ORCID Profile
0000-0002-1840-2951
Current Organisations
University of Pretoria Faculty of Veterinary Science
,
McMaster University
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Publisher: Oxford University Press (OUP)
Date: 02-2014
DOI: 10.2522/PTJ.20120416
Abstract: It has been suggested that low back pain (LBP) is a condition with an unpredictable pattern of exacerbation, remission, and recurrence. However, there is an incomplete understanding of the course of LBP and the determinants of the course. The purposes of this study were: (1) to identify clusters of LBP patients with similar fluctuating pain patterns over time and (2) to investigate whether demographic and clinical characteristics can distinguish these clusters. This study was a secondary analysis of data extracted from a randomized controlled trial. Pain scores were collected from 155 participants with chronic nonspecific LBP. Pain intensity was measured monthly over a 1-year period by mobile phone short message service. Cluster analysis was used to identify participants with similar fluctuating patterns of pain based on the pain measures collected over a year, and t tests were used to evaluate if the clusters differed in terms of baseline characteristics. The cluster analysis revealed the presence of 3 main clusters. Pain was of fluctuating nature within 2 of the clusters. Out of the 155 participants, 21 (13.5%) had fluctuating pain. Baseline disability (measured with the Roland-Morris Disability Questionnaire) and treatment groups (from the initial randomized controlled trial) were significantly different in the clusters of patients with fluctuating pain when compared with the cluster of patients without fluctuating pain. A limitation of this study was the fact that participants were undergoing treatment that may have been responsible for the rather positive prognosis observed. A small number of patients with fluctuating patterns of pain over time were identified. This number could increase if in iduals with episodic pain are included in this fluctuating group.
Publisher: Oxford University Press (OUP)
Date: 03-2012
DOI: 10.2522/PTJ.20110290
Abstract: Motor control exercises to improve control and coordination of trunk muscles and graded activity under the principles of cognitive-behavioral therapy are 2 commonly used exercise therapies, yet there is little evidence to support the use of one intervention over the other. The objective of this study was to compare the effectiveness of motor control exercises and graded activity for patients with chronic nonspecific low back pain. This study was a prospectively registered randomized controlled trial with outcome assessment and statistical analyses conducted blind to group. The study was conducted in primary care settings. The participants were 172 patients with chronic (& weeks) nonspecific low back pain. Patients were randomly assigned to receive either motor control exercises or graded activity. There was no attempt to subclassify patients to match them to a treatment. Patients in both groups received 14 sessions of in idualized, supervised exercise therapy. Primary outcomes were average pain over the previous week (numeric rating scale) and function (Patient-Specific Functional Scale) secondary outcomes were disability (24-item Roland-Morris Disability Questionnaire), global impression of change (Global Perceived Effect Scale), and quality of life (36-Item Short-Form Health Survey questionnaire [SF-36]). Outcome measures were collected at baseline and at 2, 6, and 12 months after intervention. A linear mixed models analysis showed that there were no significant differences between treatment groups at any of the time points for any of the outcomes studied. For ex le, the effect for pain at 2 months was 0.0 (−0.7 to 0.8). Clinicians could not be blinded to the interventions. The results of this study suggest that motor control exercises and graded activity have similar effects for patients with chronic nonspecific low back pain.
Publisher: Elsevier BV
Date: 10-2008
DOI: 10.1016/J.JMPT.2008.09.003
Abstract: The objective of this study was to compare ranges of motion (ROM) between dominant and nondominant sides for the joints of the upper and lower extremities. Ninety healthy white women from 18 to 59 years of age were measured in this study. Active and passive ROM were measured for the ankle, knee, hip, shoulder, elbow, and wrist using a standard goniometer. The order of the joints, motion, sides, and active or passive motion testing was randomly selected. A paired t test was used for the comparison between sides. The results of this study showed a statistically significant difference between dominant and nondominant sides for 34 of the 60 ROM measured. The maximum mean difference between sides for all ROM measured was 7.5 degrees . The results of this show that some ROM are different between body sides and that when these differences exist they are minimal and may not be clinically insignificant. These results support the practice of using the opposite side of the body as an indicator of preinjury or normal extremity ROM.
Publisher: Oxford University Press (OUP)
Date: 12-2013
DOI: 10.2522/PTJ.20120379
Abstract: Physical therapy is commonly prescribed for patients with lumbar spinal stenosis (LSS) however, little is known about its effectiveness. The purpose of this study was to systematically review randomized controlled trials (RCTs), controlled trials, and cohort studies evaluating the effectiveness of physical therapy for LSS. Studies were searched on electronic databases to January 2012. Inclusion criteria were: clinical diagnosis of LSS with confirmatory imaging, evaluation of physical therapy treatment, presence of a comparison group, and outcomes of pain, disability, function, or quality of life. Outcomes were extracted and, when possible, pooled using RevMan 5, a freely available review program from the Cochrane Library. Ten studies were included: 5 RCTs, 2 controlled trials, 2 mixed-design studies, and 1 longitudinal cohort study. Pooled effects of 2 studies revealed that the addition of a physical therapy modality to exercise had no statistically significant effect on outcome. Pooled effects results of RCTs evaluating surgery versus physical therapy demonstrated that surgery was better than physical therapy for pain and disability at long term (2 years) only. Other results suggested that exercise is significantly better than no exercise, that cycling and body-weight–supported treadmill walking have similar effects, and that corsets are better than no corsets. The limitations of this review include the low quality and small number of studies, as well as the heterogeneity in outcomes and treatments. No conclusions could be drawn from the review regarding which physical therapy treatment is superior for LSS. There was low-quality evidence suggesting that modalities have no additional effect to exercise and that surgery leads to better long-term (2 years) outcomes for pain and disability, but not walking distance, than physical therapy in patients with LSS.
Publisher: Elsevier BV
Date: 07-2016
DOI: 10.1016/J.SPINEE.2016.02.050
Abstract: In routine clinical practice, the presence of lumbar spinal stenosis (LSS) is assessed on axial magnetic resonance images (MRI) typically acquired using a preselected spine sagittal angle. Given the natural lordosis of the lumbar spine, not all axial slices will be parallel to the disc and perpendicular to the spinal canal and, thus, are not optimal for the assessment of dural sac cross-sectional area (DCSA). The objective of this study was to compare DCSA measurements from routinely acquired clinical images with three-dimensional (3D)-reconstructed images. This is a cross-sectional study. The s le consists of 390 patients referred for lumbar imaging with some aspect of anatomical LSS found, with no prior back surgery, 40 years of age or older, and with available volumetric MR images to allow 3D reconstruction of the spine. The outcome of interest in this study was dural sac cross sectional area. Spine images were 3D reconstructed at the level of the disc, perpendicular to the spinal canal. Dural sac cross-sectional area was measured for both 3D-reconstructed and routinely acquired clinical images using the slice orientation captured. Dural sac cross-sectional area for the lower lumbar levels (L4-L5 and L5-S1) was significantly different between routinely acquired clinical images and 3D-reconstructed images, with a standard error of measurement of 12.98 and 19.73 mm(2), respectively. When canal size is of interest, particularly when LSS affecting the lower lumbar levels is of concern, 3D reconstruction of clinical images should be considered.
Publisher: Elsevier BV
Date: 10-2021
Publisher: Oxford University Press (OUP)
Date: 07-2013
DOI: 10.2522/PTJ.20120457
Abstract: Several studies have investigated differences in paraspinal muscle morphology between patients with low back pain (LBP) and control patients. However, inconsistencies in the results of some of these studies may limit generalizations. The purpose of this study was to systematically review studies evaluating paraspinal muscle morphology in patients with LBP and control patients, with a focus on the effects of blinding. An electronic search was performed with the use of relevant databases. Study quality was evaluated by means of the Newcastle-Ottawa Quality Assessment Scale. Case-control studies investigating paraspinal muscle size between patients with LBP and control patients who were healthy were included. Studies that compared paraspinal muscle size between symptomatic and asymptomatic sides of patients with unilateral LBP also were included. Studies investigating the same outcome—at the same spinal level and for the same muscle and population—were pooled. Mean differences with 95% confidence interval were calculated for each study. Eleven studies were included. With 1 exception, all pooled results were significantly different statistically between groups, suggesting that paraspinal muscles are smaller in patients with chronic LBP than in control patients and on the symptomatic side of patients with chronic unilateral LBP. In patients with acute unilateral LBP, there was no significant difference between sides. A qualitative examination demonstrated a trend toward an increased effect size when outcome assessors were unblinded. Limitations of this review include the small number of studies included and their small s le size. Misclassification of blinding status may have occurred when the study did not report blinding status. Evidence suggests that paraspinal muscles are significantly smaller in patients with chronic LBP than in control patients. Although no definite conclusion could be taken as to the effects of blinding, future imaging studies should consider the use of blinded outcome assessors.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 15-08-2016
Publisher: Wiley
Date: 10-02-2016
Publisher: SAGE Publications
Date: 15-05-2023
DOI: 10.1177/00084174231165832
Abstract: Background. The coronavirus disease 2019 (COVID-19) pandemic disrupted daily life with corresponding implications on levels of distress. Purpose. To describe factors associated with high distress among community-dwelling older adults during the first lockdown and explore how occupational participation was managed. Methods. A mixed methods design whereby multivariate regression analysis of a survey ( N = 263) identified factors associated with high distress, as per the Impact of Events of Scale-Revised (IES-R). Follow-up interviews with a sub-s le of those surveyed who reflected a range of IES-R scores were conducted ( N = 32). Findings. Those with lower resilience and anxiety/depression had 6.84 and 4.09 greater odds respectively of high distress. From the interviews, the main theme, “Lost and Found,” and subthemes (Interruption and Disruption Surving, not Thriving Moving Forward, Finding Meaning) highlighted the process and corresponding stages, including adaptive strategies, by which participants navigated changes in their occupational participation. Implications. While the results suggest that many older adults, including those with high distress, were able to manage daily life under lockdown, some experienced ongoing challenges in doing so. Future studies should focus on those who experienced or who are at-higher risk for such challenges to identify supports that mitigate adverse consequences if another event of this magnitude occurs again.
Publisher: University of Toronto Press Inc. (UTPress)
Date: 11-2020
Publisher: BMJ
Date: 12-2021
DOI: 10.1136/BMJOPEN-2021-053758
Abstract: The novel COVID-19 required many countries to impose public health measures that likely impacted the participation and mobility of community-dwelling older adults. This protocol details a multimethod cohort design undertaken to describe short-term and medium-term changes to the mobility and participation of older Canadians living in the community rather than retirement facilities during the COVID-19 pandemic. A longitudinal telephone (or online)-administered survey is being conducted with a random s le of older adults living within 20 km of McMaster University, Hamilton, Ontario, Canada, identified from census dissemination areas. Baseline data collection of community-dwelling older adults aged 65 years and over began in May 2020 with follow-ups at 3, 6, 9 and 12 months. The Late-Life Function and Disability Instrument and global rating of change anchors are the primary outcomes of interest. A subs le of respondents will participate in open-ended, semistructured interviews conducted over the telephone or through video-conference, to explore participants’ lived experiences with respect to their mobility and participation during the pandemic. Descriptive statistics and quantitative approaches will be used to determine changes in mobility and social and personal participation, and associated personal and environmental factors. For the interviews, qualitative data will be analysed using descriptive phenomenology. Approval was obtained from the Hamilton Integrated Research Ethics Board of McMaster University (2020-10814-GRA). This study may inform the design of programmes that can support community-dwelling older adults during and after the COVID-19 pandemic. Findings will be disseminated through peer-reviewed publications and conferences focused on ageing.
Publisher: Elsevier BV
Date: 09-2020
Publisher: Wiley
Date: 08-01-2016
Publisher: JMIR Publications Inc.
