ensure active participation.

Adolescent↗
PubMed2006

A review of evidence on the conceptual elements informing client-centred practice.

BACKGROUND: Client-centred practice is a central concept in occupational therapy in Canada. Since 1980, Canadian occupational therapy publications have discussed the elements of a client-centred practice approach. PURPOSE: The purpose of this paper is to enhance the understanding of key elements of a client-centred approach and to highlight the implications for practice that arise from this discussion. METHOD: Literature about client-centred practice in health care from 1990 - 2005 was reviewed regarding thoughts and ideas about client-centred practice. The content was analyzed for thematic focus about client-centred practice conceptual ideas and their influence on practice. RESULTS: Thematic conceptual elements emerging from the review include an overarching theme of power, with important underpinning themes of listening and communicating, partnership, choice, and hope. Selected definitions of client-centred practice and the link to best practice provide the context for the presentation of the concepts and recommendations for the implementation of client-centred practice. PRACTICE IMPLICATIONS: The paper concludes with a discussion of practice implications through the presentation of questions for therapists to consider as a quick reference tool and suggestions for further research and dialogue concerning client-centred practice.

Canada↗
PubMed2006

Mysteries and mazes: parents' experiences of children with developmental coordination disorder.

BACKGROUND: Children with Developmental Coordination Disorder (DCD) represent 5 to 6% of the school-aged population and are often seen by occupational therapists in the school system. Although a family-centred approach has been identified as best practice in pediatric care, the perspective of parents is often overlooked both in research and in practice. PURPOSE AND METHOD: In this study, a qualitative, phenomenological approach was adopted to explore the insights and experiences of 13 parents of children with DCD. Each parent participated in two in-depth interviews and completed a set of questionnaires. RESULTS: Analysis of the study findings led to three primary themes that captured the experience of parents as they attempted to understand and get help for their child. The theme of unravelling the mystery highlights parents' impressions of their child's difficulties. The second theme of negotiating the maze refers to the many pathways followed by families as they sought to affirm their perceptions and obtain services for their child and the final theme of parenting dilemmas underscores some of the common challenges faced by parents in trying to deal with their child's limitations. PRACTICE IMPLICATIONS: For occupational therapists, the study findings illustrate the importance of focusing on occupational performance issues for children with DCD, facilitating the understanding of parents, and the need for early intervention.

Adolescent↗
PubMed2006

A critical appraisal of literature reviews about the transition to adulthood for youth with disabilities.

A critical appraisal of five review articles on the transition to adulthood for youth with disabilities was conducted to identify evidence about (1) the factors that help or hinder the transition process, and (2) "what's working" in transition services. The appraisal identified a number of important "success" factors and elements of service delivery that are worthy of consideration by service providers and researchers. These include the need for skill development of youth with disabilities, environmental supports, and an individualized approach to service delivery. All of the reviews identified the need for more evidence to support the implementation and evaluation of best practice models/approaches that address the complex issue of the transition from paediatric to adult services for youth with disabilities.

Adolescent↗
PubMed2006

The transition study: a look at youth and adults with cerebral palsy, spina bifida and acquired brain injury.

A group of 100 adults and 190 youth who have cerebral palsy (CP), spina bifida (SB), and acquired brain injuries from childhood (ABIc) participated in a multi-method study focused on the transition to adult health care. The results show that 95% of youth and 61% of adults were living with their parents; 23% of the youth and 55% of adults were employed; and 60% of youth and 42% of adults reported "excellent" or "very good" health. The lowest health scores were reported by adults with SB. These findings provide a starting point for examining health issues specific to youth and young adults with CP, SB, and ABIc.

Adolescent↗
PubMed2006

Creating connections: a community capacity-building project with parents and youth with disabilities in transition to adulthood.

