Dissertationen zum Thema „321024 Rehabilitation and therapy: occupational and physical“

The purpose of this study was to describe participant experiences of how a rehabilitation centre can facilitate social inclusion for people with physical disabilities in Mexico. This research was a qualitative interview study with a semi-structured interview approach. Ten participants were recruited using purposive sampling. The participants were individuals with physical disabilities, including both mobility and visual impairments, who had a connection with the rehabilitation centre. Content analysis was used while examining the collected data. The result consisted of one main category ‘individual experiences of achieving social inclusion’, four categories; ‘being supported by a community’, ‘acceptance of disability’, ‘the centre's work and its effect in the society’ and ‘the importance of work’. Each category contained several sub-categories. In conclusion, the rehabilitation centre facilitates inclusion through work opportunities and the sense of belonging to a community which has a positive impact on persons with a disability. Changing attitudes in the society by raising awareness about disability and generating an acceptance of one’s disabilities were important facilitating factors.

Background and rationale. Cerebral palsy (CP) is one of the most common disabling disorders of childhood and constitutes a substantial portion of pediatric rehabilitation. This condition demands comprehensive rehabilitation using age-appropriate tasks and activities and encompassing aspects of body function and structure, activity and participation, and personal and environmental factors. Yet little is known regarding actual occupational therapy (OT) and physical therapy (PT) practices.
Objective. The primary objective of this doctoral thesis was to describe OT and PT practices for young children with CP in the Province of Quebec, Canada.
Methods. This was a cross-sectional, multi-centered survey. All eligible and consenting pediatric occupational therapists (OTs) and physical therapists (PTs) were interviewed using a structured telephone interview based on vignettes of two typical children with CP at two age points---18 months and 4 years. Reported practices were grouped according to the International Classification of Functioning, Disability, and Health (ICF). Literature review of pediatric assessments and interventions potentially used for CP was done to determine their level of evidence of effectiveness. In addition, two expert groups provided, for each vignette, a best practice problem identification list and a best practice intervention list.
Results. A total of 62 PTs (83.8% participation rate) and 85 OTs (91.4% participation rate) participated in the study. Overall, 91.9% of PTs and 67.1% of OTs reported using at least one standardized pediatric assessment for at least one vignette. OT and PT interventions focused primarily on impairments and primary function, with less attention to interventions related to play and recreation/leisure. Clinicians reported the need for more training and education specific to CP and to the use of research findings in clinical practice. Wide variations and gaps were identified in therapists' responses suggesting the need for a basic standard of PT and OT management as well as strategies to encourage knowledge dissemination regarding current best practice. Further, implementation of evidence-based practice necessitates more collaboration between researchers, clinicians and administrators.

Educational Psychology
Ph.D.
Background: In today's health care environment, developing expertise and making good decisions can be challenging when confronted with demands for high performance, high productivity, and low cost. Mindfulness may be a practice that can promote expertise and improve decision making, despite the pressures faced by occupational and physical therapists. Purpose: The purpose of this study was to explore and examine the potential relationships between expertise, mindfulness, and decision making. Methods: Occupational and physical therapists participated in a two-part study that included both quantitative and qualitative methodology. Seventy-five therapists completed a demographic questionnaire, a modified version of the Kentucky Inventory of Mindfulness Skills (KIMS-M), and the Peer-Rated Expertise in Occupational and Physical Therapy Scale (PREOPT). In the second part of the study, four therapists completed a case study using a think aloud protocol. Their verbalizations were analyzed, using verbal protocol, for trends and patterns that would reveal differences in the therapists' decision making processes. Results: Results of the first part of the study did not reveal a significant relationship between mindfulness, measure by the KIMS-M and expertise, measured by the PREOPT. Qualitative analysis suggests that mindfulness may affect therapists' approaches to decision making but does not indicate that these approaches result in better decision making. Further, the differences were surprising, as they were not consistent with current arguments about the effects of mindfulness. Conclusion: These preliminary results suggest a relationship between mindfulness and decision making approaches. However, further research is needed to confirm these observations and explore the nature of this relationship.
Temple University--Theses

