Sonya Allin - Academia.edu (original) (raw)

Papers by Sonya Allin

Osteoporosis International, 2019

This study sought to understand patient experiences, benefits, and challenges to osteoporosis car... more This study sought to understand patient experiences, benefits, and challenges to osteoporosis care delivered virtually by telemedicine. Telemedicine bridges the access gap to specialized osteoporosis care in remote areas. Improving coordination of investigations, access to allied health members, and future initiatives may improve osteoporosis-related morbidity and mortality in this population. Introduction There is limited research on the role of telemedicine (TM) in the management of osteoporosis (OP). We previously reported that OP patients assessed by TM had a higher prevalence of fragility fractures, co-morbidities, and need for allied health resources than those serviced by the outpatient clinic. The purpose of this study is to understand the experiences, benefits, and challenges associated with receiving OP care by TM from the patient perspective. Methods We adopted a convergent, mixed methods study design whereby both a quantitative component (mailed survey) and qualitative component (30-min telephone interviews) were conducted simultaneously. In addition to reporting survey data, thematic analysis was applied to interview data. Results Participants were comfortable with virtual technology and perceived that their quality of care by TM was comparable to in-person visits. Expressed benefits included the convenience of timely care close to home, reduced burden of travel and costs, and enhanced sense of confidence with being assessed by an osteoporosis specialist. Perceived barriers included poor follow-up with allied health professionals in the TM program (e.g., physiotherapist) and coordination of tests and investigations. Many participants indicated interest in an OP self-management program, with content focusing on diet and lifestyle factors. Conclusion The TM program bridges the access gap for those living with OP in underserviced and remote areas. However, we identified the need to improve the existing processes to better coordinate access to allied health team members and arrangements for investigations. Participants also expressed interest for a virtual osteoporosis self-management program.

CMAJ open, 2014

On Apr. 1, 2008, a revision was made to the fee schedule for bone mineral density testing with du... more On Apr. 1, 2008, a revision was made to the fee schedule for bone mineral density testing with dual-energy x-ray absorptiometry (DXA) in the province of Ontario, Canada, reducing the frequency of repeat screening in individuals at low risk of osteoporosis. We evaluated whether the change in physician reimbursement successfully promoted appropriate bone mineral density testing, with reduced use among women at low risk and increased use among women and men at higher risk of osteoporosis-related fracture. We analyzed data from administrative databases on physician billings, hospital discharges and emergency department visits. We included all physician claims for DXA in the province to assess patterns in bone mineral density testing from Apr. 1, 2002, to Mar. 31, 2011. People at risk of an osteoporosis-related fracture were defined as women and men aged 65 years or more and those who had a recent (< 6 mo) fracture after age 40 years. Joinpoint regression analysis was used to examine ...

BACKGROUND Globally, 1 in 3 adults live with multiple chronic conditions. Thus, effective interve... more BACKGROUND Globally, 1 in 3 adults live with multiple chronic conditions. Thus, effective interventions are needed to prevent and manage these chronic conditions and to reduce the associated health care costs. Teaching effective self-management practices to people with chronic diseases is one strategy to address the burden of chronic conditions. With the increasing availability of and access to the internet, the implementation of web-based peer support programs has become increasingly common. OBJECTIVE The purpose of this scoping review is to synthesize existing literature and key characteristics of web-based peer support programs for persons with chronic conditions. METHODS This scoping review follows the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) extension for scoping reviews guidelines. Studies were identified by searching MEDLINE, CINAHL, Embase, PsycINFO, and the Physiotherapy Evidence Database. Chronic diseases identified by the Public Health A...

BACKGROUND Rehospitalization rates resulting from secondary conditions in persons with spinal cor... more BACKGROUND Rehospitalization rates resulting from secondary conditions in persons with spinal cord injuries (SCI) are high. Self-management programs for many chronic conditions have been associated with decreases in hospital readmissions. However, in the SCI community, evidence suggests that satisfaction with traditional self-management programs is low. Users with SCI have indicated preference for programs that are online (rather than in-person), that target SCI-specific concerns, and are led by peers with SCI. There is currently no program with all of these features, which addresses self-management of secondary conditions after SCI. OBJECTIVE The aim of this study was to provide details of a participatory design (PD) process for an internet-mediated self-management program for users with SCI (called SCI & U) and illustrate how it has been used to define design constraints and solutions. METHODS Users were involved in development as codesigners, codevelopers, and key informants. Cod...