The transition to adulthood presents many challenges for youth with disabilities and their families. Barriers in the environment often limit the full inclusion of these youth in daily community life. The purpose of this paper is to describe a community capacity-building (CCB) approach to facilitating the transition to adulthood for youth with developmental disabilities and their families. A pilot project that used a CCB approach with this population in one community in southcentral Ontario is described. The results of a qualitative, participatory evaluation demonstrate the benefits and challenges of this approach, with themes of increased community connections for youth and a greater awareness of their strengths and capacities. The perceived outcomes of the participants and the "lessons learned" for future initiatives using a CCB approach with different populations are discussed, as well as the fit between community capacity-building and occupational therapy. This pilot project demonstrates that a CCB approach has the potential to assist youth with disabilities to participate within their own communities.

Adolescent↗
PubMed2005

Effective rehabilitation for children and adolescents with brain injury: evaluating and disseminating the evidence.

OBJECTIVE: To develop and evaluate literature reviews of the effectiveness of rehabilitation interventions for children with brain injury. DESIGN: We wrote 6 research summaries, which were evaluated by study participants. SETTING: Community. PARTICIPANTS: A convenience sample that included 18 parents of children with brain injury, 18 service providers, and 12 insurance industry representatives. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Questionnaire designed for the evaluation of printed material. RESULTS: Few articles were found that focused on evaluation of rehabilitation interventions for children with brain injury. Study participants were representative of a broad range of educational and professional backgrounds. Before reading the research summaries, service providers reported greater familiarity with the topics than did parents and insurance representatives. Despite this finding, there were no significant between-group differences in the format, content, and impact ratings provided by the 3 participant groups. CONCLUSIONS: Research summaries written in a clear, straightforward manner are appropriate for people with different educational and professional backgrounds. Further research into the effectiveness of rehabilitation interventions is needed to support informed decision-making that results in the best outcomes for children with brain injury.

Adolescent↗
PubMed2005

Home and community occupational therapy for children and youth: a before and after study.

BACKGROUND: There has been an increased focus on home care service provision in recent years, yet there are few data available about the provision of home and community occupational therapy for children and youth. PURPOSE: To evaluate key elements of a service provision model for home care occupational therapy in terms of occupational performance outcomes, perception of care and cost. METHODS: Eleven centres in Ontario and Quebec recruited 167 children and youth up to 18 years of age to a before and after study of occupational therapy services in the home and community. Occupational performance, quality of life and costs were measured at baseline and study end. Perception of care was measured at study completion. RESULTS: A statistically and clinically significant improvement in occupational performance was demonstrated (p < 0.001). The clients' families gave high ratings to the process of care provided by the occupational therapists. These data did not demonstrate a clear relationship between amount of service, cost and occupational performance outcome. PRACTICE IMPLICATIONS: Children receiving home and community occupational therapy services change in their occupational performance abilities. These changes are not directly related to the amount or focus of the occupational therapy services.

Adolescent↗
PubMed2005

Targeted applications of the Canadian Occupational Performance Measure.

BACKGROUND: The Canadian Occupational Performance Measure (COPM) is an outcome measure designed to assess performance and satisfaction with occupation. It was developed to coincide with the occupation-focused, client-centred Canadian Model of Occupational Performance. PURPOSE: The COPM has been a feature of the occupational therapy landscape for approximately 15 years and has pervaded the consciousness of occupational therapists around the world. In this paper, we examine issues associated with application of the COPM in targeted clinical and non-clinical situations. RESULTS: The paper suggests considerations required to ensure that the highest quality of information is derived from the COPM in all situations. PRACTICE IMPLICATIONS: Although the paper emphasizes the centrality of the client-centred approach, it also demonstrates the flexibility and adaptability of the COPM to different situations, clients, settings and purposes.

Activities of Daily Living↗
PubMed2005

Editorial.

Explore the source record for details and available documents.

Child↗
PubMed2004

The Canadian Occupational Performance Measure: a research and clinical literature review.

