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Publications of 2024

Joyce Lo, Sharan Jaswal, Matthew Yeung, Vijay Kumar Chattu, Ali Bani-Fatemi, Aaron Howe, Amin Yazdani, Basem Gohar, Douglas P. Gross, Behdin Nowrouzi-Kia

Alan Li, Ziru Wang, Raabia Khan, Ramasubramanian Ponnusamy, Dinesh Krishna & Behdin Nowrouzi-Kia

Kathy Zhou, Bushra Alam, Ali Bani-Fatemi, Aaron Howe, Vijay Kumar Chattu & Behdin Nowrouzi-Kia

Autistic individuals often experience a wide range of barriers and challenges with employment across their lifetime. Despite their strengths and abilities to contribute to the workforce, many individuals experience unemployment, underemployment and malemployment. However, current supports and services are often inadequate to meet their needs. To allow autistic people to achieve vocational success, we explore four contributors to employment and expand upon the issues and potential solutions to each. These positions include the importance of family support and its consideration in the application of vocational support interventions, addressing transitional needs for autistic youth, building employer capacity, and conducting research that advises the development of meaningful programs and policies. By advocating for these positions, we aim to foster greater inclusivity and support for individuals with ASD in the workplace.

Gender-based violence (GBV) poses a significant concern in the construction and natural resources industries, where women, due to lower social status and integration, are at heightened risk. This systematic review aimed to identify the prevalence and experience of GBV in the construction and natural resources industries. A systematic search across databases including PubMed, OVID, Scopus, Web of Science, and CINAHL was conducted. The Risk of Bias Instrument for Cross-sectional Surveys of Attitudes and Practices by McMaster University and the Critical Appraisal of Qualitative Studies by the Center for Evidence Based Medicine at the University of Oxford were used to assess the studies included in the review. Six articles were included after full-text analysis. GBV was reported in the construction, mining, urban forestry, and arboriculture sectors. Workplace GBV was measured differently across the studies, and all studies examined more than one form of GBV. The main forms of GBV discussed in these studies were discrimination, sexual harassment, and sexism. The studies provided some insight for demographic factors that may or may not be associated with GBV, such as age, region of work, and number of years working in the industry. The review also suggests that workplace GBV has a negative impact on mental health and well-being outcomes, such as higher levels of stress and lower job satisfaction. The current research has not established the effectiveness of interventions, tools, or policies in these workplaces. Thus, additional research should include intervention studies that aim to minimize or prevent GBV in male-dominated workplaces. The current study can bring awareness and acknowledgement towards GBV in the workplace and highlight the importance of addressing it as this review outlines the negative consequences of GBV on mental health and well-being in these male-dominated industries.

Study design

We conducted a mixed-methods sequential explanatory study. In India, most spinal cord injuries (SCI) occur within low socioeconomic status populations, typically resulting in poor vocational outcomes post-injury and difficulty reintegrating into the community. This study will increase our understanding of how vocational rehabilitation affects patients with SCI.


This study aims to understand the factors affecting vocational outcomes, quality of life and social inclusion for patients who have completed the Amar Seva Sangam (ASSA’s) rehabilitation program, by examining both quantitative and qualitative measures.


Conducted at the University of Toronto, we used self-administered questionnaires via REDCap for quantitative data collection and semi-structured interviews for qualitative data collection to capture aspects of lived SCI experience for five participants.


Thirty-two participants completed the quantitative phone questionnaire of which 17 were paraplegic and 15 were quadriplegic. Four themes emerged including physical barriers to employment, social inclusion of SCI patients, low income, and state of mental health.


This study provided a detailed examination of demographic information and lived experiences of ASSA participants. The findings will be relevant and applicable to both clinical and public health sectors in SCI rehabilitation in India and other low- and middle-income countries by directing rehabilitation programs to better address areas of function that allow patients to find success following rehabilitation.

Aaron S. Howe, Kevon Jules, Jeremy KCD Tan, Raabia Khan, Anson KC Li, Brydne Edwards, Emily C King, Sonia Nizzer, Basem Gohar, Amin Yazdani, Ali- Bani-Fatemi, Vijay Kumar Chattu, Lindsay Sinclair, Mhairi Kay, Behdin Nowrouzi-Kia

