To determine the effect of implementing a care pathway on return-to-work (RTW) levels and identify prognostic factors among workers filing their first shoulder injury claim. This retrospective cohort study included 5075 workers with a first claim for shoulder injury: 2593 workers (2004–2008) received standard of care consultations, while 2482 workers (2014–2018) underwent specialized shoulder assessments through a care pathway that also included collaborative planning for RTW. Multinomial logistic regression determined the effect of implementing a care pathway on RTW levels and identified demographics, injury, occupational and program factors associated with RTW. The most common injuries were traumatic (92.4

OBJECTIVE:To examine patterns of prednisone prescribing for rheumatoid arthritis (RA) management in primary care settings; and to explore experiences and perspectives of family physicians (FPs) and people living with RA regarding prednisone use. DESIGN:Mixed-methods study with sequential exploratory design. SETTING:Canada, particularly Alberta. PARTICIPANTS:Overall, 546 patients with RA in primary care electronic medical records in southern Alberta after excluding short-term prednisone prescriptions, 33 people living with RA from across Canada, and 16 primary care providers (14 family physicians, 1 clinic manager, 1 pharmacist). METHODS:Qualitative interviews and focus groups guided the analysis of primary care electronic medical records linked with provincial pharmaceutical dispensing data. Patterns of prednisone dispensing over 12 years, factors associated with prednisone use before and after RA documentation, and qualitative experiences with prednisone therapy were examined. MAIN FINDINGS:Each year between 2008 and 2019, at least 40% of patients with established RA received at least 1 prednisone prescription. Of patients receiving both prednisone and disease-modifying antirheumatic drugs (DMARDs) (41%, n=210), a subset (n=92) received prednisone before starting DMARDs, with 66% continuing prednisone for more than a year after DMARD initiation. Median time between first prednisone prescription and DMARD initiation was 124 days (interquartile range=13 to 1150 days). Three main qualitative themes were identified: prednisone is used as bridging therapy during the wait time to see a specialist, patients and providers have concerns about long-term use and side effects, and systemic barriers affecting access to guideline-concordant care exist and particularly impact male patients. CONCLUSION:Current prednisone prescribing patterns in RA management reveal divergence from guidelines recommending short-term use, suggesting systemic barriers to guideline-concordant care. Improving outcomes requires addressing both clinical needs driving prednisone use and systemic barriers perpetuating reliance on this medication.

The Moving Forward Together series is a collective effort developed to inform, guide and inspire musculoskeletal physical therapists to bring Indigenous health to the forefront of their work in clinical practice, research and education and to strengthen their roles in allyship and advocacy for Indigenous Communities. In the fourth article of the ‘Moving Forward Together’ series, we highlight how physical therapy education can influence, and have responsibility for, improving students’ knowledge and skills to care for Indigenous Peoples who are living with musculoskeletal conditions. Through a collaborative process, our group—comprising Indigenous educators from Aotearoa/New Zealand, Australia and Canada—has reflected on current initiatives, explored future directions, and offered suggestions on how physical therapists can contribute to positive change within Indigenous musculoskeletal education. An interconnected approach positions students to graduate as physical therapists, capable of demonstrating cultural humility to provide reflective, strengths-based and relational culturally-safe healthcare to all people with musculoskeletal conditions.

ABSTRACT Relatively little is known about the association between climate change, climate variability, weather, and health among older adults living with dementia, who face heightened risks. Our aim was to conduct a scoping review of the global published literature regarding the effects of climate change, climate variability, and weather on emergency department visits, hospitalizations, falls, morbidity, and mortality among older adults (≥ 65 years) living with dementia. Relevant subject headings and synonyms for concepts related to dementia, weather, climate change, climate variability, and health were used in the electronic search of five databases. Reviewers independently screened abstracts and then selected full texts to extract data from the included studies following PRISMA scoping review guidelines. Nineteen studies from the United States of America, Germany, Italy, Finland, China, Japan, and Australia were included. Heat waves were the most investigated climate‐sensitive events ( n = 9). Mortality ( n = 10) and hospitalizations ( n = 9) were the most frequently studied health endpoints. Extreme heat events were associated with increased hospitalizations and mortality among older adults living with dementia. Extreme cold events were also reported as increasing mortality. Heat waves and wildfires were found to exacerbate neuropsychiatric symptoms. Existing evidence shows that climate change is negatively impacting the health of older adults living with dementia, pointing to a concerning trend. However, studies on other climate‐sensitive events, including precipitation, solar radiation, disasters, and morbidities related to cardiovascular, respiratory, mental health, and falls‐related injuries in this population were scarce. Future research is warranted in climate and dementia. This article is categorized under: Assessing Impacts of Climate Change > Observed Impacts of Climate Change