Thesis (MOccTher)--Stellenbosch University, 2014.
ENGLISH ABSTRACT: Introduction: This research was conducted to establish the assessment practices of occupational therapists working with clients with upper limb injuries and/or conditions. This was done to get an updated account of frequency and variation in the use of various assessment tools as well as reasons offered for infrequent use. Methodology: A quantitative cross-sectional survey design was used. A convenience sample of therapists attending courses was recruited for the study. A questionnaire was developed for the study and face and content validity established through pilot testing. The questionnaire consisted of three sections containing demographic information and questions about upper limb assessment practices. Descriptive statistics were calculated for numerical and categorical data to describe the demographic characteristics and to identify the measurement tools that were used most frequently. The Chi-Square test of associations was used to determine whether there were any associations between frequency of use and demographic factors. Results: Questionnaires were completed by 81 (71%) respondents. Twenty-two (27.2%) of the respondents had more than five years’ experience in the field of hand therapy while the remainder (n=52, 64.2%) had less than five years. The more experienced therapists worked in the private sector (n=49, 60.5%) with two (0.03%) experienced therapists being employed in the public sector. The diagnoses that were seen most commonly were nerve injuries (90.1%), fractures (88.8%) and tendon injuries (85.1%). Of the 81 respondents 15 (18.5%) held post graduate qualifications in the field of hand therapy. Goniometry (68 of 81, 84.0%), manual muscle testing (62 of 81, 76.5%) and testing for flexor digitorum profundus and superficialis function (61 of 81, 76.3%) were used most frequently. Performance tests were used infrequently or not at all. The most common reasons for non-use of performance tests were that they were not available in the practice setting or respondents were not familiar with them. Significant associations were found between frequency of using measurement tools and practice setting, years of experience and holding a post graduate qualification in the field of hand therapy. There was a significant association between working in the private sector and using a dynamometer (p < 0.001), and working in government settings and frequent use of the test for localisation (p = 0.021). Therapists with more than five years’ experience in the field of hand therapy were significantly more likely to use Semmes Weinstein monofilaments (p = 0.034) as were those holding a post graduate qualification in hand therapy (p <0.001). Conclusion: The results of this study have serious implications in terms of the upper limb assessment practices of occupational therapists, especially in the context of evidence-based practice which has become crucial not only for the credibility of the profession, but also for its survival. Information obtained through this research could aid to guide education and training at an undergraduate and post graduate level and assist to direct a research focus for hand therapy in the South African context.
AFRIKAANSE OPSOMMING: Inleiding: Hierdie navorsing is uitgevoer om die bepalingspraktyke van arbeidsterapeute wat werk met kliënte met boonste ledemaat beserings en/of toestande vas te stel om sodoende ‘n beeld te verkry van die frekwensie en variasie van die gebruik van bepalingsinstrumente. Redes aangebied vir ongereelde gebruik hiervan is ook ondersoek. Metode: 'n Kwantitatiewe deursnee-opname-ontwerp is gebruik. ’n Gerieflikheidssteekproef van terapeute wat kursusse bygewoon het, is gewerf vir die studie. ‘n Vraelys is ontwikkel vir die studie, en voorkoms- en inhoudsgeldigheid is bepaal deur ‘n loodstudie. Die vraelys het bestaan uit drie afdelings met demografiese inligting en vrae oor boonste ledemaat bepalingspraktyke. Beskrywende statistiek is bereken vir numeriese en kategoriese data ten einde die demografiese eienskappe te beskryf en die bepalingsmetodes wat die meeste gebruik is, te identifiseer. Die Chi-kwadraat toets is gebruik om te bepaal of daar enige assosiasies tussen die frekwensie van gebruik en demografiese faktore bestaan. Resultate: Vraelyste is deur 81 (71%) respondente voltooi. Twee-en-twintig (27,2%) van die respondente het meer as vyf jaar ondervinding in die veld van handterapie gehad, terwyl die res (n = 52, 64.2%) minder as vyf jaar gehad het. Die meer ervare terapeute het gewerk in die privaatsektor (n = 49, 60.5%) met twee (0,03%) ervare terapeute in diens van die staat. Senuweebeserings (90.1%), frakture (88,8%) en tendonbeserings (85.1%) was die meeste gesien. Van die 81 respondente het 15 (18,5%) ‘n nagraadse kwalifikasie in die veld van handterapie gehad. Goniometer (68 van 81, 84.0%), spiertoetsing (62 van 81, 76,5%) en die toetse vir fleksor digitorum profundus en superficialis funksie (61 van 81, 76,3%) is die meeste gebruik. Vaardigheidstoetse is selde of glad nie gebruik nie. Die mees algemene redes aangevoer vir die feit dat vaardigheidstoetse nie gebruik is nie, was dat dit óf nie beskikbaar is in die respondent se werksarea nie, óf dat respondente nie vertroud is met die toetse nie. Beduidende assosiasies is gevind tussen die frekwensie van die gebruik van bepalingsmetodes en werksarea, jare ervaring in handterapie en 'n nagraadse kwalifikasie in die veld van die handterapie. Daar was 'n beduidende assosiasie tussen terapeute werksaam in privaatpraktyk en die gebruik van 'n dinamometer (p < 0,001) en terapeute werksaam in die staat en gereelde gebruik van die lokalisasie toets (p = 0.021). Terapeute met meer as vyf jaar ondervinding, sowel as diegene met ’n nagraadse kwalifikasie in handterapie was beduidend meer geneig om Semmes Weinstein monofilaments te gebruik (p = 0,034 en p < 0,001 respektiewelik). Gevolgtrekking : Die bevindinge van hierdie studie het ernstige implikasies in terme van die arbeidsterapie bepalingspraktyke van die boonste ledemaat, veral in die konteks van bewys-gebaseerde praktykvoering (evidence based practice) wat noodsaaklik geword het nie net vir die geloofwaardigheid van die beroep nie, maar ook vir die oorlewing daarvan. Inligting wat verkry is deur middel van hierdie navorsing kan help met onderrig en opleiding op 'n voor-en nagraadse vlak. Dit kan ook help om navorsing in handterapie te rig binne die Suid- Afrikaanse konteks.