Candice Crooks, Helena Toolsiedas, Alicia McDougall, Behdin Nowrouzi-Kia

Home care rehabilitation professionals (hcRPs) provide health services for clients with a broad range of medical conditions. During the COVID-19 pandemic, home care rehabilitation professionals experienced exacerbations of pre-existing work-related stressors, increased risk of transmission of the COVID-19 virus, reduced resource availability, greater workloads, and staffing shortages. The primary aim of this study was to examine the experience and impact of occupational and mental stress on hcRPs working during the COVID-19 pandemic. Semi-structured interviews were conducted with 24 hcRPs working in Ontario, Canada during the COVID-19 pandemic. Inductive thematic analysis was used to interpret and organize the data into conceptualized themes. Interview data was organized into three themes: (a) unique challenges of a home care rehabilitation professional, (b) COVID-19 exacerbations of home care occupational and mental stress, and (c) personal and workplace coping strategies. Many participants reported reducing their hours or taking on adjunctive roles in different clinical settings outside of home care due to work-related stress exacerbated by the COVID-19 pandemic. With a focus on the effects of COVID-19 on the practice of home care, this study provides a unique perspective on the challenges experienced by hcRPs during an emergent and evolving global public health concern. The exploratory nature of this research works towards providing a framework of factors to be addressed when creating sustainable healthcare interventions, as well as recommendations to support hcRPs to benefit both the community and health-care providers.

Wils Nielsen, Vibeke Strand, Lee S Simon, Ioannis Parodis, Alfred H J Kim, Maya Desai, Yvonne Enman, Daniel Wallace, Yashaar Chaichian, Sandra Navarra, Cynthia Aranow, Meggan MacKay, Kimberly Trotter, Oshrat E Tayer-Shifman, Ali Duarte-Garcia, Lai Shan Tam, Manuel F Ugarte-Gil, Guillermo J PonsEstel, John A Reynolds, Mandana Nikpour, Alberta Hoi, Juanita Romero-Diaz, Danaë Papachristos, Amita Aggarwal, Chi Chiu Mok, Keishi Fujio, Rosalind Ramsey-Goldman, Aaron Howe, Behdin Nowrouzi Kia, Dennisse Bonilla, Julian Thumboo, Marta Mosca, Martin Aringer, Sindhu R Johnson, Aaron M Drucker, Eric Morand, Ian Bruce, Zahi Touma

Background: The Outcome Measures in Rheumatology (OMERACT) Systemic Lupus Erythematosus (SLE) Working Group held a Special Interest Group (SIG) at the OMERACT 2023 conference in Colorado Springs where SLE collaborators reviewed domain sub-themes generated through qualitative research and literature review.

Objective: The objective of the SIG and the subsequent meetings of the SLE Working Group was to begin the winnowing and binning of candidate domain sub-themes into a preliminary list of candidate domains that will proceed to the consensus Delphi exercise for the SLE COS.

Methods: Four breakout groups at the SLE SIG in Colorado Springs winnowed and binned 132 domain sub-themes into candidate domains, which was continued with a series of virtual meetings by an advisory group of SLE patient research partners (PRPs), members of the OMERACT SLE Working Group Steering Committee, and other collaborators.

Results: The 132 domain sub-themes were reduced to a preliminary list of 20 candidate domains based on their clinical and research relevance for clinical trials and research studies.

Conclusion: A meaningful and substantial winnowing and binning of candidate domains for the SLE COS was achieved resulting in a preliminary list of 20 candidate domains.

Introduction: Mood disorders can have a negative impact on daily functioning because cognitive deficits are exacerbated when individuals experience associated symptoms. Nevertheless, yoga therapy has been found to have enhancing features to well-being and quality of life. Occupational therapists are well positioned to include yoga as a modality to benefit clients experiencing mood disorders. However, literature on yoga interventions for mood disorders is underdeveloped causing an inadequate understanding of the health benefits. Thus, the aim of this study is to gain further knowledge associated with the implications of yoga as an intervention to increase participation in activities of daily living and enhance the quality of life of individuals experiencing mood disorders. This review will answer the following research question: can yoga therapy be used as an effective modality in occupational therapy practice to manage symptomatology related to mood disorders through increasing engagement in daily tasks?

Methods and analysis: OVID Medline, Embase as well as CINAHL Plus, Cochrane Library (Wiley), APA PsycINFO and Scopus will be explored to adhere to the following criteria: (1) studies discussing adults diagnosed with mood disorders, specifically bipolar and related disorders or depressive disorders as stated in the Diagnostic Statistical Manual of Mental Disorders-5; (2) studies discussing implementation of yoga therapy; (3) a correlation between mood disorders and effectiveness of yoga therapy.

Ethics and dissemination: Ethics approval is not applicable for this study, due to obtaining data from existing research articles. The completed manuscript will be submitted in a peer-reviewed journal for publication.

