By the year 2024, one in four adults in Canada will be over the age of 65. In Ontario alone, 100,000 residents live in long-term care (LTC). Residents sometimes experience poor quality-of-life (QOL). Culture change has been proposed as an approach to improve residents’ QOL in LTC. One large LTC organization, Schlegel Villages, has developed and implemented an organizational culture change called Neighbourhood Team Development (NTD). This approach focuses on building cross-functional teams to enhance resident-centredness and promote QOL through optimizing residents’ autonomy and dignity. Implementation of NTD started in 2013 in six LTC homes. The aim of this secondary analysis was to evaluate if NTD has an impact on residents’ QOL in LTC. Using a quantitative repeated-measures design, residents from six LTC homes completed QOL assessments. Quantitative data were collected through the Resident Assessment Instrument-Minimum Data Set 2.0 (RAI-MDS) and the interRAI QOL Survey Short Form. QOL data were analyzed using a paired t-test to assess change scores between time point 1 (data collected between August 2011 and December 2012) and time point 2 (data collected between January 2014 and November 2015) for 232 residents. Study results demonstrate that NTD increased residents’ QOL (p = .003). Organizational culture change such as NTD can lead to innovative approaches to improve the QOL of residents in LTC. This study contributes to literature examining culture change in LTC, and helps inform LTC care models, and interventions to increase residents’ QOL in LTC. / Thesis / Master of Science (MSc)

Background: Tibial fractures are associated with prolonged recovery. The aim of this study was to identify predictors of long-term physical functioning after tibial shaft fracture. Methods: We used data from the Trial to Re-evaluate Ultrasound in the Treatment of Tibial Fractures (TRUST) to determine, in patients with unilateral, open or closed tibial shaft fracture, the association between baseline factors and physical functioning at 1-year. All fractures were fixed using intramedullary nails. Physical functioning was measured using the 100-point Short Form-36 (SF-36) Physical Component Summary (PCS) score; higher is better; minimally important difference is 2 to 5 points. Results: There were 299 tibial fracture patients with complete data available for analysis. In an adjusted analysis, the factors associated with lower physical functioning at 1-year were: (1) current smokers (mean difference [MD] -2.55, 95% confidence interval [95%CI] -4.63 to -0.46, p=0.017), (2) body mass index >30 kg/m² (MD -2.57, 95% CI -4.86, -0.27, p = 0.029), and (3) patients who were receiving disability benefits or involved in litigation, or planned to be (MD -2.65, 95% CI -4.58 to -0.72, p = 0.007). Patients who were employed at the time of their fracture reported significantly higher physical functioning at 1-year (MD 4.56, 95% CI 2.32 to 6.80, p= <0.001) and those who were allowed to partial or full weight-bear post-operatively (MD 1.98, 95% CI 0.13 to 3.82, p=0.036). Neither age, sex, fracture severity or receipt of physical therapy were associated with long-term physical functioning. Conclusions: Among patients undergoing surgical repair of tibial fractures, partial or full weight-bearing post-operatively and employment at the time of injury predict better long-term functioning, whereas smoking, obesity, and receipt of disability benefits or involvement in litigation (or plans to be) predict worse long-term functioning. / Thesis / Master of Science (MSc)

The purpose of this study was to determine the effects of cessation of a 12-month thrice-weekly body-weight supported treadmill training (BWSTT) program on functional ambulation and aspects of health-related quality of life (HRQL) in individuals with incomplete SCI. Twelve men and women (aged 22-55) with chronic (> 1 year post-injury) incomplete SCI (ASIA B or C) returned for follow-up (FOL) testing 37 weeks (SD 2.1) following their final scheduled BWSTT session. Functional ambulation was compared based on: i) required percentage of body-weight support (%BWS) on the treadmill, ii) preferred treadmill speed and iii) overground walking. Evaluation of HRQL included measures of: i) satisfaction with life, ii) perceived ability to perform activities of daily living (ADL), iii) perceptions of health, and iv) depressive symptomology. Participants were invited to participate in once-weekly BWSTT and twice-weekly fitness training during the FOL period (37 sessions); the actual number of BWSTT sessions attended was only 11.6 (range 0-29) and the total days of exercise was 29.1 (range 0-75). The 12-month BWSTT program resulted in a decrease in the required %BWS (73±10% to 19±12%; p<.01), an increase in treadmill speed (0.5±0.3 to 1.4±0.8 km/h; p<.01), improved overground walking in 4 individuals, and improved group satisfaction with life (p<.05). At FOL, %BWS increased to 35±14% (p<.01), but was still less than at pre-training (p<.01). There were no differences between 12-month and FOL scores on any HRQL-related measures. High exercise adherence during the FOL period had a strong correlation with a positive percent change in perceived ability to perform ADL (r = .70; p<.05), as well as non-significant trends with positive percent change in perceptions of health and negative percent change in depressive symptomology (r = .49; p=.13 and r = .51; p=.ll, respectively). Therefore, even with very limited access to the BWS treadmill, much of the improvement in treadmill walking ability and satisfaction with life following long-term BWSTT in individuals with incomplete SCI can be retained for at least 8 months. Continued exercise participation, however, may contribute to maintain or further improve aspects of HRQL in this population. / Thesis / Master of Science (MS)