Date: 15-01-2019
DOI: 10.2196/11127
Publisher: Oxford University Press (OUP)
Date: 02-09-2019
DOI: 10.1093/PTJ/PZZ124
Abstract: There is evidence to suggest that a large proportion of in iduals seeking care for lumbopelvic pain also have pelvic floor muscle dysfunction (PFMD). Because the majority of physical therapists do not have the requisite training to adequately assess pelvic floor musculature, determining predictors of PFMD could be clinically useful. The objective was to establish a combination of factors (self-report and physical) predictive of PFMD in women with lumbopelvic pain. This was a cross-sectional study. Participants completed a battery of self-report and physical assessments (masked assessors). Three clinical findings characterized PFMD: weakness of the pelvic floor, lack of coordination of the pelvic floor, and pelvic floor muscle tenderness on palpation (bilateral obturator internus). Univariate and multivariate logistic regression analyses were used to determine the extent to which different predictors were associated with PFMD. One hundred eight women with self-reported lumbopelvic pain (within the past week) were included in the study (mean age = 40.4 years SD = 12.6 years). None of the examined factors predicted pelvic floor muscle weakness. Two factors independently predicted pelvic floor muscle tenderness on palpation: very strong and/or uncontrollable urinary urges (odds ratio [OR] = 2.93 95% confidence interval [CI] = 1.13–7.59) and Central Sensitization Inventory scores of 40 or greater (OR = 3.13 95% CI = 1.08–9.10). The s le consisted of young women, some of whom were not actively seeking care. Additionally, the technique for assessing pelvic floor muscle tenderness on palpation requires further validation. Women who have lumbopelvic pain, uncontrollable urinary urgency, and central sensitization were, on average, 2 times more likely to test positive for pelvic floor muscle tenderness on palpation. Further studies are needed to validate and extend these findings.
Publisher: Oxford University Press (OUP)
Date: 02-2008
DOI: 10.2522/PTJ.20070147
Abstract: The methodological quality of randomized controlled trials (RCTs) is commonly evaluated in order to assess the risk of biased estimates of treatment effects. The purpose of this systematic review was to identify scales used to evaluate the methodological quality of RCTs in health care research and summarize the content, construction, development, and psychometric properties of these scales. Extensive electronic database searches, along with a manual search, were performed. One hundred five relevant studies were identified. They accounted for 21 scales and their modifications. The majority of scales had not been rigorously developed or tested for validity and reliability. The Jadad Scale presented the best validity and reliability evidence however, its validity for physical therapy trials has not been supported. Many scales are used to evaluate the methodological quality of RCTs, but most of these scales have not been adequately developed and have not been adequately tested for validity and reliability. A valid and reliable scale for the assessment of the methodological quality of physical therapy trials needs to be developed.
Publisher: Springer Science and Business Media LLC
Date: 07-11-2020
DOI: 10.1186/S12955-020-01614-7
Abstract: Accurate diagnosis of carpal tunnel syndrome (CTS) is essential for directing appropriate treatment and for making decisions about work injury claims. The Kamath and Stothard Questionnaire (KSQ) is a self-reported tool used for the diagnosis of CTS. Comprehensibility and comprehensiveness of this questionnaire are critical to diagnostic performance and need to be established. The purpose of the study was to describe how potential respondents, clinicians, and measurement researchers interpret KSQ questions in order to identify and resolve potential sources of misclassification. Hand therapists, measurement researchers, participants with CTS, and a control group were interviewed using cognitive interviewing techniques (talk aloud, semi-structured interview probes) in Hamilton, Canada. All interviews were recorded and transcribed verbatim. A directed content analysis was done to analyze the interviews using a previously established framework. Eighteen participants were interviewed. Areas, where questions were unclear to some participants, were recorded and categorized into five themes: Clarity and Comprehension (52%), Relativeness (38%), Inadequate Response Definition (4%), Perspective Modifiers (4%), and Reference Point (2%). Respondents also identified several symptoms of CTS that are not covered by the KSQ that might be of diagnostic value, e.g., weakness and dropping items. The content validity of the current iteration of the KSQ was not established. The problematic questions identified in the study have been reported to have low specificity and negative predictive values in a previous quantitative study. The content validity issues identified may explain the poor performance. Recommendations were made to modify the wording of the KSQ and the potential addition of three new questions. Future studies should determine whether the modified questionnaire can provide better diagnostic accuracy and psychometric properties. The results of this study may assist in ruling in or out CTS diagnosis to a wide variety of target audience, such as hand specialists, physical and occupational therapists, as well as family doctors.
Publisher: CSIRO Publishing
Date: 2013
DOI: 10.1071/AH13057
Abstract: Objective The primary objective of this study was to evaluate the effect of an online education program used to implement the Australian (New South Wales) whiplash guidelines with general practitioners (GP). The secondary aim was to identify factors associated with learning. Methods An online educational and evaluation activity was developed to reflect the key messages for GP from the Australian whiplash guidelines. The educational activity was hosted on the Royal Australian College of General Practitioners’ website (www.gplearning.com.au) for a period of 3 years. Participants were recruited through advertisement and media releases. Participants completed a baseline evaluation of their knowledge, participated in the interactive educational activity and completed a post-knowledge questionnaire. The primary outcome was change in professional knowledge, predictors of learning were computed using linear regression. Results Two hundred and fifteen GP participated. Knowledge significantly improved between baseline and post-knowledge questionnaire scores (P 0.00001). A total of 57.2% of participants improved their knowledge by more than 20%, indicating a large effect. Low baseline knowledge predicted learning, accounting for 71% of the variance. Conclusions Online education of GP significantly improved their knowledge in relation to guidelines for whiplash. Those with low baseline knowledge improved their knowledge the most, suggesting that implementation strategies should be targeted at this group. What is known about the topic? Clinical guidelines are usually developed to improve knowledge and ultimately change clinical practice to reflect best practice management of that condition. However, developing and publishing guidelines alone rarely changes knowledge or clinical practice. With GP, effective implementation strategies to improve knowledge have included face to face education such as interactive educational meetings and educational outreach. However, these strategies are expensive and time consuming. Whiplash is a significant health problem in Australia, and although GP are commonly consulted for this condition, an in idual GP may only see one whiplash case per year, meaning that face to face implementation strategies may not be pragmatic for this condition. What does this paper add? This paper shows that online education was effective in improving GP knowledge of clinical guidelines for whiplash. The effect was as large as the reported effects for face to face education in other studies. Importantly this paper shows that the less GP knew about whiplash, the more they learnt, indicating that the strategy was effective for those who most required the education. Finally, the online strategy reached GP in rural and remote places in Australia. This paper therefore shows that online education can be an effective method to improve GP knowledge about managing whiplash. It is hoped that it may provide the impetus to use this strategy for implementing clinical guidelines for other conditions. What are the implications for practitioners? Practitioners can be confident that using an online educational program will improve their knowledge of managing conditions they previously knew little about. It is hoped that this will translate into a change in clinical practice. For ex le, GP using this strategy improved knowledge in knowing when to X-ray, when to refer and what interventions to provide for people with whiplash. For any health practitioners managing whiplash access to this information is still available using the New South Wales Motor Accident Authority website (www.maa.nsw.gov.au)
Publisher: Springer Science and Business Media LLC
Date: 05-05-2008
Publisher: Oxford University Press (OUP)
Date: 2014
DOI: 10.2522/PTJ.20130217
Abstract: The Pain Self-Efficacy Questionnaire (PSEQ) is used by physical therapists in clinical practice and in research. However, current understanding of the PSEQ's measurement properties is incomplete, and investigators cannot be confident that it provides unbiased information on patient self-efficacy. The aims of this study were: (1) to investigate the scale properties of the PSEQ using Rasch analysis and (2) to determine whether age, sex, pain intensity, pain duration, and pain-related disability bias function of the PSEQ. This was a retrospective study data were obtained from 3 existing studies. Data were combined from more than 600 patients with low back pain of varying duration. Rasch analysis was used to evaluate targeting, category ordering, unidimensionality, person fit, internal consistency, and item bias. There was evidence of adequate category ordering, unidimensionality, and internal consistency of the PSEQ. Importantly, there was no evidence of item bias. The PSEQ did not adequately target the s le instead, it targeted people with lower self-efficacy than this population. Item 7 was hardest for participants to endorse, showing excessive positive misfit to the Rasch model. Response strings of misfitting persons revealed older participants and those reporting high levels of disability. The in idual items of the PSEQ can be validly summed to provide a score of self-efficacy that is robust to age, sex, pain intensity, pain duration, and disability. Although item 7 is the most problematic, it may provide important clinical information and requires further investigation before its exclusion. Although the PSEQ is commonly used with people with low back pain, of whom the s le in this study was representative, the results suggest it targets patients with lower self-efficacy than that observed in the current s le.
Publisher: JMIR Publications Inc.
Date: 28-07-2022
DOI: 10.2196/38686
Abstract: It is well recognized that parents of children with neurodevelopmental disabilities can experience a considerable burden of care associated with their child’s disability, which can potentially impact their functioning and quality of life. Historically, the intervention efforts in pediatric rehabilitation have focused primarily on the child’s development and well-being and much less on parental and family well-being. The impact that a child’s diagnosis might have on parents remains unclear, and it is unknown how we can best support parents on their journey of childhood disability. It is, therefore, important to synthesize the published evidence on interventions for parents of children with neurodevelopmental disabilities so that clinicians can be better informed about the ways in which families they work with can be supported. This manuscript presents the protocol for a systematic review of the effectiveness of interventions aiming to improve the physical, psychological, or socioeconomic well-being of parents of children with neurodevelopmental disabilities when compared to usual care or no care. We will systematically search 4 databases (MEDLINE, Embase, PsycINFO, and CINAHL) from the year 2000 until the search date, for randomized controlled trials that evaluated the effectiveness of interventions to improve parental physical, psychological, or socioeconomic well-being. Two authors will independently screen the titles and abstracts, which will then be followed by full-text screening. After the eligibility assessment, two reviewers will independently extract data and conduct a risk of bias assessment using the Cochrane risk-of-bias tool. We will assess the quality of evidence using the Grading of Recommendations, Assessment, Development and Evaluation approach. If the data allow, we will perform a pairwise meta-analysis or network meta-analysis. We plan to evaluate the coherence of the network with a global test by using the node-splitting method. As of May 30, 2022, there have been two searches of data initiated: in September 2020 for articles published since 2000 and an updated search in January 2022 for articles published since 2020. We have screened all the titles and abstracts and performed eligibility assessment. However, the final number of references is still not available due to the additional information needed for some of the potentially eligible studies. The results from this systematic review will be published in an indexed journal within a year after this protocol is published. This study is expected to identify a variety of programs to address the well-being needs of parents of children with neurodevelopmental disabilities and provide directions on how parents can best be supported within health care. Such interventions might help professionals and stakeholders in creating service delivery models that can enhance parental well-being and minimize the risks to their physical, psychological, and socioeconomic functioning. PROSPERO CRD42021230706 www.crd.york.ac.uk rospero/display_record.php?RecordID=230706 DERR1-10.2196/38686
Publisher: Springer Science and Business Media LLC
Date: 03-07-2010
Publisher: Springer Science and Business Media LLC
Date: 27-10-2019
DOI: 10.1186/S12891-019-2835-2
Abstract: There are inconsistencies in findings regarding the relationship of occupational loading with spinal degeneration or structural damage. Thus, a systematic review was conducted to determine the current state of knowledge on the association of occupational loading and spine degeneration on imaging. We performed electronic searches on MEDLINE, CINAHL and EMBASE. We included cross-sectional, case control and cohort studies evaluating occupational loading as the exposure and lumbar spine structural findings on imaging as the outcomes. When possible, results were pooled. Seventeen studies were included in the review. Ten studies evaluated the association of occupational loading with disc degeneration (signal intensity), four of which were pooled into a meta-analysis. Of the 10 studies, only two did not identify a relationship between occupation loading and disc degeneration. A meta-analysis including four of the studies demonstrated an association between higher loading and degeneration for all spinal levels, with odds ratios between 1.6 and 3.3. Seven studies evaluated disc height narrowing and seven evaluate disc bulge, with six and five identifying an association of loading and with imaging findings respectively. Three studies evaluated modic changes and one identified and association with occupational load. There was moderate evidence suggesting a modest association between occupational loading and disc degeneration (signal intensity), and low-quality evidence of an association between occupational loading and disc narrowing and bulging.