Background: Although physical activity (PA) participation has known health benefits, many individuals with hypermobility spectrum disorders (HSD) and hypermobile Ehlers-Danlos syndrome (hEDS) have difficulties participating in PA. HSD/hEDS affect approximately 1 in 500 people and are more prevalent in females. HSD/hEDS may result in frequent joint injuries, chronic pain, and generalized fatigue. These symptoms, and a fear of new or reinjury, may result in barriers to PA participation. Overall, there is limited research on PA in this population. Previous exercise reviews have not included structured PA such as sports and occupational activities; unstructured PA such as play, household, or leisure activities; or younger ages, including children. Additionally, some females with HSD/hEDS report experiencing more frequent joint injuries and worsening pain and fatigue during times of hormonal transitions, such as puberty, pregnancy, as well as cyclically across the menstrual cycle. Some females also report improvements in symptoms and a reduction in injury frequency following menopause. The impacts of PA during these times of changing hormone levels for females living with HSD/hEDS are uncertain. A clear understanding of what types of structured and unstructured PA are safe and helpful for individuals of all ages with HSD/hEDS, and if PA should be adapted during times of female hormonal changes, is lacking. Objective: We propose a scoping review protocol to map and synthesize the evidence regarding considerations that may impact structured and unstructured PA participation in HSD/hEDS for individuals of all ages and during times of female hormonal transitions. Methods: A scoping review will be conducted using Covidence (Veritas Health Innovation Ltd) and Microsoft Excel (Microsoft Corp) to map the evidence regarding the impacts of PA on safety, physical health, and quality of life. These outcomes will be assessed using the World Health Organization International Classification of Functioning, Disability and Health framework. Results: The database search was performed on August 22, 2024, and updated on September 8, 2025. Data extraction started in September 2025 and is ongoing. The results are expected to be published by August 2026. Conclusions: This proposed scoping review will aid in defining critical research directions regarding PA in HSD/hEDS, which may help inform guidelines outlining the risks and benefits of structured and unstructured PA. This review will also help define existing evidence for age-specific and hormone-related considerations regarding the impacts of PA in this population. This is particularly important as PA may help ameliorate the physical and mental symptoms associated with HSD/hEDS and may improve quality of life for these individuals across the lifespan.

Objective To examine patterns of prednisone prescribingfor rheumatoid arthritis (RA) management in primary care settings; and to explore experiences and perspectives of family physicians (FPs) and people living with RA regarding prednisone use. Design Mixed-methods study with sequential exploratory design. Setting Canada, particularly Alberta. Participants Overall, 546 patients with RA in primary care electronic medical records in southern Alberta after excluding shortterm prednisone prescriptions, 33 people living with RAfrom across Canada, and 16 primary care providers (14 family physicians, 1 clinic manager,1 pharmacist). Methods Qualitative interviews and focus groups guided the analysis of primary care electronic medical records linked with provincial pharmaceutical dispensing data. Patterns of prednisone dispensing over 12 years, factors associated with prednisone use before and after RA documentation, and qualitative experiences with prednisone therapy were examined. Main findings Each year between 2008 and 2019, at least 40% of patients with established RA received at least 1 prednisone prescription. Of patients receiving both prednisone and disease-modifying antirheumatic drugs (DMARDs) (41%, n=210), a subset (n=92) received prednisone before starting DMARDs, with 66% continuing prednisone for more than a year after DMARD initiation. Median time between first prednisone prescription and DMARD initiation was 124 days (interquartile range=13 to 1150 days). Three main qualitative themes were identified: prednisone is used as bridgingtherapy duringthe waittime to see a specialist, patients and providers have concerns about long-term use and side effects, and systemic barriers affecting access to guideline-concordant care exist and particularly impact male patients. Conclusion Current prednisone prescribing patterns in RA management reveal divergence from guidelines recommending short-term use, suggesting systemic barriers to guideline-concordant care. Improving outcomes requires addressing both clinical needs driving prednisone use and systemic barriers perpetuating reliance on this medication.

