2024-03-28T14:18:20Z
http://ir.lib.uwo.ca/do/oai/
oai:ir.lib.uwo.ca:ptpub-1000
2009-05-14T23:06:21Z
publication:pt
publication:faculties
publication:epidem
publication:ptpub
publication:epidempub
Change in Patient Concerns Following Total Knee Arthroplasty Described with the International Classification of Functioning, Disability and Health: A Repeated Measures Design
Rastogi, Ravi
Chesworth, Bert M.
Davis, Aileen M.
Background: There is no published evidence of how patient concerns change during the first six weeks following total knee arthroplasty (TKA). An understanding of the recovery process from the patient's perspective will inform clinicians on how to best educate patients about their postoperative concerns. Our objectives were to (1) quantify the level of importance for each of 32 previously identified concerns pre-operatively, and across the first six weeks following primary TKA and, (2) convey this change in importance post-operatively using the components of the International Classification of Functioning, Disability and Health (ICF).
Methods: The objectives were achieved using a repeated measures design. Convenience sampling was used to recruit 54 consecutive patients undergoing primary TKA at a hospital in Ontario, Canada. Pre-operatively and at two, four and six weeks post-operatively subjects rated the level of importance for each of the 32 previously identified patient concerns
Results: The importance rating of patient concerns in all four ICF components changed from before surgery to two weeks after surgery. Patient concerns in the Participation component became increasingly important after the first two weeks following surgery. Post-operatively from week two to week four, changes in importance ratings were also found in the Body Function and Activity components, but not in the Environmental Factors component.
Conclusion: Changes in patient concerns mirror their early recovery from TKA surgery. Consistent with this, Participation restrictions become increasingly important to patients after discharge from acute care suggesting that clinicians should think of managing patient expectations for return to societal roles early in post-operative rehabilitation.
2008-12-11T08:00:00Z
article
https://ir.lib.uwo.ca/ptpub/1
http://www.hqlo.com/content/6/1/112
Physical Therapy Publications
Scholarship@Western
Patient concern
Total knee arthroplasty
Post-operative rehabilitation
International Classification of Functioning
Disability and Health
Physical Therapy
oai:ir.lib.uwo.ca:ptpub-1001
2009-05-14T23:05:05Z
publication:pt
publication:faculties
publication:epidem
publication:ptpub
publication:epidempub
A Cross-sectional Look at Patient Concerns in the First Six Weeks Following Primary Total Knee Arthroplasty
Rastogi, Ravi
Davis, Aileen M.
Chesworth, Bert M.
Background: To date, no researchers have investigated patient concerns in the first six weeks following primary total knee arthroplasty (TKA). An understanding of patient concerns at a time when physical therapists are involved in the treatment of these patients will aid clinicians in providing patient-centered care. Linking of items to the International Classification of Functioning, Disability and Health (ICF) allows for comparison and sharing of data amongst researchers, as the ICF is the accepted framework for evaluating disability in rehabilitation. The objective of this study was to identify patient concerns in the first six weeks following primary TKA and link these concerns to components of the ICF and map them to commonly used outcome measures.
Methods: Individual interviews were conducted to identify patient concerns during their recovery following primary TKA. Concerns identified by patients were analysed for content and linked to the components of the ICF using the operational definitions of the ICF components. These concerns were mapped to the WOMAC, KOOS and Oxford Knee Scale.
Results: Thirty patients (18 female) with an average age (SD) of 68.4 (11.1) years completed the study. Patients identified 32 concerns. Twenty-two percent (n = 7) of the concerns linked to Body Function and Structure, 47% (n = 15) to Activity, 13% (n = 4) to Participation, and 13% (n = 4) to the Environmental Factors component of the ICF. Six percent (n = 2) of the concerns did not link to the ICF. Of the 32 concerns identified by patients 14 mapped to the KOOS, 11 to the WOMAC and 4 to the Oxford Knee Scale.
Conclusion: Patient concerns linked to four different components of the ICF indicating that patients are involved in or are thinking of multiple aspects of life even in this early phase of recovery. The KOOS was found to be the most appropriate for use based on the patients' perspective. However, less than half of the concerns identified by patients were covered by the KOOS, WOMAC or Oxford Knee Scale indicating that other existing measures that evaluate the concepts identified as important to patients should be considered when evaluating outcomes during this acute phase of recovery following primary TKA.
2007-08-01T07:00:00Z
article
https://ir.lib.uwo.ca/ptpub/2
http://www.hqlo.com/content/5/1/48
Physical Therapy Publications
Scholarship@Western
Patient concern
Total knee arthroplasty
International Classification of Functioning
Disability and Health
Physical Therapy
oai:ir.lib.uwo.ca:nursingpub-1018
2009-07-30T23:53:56Z
publication:pt
publication:pmid
publication:faculties
publication:nursing
publication:nursingpub
publication:ptpub
Physical Activity Programs for Persons with Dementia
Forbes, Dorothy
Forbes, Sean
Morgan, Debra G.
