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Overactive Bladder 5 years After the Mid-Urethral Sling Tensioning (MUST) Trial: Prospective Cohort Study Following a Multi-centre Randomized Controlled Trial in Alberta, Canada
(2024-06-21) Hughes, Taylor Ann Marie; Brennand, Erin; Metcalfe, Amy; Fidler-Benaoudia, Miranda; Fiest, Kirsten
Background: Mid-urethral slings (MUS) are the preferred surgical treatment for female stress urinary incontinence. However, a small subset of MUS patients experiences overactive bladder (OAB) requiring further treatment. The Mid-Urethral Sling Tensioning (MUST) Trial was a randomized controlled trial that compared MUS outcomes for intraoperative tensioning techniques: the Babcock clamp and Mayo Scissor. The trial provides an opportunity to gauge OAB after MUS through follow-up of a randomized controlled trial using patient reported outcomes and administrative health data. Objective: To assess the burden of overactive bladder (OAB) 5 years after MUS insertion using medication, surgical intervention and patient-reported OAB outcomes, and to compare OAB outcomes by MUS tensioning technique. Methods: MUST trial participants provided 5-year post-MUS data via patient-reported questionnaires linked to administrative health data. OAB burden was assessed by analyzing changes in pre- and 5-year post-op scores on validated OAB questionnaires, post-op OAB medication use and incidence of bladder onabotulinumtoxinA procedures. Results: Of the 318 MUST trial participants, 260 completed questionnaire data at 5 years; among them, 225 (86.9%) reported baseline OAB symptoms and 211 (81.5%) post-MUS. 127 (48.9%) experienced clinically significant worsening in at least one OAB symptom: 19.0% in daily urination, 22.5% in urgency, 18.1% in urine leakage, 23.9% in nightly urination; conversely, 38.7%, 40.3%, 47.6%, and 23.9% showed a significant improvement in these respective domains. Of total participants, 21.4% used OAB medication with a median start at 151 days post-op for a median duration of 319 days. Seven underwent an onabotulinumtoxinA procedure. In comparison of groups, the Babcock clamp tensioning technique provided less frequent nightly urination (19.5% versus 28.0%) and less leakage (11.3% versus 24.9%) than the Mayo Scissor. Conclusions: After MUS, 72.3% of patients experienced improvement of at least 1 OAB symptom, 79.2% were stable, and 48.9% reported worsening. 20% of patients trialed OAB medications, but by study end 75% had discontinued. This information advises surgeons and their patients of realistic expectations for OAB outcomes after MUS. Surgeons can freely choose tensioning techniques, expecting no significant difference in OAB outcomes.
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Open Access
Designing strategies to support Implementation of iNtensive Therapy for Early Reach through PLAY (INTERPLAY) for young children with cerebral palsy: a study protocol
(2024-06-18) Hilderley, Alicia; Cassidy, Christine; Reist-Asencio, Sandra; Tao, Chelsea; Tao, Stephen; McCoy, Susan; Vurrabindi, Divya; O’Grady, Kathleen; Herrero, Mia; Cambridge, Liz; Leverington, Eleanor; Micek, Victoria; Andersen, John; Fehlings, Darcy; Kirton, Adam
Abstract Background Intensive manual therapy is important for improving lifelong upper limb motor outcomes for infants and toddlers with cerebral palsy. This play-based therapy is delivered by caregivers who are coached by occupational therapists. However, access to this therapy is very limited for Canadian children with cerebral palsy younger than two years old. This project aims to first identify barriers and facilitators and then design implementation strategies to support early intensive manual therapy delivery for infants and toddlers with cerebral palsy across Canada. Methods A mixed-methods sequential explanatory design will be used with four consecutive phases. The updated Consolidated Framework for Implementation Research will guide the study. Quantitative data will be collected from a survey in Phase One. Participants will be recruited from three groups: (1) Caregivers of children with cerebral palsy six years old and younger who are eligible for manual therapy; (2) occupational therapists who treat children with cerebral palsy; and (3) healthcare administrators or people responsible for managing pediatric occupational therapy programs. In Phase Two, quantitative data from the survey will be used to map to implementation strategies known to be effective at addressing the identified modifiable barriers and facilitators. Phase Three will collect qualitative data from semi-structured interviews for the purpose of explaining Phase One quantitative findings in greater depth, and for understanding the appropriateness of strategies identified in Phase Two. The participant recruitment strategy and interview guide content for Phase Three will be informed by results of Phase One. Phase Four will use a modified nominal group technique to refine and prioritize an implementation strategy toolbox. Results will be widely disseminated to knowledge users to provide them with tailorable strategies to increase delivery of early intensive manual interventions. Discussion This study will provide a comprehensive understanding of the barriers and facilitators to implementation of early intensive manual therapy for young children with cerebral palsy in Canada. A toolbox of evidence-based and tailorable implementation strategies will be disseminated nationally to support uptake of early intensive manual therapy into clinical practice for young children with cerebral palsy.
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Open Access
Co-designing discharge communication interventions for mental health visits to the pediatric emergency department: a mixed-methods study
(2024-06-21) Ali, Amber Z.; Wright, Bruce; Curran, Janet A.; Fawcett-Arsenault, Joelle; Newton, Amanda S.