To examine prednisone prescribing patterns and use among rheumatoid arthritis (RA) patients in Canadian primary care settings, exploring adherence to current guidelines and identifying factors influencing prescribing practices. This mixed-methods study explored perspectives on RA care access through: Qualitative interviews with 33 people living with RA (PlwRA) across Canada Three focus groups with primary care providers (14 physicians, 1 manager, 1 pharmacist) in Alberta Quantitative analysis of prescribing patterns for 597 RA patients (2008-2020) using linked primary care electronic medical records (EMR) and pharmaceutical data from Southern AlbertaPlwRA interviews were guided by the Candidacy Framework[1] and a critical interpretive synthesis of RA literature.[2] Logistic regression analyzed associations between patient/physician characteristics and prednisone use. This approach combined in-depth individual perspectives with broader, generalizable data on RA care access and management. Among 597 RA patients identified from primary care EMR, annual point prevalence for prednisone (oral and injection) dispensing increased from 16% in 2008 to 29% in 2020. 65% of RA patients had at least 1 prednisone dispensation during the study period. Patients with higher comorbidity scores (calculated for the entire period of data capture) were more likely to receive prednisone (OR 1.20, 95% CI 1.02-1.41) (Table). 83% of 597 patients with incident DMARD prescriptions also had prednisone prescriptions, indicating its use as bridging therapy. Qualitative data also revealed PCPs’ reliance on prednisone for symptom management during long waits for rheumatologist consultations when no DMARDs were available to them, which ranged from less than a month to over 2 years. PlwRA reported diverse experiences with prednisone, from reluctance due to side effects to dependence for symptom control over extended periods of time. Prednisone use in RA management often extends beyond the short-term use recommended in current guidelines, largely due to systemic challenges in accessing timely rheumatology care. While serving as crucial bridging therapy, prolonged prednisone use (continuous use exceeding 3 months) raises concerns about long-term risks. These findings highlight the need for improved care pathways and closer collaboration between rheumatologists and primary care providers to optimize RA management and reduce reliance on extended prednisone use. [1.] Dixon-Woods M. BMC Med Res Methodol 2006;6:35. [2.] Koehn S. BMC Health Serv Res 2024;24:986.

This study explores how individuals with rheumatoid arthritis (RA) come to identify themselves as candidates for medical care, using the newly developed Candidacy 2.0 model. Candidacy 2.0 extends the original Candidacy Framework by emphasizing the role of the embodied intersectional relational self in healthcare access, providing a theoretical framework that transcends specific healthcare systems. Through semi-structured interviews with 33 individuals living with RA across six Canadian provinces, we examined how embodied experiences, social identities, and relational contexts shape initial recognition of care needs. Analysis revealed distinct 'tipping points' where symptom progression from single to multiple joints and unmanageable pain forced recognition of care needs. Age and gender identities created distinct barriers to care-seeking: younger individuals dismissed symptoms as affecting only older adults, while gendered expectations about caregiving delayed help-seeking among women. Professional identity emerged as particularly significant, offering knowledge advantages but sometimes hindering patient-centered care. Support networks proved crucial in symptom interpretation and help-seeking, with their importance highlighted by COVID-19-related disruptions. The study demonstrates how Candidacy 2.0's emphasis on embodied, intersectional, and relational aspects of healthcare access enhances understanding of help-seeking behaviors in chronic conditions. Findings suggest the need for targeted public health campaigns addressing age-related misconceptions, gender-sensitive clinical approaches, flexible care delivery models that accommodate support networks, and educational resources helping patients identify and act upon significant symptom changes.