Publisher: Oxford University Press (OUP)
Date: 04-2012
Publisher: Informa UK Limited
Date: 22-12-2022
Publisher: Informa UK Limited
Date: 12-07-2019
Publisher: Oxford University Press (OUP)
Date: 06-10-2022
DOI: 10.1093/PTJ/PZAC132
Abstract: Participation in life situations is a critical aspect of health recognized by the World Health Organization. Guidelines to prevent spreading of COVID-19 place older adults at risk of worsening participation. The purpose of this study was to identify the factors associated with participation during the COVID-19 pandemic among community-dwelling older adults living in Hamilton, Ontario, Canada. Participants were recruited from identified census dissemination areas in Hamilton. Participants completed surveys either by phone or online during the months of May to August 2020. Measures were organized into factors related to body functions and structures, activities, participation, as well as personal and environmental contextual factors using the International Classification of Functioning, Disability, and Health (ICF) framework. Multivariable regression analysis was conducted to identify factors associated with participation as measured by the Late-Life Disability Instrument’s (LLDI) frequency and limitations scales. A total of 272 older adults completed the survey (78 [7.3] years 70% female). Use of a walking aid, driving status, perceived mental health status, nutrition risk, and physical function explained 48.2% of the variance observed in the LLDI-frequency scale scores. Use of a walking aid, driving status, perceived mental health status, receiving health assistance, and physical function explained 38.5% of the variance observed in the LLDI-limitation scale scores. Results highlighted factors across multiple ICF domains that are associated with participation restriction among a s le of community-dwelling older adults during the pandemic. Participation during the pandemic was greatest in those that were able to walk without needing to use a walking aid, being a licensed and current driver, perceiving good to excellent mental health, and having greater physical function. Our findings contribute to the literature on older adult participation during lockdowns, restrictions, pandemics, and/or other similar circumstances.
Publisher: Springer Science and Business Media LLC
Date: 07-04-2021
DOI: 10.1186/S12891-021-04202-Y
Abstract: Carpal tunnel syndrome (CTS) is the most common entrapment mononeuropathy of the upper extremity. The previous systematic review of the diagnostic tests for CTS was outdated. The objective of this study was to compile and appraise the evidence on the accuracy of sensory and motor tests used for the diagnosis of CTS. MEDLINE, CINAHL, and Embase databases were searched on January 20, 2020. Studies assessing at least one diagnostic accuracy property of the sensory or motor tests for CTS diagnosis were selected by two independent reviewers. Diagnostic test accuracy extension of the PRISMA guidelines was followed. Risk of bias and applicability concerns were rated using QUADAS-2 tool. Any reported diagnostic accuracy property was summarized. Study characteristics and any information on the accuracy of the sensory and motor tests for CTS diagnosis were extracted. We included sixteen clinical studies, assessing thirteen different sensory or motor tests. The most sensitive test for CTS diagnosis was the Semmes-Weinstein monofilament test (with 3.22 in any radial digit as the normal threshold) with sensitivity from 0.49 to 0.96. The tests with the highest specificity (Sp) were palmar grip strength (Sp = 0.94), pinch grip strength (Sp from 0.78 to 0.95), thenar atrophy (Sp from 0.96 to 1.00), and two-point discrimination (Sp from 0.81 to 0.98). The evidence was inconclusive on which sensory or motor test for CTS diagnosis had the highest diagnostic accuracy. The results suggest that clinicians should not use a single sensory or motor test when deciding on CTS diagnosis. PROSPERO CRD42018109031 , on 20 December 2018.
Publisher: Springer Science and Business Media LLC
Date: 03-03-2020
DOI: 10.1186/S12891-020-3154-3
Abstract: Low back pain (LBP) is one of the greatest contributors to disability in the world and there is growing interest on the role of biomarkers in LBP. To purpose of this review was to analyze available evidence on the relationship between inflammatory biomarkers, clinical presentation, and outcomes in patients with acute, subacute and chronic non-specific low back pain (NSLBP). A search was performed in Medline, Embase, Cinahl and Amed databases. Studies which measured levels of inflammatory biomarkers in participants with NSLBP were included. Two reviewers independently screened titles and abstracts, full-texts, and extracted data from included studies. Methodological quality was assessed using the Newcastle Ottawa Quality Assessment Scale. Level of evidence was assessed using the modified GRADE approach for prognostic studies. Seven primary studies were included in this review. All results assessed using the modified GRADE demonstrated low to very low quality evidence given the small number of studies and small s le. Three studies examined C-reactive protein (CRP), one of which found significantly higher CRP levels in an acute NSLBP group than in controls and an association between high pain intensity and elevated CRP. Three studies examined tumor necrosis factor alpha (TNF-α), two of which found elevated TNF-α in chronic NSLBP participants compared to controls. Two studies examined interleukin 6 (IL-6), none of which found a significant difference in IL-6 levels between NSLBP groups and controls. Two studies examined interleukin 1 beta (IL-β), none of which found a significant difference in IL-β levels between NSLBP groups and controls. This review found evidence of elevated CRP in in iduals with acute NSLBP and elevated TNF-Α in in iduals with chronic NSLBP. There are a limited number of high-quality studies evaluating similar patient groups and similar biomarkers, which limits the conclusion of this review.
Publisher: JMIR Publications Inc.
Date: 31-05-2018
Abstract: ow back pain (LBP) is one of the most debilitating conditions among older adults. Unfortunately, existing LBP outcome questionnaires are not adapted for specific circumstances related to old age, which may make these measures less than ideal for evaluating LBP in older adults. o explore the necessity of developing age-specific outcome measures, crowdsourcing was conducted to solicit opinions from clinicians globally. linicians around the world voted and/or prioritized various LBP outcome indicators for older adults on a pairwise wiki survey website. Seven seed outcome indicators were posted for voting while respondents were encouraged to suggest new indicators for others to vote rioritize. The website was promoted on the social media of various health care professional organizations. An established algorithm calculated the mean scores of all ideas. A score points means that the idea has % probability of beating another randomly presented indicator. ithin 42 days, 128 respondents from 6 continents cast 2466 votes and proposed 14 ideas. Indicators pertinent to improvements of physical functioning and age-related social functioning scored while self-perceived reduction of LBP scored 32. his is the first crowdsourcing study to address LBP outcome indicators for older adults. The study noted that age-specific outcome indicators should be integrated into future LBP outcome measures for older adults. Future research should solicit opinions from older patients with LBP to develop age-specific back pain outcome measures that suit clinicians and patients alike.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2016
Publisher: Elsevier BV
Date: 08-2010
DOI: 10.1016/J.JCLINEPI.2009.10.005
Abstract: To evaluate the convergent and construct validity of the Physiotherapy Evidence Database (PEDro) scale used to rate the methodological quality of randomized trials in physiotherapy. PEDro total scores and in idual-item scores were extracted from 9,456 physiotherapy trials indexed on PEDro. Convergent validity was tested by comparing PEDro total scores with three other quality scales. Construct validity was tested by regressing the PEDro score and in idual-item scores with the Institute for Scientific Information Web of Knowledge impact factors (IF) and SCImago journal rankings (SJR) for the journals in which the trials were published. Testing of convergent validity revealed correlations with the other quality scales ranging from 0.31 to 0.69. The PEDro total score was weakly but significantly associated with IF and SJR (P < 0.0001). Eight of the 10 in idual scale items that contribute to the PEDro total score were significantly associated with IF. This study provides preliminary evidence of the convergent and construct validity of the PEDro total score and the construct validity of eight in idual scale items.
Publisher: Springer Science and Business Media LLC
Date: 14-11-2013
Publisher: Elsevier BV
Date: 04-2022
Publisher: Springer Science and Business Media LLC
Date: 22-05-2021
DOI: 10.1186/S12891-021-04346-X
Abstract: Exercise is a common approach for the management of patients with chronic non-specific low back pain (LBP). However, there is no clear mechanistic evidence or consensus on what type of exercise is more effective than others. While considerable evidence suggests a link between lumbar muscle health (e.g., atrophy and fatty infiltration) with functional deficits, it is unknown whether exercises targeting the lumbar spine can lead to noticeable improvements in muscle health and functional outcomes. The primary aim of this study is to compare the effect of combined motor control and isolated strengthening lumbar exercises (MC + ILEX) versus a general exercise group (GE) on multifidus muscle morphology (size and composition). Secondary aims include assessing the effect of the interventions on overall paraspinal muscle health, pain and disability, as well as psychological factors as possible effect modifiers. A total of 50 participants with chronic non-specific LBP and moderate to severe disability, aged between 18 and 60, will be recruited from the local orthopaedic clinics and university community. Participants will be randomised (1:1) to either the MC + ILEX or GE group. Participants will undergo 24 in idually supervised exercise sessions over a 12-week period. The primary outcome will be multifidus morphology (atrophy) and composition (fatty infiltration). Secondary outcomes will be muscle function (e.g., % thickness change during contraction), morphology, lumbar extension strength, pain intensity and disability. Potential treatment effect modifiers including maladaptive cognitions (fear of movement, catastrophizing), anxiety, depression, physical activity, and sleep quality will also be assessed. All measurements will be obtained at baseline, 6-week and 12-week self-reported outcomes will also be collected at 24-week. Between-subjects repeated measure analysis of variance will be used to examine the changes in paraspinal muscle morphology over the different time points. Linear mixed models will be used to assess whether baseline scores can modify the response to the exercise therapy treatment. The results of this study will help clarify which of these two common interventions promote better results in terms of overall paraspinal muscle heath, back pain, disability and psychological factors in adults with chronic LBP. NTCT04257253 , registered prospectively on February 5, 2020.
Publisher: Elsevier BV
Date: 08-2023
Publisher: SAGE Publications
Date: 2023
DOI: 10.1177/1759720X231182894
Abstract: Exercise is one of the most recommended management strategies by treatment guidelines for fibromyalgia (FM) however, the mechanism through which exercise improves pain in FM is still unknown. We aimed to summarize the hypothesized theoretical mechanisms for the pain-relieving effects of exercise in people with FM. Randomized controlled trials (RCTs) in English reporting mechanisms for pain-relieving effects of exercise in the ‘Introduction’ and ‘Discussion’ sections and significant within- group or between-group effects of exercise interventions were included. We searched the databases Ovid MEDLINE(R), EMBASE, CINAHL, COCHRANE, Sports Discuss, and AMED with the keywords: exercise and fibromyalgia until December 2021. Two authors independently performed title/abstract, full-text review, and data abstraction using a data abstraction form. The hypothesized mechanisms from in idual studies were grouped into three categories. The literature search resulted in 2147 studies, out of which 220 studies were considered for full-text review. A total of 50 RCTs proposing 29 unique mechanisms for the pain-relieving effects of exercise were included. These mechanisms were ided into three categories: physical, neuro-physiological, and psychological. The neuro-physiological category was further sub ided into exercise-induced hypoalgesia (EIH), pain sensitization, the autonomic system, the immune system, the endocrine system, and miscellaneous categories. The most frequently hypothesized mechanisms were EIH ( n = 15), autonomic modulation ( n = 7), improved sleep ( n = 6), muscle oxygenation ( n = 6), self-efficacy ( n = 5), mental health ( n = 4), and benefits of the aquatic environment ( n = 12). While all exercise interventions involved FM patients, most of the supporting evidence for these mechanisms was cited from previous studies conducted on healthy s les. No studies performed analyses to demonstrate causal associations between the mechanisms and outcomes. Multiple mechanisms were hypothesized for the positive influence of exercise in people with FM. Future studies using causal analyses, such as mediation analysis, are recommended to validate these mechanisms.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 31-08-2022
DOI: 10.1097/JTE.0000000000000248
Abstract: The purpose of this study was to provide insight into carryover bias in the vertical and horizontal methods of assessing virtual admission interviews for physiotherapy candidates and to estimate interrater reliability of items within the 2 assessment methods and assessors’ satisfaction with the new horizontal method of assessment. This was a quality improvement study using retrospective data analysis of 2 datasets. The vertical scoring method (2020 dataset) consisted of 2 assessors scoring all items for a single candidate. The horizontal method (2021 dataset) had assessors evaluate selected candidates for a single group of items. Assessors completed a virtual survey asking about their satisfaction with the new horizontal scoring method. To investigate carryover bias, multiquestion, multirater correlation matrices were generated for the 2020 and 2021 datasets. Interrater reliability was examined by calculating Shrout and Fleiss class 1 and 2 intraclass correlation coefficients (ICCs). Descriptive statistics were used to summarize scaling questions on the satisfaction survey. Open-ended questions were analyzed using content analysis to identify common themes. Correlation matrices for the multiquestion, multirater correlation analysis supported carryover bias in the analysis of the 2020 dataset. In contrast for the 2021 data, higher correlations were obtained between raters within a question, demonstrating a reduced carryover effect. Interrater reliability based on the average of 2 raters was 0.62 (95% CI: 0.70–0.77) for the 2020 cohort and 0.74 (95% CI: 0.02–0.22) for the 2021 cohort. The ICC difference between the datasets was statistically significant ( Z = 2.40, P = .016). Most assessors agreed that they enjoyed reviewing applicants more horizontally than vertically. Results of this study demonstrated reduced carryover bias and increased interrater reliability and assessor satisfaction with the horizontal method of scoring physiotherapy admissions interviews compared with the traditional vertical method. Continued exploration of admissions processes is vital to ensure the fairest method of conducting online physiotherapy admission interviews for a large pool of candidates.
