ORCID Profile
0000-0002-5883-1590
Current Organisations
University of Montreal
,
Murdoch University
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Publisher: BMJ
Date: 2019
DOI: 10.1136/BMJOPEN-2018-023214
Abstract: Needle-related procedures are considered as the most important source of pain and distress in children in hospital settings. Considering the physiological and psychological consequences that could result from these procedures, management of pain and distress through pharmacological and non-pharmacological methods is essential. Therefore, it is important to have interventions that are rapid, easy-to-use and likely to be translated into clinical practice for routine use. The aim of this study will be to determine whether a device combining cold and vibration (Buzzy) is non-inferior to a topical anaesthetic (liposomal lidocaine 4% cream) for pain management of children undergoing needle-related procedures in the emergency department. This study will be a randomised controlled non-inferiority trial comparing the Buzzy device to liposomal lidocaine 4% cream for needle-related pain management. A total of 346 participants will be randomly assigned in a 1:1 ratio to one of the two study groups. The primary outcome will be the mean difference in pain intensity between groups during needle-related procedures. A non-inferiority margin of 0.70 on the Color Analogue Scale will be considered. A Non-inferiority margin of 0.70 on the Color Analogue Scale will be considered. The secondary outcomes will be the level of distress during the procedure, the success of the procedure at first attempt, the occurrence of adverse events, the satisfaction of both interventions and the memory of pain 24 hours after the procedure. The primary outcome will be assessed for non-inferiority and the secondary outcomes for superiority. This study protocol was reviewed and approved by the institutional review board of the study setting. Findings of this trial will be disseminated via peer-reviewed publications and conference presentations. NCT02616419 .
Publisher: Brighthall
Date: 28-10-2023
DOI: 10.7899/JCE-20-7
Abstract: This study aimed to explore chiropractic students' perceptions and attitudes about the appropriateness of peer physical examination as a teaching tool and their willingness and comfort with it. A modified version of a validated questionnaire was used. First- and 2nd-year chiropractic students at Murdoch University were approached during their practical sessions. The responses were analyzed using descriptive statistics reporting frequencies and percentages. Comparison between classes, age, and sex was evaluated by cross-tabulation. A total of 184 questionnaires were completed with a response rate of 76.6%. Our results demonstrated that most students were comfortable with and willing to participate in peer physical examination as well as trusted it as an appropriate part of their training and a valuable learning experience. Nevertheless, a small percentage were uncomfortable with peer physical examination and regarded it as an unprofessional activity. In addition, it was revealed that younger females (≤20 years) reported feeling unnecessarily exposed and therefore significantly less comfortable with peer physical examination. They were also less comfortable when examined in the inguinal area by a student of the opposite sex. Although peer physical examination appears to be a very popular training tool, it still has a few areas of concern that need to be investigated and addressed to improve students' attitude, perception, and comfort with this teaching technique. Further studies could investigate how other factors such as religious beliefs contribute toward students' perception and attitudes regarding peer physical examination.
Publisher: Informa UK Limited
Date: 2017
DOI: 10.2147/JPR.S124365
Publisher: Elsevier BV
Date: 11-2020
Publisher: Springer Science and Business Media LLC
Date: 27-11-2019
DOI: 10.1186/S12998-019-0285-4
Abstract: In Australia, about 1 in 3 chiropractors choose not to belong to either of the two professional associations and this is considerably lower compared to other health professional organisations in this country. The reasons for this remain unknown. We sought to explore possible reasons by asking chiropractic students their perceptions of barriers and facilitators to joining a professional association. However, we were unable to identify validated survey instruments that could be used to obtain information about reasons for joining health professional associations. Therefore, the objectives of this study were to: 1) develop a survey instrument that captures information about what influences chiropractic students in joining professional association and 2) identify factors that promote association membership among chiropractic students. A literature review was undertaken to identify known determinants of professional association membership and were used to construct a preliminary survey instrument, which comprised 47 items. Six fourth-year chiropractic students assessed the preliminary survey instrument’s content validity. Principal components analysis was used to establish the structure of the scales. Cronbach’s alpha was derived to determine whether all items in each scale tapped a discrete construct. Logistic regression was used to examine the association between the scale scores and having joined a chiropractic professional association. In March 2019, 348 chiropractic students from Murdoch University (71.0%) responded to a voluntary, anonymous questionnaire. Principal components analysis resulted in the retention of 21 items that strongly loaded onto 6 factors. Internal consistency was found to be adequate. The results of the logistic regression analysis demonstrated that only “development of the profession” was significantly associated with have joined a professional chiropractic association ( p = 0.049, OR = 2.22 95% CI = 1.26–3.40). Chiropractic organisations can probably most effectively increase membership numbers through raising awareness of their contribution to the development of the profession.