Rheumatoid arthritis (RA) is a chronic inflammatory condition with increasing prevalence, particularly in older adults. This study examined differences in prescribing patterns of biologic DMARDs (bDMARDs) between younger (< 65 years) and older (≥ 65 years) adults and explored factors influencing delays in therapy initiation. A retrospective comparison of bDMARD use in younger (< 65 years) and older (≥ 65 years) adults who have RA was conducted using data from the Rheumatoid Arthritis Pharmacovigilance Program and Outcomes Research in Therapeutics (RAPPORT) registry. Disease activity was assessed using the Disease Activity Score (DAS28) and Health Assessment Questionnaire (HAQ). multivariable regression analysis was performed to explore factors associated with delayed bDMARD prescription. Among 3411 patients, older adults experienced significantly longer delays in bDMARD initiation compared to younger patients (p < 0.0001). Older adults also demonstrated higher disease activity (HAQ: 1.75 vs. 1.48, DAS28: 5.95 vs. 5.49, both p < 0.0001) and elevated inflammatory markers. Regression analysis revealed that advanced age, comorbidity burden, smoking, and seropositivity were associated with delays in bDMARD initiation. Despite evidence supporting bDMARD efficacy and safety, older RA patients face significant delays in therapy, leading to suboptimal disease control and increased adverse outcomes. Addressing age-related barriers to RA treatment is critical to improving equitable access. Further research is needed to investigate mechanisms underlying these disparities and assess the benefits of timely bDMARD initiation on long-term outcomes in older adults.

Purpose: Despite the health benefits for people with mobility limitations of participating in community-based exercise programmes (CBEPs), accessing and implementing in-person CBEPs can be challenging. We describe a theory-based approach to adapting a group task-oriented, in-person CBEP targeting balance and mobility to a virtual format. Method: We used the Knowledge-to-Action and Medical Research Council frameworks to guide adaptation of an established CBEP for virtual delivery. We undertook consultations with knowledge users (i.e., CBEP providers, health care professionals, managers, policy-makers) and researchers on adapting programme components to optimize the feasibility of virtual delivery and retain benefits of the in-person CBEP. Concurrently, we conducted three feasibility studies involving post-programme participant surveys to evaluate and refine programme components. Results: Programme components, including a pre-programme safety video and use of trained facilitators to stream exercise videos via videoconferencing and facilitate social times, met safety, feasibility, and acceptability benchmarks. In studies 1, 2, and 3, the majority of participants described benefit to physical function (59%, 64%, and 79%, respectively) and emotional well-being (64%, 62%, and 75%, respectively). Conclusions: Theoretical frameworks were useful to guide adaptation of an established in-person CBEP to a virtual format. This theoretical approach may inform virtual programme development for other populations and targeted outcomes. Objectif : malgr & eacute; les bienfaits de la participation & agrave; des programmes d'exercice en milieu communautaire (PEMC) pour les personnes ayant des limitations fonctionnelles, il peut & ecirc;tre difficile d'y acc & eacute;der et de les mettre en oe uvre. Les autrices d & eacute;crivent une approche th & eacute;orique pour adapter en format virtuel un PEMC de groupe en personne orient & eacute; vers les t & acirc;ches visant l'& eacute;quilibre et la mobilit & eacute;. M & eacute;thodologie : les autrices ont utilis & eacute; le cadre des connaissances & agrave; la pratique et celui du Conseil m & eacute;dical de la recherche pour orienter vers un format virtuel l'adaptation d'un PEMC & eacute;tabli. Elles ont entrepris des consultations avec des utilisateurs des connaissances (fournisseurs du PEMC, professionnels de la sant & eacute;, gestionnaires, d & eacute;cideurs) et des chercheurs pour adapter les & eacute;l & eacute;ments du programme en vue d'optimiser la faisabilit & eacute; de la prestation virtuelle et de conserver les avantages du PEMC donn & eacute; en personne. Parall & egrave;lement, elles ont r & eacute;alis & eacute; trois & eacute;tudes de faisabilit & eacute; & agrave; partir de sondages aupr & egrave;s des participants apr & egrave;s le programme pour & eacute;valuer et peaufiner les & eacute;l & eacute;ments du programme. R & eacute;sultats : les & eacute;l & eacute;ments du programme, y compris une vid & eacute;o de s & eacute;curit & eacute; avant le programme et le recours & agrave; des facilitateurs form & eacute;s pour diffuser des vid & eacute;os d'exercice par visioconf & eacute;rence et faciliter les p & eacute;riodes de socialisation, respectaient les normes de s & eacute;curit & eacute;, de faisabilit & eacute; et d'acceptabilit & eacute;. Dans les & eacute;tudes 1, 2 et 3, la majorit & eacute; des participants en ont d & eacute;crit les avantages pour le fonctionnement physique (59 %, 64 % et 79 %, respectivement) et le bien-& ecirc;tre affectif (64 %, 62 % et 75 %, respectivement). Conclusions : les cadres th & eacute;oriques & eacute;taient utiles pour orienter l'adaptation d'un PECM & eacute;tabli en personne vers un format virtuel. Cette approche th & eacute;orique peut & eacute;clairer l'& eacute;laboration d'un programme virtuel pour d'autres populations et r & eacute;sultats cibl & eacute;s.