Adherence is considered a prerequisite for the success of exercise programs for musculoskeletal disorders. The negative effects of non-adherence to exercise recommendations impact the cost of care, and also treatment effectiveness, treatment duration, the therapeutic relationship, waiting times, the efficiency of personnel and use of equipment. Adherence to therapeutic exercise intervention is a multifaceted problem. The World Health Organization (WHO) established the multidimensional adherence model (MAM). The MAM describes five interactive dimensions (socioeconomic, healthcare team and system, condition-related, therapy-related, and patient-related factors) that have an effect on patient adherence. The first purpose of this dissertation was to explore the MAM dimension of condition-related factors to determine the Quick Disabilities of the Arm Shoulder and Hand (QDASH) minimal clinical important difference (MCID) for three distal upper extremity conditions. The second purpose was to explore the MAM dimension of personal factors to learn from individuals who expressed incongruence between their QDASH and GROC scores; how they described their perceived change in therapy. The third purpose was to explore the MAM dimension of therapy-related factors to examine the effect of patient-therapist collaborative goal setting on patient adherence to treatment and QDASH outcomes. Results demonstrated in the first study that diagnosis specific MCID’s differed from the global MCID using multiple diagnoses. In the second study results demonstrated that patients expect to have a dedicated therapist who they can trust to work collaboratively with them to establish goals and spend time with them to achieve these goals. In the third study, our first hypothesis was not supported for all three measures of adherence. The median for home exercise program diary adherence was found to trend towards significance by 8.7 percent favoring the experimental group Mann-Whitney U (p < .100). Our second hypothesis was not supported. The experimental group receiving collaborative goal setting intervention had similar QDASH mean change scores 45.9±27.6 compared to the control group 46.1±23.8, Mann-Whitney U (p < .859).

