Conceptualizing a Strategy to Improve Transitions between Healing and Recovery Services for People with Spinal Cord Injuries in Alberta
Notice bibliographique
Résumé
Spinal cord injuries (SCI) result from damage to the spinal cord and may result in chronic conditions that require ongoing management. Each person experiences a unique set of impairments or disabilities after SCI, depending on the spinal level and severity of their injury. Individuals with complex chronic health conditions such as SCI frequently require care across multiple healthcare settings and from a diverse array of healthcare providers. However, these interactions are often fragmented and lack coordination, resulting in significant challenges during transitions in care and increasing the risk of suboptimal health outcomes. Consequently, people living with SCI are vulnerable to experiencing gaps during their transitions between the healthcare system and the community throughout their lifespan. For instance, one of the most critical gaps experienced by people with SCI is the lack of availability and or access to rehabilitation interventions that foster healing and recovery, such as activity-based therapy. My PhD thesis aims to build a comprehensive understanding of the current Transitions in Care practices in Alberta and propose a way forward for the transitions related to services focused on healing and recovery. The objectives of my thesis are: Objective 1: To identify needs to improve the Transitions in Care for people living with SCI in Alberta through understanding their experiences, along with perceptions from their family members and providers. Objective 2: To identify and describe key elements to facilitate the creation and implementation of a Transitions in Care model for SCI in Alberta through the implementation of a community-based participatory research strategy guided by the U process. Objective 3: To engage SCI stakeholders through a community-based participatory research strategy guided by the U process to: (a) Explore perspectives on how programs delivering healing and recovery services, especially activity-based therapy, are being delivered and accessed in Alberta. (b) Define a strategy to improve access and continuity of activity-based therapy services for people with SCI in Edmonton. These objectives are addressed by the three papers included in the dissertation. The first paper (chapter 2) identified nine overarching themes that encompass the TiC experiences for people with SCI, their family members and care providers. These themes allowed us to identify key areas of opportunity to improve the transitions of people living with SCI in Alberta, ultimately helping improve their Transitions in Care experiences. The Second paper presents the result of a community engagement process with a diverse group of SCI stakeholders, who worked together to successfully identify five elements to inform the development of a SCI system of services to improve the TiC for people living in Alberta. These elements include: 1) resources, 2) person-centred care, 3) building a community of practice, 4) training to build life skills, and 5) transitional housing. These key elements will inform the development of a TiC model that integrates an SCI system of services and improves their continuity and integration in Alberta. The third paper revealed that advancing healing and recovery after SCI through practices such as adapted exercise, especially activity-based therapy, requires a fundamental shift towards a recovery-oriented, patient-centred approach, integrated through a strong learning organization system. To unlock the full potential of activity-based therapy, healthcare providers must move beyond fragmented, compensatory rehabilitation models and embrace integrated, collaborative networks that ensure continuity of healing and recovery interventions across all settings, thereby enabling people with SCI to achieve the highest possible quality of life. The work completed as part of this dissertation marks a significant step forward towards improving the SCI healthcare system in Alberta. It is the first effort of its kind to improve TiC experiences for people with SCI and will serve as a blueprint for other regions within Canada and internationally. At the system micro level, the work on this thesis empowered people with SCI and their caregivers by enabling their experiences to inform improvements in the current Transitions in Care. At the system meso level, it supported SCI healthcare and community organizations by providing avenues to recognize their collective strength and opportunities for better integration. Finally, at the system macro level, this work helped re-conceptualize the current state of SCI programs and services as a system capable of taking concrete steps to become an efficient learning organization, thereby enhancing their efficiency and effectiveness.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,010 | 0,006 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,002 | 0,002 |
| Études des sciences et des technologies | 0,024 | 0,014 |
| Communication savante | 0,010 | 0,004 |
| Science ouverte | 0,005 | 0,011 |
| Intégrité de la recherche | 0,004 | 0,004 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».