We are pleased to introduce the collection Frontiers in Rehabilitation Sciences – Highlights in Translational Research in Rehabilitation 2021/22. This collection will welcome and showcase a selection of high impact articles authored by leaders in the field. The work presented here highlights the broad diversity of research performed across the Translational Research in Rehabilitation section, and aims to put a spotlight on the main areas of interest. This collection aims to further support Frontiers’ strong community by shining a spotlight on our authors' highly impactful research.

Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of Toronto

University of Alberta

Explore a diverse range of topics in Translational Research in Rehabilitation today!

. This research topic explores the administration process of the interRAI Community Health Assessment (CHA) and its Deafblind Supplement for assessing older adults with dual sensory impairment (DSI). It also examines the links between cognitive and physical impairments, the efficacy and functionality of commercially available wrist-hand orthoses, and the Specific Timely Appointments for Triage (STAT) model to reduce waiting times. <ul> <li>Suggestions were generated to help assessors deepen their understanding of the person's sensory status and optimize the assessment process.</li> <li>Cognitive variables at 2 months post-TBI can predict gait outcomes at 12 months post-TBI.</li> <li>None of the orthoses performed effectively or consistently across participants, and there was a detrimental impact on grip strength with all of them.</li> <li>The STAT model has been adopted by health services to reduce waiting times, with evidence from trials showing a reduction of 30-40%.</li> <li>Perceived barriers to implementation include an overwhelming existing waiting list and lack of resources.</li> </ul>

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Frontiers in Rehabilitation Sciences

Translational Research in Rehabilitation

Highlights in Translational Research in Rehabilitation 2021/22

Editorial on the Research Topic <a href="https://www.frontiersin.org/research-topics/32732/highlights-in-translational-research-in-rehabilitation-202122">Highlights in translational research in rehabilitation 2021/22</a>Translational research encompasses a wide spectrum of concepts, depending on the translation's discipline and focus. From a biological perspective, translational research concerns the translation of knowledge from basic science research into clinical medicine. As Woolf (<a href="#B1">1</a>) has mentioned, this area of research, the interface between basic science and clinical medicine, is geared towards generating new treatments, such as drugs and invasive procedures, that can be applied clinically and commercially. This area of translational research requires the establishment of a variety of knowledge from genetics and molecular biology, as well as supportive technologies to bring basic science to clinical practice. Thus, the research outcome fosters new techniques and approaches for preventing, diagnosing, and treating diseases necessary for maintaining or improving health (<a href="#B2">2</a>). From a socio-economical perspective, translation research ensures that the new treatment techniques and approaches reach the people or patients who need them. This area of research typically involves knowledge users, such as healthcare providers, researchers, patients, and the public, an integrative process of knowledge transfer, and methodologies for outcome evaluation. Thus, this area of translational research concerns not only the treatment techniques that are to be translated into clinical practice but also the quality of treatment, such as the patient-clinician relationship, the quality of care, the ease of service access, etc. In other words, the research fosters the multidirectional and multidisciplinary integration of basic research, patient-oriented research, and population-based research, with the long-term aim of improving the public's health (<a href="#B3">3</a>). In short, regardless of the nature of knowledge transfer, whether biological or socio-economical, the goal of translational research is to close the gap between new scientific discoveries and their endpoint application to clinical practice, interventions, decision-making, and health policy (<a href="#B4">4</a>, <a href="#B5">5</a>).Rehabilitative interventions are often longitudinal in nature and are implemented through therapeutic interaction in real-life situations as well as virtual reality environments to promote functional recovery. For a new intervention or approach to be successfully translated into clinical practice, the effectiveness of the intervention or approach must first be established through rigorous experimental and/or clinical testing, followed by the implementation and evaluation of the effective intervention and assessment procedures in clinical practice. Thus, the focus of translational research is diverse, covering different aspects as mentioned above. The current research topic highlights four unique studies that have emphasized translational research in clinical practice. Their research spans different focuses, including assessing the design of assistive devices, testing longitudinally throughout a recovery process, optimizing the administrative process of an assessment tool, and evaluating a strategy to facilitate the delivery of health services.<a href="https://doi.org/10.3389/fresc.2021.687554">Aranceta-Garza and Ross</a> examined the limitation of current designs of prefabricated wrist-hand orthoses (WHOs). Their study raised questions that challenge the design of the WHOs though they are widely used clinically. The study highlighted the gap between the scientific design of the assistive device and its safe and effective applications for clinical practice. This was an important area in the field of health science. The functionality of an assistive device could not be maximized without fitting its purpose defined by the users. Thus, the study is one of the important areas in translational research.<a href="https://doi.org/10.3389/fresc.2021.726452">Vuong et al.</a> focused on examining the longitudinal change of patients who were recovering from traumatic brain injury (TBI). Their study tested cognitive abilities and gait variables along the recovery trajectory, recognizing that both cognition and physical components contribute to functional performance. This study highlighted the importance of tracking different elements in the recovery process and examining the inter-relation of the elements throughout functional recovery. Additionally, the consideration of cognitive and physical outcomes and their relationships in the recovery process appears to be beneficial to the development of rehabilitation approaches for people with TBI.<a href="https://doi.org/10.3389/fresc.2021.764022">Alfaro et al.</a> examined the administrative process of the InterRAI Community Health Assessment, a tool used for evaluating older adults’ vision and hearing loss. This kind of translational research assists in optimizing the assessment process and generating recommendations for improving the evaluation process in clinical practice. The results could help inform the efficiency of clinical practice.<a href="https://doi.org/10.3389/fresc.2021.638602">Harding et al.</a> used mixed methods to evaluate a strategy—the Specific Timely Appointments for Triage (STAT)—that could be implemented to reduce healthcare waiting time. The evidence obtained was translated into clinical practice to improve access to healthcare. This could set an example for future studies that aim to demonstrate the uptake of evidence to improve the delivery of health services.In summary, translational research is an essential part of evidence-based clinical practice. It connects knowledge, scientists, inventors, engineers, healthcare professionals, patients, users, administrators, and policymakers together to deliver quality care within the healthcare system. The studies presented in this research topic offer readers some insights and references into the scope of translational research.AL wrote the first draft and completed the final version of the manuscript, BN edited the first draft and added content to the manuscript. All authors contributed to the article and approved the submitted version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