Publisher: Springer Science and Business Media LLC
Date: 12-01-2023
DOI: 10.1186/S12998-023-00474-4
Abstract: There is a paucity of research assessing cultural competency among Canadian chiropractors. Therefore, the aims of this study were to (1) measure cultural competency among Canadian chiropractors, (2) understand chiropractors’ perspectives of challenges and attitudes regarding the delivery of chiropractic services to equity-seeking communities, and (3) assess contextual factors associated with cultural competency. We conducted a cross-sectional survey of members of the Canadian Chiropractic Association (CCA) (May–July 2021). The survey instrument consisted of 57 questions related to demographics, cultural competency, perceptions about health disparities, and challenges in delivery of rehabilitation. Cultural competency was measured using the Cultural Awareness and Sensitivity and Cultural Competence Behaviours subscales of the Cultural Competence Assessment Instrument. We conducted a multivariate linear regression to assess factors that may be associated with cultural competency. A total of 3143 CCA members responded (response rate of 41%). Mean scores for the Cultural Awareness and Sensitivity subscale were 5.8/7 (95% CI 5.7 5.8) and 4.2/7 (95% CI 4.1 4.2) for the Cultural Competence Behaviour subscale. Most chiropractors (72–78%) reported observing important cultural health disparities across various care-related outcomes. Cost of services and language were identified as barriers to providing care to equity-seeking communities. Cultural Awareness and Sensitivity scores were weakly associated with gender (men), years of clinical practice, cultural health disparities, the statement “I think some people have an agenda to look for discrimination even where it does not exist (DEI attitudes),” race (Caucasian), and prior DEI training, (R 2 = 0.15, p 0.0001). Cultural Competence Behaviour scores were weakly associated with race (Caucasian), cultural health disparities, prior DEI training, increased years of clinical experience, and higher Cultural Awareness and Sensitivity scores (R 2 = 0.19, p 0.0001). This study provides the first description of cultural competency within the chiropractic profession in Canada. Findings suggest a gap between knowledge and behaviour and uncover several barriers and challenges that may inform the development of profession-specific training in cultural competence.
Publisher: Elsevier BV
Date: 09-2014
DOI: 10.1016/J.SPINEE.2013.11.030
Abstract: Walking capacity is a primary outcome indicator for in iduals with lumbar spinal stenosis (LSS). Therefore, there is a demand for psychometrically sound measures of walking that are responsive to change. The primary objective of this study was to examine longitudinal construct validity of the Physical Function Scale of the Swiss Spinal Stenosis Questionnaire (PF Scale), the Oswestry Disability Index (ODI), and the walking capacity items from these scales specifically for the assessment of walking capacity in LSS using the objective Self-Paced Walking Test (SPWT) as the external standard. A secondary objective was to examine responsiveness of measures of walking using a self-reported walking capacity change scale as the external criterion standard. Patients were prospectively enrolled. Twenty-six patients were included in this study (17 women and 9 men), with an average age of 68.5 years (SD, 9.2). All participants had LSS diagnosed by a spine specialist surgeon based on both clinical examination and imaging, as well as self-reported walking limitations (neurogenic claudication). The self-reported outcome measures included in this study were PF Scale, ODI, and self-reported walking capacity change score. The functional measure used in the study was SPWT. Longitudinal construct validity was assessed using the correlational method. Internal responsiveness was examined using Guyatt responsiveness index and external responsiveness using receiver operating characteristic analysis. Change in the SPWT and the self-reported walking capacity change score were used as external criteria for the analysis. The highest correlations with change in the SPWT were 0.78 for the ODI walking item and 0.78 for the walking capacity change score. Changes in the PF Scale and ODI score were correlated with change in the criterion SPWT at r=0.56 and r=0.70, respectively. There were no differences observed between the PF Scale and ODI for any of the responsiveness indices. The PF Scale, ODI, and walking capacity change score are able to detect changes in walking capacity in people with LSS. The in idual walking capacity item from the ODI appears to be the most valid and responsive to changes in measured walking and may be a reasonable alternative for measuring walking when an objective test such as the SPWT is not feasible.
Publisher: Springer Science and Business Media LLC
Date: 16-02-2021
DOI: 10.1186/S12891-021-04028-8
Abstract: Proven treatments for low back pain, at best, only provide modest overall benefits. Matching people to treatments that are likely to be most effective for them may improve clinical outcomes and makes better use of health care resources. We conducted an in idual participant data meta-analysis of randomised controlled trials of three types of therapist delivered interventions for low back pain (active physical, passive physical and psychological treatments). We applied two statistical methods (recursive partitioning and adaptive risk group refinement) to identify potential subgroups who might gain greater benefits from different treatments from our in idual participant data meta-analysis. We pooled data from 19 randomised controlled trials, totalling 9328 participants. There were 5349 (57%) females with similar ratios of females in control and intervention arms. The average age was 49 years (standard deviation, SD, 14). Participants with greater psychological distress and physical disability gained most benefit in improving on the mental component scale (MCS) of SF-12/36 from passive physical treatment than non-active usual care (treatment effects, 4.3 95% confidence interval, CI, 3.39 to 5.15). Recursive partitioning method found that participants with worse disability at baseline gained most benefit in improving the disability (Roland Morris Disability Questionnaire) outcome from psychological treatment than non-active usual care (treatment effects, 1.7 95% CI, 1.1 to 2.31). Adaptive risk group refinement did not find any subgroup that would gain much treatment effect between psychological and non-active usual care. Neither statistical method identified any subgroups who would gain an additional benefit from active physical treatment compared to non-active usual care. Our methodological approaches worked well and may have applicability in other clinical areas. Passive physical treatments were most likely to help people who were younger with higher levels of disability and low levels of psychological distress. Psychological treatments were more likely to help those with severe disability. Despite this, the clinical importance of identifying these subgroups is limited. The sizes of sub-groups more likely to benefit and the additional effect sizes observed are small. Our analyses provide no evidence to support the use of sub-grouping for people with low back pain.
Publisher: Springer Science and Business Media LLC
Date: 31-10-2011
Publisher: Elsevier BV
Date: 06-2011
Publisher: Elsevier BV
Date: 05-2015
Publisher: Elsevier BV
Date: 06-2007
Publisher: JMIR Publications Inc.
Date: 30-03-2020
Abstract: ow back pain (LBP) is a highly prevalent condition affecting in iduals of all ages. To manage the symptoms and prevent recurrences and flare-ups, physical activity in conjunction with self-management education is recommended. Tools such as diaries and questionnaires have been the gold standard for tracking physical activity in clinical studies. However, there are issues with consistency, accuracy, and recall with the use of these outcome measures. Given the growth of technology in today’s society, consumer-grade activity monitors have become a common and convenient method of recording physical activity data. he aim of this study is to test the feasibility and convergent validity of a Garmin Vivofit 3 activity tracker in evaluating physical activity levels in a clinical trial of patients with LBP. e recruited 17 in iduals with nonspecific LBP referred from health care professionals or self-referred through advertisements in the community. The participants entered into a 12-week physical activity and self-management program. Physical activity was assessed using a self-reported questionnaire and the Garmin activity tracker. Activity tracker data (eg, steps taken, distance walked, and intensity minutes) were extracted weekly from the Garmin Connect online platform. Outcomes of pain and activity limitation were assessed weekly using a mobile app. A linear regression was conducted to evaluate if demographic factors (ie, age, gender, pain level) affected the adherence rates to the activity monitor. We also used Pearson correlations to evaluate the convergent validity of the Garmin activity tracker with the physical activity questionnaire. he mean daily adherence rate for activity monitors was 70% (SD 31%) over the 26 weeks of study. The mean response rate for the weekly physical activity measures using REDCap for the first 12 weeks of the study was 91% (SD 17%). None of the hypothesized variables or questionnaires were predictors of response rate. he majority of participants were compliant with wearing the tracker, and demographic factors were not found to be predictors of adherence to wearing the device. However, there were poor correlations between the modified International Physical Activity Questionnaire Short Form (IPAQ-SF) and the activity monitor, demonstrating problems with convergent validity.
Publisher: Informa UK Limited
Date: 16-08-2022
DOI: 10.1080/09638288.2021.1965232
Abstract: The purpose of this qualitative study is to understand the perceived patient barriers and facilitators of post-surgical exercise adherence in patients undergoing TKA. We used an interpretive description approach. Data was gathered using semi-structured qualitative interviews. Participants were interviewed at 8 weeks post-operatively to capture physical, psychological, social and contextual changes and information. Topics that were explored included participants' experience with physical activity and exercise, motivation to perform physical activity, beliefs that exercise will reduce pain, factors that limit their ability to engage in exercise, and the importance of self-regulation in exercise adherence. This study identified 4 themes within the WHO adherence framework: patient-related factors, condition-related factors, health care system, and social support. In particular, self-regulation, knowledge of exercise, post-operative complications, comorbidities, social support, and lack of guidance from health care providers were identified as personal and environmental characteristics that influence exercise adherence. Exercise adherence is a multidimensional, interconnected construct and future research should focus on understanding the factors, particularly health care system, that impact adherence.IMPLICATIONS FOR REHABILITATIONRehabilitation therapists should aim to foster competence and confidence in post-operative rehabilitation by implementing strategies such as positive-reinforcement, goal setting, and increased education regarding the benefits of exercise.Clinical strategies to improve exercise adherence should be implemented both pre-and-post-operatively.Health care providers should clearly discuss post-operative outcomes and expectations (e.g., complications, etc.) with patients prior to surgery.
Publisher: Elsevier BV
Date: 05-2021
Publisher: Informa UK Limited
Date: 2009
DOI: 10.1080/09593980802686870
Abstract: The purposes of this study were to investigate whether age influences passive range of motion (PROM) in women and to compare obtained values with other available data. Ninety healthy Caucasian women from 18 to 59 years of age had the PROM of their ankle, knee, hip, shoulder, elbow, and wrist measured by using a standard goniometer. Data were analyzed by using descriptive statistics (mean/SD) and linear regression (to analyze the effect of age on ROM). Age did not significantly influence PROM for the majority of movements tested. For 11 of the tested movements (knee flexion, hip flexion, hip external rotation, glenohumeral and shoulder complex flexion, glenohumeral and shoulder complex external rotation, shoulder complex abduction, shoulder complex extension, and elbow extension), increasing age was associated with a statistically significant decrease in PROM, whereas for ankle dorsiflexion, ankle plantarflexion, ankle inversion, and hip abduction, increasing age was associated with an increase in PROM. The change in PROM associated with age was typically small and ranged from -0.420 to 0.207 degrees per year. The difference in mean PROM between this study and published normative values ranged from -16.6 to +25.9 degrees. For women aged 18 to 59, PROM of the extremities is relatively constant, suggesting that a single table of reference values for adult females is an appropriate approximation for clinical practice except for glenohumeral and shoulder complex external rotation, which were found to clinically significantly decrease with age.
Publisher: JMIR Publications Inc.
