Dorcas E Beaton

Institute for Work and Health, Toronto, Ontario, Canada

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Publications (227)622.17 Total impact

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    ABSTRACT: As spinal cord injury (SCI) trials begin to involve subjects with acute cervical SCI, establishing the property of an upper limb outcome measure to detect change over time is critical for its usefulness in clinical trials. The objectives of this study were to define responsiveness, sensitivity and minimally detectable difference (MDD) of the Graded Redefined Assessment of Strength, Sensibility, and Prehension (GRASSP). An observational, longitudinal study was conducted. International Standards of Neurological Classification of SCI (ISNCSCI), GRASSP, Capabilities of Upper Extremity Questionnaire (CUE-Q), and Spinal Cord Independence Measure (SCIM) were administered 0-10 days, 1, 3, 6, and 12 months post injury. Standardized Response Means (SRM) for GRASSP and ISNCSCI measures were calculated. Longitudinal construct validity was calculated using Pearson correlation coefficients. Smallest real difference (SRD) for all subtests was calculated to define the MDD values for all GRASSP subtests. Longitudinal construct validity demonstrated GRASSP and all external measures to be responsive to neurological change for 1 year post-injury. SRM values for the GRASSP subtests ranged from 0.25 to 0.85 units greater than that for ISNCSCI strength and sensation, SCIM-SS, and CUE-Q. MDD values for GRASSP subtests ranged from 2-5 points. GRASSP demonstrates good responsiveness and excellent sensitivity that is superior to ISNCSCI and SCIM III. MDD values are useful in the evaluation of interventions in both clinical and research settings. The responsiveness and sensitivity of GRASSP make it a valuable condition-specific measure in tetraplegia, where changes in upper limb neurological and functional outcome are essential for evaluating the efficacy of interventions.
    Journal of neurotrauma 11/2015; DOI:10.1089/neu.2015.4217 · 3.71 Impact Factor
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    ABSTRACT: Objective: We examined what was known about individuals in Canada who were assessed as being at moderate risk for future fracture. Methods: A scoping review was conducted. Eligible articles were Canadian studies published from 2010 onwards reporting on primary data that included patients at moderate risk for future fracture. We limited the search to Canada as fracture risk categorization is unique to each country. Studies were identified by searching relevant databases. Two reviewers independently reviewed titles and abstracts to determine each study's eligibility. General information about each study, demographic information about the moderate risk groups (including tool used to determine moderate risk (Fracture Risk Assessment Tool (FRAX), Canadian Association of Radiologists and Osteoporosis Canada (CAROC)), and outcomes (number of patients: recommended treatment, prescribed treatment, initiating treatment, persisting with treatment after six months, who re-fractured, who died) were documented. Results: We identified 1193 papers which were further screened for eligibility. Of the 1193 identified, 7 were eligible for the review but only 4 articles contained demographic or outcome data on moderate risk patients. In one study, 1.8% of moderate risk patients died over a mean 5.3 years of observation and in three studies, the risk of fracture was 5.9% over a median of 3 years of follow-up, 8.3% over a mean of 5.4 years, and 14.7% over 10 years of follow-up. Conclusion: There is a wide knowledge gap in the literature concerning individuals who are assessed as moderate risk for future fracture in Canada.
    Health 11/2015; 07(05):514-520. DOI:10.4236/health.2015.75061 · 0.51 Impact Factor
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    ABSTRACT: Objective: Analysis of clinical documents such as bone mineral density (BMD) reports is an important component of program evaluation because it can provide insights into the accuracy of assessment of fracture risk communicated to patients and practitioners. Our objective was to compare fracture risk calculations from BMD test reports to those based on the 2010 Canadian guidelines. Methods: We retrieved BMD reports from fragility fracture patients screened through a community hospital fracture clinic participating in Ontario's Fracture Clinic Screening Program. Fracture risk was determined according to the 2010 Canadian guidelines using age, sex, and T-score at the femoral neck, in addition to three clinical factors. Three researchers classified patients' fracture risk until consensus was achieved. Results: We retrieved reports for 17 patients from nine different BMD clinics in the Greater Toronto Area. Each patient had a different primary care physician and all BMD tests were conducted after the 2010 Canadian guidelines were published. The fracture risk of 10 patients was misclassified with 9 of the 10 reports underestimating fracture risk. Nine reports acknowledged that the prevalence of a fragility fracture raised the risk category by one level but only four of these reports acknowledged that the patient had, or may have sustained, a fragility fracture. When we raised fracture risk by one level according to these reports, eight patients were still misclassified. Fracture risk in the majority of these patients remained underestimated. Inconsistent classification was found in the majority of cases where reports came from the same clinic. Four reports described risk levels for two different types of risk. Conclusions: More than half of patients received BMD reports which underestimated fracture risk. Bone health management recommendations based on falsely low fracture risk are likely to be sub-optimal.