Editorial: Highlights in Translational Research in Rehabilitation 2021/22

Purpose: Service providers must identify and assess older adults who have concurrent vision and hearing loss, or dual sensory impairment (DSI). An assessment tool suitable for this purpose is the interRAI Community Health Assessment (CHA) and its Deafblind Supplement. This study's goal was to explore this assessment's administration process and to generate suggestions for assessors to help them optimize data collection.Methods: A social worker with experience working with adults who have sensory loss, who was also naïve to the interRAI CHA, administered the assessment with 200 older adults (65+) who had visual and/or hearing loss. The assessor evaluated the utility of the instrument for clinical purposes, focusing on sections relevant to identifying/characterizing adults with DSI.Results: Suggestions include the recommendation to ask additional questions regarding the person's functional abilities. This will help assessors deepen their understanding of the person's sensory status. Recommendations are also provided regarding sensory impairments and rehabilitation, in a general sense, to help assessors administer the interRAI CHA.Conclusions: Suggestions will help assessors to deepen their knowledge about sensory loss and comprehensively understand the assessment's questions, thereby allowing them to optimize the assessment process and increase their awareness of sensory loss in older adults.

Purpose: Service providers must identify and assess older adults who have concurrent vision and hearing loss, or dual sensory impairment (DSI). An assessment tool suitable for this purpose is the interRAI Community Health Assessment (CHA) and its Deafblind Supplement. This study's goal was to explore this assessment's administration process and to generate suggestions for assessors to help them optimize data collection.Methods: A social worker with experience working with adults who have sensory loss, who was also naïve to the interRAI CHA, administered the assessment with 200 older adults (65+) who had visual and/or hearing loss. The assessor evaluated the utility of the instrument for clinical purposes, focusing on sections relevant to identifying/characterizing adults with DSI.Results: Suggestions include the recommendation to ask additional questions regarding the person's functional abilities. This will help assessors deepen their understanding of the person's sensory status. Recommendations are also provided regarding sensory impairments and rehabilitation, in a general sense, to help assessors administer the interRAI CHA.Conclusions: Suggestions will help assessors to deepen their knowledge about sensory loss and comprehensively understand the assessment's questions, thereby allowing them to optimize the assessment process and increase their awareness of sensory loss in older adults.

Optimizing Evaluation of Older Adults With Vision and/or Hearing Loss Using the interRAI Community Health Assessment and Deafblind Supplement