Stroke recovery is complex and poorly understood. As a legacy of pervasive pessimism in the face of limited treatment, it is conceptualised and researched from biomedical and psychosocial perspectives that address impairment, problems of performance, quality of life, burden and disruption. Little stroke research is conducted once professional input has ceased, and yet considerable change occurs after this period with evidence that post-stroke wellbeing is independent of impairment and function -- many people do well in the face of poor prognoses, while others remain miserable despite 'good recovery'. Current advances in acute stroke management are generating increasing optimism, but lack of understanding about individuals' post-stroke experiences and long-term outcomes continues. While it is recognised that the impact of stroke on the lives of survivors and families is profound, rehabilitation focuses on recovery as task achievement and measured functional outcomes. For many survivors and their families 'recovery' is contested, ambiguous and extended. For some, it becomes a lifetime marathon because stroke represents an assault, not only to the body, but to the self and the lifeworld -- it is a 'life' event. This narrative inquiry into life after stroke explores recovery as a process taking place over time and conceptualised as a life transition. The work is grounded in narrative theory with the concept of transition providing the lens and focus for the research, its processes and analyses. Individuals' stories remain intact enabling evocation of diverse stroke meanings and the mapping of individual experience. Bringing these whole stories into conversation with each other elucidates post-stroke transition which is interpreted in light of theories of response to traumatic loss and informed by narrative theory. The thesis presents stories of trauma, loss and grief, situated in past lives and selves where assumptions about selves and future lives are shattered. The future makes no sense in terms of participants' past and present lives; life plots are lost and stroke therefore represents 'lost futures'. Stories of moving on to new lives are focused on being and doing in the present and have an expectant view of life. Although mindful of past lives and enduring losses, survivors actively engage in processes to reconfigure their lives with hope for a meaningful future. Transition is interpreted as 'reconfiguring the future'. The life tasks of reconfiguration are embedded in dynamic models of traumatic loss where grief is conceptualised as recursive movement between loss and meaning reconstruction evident in narratives that slowly move towards wellbeing. Despite broad recognition that loss and grief are part of the stroke experience, they are rarely addressed; where attention is paid it is likely embedded in explanatory models of staged response that oversimplify human experience. This thesis offers a new framework. It represents a fresh interpretation that highlights the ongoing traumatic impact of stroke. The post-stroke journeys of survivors and families are affected by individual circumstances and meanings. Although their stories are permeated with loss, many people move forward towards lives worth living. This interpretation suggests ways of reconfiguring lives in the face of devastation and ongoing traumatic loss. The work identifies a complex interaction of individual, emotional and social factors contributing to transitions to wellbeing following stroke and thus adds to a prospective vision of post-stroke life that can inform rehabilitation, discharge and stroke support strategies. Post-stroke transition will be enhanced when we use narrative framing and understanding to guide rehabilitative practice that uses meaning-centred models to prepare survivors and their families for a return to the lifeworld.
Thesis (PhD)--University of South Australia, 2009

Hospital stays have grown increasingly shorter with a corresponding increase in the use of homecare services. However, we have a limited understanding of how homecare services are allocated in Ontario, particularly homecare rehabilitation services. The primary objective of this research is to explore the current decision-making processes for the allocation of occupational and physical therapy services in homecare for the long stay clients. To address this objective a exploratory study using key informant interviews was conducted. The results indicate that the process of decision making for the allocation of therapy services is comprised of a series of stages called intake, assessment, referral to service provider and reassessment. Amongst these the process of determining the volume of therapy services varies widely across different region. These variations are primarily due to the regional contextual (e.g. financial constraints) factors of the individual CCACs.

