Showing papers in "Physiotherapy Canada in 2012"
TL;DR: The study results provide evidence for the test-retest reliability, cross-sectional convergent construct validity, and sensitivity to change of the TSK-11 in a population with heterogeneous chronic pain.
Abstract: Purpose: To determine the psychometric properties of the 11-item Tampa Scale for Kinesiophobia (TSK-11) in patients with heterogeneous chronic pain. Methods: The study evaluated test–retest reliability (intra-class correlation coefficient), cross-sectional convergent construct validity (Pearson product–moment correlation between TSK-11 and the Pain Catastrophizing Scale [PCS] scores at admission), and sensitivity to change of the TSK-11 (area under the receiver operating characteristic [ROC] curve) in patients (n=74) with heterogeneous chronic pain. We used two data sets (retrospective, n=56; prospective, n=18). All patients attended the 4-week interdisciplinary chronic pain management programme at Chedoke Hospital, Hamilton Health Sciences, Hamilton, Ontario. Results: The test–retest reliability of the TSK-11 was 0.81 (95% CI, 0.58–0.93), the standard error of measurement was 2.41 (90% CI, 1.47–2.49), and the minimal detectible change score was 5.6. The correlation between TSK-11 and PCS at admi...
103 citations
TL;DR: Changes in muscle architecture contributing to weakness, such as muscle-fibre length, pennation angle, muscle atrophy, and tendon compliance, should be prevented or reversed by means of an appropriate rehabilitation programme.
Abstract: Purpose: To provide a comprehensive review of changes that occur in the muscle after stroke and how these changes influence the force-generating capacity of the muscle. Methods: A literature search of PubMed, CINAHL, MEDLINE, and Embase was conducted using the search terms stroke, hemiparesis, muscle structure, cross sectional area, atrophy, force, velocity, and torque. There were 27 articles included in this review. Results: Three changes occur in the muscle after stroke: a decrease in muscle mass, a decrease in fibre length, and a smaller pennation angle. In addition, the tendon is stretched and becomes more compliant. All of these factors reduce the affected muscle's ability to generate forces similar to controls or to non-paretic muscles. The result is a leftward shift in the length–tension curve, a downward shift in the torque–angle curve, and a downward shift in the force–velocity curve. Conclusion: Changes in muscle architecture contributing to weakness, such as muscle-fibre length, pennation angle, muscle atrophy, and tendon compliance, should be prevented or reversed by means of an appropriate rehabilitation programme.
81 citations
TL;DR: People with mild or moderate dementia may show improved function and ambulation and decreased fall risk after rehabilitation post hip fracture, similar to gains achieved by those without dementia.
Abstract: Purpose: Best rehabilitation practices after hip fracture for people with dementia have not been established. A systematic review was conducted to determine current evidence for rehabilitation in this population, including residents in continuing care. Methods: Standardized review methodology was used to search eight databases for literature on hip-fracture rehabilitation for people with dementia. Eligible studies included participants with dementia who had a hip fracture; performed a rehabilitation intervention; and evaluated one or more of function, ambulation, discharge location, or falls. The Newcastle–Ottawa Scale was used to assess validity. Results: A total of 13 studies were included: five randomized controlled trials (RCTs), seven prospective cohort series, and one retrospective cohort study. Average quality ratings for RCTs and cohort studies were good and fair respectively. Participants with mild to moderate dementia receiving rehabilitation showed similar relative gains in function to those without dementia. Only one study examined the effect of rehabilitation among residents in continuing care. Conclusions: People with mild or moderate dementia may show improved function and ambulation and decreased fall risk after rehabilitation post hip fracture, similar to gains achieved by those without dementia. More research is required to ascertain the effect of rehabilitation in people with moderate to severe dementia, including those residing in continuing-care settings.
74 citations
TL;DR: Compared to control interventions of equal duration and dose, CIMT produced greater improvements in a variety of indicators of UL function in adult survivors of a stroke with residual movement of their upper limb.
Abstract: Purpose: To summarize the existing literature examining constraint-induced movement therapy (CIMT), relative to dose-matched control interventions, for upper-limb (UL) dysfunction in adult survivors of stroke. Methods: CINAHL, Cochrane Library, Embase, NARIC/CIRRIE—Rehabdata, PEDro, PubMed, Scopus, and Web of Science were searched from their inception to February 2011. Trial quality was described using the PEDro scale. The findings were summarized with meta-analysis. Results: For the 22 trials identified, the mean (SD) PEDro score was 6.4 (1.2). Meta-analysis showed CIMT to be superior to dose-matched interventions based on indicators of UL motor capacity (15 trials, n=432; standardized mean difference [SMD]=0.47, 95% CI, 0.27–0.66) and UL ability (14 trials, n=352; SMD=0.80, 95% CI, 0.57–1.02); Functional Independence Measure scores (6 trials, n=182; mean difference [MD]=5.05, 95% CI, 2.23–7.87); and Motor Activity Log scores (Amount of Use: 12 trials, n=318; MD=1.05, 95% CI, 0.85–1.24; Quality ...
55 citations
TL;DR: Findings from this study make initial steps toward understanding how MS self-management evolves over the life course and how self- management programmes can help people with MS begin to manage wellness earlier in their lives.