Background: A common and debilitating challenge experienced by people with TBI is gait-associated mobility impairment and persisting cognitive impairments. Cognitive and physical impairments are often addressed independently during rehabilitation, however, increasing evidence links cognitive and motor processes more closely.Objectives: (1) To determine if correlations exist between measures of cognitive and gait recovery, post-TBI. (2) To investigate the predictive power of cognition at 2-months on gait outcomes at 12-months post-TBI.Methods: In this secondary, longitudinal study of cognitive and neural recovery, data from 93 participants admitted to an inpatient neurorehabilitation program were analyzed. Spatiotemporal gait variables [velocity, step time variability (STV), step length variability (SLV)] were collected along with cognitive variables [Trail Making Test-B (TMT-B), Digit Span-Forward (DS-F)]. Spearman's correlation coefficients were calculated between gait and cognitive variables. Multilinear and step wise regression analyses were calculated to determine predictive value of cognitive variables at 2-months on gait performance at 12-months-post TBI.Results: At 2-months post-injury, TMT-B was significantly correlated with gait velocity and STV; and DS-F was significantly correlated with velocity. At 12-months post-injury, TMT-B and DS-F was still significant correlated with velocity. TMT-B at 2-months was correlated with SLV and STV at 12-months; and DS-F correlated significantly with velocity. Regression models showed TMT-B at 2-months predicting STV, SLV, and velocity at 12-months.Conclusions: Significant associations and predictions between physical and cognitive recovery post-TBI were observed in this study. Future directions may consider a “neural internetwork” model as a salient rehabilitation approach in TBI that integrates physical and cognitive functions.

Background: A common and debilitating challenge experienced by people with TBI is gait-associated mobility impairment and persisting cognitive impairments. Cognitive and physical impairments are often addressed independently during rehabilitation, however, increasing evidence links cognitive and motor processes more closely.Objectives: (1) To determine if correlations exist between measures of cognitive and gait recovery, post-TBI. (2) To investigate the predictive power of cognition at 2-months on gait outcomes at 12-months post-TBI.Methods: In this secondary, longitudinal study of cognitive and neural recovery, data from 93 participants admitted to an inpatient neurorehabilitation program were analyzed. Spatiotemporal gait variables [velocity, step time variability (STV), step length variability (SLV)] were collected along with cognitive variables [Trail Making Test-B (TMT-B), Digit Span-Forward (DS-F)]. Spearman's correlation coefficients were calculated between gait and cognitive variables. Multilinear and step wise regression analyses were calculated to determine predictive value of cognitive variables at 2-months on gait performance at 12-months-post TBI.Results: At 2-months post-injury, TMT-B was significantly correlated with gait velocity and STV; and DS-F was significantly correlated with velocity. At 12-months post-injury, TMT-B and DS-F was still significant correlated with velocity. TMT-B at 2-months was correlated with SLV and STV at 12-months; and DS-F correlated significantly with velocity. Regression models showed TMT-B at 2-months predicting STV, SLV, and velocity at 12-months.Conclusions: Significant associations and predictions between physical and cognitive recovery post-TBI were observed in this study. Future directions may consider a “neural internetwork” model as a salient rehabilitation approach in TBI that integrates physical and cognitive functions.

Relationship Between Cognition and Gait at 2- and 12-Months Post-Traumatic Brain Injury

Objective: Wrist-hand orthoses (WHOs) are prescribed for a range of musculoskeletal/neurological conditions to optimise wrist/hand position at rest and enhance performance by controlling its range of motion (ROM), improving alignment, reducing pain, and optimising grip strength. The objective of this research was to study the efficacy and functionality of ten commercially available WHOs on wrist ROM and grip strength.Design: Randomised comparative functional study of the wrist/hand with and without WHOs.Participants: Ten right-handed female participants presenting with no underlying condition nor pain affecting the wrist/hand which could influence motion or grip strength. Each participant randomly tested ten WHOs; one per week, for 10 weeks.Main outcome measures: The primary outcome was to ascertain the impact of WHOs on wrist resting position and flexion, extension, radial, and ulnar deviation. A secondary outcome was the impact of the WHOs on maximum grip strength and associated wrist position when this was attained.Results: From the 2,400 tests performed it was clear that no WHO performed effectively or consistently across participants. The optimally performing WHO for flexion control was #3 restricting 86.7%, #4 restricting 76.7% of extension, #9 restricting 83.5% of radial deviation, and #4 maximally restricting ulnar deviation. A grip strength reduction was observed with all WHOs, and ranged from 1.7% (#6) to 34.2% (#4).Conclusion: WHOs did not limit movement sufficiently to successfully manage any condition requiring motion restriction associated with pain relief. The array of motion control recorded might be a contributing factor for the current conflicting evidence of efficacy for WHOs. Any detrimental impact on grip strength will influence the types of activities undertaken by the wearer. The design aspects impacting wrist motion and grip strength are multifactorial, including: WHO geometry; the presence of a volar bar; material of construction; strap design; and quality of fit. This study raises questions regarding the efficacy of current designs of prefabricated WHOs which have remained unchanged for several decades but continue to be used globally without a robust evidence-base to inform clinical practise and the prescription of these devices. These findings justify the need to re-design WHOs with the goal of meeting users' needs.