    Health 11/2015; 07(05):566-571. DOI:10.4236/health.2015.75067 · 0.51 Impact Factor
  • Maja Stupar · Pierre Côté · Dorcas E. Beaton · Eleanor Boyle · J David Cassidy ·
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    ABSTRACT: Objective: The purpose of this study was to determine the test-retest reliability and the Minimal Detectable Change (MDC) of the Whiplash Disability Questionnaire (WDQ) in individuals with acute whiplash-associated disorders (WADs). Methods: We performed a test-retest reliability study. We included insurance claimants from Ontario who were at least 18years of age, within 21days of their motor vehicle collision and diagnosed as having acute WAD grades I to III. The WDQ, a 13-item questionnaire scored from 0 (no disability) to 130 (complete disability), was administered to all participants at baseline and by telephone 3days later. We computed the intraclass correlation coefficient (model 2,1) and the MDC with 95% confidence intervals (CIs; MDC95). Results: The mean (SD) age of the 66 participants was 41.6 (12.7) years and 71.2% were female. Twenty-nine percent had WAD I and 71.2% had WAD II. Time since injury ranged from 0 to 19 days. The mean (SD) baseline WDQ score was 49.3 (28.8) and 46.5 (29.8) 3days later. The intraclass correlation coefficient for the WDQ total score was 0.89 (95% CI, 0.85-0.92) in the entire sample and 0.83 (95% CI, 0.69-0.93) for the 15 participants reporting no change in neck pain. The MDC95 of the WDQ was 21.4 (SD = 14.9) for participants reporting no change. Conclusion: The WDQ was reliable in individuals with acute WAD. There is 95% confidence that a change of approximately one-sixth of the total score is beyond the daily variation of a stable condition. This level of measurement error must be taken into consideration when interpreting change in WDQ scores.
    Journal of manipulative and physiological therapeutics 11/2015; DOI:10.1016/j.jmpt.2015.10.003 · 1.48 Impact Factor
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    ABSTRACT: Objective: To assess the current state of reporting of pain outcomes in Cochrane reviews on chronic musculoskeletal painful conditions and to elicit opinions of patients, healthcare practitioners, and methodologists on presenting pain outcomes to patients, clinicians, and policymakers. Methods: We identified all reviews in the Cochrane Library of chronic musculoskeletal pain conditions from Cochrane review groups (Back, Musculoskeletal, and Pain, Palliative, and Supportive Care) that contained a summary of findings (SoF) table. We extracted data on reported pain domains and instruments and conducted a survey and interviews on considerations for SoF tables (e.g., pain domains, presentation of results). Results: Fifty-seven SoF tables in 133 Cochrane reviews were eligible. SoF tables reported pain in 56/57, with all presenting results for pain intensity (20 different outcome instruments), pain interference in 8 SoF tables (5 different outcome instruments), and pain frequency in 1 multiple domain instrument. Other domains like pain quality or pain affect were not reported. From the survey and interviews [response rate 80% (36/45)], we derived 4 themes for a future research agenda: pain domains, considerations for assessing truth, discrimination, and feasibility; clinically important thresholds for responder analyses and presenting results; and establishing hierarchies of outcome instruments. Conclusion: There is a lack of standardization in the domains of pain selected and the manner that pain outcomes are reported in SoF tables, hampering efforts to synthesize evidence. Future research should focus on the themes identified, building partnerships to achieve consensus and develop guidance on best practices for reporting pain outcomes.