BACKGROUND: It has been 13 years since the Canadian Occupational Performance Measure (COPM) was published. In that time there has been a remarkable growth in its acceptance as an outcome measure within the occupational therapy practice and research. PURPOSE: The purpose of this paper is to review the emerging research and clinical literature related to the COPM since 1994 and to document its impact upon occupational therapy practice and research throughout the world. METHOD: A systematic search was conducted to the professional and research literature in English publications (primarily occupational therapy). Eighty-eight papers that met the inclusion criteria were reviewed, 86% of which examined the COPM in relation to its psychometric properties (19 papers), research outcomes (33 papers) or practice (33 papers). RESULTS: Overall, although there are a few limitations discussed in the review, the conclusion is that the COPM is a valid, reliable, clinically useful and responsive outcome measure acceptable for occupational therapist practitioners and researchers. PRACTICE IMPLICATIONS: The COPM is used with a wide variety of clients, enables client-centred practice, facilitates evidence-based practice and supports outcomes research.

Biomedical Research↗
PubMed2003

Selecting outcomes measures in children's rehabilitation: a comparison of methods.

OBJECTIVE: To evaluate the effects of using a computerized self-directed software program, All About Outcomes, to facilitate decisions about the most appropriate outcome measures to use in specific pediatric rehabilitation scenarios. DESIGN: A randomized controlled trial using a crossover design to test the accuracy, time, and ease of use of the decision-making outcome software in selecting 3 potential clinical outcome measures for each of 2 clinical scenarios. SETTING: The trial was conducted in a university school of rehabilitation science in Ontario, Canada. PARTICIPANTS: Thirty student occupational therapists and physiotherapists enrolled at the university participated in the trial. INTERVENTIONS: Six clinical scenarios were created and paired into 3 sets with similar levels of difficulty. Participants were randomly assigned to select the 3 most appropriate outcome measures for 2 scenarios in 1 of the 3 sets by using the library or the software program. The order of the method of searching was randomized to control for order effect. MAIN OUTCOME MEASURES: Accuracy in identifying appropriate outcome measures, time for the search, ease of searching, and satisfaction with the search process were measured for all participants. Accuracy was rated by 2 independent raters who were unaware of the search method used to identify the outcome measures. RESULTS: In comparison to the library search method, the software search method was significantly more accurate, took less time, and was rated as easier in identifying appropriate outcome measures for the clinical scenarios. Users were also significantly more satisfied with the software searching method. The accuracy of the software method was not affected by whether participants used it first or second. However, the accuracy of the library search method improved if it was used after the software method. CONCLUSIONS: Software improved the accuracy and ease of identifying outcome measures for rehabilitation students. Further research is needed to evaluate whether identifying appropriate measures leads to an increased use of outcome measures in clinical practice.

Child↗
PubMed2003

The effects of family-centred functional therapy on the occupational performance of children with cerebral palsy.

BACKGROUND: Family-Centred Functional Therapy (FCFT) is a comprehensive approach to paediatric occupational therapy that considers and addresses the skills of the child, the requirements of functional tasks and the elements within the tasks environment, including family goals and preferences. PURPOSE: The purpose of the present study was to determine if interventions based on FCFT, but limited to addressing elements of the task and environment, would improve task performance. METHOD: A single subject, multiple baseline design was applied to three children, for three tasks each. Tasks were selected by parents and measured during baseline and intervention phases. RESULTS: Results indicate that for each child at least one of the two tasks for which intervention was provided demonstrated improved performance. Parents reported a clinically significant improvement in satisfaction with their children's performance in the tasks that were addressed. PRACTICE IMPLICATIONS: This study provides preliminary evidence of the effectiveness of the FCFT approach.

Cerebral Palsy↗
PubMed2003

A conceptual model of the factors affecting the recreation and leisure participation of children with disabilities.

Participation in everyday activities is considered to be a vital part of children's development, which is related to their quality of life and future life outcomes. Research studies indicate that children with disabilities are at risk for lower participation in ordinary activities at home and in the community. This article presents a conceptual model of 11 environmental, family, and child factors that are thought to influence children's participation in recreation and leisure activities. The article outlines the existing evidence for the influence of these factors on one another and on children's participation. The review encompasses four bodies of literature: the participation of children or adults with disabilities, the risk and resilience of children facing adversity, the determinants of leisure and recreation activities, and the factors influencing physical activity and exercise. The proposed model is expected to be a useful tool for guiding future research studies and for developing policies and programs for children with disabilities and their families.

Child↗