Publisher: Elsevier BV
Date: 12-2021
Publisher: Public Library of Science (PLoS)
Date: 02-06-2023
DOI: 10.1371/JOURNAL.PONE.0285993
Abstract: Systematic reviews and studies exploring associations between morphologic change of paraspinal muscles and low back pain or related outcomes such as disability, radiculopathy, and physical workload, have reported conflicting results. This study explores the associations between lumbar multifidus muscle quality and clinical outcomes relating to low back pain. Cross-sectional study of spinal clinic outpatients presenting with a primary complaint of low back and/or leg symptoms. Univariable and multivariable regression models were used to investigate associations between MRI-based multifidus muscle cross-sectional area at L4 and L5 and clinical outcomes for low back pain, leg pain, disability, restricted motion, and strenuous nature of work. Results were reported with β-coefficients, odds ratios (OR), or incidence rate ratios (IRR) and their corresponding 95% confidence intervals, based on a 10% difference in muscle quality for each clinical variable. Multivariable analyses were adjusted for age, sex, and BMI. 875 patients [487 females mean (SD) age: 43.6 (10.2) years] were included. In the multivariable analyses, muscle quality was significantly associated with disability (0–23 scale) [β: -0.74, 95% CI: -1.14, -0.34], leg pain intensity (0–10 scale) [β: -0.25, 95% CI: -0.46, -0.03], and current pain duration of more than 12 months [OR: 1.27, 95% CI: 1.03, 1.55]. No associations were found for low back pain intensity, morning stiffness, painful active range of motion, or work nature. Patients with higher lumbar multifidus muscle quality reported lower levels of low back pain-related disability and leg pain intensity, indicating that muscle quality may play a role in the etiology of lumbar spine disorders. However, the clinical importance of these associations is uncertain due to the low magnitude of identified associations. Future longitudinal studies are needed to understand the effect of lumbar multifidus muscle quality on lumbar-related pain and disability.
Publisher: Springer Science and Business Media LLC
Date: 19-12-2022
DOI: 10.1186/S12998-022-00470-0
Abstract: Clinicians rely on certain physical examination tests to diagnose and potentially grade ankle sprains and ankle instability. Diagnostic error and inaccurate prognosis may have important repercussions for clinical decision-making and patient outcomes. Therefore, it is important to recognize the diagnostic value of orthopaedic tests through understanding the reliability and validity of these tests. To systematically review and report evidence on the reliability and validity of orthopaedic tests for the diagnosis of ankle sprains and instability. PubMed, CINAHL, Scopus, and Cochrane databases were searched from inception to December 2021. In addition, the reference list of included studies, located systematic reviews, and orthopaedic textbooks were searched. All articles reporting reliability or validity of physical examination or orthopaedic tests to diagnose ankle instability or sprains were included. Methodological quality of the reliability and the validity studies was assessed with The Quality Appraisal for Reliability studies checklist and the Quality Assessment of Diagnostic Accuracy Studies-2 respectively. We identified the number of times the orthopaedic test was investigated and the validity and/or reliability of each test. Overall, sixteen studies were included. Three studies assessed reliability, eight assessed validity, and five evaluated both. Overall, fifteen tests were evaluated, none demonstrated robust reliability and validity scores. The anterolateral talar palpation test reported the highest diagnostic accuracy. Further, the anterior drawer test, the anterolateral talar palpation, the reverse anterior lateral drawer test, and palpation of the anterior talofibular ligament reported the highest sensitivity. The highest specificity was attributed to the anterior drawer test, the anterolateral drawer test, the reverse anterior lateral drawer test, tenderness on palpation of the proximal fibular, and the squeeze test. Overall, the diagnostic accuracy, reliability, and validity of physical examination tests for the assessment of ankle instability were limited. Physical examination tests should not be used in isolation, but rather in combination with the clinical history to diagnose an ankle sprain. Preliminary evidence suggests that the overall validity of physical examination for the ankle may be better if conducted five days after the injury rather than within 48 h of injury.