Date: 26-03-2021
DOI: 10.2196/18942
Abstract: Low back pain (LBP) is a highly prevalent condition affecting in iduals of all ages. To manage the symptoms and prevent recurrences and flare-ups, physical activity in conjunction with self-management education is recommended. Tools such as diaries and questionnaires have been the gold standard for tracking physical activity in clinical studies. However, there are issues with consistency, accuracy, and recall with the use of these outcome measures. Given the growth of technology in today’s society, consumer-grade activity monitors have become a common and convenient method of recording physical activity data. The aim of this study is to test the feasibility and convergent validity of a Garmin Vivofit 3 activity tracker in evaluating physical activity levels in a clinical trial of patients with LBP. We recruited 17 in iduals with nonspecific LBP referred from health care professionals or self-referred through advertisements in the community. The participants entered into a 12-week physical activity and self-management program. Physical activity was assessed using a self-reported questionnaire and the Garmin activity tracker. Activity tracker data (eg, steps taken, distance walked, and intensity minutes) were extracted weekly from the Garmin Connect online platform. Outcomes of pain and activity limitation were assessed weekly using a mobile app. A linear regression was conducted to evaluate if demographic factors (ie, age, gender, pain level) affected the adherence rates to the activity monitor. We also used Pearson correlations to evaluate the convergent validity of the Garmin activity tracker with the physical activity questionnaire. The mean daily adherence rate for activity monitors was 70% (SD 31%) over the 26 weeks of study. The mean response rate for the weekly physical activity measures using REDCap for the first 12 weeks of the study was 91% (SD 17%). None of the hypothesized variables or questionnaires were predictors of response rate. The majority of participants were compliant with wearing the tracker, and demographic factors were not found to be predictors of adherence to wearing the device. However, there were poor correlations between the modified International Physical Activity Questionnaire Short Form (IPAQ-SF) and the activity monitor, demonstrating problems with convergent validity.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2011
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2012
Publisher: Springer Science and Business Media LLC
Date: 30-06-2021
DOI: 10.1186/S12891-021-04460-W
Abstract: The aim of this study was to evaluate the completeness of reporting of exercise adherence and exercise interventions delivered as part of clinical trials of post-operative total knee replacement (TKA) rehabilitation. Design: Scoping review A literature search was conducted in PubMed, EMBASE, AMED, CINAHL, SPORTDiscus and Cochrane Library. All randomized controlled trials (RCT) that examined post-operative exercise-based interventions for total knee arthroplasty were eligible for inclusion. Studies that were multifactorial or contained exercise interventions for both hip and knee arthroplasty were also included. The definition, type of measurement used and outcome for exercise adherence were collected and analyzed descreptively. Quality of reporting of exercise interventions were assessed using the Consensus for Exercise Reporting Tool (CERT) and the Cochrane Risk of Bias Tool. There were a total of 112 RCTs included in this review. The majority of RCTs (63%, n = 71) did not report exercise adherence. Only 23% ( n = 15) of studies provided a definition of adherence. RCTs were of poor quality, with 85% ( n = 95) of studies having high or unclear risk of bias. Reporting of exercise interventions was poor, with only 4 items (of 19) (21%) of the CERT adequately reported (88–99%), with other items not fulfilled on at least 60% of the RCTs. There were no RCTs that had fulfilled all the criteria for the CERT. The RCTs included in this study poorly reported exercise adherence, as well as description of the post-operative TKA rehabilitation intervention. Future RCTs should use valid and reliable measures of adherence and a proper tool for reporting of exercise interventions (e.g., CERT, TiDER). OSF: osf.io/9ku8a/
Publisher: Journal of Athletic Training/NATA
Date: 26-05-2022
DOI: 10.4085/1062-6050-0521.20
Abstract: Chronic musculoskeletal pain continues to constitute a rising cost and burden on in iduals and society on a global level, thus driving the demand for improved management strategies. The biopsychosocial model has long been a recommended approach to help manage chronic pain, with its consideration of the person and his or her experiences, psychosocial context, and societal considerations. However, the biomedical model continues to be the basis of athletic therapy and athletic training programs and therefore clinical practice. For more than 30 years, psychosocial factors have been identified in the literature as outcome predictors relating to chronic pain, including (but not limited to) catastrophizing, fear avoidance, and self-efficacy. Physical assessment strategies such as validated outcome measures can be used by the athletic therapist and athletic trainer to determine the presence or severity (or both) of nonbiogenic pain. Knowledge of these predictors and strategies allows the athletic therapist and athletic trainer to frame the use of exercise (eg, graded exposure), manual therapy, and therapeutic modalities in the appropriate way to improve clinical outcomes. Through changes in educational curricula content, such as those recommended by the International Association for the Study of Pain, athletic therapists and athletic trainers can develop profession-specific knowledge and skills that will enhance their clinical practice and enable them to better assist those living with chronic musculoskeletal pain conditions.
Publisher: Canadian Society of Hospital Pharmacists (CSHP)
Date: 25-04-2019
Abstract: ABSTRACTBackground: Postoperative nausea and vomiting (PONV) is one of the most commonly reported adverse experiences after surgery. PONV is a major risk factor for delayed patient mobilization and consequently increased length of hospital stay.Objectives: The primary objective was to compare the effectiveness of scheduled versus as-needed administration of antiemetic for the prevention and treatment of PONV in the first 48 h after elective hip or knee arthroplasty. The secondary objective was to determine whether PONV affected mobilization on either postoperative day 0 or postoper-ative day 1 in each study group.Methods: This retrospective cohort study used chart reviews for collection of patient data. PONV and mobilization were compared for patients who received antiemetics on a scheduled or as-needed basis following elective hip or knee arthroplasty performed between January and September 2016. Results: Of the 132 patients included in the study, 65 received antiemetics on an as-needed basis and 67 had scheduled antiemetic therapy. Thirty-one (46%) of the patients in the “scheduled” group received antiemetics as intended the others missed one or more of the scheduled doses. There was no statistical difference in PONV between treatment groups with either intention-to-treat or as-treated analysis. Furthermore, there was no statistically significant difference in mobilization, on either POD 0 or POD 1, between patients who received scheduled antiemetic and those who received antiemetic on an as-needed basis. Conclusions: Scheduled use of antiemetics did not significantly affect PONV, nor did it positively influence mobilization in the postoperative period for patients undergoing elective arthroplasty. Further high-quality prospective studies are needed to confirm these results.RÉSUMÉContexte : Les nausées et vomissements postopératoires sont parmi les réactions indésirables les plus fréquentes après une intervention chirurgicale. Elles représentent un facteur de risque important de retard de mobilisation et par conséquent de prolongation du séjour à l’hôpital.Objectifs : L’objectif principal visait la comparaison de l’efficacité d’une administration régulière d’antiémétiques à une administration au besoin pour la prévention et le traitement des nausées et vomissements postopératoires au cours des 48 heures suivant une arthroplastie non-urgente de la hanche ou du genou. L’objectif secondaire était de déterminer si les nausées et vomissements postopératoires avaient des répercussions sur la mobilisation des patients durant la journée postopératoire 0 ou 1 dans chaque groupe à l’étude.Méthodes : Les données de la présente étude de cohorte rétrospective proviennent des analyses de dossiers des patients. La comparaison portait sur les nausées et vomissements postopératoires et la mobilisation de patients ayant reçu des antiémétiques prescrits régulièrement ou au besoin après avoir subi une arthroplastie non-urgente de la hanche ou du genou, réalisée entre janvier et septembre 2016. Résultats : Parmi les 132 patients admis à l’étude, 65 ont reçu des antiémétiques au besoin et 67 en ont pris régulièrement. Trente et un (46 %) patients du groupe auquel on avait prescrit une prise régulière ont reçu des antiémétiques comme prévu, les autres ont sauté une ou plusieurs doses prévues. Aucune différence statistique n’a été relevée quant aux nausées et vomissements postopératoires entre les groupes, que ce soit à l’aide d’une analyse selon l’intention de traiter ou selon le traitement reçu. De plus, il n’y avait aucune différence statistiquement significative du point de vue de la mobilisation, pour les jours postopératoires 0 et 1 entre les patients ayant pris régulièrement des antiémétiques et ceux en ayant pris au besoin. Conclusions : L’administration régulière d’antiémétiques n’a pas eu d’effet significatif sur les nausées et vomissements postopératoires tout comme elle n’a pas influencé positivement la mobilisation au cours de la période postopératoire des patients ayant subi une arthroplastie non-urgente. De plus les études prospectives de grande qualité sont nécessaires pour confirmer ces résultats.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2011
DOI: 10.1016/J.PAIN.2010.11.034
Abstract: It is often assumed that patients with pain-related disability due to low back pain (LBP) will have reduced physical activity levels, but recent studies have provided results that challenge this assumption. The aim of our systematic review was to examine the relationship between physical activity and disability in LBP. The literature search included 6 electronic databases and the reference list of relevant systematic reviews and studies to May 2010. To be included, studies had to measure both disability (eg, with the Roland Morris Disability Questionnaire) and physical activity (eg, by accelerometry) in patients with non-specific LBP. Two independent reviewers screened search results and extracted data, and authors were contacted for additional data. Correlation coefficients were pooled using the random-effects model. The search identified 3213 records and 18 studies were eligible for inclusion. The pooled results showed a weak relationship between physical activity and disability in acute or subacute ( 3months) LBP (r=-0.33, 95% confidence interval=-0.51 to -0.15). That is, persons with acute or subacute LBP appear to vary in the levels of physical activity independent of their pain-related disability. Persons with chronic LBP with high levels of disability are also likely to have low levels of physical activity. Persons with acute or subacute back pain appear to vary in the levels of physical activity independent of disability. Persons with chronic back pain with high levels of disability will likely have low levels of physical activity.
Publisher: BMJ
Date: 28-11-2020
DOI: 10.1136/BJSPORTS-2019-101205
Abstract: Low back pain is one of the leading causes of disability worldwide. Exercise therapy is widely recommended to treat persistent non-specific low back pain. While evidence suggests exercise is, on average, moderately effective, there remains uncertainty about which in iduals might benefit the most from exercise. In parallel with a Cochrane review update, we requested in idual participant data (IPD) from high-quality randomised clinical trials of adults with our two primary outcomes of interest, pain and functional limitations, and calculated global recovery. We compiled a master data set including baseline participant characteristics, exercise and comparison characteristics, and outcomes at short-term, moderate-term and long-term follow-up. We conducted descriptive analyses and one-stage IPD meta-analysis using multilevel mixed-effects regression of the overall treatment effect and prespecified potential treatment effect modifiers. We received IPD for 27 trials (3514 participants). For studies included in this analysis, compared with no treatment/usual care, exercise therapy on average reduced pain (mean effect/100 (95% CI) -10.7 (-14.1 to -7.4)), a result compatible with a clinically important 20% smallest worthwhile effect. Exercise therapy reduced functional limitations with a clinically important 23% improvement (mean effect/100 (95% CI) -10.2 (-13.2 to -7.3)) at short-term follow-up. Not having heavy physical demands at work and medication use for low back pain were potential treatment effect modifiers-these were associated with superior exercise outcomes relative to non-exercise comparisons. Lower body mass index was also associated with better outcomes in exercise compared with no treatment/usual care. This study was limited by inconsistent availability and measurement of participant characteristics. This study provides potentially useful information to help treat patients and design future studies of exercise interventions that are better matched to specific subgroups. PROTOCOL PUBLICATION: 0.1186/2046-4053-1-64.