    The Journal of Rheumatology 10/2015; 42(10). DOI:10.3899/jrheum.141423) · 3.19 Impact Factor
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    ABSTRACT: Objectives: This study sought to: (i) explore the impact of mood disorders (such as depression, bipolar disorder, mania, or dysthymia) and five age-related chronic physical conditions (arthritis, back pain, diabetes, heart disease, and hypertension) on presenteeism (as indicated by self-reported activity limitations at work), and (ii) examine how mood disorders interact with each physical condition to affect this work outcome. Methods: Using Canadian Community Health Survey (CCHS) data, we modeled the relationships between self-reported restrictions at work and each health condition. We then calculated synergy indices (SI) for the interaction between mood disorders and each of the five physical conditions. Results: All six health conditions were associated with presenteeism. The strongest association was observed for back pain [prevalence ratio (PR) 2.70, 95% confidence interval (95% CI) 2.57-2.83] and the weakest for hypertension (PR 1.18, 95% CI 1.11-1.25). The unadjusted SI indicated no interactions between mood disorders and any of the physical conditions, while the adjusted SI indicated statistically significant interactions between mood disorders and each of the five physical conditions. The statistically significant adjusted interactions were in a negative direction, such that having a mood disorder concurrent with a chronic physical condition was associated with a lower burden of presenteeism than expected. Post-hoc analyses revealed that this unexpected finding was attributable to adjustment for other co-morbid health conditions, particularly arthritis and back pain. Conclusions: Our results suggest that targeting chronic physical conditions or mood disorders may be productive in reducing presenteeism. The combined effect on presenteeism when the two types of conditions occur simultaneously is similar to the additive effect of these conditions when each occurs in isolation.
    Scandinavian Journal of Work, Environment & Health 09/2015; 41(6). DOI:10.5271/sjweh.3524 · 3.45 Impact Factor
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    ABSTRACT: Objective: Systematic reviews often struggle with how to combine information when more than 1 instrument is used across studies being synthesized. Different techniques have been suggested based on frequency of use in the literature, or on consensus. We explore an approach blending 2 initiatives: OMERACT (Outcome Measurement in Rheumatology) and COSMIN (Consensus On Selection of Measurement Instruments), and investigate the effects of an evidence-based measurement approach on selection of outcomes. Methods: Readings were circulated to attendees registered for a preconference workshop on pain measurement. Three instruments were considered and exercises conducted to engage people in the content and measurement performance of these tools. Consensus was sought that an evidence-based approach could be created for selection of instruments for summary of findings (SoF) tables. Results: The blending of COSMIN and OMERACT approaches led to an evidence-based approach that depended both on a clear definition of target concept and a review of measurement performance of the instrument. Participants emphasized that conceptual clarity and practical considerations should come before measurement property results. Conclusion: Evidence-based approaches can be adopted for selection of instruments for SoF tables. A research agenda was formulated.
    The Journal of Rheumatology 09/2015; 42(10). DOI:10.3899/jrheum.141446 · 3.19 Impact Factor
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    ABSTRACT: Indicators of work role functioning (being at work, and being productive while at work) are important outcomes for persons with arthritis. As the worker productivity working group at OMERACT (Outcome Measures in Rheumatology), we sought to provide an evidence base for consensus on standardized instruments to measure worker productivity [both absenteeism and at-work productivity (presenteeism) as well as critical contextual factors]. Literature reviews and primary studies were done and reported to the OMERACT 12 (2014) meeting to build the OMERACT Filter 2.0 evidence for worker productivity outcome measurement instruments. Contextual factor domains that could have an effect on scores on worker productivity instruments were identified by nominal group techniques, and strength of influence was further assessed by literature review. At OMERACT 9 (2008), we identified 6 candidate measures of absenteeism, which received 94% endorsement at the plenary vote. At OMERACT 11 (2012) we received over the required minimum vote of 70% for endorsement of 2 at-work productivity loss measures. During OMERACT 12 (2014), out of 4 measures of at-work productivity loss, 3 (1 global; 2 multiitem) received support as having passed the OMERACT Filter with over 70% of the plenary vote. In addition, 3 contextual factor domains received a 95% vote to explore their validity as core contextual factors: nature of work, work accommodation, and workplace support. Our current recommendations for at-work productivity loss measures are: WALS (Workplace Activity Limitations Scale), WLQ PDmod (Work Limitations Questionnaire with modified physical demands scale), WAI (Work Ability Index), WPS (Arthritis-specific Work Productivity Survey), and WPAI (Work Productivity and Activity Impairment Questionnaire). Our future research focus will shift to confirming core contextual factors to consider in the measurement of worker productivity.