Abstract Background Discharge communication is essential to convey information regarding the care provided and follow-up plans after a visit to a hospital emergency department (ED), but it can be lacking for visits for pediatric mental health crises. Our objective was to co-design and conduct usability testing of new discharge communication interventions to improve pediatric mental health discharge communication. Methods The study was conducted in two phases using experience-based co-design (EBCD). In phase 1 (Sep 2021 to Jan 2022), five meetings were conducted with a team of six parents and two clinicians to co-design new ED discharge communication interventions for pediatric mental health care. Thematic analysis was used to identify patterns in team discussions and participant feedback related to discharge communication improvement and the Capability, Opportunity, Motivation, Behavior (COM-B) model was used to identify strategies to support the delivery of the new interventions. After meeting five, team members completed the Public and Patient Engagement Evaluation Tool (PPEET) to evaluate the co-design experience. In phase 2 (Apr to Jul 2022), intervention usability and satisfaction were evaluated by a new group of parents, youth aged 16–24 years, ED physicians, and nurses (n = 2 of each). Thematic analysis was used to identify usability issues and a validated 5-point Likert survey was used to evaluate user satisfaction. Evaluation results were used by the co-design team to finalize the interventions and delivery strategies. Results Two discharge communication interventions were created: a brochure for families and clinicians to use during the ED visit, and a text-messaging system for families after the visit. There was high satisfaction with engagement in phase 1 (overall mean PPEET score, 4.5/5). In phase 2, user satisfaction was high (mean clinician score, 4.4/5; mean caregiver/youth score, 4.1/5) with both interventions. Usability feedback included in the final intervention versions included instructions on intervention use and ensuring the text-messaging system activates within 12–24 h of discharge. Conclusions The interventions produced by this co-design initiative have the potential to address gaps in current discharge practices. Future testing is required to evaluate the impact on patients, caregivers, and health care system use after the ED visit.
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Open Access
Impact of maternal depression and anxiety on immunization status of children: a prospective cohort study
(2024-06-17) MacDonald, Shannon E.; Dhungana, Manisha; Stagg, Victoria; McDonald, Sheila; McNeil, Deborah; Kellner, James D.; Tough, Suzanne; Saini, Vineet
Abstract Background Maternal depression and anxiety can have a detrimental impact on birth outcomes and healthy child development; there is limited knowledge on its influence on immunization schedule adherence. Therefore, the objectives of this study were to determine the impact of maternal depression and anxiety in the perinatal period on prolonged vaccine delay of childhood vaccines. Methods In this prospective cohort study, we analyzed linked survey and administrative data of 2,762 pregnant women in Calgary, Alberta, Canada. Data were collected at two time-points: prenatal (< 25 weeks of gestation) and postpartum (4 months postpartum). We used multivariable logistic regression to examine the association between depression and anxiety with prolonged immunization delay, adjusting for covariates. Results In multivariable analysis, maternal depression at either time point was not associated with prolonged delay for DTaP-IPV-Hib (OR 1.16, 95% CI 0.74–1.82), MMR/MMRV (OR 1.03, 95% CI 0.72–1.48), or all routine childhood vaccines combined (OR 1.32, 95% CI 0.86–2.04). Maternal anxiety at either time point was also not associated with prolonged delayed for DTaP-IPV-Hib (OR 1.08, 95% CI 0.77–1.53), MMR/MMRV (OR 1.07, 95% CI 0.82–1.40), or all vaccines combined (OR 1.00, 95% CI 0.80–1.26). In both the depression and anxiety models, children of Canadian-born mothers had higher odds of prolonged delay, as did those with low-income mothers. Conclusion Health care providers can be reassured that maternal depression and anxiety do not appear to influence maternal commitment to routine immunization. Findings suggested that low income and household moves may influence adherence to vaccine schedules and health care providers may want to provide anticipatory guidance to these families.
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Open Access
Well-being approaches targeted to improve child and youth health post-COVID-19 pandemic: a scoping review
(2024-06-21) Moss, Stephana J.; Sriskandarajah, Cynthia; Brundin-Mather, Rebecca; Cherak, Michal S.; Mizen, Sara J.; Stelfox, Maia; Halperin, Donna; Halperin, Scott; Ahmed, Sofia B.; Lorenzetti, Diane L.; Smith, Stacie; Harley, Micaela; Tutelman, Perri R.; Birnie, Kathryn A.; Anglin, Melanie C.; Stelfox, Henry T.; Fiest, Kirsten M.; Racine, Nicole; Parsons Leigh, Jeanna
Abstract Background Our previous work synthesized published studies on well-being interventions during COVID-19. As we move into a post-COVID-19 pandemic period there is a need to comprehensively review published strategies, approaches, and interventions to improve child and youth well-being beyond deleterious impacts experienced during COVID-19. Methods Seven databases were searched from inception to January 2023. Studies were included if they: (1) presented original data on an approach (i.e., approach applied) or (2) provided recommendations to inform development of a future approach (i.e., approach suggested), (3) targeted to mitigate negative impacts of COVID-19 on child and youth (≤18 year) well-being, and (4) published on or after December 2019. Results 39 studies (n = 4/39, 10.3% randomized controlled trials) from 2021 to 2023 were included. Twenty-two studies applied an approach (n = 22/39, 56.4%) whereas seventeen studies (n = 17/39, 43.6%) suggested an approach; youth aged 13–18 year (n = 27/39, 69.2%) were most frequently studied. Approach applied records most frequently adopted an experimental design (n = 11/22, 50.0%), whereas approach suggested records most frequently adopted a cross-sectional design (n = 13/22, 59.1%). The most frequently reported outcomes related to good health and optimum nutrition (n = 28/39, 71.8%), followed by connectedness (n = 22/39, 56.4%), learning, competence, education, skills, and employability (n = 18/39, 46.1%), and agency and resilience (n = 16/39, 41.0%). Conclusions The rapid onset and unpredictability of COVID-19 precluded meaningful engagement of children and youth in strategy development despite widespread recognition that early engagement can enhance usefulness and acceptability of interventions. Published or recommended strategies were most frequently targeted to improve connectedness, belonging, and socialization among children and youth.