Publisher: Springer Science and Business Media LLC
Date: 19-06-2023
DOI: 10.1186/S12891-023-06630-4
Abstract: Musculoskeletal disorders (MSKDs) present a significant burden to health care systems worldwide. Evidence suggests that university students may have unique risk factors for developing MSKDs however, research on the corresponding prevalence and risk factors of MSKDs in Canadian students is limited. Using a multi-year cross-sectional survey, we aimed to understand the prevalence and risk factors of MSKDs in students at McMaster University. A survey on the prevalence of MSKD as well as potential risk factors was conducted online in the years 2018–2022. Our outcomes were the prevalence of MSKDs over the last 7 days and the last 12 months, as well as presence of lower body, upper body, and spine MSKDs. We investigated risk factors using negative binomial regression analysis, including a sex-stratified analysis. There were a total of 289 respondents in 2018 with a decrease in the number of participants in the subsequent years (n 2019 = 173, n 2020 = 131, n 2021 = 76). Participants reported a median of 2–3 pain sites in the last year and 1–2 pain sites in the last week in all four years. The most prevalent sources of self-reported pain were the lower back and neck. Depending on the year and outcome studied, 59–67% of participants reported neck/lower back pain in the last year, and 43–49% reported it in the last week. Although risk factors were different depending on the year and sex, overall, poorer mental health, being in health care studies, regular sports participation (males only), older age, and less hours of sleep were significantly associated with higher prevalence of MSKDs. This study identified that MSKDs are a prevalent source of pain in university students. While some risk factors, such as mental health, are known to play a role in developing MSKDs, sports activity and academic pressure are risk factors that are unique to students. Our study also suggests that there may be differences in risk factors between sexes.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2013
Publisher: Springer Science and Business Media LLC
Date: 24-06-2021
DOI: 10.1186/S40814-021-00863-7
Abstract: Low back pain (LBP) is a long-term health condition with an unpredictable pattern of symptomatic episodes, remission, and recurrence. Recently published systematic reviews suggest that exercise is the most effective intervention for preventing recurrences of LBP in persons that have recovered. Similar programs may also be effective in preventing flare-ups in persistent LBP. The aim of this study was to test the feasibility of the Back to Living Well program (Physical activity + Education + Self-management) developed to prevent recurrence or flare-ups of LBP. The study evaluated feasibility in terms of recruitment rate, adherence, satisfaction with the exercise and education sessions, and the data collection procedures. We also aimed to evaluate barriers and facilitators to the engagement in the program. Seventeen participants with non-specific LBP recently discharged from care from physiotherapy, chiropractors or physician care ( 3 months) were referred to the study by health care providers or community advertisements between December 2018 and February 2019. Participants underwent a 12-week (1 session/week) in idualized, group-based exercise in the community and 4 sessions (30 min each) of education. All participants completed an action plan weekly for 12 weeks and wore an activity monitor for 6 months. All participants responded to weekly pain measures and completed study questionnaires at baseline, 3- and 6-months. Feasibility outcomes included recruitment, attrition rates and satisfaction. At the end of the intervention, participants completed an end-of-program survey. Twenty-nine participants were screened for eligibility 20 were deemed eligible, while 17 were included over a 2-month period meeting our feasibility targets. In total, 16 completed follow-up study questionnaires at 3 months, and 15 completed the 6-month follow-up. Fourteen participants responded to weekly messages, while 3 participants reported not having a mobile device or Internet access. In total, 15 participants responded to our end-of-program survey. Average age was 54.9 (11.7) 9 were female (53%), and the mean duration of LBP was 62.9 (69.7) months. All satisfaction responses in relation to the exercise program, education program and data collection procedures reached our threshold of 70% out of 100%. Reported barriers to engagement in the program included fear of injury, lack of motivation and travel. Facilitators included proximity to home, low cost, flexible schedule and friendly location. The results show the program is feasible in terms of recruitment, low attrition, and patient satisfaction. Participants highlighted the excellent, relevant education program and the positive, personalized exercise. Future studies should evaluate the effectiveness of this intervention within a fully powered randomized controlled trial. NCT03328689
Publisher: Oxford University Press (OUP)
Date: 11-2014
DOI: 10.2522/PTJ.20140014
Abstract: Current treatments for low back pain have small effects. A research priority is to identify patient characteristics associated with larger effects for specific interventions. The aim of this study was to identify simple clinical characteristics of patients with chronic low back pain who would benefit more from either motor control exercises or graded activity. This study was a secondary analysis of the results of a randomized controlled trial. One hundred seventy-two patients with chronic low back pain were enrolled in the trial, which was conducted in Australian physical therapy clinics. The treatment consisted of 12 initial exercise sessions over an 8-week period and booster sessions at 4 and 10 months following randomization. The putative effect modifiers (psychosocial features, physical activity level, walking tolerance, and self-reported signs of clinical instability) were measured at baseline. Measures of pain and function (both measured on a 0–10 scale) were taken at baseline and at 2, 6, and 12 months by a blinded assessor. Self-reported clinical instability was a statistically significant and clinically important modifier of treatment response for 12-month function (interaction: 2.72 95% confidence interval=1.39 to 4.06). Participants with high scores on the clinical instability questionnaire (≥9) did 0.76 points better with motor control exercises, whereas those who had low scores (& ) did 1.93 points better with graded activity. Most other effect modifiers investigated did not appear to be useful in identifying preferential response to exercise type. The psychometric properties of the instability questionnaire have not been fully tested. A simple 15-item questionnaire of features considered indicative of clinical instability can identify patients who respond best to either motor control exercises or graded activity.
Publisher: Springer Science and Business Media LLC
Date: 17-04-2020
DOI: 10.1186/S12891-020-03237-X
Abstract: Only a small proportion of anterior cruciate ligament (ACL) tears are diagnosed on initial healthcare consultation. Current clinical guidelines do not acknowledge that primary point-of-care practitioners rely more heavily on a clinical history than special clinical tests for diagnosis of an ACL tear. This research will assess the accuracy of combinations of patient-reported variables alone, and in combination with clinician-generated variables to identify an ACL tear as a preliminary step to designing a primary point-of-care clinical decision support tool . Electronic medical records (EMRs) of in iduals aged 15–45 years, with ICD-9 codes corresponding to a knee condition, and confirmed (ACL + ) or denied (ACL − ) first-time ACL tear seen at a University-based Clinic between 2014 and 2016 were eligible for inclusion. Demographics, relevant diagnostic indicators and ACL status based on orthopaedic surgeon assessment and/or MRI reports were manually extracted. Descriptive statistics calculated for all variables by ACL status. Univariate between group comparisons, clinician surveys ( n = 17), availability of data and univariable logistic regression (95%CI) were used to select variables for inclusion into multivariable logistic regression models that assessed the odds (95%CI) of an ACL-tear based on patient-reported variables alone (consistent with primary point-of-care practice), or in combination with clinician-generated variables. Model performance was assessed by accuracy, sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios (95%CI). Of 1512 potentially relevant EMRs, 725 were included. Participant median age was 26 years (range 15–45), 48% were female and 60% had an ACL tear. A combination of patient-reported (age, sport-related injury, immediate swelling, family history of ACL tear) and clinician-generated (Lachman test result) variables were superior for ACL tear diagnosis [accuracy 0.95 (90,98), sensitivity 0.97 (0.88,0.98), specificity 0.95 (0.82,0.99)] compared to the patient-reported variables alone [accuracy 84% (77,89), sensitivity 0.60 (0.44,0.74), specificity 0.95 (0.89,0.98)]. A high proportion of in iduals without an ACL tear can be accurately identified by considering patient-reported age, injury setting, immediate swelling and family history of ACL tear. These findings directly inform the development of a clinical decision support tool to facilitate timely and accurate ACL tear diagnosis in primary care settings.
Publisher: Informa UK Limited
Date: 08-2021
DOI: 10.2147/JPR.S314971
Publisher: Oxford University Press (OUP)
Date: 2009
DOI: 10.2522/PTJ.20080103
Abstract: Previous systematic reviews have concluded that the effectiveness of motor control exercise for persistent low back pain has not been clearly established. The objective of this study was to systematically review randomized controlled trials evaluating the effectiveness of motor control exercises for persistent low back pain. Electronic databases were searched to June 2008. Pain, disability, and quality-of-life outcomes were extracted and converted to a common 0 to 100 scale. Where possible, trials were pooled using Revman 4.2. Fourteen trials were included. Seven trials compared motor control exercise with minimal intervention or evaluated it as a supplement to another treatment. Four trials compared motor control exercise with manual therapy. Five trials compared motor control exercise with another form of exercise. One trial compared motor control exercise with lumbar fusion surgery. The pooling revealed that motor control exercise was better than minimal intervention in reducing pain at short-term follow-up (weighted mean difference=−14.3 points, 95% confidence interval [CI]=−20.4 to −8.1), at intermediate follow-up (weighted mean difference=−13.6 points, 95% CI=−22.4 to −4.1), and at long-term follow-up (weighted mean difference=−14.4 points, 95% CI=−23.1 to −5.7) and in reducing disability at long-term follow-up (weighted mean difference=−10.8 points, 95% CI=−18.7 to −2.8). Motor control exercise was better than manual therapy for pain (weighted mean difference=−5.7 points, 95% CI=−10.7 to −0.8), disability (weighted mean difference=−4.0 points, 95% CI=−7.6 to −0.4), and quality-of-life outcomes (weighted mean difference=−6.0 points, 95% CI=−11.2 to −0.8) at intermediate follow-up and better than other forms of exercise in reducing disability at short-term follow-up (weighted mean difference=−5.1 points, 95% CI=−8.7 to −1.4). Motor control exercise is superior to minimal intervention and confers benefit when added to another therapy for pain at all time points and for disability at long-term follow-up. Motor control exercise is not more effective than manual therapy or other forms of exercise.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-05-2021
Publisher: JMIR Publications Inc.
Date: 06-05-2020
DOI: 10.2196/17088
Abstract: Ineffective coping has been linked to prolonged pain, distress, anxiety, and depression after a hand and upper limb injury. Evidence shows that interventions based on cognitive behavioral therapy (CBT) may be effective in improving treatment outcomes, but traditional psychological interventions are resource intensive and unrealistic in busy hand therapy practices. Developing web-based, evidence-based psychological interventions specifically for hand therapy may be feasible in clinical practice and at home with reduced training and travel costs. Hand Therapy Online Coping Skills (HOCOS) is a program developed to supplement traditional hand therapy with therapist-assisted coping skills training based on principles from CBT and the Technology Acceptance Model. This study aimed to describe the development and assess the usability of HOCOS to support hand therapists in the management of psychosocial problems. The ADDIE model (Analysis, Design, Development, Implementation, and Evaluation) of system design was applied to create HOCOS. The usability testing of HOCOS involved a 2-stage process. In the first step, heuristic testing with information and communications technology (ICT) experts was completed using two sets of heuristics: Monkman heuristics and the Health Literacy Online (HLO) checklist. The second step involved user testing with hand therapists performing a series of online and face-to-face activities, completing 12 tasks on the website using the think-aloud protocol, completing the system usability scale (SUS) questionnaire, and a semistructured feedback interview in 2 iterative cycles. Descriptive statistics and content analyses were used to organize the data. In total, 4 ICT experts and 12 therapists completed usability testing. The heuristic evaluation revealed 15 of 35 violations on the HLO checklist and 5 of 11 violations on the Monkman heuristics. Initially, hand therapists found 5 tasks to be difficult but were able to complete all 12 tasks after the second cycle of testing. The cognitive interview findings were organized into 6 themes: task performance, navigation, design esthetics, content, functionality and features, and desire for future use. Usability issues identified were addressed in two iterative cycles. There was good agreement on all items of the SUS. Overall, therapists found that HOCOS was a detailed and helpful learning resource for therapists and patients. We describe the development and usability testing of HOCOS a new web-based psychosocial intervention for in iduals with a hand and upper limb injuries. HOCOS targets psychosocial problems linked to prolonged pain and disability by increasing access to therapist-guided coping skills training. We actively involved target users in the development and usability evaluation of the website. The final website was modified to meet the needs and preferences of the participants.
Publisher: Informa UK Limited
Date: 21-12-2020
Publisher: Springer Science and Business Media LLC
Date: 13-06-2013
Publisher: Oxford University Press (OUP)
Date: 06-2010
DOI: 10.2522/PTJ.20090303
Abstract: Graded activity and graded exposure are increasingly being used in the management of persistent low back pain however, their effectiveness remains poorly understood. The aim of this study was to systematically review randomized controlled trials that evaluated the effectiveness of graded activity or graded exposure for persistent (& weeks in duration or recurrent) low back pain. Trials were electronically searched and rated for quality by use of the PEDro scale (values of 0–10). Randomized controlled trials of graded activity or graded exposure that included pain, disability, global perceived effect, or work status outcomes were included in the study. Outcomes were converted to a scale from 0 to 100. Trials were pooled with software used for preparing and maintaining Cochrane reviews. Results are presented as weighted mean differences with 95% confidence intervals. Fifteen trials with 1,654 patients were included. The trials had a median quality score of 6 (range=3–9). Pooled effects from 6 trials comparing graded activity with a minimal intervention or no treatment favored graded activity, with 4 contrasts being statistically significant: mean values (95% confidence intervals) for pain in the short term, pain in the intermediate term, disability in the short term, and disability in the intermediate term were −6.2 (−9.4 to −3.0), −5.5 (−9.9 to −1.0), −6.5 (−10.1 to −3.0), and −3.9 (−7.4 to −0.4), respectively. None of the pooled effects from 6 trials comparing graded activity with another form of exercise, from 4 trials comparing graded activity with graded exposure, and from 2 trials comparing graded exposure with a waiting list were statistically significant. Limitations of this review include the low quality of the studies, primarily those that evaluated graded exposure the use of various types of outome measures and differences in the implementation of the interventions, adding to the heterogeneity of the studies. The available evidence suggests that graded activity in the short term and intermediate term is slightly more effective than a minimal intervention but not more effective than other forms of exercise for persistent low back pain. The limited evidence suggests that graded exposure is as effective as minimal treatment or graded activity for persistent low back pain.