    The Journal of Rheumatology 09/2015; DOI:10.3899/jrheum.141077 · 3.19 Impact Factor
  • Brenda Mori · Kathleen E. Norman · Dina Brooks · Jodi Herold · Dorcas E. Beaton ·

    Physiotherapy Canada 08/2015; DOI:10.3138/ptc.2015-35E · 0.77 Impact Factor
  • J. H. E. Yong · L. Masucci · J. S. Hoch · R. Sujic · D. Beaton ·

    Osteoporosis International 08/2015; DOI:10.1007/s00198-015-3280-1 · 4.17 Impact Factor
  • Brenda Mori · Dina Brooks · Kathleen E. Norman · Jodi Herold · Dorcas E. Beaton ·
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    ABSTRACT: Purpose: To develop the first draft of a Canadian tool to assess physiotherapy (PT) students’ performance in clinical education (CE). Phase 1: to gain consensus on the items within the new tool, the number and placement of the comment boxes, and the rating scale; Phase 2: to explore the face and content validity of the draft tool. Methods: Phase 1 used the Delphi method; Phase 2 used cognitive interviewing methods with recent graduates and clinical instructors (CIs) and detailed interviews with clinical education and measurement experts. Results: Consensus was reached on the first draft of the new tool by round 3 of the Delphi process, which was completed by 21 participants. Interviews were completed with 13 CIs, 6 recent graduates, and 7 experts. Recent graduates and CIs were able to interpret the tool accurately, felt they could apply it to a recent CE experience, and provided suggestions to improve the draft. Experts provided salient advice. Conclusions: The first draft of a new tool to assess PT students in CE, the Canadian Physiotherapy Assessment of Clinical Performance (ACP), was developed and will undergo further development and testing, including national consultation with stakeholders. Data from Phase 2 will contribute to developing an online education module for CIs and students.
    Physiotherapy Canada 08/2015; 67(3):281-289. DOI:10.3138/ptc.2014-29E · 0.77 Impact Factor
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    ABSTRACT: The aims of this study were to examine the availability of diverse job accommodations (or "flexible working arrangements") and describe their use among people with systemic lupus erythematosus, as well as to examine factors associated with the use of job accommodations. A mail survey was sent to adult lupus patients receiving care from a lupus clinic based in Toronto, Canada. The survey assessed demographic information, self-reported disease activity, work history, workplace activity limitations, job strain and job accommodation availability and use. Standard multivariable linear regression analysis was used to examine factors associated with the use of job accommodations. We received 362 responses out of 604 (60%) mailed surveys. Participants who were employed within the last 5 years, but who were not currently working, were less likely to report having had job accommodations available to them at their last place of employment than currently employed participants. Job accommodation use was reported by 70% of currently employed respondents and 72% of those not currently employed. The most common job accommodations used was the use of sick leave days. Factors positively associated with job accommodation use among employed included greater education, being diagnosed with fibromyalgia, at least one episode of short-term work disability, not belonging to a union, greater workplace activity limitations and greater job strain. Job accommodation use among people with lupus is common. Work context factors such as workplace activity limitations and job strain are the main factors associated with use of job accommodation. This article is protected by copyright. All rights reserved. © 2015, American College of Rheumatology.