Indiana University-Purdue University Indianapolis (IUPUI)
Background: Rehabilitation Robotics (RR) has become a more widely used and better understood treatment intervention and research tool in the last 15 years. Traditional research involves pre and post-test outcomes, making it difficult to analyze changes in behavior during the treatment process. Harnessing kinematics captured throughout each treatment allows motor learning to be quantified and questions of application and dosing to be answered. Objective: The aims of this secondary analysis were: (i) to investigate the impact of treatment presentation during RR on upper extremity movement time (mt) in children with hemiplegic cerebral palsy (CP) and (ii) to investigate the impact of training structure (dose and intensity) on mt in children with CP participating in RR. Methods: Subjects completed 16 intervention sessions of RR (2 x week; 8 weeks) with a total of 1,024 repetitions of movement per session and three assessments: pre, post and 6 month f/u. During each assessment and intervention, subjects completed “one-way record” assessments tracking performance on a planar task without robotic assistance. Kinematics from these records were extracted to assess subject performance over the course of and within sessions. Results: For all participants, a significant decrease in mt was found at post-test and follow-up. No significant differences were found in mt for age, severity or group placement. A significant interaction was found between treatment day, block and group (p = .033). Significant mt differences were found between the three blocks of intervention within individual days (p = .001). Specifically, significant differences were found over the last block of treatment (p = .032) and between successive treatment days (p = .001). Conclusion: The results indicate that for children with CP participating in RR, the number of repetitions per session is important. We hypothesized that children’s performance would plateau during a treatment day as attention waned, the opposite proved to be true. Despite the high-number of repetitions and associated cognitive demand, subjects’ performance actually trended upwards throughout the 1,024 repetitions suggesting that children were able to tolerate and learn from a high volume of repetitions.

Stroke is the leading cause of disability in the United States. The majority of stroke survivors have persistent arm dysfunction, which impedes their daily task performance. Mirror therapy (MT) as an adjunct to occupational therapy (OT) has been shown to be effective in upper extremity (UE) recovery post-stroke. Two protocols, unimanual mirror therapy (UMT) and bimanual mirror therapy (BMT), have been used in OT practice; however, research specifically comparing these two intervention protocols is absent. The purpose of this study was to compare: (a) home-based UMT and BMT protocols, and (b) both MT protocols to home-based traditional occupational therapy (TOT) regarding upper limb recovery post-stroke. Twenty-two chronic stroke participants were randomized into one of three groups: UMT, BMT, or TOT. The Action Research Arm Test (ARAT), Fugl-Meyer Assessment (FMA), ABILHAND, grip strength, and the Stroke Impact Scale (SIS) were administered pre- and post-intervention. Participants received outpatient OT 2 days/week for 45 minutes, plus a home program 30 minutes a day, 5 days/week for 6 weeks. A repeated measure ANOVA, Kruskal-Wallis Test, and Wilcoxon Ranked-Signed Test were used to compare the three groups, and 95% confidence intervals (CI) and effect sizes were calculated. There was a main effect of time for all groups, except for SIS-strength and activities of daily living (ADL); however, no group differences were noted on any of the measures. When comparing UMT and BMT, the effect size for all measures, except for grip strength, favored UMT. In comparing both mirror groups to TOT, UMT had a moderate to large effect size on the ARAT, FMA, and ABILHAND, as compared to the small effect size for BMT. Furthermore, 95% CI data for the ABILHAND showed clinical significance in favor of UMT compared to TOT, but not for BMT. This study showed that all groups improved over time and UMT may be more beneficial for UE recovery in chronic stroke individuals, compared to either BMT or TOT. However, given the small sample size, future studies comparing the two mirror protocols are necessary for more definitive conclusions to better inform clinicians of the optimal mode of MT treatment.