Abstract: Purpose: This qualitative study sought to explore older people's experience of ageing with multiple sclerosis (MS) and to describe the natural history of self-management from their points of view. Methods: Eighteen people over age 55 and living with MS for at least 20 years were recruited from an MS clinic and rehabilitation outpatient records. Interviews (60–80 min), using open-ended questions, explored participants' lifelong experiences of MS. Following interview transcription, data were coded and analyzed; themes, subthemes, and their relationships were described based on consensus. Results: Participants recounted their diagnosis process, their life experience with MS, and how they eventually accepted their disease, adapted, and moved toward self-management. The findings included vivid descriptions of social relationships, health care interactions, overcoming barriers, and the emotions associated with living with MS. A conceptual model of phases of self-management, from diagnosis to integration of MS into a sense of self, was developed. Conclusions: Study participants valued self-management and described its phases, facilitators, and inhibitors from their points of view. Over years and decades, learning from life experiences, trial and error, and interactions with health care professionals, participants seemed to consolidate MS into their sense of self. Self-determination, social support, strong problem-solving abilities, and collaborative relationships with health professionals aided adaptation and coping. Findings from this study make initial steps toward understanding how MS self-management evolves over the life course and how self-management programmes can help people with MS begin to manage wellness earlier in their lives.
51 citations
TL;DR: A single series of lunges produces a reliable LT score and clinicians should use LTDiff on initial assessment and either LT to assess change from a validity perspective.
Abstract: Purpose: To examine reliability and validity of the Lunge Test (LT) of dorsiflexion range of motion and determine the impact of different approaches to obtain a score on these parameters. Methods: Fifty-three patients with ankle injury/dysfunction provided initial assessment data for cross-sectional convergent and known-groups validity analysis with the Pearson coefficient (r) and paired t-test, respectively; data after 4–8 weeks of treatment for longitudinal validity analysis with coefficient r; and data 3 days later for test–retest reliability using the intra-class correlation coefficient (ICC) and minimal detectable change (MDC). LT scores were determined for the affected leg only (LTAff) and for the difference between the two limbs (LTDiff). Two strategies were used to calculate LT scores: a single series and the mean of three series of lunges. LTs were correlated with the Lower Extremity Functional Scale and Global Foot and Ankle Scale. Results: Reliability coefficients were high (ICC=0.93–0...
49 citations
TL;DR: Findings suggest that structured IPE clinical placements may provide students with valuable collaborative learning opportunities, enhanced respect for other professionals, and insight into the value of IPC in healthcare delivery.
Abstract: Purpose: To examine how a structured inter-professional education (IPE) clinical placement influences health care professional (HCP) students' perceptions of inter-professional collaboration (IPC) relative to that of students in a traditional clinical placement. Methods: This study used a mixed-methods design. The Interdisciplinary Education Perception Scale (IEPS) was administered to HCP students (n=36) in two Toronto hospitals before and after a structured 5-week IPE clinical placement to examine changes in their perceptions of IPC. Students in a traditional clinical placement (n=28) were used as a control group. Focus groups were then conducted with seven students who took part in the structured IPE clinical placement. A coding framework was devised a priori, and the qualitative results were used to explain the quantitative findings. Results: There were no statistically significant differences between groups after the structured IPE clinical placement, but the intervention group showed a greater positive trend in total IEPS scores from baseline to follow-up. Qualitative data suggest that students valued the knowledge and skills gained through the structured IPE clinical placement. Conclusions: Findings suggest that structured IPE clinical placements may provide students with valuable collaborative learning opportunities, enhanced respect for other professionals, and insight into the value of IPC in healthcare delivery. More research is needed to explore other factors that influence specific perceptions among physical therapy students.
43 citations
TL;DR: Triage assessment by physiotherapists can increase the efficiency of an orthopaedic surgeon's caseload by reducing the number of non-surgical referrals and can thus help to ensure more timely access to appropriate health care.
Abstract: Purpose: To describe the characteristics of participants in a physiotherapist spinal triage programme, compare the profiles of patients for whom surgery was and was not recommended by a surgeon, and determine the surgical yield among those referred to surgeons. Methods: Data were collected retrospectively by reviewing charts of people who used the service over a 3-year period (2003–2006). Data from up to1,096 people were used in the analysis; complete data were available for 299 people. Descriptive statistics were used to summarize demographics, clinical features, and management recommendations. Characteristics of those who were and were not recommended for surgery were examined using Pearson's chi-square or Fisher's Exact tests. Results: The majority of 746 participants were classified as “mechanical spine” (92.5%), 2.9% were “other body part,” 2.5% were “medical/other,” and only 2% were classified as “surgical spine.” Recommendations for surgery (by a surgeon) were independent of patients' age,...
42 citations
TL;DR: Interventions using resistance training have a beneficial impact on the domains of physical function and ADL in participants with osteoporosis or osteopenia, and more high-quality studies are needed to lend further validity to this supposition.
Abstract: Purpose: To examine the effect of resistance exercises on self-reported physical function and activities of daily living (ADL) in older adults with osteoporosis or osteopenia. Methods: A search of available literature was conducted using PubMed, CINAHL, SPORTDiscus, PEDro, ProQuest Nursing and Allied Health Source, and Cochrane Controlled Trials Register. Studies were included if they involved (1) randomized controlled trials; (2) participants with osteoporosis or osteopenia; (3) resistance exercise as an intervention; and (4) self-report of physical function or ADL. Articles were independently reviewed for quality by two authors using the Physiotherapy Evidence Database (PEDro) scale. Cohen's d effect size was calculated by dividing standardized mean differences by the standard deviation to determine treatment effect in terms of physical function or ADL. Results: Five full-text articles were selected for inclusion. PEDro scores ranged from 5 to 7 (out of 10). Effect size mean differences as a re...