BackgroundThe Getting Older Adults Outdoors (GO-OUT) randomized controlled trial showed that a workshop and 10-week park-based outdoor walk group (OWG) was superior to the workshop and 10 weekly reminders (WR) with increasing walking capacity, but not outdoor walking activity, health-promoting behavior, or successful aging, among older adults with difficulty walking outdoors. The objective of this planned process evaluation was to explore participants' perceptions of mechanisms of impact of and contextual factors influencing experiences with the interventions to help explain the observed intervention effects on study outcomes.MethodsA qualitative descriptive study involving semi-structured interviews conducted at 6-months post-baseline was conducted. A directed content analysis was undertaken.ParticipantsWe interviewed 27 adults (52% male, 48% female, mean age 76 years) from the OWG (n = 13) and WR group (n = 14).ResultsWe identified two themes including: "Holding Me Accountable to Walk More Frequently", and "We Walked Farther, With More Ease and Confidence, and We Felt Better". Participants in both groups described how the OWG and WR programs provided some degree of structure and accountability to others that increased their motivation to walk outdoors. Participants described how the OWG led to improved walking capacity (e.g., increased walking distance) and confidence. Interacting with people during OWG sessions led to a sense of enjoyment, and well-being.ConclusionsCommunity programs that incorporate structure, accountability, and opportunities for social interaction, can help improve motivation to increase outdoor walking activity and a sense of belonging for older adults with difficulty walking outdoors. Park-based OWG programs appear to convey additional important benefits related to improved physical function and well-being.Trial registrationClinicalTrials.gov NCT03292510 Date of registration: September 25, 2017.

BACKGROUND AND OBJECTIVES:Hospitalized older adults are at risk for both physical and cognitive functional decline. To support the implementation of interventions optimizing their function, both healthcare professional knowledge and other factors that may impact practice change should be addressed. The objective of this study was to examine the characteristics and type of interventions supporting the translation of gerontological evidence into practice to optimize functional outcomes for hospitalized older adults. MATERIALS AND METHODS:This scoping review used the guidelines recommended by Peters et al. Six electronic databases were searched from database inception to 2024. Included studies were primary research studies that 1) described an educational intervention for healthcare professionals as part of an initiative to promote practice change and 2) assessed functional outcomes (physical and/or cognitive). RESULTS:Thirty-eight studies were deemed eligible. Numerous interventions to support implementation of knowledge to improve functional outcomes were identified. In addition to educational strategies, other interventions addressed care processes, changes to the built environment, administration/management support, leadership support/facilitation, and discharge/transition planning. Studies employed a range of measures to assess functional outcomes among hospitalized older adults. DISCUSSION:Older studies tended to focus on nurse-driven interventions, and newer ones on interprofessional interventions. Knowledge gaps were highlighted in terms of theory, research designs, intervention descriptions, country representation, policy, environmental changes, and leadership roles. Future evaluations of interventions to enhance older adults' functioning should examine effectiveness and compare single- and multi-intervention programs. Strategies based on implementation science theory are needed to ensure successful uptake of effective interventions, while also addressing real-world issues in hospital units, such as short staffing, resource constraints, and overcrowding.