Publisher: Brighthall
Date: 07-10-2004
DOI: 10.7899/JCE-18-3
Abstract: This study examined the association between anxiety and temporomandibular disorder (TMD) in Australian chiropractic students, particularly its effect on quality of life. Chiropractic students (n = 185) completed online surveys, including the Oral Health Impact Profile for TMDs (OHIP-TMD) and the Patient-Reported Outcomes Measurement Information System (PROMIS) questionnaire. The OHIP-TMD psychometric properties were assessed using principal component analysis. Linear regression models were used to examine demographic predictors for anxiety and TMD. A general linear model assessed the association between anxiety and the psychosocial and function scales identified through analysis of the OHIP-TMD questionnaire. The mean value for the OHIP-TMD and PROMIS was 1.3 (SD = 0.7) and 9.5 (SD = 4.1), respectively. Women reported significantly lower quality of life (QoL) related to TMD symptoms (p = 0.006) and that QoL related to TMD symptoms increased significantly as students progressed through the course (p = .025). Lower levels of anxiety were significantly associated with male gender (p = .000), employment (p = .008), higher program levels (p = .003), and having children (p = .005). General linear model analysis revealed that increased anxiety was significantly associated with higher levels of oral physical function impairment (p = .003) and elevated psychosocial distress (p = .0001). Anxiety was significantly associated with psychosocial distress and oral physical function impairment in university chiropractic students. In addition to impacting on oral health-related QoL, anxiety also affects students' engagement with learning and academic performance. It would therefore be beneficial to implement strategies that mitigate students' anxiety levels.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2017
Publisher: Springer Science and Business Media LLC
Date: 04-05-2202
DOI: 10.1186/S12998-020-00312-X
Abstract: In the midst of the coronavirus pandemic, the International Chiropractors Association (ICA) posted reports claiming that chiropractic care can impact the immune system. These claims clash with recommendations from the World Health Organization and World Federation of Chiropractic. We discuss the scientific validity of the claims made in these ICA reports. We reviewed the two reports posted by the ICA on their website on March 20 and March 28, 2020. We explored the method used to develop the claim that chiropractic adjustments impact the immune system and discuss the scientific merit of that claim. We provide a response to the ICA reports and explain why this claim lacks scientific credibility and is dangerous to the public. More than 150 researchers from 11 countries reviewed and endorsed our response. In their reports, the ICA provided no valid clinical scientific evidence that chiropractic care can impact the immune system. We call on regulatory authorities and professional leaders to take robust political and regulatory action against those claiming that chiropractic adjustments have a clinical impact on the immune system.