39 citations
TL;DR: There was strong agreement that physiotherapists have a role to play in the management of clients who are obese through exercise interventions, mobility training, and cardiorespiratory programmes for impairments associated with obesity, but these are important components but do not by themselves constitute an overall management plan.
Abstract: Purpose: To examine physiotherapists' perceptions of their role in the rehabilitation management of individuals with obesity. Methods: A Web-based survey was conducted in 2008. Participants were recruited through the Canadian Physiotherapy Association (CPA) via electronic communication and were eligible if they had entry level to practice qualifications and were residents of Canada. The online questionnaire consisted of 61 statements pertaining to potential PT roles, barriers, and learning needs, developed using the framework of CPA's position statement on obesity. Frequencies were computed for all Likert-scale response items on the questionnaire. Results: A total of 851 physiotherapists, representative of CPA membership, participated in the study. There was strong agreement that physiotherapists have a role to play in the management of clients who are obese through exercise interventions (96%), mobility training (97%), and cardiorespiratory programmes for impairments associated with obesity (95%). Respondents were less clear about their role in the assessment of body fat or patients' weight loss. Lack of client motivation was identified as a barrier to treatment. Conclusion: Physiotherapists were clear that they see their role as largely focused on exercise and education to treat conditions associated with obesity. These are important components but do not by themselves constitute an overall management plan.
34 citations
TL;DR: The top three characteristics that physical therapists perceive as important differ from those reported among other health care professions and must be understood to understand whether the presence of multiple health care professionals in an acute-care setting facilitates leadership opportunities or whether physical therapists feel overshadowed.
Abstract: Purpose: To explore the concept of leadership from the perspective of physical therapists in Canada. Methods: A quantitative, cross-sectional nationwide study was performed using a Web-based survey distributed to all members of the Canadian Physiotherapy Association (CPA) with a registered e-mail address (n=6,156). Frequency distributions and percentages were obtained for all leadership characteristics, and chi-square tests were performed, with significance set at p<0.05. Results: A total of 1,875 members responded, for a 30% response rate. Communication, professionalism, and credibility were rated as extremely important leadership characteristics by the majority of respondents across all three settings (workplace, health care system, and society); practising in the private sector contributed significantly to the perceived importance of business acumen (p<0.001). Overall, 79.6% of respondents self-declared as leaders; male gender, primary work facility in private practice or educational instituti...
TL;DR: A need exists to assess fall risk in older adults with hip and knee OA and a conceptual framework of fall-risk screening and assessment is developed to help direct treatment planning.
Abstract: Purpose: As the numbers of Canadians aged 65 years and over increases over the next 20 years, the prevalence of chronic conditions, including arthritis, will rise as will the number of falls. Although known fall-risk factors are associated with hip and knee osteoarthritis (OA), minimal research has evaluated fall and fracture risk and/or rates in this population. Thus, the purpose was to summarize research on fall and fracture risk in older adults with hip or knee OA and to develop a conceptual framework of fall-risk screening and assessment. Method: The International Classification of Functioning, Disability and Health, clinical practice guidelines for fall-risk screening, and a selected literature review were used. Results: Gaps exist in our knowledge of fall and fracture risk for this population. Muscle performance, balance, and mobility impairments have been identified, but little is known about whether personal and environmental contextual factors impact fall and fracture risk. Physical activity may help to prevent falls, but non-adherence is a problem. Conclusion: A need exists to assess fall risk in older adults with hip and knee OA. Promoting regular physical activity by focusing on disease- and activity-specific personal contextual factors may help direct treatment planning.
TL;DR: In this article, the authors determined interrater agreement for foot type classification based on photo-box-derived arch index values using intra-class correlations; agreement on foot-type classification was determined using quadratic weighted kappa (κw).
Abstract: Purpose: The lack of a reliable classification standard for foot type makes drawing conclusions from existing research and clinical decisions difficult, since different foot types may move and respond to treatment differently. The purpose of this study was to determine interrater agreement for foot-type classification based on photo-box-derived arch index values. Method: For this correlational study with two raters, a sample of 11 healthy volunteers with normal to obese body mass indices was recruited from both a community weight-loss programme and a programme in physical therapy. Arch index was calculated using AutoCAD software from footprint photographs obtained via mirrored photo-box. Classification as high-arched, normal, or low-arched foot type was based on arch index values. Reliability of the arch index was determined with intra-class correlations; agreement on foot-type classification was determined using quadratic weighted kappa (κw). Results: Average arch index was 0.215 for one tester and 0.219 for the second tester, with an overall range of 0.017 to 0.370. Both testers classified 6 feet as low-arched, 9 feet as normal, and 7 feet as high-arched. Interrater reliability for the arch index was ICC=0.90; interrater agreement for foot-type classification was κw=0.923. Conclusions: Classification of foot type based on arch index values derived from plantar footprint photographs obtained via mirrored photo-box showed excellent reliability in people with varying BMI. Foot-type classification may help clinicians and researchers subdivide sample populations to better differentiate mobility, gait, or treatment effects among foot types.