Behdin Nowrouzi-Kia, Sarah Sirek, Grace Granofsky, Mitchel Morrison & Ivan Steenstra

Anson Kwok Choi Li, Behdin Nowrouzi-Kia

To evaluate the effectiveness of Employee Assistance Program (EAP) interventions, the Workplace Outcome Suite (WOS) was developed. This study aims to determine if the new WOS 5-item version can be used to approximate the WOS 25-item version without excessive loss of reliability, validity, or sensitivity. A quantitative psychometric evaluation study design was employed. Secondary data analysis of the WOS 25-item questionnaire was conducted before and after EAP services were delivered to participants. This analysis used 2046 data responses from 1023 participants. Quantitative data analysis included descriptive statistics, Cohen’s d, paired t-test, the Wilcoxon signed-rank (non-parametric test), and bivariate factor analysis. Findings demonstrate that the WOS 5-item version can successfully detect changes in workplace functioning. Within all five constructs, users’ scores improved after EAP interventions, indicating improvement in mental health. Significant changes were detected for absenteeism, presenteeism, work engagement, and workplace distress. Bivariate correlation results indicate the WOS 5-item is a good representation of the 25-item version. There are strong correlations between each item on the WOS-5 and the corresponding items in each construct on the WOS-25. This evidence suggests the WOS 5-item version can be used to approximate the WOS 25-item version without excessive loss of reliability, validity, or sensitivity.


The annual cost of mental illnesses in Canada is estimated to be $50 billion. Research from other countries have suggested that employment status is associated with mental and physical health. Within the Canadian context, there is a dearth of research on the relationship between employment and mental health.


To explore the relationships between age, gender, income, and employment status on mental and physical health.


The 2021 Canadian Digital Health Survey dataset was used for this study. Data records, which included responses for the questions on age, gender, income, employment status, mental, and physical health, were used in the analysis. Ordinal logistics regression was applied to investigate the associations that may exist between mental and physical health with the various sociodemographic factors. Descriptive statistics were also provided for the data.


The total sample size included in the analysis was 10,630. When compared to respondents who had full-time employment, those who were unemployed were more likely to have lower self-perceived mental health (OR: 1.91; 95% CI: 1.55–2.34). Retired respondents were less likely to have worse mental health than respondents who were employed full-time (OR: 0.78; 95% CI: 0.68–0.90). Self-perceived physical health was more likely to be lower for those who were unemployed (OR: 1.74; 95% CI: 1.41–2.14) or retired (OR: 1.28; 95% CI: 1.12–1.48) when compared to respondents employed full-time. The likelihood of worsening mental and physical health was also found to be associated with age, gender, and income.


Our findings support the evidence that different factors contribute to worsening mental and physical health. Full-time employment may confer some protective effects or attributes leading to an increased likelihood of having improved mental health compared to those who are unemployed. Understanding the complex relationships on how various factors impact mental health will help better inform policymakers, clinicians, and other stakeholders on how to allocate its limited resources.

Mary T. Fox, Jeffrey I. Butler, Adam M. B. Day, Evelyne Durocher, Behdin Nowrouzi-Kia, Souraya Sidani, Ilo-Katryn Maimets, Sherry Dahlke, Janet Yamada


There is a pressing need for transitional care that prepares rural dwelling medical patients to identify and respond to the signs of worsening health conditions. An evidence-based warning signs intervention has the potential to address this need. While the intervention is predominantly delivered by nurses, other healthcare providers may be required to deliver it in rural communities where human health resources are typically limited. Understanding the perspectives of other healthcare providers likely to be involved in delivering the intervention is a necessary first step to avert consequences of low acceptability, such as poor intervention implementation, uptake, and effectiveness. This study examined and compared nurses’ and other healthcare providers’ perceived acceptability of an evidence-based warning signs intervention proposed for rural transitional care.


A cross-sectional design was used. The convenience sample included 45 nurses and 32 other healthcare providers (e.g., physical and occupational therapists, physicians) who self-identified as delivering transitional care to patients in rural Ontario, Canada. In an online survey, participants were presented with a description of the warning signs intervention and completed established measures of intervention acceptability. The measures captured 10 intervention acceptability attributes (effectiveness, appropriateness, risk, convenience, relevance, applicability, usefulness, frequency of current use, likelihood of future use, and confidence in ability to deliver the intervention). Ratings ≥ 2 indicated acceptability. Data analysis included descriptive statistics, independent samples t-tests, as well as effect sizes to quantify the magnitude of any differences in acceptability ratings between nurses and other healthcare providers.


Nurses and other healthcare providers rated all intervention attributes > 2, except the attributes of convenience and frequency of current use. Differences between the two groups were found for only three attributes: nurses’ ratings were significantly higher than other healthcare providers on perceived applicability, frequency of current use, and the likelihood of future use of the intervention (all p’s < .007; effect sizes .58 - .68, respectively).


The results indicate that both participant groups had positive perspectives of the intervention on most of the attributes and suggest that initiatives to enhance the convenience of the intervention’s implementation are warranted to support its widespread adoption in rural transitional care. However, the results also suggest that other healthcare providers may be less receptive to the intervention in practice. Future research is needed to explore and mitigate the possible reasons for low ratings on perceived convenience and frequency of current use of the intervention, as well as the between group differences on perceived applicability, frequency of current use, and the likelihood of future use of the intervention.


The intervention represents a tenable option for rural transitional care in Ontario, Canada, and possibly other jurisdictions emphasizing transitional care.

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