BACKGROUND Individuals with spinal cord injury (SCI) have a high risk of experiencing a condition... more BACKGROUND Individuals with spinal cord injury (SCI) have a high risk of experiencing a condition secondary to injury like a pressure sore. Self-management programs may reduce the risk of such complications, but traditional programs have proven to be insufficiently tailored to the needs of people with SCI. To overcome barriers to self-management support, an online self-management program was developed for Canadians with SCI called “SCI&U”. OBJECTIVE To evaluate the feasibility and potential impact of the “SCI&U” program in the context of a mixed-methods pilot study. METHODS The study followed an explanatory sequential mixed-methods design. Participants (N=11) were Canadians with SCI who had been living in the community for more than 1 year. Each took part in a self-paced, 6-session self-management program guided by a trained peer health coach. During most sessions participants could elect to discuss a health topic with their coach from a pre-defined list (e.g. Skin or Bowel Manageme...

JMIR rehabilitation and assistive technologies, Jan 21, 2018

Rehospitalization rates resulting from secondary conditions in persons with spinal cord injuries ... more Rehospitalization rates resulting from secondary conditions in persons with spinal cord injuries (SCI) are high. Self-management programs for many chronic conditions have been associated with decreases in hospital readmissions. However, in the SCI community, evidence suggests that satisfaction with traditional self-management programs is low. Users with SCI have indicated preference for programs that are online (rather than in-person), that target SCI-specific concerns, and are led by peers with SCI. There is currently no program with all of these features, which addresses self-management of secondary conditions after SCI. The aim of this study was to provide details of a participatory design (PD) process for an internet-mediated self-management program for users with SCI (called SCI & U) and illustrate how it has been used to define design constraints and solutions. Users were involved in development as codesigners, codevelopers, and key informants. Codesigners and codevelopers wer...

The Journal of Spinal Cord Medicine

To determine the implementation considerations for a targeted self-management program for individ... more To determine the implementation considerations for a targeted self-management program for individuals with spinal cord injury (SCI) from the perspective of a national stakeholder advisory group using the Theoretical Domains Framework (TDF) as a guide. Qualitative descriptive approach. Two focus groups held at the 6th National Spinal Cord Injury Conference (October 2-4th, 2014) in Toronto, Ontario, Canada. A total of 25 stakeholders from across Canada participated in focus groups or &amp;amp;amp;quot;brainstorming sessions&amp;amp;amp;quot;. The stakeholders included 5 clinicians, 14 researchers, 3 policy makers, and 3 individuals with SCI. Not applicable. Not applicable. All 14 theoretical domains were identified in the brainstorming sessions. No new themes or domains were identified. The need to consider the theoretical domains of Knowledge, Skills, Reinforcement, Intentions, Goals (e.g. the readiness of the individual with SCI), Environmental Context and Resources (e.g. considerations for governance and ownership of the program and a business model for sustainability), as well as Social Influences (e.g. issues of privacy and security in the context of on-line delivery) was identified. The current study provides complementary results to our previous series of studies on the implementation considerations for the development of a targeted self-management program for individuals with SCI by emphasizing the health care professional/health policy perspective. It is anticipated that such a program could not only reduce secondary complications and subsequent inappropriate health care use but it may also improve the quality of life for individuals with SCI and their caregivers.

BMJ Open

IntroductionPeer support is receiving increasing attention as both an effective and cost-effectiv... more IntroductionPeer support is receiving increasing attention as both an effective and cost-effective intervention method to support the self-management of chronic health conditions. Given that an increasing proportion of Canadians have internet access and the increasing implementation of web-based interventions, online peer support interventions are a promising option to address the burden of chronic diseases. Thus, the specific research question of this scoping review is the following:What is known from the existing literature about the key characteristics of online peer support interventions for adults with chronic conditions?Methods and analysisWe will use the methodological frameworks used by Arksey and O’Malley as well as Levac and colleagues for the current scoping review. To be eligible for inclusion, studies must report on adults (≥18 years of age) with one of the Public Health Agency of Canada chronic conditions or HIV/AIDS. We will limit our review to peer support interventi...