TL;DR: The 18-month high-impact exercise intervention strengthened the femoral neck in premenopausal women by enhancing its structural properties; however, this benefit was not maintained at 3.5 year follow-up and the exercise benefits on physical performance continued to be maintained 3.
Abstract: Purpose: This study evaluated the training effects of an 18-month exercise intervention and subsequent 3.5-year follow-up on femoral neck structure in premenopausal women. Methods: Of 98 women who participated in this randomized controlled study, 84 (39 trainees and 45 controls) completed the 18-month intervention. At both 18 months and 3.5 years, dual-energy X-ray absorptiometry data on 22 trainees and 22 control participants (ages 35–45 y) were available for hip structural analysis. The section modulus (Z), cross-sectional area (CSA), and subperiosteal width at the femoral neck were analyzed. Lower-leg explosive power and estimated maximal oxygen uptake (Vo2max) were assessed by vertical countermovement jump and standardized 2 km walking test, respectively. Progressive supervised high-impact exercises were done three times per week for 18 months. Results: Significant between-group differences in favour of trainees were observed after the 18-month intervention in Z (3.2%, p=0.047) and CSA (2.8%,...
TL;DR: Examination of academically dishonest behaviours based on physical therapy students' current practices and educators' prior behaviours as PT students suggests that some forms of cheating are accepted as the social norm and may be a function of the environment.
Abstract: Purpose: To examine academically dishonest behaviours based on physical therapy (PT) students’ current practices and educators’ prior behaviours as PT students. Method: A Web-based questionnaire was sent to 174 students and 250 educators from the PT programme at the University of Toronto. The questionnaire gathered data on demographics as well as on the prevalence of, seriousness of, and contributing factors to academic dishonesty (AD). Results: In all, 52.4% of educators and 44.3% of students responded to the questionnaire over a 6-week data-collection period. Scenarios rated the most serious were the least frequently performed by educators and students. The impact of generation on attitudes and prevalence of AD was not significant. The factors most commonly reported as contributing to AD were school-related pressure, disagreement with evaluation methods, and the perception that ‘‘everyone else does it.’’ Conclusion: This study parallels the findings of similar research conducted in other health care programmes: AD does occur within the PT curriculum. AD was more prevalent in situations associated with helping peers than in those associated with personal gain. The consistency in behaviours reported across generations suggests that some forms of cheating are accepted as the social norm and may be a function of the environment.
TL;DR: Building a shared passion for learning, as well as a mentor's commitment to the mentee's success, forms the foundation of meaningful mentorship in physiotherapy and enable physiotherapists to adapt to the changing health care system, advance patient care, and develop the profession.
Abstract: Purpose: To describe the meaning of mentorship among Canadian orthopaedic physiotherapists. Methods: As part of a phenomenological qualitative study, 14 registered physiotherapists (13 women, 1 man) each participated in a single 60-minute, semi-structured face-to-face interview. Participants reflected on their experiences in receiving and providing mentorship and described the impact of mentorship on their careers. Interviews were transcribed verbatim and analyzed using a phenomenological approach. Results: Participants described mentorship as any nurturing process in which they used their skills and experience to guide, teach, and encourage a less skilled or less experienced colleague for the purpose of promoting professional and personal development. Participants experienced mentorship as a positive, reflective phenomenon. According to participants, the true essence of mentorship in physiotherapy consists of building passion, keeping fresh, making us stronger, and promoting deeper learning. Conclusions: Building a shared passion for learning, as well as a mentor's commitment to the mentee's success, forms the foundation of meaningful mentorship in physiotherapy. These mentoring relationships enable physiotherapists to adapt to the changing health care system, advance patient care, and develop the profession.
TL;DR: Forearm MCSA was a dominant predictor of radius bone content and estimated strength and in the tibia, both body mass and lower-leg MCSA contributed to predicting bone contentand estimated strength.
Abstract: Purpose: To investigate the predictive ability of muscle cross-sectional area (MCSA) and body mass on bone mineral content, compressive bone strength index (BSIc), and the polar stress-strain index (SSIp) of the forearms and lower legs of middle-aged adults. Methods: A total of 53 healthy adults (37 male, 16 female; mean age 50.4; SD 2.1 y) were scanned with peripheral quantitative computed tomography (pQCT) to measure radius and tibia total and cortical bone mineral content, BSIc, SSIp, and forearm and lower-leg MCSA (BSIc: 4% distal; SSIp and MCSA at 65% and 66% radius and tibia shaft sites, respectively). Multiple regression models adjusted for sex and height were used to assess the relative variance in radius or tibia bone outcomes predicted by body mass and/or forearm or lower-leg MCSA. Results: Forearm MCSA independently predicted total bone-mineral content, BSIc, and SSIp in radius (rpartial=0.59, 0.56, 0.42). Body mass was a negative predictor of radius BSIc (rpartial=−0.32) and did not p...
TL;DR: It is indicated that the LLFDI has appropriate validity for older patients (>60 years) with CHD and can be completed independently by patients rather than administered by clinicians.