Introduction While group, task-oriented, community-based exercise programs (CBEPs) delivered in-person can increase exercise and social participation in people with mobility limitations, challenges with transportation, cost and human resources, threaten sustainability. A virtual delivery model may help overcome challenges with accessing and delivering in-person CBEPs. The study objective is to estimate the short-term effect of an 8-week, virtual, group, task-oriented CBEP called TIME™ (Together in Movement and Exercise) at Home compared with a waitlist control on improving everyday function in community-dwelling adults with mobility limitations.Methods and analysis A randomised controlled trial incorporating a type 1 effectiveness-implementation hybrid design is being conducted in four Canadian metropolitan centres. We aim to stratify 200 adults with self-reported mobility limitations by site, participation alone or with a partner, and functional mobility level, and randomise them using REDCap software to either TIME™ at Home or a waitlist control group. During TIME™ at Home classes (2 classes/week, 1.5 hours/class), two trained facilitators stream a 1-hour exercise video and facilitate social interaction prevideo and postvideo using Zoom. A registered healthcare professional at each site completes three e-visits to monitor and support implementation. Masked evaluators with physical therapy training evaluate participants and their caregivers at 0, 2 and 5 months using Zoom. The primary outcome is the change in everyday function from 0 to 2 months, measured using the physical scale of the Subjective Index of Physical and Social Outcome. The study is powered to detect an effect size of 0.4, given α=0.05, power=80% and a 15% attrition rate. Secondary outcomes are mobility, well-being, reliance on walking aids, caregiver assistance, caregiver mood, caregiver confidence in care-recipient balance and cost-effectiveness. A multimethod process evaluation is proposed to increase understanding of implementation fidelity, mechanisms of effect and contextual factors influencing the complex intervention. Qualitative data collection immediately postintervention involves interviewing approximately 16 participants and 4 caregivers from the experimental group, and 8 participants and 4 caregivers from the waitlist control group, and all healthcare professionals, and conducting focus groups with all facilitators to explore experiences during the intervention period. A directed content analysis will be undertaken to help explain the quantitative results.Ethics and dissemination TIME™ at Home has received ethics approval at all sites. Participants provide verbal informed consent. A data safety monitoring board is monitoring adverse events. We will disseminate findings through lay summaries, conference presentations, reports and journal articles.Trial registration number NCT06245135.

OBJECTIVES:Falls in older adults are a public health concern, yet little is known about falls in adults with hip or knee total joint arthroplasty (TJA) who may be at a higher risk than the general population. The study objectives were to compare the number of fallers and fear of falling in TJA patients to age and sex matched community controls, and determine whether the type of risk factors for falls reported in TJA differed from the community group. METHODS:A cross sectional comparative study was conducted with patients waiting or recovering from TJA and age and sex matched comparison group of older adults residing in the community. Reported falls and risk factors for falling were compared to age and sex matched controls from the community. Fear of falling was measured using the Activities-specific Balance Confidence (ABC) Scale. Logistic regression was used to determine risk factors associated with falls in TJA and community participants. RESULTS:Of the 198 TJA participants, 29% (n = 57) reported falls within the past 12 months compared to 24% (n = 24) of 100 participants in the control group (p = 0.36). Of those who fell, 25 (44%) were recurrent fallers in the TJA cohort compared with 6 (25%) in the community cohort. Eleven participants reported falls after TJA surgery. Fear of falling was greater in the TJA group (ABC score, mean ± SD: 67.1 ± 24.4) than in the community group (88.1 ± 14.9) (p < 0.001). CONCLUSION:Although the number of participants who reported falls was comparable in both groups, the TJA group had more recurrent falls, different risk factors for falls, and more fear of falling. Fall prevention programs should be embedded in pre-operative programs for patients undergoing surgery for TJA.