Publisher: Elsevier BV
Date: 06-2019
Publisher: Elsevier BV
Date: 07-2017
DOI: 10.1016/J.JMPT.2017.03.009
Abstract: The purpose of this study was to perform a systematic review of clinical trials of spinal manipulative therapy for adolescent idiopathic scoliosis. Search strategies were developed for PubMed, CINHAL, and CENTRAL databases. Studies were included through June 2016 if they were prospective trials that evaluated spinal manipulative therapy (eg, chiropractic, osteopathic, physical therapy) for adolescent idiopathic scoliosis. Data were extracted and assessed by 2 independent reviewers. Cochrane risk of bias tools were used to assess the quality of the included studies. Data were reported qualitatively because heterogeneity prevented statistical pooling. Four studies satisfied the inclusion criteria and were critically appraised. The findings of the included studies indicated that spinal manipulative therapy might be effective for preventing curve progression or reducing Cobb angle. However, the lack of controls and small s le sizes precluded robust estimation of the interventions' effect sizes. There is currently insufficient evidence to establish whether spinal manipulative therapy may be beneficial for adolescent idiopathic scoliosis. The results of the included studies suggest that spinal manipulative therapy may be a promising treatment, but these studies were all at substantial risk of bias. Further high-quality studies are warranted to conclusively determine if spinal manipulative therapy may be effective in the management of adolescent idiopathic scoliosis.
Publisher: Elsevier BV
Date: 06-2015
DOI: 10.1016/J.PMN.2014.06.004
Abstract: Orthopedic surgery for adolescent idiopathic scoliosis entails anxiety and severe postoperative pain. The aim of this pilot study was to investigate an intervention for adolescent post-spinal fusion pain management in patients from a tertiary care hospital in Montreal, Canada. Participants were adolescents and young adults ages 11 to 20 years undergoing spinal fusion. Participants were randomized to standard care or standard care with adjunct intervention. The intervention consisted of a DVD with information and guided imagery/relaxation exercises to practice at least three times a week at home. A nurse screened the DVD with the patient preoperatively and at discharge (T1) and telephoned 2 weeks post-discharge (T2) to reinforce the technique. Both groups completed questionnaires at T1, T2, and T3 (1-month postoperative follow-up). Outcome measures included pain intensity, anxiety, coping mechanisms, and daily activities. From March 2010 to June 2011, we enrolled 40 of 45 eligible participants (n = 20 per group), average age 15 ± 2.1 years, 7 participants were male. Compared with the control group, the experimental group experienced significantly less overall pain at all time points, with moderate to large effect sizes at T2, T3 (p ≤ .007). Worst pain in 24 hours was moderately decreased at T2 (p = .01). State-trait anxiety remained high. On a 10-point scale, a median 2.5-point benefit was seen in eating and sleeping (Mann-Whitney test, p = .002), and 2 points in walking (Mann-Whitney test, p = .003). Coping strategies showed no significant differences. Addition of a guided imagery and relaxation exercise DVD for home use was more effective than standard care alone for postoperative pain. Our nonpharmacologic adjunct looks promising. Larger s le size and longer (6-9 months) follow-up will permit refinement.
Publisher: Springer Science and Business Media LLC
Date: 17-07-2017
Publisher: Hindawi Limited
Date: 2015
DOI: 10.1155/2015/674354
Abstract: BACKGROUND: Back pain (BP) has often been associated with adolescent idiopathic scoliosis (AIS), which is a three-dimensional deviation of the vertebral column. In adolescents, chronic pain appears to be a predictor of health care utilization and has a negative impact on physical, psychological and family well-being. In this population, BP tends to be persistent and may be a predictor of BP in adulthood. OBJECTIVE: To document the prevalence and management of BP in AIS patients. METHODS: A retrospective chart review of AIS patients who were referred to Sainte-Justine University Teaching Hospital (Montreal, Quebec) from 2006 to 2011 was conducted. RESULTS: A total of 310 randomly selected charts were reviewed. Nearly one-half of the patients (47.3%) mentioned that they experienced BP, most commonly in the lumbar (19.7%) and thoracic regions (7.7%). The type of BP was documented in only 36% (n=112) of the charts. Pain intensity was specified in only 21% (n=65) of the charts. In approximately 80% (n=248) of the charts, no pain management treatment plan was documented. CONCLUSIONS: The prevalence of BP was moderately high among the present s le of adolescents with AIS. An improved system for documenting BP assessment, type, treatment plan and treatment effectiveness would improve pain management for these patients.