    07/2015; DOI:10.1002/acr.22662
  • Maja Stupar · Pierre Côté · Dorcas E Beaton · Eleanor Boyle · J David Cassidy ·
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    ABSTRACT: Few instruments are available to measure disability associated with Whiplash-associated disorders (WAD). The Whiplash Disability Questionnaire (WDQ) was developed to measure disability resulting from WAD, but its validity is unknown for acute WAD. To determine the structural and construct validity of the WDQ in individuals with acute WAD. Cohort study. Ontario adults with WAD were enrolled within three weeks of their motor vehicle collision. Whiplash Disability Questionnaire. We included insurance claimants who were 18 years of age or older and diagnosed with acute WAD Grades I-III. All participants completed the WDQ, a 13-item questionnaire scored from 0 (no disability) to 130 (complete disability). We assessed the factor structure of the WDQ and tested its construct validity against self-perceived recovery, neck pain (Numerical Rating Scale [NRS]), neck disability (Neck Disability Index [NDI] and Neck Bournemouth Questionnaire), health-related quality of life (SF-36), and depressive symptoms (CES-D). The mean age of the 130 participants was 42.1 years (s.d.= 13.2) and 70% were female. Twenty six percent had WAD I, 73.1% had WAD II and 0.8% had WAD III. Mean time since injury was 6.5 days (s.d. = 4.9). The mean WDQ score was 49.8 (s.d.=29.1). Our analysis suggested that the WDQ includes two factors: daily activities and emotional status. This factor structure remained stable in sensitivity analyses (e.g. zeros imputed for missing values and the item with the most missing values or resulting in complex loading excluded). Strong correlations were found between the total WDQ score and the NDI, the Bournemouth questionnaire, the SF-36 physical function and the NRS (for the neck, shoulder, mid and low back pain) satisfying a priori hypotheses. We found a priori hypothesized moderate correlations between the WDQ, and the CES-D and SF-36 mental function. The WDQ includes two factors and has strong construct validity in individuals with acute WAD. Our results demonstrate that the WDQ is valid for use as an overall summative scale or as the daily activities and emotional subscales in clinical and research settings to determine disability status. Copyright © 2015 Elsevier Inc. All rights reserved.
    The spine journal: official journal of the North American Spine Society 07/2015; 15(11). DOI:10.1016/j.spinee.2015.07.006 · 2.43 Impact Factor
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    ABSTRACT: We examined fracture patients' understanding of "high" fracture risk after they were screened through a post-fracture secondary prevention program and educated about their risk verbally, numerically, and graphically. Our findings suggest that messages about fracture risk are confusing to patients and need to be modified to better suit patients' needs. The aim of this study was to examine fracture patients' understanding of high risk for future fracture. We conducted an in-depth qualitative study in patients who were high risk for future fracture. Patients were screened through the Osteoporosis Exemplary Care Program where they were educated about fracture risk: verbally told they were "high risk" for future fracture, given a numerical prompt that they had a >20 % chance of future fracture over the next 10 years, and given a visual graph highlighting the "high risk" segment. This information about fracture risk was also relayed to patients' primary care physicians (PCPs) and specialists. Participants were interviewed at baseline (within six months of fracture) and follow-up (after visit with a PCP and/or specialist) and asked to recall their understanding of risk and whether it applied to them. We recruited 27 patients (20 females, 7 males) aged 51-87 years old. Fractures were sustained at the wrist (n = 7), hip (n = 7), vertebrae (n = 2), and multiple or other locations (n = 11). While most participants recalled they had been labeled as "high risk" (verbal cue), most were unable to correctly recall the other elements of risk (numerical, graphical). Further, approximately half of the patients who recalled they were high risk did not believe that high risk applied, or had meaning, to them. Participants also had difficulty explaining what they were at risk for. Our results suggest that health care providers' messages about fracture risk are confusing to patients and that these messages need to be modified to better suit patients' needs.
    Osteoporosis International 06/2015; DOI:10.1007/s00198-015-3214-y · 4.17 Impact Factor
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    ABSTRACT: To explore the outcome domains and measurement instruments reported in published randomised controlled trials of physical therapy interventions for shoulder pain (rotator cuff disease, adhesive capsulitis or non-specific shoulder pain). We included trials comparing physical therapy to any other intervention for shoulder pain, indexed up to March 2015 in CENTRAL, MEDLINE, EMBASE, or CINAHL Plus. Two authors independently selected trials for inclusion and extracted information on the domains and measurement instruments reported. We included 171 trials. Most trials measured pain (87%), function (72%) and range of movement (67%), while adverse events, global assessment of treatment success, strength and health-related quality of life were measured in 18-27% of trials, and work disability and referral for surgery were measured in less than 5% of trials. Thirty-five different measurement instruments for pain and 29 for function were noted. Measurement of function increased markedly from 1973 to 2014. In rotator cuff disease trials there was more frequent measurement of pain and strength and less frequent measurement of range of movement compared with adhesive capsulitis trials. There was wide diversity in the domains and measurement instruments reported. Our results provide the foundation for the development of a core domain and measurement set for use in future shoulder pain trials. Copyright © 2015 Elsevier Inc. All rights reserved.
