Current & Recent Projects
REACT: Developing Theory-Based Interventions to Increase Clinical Measurement of Reactive Balance in Adults at Risk of Falls
Reactive balance is a critical skill for fall avoidance, but isn’t regularly assessed in clinical practice. This study attempts to implement a clinically feasible measure of reactive balance in three Ontario rehabilitation hospitals. In addition, this study addresses a gap in evidence for effective implementation interventions in rehabilitation settings. We have published a case report describing how the Theoretical Domains Framework (TDF) was used to develop an intervention to increase clinical measurement of reactive balance among physiotherapists who treat adults at risk of falls.
Core Outcome Set Development in Balance Exercise & Falls Prevention
Balance is a complex skill necessary to mobility and fall avoidance. There is a great interest in identifying best practices for maintaining and improving balance. Exercise plays a major role in balance and is a key component of fall interventions. However, putting together the best prescription for balance training is difficult, because over 60 different balance measures exist in the literature, and their use varies among clinical practitioners.
There is a need for consistency in standing balance measurement in both research and practice. One approach to achieving standardization is the development of a core outcome set (COS) for measuring standing balance. A COS is a recommended minimum set of outcomes or outcome measures for a particular health construct, condition, or population wherein the results should be reported for all trials related to that issue. COS recommendations do not imply that measurement be restricted to the COS, but rather that the COS forms a consistent component of measurement, to which specific evaluation tools can be added.
Through this initiative, we developed recommendations for a COS for measuring balance in research and practice in adult populations. The recommendations were developed with a consensus-based approach with 14 experts from around the world. Fifty-six validated balance measures used in the past 5 years were considered for the COS – of these, 2 measures reached consensus for recommendation. The expert panel recommended that (at a minimum), either the Berg Balance Scale (BBS) or Mini Balance Evalution Systems Test (Mini BESTest) be used when measuring standing balance in adult populations.
This project reflects the first attempt to make COS recommendations for the field of balance research and practice, and should be both viewed as a starting point and revisited in the future. The BBS and Mini-BESTest received the required votes because they collectively best represent the objectives of the standing balance COS. The expert panel noted that the BBS may be considered more suitable for lower functioning adults, while the Mini BESTest is a more comprehensive measure of balance.
Valuing All Voices: Towards a More Inclusive Framework for Patient Engagement in Health Research
In the Spring of 2015, the George and Fay Yee Centre for Healthcare Innovation hosted a workshop titled Patients as Research Partners in Manitoba that brought together 50 stakeholders from across Manitoba (including patients, caregivers, community researchers, healthcare practitioners, and policy-makers) for a one-day, face-to-face meeting. The purpose of the meeting was to explore how stakeholders conceptualize patient engagement, identify barriers and facilitators to patient engagement in health research in Manitoba, and prioritize next steps for a provincial patient engagement strategy.
Participants provided highly valuable insight into the climate of patient engagement in Manitoba, to which we responded by beginning to explore various practical and theoretical approaches to build a more inclusive framework for the involvement of patients and the public in health research in Manitoba. We developed an enhanced Valuing All Voices Framework, for which we have received a CIHR Collaborative Patient Engagement Grant that will be used to validate this framework through discussion groups and integrated knowledge translation activities with key stakeholders. This framework will help inform the development of a set of tools to assist researchers and the public in engaging in inclusive, safe, meaningful, and authentic engagement relationships.