Publisher: Elsevier BV
Date: 06-2019
DOI: 10.1016/J.CTIM.2019.03.023
Abstract: The objectives of this study were to identify: 1) the extent to which final year chiropractic students used components of person-centred care in a clinical setting and 2) determine the effect of chiropractic students' use of person-centred care on musculoskeletal pain. An observational study was conducted at three Western Australian chiropractic teaching clinics. Pragmatic in idualised chiropractic care was delivered to 108 adults who experienced non-specific spinal pain. The instruments used in this study were the Consultation and Relational Empathy questionnaire, Picker Musculoskeletal Disorder Questionnaire, and Numerical Rating scale for Pain intensity. Participants experienced reductions in pain that exceeded the level required for minimal clinically reported improvement. In addition, high levels of empathy and patient -centred care were reported. Ceiling effects for the measures assessing empathy and patient-centred care precluded analyses examining the relationship between changes in pain intensity, empathy, and patient-centred care. The participants in this study displayed very positive attitudes about most aspects of the chiropractic students' person-centred care skills. Person-centred care processes for which there was considerable scope for improvement included advice about alternative treatment options, and the adaptation of lifestyle and workplace situations to alleviate pain and enhance health. Our findings also showed that the participants experienced clinically important improvement in pain. However, the skewed nature of our dataset precluded identifying whether the students' person-centred care skills influenced such improvement.
Publisher: Informa UK Limited
Date: 2017
Publisher: Elsevier BV
Date: 06-2019
Publisher: Research Square Platform LLC
Date: 06-06-2022
DOI: 10.21203/RS.3.RS-1724016/V1
Abstract: Background: Systematic reviews and studies exploring associations between morphologic change of paraspinal muscles and low back pain or related outcomes such as disability, radiculopathy, and physical workload, have reported conflicting results. This study explores the associations between lumbar multifidus muscle quality and clinical outcomes related to low back pain. Methods: Cross-sectional study of spinal clinic outpatients presenting with a primary complaint of low back and/or leg symptoms. Univariable and multivariable regression models were used to investigate associations between MRI-based multifidus muscle cross-sectional area at L4 and L5 and clinical outcomes for low back and leg pain, disability, restricted motion, and strenuous nature of work. Results were reported with β-coefficients, odds ratios (OR), or incidence rate ratios (IRR) and their corresponding 95% confidence intervals, based on a 10% difference in muscle quality for each clinical variable. Multivariable analyses were adjusted for age, sex, and BMI. Results: 875 patients [487 females mean (SD) age: 43.6 (10.2) years] were included. In the multivariable analyses, muscle quality was significantly associated with disability (0-23 scale) [β: -0.74, 95% CI: -1.14, -0.34], leg pain intensity (0-10 scale) [β: -0.25, 95% CI: -0.46, -0.03], and current pain duration of more than 12 months [OR: 1.27, 95% CI: 1.03, 1.55]. No associations were found for low back pain intensity, morning stiffness, painful active range of motion, or work nature. Conclusions: Patients with higher lumbar multifidus muscle quality reported lower levels of low back pain-related disability and leg pain intensity, indicating that muscle quality may play a role in the etiology of lumbar spine disorders. However, the clinical importance of these associations is uncertain. Future longitudinal studies are needed to understand the effect of lumbar multifidus muscle quality on lumbar-related pain and disability.