Abstract: Purpose: The purpose of this study was to examine the concurrent validity of the Late Life Function and Disability Instrument (LLFDI) in patients with coronary heart disease (CHD) and to evaluate the accuracy of information obtained through self-report questionnaire versus interview formats. Methods: The study included 29 patients older than 60 years attending an outpatient cardiac rehabilitation program. Participants completed the LLFDI, three additional self-report criterion measures, and six performance-based tests; they completed the LLFDI a second time via interview. We used descriptive statistics, correlations, and t-tests to analyze the data. Results: All LLFDI components were correlated (rs=0.36–0.83) with the self-report criterion measures. The Function Component of the LLFDI was moderately correlated with the 6-Minute Walk Test (r=0.62), timed up-and-go (r=−0.58), walking speed (r=−0.57), and timed sit-to-stand (r=−0.56) scores. The LLFDI demonstrated a ceiling effect (10%) only in the Disability Limitation component. All LLFDI component scores obtained via self-report questionnaire were correlated with scores obtained via interview; except in a single subcategory, there was no difference between LLFDI scores obtained through self-report questionnaire and those obtained through interview. Conclusions: Results indicate that the LLFDI has appropriate validity for older patients (>60 years) with CHD and can be completed independently by patients rather than administered by clinicians.
TL;DR: The SHORTWORC has indicators of validity, relative efficiency, and sensitivity to change comparable to those of the original version but has a smaller response burden.
Abstract: Purpose: The objective of this study was to develop and examine the measurement properties of a shortened version of the Western Ontario Rotator Cuff Index (WORC), the SHORTWORC, in individuals with rotator-cuff pathology. Methods: The study occurred in two stages, both using secondary analysis of existing data sets. The first stage used cross-sectional data from candidates for rotator-cuff surgery to develop the SHORTWORC. The second stage examined various measurement properties of the SHORTWORC by analyzing scores from the WORC, the American Shoulder and Elbow Surgeons questionnaire, and the Constant–Murley score obtained from patients before and after rotator-cuff surgery. Approaches to validating the SHORTWORC included calculating the standard error of measurement (SEM) at an instant in time, performing a confirmatory factor analysis, correlating findings among the questionnaires, and examining differences between men and women. Sensitivity to change was investigated using standardized response mean and relative efficiency. Results: Data for 712 patients were used to develop the SHORTWORC, the final version of which consisted of 7 questions. Data for 166 patients (86 men, 80 women; mean age 57±11 years) were used for validation. The SEM based on internal consistency (SEMIC) was calculated as 7.43 SHORTWORC points. The SHORTWORC had similar convergent validity (r=0.72−0.82) and sensitivity to change (SRM=1.20 vs. 1.25, p>0.05) to the longer version. The relative efficiency of the SHORTWORC was 3.19 times that of the WORC (95% CI, 1.50–71.51) in discriminating men's from women's level of disability. Conclusions: The SHORTWORC has indicators of validity, relative efficiency, and sensitivity to change comparable to those of the original version but has a smaller response burden.
TL;DR: While each imaging modality has strengths and limitations, currently CT-based methods are best suited for determining the effects of mechanical loading on bone properties—particularly in the peripheral skeleton.
Abstract: Purpose: To describe the most common in vivo imaging-based research tools used to assess bone properties that are influenced by mechanical loading associated with exercise, habitual physical activity, or disease states. Bone is a complex metabolically active tissue that adapts to changes in mechanical loading by altering the amount and spatial organization of mineral. Method: Using a narrative review design, the authors provide an overview of bone biology and biomechanics to emphasize the importance of bone size scale, porosity, and degree of mineralization when interpreting measures acquired using quantitative ultrasound (QUS), dual-energy X-ray absorptiometry (DXA), computed tomography (CT), magnetic resonance imaging (MRI), and finite element analysis (FEA). For each imaging modality, basic imaging principles, typical outcome measures associated with changes in mechanical loading, and salient features for physiotherapists are described. Main Results: While each imaging modality has strengths and limitations, currently CT-based methods are best suited for determining the effects of mechanical loading on bone properties—particularly in the peripheral skeleton. Conclusions: Regardless of the imaging technology used, the physiotherapist must carefully consider the assumptions of the imaging-based method, the clinical context, the nature of the change in mechanical loading, and the expected time course for change in bone properties.
TL;DR: The recruitment and retention strategies considered most important and feasible for rehabilitation therapists, regardless of setting, were communication between employer and worker, compensation packages, access to research, and professional development in budget planning.
Abstract: Purpose: The objective of this study was to compare hospital and home care employers' rankings of both the importance and the feasibility of workforce strategies for recruiting and retaining rehabilitation professionals. Methods: An online self-administered questionnaire was distributed to all employers of rehabilitation professionals in Ontario hospitals (n=144) and Community Care Access Centre home care providers (n=34). Importance and feasibility rankings were based on the percentage of high ratings; 95% CIs were used to determine significant differences between hospital and home care rankings of recruitment and retention strategies. Results: The response rate was 50% (72/144) from hospitals and 73.5% (25/34) from home-care settings. The recruitment and retention strategies considered most important and feasible for rehabilitation therapists, regardless of setting, were communication between employer and worker, compensation packages, access to research, and professional development in budget planning. Tangible resources, support personnel, work safety, and marketing rehabilitation careers to high school students were ranked significantly higher by hospitals than by home care providers. Conclusions: Similarities exist between hospital and home care employers in terms of the importance and feasibility of recruitment and retention strategies for rehabilitation professionals. However, when developing a rehabilitation health human resources plan, the strategies identified as different between hospital and home care settings should be taken into account.
TL;DR: The survey results suggest that WHPTs practising in Canada seek post-professional training with an emphasis on pelvic floor assessment and treatment, obstetrics and gynecology, urogenital concerns, complications of cancer, wellness and health promotion, and research.