Publisher: Canadian Science Publishing
Date: 2023
Abstract: Nutrition risk is linked to hospitalization, frailty, depression, and death. Loneliness during the coronavirus disease 2019 (COVID-19) pandemic may have heightened nutrition risk. We sought to determine prevalence of high nutrition risk and whether loneliness, mental health, and assistance with meal preparation/delivery were associated with risk in community-dwelling older adults (65+ years) after the first wave of COVID-19 in association analyses and when adjusting for meaningful covariates. Data were collected from 12 May 2020 to 19 August 2020. Descriptive statistics, association analyses, and linear regression analyses were conducted. For our total s le of 272 participants (78 ± 7.3 years old, 70% female), the median Seniors in the Community: Risk evaluation for Eating and Nutrition (SCREEN-8) score (nutrition risk) was 35 [1st quartile, 3rd quartile: 29, 40], and 64% were at high risk (SCREEN-8 38). Fifteen percent felt lonely two or more days a week. Loneliness and meal assistance were associated with high nutrition risk in association analyses. In multivariable analyses adjusting for other lifestyle factors, loneliness was negatively associated with SCREEN-8 scores (−2.92, 95% confidence interval [−5.51, −0.34]), as was smoking (−3.63, [−7.07, −0.19]). Higher SCREEN-8 scores were associated with higher education (2.71, [0.76, 4.66]), living with others (3.17, [1.35, 4.99]), higher self-reported health (0.11, [0.05, 0.16]), and resilience (1.28, [0.04, 2.52]). Loneliness, but not mental health and meal assistance, was associated with nutrition risk in older adults after the first wave of COVID-19. Future research should consider longitudinal associations among loneliness, resilience, and nutrition.
Publisher: Oxford University Press (OUP)
Date: 12-2013
DOI: 10.2522/PTJ.20120464
Publisher: Informa UK Limited
Date: 20-07-2023
Publisher: MDPI AG
Date: 12-09-2023
DOI: 10.3390/JCM12185920
Publisher: JMIR Publications Inc.
Date: 18-11-2019
Abstract: neffective coping has been linked to prolonged pain, distress, anxiety, and depression after a hand and upper limb injury. Evidence shows that interventions based on cognitive behavioral therapy (CBT) may be effective in improving treatment outcomes, but traditional psychological interventions are resource intensive and unrealistic in busy hand therapy practices. Developing web-based, evidence-based psychological interventions specifically for hand therapy may be feasible in clinical practice and at home with reduced training and travel costs. Hand Therapy Online Coping Skills (HOCOS) is a program developed to supplement traditional hand therapy with therapist-assisted coping skills training based on principles from CBT and the Technology Acceptance Model. his study aimed to describe the development and assess the usability of HOCOS to support hand therapists in the management of psychosocial problems. he ADDIE model (Analysis, Design, Development, Implementation, and Evaluation) of system design was applied to create HOCOS. The usability testing of HOCOS involved a 2-stage process. In the first step, heuristic testing with information and communications technology (ICT) experts was completed using two sets of heuristics: Monkman heuristics and the Health Literacy Online (HLO) checklist. The second step involved user testing with hand therapists performing a series of online and face-to-face activities, completing 12 tasks on the website using the think-aloud protocol, completing the system usability scale (SUS) questionnaire, and a semistructured feedback interview in 2 iterative cycles. Descriptive statistics and content analyses were used to organize the data. n total, 4 ICT experts and 12 therapists completed usability testing. The heuristic evaluation revealed 15 of 35 violations on the HLO checklist and 5 of 11 violations on the Monkman heuristics. Initially, hand therapists found 5 tasks to be difficult but were able to complete all 12 tasks after the second cycle of testing. The cognitive interview findings were organized into 6 themes: task performance, navigation, design esthetics, content, functionality and features, and desire for future use. Usability issues identified were addressed in two iterative cycles. There was good agreement on all items of the SUS. Overall, therapists found that HOCOS was a detailed and helpful learning resource for therapists and patients. e describe the development and usability testing of HOCOS a new web-based psychosocial intervention for in iduals with a hand and upper limb injuries. HOCOS targets psychosocial problems linked to prolonged pain and disability by increasing access to therapist-guided coping skills training. We actively involved target users in the development and usability evaluation of the website. The final website was modified to meet the needs and preferences of the participants.
Publisher: Informa UK Limited
Date: 30-11-2022
DOI: 10.1080/09638288.2020.1851785
Abstract: To determine the effectiveness of ultrasound honophoresis as an adjuvant to exercise or manual therapy for the improvement of patient-centred outcomes in adults with non-specific neck pain (NSNP). Seven electronic databases were systematically searched up to September 2020. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach was used to judge the Quality of Evidence (QoE). Six studies involving 249 participants were included. The QoE was very low GRADE. Phonophoresis with capsaicin plus exercise improved pain at immediate post-treatment (MD: -3.30 [-4.05, -2.55]) but not with diclofenac sodium plus exercise as compared to exercise. Continuous ultrasound (CUS) plus exercise improved pain and pressure pain threshold (PPT) at immediate post-treatment (pain: MD: -3.42 [-4.08, -2.7]) (PPT: MD: 0.91 [0.68, 1.14]) and at intermediate-term as compared to exercise. CUS or high power pain threshold (HPPT) ultrasound plus manual therapy and exercise showed no benefit for pain reduction (MD: -0.75 [-2.08, 0.58]) did not improve function/disability (MD: -1.05 [-4.27, 2.17]) at immediate or short-term as compared to manual therapy and exercise. Due to high risk of bias, inconsistency, and indirectness the QoE is very low in support of benefit of ultrasound honophoresis as an adjuvant treatment for NSNP.Implication for rehabilitationDue to high risk of bias, inconsistency, and indirectness the quality of evidence (QoE) is very low in support of benefit of adding ultrasound or phonophoresis to exercise or manual therapy for pain reduction or improvement in function/disability for those with sub-acute and chronic myofascial associated neck pain. However, our confidence in the findings is very low and conclusions are likely to change as more evidences emerges.Clinicians using ultrasound therapy as an adjuvant intervention for management of chronic myofascial associated neck pain should carefully consider the available evidence on ultrasound, including the benefits and costs involved.
Publisher: Informa UK Limited
Date: 21-01-2021
DOI: 10.1080/09638288.2020.1857850
Abstract: The objectives of this review were to: (a) explore the extent and nature of available research on non-custodial grandparents of children with physical, intellectual, or neurodevelopmental disabilities and (b) descriptively summarize the research findings from those studies. We followed the five-stage scoping review methodology to identify relevant studies from four databases: Medline, CINAHL, Embase, and PsycINFO. Primary, peer-reviewed studies that explored grandparent-related topics in the context of childhood disability were included. Thirty-one studies were identified and analyzed. All of the studies followed non-experimental and qualitative study designs. In the last decade, there has been a growing interest in research on this population ( Grandparents of children with disabilities are a heterogeneous population that experiences unique challenges in their grandparenting role. Future studies on this topic should be oriented toward high-quality, experimental study designs that take into consideration cultural, religious and demographic factors. Grandparents' involvement in healthcare should be encouraged.IMPLICATIONS FOR REHABILITATIONGrandparents of children with developmental disabilities who are not primary caregivers to their grandchild(ren) are significant family members in many families.They face unique challenges in adapting to their grandchild's disability and interacting with professionals regarding their grandchild's disability and functioning.Although there is considerable heterogeneity within this population, most grandparents share the experiences of gradual emotional adjustment to their grandchild's disability, active family involvement, positive perceptions of their family and grandchild's disability and lack of services for them.There are no identified interventions in the research literature that aimed to support grandparents of children with disabilities.
Publisher: Springer Science and Business Media LLC
Date: 09-12-2022
DOI: 10.1186/S12998-022-00463-Z
Abstract: Little is known about the ersity of the chiropractic profession with respect to gender, sexual orientation, race, ethnicity and community of practice. This knowledge is important as profession representation of key equity seeking groups may impact quality of care and access for vulnerable communities. The aim of this cross-sectional survey was to explore the ersity of the chiropractic profession in Canada. All registered members of the Canadian Chiropractic Association ( N = 7721) were invited to participate in a web-based survey between May and June 2021. Survey questions explored ersity with respect to personal demographics (age, sex, gender, sexual orientation, race, ethnicity, language) and practice characteristics (community setting, practice type). Where possible, survey data was compared to data from the 2016 Census of the Canadian population. We received a total of 3143 survey responses (response rate—41%). The average age of our s le was 44.7 years (standard deviation 12.7). Forty-five percent were female with the same proportion (45.2%) self-identifying as women. Ninety-one percent of the s le self-identified as heterosexual. With respect to race, 80% of respondents were Caucasian. Seventy percent of chiropractors in our s le identified with Canadian ancestry and 29% with European ancestry. In comparison to the Canadian population, some visible minorities were underrepresented. The greatest discrepancy between the Canadian population and our s le was in the proportion of Black and Indigenous chiropractors. With respect to ethnicity, chiropractors identifying themselves with Canadian ancestry were overrepresented in our s le compared to others, specifically those with North American Indigenous and South, Central and Latin American ancestry. Sixty-one percent of chiropractors practiced in major cities and most work in interdisciplinary clinics (42% Complementary and Alternative Medicine and 33% rehabilitation). This study provides an initial description of ersity within the chiropractic profession in Canada. Women represent less than 50% of the profession nationally. Overall, there is little racial and ethnic ersity in the chiropractic profession compared to the Canadian population, with Black and Indigenous peoples being underrepresented. Future work should focus strategies to foster the development of a more erse chiropractic workforce.
Publisher: Springer Science and Business Media LLC
Date: 23-05-2022
DOI: 10.1186/S12891-022-05391-W
Abstract: Low back pain has been associated with obesity or with being overweight. However, there are no high-quality systematic reviews that have been conducted on the effect of all types of weight loss programs focused on in iduals with low back pain. Therefore, the present systematic review aims to evaluate the effectiveness of weight loss programs in reducing back pain and disability or increasing quality of life for in iduals experiencing low back pain. Searches for relevant studies were conducted on CINAHL, Web of Science, Ovid Medline, Ovid Embase and AMED. Studies were included if they were randomized controlled trials, non-randomized studies of intervention or quasi-experimental designs evaluating a weight loss program for persons with low back pain aimed at decreasing back pain and disability. The Effective Public Health Practice Project (EPHPP) Quality Assessment Tool was used to evaluate in idual studies and GRADE was used to summarize the quality of the evidence. The review was prospectively registered PROSPERO#: CRD42020196099. Eleven studies ( n = 689 participants) including one randomized controlled trial, two non-randomized studies of intervention and eight single-arm studies were included (seven of which evaluated bariatric surgery). There was low-quality evidence that a lifestyle intervention was no better than waitlist for improving back pain and very low-quality evidence from single-arm studies that back pain improved from baseline after bariatric surgery. Most studies included were of poor quality, primarily due to selection bias, uncontrolled confounders, and lack of blinding, limiting the quality of evidence. There is very low-quality evidence that weight loss programs may improve back pain, disability, and quality of life in patients with LBP, although adherence and maintenance are potential barriers to implementation.