Serious gaps between best and actual stroke rehabilitation practices continue to exist, even with the plethora of evidence and guidelines for stroke best practice management. To address this knowledge gap with an effective knowledge translation (KT) intervention, six steps of the Knowledge to Action (KTA) Model were applied to these specific research objectives: 1) to conduct a systematic review to examine evidence on the effectiveness of single/multi-component KT interventions for improving knowledge, attitudes, and rehabilitation practice behaviors of occupational therapists (OTs) and physical therapists (PTs), in order to inform the design of a KT intervention; 2) to conduct usability testing to explore factors that facilitate or hinder OTs' and PTs' use of an evidence-based, stroke rehabilitation-specific e-learning resource (Stroke Engine; www.strokengine.ca), as a preliminary step in its potential use as a KT intervention; and, 3) to conduct a KT intervention study to determine the extent of knowledge acquired regarding stroke rehabilitation best practices by OTs and PTs while using Stroke Engine as an e-learning KT intervention for three months. A sub-objective was to identify the association between knowledge acquired and factors related to the clinician, their work environment, and adherence to the KT intervention. Main findings from this research agenda suggested that use of active, multi-component KT interventions resulted in some knowledge gains among physical therapists, but additional research was needed to understand impact of these strategies on occupational therapists. During Stroke Engine testing, factors hindering its use were identified and the website was modified to maximize its usability as an e-learning KT intervention. Clinicians were satisfied with Stroke Engine as it provided them with the latest stroke evidence in a quick, user-friendly format. Finally, significant improvements in clinicians' proportion of 'evidence-based' responses on the Stroke Rehabilitation Knowledge Questionnaire were observed between baseline and following Stroke Engine use as a KT intervention. Intensity of Stroke Engine use was the most significant predictor for clinicians' improved 'evidence-based' knowledge on the Questionnaire. It was concluded that Stroke Engine has promise as an effective e-learning KT intervention for enhancing rehabilitation clinicians' knowledge of stroke best practices.

The hypothesis underlying this research is that hand activity produces changes in the tissues of the hand which are reflected in the various functions of those tissues. Understanding the effect of hand activity upon hand function would allow occupational therapists to assess the efficacy of therapeutic interventions upon a clients ability to perform hand activity without damage to the tissues of the hand. Such information could assist in the design of safe and sustainable work tasks. The first step towards understanding how activity affects the hand is to measure its effects. The aim of this research is to determine which instruments can measure the effects of activity upon the hand.

Most physical rehabilitation services are not person-centered. Occupational therapy practitioners (OTPs) are vested in person-centered approaches, thereby they are optimally positioned to take leading roles in these quality improvement (QI) activities. Yet, there is a lack of OTPs-led QI activities on person-centered rehabilitation, and seminally, a lack of a QI guide informing these activities. To shape the evidence- and theory-based QI guide, we engaged a small international sample (n= 8) of potential end-users, i.e., OTPs in practice or management roles. The process involved three rounds of mixed-methods surveys, which helped in the design, refinement, and preliminary evaluation of the QI guide. Informed by theory, evidence and participants’ feedback, the final guide followed a “why, what, and how” structure. Six out of the eight participants rated the QI guide as one they are “very likely” to use. Also, the median rated value of the guide was “9” in a “0-10” scale. The QI was also well appraised by being an all-in-one resource to enable OTPs close the gap in person-centered rehabilitation practices and its improvement. The final version of the QI guide is ready to use and freely available in the Open Science Framework platform: http://osf.io/xzgpe/.

