Conceptualizing a Strategy to Improve Transitions between Healing and Recovery Services for People with Spinal Cord Injuries in Alberta
Bibliographic record
Abstract
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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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.010 | 0.006 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.024 | 0.014 |
| Scholarly communication | 0.010 | 0.004 |
| Open science | 0.005 | 0.011 |
| Research integrity | 0.004 | 0.004 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".