Publisher: Journal of Orthopaedic & Sports Physical Therapy (JOSPT)
Date: 09-2018
Abstract: Background Investigations on the causes of patellar tendinopathy should consider impairments at the hip and foot/ankle because they are known to influence movement patterns and affect patellar tendon loading. Objectives To investigate hip and foot/ankle impairments associated with patellar tendinopathy in volleyball and basketball athletes using classification and regression tree analysis. Methods In this clinical measurement, cross-sectional study, 192 athletes were assessed for impairments of the hip and foot/ankle, including shank-forefoot alignment, dorsiflexion range of motion (ROM), iliotibial band flexibility, passive hip internal rotation ROM, and hip external rotator and hip abductor isometric strength. Athletes with tenderness and/or pain at the inferior pole of the patella were considered to have patellar tendinopathy. Athletes with scores higher than 95 points on the Victorian Institute of Sport Assessment-patella (VISA-P), no pain during the single-leg decline squat, and no history of patellar tendon pain were considered not to have patellar tendinopathy. Classification and regression tree analyses were performed to identify interacting factors associated with patellar tendinopathy. Results Interactions among passive hip internal rotation ROM, shank-forefoot alignment, and hip external rotator and abductor strength identified athletes with and without patellar tendinopathy. The model achieved 71.2% sensitivity and 74.4% specificity. The area under the receiver operating characteristic curve was 0.77 (95% confidence interval: 0.70, 0.84 P<.001). Conclusion Impairments of the hip and foot/ankle are associated with the presence of patellar tendinopathy in volleyball and basketball athletes. Future studies should evaluate the role of these impairments in the etiology of patellar tendinopathy. J Orthop Sports Phys Ther 2018 (9):676-684. Epub 23 May 2018. doi:10.2519/jospt.2018.7426.
Publisher: BMJ
Date: 2021
DOI: 10.1136/BMJOPEN-2020-042792
Abstract: Exercise therapy is the most recommended treatment for chronic low back pain (LBP). Effect sizes for exercises are usually small to moderate and could be due to the heterogeneity of people presenting with LBP. Thus, if patients could be better matched to exercise based on in idual factors, then the effects of treatment could be greater. A recently published study provided evidence of better outcomes when patients are matched to the appropriate exercise type. The study demonstrated that a 15-item questionnaire, the Lumbar Spine Instability Questionnaire (LSIQ), could identify patients who responded best to one of the two exercise approaches for LBP (motor control and graded activity). The primary aim of the current study isill be to evaluate whether preidentified baseline characteristics, including the LSIQ, can modify the response to two of the most common exercise therapies for non-specific LBP. Secondary aims include an economic evaluations with a cost-effectiveness analysis. Participants (n=414) will be recruited by primary care professionals and randomised (1:1) to receive motor control exercises or graded activity. Participants will undergo 12 sessions of exercise therapy over an 8-week period. The primary outcome will be physical function at 2 months using the Oswestry Disability Index. Secondary outcomes will be pain intensity, function and quality of life measured at 2, 6 and 12 months. Potential effect modifiers will be the LSIQ, self-efficacy, coping strategies, kinesiophobia and measures of nociceptive pain and central sensitisation. We will construct linear mixed models with terms for participants (fixed), treatment group, predictor (potential effect modifier), treatment group×predictor (potential effect modifier), physiotherapists, treatment group×physiotherapists and baseline score for the dependent variable. This study received ethics approval from the Hamilton Integrate Research Ethics Board. Results will be submitted for publication in peer-reviewed journals. NCT04283409 .
Publisher: Oxford University Press (OUP)
Date: 12-2021
DOI: 10.1093/GERONI/IGAB046.2708
Abstract: Public health guidelines to prevent spreading COVID-19 place older adults at risk of loneliness and social isolation. Evidence suggests that participation protects older adults from such detrimental outcomes, therefore we aimed to identify the factors associated with participation in life roles among older adults living in the community during the COVID-19 pandemic. We conducted a telesurvey on a random s le of community-dwelling older adults living in Hamilton, Ontario, Canada, between May and July 2020. Outcome measures included participation in life roles, physical function, physical activity, mobility, mental health, nutrition, and demographics. We conducted two multivariate regression analyses with the Late Life Disability Instrument’s (LLDI) frequency and limitations scales as the dependent variables. Candidate factors were organized by International Classification of Functioning, Disability, and Health (ICF) framework domains personal factors, body functions and structures, activities, and environmental factors. A total of 272 older adults completed the telesurvey (mean age 78 ±7.3 yrs, 70% female). Age, using walking aids, driving status, household income, education, mental health, nutrition, physical function, and dwelling type explained 47.1% (p& .001) of the variance observed in LLDI frequency scores. Using walking aids, driving status, receiving health assistance, mental health, and physical function explained 33.9% (p& .001) of the variance observed in LLDI limitation scores. These findings highlight factors from multiple ICF domains that are associated with participation limitation and frequency among older adults during the pandemic. Our findings have implications for developing public health initiatives to mitigate the effects of the pandemic on the participation of older adults.
Publisher: Informa UK Limited
Date: 28-10-2022
DOI: 10.1080/09593985.2022.2137384
Abstract: The first objective was to evaluate clinical data from a multi-component fall prevention program. The second objective was to explore the relationship between physical function and fear of falling (FoF). Adults (N = 287, mean age = 76 years) who participated in the Building Balance Program between 2011-2020 were assessed with five physical function measures and two FoF measures. Repeated measures ANOVA controlling for age and sex were performed to assess change from baseline. Linear regressions were conducted to evaluate how physical function explained variations in FoF. There were significant improvements between pre and post-program Berg Balance Scale (BBS) scores (p < .001), Timed-Up and Go (TUG) times (p < .001), 30 second Chair-Stand (30 CST repetitions) (p < .001), Functional Reach (FR) distance (p < .001), gait speed (p < .001), single item-FoF score (p < .001), and short Falls Efficacy Scale-International (FES-I score) (p < .001). After controlling for sex on all regression analyses, age, and pre-program gait speed explained variations in pre-program short FES-I scores (Adjusted R A multi-component fall prevention program improved physical function and decreased FoF. A small association between physical function and FoF similar between pre- and post-program conditions was identified.
Publisher: Frontiers Media SA
Date: 16-05-2022
DOI: 10.3389/FRESC.2022.881606
Abstract: The COVID-19 pandemic has disrupted everyday rehabilitation research. Many academic institutions have halted in-person human research including rehabilitation sciences. Researchers are faced with several barriers to continuing their research programs. The purpose of this perspective article is to report the results of an interdisciplinary workshop aimed at understanding the challenges and corresponding strategies for conducting rehabilitation research during the COVID-19 pandemic. Twenty-five rehabilitation researchers (17 trainees and eight faculty) attended a 2-h facilitated online workshop in to discuss challenges and strategies they had experienced and employed to conduct rehabilitation research during the COVID-19 pandemic. Rehabilitation researchers reported challenges with (1) pandemic protocol adjustments , (2) participant accessibility , and (3) knowledge dissemination , along with corresponding strategies to these challenges. Researchers experienced disruptions in study outcomes and intervention protocols to adhere to public health guidelines and have suggested implementing novel virtual approaches and study toolkits to facilitate offsite assessment. Participant accessibility could be improved by engaging community stakeholders in protocol revisions to ensure equity, safety, and feasibility. Researchers also experienced barriers to virtual conferences and publication, suggested opportunities for smaller networking events, and revisiting timeframes for knowledge dissemination. This perspective article served as a catalyst for discussion among rehabilitation researchers to identify novel and creative approaches that address the complexities of conducting rehabilitation research during the COVID-19 pandemic and beyond.
Publisher: FapUNIFESP (SciELO)
Date: 2022
Publisher: BMJ
Date: 12-2020
DOI: 10.1136/BMJSEM-2020-000972
Abstract: The purpose of this scoping review is to determine if and how sex and gender have been incorporated into low back pain (LBP) clinical practice guidelines (CPG), and if sex and gender terms have been used properly. CPGs were searched on MEDLINE, Embase, NICE, TRIP and PEDro from 2010 to 2020. The inclusion criteria were English language, CGPs within physiotherapy scope of practice and for adult population with LBP of any type or duration. Three pairs of independent reviewers screened titles, abstracts and full texts. Guidelines were searched for sex/gender-related terms and recommendations were extracted. The AGREE II (Appraisal of Guidelines for Research and Evaluation II) was used to evaluate the quality of the CPGs. Thirty-six CPGs were included, of which 15 were test-positive for sex or gender terms. Only 33% (n=5) of CPGs incorporated sex or gender into diagnostic or management recommendations. Sixty percent of guidelines (n=9) only referenced sex or gender in relation to epidemiology, risk factors or prognostic data, and made no specific recommendations. Overall, there was no observable relationship between guideline quality and likeliness of integrating sex or gender terms. The majority of guidelines used sex and gender terms interchangeably, and no guidelines defined sex or gender. CPGs did not consistently consider sex and gender differences in assessment, diagnosis or treatment of LBP. When it was considered, sex and gender terms were used interchangeably, and considerations were primarily regarding pregnancy. Researchers should consider the importance of including sex-based and/or gender-based recommendations into future LBP CPGs.
Publisher: Elsevier BV
Date: 08-2015
DOI: 10.1016/J.VACCINE.2015.07.014
Abstract: Pigs play a significant role during outbreaks of foot-and-mouth disease (FMD) due to their ability to lify the virus. It is therefore essential to determine what role vaccination could play to prevent clinical disease and lower virus excretion into the environment. In this study we investigated the efficacy of the double oil emulsion A Malaysia 97 vaccine (>6PD50/dose) against heterologous challenge with an isolate belonging to the A SEA-97 lineage at 4 and 7 days post vaccination (dpv). In addition, we determined whether physical separation of pigs in the same room could prevent virus transmission. Statistically there was no difference in the level of protection offered by 4 and 7 dpv. However, no clinical disease or viral RNA was detected in the blood of pigs challenged 4 dpv, although three of the pigs had antibodies to the non-structural proteins (NSPs), indicating viral replication. Viral RNA was also detected in nasal and saliva swabs, but on very few occasions. Two of the pigs vaccinated seven days prior to challenge had vesicles distal from the injection site, but on the inoculated foot, and two pigs had viral RNA detected in the blood. One pig sero-converted to the NSPs. In contrast, all unvaccinated and inoculated pigs had evidence of infection. No infection occurred in any of the susceptible pigs in the same room, but separated from the infected pigs, indicating that strict biosecurity measures were sufficient under these experimental conditions to prevent virus transmission. However, viral RNA was detected in the nasal swabs of one group of pigs, but apparently not at sufficient levels to cause clinical disease. Vaccination led to a significant decrease in viral RNA in vaccinated pigs compared to unvaccinated and infected pigs, even with this heterologous challenge, and could therefore be considered as a control option during outbreaks.
Publisher: BMJ
Date: 03-2021
DOI: 10.1136/BMJOPEN-2020-045504
Abstract: While multiple pharmacological and non-pharmacological interventions treating chronic non-specific low back pain (CLBP) are available, they have been shown to produce at best modest effects. Interventions such as repetitive transcranial magnetic stimulation (rTMS), a form of non-invasive brain stimulation, have exhibited promising results to alleviate chronic pain. However, evidence on the effectiveness of rTMS for CLBP is scarce due to limited rigorous clinical trials. Combining rTMS with motor control exercises (MCE) may help to address both central and nociceptive factors contributing to the persistence of LBP. The primary aim of this randomised controlled trial is to compare the effectiveness of a combination of rTMS and MCE to repeated rTMS sessions alone, sham rTMS and a combination of sham rTMS and MCE on pain intensity. One hundred and forty participants (35/group) with CLBP will be randomised into four groups (active rTMS+MCE, sham rTMS+MCE, active rTMS and sham rTMS) to receive 10 sessions of their allocated intervention. The primary outcome will be the pain intensity, assessed at baseline, 4, 8, 12 and 24 weeks. Secondary outcomes will include disability, fear of movement, quality of life and patient global rating of change. Ethics approval was obtained from the Comité d’éthique de la recherche sectoriel en réadaptation et intégration sociale, CIUSS de la Capitale Nationale in June 2019 (#2020–1844 – CER CIUSSS-CN). The results of the study will be submitted to a peer-reviewed journal and scientific meetings. NCT04555278 .
Publisher: Elsevier BV
Date: 09-2023
Publisher: Elsevier BV
Date: 2023
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2013
Publisher: Elsevier BV
Date: 09-2016
Location: South Africa
Location: Canada
Start Date: 2011
End Date: 2015
Funder: Canadian Institutes of Health Research
View Funded ActivityStart Date: 2011
End Date: 2015
Funder: Alberta Innovates
View Funded ActivityStart Date: 2013
End Date: 2014
Funder: Canadian Institutes of Health Research
View Funded Activity