Journal of osteoporosis, 2016

Introduction. The purpose of this study is to understand the experience of primary care providers... more Introduction. The purpose of this study is to understand the experience of primary care providers (PCPs) using an evidence-based requisition for bone mineral density (BMD) testing. Methods. A qualitative descriptive approach was adopted. Participants were given 3 BMD Recommended Use Requisitions (RUR) to use over a 2-month period. Twenty-six PCPs were interviewed before using the RUR. Those who had received at least one BMD report resulting from RUR use were then interviewed again. An inductive thematic analysis was performed. Results. We identified four themes in interview data: (1) positive and negative characteristics of the RUR, (2) facilitators and barriers for implementation, (3) impact of the RUR, and (4) requisition preference. Positive characteristics of the RUR related to both its content and format. Negative characteristics related to the increased amount of time needed to complete the form. Facilitators to implementation included electronic availability and organizationa...

Journal of Clinical Densitometry, 2016

Fracture risk assessments are not always clearly communicated on bone mineral density (BMD) repor... more Fracture risk assessments are not always clearly communicated on bone mineral density (BMD) reports; evidence suggests that structured reporting (SR) tools may improve report clarity. The aim of this study is to compare fracture risk assessments automatically assigned by SR software in accordance with Canadian Association of Radiologists and Osteoporosis Canada (CAROC) recommendations to assessments from experts on narrative BMD reports. Charts for 500 adult patients who recently received a BMD exam were sampled from across University of Toronto&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s Joint Department of Medical Imaging. BMD measures and clinical details were manually abstracted from charts and were used to create structured reports with assessments generated by a software implementation of CAROC recommendations. CAROC calculations were statistically compared to experts&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; original assessments using percentage agreement (PA) and Krippendorff&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s alpha. Canadian FRAX calculations were also compared to experts&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;, where possible. A total of 25 (5.0%) reported assessments did not conform to categorizations recommended by Canadian guidelines. Across the remainder, the Krippendorff&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s alpha relating software assigned assessments to physicians was high at 0.918; PA was 94.3%. Lower agreement was associated with reports for patients with documented modifying factors (alpha = 0.860, PA = 90.2%). Similar patterns of agreement related expert assessments to FRAX calculations, although statistics of agreement were lower. Categories of disagreement were defined by (1) gray areas in current guidelines, (2) margins of assessment categorizations, (3) dictation/transcription errors, (4) patients on low doses of steroids, and (5) ambiguous documentation of modifying factors. Results suggest that SR software can produce fracture risk assessments that agree with experts on most routine, adult BMD exams. Results also highlight situations where experts tend to diverge from guidelines and illustrate the potential for SR software to (1) reduce variability in, (2) ameliorate errors in, and (3) improve clarity of routine adult BMD exam reports.

... We illustrate the accuracy of each paradigm, and discuss several of the underlying statistics... more ... We illustrate the accuracy of each paradigm, and discuss several of the underlying statistics found to correlate strongly and consistently with functional score. ... 143 5.1 Methods . . ... Medi-care, for example, has routinely enforced caps on the amount of outpatient therapy it will reim-...

Journal of Osteoporosis, 2016

Introduction. Evidence of inappropriate bone mineral density (BMD) testing has been identified in... more Introduction. Evidence of inappropriate bone mineral density (BMD) testing has been identified in terms of overtesting in low risk women and undertesting among patients at high risk. In light of these phenomena, the objective of this study was to understand the referral patterns for BMD testing among Ontario’s family physicians (FPs).Methods. A qualitative descriptive approach was adopted. Twenty-two FPs took part in a semi-structured interview lasting approximately 30 minutes. An inductive thematic analysis was performed on the transcribed data in order to understand the referral patterns for BMD testing.Results. We identified a lack of clarity about screening for osteoporosis with a tendency for baseline BMD testing in healthy, postmenopausal women and a lack of clarity on the appropriate age for screening for men in particular. A lack of clarity on appropriate intervals for follow-up testing was also described.Conclusions. These findings lend support to what has been documented a...