Abstract: Purpose: The aims of this study were to identify (1) practice patterns of Canadian physiotherapists who consider themselves women's health providers or educators (WHPTs); (2) WHPTs' perception of the relative importance of entry-level and post-professional education curricular content directed at women's health issues; and (3) WHPTs' patterns and preferences with respect to continuing education. Method: A survey link was sent via e-mail to all 429 members of the Women's Health Division of the Canadian Physiotherapy Association and to physiotherapist educators at the 14 Canadian physiotherapy programmes. Results: A total of 114 WHPTs responded (27%), including 16 educators. Of the 114 respondents, 53% spent less than 25% of their practice specifically treating women's health issues. Over half of the 114 respondents felt that entry-level preparation must include aging issues, musculoskeletal dysfunction, osteoporosis, and sports injuries in women. Respondents' stated that post-professional education should also include female anatomy, obstetrics and gynecology, pelvic floor assessment, treatment of urogenital concerns, complications of cancer, wellness and health promotion, and research. Most respondents (63%) showed interest in achieving continuing-education credentials in women's health, preferably using a combined theoretical online and hands-on weekend-based format. Conclusions: The survey results suggest that WHPTs practising in Canada seek post-professional training with an emphasis on pelvic floor assessment and treatment, obstetrics and gynecology, urogenital concerns, complications of cancer, wellness and health promotion, and research. Future research should focus on the barriers to devoting full-time practice hours to WHPTs.
TL;DR: The findings highlight the importance of university programme support to provide a nurturing environment and structure to overcome barriers, promote commitment, and facilitate successful participation in peer mentorship programming for Canadian MPT students.
Abstract: Purpose: To describe Canadian Master of Physical Therapy (MPT) students' knowledge, attitudes, and practices regarding peer mentorship. Methods: A quantitative cross-sectional survey study was conducted. An online questionnaire was sent to 945 MPT students via e-mail, using a modified Dillman approach. Data were analyzed using descriptive statistics to describe the knowledge, attitudes, and practices of Canadian MPT students. Results: A total of 260 MPT students (27.5%) responded to the questionnaire. Most respondents (68.7%) did not have any experience in a peer mentorship relationship during their MPT programme. A few respondents (5.4%) reported having received formal training on peer mentorship as part of their PT curriculum. Respondents generally held positive attitudes toward peer mentorship: 65.9% agreed that including peer mentorship is important, 89.5% agreed that peer mentorship can assist with learning in clinical internships, and 84.1% agreed that peer mentorship can help the transition from student to professional. Most respondents (52.5%) did not participate in a peer mentorship relationship during a typical month. Conclusions: MPT students' attitudes toward peer mentorship are positive, yet their knowledge of and resources for peer mentorship are limited, and few students have been involved in peer mentorship practices. The findings highlight the importance of university programme support to provide a nurturing environment and structure to overcome barriers, promote commitment, and facilitate successful participation. The evidence from this study provides a rationale to support and guide peer mentorship programming for Canadian MPT students.
TL;DR: Policies aimed at mediating "brain drain" should take age and experience into consideration and should be geared toward creating opportunities for career advancement and continuing education.
Abstract: Purpose: Physiotherapists from developing countries are attracted to developed countries, where health personnel are in high demand. We investigated Nigerian physiotherapists' desire to emigrate, explored the possible relationship between job satisfaction and emigration, and elucidated common reasons why physiotherapists emigrate to other countries. Methods: Nigerian physiotherapists (n=181) were surveyed using a three-part questionnaire. Part 1 elicited socio-demographic information; part 2 assessed satisfaction with work; and part 3 assessed the importance of some possible reasons that physiotherapists choose to emigrate. Results: Close to half of the physiotherapists surveyed have plans to emigrate, but no relationship exists between job satisfaction level and desire to emigrate. An overwhelming majority felt that better or more realistic remuneration was the most important reason for them to leave their country, whereas age and practice experience were inversely related to physiotherapists' desire to emigrate. Conclusion: Policies aimed at mediating “brain drain” should take age and experience into consideration and should be geared toward creating opportunities for career advancement and continuing education.
TL;DR: This research focus expanded to increasing physical activity and ways to reduce sedentary behaviour, or sitting time, and deliberately chose to use a pedometer rather than an accelerometer to track my activity patterns, for the lower cost and ease of pedometer use, and the immediate feedback I received.