    Journal of clinical epidemiology 06/2015; 68(11). DOI:10.1016/j.jclinepi.2015.06.006 · 3.42 Impact Factor
  • Joanne Crawford · Farah Ahmad · Dorcas E. Beaton · Arlene S. Bierman ·
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    ABSTRACT: Purpose - The purpose of this paper is to gain an in-depth understanding of beliefs, attitudes, and reasons for decision making about colorectal cancer (CRC) screening among South Asian (SA) immigrants. Design/methodology/approach - Six focus groups conducted in English, Punjabi, and Urdu were held with 42 SA immigrants, 50-74 years old and at average risk for CRC, from November 2012 to May 2013. All focus group discussions were audio-taped and transcribed verbatim. Data analysis used an inductive and systematic approach employing constant comparison techniques. Findings - Three dominant themes emerged. Beliefs and attitudes towards cancer and screening represented SA immigrant's perceptions that early detection was beneficial; screening was not necessary in the absence of symptoms; cancer was scary; and the loss of previously established bowel practices upon immigration as potential risks for CRC. Knowledge and awareness focused on unscreened participants' cancer stories; screened participants' knowledge of CRC, risk factors, and screening; experiential learning from focus groups; and screened participants' strategies to promote screening. Support and accessibility concentrated on physician support and responsibility to provide information, explanation, and recommend screening to facilitate access. Originality/value - Findings provide novel insights on socio-cultural context, beliefs, and barriers to CRC screening among SA immigrants. Culturally appropriate community-based strategies included story-telling, the use of social networks, and greater physician engagement. Enhancing collaborative partnerships with physicians and public health may minimize structural barriers and reduce health disparities. Future research could explore effectiveness of outreach strategies including these collaborations.
    06/2015; 11(2):130-146. DOI:10.1108/IJMHSC-09-2014-0037
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    ABSTRACT: To investigate the predictive ability of the Upper-Limb Work Instability Scale (UL-WIS) for transitioning out of work among injured workers with chronic work-related upper-extremity disorders (WRUEDs) DESIGN: Secondary analysis of a 12-month cohort study with data collection at baseline, and 3, 6, and 12-month follow-up. Survey questionnaires were used to collect data on an array of socio-demographic, health-related, and work-related variables SETTING: Upper-Extremity Specialty clinics operated by the Workplace Safety & Insurance Board of Ontario PARTICIPANTS: Injured workers with WRUEDs who were working at time of initial clinic attendance (n=356) INTERVENTIONS: Not applicable. Transitioning out of work. Multivariable logistic regression that considered nine potential confounders revealed baseline UL-WIS (range: 0-17) to be a statistically significant predictor of a subsequent transition out of work (adjusted odds ratio=1.18 [95%CI: 1.07, 1.31], p=0.001). An assessment of predictive values across the UL-WIS score range identified cut-scores of <6 (negative predictive value=0.81 [95%CI, 0.62, 0.94]) and >15 (positive predictive value=0.80, [95%CI: 0.52, 0.96]), differentiating the scale into three bands representing low, moderate, and high risk of exiting work. The UL-WIS was shown to be an independent predictor of poor work sustainability among injured workers with chronic WRUEDs; however, when applied a standalone tool in clinical settings, some limits to its predictive accuracy should also be recognized. Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
    Archives of physical medicine and rehabilitation 05/2015; 96(9). DOI:10.1016/j.apmr.2015.04.022 · 2.57 Impact Factor
  • J. Epstein · R.H. Osborne · G.R. Elsworth · D.E. Beaton · F. Guillemin ·

    Revue d Épidémiologie et de Santé Publique 05/2015; 63:S60. DOI:10.1016/j.respe.2015.03.052 · 0.59 Impact Factor
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    ABSTRACT: To examine work absenteeism, job disruptions and perceived productivity loss and factors associated with each outcome in young adults living with systemic lupus erythematosus (SLE) and juvenile arthritis (JA). One hundred and forty three young adults, ages 18 to 30 years, with SLE (54.5%) and JA (45.5%) completed an online survey of work experiences. Demographic, health (e.g., fatigue, disease activity), psychosocial (e.g., independence, social support) and work context (e.g., career satisfaction, job control, self-disclosure) information were collected. Participants were asked about absenteeism, job disruptions and perceived productivity loss in the last six months. Log-Poisson regression analyses examined factors associated with work outcomes. A majority of participants were employed (59%) and reported a well-managed health condition. Employed respondents were satisfied with their career progress and indicated moderate job control. Over forty percent of participants reported absenteeism, job disruptions and productivity loss. Greater job control and self-disclosure, and less social support were related to a higher likelihood of absenteeism; more disease activity was related to a greater likelihood of reporting job disruptions; lower fatigue and higher job control was associated with a reduced likelihood of a productivity loss. Young adult respondents with rheumatic disease experienced challenges with employment including absenteeism, job disruptions and productivity loss. While related to greater absenteeism, job control could play a role in a young person's ability to manage their health condition and sustain productive employment. Greater attention should also be paid to understanding health factors, and social support in early work experiences. This article is protected by copyright. All rights reserved. © 2015 American College of Rheumatology.