The purpose of this thesis investigation was to determine the responsiveness and validity of a previously developed evaluative instrument (QL-SP), purported to measure quality of life in spouses of patients who have suffered a myocardial infarction. The 26 questions of the index address emotional concerns, functional limitations, sleep disturbances, and lifestyle changes; they are categorized into the Emotional Function Dimension (EFD) , and the Physical and Social Function Dimension (PSFD). Subjects (n=39) completed the QL-SP and a battery of established questionnaires during home visitations, 1-2 weeks after the patient member of the pair had been discharged from the hospital, and 8 weeks later. Predicted associations were derived according to standardized consensus methods suggesting how changes in the QL-SP dimensions should correlate with changes in the other indexes. Scores on the QL-SP between admission to the study and the second visit were improved for both the emotional function (t = 5.56, p < 0.001), and physical and social function (t = 6.11, p < 0.001) dimensions. The agreement between predicted and observed relationships, as measured statistically by a Kappa with Cicchetti weights, was significant (Kw = 0.43, p = 0.0012). The QL-SP appears to be a responsive and valid measure of quality of life in spouses of MI patients related to their partner's illness. It may be useful in clinical practice as a routine periodic assessment throughout the post-MI convalescent period, and as an evaluation tool for intervention strategies. / Thesis / Master of Science (MS)

Objective: Existing patient-reported outcome measures (PROM)s for patients with facial differences lack content validity, as few items address appearance and function issues. The FACE-Q is a new PROM developed to measure outcomes important to patients aged 8-29 years with craniofacial conditions. A process was needed to determine if the FACE-Q content is relevant to patients with head and neck cancer (HNC). Methods: Cognitive interviews with patients with HNC aged 8 to 29 years (n=15) were conducted and feedback from experts in pediatric oncology (n=21) was obtained. Input was sought on all aspects of the FACE-Q content. Results: A total of 1573 codes were developed from patient comments and 234 codes were developed from expert feedback that related to the COSMIN criteria for judging content validity. A total of 12 items were flagged for review from qualitative interviews and 4 comments were coded from expert feedback among the core scales for comprehensibility. Instructions, time frame, and response options were found to be comprehensible and appropriate by almost all patient and expert participants. Participants identified a total of 10 missing items identified across the core scales, while no additional items were identified by experts for the core scales. However, 4 experts identified swallowing/dysphagia as an important item missing from the mouth function scale. Discussion: Content validity of the FACE-Q for patients with HNC was evaluated through cognitive interviews with patients and feedback from pediatric oncology experts. The core scales were answered by all participants and demonstrate overall content validity from feedback offered by both patients and experts. Conclusion: The FACE-Q showed evidence of content validity for its core scales along with limited evidence that the remaining scales covered issues relevant to specific HNC patients. Assessment of the psychometric properties of the new measure is forthcoming as part of an international FACE-Q field-test study. / Thesis / Master of Science (MSc) / The FACE-Q is a patient-reported outcome measure developed to assess outcomes important to patients aged 8-29 years with craniofacial conditions. The current study aimed to determine its content validity for use in patients with head and neck cancer (HNC). Cognitive interviews with patients with HNC aged 8-29 years (n=15) were conducted and feedback from experts in pediatric oncology (n=21) was obtained. A total of 1573 codes from patient comments and 234 codes from expert feedback were developed. A total of 12 items were flagged for review from qualitative interviews along with 4 items from expert feedback among the core scales for comprehensibility. Instructions and response options were found to be comprehensible and appropriate. A total of 10 missing items were identified across the core scales by patient participants while experts identified 1 missing item. The FACE-Q evidenced content validity for core scales along with limited evidence for remaining scales.

Yes / Research Question: To assess the feasibility of the MGSIS-5and G3L-20 in a community sample of cisgender men aged 40 years and older Research problem: Psychometric measures can aid urologic practice by prompting patients to talk about aspects of their body that are either too sensitive or a natural part of aging. Importantly, reliable and valid measures can also contribute to a an evidenced-based-practice-based-evidence cycle where they can establish the impact of changes recommended by research while using the results in turn to inform research. In this study, we examine two psychometric measures on the opposite ends of a psychological-physical continuum; the Male Genital Self-Image Scale (MGSIS-5) and the Groin and Lower Limb Lymphedema questionnaire (G3L-20) Methodology: Non-experimental psychometric design administering the questionnaires online to a community sample of cisgender men aged 40 years old and above. Validity and reliability analyses were conducted. Results: 30 men completed the study; 14 aged 40-49, 14 aged 50-59 and 2 aged 60-69. The MGSIS-5 and G3L-20 show acceptable reliability and validity with one- and three-component structures respectively. Conclusions: The MGSIS-5 and G3L-20 show sufficient feasibility to justify the resources for studies with larger community samples and for pilot studies with clinical populations.