Objective: Wrist-hand orthoses (WHOs) are prescribed for a range of musculoskeletal/neurological conditions to optimise wrist/hand position at rest and enhance performance by controlling its range of motion (ROM), improving alignment, reducing pain, and optimising grip strength. The objective of this research was to study the efficacy and functionality of ten commercially available WHOs on wrist ROM and grip strength.Design: Randomised comparative functional study of the wrist/hand with and without WHOs.Participants: Ten right-handed female participants presenting with no underlying condition nor pain affecting the wrist/hand which could influence motion or grip strength. Each participant randomly tested ten WHOs; one per week, for 10 weeks.Main outcome measures: The primary outcome was to ascertain the impact of WHOs on wrist resting position and flexion, extension, radial, and ulnar deviation. A secondary outcome was the impact of the WHOs on maximum grip strength and associated wrist position when this was attained.Results: From the 2,400 tests performed it was clear that no WHO performed effectively or consistently across participants. The optimally performing WHO for flexion control was #3 restricting 86.7%, #4 restricting 76.7% of extension, #9 restricting 83.5% of radial deviation, and #4 maximally restricting ulnar deviation. A grip strength reduction was observed with all WHOs, and ranged from 1.7% (#6) to 34.2% (#4).Conclusion: WHOs did not limit movement sufficiently to successfully manage any condition requiring motion restriction associated with pain relief. The array of motion control recorded might be a contributing factor for the current conflicting evidence of efficacy for WHOs. Any detrimental impact on grip strength will influence the types of activities undertaken by the wearer. The design aspects impacting wrist motion and grip strength are multifactorial, including: WHO geometry; the presence of a volar bar; material of construction; strap design; and quality of fit. This study raises questions regarding the efficacy of current designs of prefabricated WHOs which have remained unchanged for several decades but continue to be used globally without a robust evidence-base to inform clinical practise and the prescription of these devices. These findings justify the need to re-design WHOs with the goal of meeting users' needs.

A Comparative Study of Efficacy and Functionality of Ten Commercially Available Wrist-Hand Orthoses in Healthy Females: Wrist Range of Motion and Grip Strength Analysis

Background: Waiting lists are often thought to be inevitable in healthcare, but strategies that address patient flow by reducing complexity, combining triage with initial management, and/or actively managing the relationship between supply and demand can work. One such model, Specific Timely Appointments for Triage (STAT), brings these elements together and has been found in multiple trials to reduce waiting times by 30–40%. The next challenge is to translate this knowledge into practice.Method: A multi-faceted knowledge translation strategy, including workshops, resources, dissemination of research findings and a community of practice (CoP) was implemented. A mixed methods evaluation of the strategy was conducted based on the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework, drawing on an internal database and a survey of workshop and CoP participants.Results: Demonstrating reach, at July 2020 an internal database held details of 342 clinicians and managers from 64 health services who had participated in the workshop program (n = 308) and/or elected to join an online CoP (n = 227). 40 of 69 (58%) respondents to a survey of this population reported they had adopted the model, with some providing data demonstrating that the STAT model had been efficacious in reducing waiting time. Perceived barriers to implementation included an overwhelming existing waiting list, an imbalance between supply and demand and lack of resources.Conclusion: There is high quality evidence from trials that STAT reduces waiting time. Using the RE-AIM framework, this evaluation of a translation strategy demonstrates uptake of evidence to reduce waiting time in health services.

Background: Waiting lists are often thought to be inevitable in healthcare, but strategies that address patient flow by reducing complexity, combining triage with initial management, and/or actively managing the relationship between supply and demand can work. One such model, Specific Timely Appointments for Triage (STAT), brings these elements together and has been found in multiple trials to reduce waiting times by 30–40%. The next challenge is to translate this knowledge into practice.Method: A multi-faceted knowledge translation strategy, including workshops, resources, dissemination of research findings and a community of practice (CoP) was implemented. A mixed methods evaluation of the strategy was conducted based on the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework, drawing on an internal database and a survey of workshop and CoP participants.Results: Demonstrating reach, at July 2020 an internal database held details of 342 clinicians and managers from 64 health services who had participated in the workshop program (n = 308) and/or elected to join an online CoP (n = 227). 40 of 69 (58%) respondents to a survey of this population reported they had adopted the model, with some providing data demonstrating that the STAT model had been efficacious in reducing waiting time. Perceived barriers to implementation included an overwhelming existing waiting list, an imbalance between supply and demand and lack of resources.Conclusion: There is high quality evidence from trials that STAT reduces waiting time. Using the RE-AIM framework, this evaluation of a translation strategy demonstrates uptake of evidence to reduce waiting time in health services.