Abstract: Sedentary behaviour, or too much sitting, is increasingly recognized as a serious contributor to poor health outcomes.1,2 Research evidence is rapidly emerging on the contributing role of our increasingly sedentary lifestyle on morbidity3 and mortality.1 Growing up in the 1960s and 1970s, I looked forward to an environment filled with automation. There was an idea that we would have little physical labour to do and more time to think and create. While this was an exciting period, I am not sure we really thought this through. So here we are in 2011, and the dreams of automation have been realized—but this efficiency has come at a price. In the often-quoted words of Dr. Steven Blair, “we have engineered energy expenditure out of our lives.”4 This loss of light activity may be a significant contributor to our increasing obesity rates in North America and in other countries around the world.5,6
My background and training is in physiotherapy, specifically physical activity and the promotion of active lifestyles. Over the past few years, however, I have transitioned from practising physiotherapist to academic faculty member. This transition has led to a significant reduction in my own workplace activity. Although my focus remains in the area of increasing physical activity, I began to recognize that the more I studied physical activity, the less active I became. At the same time, I was cognizant that despite best evidence, and our best efforts, it remains a challenge for people to take up and adhere to an active lifestyle. My research focus therefore expanded to increasing physical activity and ways to reduce sedentary behaviour, or sitting time. This expanded focus, in turn, forced me to re-evaluate my own life: I had always aimed to meet physical activity guidelines, but I was beginning to think I was one of those “active couch potatoes” spending hours in front of a computer screen. Importantly, emerging literature highlights the fact that even if we are active enough to meet physical activity guidelines, there may be negative health consequences if we sit the rest of the day.7
In the midst of preparing for a lengthy grant submission (ironically, on the topic of reducing sedentary behaviour), I was also testing out some new accelerometers purchased to objectively describe physical activity and sedentary behaviour patterns. As per my normal protocol, I wore the accelerometer for a week to better understand the data output and determine its full capacity and application. I was quite surprised, on receiving my results, to find that, indeed, on some days that I was not walking more than 3,000–4,000 steps. Thus began an experiment to examine my own patterns of physical activity and sedentary behaviour.
Since January 2010 I have captured my step count with a pedometer and my hours worked on a daily basis in a spreadsheet. My job involves collecting data, so tracking my own activity patterns and work hours was not difficult. Over the course of 20 months I monitored how active or sedentary I was to determine whether there was any association between my physical activity and my work hours. I deliberately chose to use a pedometer rather than an accelerometer to track my activity patterns, for two reasons: the lower cost and ease of pedometer use, and the immediate feedback I received.
Wearing a pedometer every day for 20 months has been less challenging than I initially anticipated. Figure Figure11 charts my average step count versus my average work hours per day. I was not particularly surprised to see that I was active all year long; my own experience collecting data from this region of Canada suggested that there is little seasonal variation in moderate to vigorous physical activity8 for healthy community-dwelling older women, although we did find a difference in sedentary time between summer and winter.9 But there were clear patterns that emerged in the relationship between my work seasons and my physical activity. The noticeable dip in walking seen in Figure 1 corresponds to a period of increased work (and sitting) accumulated around submission of grant applications. In this case study, there was indeed a statistically significant correlation between step count and work hours (r=−0.355, p<0.0001). However, the limitation of using a pedometer rather than an accelerometer for this exploration was that I did not directly capture my sitting time.
Figure 1
Summary highlighting the average number of steps and the average daily work minutes over 20 months. The horizontal line indicates 10,000 steps.
As my understanding of the literature on sedentary behaviour increased, I tried to add light activity throughout my day in order to sit less. For example, I developed a routine of taking the stairs while at work and taking frequent breaks from the computer. Based on available evidence,10 it is important to have frequent postural transitions throughout the day, rather than just sitting or standing all the time. So, despite having a standing desk, I do not stand all the time but, rather, alternate between sitting and standing. I also try to increase my workplace activity in other ways—walking meetings, walking to a printer farther away, taking the stairs rather than an elevator, walking to see a colleague rather than sending an e-mail. In this area, however, more empirical evidence is needed to provide specific guidance on best practice for how long to sit before getting up, not only for cardiometabolic health but also for musculoskeletal health and productivity.
I believe that my behaviour change may also have had an impact on some of my colleagues. Since moving into a new activity-permissive building, I have an office very close to the elevator. Colleagues have commented on whether I might have been placed there strategically to try to dissuade people from using the elevator; sometimes when people see me, they start taking the stairs rather than using the elevator. I have noticed that several colleagues in my group have also started to wear a pedometer, and we give updates on how many steps we are at during the day. My colleagues and I often joke that perhaps now I am an intervention; that is, when people see me they are more physically active. I think I can live with this—unless, of course, it means that people are running away from me.
For the moment, my plan is to keep up this journey of tracking my activity patterns. I have resolved to think of it like writing a diary, only a more interactive journal. As I realize that I am able to incorporate more activity into my day, I am now trying to incorporate more moderate to vigorous physical activity throughout my week. I support the idea that it is a two-step message that we need to deliver—“move more and sit less!”11
TL;DR: Substantial regional variation exists in access to weekend physiotherapy services in acute-care community hospitals in Canada, and research on the efficacy and cost-effectiveness of such services is required.
Abstract: Purpose: To analyze weekend physiotherapy services in acute-care community hospitals across Canada Method: Questionnaires were mailed to acute-care community hospitals (institutions with >100 inpatient beds, excluding psychiatric, mental health, paediatric, rehabilitation, tertiary, and long-term care facilities) across Canada from January to April 2010 The questionnaire collected information on patient referral criteria, staffing, workload, and compensation for weekend physiotherapy services and on the availability of other rehabilitation health professionals Results: Of 146 community hospitals deemed eligible, 104 (71%) responded Weekend physiotherapy was offered at 69% of hospitals across Canada, but this rate varied: ≥75% in all regions except Quebec (30%) Hospitals with a high proportion of acute-care beds were more likely to offer weekend physiotherapy services (logistic regression, p=0021) Services differed among Saturdays, Sundays, and holidays in terms of the numbers of both physiotherapists and physiotherapy assistants working (Kruskal–Wallis, p<002 for each) Physiotherapists were predominantly compensated via time off in lieu Of hospitals not offering weekend physiotherapy, 53% reported that it would benefit patients; most perceived staffing and financial barriers Social-work services were offered on the weekend at 24% of hospitals and occupational therapy at 16% Conclusions: Substantial regional variation exists in access to weekend physiotherapy services in acute-care community hospitals To address the importance of this variation, research on the efficacy and cost-effectiveness of such services is required
TL;DR: AMPTs' preferred CE formats are inconsistent with the CE opportunities in which they participate and should include hands-on training and should account for time and cost to make CE opportunities more readily available to them.