L’arthrite est l’une des causes principales de douleur et d’incapacité auprès de la population canadienne. Les gens atteints d’arthrite rhumatoïde (AR) devraient être évalués par un rhumatologue moins de trois mois suivant l’apparition des premiers symptômes et ce afin de débuter un traitement médical approprié qui leur sera bénéfique. La physiothérapie et l’ergothérapie s’avèrent bénéfiques pour les patients atteints d’ostéoarthrite (OA) et d’AR, et aident à réduire l’incapacité. Notre étude a pour but d’évaluer les délais d’attente afin d’obtenir un rendez-vous pour une consultation en rhumatologie et en réadaptation dans le système de santé public québécois, et d’explorer les facteurs associés. Notre étude est de type observationnel et transversal et s’intéresse à la province de Québec. Un comité d’experts a élaboré trois scénarios pour les consultations en rhumatologie : AR présumée, AR possible, et OA présumée ; ainsi que deux scénarios pour les consultations en réadaptation : AR diagnostiquée, OA diagnostiquée. Les délais d’attente ont été mesurés entre le moment de la requête initiale et la date de rendez-vous fixée. L’analyse statistique consiste en une analyse descriptive de même qu’une analyse déductive, à l’aide de régression logistique et de comparaison bivariée. Parmi les 71 bureaux de rhumatologie contactés, et pour tous les scénarios combinés, 34% ont donné un rendez-vous en moins de trois mois, 32% avaient une attente de plus de trois mois et 34% ont refusé de fixer un rendez-vous. La probabilité d’obtenir une évaluation en rhumatologie en moins de trois mois est 13 fois plus grande pour les cas d’AR présumée par rapport aux cas d’OA présumée (OR=13; 95% Cl [1.70;99.38]). Cependant, 59% des cas d’AR présumés n’ont pas obtenu rendez-vous en moins de trois mois. Cent centres offrant des services publics en réadaptation ont été contactés. Pour tous les scénarios combinés, 13% des centres ont donné un rendez-vous en moins de 6 mois, 13% entre 6 et 12 mois, 24% avaient une attente de plus de 12 mois et 22% ont refusé de fixer un rendez-vous. Les autres 28% restant requéraient les détails d’une évaluation relative à l’état fonctionnel du patient avant de donner un rendez-vous. Par rapport aux services de réadaptation, il n’y avait aucune différence entre les délais d’attente pour les cas d’AR ou d’OA. L’AR est priorisée par rapport à l’OA lorsque vient le temps d’obtenir un rendez-vous chez un rhumatologue. Cependant, la majorité des gens atteints d’AR ne reçoivent pas les services de rhumatologie ou de réadaptation, soit physiothérapie ou ergothérapie, dans les délais prescrits. De meilleures méthodes de triage et davantage de ressources sont nécessaires.
Arthritis is a leading cause of pain and disability in Canada. Persons with rheumatoid arthritis (RA) should be seen by a rheumatologist within three months of symptom onset to begin appropriate medical treatment and improve health outcomes. Early physical therapy (PT) and occupational therapy (OT) are beneficial for both osteoarthritis (OA) and RA and may prevent disability. The objectives of the study are to describe wait times from referral by primary care provider to rheumatology and rehabilitation consultation in the public system of Quebec and to explore associated factors. We conducted a cross-sectional study in the province of Quebec, Canada whereby we requested appointments from all rheumatology practices and public rehabilitation departments using case scenarios that were created by a group of experts. Three scenarios were developed for the rheumatology referrals: Presumed RA; Possible RA; and Presumed OA and two scenarios for the rehabilitation referrals: diagnosed RA and diagnosed OA. Wait times were evaluated as the time between the initial request and the appointment date provided. The statistical analysis consisted primarily of descriptive statistics as well as inferential statistics (bivariate comparisons and logistic regression). Seventy-one rheumatology practices were contacted. For all scenarios combined, 34% were given an appointment with a rheumatologist within three months of referral, 32% waited longer than three months and 34% were refused services. The odds of getting an appointment with a rheumatologist within three months was 13 times greater for the Presumed RA scenario versus the Presumed OA scenario (OR=13; 95% Cl[1.70;99.38]). However, 59% of the Presumed RA cases did not receive an appointment within three months. One hundred rehabilitation departments were also contacted. For both scenarios combined, 13% were given an appointment within 6 months, 13% within 6 to 12 months, 24% waited longer than 12 months and 22% were refused services. The remaining 28% were told that they would require an evaluation appointment based on functional assessment prior to being given an appointment. There was no difference with regards to diagnosis, RA versus OA, for the rehabilitation consultation. RA is prioritized over OA when obtaining an appointment to a rheumatologist in Quebec. However, the majority of persons with RA are still not receiving rheumatology or publicly accessible PT or OT intervention in a timely manner. Better methods for triage and increased resource allocation are needed.