    04/2015; 67(9). DOI:10.1002/acr.22601
  • Joanne Crawford · Farah Ahmad · Dorcas Beaton · Arlene S Bierman ·
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    ABSTRACT: South Asian (SA) immigrants settled in the United Kingdom (UK) and North America [United States (US) and Canada] have low screening rates for breast, cervical and colorectal cancers. Incidence rates of these cancers increase among SA immigrants after migration, becoming similar to rates in non-Asian native populations. However, there are disparities in cancer screening, with low cancer screening uptake in this population. We conducted a scoping study using Arksey & O'Malley's framework to examine cancer screening literature on SA immigrants residing in the UK, US and Canada. Eight electronic databases, key journals and reference lists were searched for English language studies and reports. Of 1465 identified references, 70 studies from 1994 to November 2014 were included: 63% on breast or cervical cancer screening or both; 10% examined colorectal cancer screening only; 16% explored health promotion/service provision; 8% studied breast, cervical and colorectal cancer screening; and 3% examined breast and colorectal cancer screening. A thematic analysis uncovered four dominant themes: (i) beliefs and attitudes towards cancer and screening included centrality of family, holistic healthcare, fatalism, screening as unnecessary and emotion-laden perceptions; (ii) lack of knowledge of cancer and screening related to not having heard about cancer and its causes, or lack of awareness of screening, its rationale and/or how to access services; (iii) barriers to access including individual and structural barriers; and (iv) gender differences in screening uptake and their associated factors. Findings offer insights that can be used to develop culturally sensitive interventions to minimise barriers and increase cancer screening uptake in these communities, while recognising the diversity within the SA culture. Further research is required to address the gap in colorectal cancer screening literature to more fully understand SA immigrants' perspectives, as well as research to better understand gender-specific factors that influence screening uptake. © 2015 John Wiley & Sons Ltd.
    Health & Social Care in the Community 02/2015; DOI:10.1111/hsc.12208 · 1.15 Impact Factor

Publication Stats

13k Citations
622.17 Total Impact Points


  • 1996-2015
    • Institute for Work and Health
      Toronto, Ontario, Canada
  • 1995-2015
    • St. Michael's Hospital
      • Department of Surgery
      Toronto, Ontario, Canada
  • 1993-2015
    • University of Toronto
      • • Department of Occupational Science and Occupational Therapy
      • • Institute of Health Policy, Management and Evaluation
      • • Department of Physical Therapy
      • • Department of Anesthesia
      • • Faculty of Medicine
      • • Department of Rehabilitation Science
      Toronto, Ontario, Canada
  • 2010-2014
    • Christus St. Michaels' Hospital
      Arkansas, United States
    • Peterborough Regional Health Centre
      Питерборо, Ontario, Canada
  • 2013
    • University of Ottawa
      • Institute of Population Health
      Ottawa, Ontario, Canada
  • 1993-2012
    • Saint Michael's Medical Center
      Newark, New Jersey, United States
  • 2002
    • Health Canada
      Ottawa, Ontario, Canada