Parkinson’s disease (PD) is a leading cause of neurological disability among older adults, with an age-standardized global prevalence in 2021 of 139/100,000 and projected to increase by 112 https://doi.org/10.17605/OSF.IO/2T7KG .

BackgroundParkinson's disease (PD) is a neurological disorder that significantly impacts individuals, their families, and the healthcare system. Alongside drug therapies and surgical interventions, exercise has shown potential in improving motor and non-motor symptoms. This study explored perspectives of individuals with PD, care partners, and program providers regarding a community-based exercise program for PD.MethodsIndividuals with PD (Hoehn & Yahr stages I-III), on a stable medication regime, who participated in a PD-specific community-based exercise program twice weekly for at least 12 weeks, along with care partners and program providers were recruited. In-depth interviews were conducted with individuals with PD (n = 17), care partners (n = 7), and program providers (n = 3) from January to May 2024. Data were analyzed using an interpretative phenomenology analysis and mapped onto a behavior-change model. Two patient advisors and care partners assisted in data analysis and interpretation.ResultsParticipants highlighted the PD-specific nature of the program and group exercise benefits as key motivators. Pre-program challenges included difficulties obtaining a diagnosis, adapting to non-motor symptoms, medication side effects, and finding motivation. Post-program outcomes included symptom improvement, mutual motivation, community support, and reduced self-consciousness, prompting the recommendation of greater community awareness. Barriers to participation included transportation difficulties and cost. These findings suggest addressing barriers is essential to enhance accessibility and program benefits.ConclusionsThe PD-specific exercise program was perceived as beneficial to overall health and wellness, providing physical, emotional, and social benefits. A lack of awareness about the significance of exercise in PD remains a critical challenge.

BACKGROUND:The Dixon-Woods et al. Candidacy Framework, a valuable tool since its 2006 introduction, has been widely utilized to analyze access to various services in diverse contexts, including healthcare. This social constructionist approach examines micro, meso, and macro influences on access, offering concrete explanations for access challenges rooted in socially patterned influences. This study employed the Candidacy Framework to explore the experiences of individuals living with rheumatoid arthritis (RA) and their formal care providers. The investigation extended to assessing supports and innovations in RA diagnosis and management, particularly in primary care. METHODS:This systematic review is a Critical Interpretive Synthesis (CIS) of qualitative and mixed methods literature. The CIS aimed to generate theory from identified constructs across the reviewed literature. The study found alignment between the seven dimensions of the Candidacy Framework and key themes emerging from the data. Notably absent from the framework was an eighth dimension, identified as the "embodied relational self." This dimension, central to the model, prompted the proposal of a revised framework specific to healthcare for chronic conditions. RESULTS:The CIS revealed that the eight dimensions, including the embodied relational self, provided a comprehensive understanding of the experiences and perspectives of individuals with RA and their care providers. The proposed Candidacy 2.0 (Chronic Condition (CC)) model demonstrated how integrating approaches like Intersectionality, concordance, and recursivity enhanced the framework when the embodied self was central. CONCLUSIONS:The study concludes that while the original Candidacy Framework serves as a robust foundation, a revised version, Candidacy 2.0 (CC), is warranted for chronic conditions. The addition of the embodied relational self dimension enriches the model, accommodating the complexities of accessing healthcare for chronic conditions. TRIAL REGISTRATION:This study did not involve a health care intervention on human participants, and as such, trial registration is not applicable. However, our review is registered with the Open Science Framework at https://doi.org/10.17605/OSF.IO/ASX5C .