Tara Packham

Background: Inequities in access, engagement, and outcomes persist across outpatient rehabilitation services in Canada, disproportionately affecting Indigenous Peoples, newcomers and refugees, gender‐ and sexually‐diverse individuals, and people with lower income. Although rehabilitation professionals report strong awareness of equity, diversity, inclusion, and cultural safety principles, a persistent gap remains between knowledge and day‐to‐day clinical practice. Existing resources largely focus on education without providing practical, clinic‐level tools or aligned patient‐facing supports to enable sustained practice change. Objective: The Inclusive Rehabilitation Equity Assessment and Consensus Hub (iREACH) study aims to co‐design a national, evidence‐informed roadmap of prioritised, actionable strategies to enhance cultural safety and equity in outpatient rehabilitation, including physiotherapy, occupational therapy, and chiropractic settings across Canada. Methods: The iREACH study will use a two‐phase, sequential co‐design approach. Phase 1 will employ qualitative methods guided by Interpretive Description, including semi‐structured interviews, to explore patients' experiences of cultural safety and unsafety in rehabilitation care. Participants will be purposefully sampled to reflect diversity across social identities and locations, geographic regions, and provider types. Data will be analysed using inductive Reflexive Thematic Analysis within the overarching framework of Interpretative Description. Phase 2 will involve a national co‐design workshop with an intersectional panel of patients, clinicians, and system leaders. Findings from Phase 1 and prior research will be collaboratively translated into prioritised strategies and practical clinician‐ and patient‐facing resources to support culturally safe and equitable rehabilitation care. Expected Outcomes: The primary outcome will be a bilingual (English and French) co‐designed Shared Blueprint comprising prioritised, actionable strategies for clinicians, organisations, and health system leaders, together with complementary patient‐facing resources to support culturally safe and equitable rehabilitation care across Canada. By integrating lived experience, clinical perspectives, and system leadership, iREACH aims to bridge the gap between cultural safety intent and implementation, supporting more equitable, accessible, and patient‐centred rehabilitation care across Canada. Patient or Public Contribution: Patient partner has been actively involved in the study design, including development of the research questions, interview guide, and co‐design approach. They will remain involved throughout the study as member of the research team contributing to data interpretation and the co‐development of study outputs.

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Relationships among pain, sleep, and occupational engagement are well known; however, evidence on these relationships relative to quality of life (QOL) remains limited. This study examines pain, sleep, and occupational engagement (including social-emotional contexts) as predictors of QOL in persons with complex regional pain syndrome (CRPS). This descriptive survey research was conducted over 5 months. Participants were recruited through three organizations and were aged 18 or older, diagnosed with CRPS, English-speaking, and equipped with internet access. The sample was predominantly White, female, urban, and middle-aged. Function, coping, pain, and sleep were predictive of QOL ( r ² = .83). Occupational engagement, pain, coping, and sleep together predict QOL in people with CRPS. Future research would be beneficial to explore whether occupational engagement mediates the relationship between pain and QOL and between sleep and QOL in this population.

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Background. Many Canadians experience health disparities when accessing health care. Occupational therapists have historically advocated for the elimination of health disparities. However, occupational therapy was founded in colonial ideals and systems, which continue to perpetuate health disparities. Purpose. Understand how Canadian occupational therapists describe the challenges and opportunities involved in addressing health disparities in provision of care. Methods. We used an interpretative descriptive methodology. Criterion and snowball sampling was used to recruit participants across Canada. Data from semistructured individual interviews were analyzed using reflexive thematic analysis. Findings. A total of 11 occupational therapists (M = 1, F = 10) participated. Four central themes were identified: (1) health equity is a core principle of occupational therapy, (2) systemic barriers are central to the occupational therapy process and can affect the delivery and access of equity-centric care, (3) occupational therapists as advocates against health disparities, and (4) health disparities must be considered when hiring and retaining occupational therapists in practice. Conclusion: Our study highlights the successes and challenges of the field of occupational therapy in addressing health disparities, providing constructive suggestions to move the field forward. Our study provides important implications for research, practice, and policy; these goals are aligned with recent initiatives from the Canadian Association for Occupational Therapists.

Introduction: Brain fog may decrease quality of life (QOL) in Veterans with pain by reducing cognitive capacity and functional engagement. Veterans with higher pain interference (PI) experience worse QOL. Given PI’s relationship with QOL, it is important to explore brain fog within the context of PI levels. This study compared health-related QOL, functional cognition, and functional abilities between Veterans with high versus low PI and brain fog. Method: A cross-sectional study, using a one-way MANOVA, explored whether Veterans with brain fog and pain symptoms perceived PI-affected measures of QOL. Exploratory post hoc testing compared gender differences and correlations between perceived confidence with abilities and QOL. Results: Thirty-four Veterans participated. The results of the MANOVA showed a significant main effect of PI between constructs. Univariate tests revealed differences in physical health, symptoms of mental health issues, and perceived confidence with abilities. No differences in outcomes based on gender were found. The exploratory correlation analysis demonstrates that in Veterans with brain fog and painful symptoms, there are high correlations between physical health and perceived confidence with abilities and moderate correlations between mental health and perceived confidence with abilities, and between functional cognition and perceived confidence with abilities. Discussion: Veterans with pain symptoms and brain fog with high PI demonstrated more mental health symptoms, poorer physical functioning, and reduced perceived abilities. Results from the correlation analysis demonstrate that perceived confidence plays a role in QOL. This study contributes to the overall understanding of this experience, identifying evidence-based suggestions for future exploration.

Background. National and provincial professional associations and regulatory bodies for occupational therapists (OTs) in Canada emphasize culture, equity, and justice as essential competencies. This study investigates the diversity within the occupational therapy profession and explores OTs’ perspectives on providing culturally responsive care to members of equity-deserving groups, with a particular focus on cultural competence and agility. Method. OTs were administered a cross-sectional mixed-methods survey that included demographics, the Cultural Competence Assessment Instrument (Two subscales: Awareness and Sensitivity and Competence Behaviour), and an open-ended question examining their perceived cultural competence. Quantitative data were analyzed using descriptive statistics, and qualitative themes were determined through content analysis. Findings. A total of 240 OTs participated in this survey, with an average age of 45.3 (22.5), identifying primarily as females/women (90.7%). Less than half of respondents (41%) identified their race; of those who did, they were primarily of Southeast Asian descent (21.3%). OTs had lower scores for Cultural Awareness and Sensitivity (3.17/7 [3.11, 3.23]) and for Cultural Competence Behaviour (3.22/7 [3.08, 3.37]). While highlighting the healthcare system distrust and barriers to culturally responsive care, most felt confident addressing them. OTs reported that greater awareness and inclusivity at individual and systemic levels are needed. Conclusion. Our sample of OTs suggests little diversity related to gender, race, and ethnicity. OTs in Canada vary in their perceptions of health disparities, barriers for patients in accessing and receiving health care, and efficacy in addressing barriers.