Abstract: Purpose: Our purpose was to determine advanced manual and manipulative physiotherapists' (AMPTs') current use and awareness of continuing education (CE) opportunities; to establish their perceived CE needs by identifying facilitators and barriers to participation; and to explore the association of demographics with CE needs. Methods: A questionnaire was e-mailed to 456 registered members of the Canadian Academy of Manipulative Physiotherapy. Data analyses using frequencies and percentages of total responses and t-tests for group comparisons were performed. Results: One hundred thirty-three (29.2%) participants responded. Most lived in an urban region and worked predominantly in direct patient care. More respondents reported engaging in informal CE than in formal CE. Hands-on or practical workshops were the preferred CE format. Common barriers to CE included professional commitments and cost and time of travel; facilitators included interest in the topic and increasing knowledge and competency. AMPTs with less physical therapy experience found cost to be a greater barrier and were more interested in mentorship programs and CE as a means to obtain credentials. Conclusions: AMPTs' preferred CE formats are inconsistent with the CE opportunities in which they participate. CE initiatives for AMPTs should include hands-on training and should account for time and cost to make CE opportunities more readily available to them.
TL;DR: This Australian sample with PD perceived their HRQOL as poor, although it was less severely compromised than that of international samples, and these findings can inform the clinical decision-making processes of physiotherapists.
Abstract: Purpose: This study describes the health-related quality of life (HRQOL) of Australians living with Parkinson disease (PD) and compares the findings to international reports. Methods: The Parkinson's Disease Questionnaire-39 (PDQ-39) was used to measure HRQOL in 210 individuals with PD living in Australia. In parallel, a tailored literature search identified previous studies on HROQL in people with PD. A quantitative meta-analysis with a random-effects model was used to compare the HRQOL of individuals with PD living in Australia and other countries. Results: The mean PDQ-39 summary index (SI) score for this sample of Australians with PD was 20.9 (SD 12.7). Ratings for the dimension of social support and stigma were significantly lower than ratings for bodily discomfort, mobility, activities of daily living, cognition, and emotional well-being. Comparing the Australian and international PD samples revealed a significant heterogeneity in overall HRQOL (I2=97%). The mean PDQ-39 SI scores for Australians were lower, indicating better HRQOL relative to samples from other countries. Conclusions: This Australian sample with PD perceived their HRQOL as poor, although it was less severely compromised than that of international samples. While further research is required, these findings can inform the clinical decision-making processes of physiotherapists.
TL;DR: This combination of NMES and bilateral exercise may prove to be an effective component of a comprehensive shoulder rehabilitation program for patients with persistent trapezius muscle dysfunction as a result of SAN damage.
Abstract: Purpose: Damage to the spinal accessory nerve (SAN) can result in denervation of the trapezius muscle in patients undergoing surgery for head and neck cancer Trapezius denervation leads to muscle weakness and dysfunction that, for some patients, persists despite the return of conduction along the SAN This prospective case series describes an intervention involving a combination of a novel type of neuromuscular electrical stimulation (NMES) with bilateral exercise Methods: Three survivors of head and neck cancer participated in the 6-week program NMES was applied over the region of the SAN on the affected side while subjects performed bilateral voluntary scapular retraction and elevation exercises against resistance The NMES was delivered using relatively wide pulse widths and high frequencies to enhance the electrically evoked sensory volley and was triggered by the onset of trapezius muscle activity on the non-affected side Shoulder range of motion (ROM) assessments and patient-rated outcomes were administered at baseline and 6 weeks Results: All patients showed improvements in shoulder flexion and abduction ROM and reported reductions in pain and disability Conclusions: This combination of NMES and bilateral exercise may prove to be an effective component of a comprehensive shoulder rehabilitation program for patients with persistent trapezius muscle dysfunction as a result of SAN damage
TL;DR: Assessment of the diagnostic validity of clinical tests for temporomandibular internal derangement relative to magnetic resonance imaging (MRI) revealed a lack of high-quality studies; further research with adequate description of patient populations, blinded assessments, and both sagittal and coronal MRI planes is therefore recommended.
Abstract: Purpose: To assess the diagnostic validity of clinical tests for temporomandibular internal derangement relative to magnetic resonance imaging (MRI). Methods: MEDLINE and Embase were searched from 1994 through 2009. Independent reviewers conducted study selection; risk of bias was assessed using Quality Assessment of studies of Diagnostic Accuracy included in Systematic reviews (QUADAS); ≥9/14) and data abstraction. Overall quality of evidence was profiled using Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Agreement was measured using quadratic weighted kappa (κw). Positive (+) or negative (−) likelihood ratios (LR) with 95% CIs were calculated and pooled using the DerSimonian–Laird method and a random-effects model when homogeneous (I2≥0.40, Q-test p≤0.10). Results: We selected 8 of 36 studies identified. There is very low quality evidence that deflection (+LR: 6.37 [95% CI, 2.13–19.03]) and crepitation (LR:5.88 [95% CI, 1.95–17.76]) as single tests and crepitation...