We are interested in using a virtual environment with a robotic device to extend the strength and... more We are interested in using a virtual environment with a robotic device to extend the strength and mobility of people recovering from strokes by steering them beyond what they had thought they were capable of doing. Previously, we identified just noticeable differences (JND) of a finger's force production and position displacement in a virtual environment. In this paper, we extend

This paper describes preliminary work in the use of a virtual environment to derive just noticeab... more This paper describes preliminary work in the use of a virtual environment to derive just noticeable differences (JNDs) for force. Specifically, we look for thresholds of force sensitivity so that we may ultimately construct therapeutic force feedback distortions that stay below these thresholds. Initially, we have concentrated on JNDs as they are applied to the index finger; preliminary data in healthy individuals shows an average JND of approximately 10%. More significantly, the data indicate that visual feedback distortions in a virtual environment can be created to encourage increased force productions by up to 10%, and that this can be done without a patient's awareness. 1.

The ability to rise from a chair is a prerequisite for upright mobility and independent living. W... more The ability to rise from a chair is a prerequisite for upright mobility and independent living. We are developing an inexpensive stereo based system capable of cheaply and automatically assessing the quality of “sit-tostand” movements in environments outside of clinics. Automated assessments have been designed to translate perceived kinematics onto assessment scores that are consistent with expert opinion on the Berg Balance Scale (BBS). In addition, automated assessments reveal movement strategies associated with age and disability, like the use of the arms while rising or excess extension at the knees. In this paper, we present preliminary work to translate perceived movement kinematics from community dwelling balance impaired elders onto expert assessments of sit-to-stand health. Our ultimate goal is to create automated tools to identify falls risk, quantify real-world movement changes that result from therapeutic interventions, and perform ergonomic analyses of elders’ seating a...

... Feedback: Implications for Rehabilitation Sonya Allin Human Computer Interaction Institute Ca... more ... Feedback: Implications for Rehabilitation Sonya Allin Human Computer Interaction Institute Carnegie Mellon University sonyaa@cs.cmu.edu Yoky Matsuoka Robotics Institute Carnegie Mellon University yoky@cs.cmu.edu Roberta ...

States over the course of the last century. The challenges of caring for a graying population are... more States over the course of the last century. The challenges of caring for a graying population are exemplified by Alzheimer's disease (AD), the most common cause of dementia among persons age 65 and older. The current annual direct and indirect cost of 100 billion dollars devoted to dementia care will increase as the number of Americans suffering from AD nearly triples to 14 million by the year 2050 .

IFMBE Proceedings, 2009

... Scand J Rehab Med, 30: 8 1-86. 5. Papa, E and . Sit-to-stand motor strategies investigated in... more ... Scand J Rehab Med, 30: 8 1-86. 5. Papa, E and . Sit-to-stand motor strategies investigated in able-bodied young and elderly subjects. J Biomechanics, 33(9): 1113 1122. ... Conf Proc IEEE Eng Med Biol Soc. 6118-21. 18. Allin, S. and Ramanan, D(2007). ...

$Research paper thumbnail of Capture of osteoporosis and fracture information in an electronic medical record database from primary care$

AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium, 2014

In a large database of EMR records, we explore: 1) completeness in capture of bone mineral densit... more In a large database of EMR records, we explore: 1) completeness in capture of bone mineral density (BMD) T-scores required for diagnosis of osteoporosis; 2) concordance of BMD exam information with other osteoporosis information; and 3) evidence of osteoporosis screening among fracture patients. To explore completeness of exam capture, BMD exams in the EMR were related to a provincial billing database. To explore concordance of information and screening rates, 7500 EMR records were reviewed for osteoporosis and fracture details. Results show that 98% of exams billed to the province for EMR patients were found in the EMR. However, documented osteoporosis was substantiated with BMD results only 55.8% of the time. Of 151 charts for fragility fracture patients, 1 in 4 contained no evidence of osteoporosis investigation. In summary, while EMR information about osteoporosis is of variable quality, EMR records shed light on osteoporosis management indicators and completely capture BMD resu...