Publisher: Springer Science and Business Media LLC
Date: 29-08-2022
DOI: 10.1038/S41598-022-18984-1
Abstract: Associations between multifidus muscle morphology and degenerative pathologies have been implied in patients with non-specific low back pain, but it is unknown how these are influenced by pathology severity, number, or distribution. MRI measures of pure multifidus muscle cross-sectional area (CSA) were acquired from 522 patients presenting with low back and/or leg symptoms in an outpatient clinic. We explored cross-sectional associations between the presence, distribution, and/or severity of lumbar degenerative pathologies (in idually and in aggregate) and muscle outcomes in multivariable analyses (beta coefficients [95% CI]). We identified associations between lower pure multifidus muscle CSA and disc degeneration (at two or more levels): − 4.51 [− 6.72 − 2.3], Modic 2 changes: − 4.06 [− 6.09 − 2.04], endplate defects: − 2.74 [− 4.58 − 0.91], facet arthrosis: − 4.02 [− 6.26 − 1.78], disc herniations: − 3.66 [− 5.8 − 1.52], and when 5 pathologies were present: − 6.77 [− 9.76 − 3.77], with the last supporting a potential dose–response relationship between number of spinal pathologies and multifidus morphology. Our findings could hypothetically indicate that these spinal and muscle findings: (1) are part of the same degenerative process, (2) result from prior injury or other common antecedent events, or (3) have a directional relationship. Future longitudinal studies are needed to further examine the complex nature of these relationships.
Publisher: Elsevier BV
Date: 12-2021
Publisher: Springer Science and Business Media LLC
Date: 05-09-2017
Publisher: Research Square Platform LLC
Date: 13-05-2022
DOI: 10.21203/RS.3.RS-1650708/V1
Abstract: Background: There is ongoing interest in assessing the lumbar multifidus muscles to determine their role in patients with non-specific low back pain. While associations between lumbar-related pain, altered multifidus morphology, and/or degenerative pathologies have been implied, it is unknown how these associations may be influenced by the severity, number, or distribution of pathologies. This study explores the associations of degenerative lumbar magnetic resonance imaging (MRI) findings, both in idually and in combination, to multifidus muscle morphology. Methods: Cross-sectional study in a secondary care setting. Outpatient spinal clinic patients, 17 to 72 years of age, presented with a primary complaint of low back and/or leg symptoms. MRI-based average percentage pure multifidus muscle cross-sectional area (% MCSA) at L4 and L5, and the worst % MCSA measures at L4 or L5, were acquired. Univariable and multivariable linear regression models, adjusted for age, sex and BMI, investigated for cross-sectional associations between the presence, distribution, and/or severity of MRI-identified lumbar degenerative pathologies (both in idually and in aggregate) and the outcome measures. Results were reported with unstandardized beta coefficients and [95% confidence intervals].Results: Data from 522 patients [294 females mean (SD) age: 43.6 (9.8) years] were included. The average and worst % MCSA were lower in the presence of each type of pathology, as the severity or distribution increased, and as the number of different pathologies increased. Multivariable analysis identified disc degeneration at two or more levels (average: -4.51 [-6.72 -2.3] worst: -4.32 [-6.52 -2.12]), Modic type 2 changes (average: -4.06 [-6.09 -2.04] worst: -4.35 [-6.36 -2.35]), endplate defects (average: -2.74 [-4.58 -0.91] worst: -2.18 [-4.0 -0.36]), facet joint arthrosis (average: -4.02 [-6.26 -1.78] worst: -3.78 [-6.01 -1.54]), and moderate to severe disc herniations (average: -3.66 [-5.8 -1.52]) as being associated with lower % MCSA. The presence of 6 or more pathologies demonstrated the greatest % MCSA difference for all variables (average: -6.77 [-9.76 -3.77] worst: -6.28 [-9.28 -3.28]), supporting a potential dose-response relationship between spinal pathology and LMM morphology.Conclusions: Significant associations were identified between disc degeneration, facet joint arthrosis, Modic type 2 marrow changes, an increasing aggregate of pathologies, and lower % MCSA. These associations could hypothetically indicate that the spinal and muscle findings: 1) are both part of the same degenerative process, 2) both result from prior injury or other common antecedent events, or 3) may contain a directional relationship. Future longitudinal studies are needed to further examine the complex nature of these relationships, taking into account the type, severity, total levels affected, and total number of different pathologies present.
No related grants have been discovered for Jean Theroux.