Policymakers, public administrators, the media, and others are celebrating the "success" of the latest version of welfare reform, codified into law in the Personal Responsibility and Work Opportunity Reconciliation Act of 1996. Most often, success is defined in terms of declining caseloads or in some other economic form - a practice that does not provide a true sense of the impact of policy changes such as welfare reform. Assessing the human impact of policy change requires more than the evaluation of economic outcomes; it requires knowing about the resources of beneficiaries of social services and their conditions of life from various perspectives. Thus, we have to strive for greater understanding about the socio-cultural aspects of people's lives that create the whole person, aspects such as health, family and friendship networks, housing situations, public and private support service and program use, conditions of work, and so forth (Erikson, 1993). This is how we come to understand one;s quality of life. The present research creates a conceptual model called quality of life, and illustrates the model using data from a follow-up study of former welfare recipients in a county in northern Virginia. Evaluation activities premised on a quality of life model will assist policy actors in understanding policy impacts and how to strategically manage public institutions within their very complex contexts, especially in an era of welfare reform. / Ph. D.

There have been extensive debates on the factors that influence local policy decisions. Although many researchers have contributed to uncovering various influences such as political, economic, institutional, and demographic factors on local policy decisions, however, the concept of QoL rarely has used in extant literature. Local government spending is likely to be affected by citizen demands for achieving community well-being. Additionally, given that different policy functions variably affect local circumstances, the impact of QoL on local policy decisions will depend on the policy area. Hence, this study examined the relationship between QoL and local budgetary decisions based on Peterson's (1981) policy scheme of, three distinct policy arenas (developmental, allocational, and redistributive policy). In examining the relationship of QoL and city spending across policy functions, I also considered economic, political, institutional, and demographic factors, derived from various theoretical perspectives on local policy decisions. The relative influences of community QoL as well as other factors on local policy decisions were estimated by two-stage least squares regression analysis (2SLS) for developmental spending and by ordinary least squares (OLS) for allocational and redistributive spending. To measure community QoL, this study used 89,066 completed surveys from 167 communities in the United States for 2002-2008 are used. QoL appeared as a critical factor influencing local government expenditures in the three policy areas. The impact of QoL on local spending in the three areas differed depending on city income levels; city income levels then moderated local policy decisions. These findings suggest that local policy priorities adjusted in accordance with economic growth. Allocational policy functions also should be thought to be functions of cities geared toward giving them a competitive edge over other cities by meeting evolved citizen preferences for city amenities. These findings also point to distinct patterns of political activities in each policy arena. Given that community QoL reflects adjusted citizens' demands, I contend that community QoL can contribute to performance management by providing additional public information and a complementary performance indicator. / Ph. D.

A three part survey instrument was distributed to 84 adults over the age of 60, to assess leisure satisfaction and life satisfaction. The specific areas of investigation were i) the relationship between leisure satisfaction and life satisfaction, and ii) the relationship between leisure satisfaction and income, health, quality of friendship and activity participation. Subjects for the study were associated with one of seven participating agencies and organizations. These groups consisted of a recreation center, nursing homes and retirement communities. The data were analyzed using correlation coefficients, chi-squares and discriminant analysis. No systematic relationship was found between leisure satisfaction and life satisfaction (correlation coefficient of 0.17), or between leisure satisfaction and income (0.23), health (0.15), or quality of friendship (0.10). Using chi-squares, significant differences were found between six of ten paired activities, with regard to level of leisure satisfaction. The results of the discriminant analysis procedure indicated that length of time in current state of health was the most discriminating variable between low and high leisure satisfaction. Other discriminating variables were identified, which may provide a basis from which to consider future research. / M.S.

The purpose of this project is to explore potential social cognitive and psychosocial predictors of lifestyle changes, including diet and physical activity behaviors, in a sample of colorectal cancer survivors who are at high risk of developing a second colorectal cancer. Participants, recruited from Georgetown University's Lombardi Comprehensive Cancer Center, are colorectal cancer survivors from families at high or confirmed risk of having a hereditary colorectal cancer syndrome. Results indicate that, at the bivariate level, many of the psychosocial and social cognitive variables of interest are significantly associated with one another as well as with various health behaviors and health behavior changes. Correlational data indicate that lower distress is associated with higher psychosocial functioning, self-efficacy, and self-regulatory ability. In addition, the data also suggest that individuals with higher self-efficacy display higher self-regulation and more positive outcome expectations related to health behaviors. Overall, participants were more likely to increase healthy behaviors or remain consistent with moderately healthy lifestyles practiced prior to their colorectal cancer diagnosis and treatment, and decrease unhealthy behaviors. Implications and directions for future research are discussed within the paper. / Master of Science