Markle-Reid, Maureen
Wood, Jennifer
Culum, Ivan
2008-01-01T08:00:00Z
article
https://ir.lib.uwo.ca/nursingpub/16
http://10.1002/14651858.CD006489.pub2
Nursing Publications
Scholarship@Western
dementia
physical activity
Nursing
oai:ir.lib.uwo.ca:nursingpub-1095
2009-10-22T16:41:24Z
publication:pt
publication:faculties
publication:otpub
publication:healthstudies
publication:nursing
publication:nursingpub
publication:healthstudiespub
publication:ptpub
publication:ot
The Influence of Personality on Falling and Engagement in Daily Activities by Community-Dwelling Older Adults
Kloseck, Marita
Hobson, Sandra
Crilly, Richard
Vandervoort, Anthony
Ward-Griffin, Catherine
The purpose of this study was to investigate the influence of personality, confidence, health, and well-being on engagement in daily activities in 199 seniors (mean age 79 years) who were fallers or feared falling. Personality, particularly extroversion, was a major determinant of engagement in activities outside the house (p < 0.001). Within the house, confidence significantly influenced independence and was associated with formal home care provision (p < 0.001). Confidence was influenced by fear (p < 0.001), subjective health (p < 0.001), and personality (p < 0.01). An older adult's personality significantly influences the impact of falling and fear of falling on their lifestyle.
2007-06-01T07:00:00Z
article
https://ir.lib.uwo.ca/nursingpub/90
http://www.informaworld.com/smpp/content~db=all~content=a903690222
Nursing Publications
Scholarship@Western
Seniors
falling
fear of falling
personality
activity engagement
community
Nursing
Physical Therapy
oai:ir.lib.uwo.ca:ptpub-1002
2009-09-21T00:18:35Z
publication:pt
publication:pmid
publication:faculties
publication:ptpub
All-arthroscopic versus Mini-open Repair of Small or Moderate-sized Rotator Cuff Tears: A Protocol for a Randomized Trial [NCT00128076]
MacDermid, Joy C.
Holtby, Richard
Razmjou, Helen
Bryant, Dianne
Canada, JOINTS
Background: Rotator cuff tears are the most common source of shoulder pain and disability. Only poor quality studies have compared mini-open to arthroscopic repair, leaving surgeons with inadequate evidence to support optimal, minimally-invasive repair.
Methods/Design: This randomized, multi-centre, national trial will determine whether an arthroscopic or mini-open repair provides better quality of life for patients with small or moderate-sized rotator cuff tears. A national consensus meeting of investigators in the Joint Orthopaedic Initiative for National Trials of the Shoulder (JOINTS Canada) identified this question as the top priority for shoulder surgeons across Canada. The primary outcome measure is a valid quality-of-life scale (Western Ontario Rotator Cuff (WORC)) that addresses 5 domains of health affected by rotator cuff disease. Secondary outcomes will assess rotator cuff functionality (ROM, strength, Constant score), secondary dimensions of health (general health status (SF-12) and work limitations), and repair integrity (MRI). Outcomes are measured at baseline, at 6 weeks, 3, 6, 12, and 24 months post-operatively by blinded research assistants and musculoskeletal radiologists. Patients (n = 250) with small or medium-sized cuff tears identified by clinical examination and MRI who meet eligibility criteria will be recruited. This sample size will provide 80% power to statistically detect a clinically important difference of 20% in WORC scores between procedures after controlling for baseline WORC score (alpha = 0.05). A central methods centre will manage randomization, data management, and monitoring under supervision of experienced epidemiologists. Surgeons will participate in either conventional or expertise-based designs according to defined criteria to avoid biases from differential surgeon expertise. Mini-open or all-arthroscopic repair procedures will be performed according to a standardized protocol. Central Adjudication (of cases), Trial Oversight and Safety Committees will monitor trial conduct. We will use an analysis of covariance (ANCOVA), where the baseline WORC score is used as a covariate, to compare the quality of life (WORC score) at 2 years post-operatively. As a secondary analysis, we will conduct the same statistical test but will include age and tear size as covariates with the baseline score. Enrollment will require 2 years and follow-up an additional 2 years. The trial will commence when funding is in place.
Discussion: These results will have immediate impact on the practice behaviors of practicing surgeons and surgical trainees at JOINTS centres across Canada. JOINTS Canada is actively engaged in knowledge exchange and will publish and present findings internationally to facilitate wider application. This trial will establish definitive evidence on this question at an international level.
2006-03-10T08:00:00Z
article
https://ir.lib.uwo.ca/ptpub/3
http://www.biomedcentral.com/1471-2474/7/25
Physical Therapy Publications
Scholarship@Western
Arthroscopy
Clinical Protocols
Disability Evaluation
Health Status
Quality of Life
Research Design
Rotator Cuff
Severity of Illness Index
Single-Blind Method
Treatment Outcome
Musculoskeletal, Neural, and Ocular Physiology
Physical Therapy
oai:ir.lib.uwo.ca:ptpub-1003
2010-03-11T23:18:37Z
publication:pt
publication:surgerypub
publication:pmid
publication:faculties
publication:surgery
publication:ptpub
Effects of Low Power Laser Irradiation on Bone Healing in Animals: A Meta-analysis
Bashardoust Tajali, Siamak
Macdermid, Joy C.
Houghton, Pamela
Grewal, Ruby
PURPOSE: The meta-analysis was performed to identify animal research defining the effects of low power laser irradiation on biomechanical indicators of bone regeneration and the impact of dosage.
METHODS: We searched five electronic databases (MEDLINE, EMBASE, PubMed, CINAHL, and Cochrane Database of Randomised Clinical Trials) for studies in the area of laser and bone healing published from 1966 to October 2008. Included studies had to investigate fracture healing in any animal model, using any type of low power laser irradiation, and use at least one quantitative biomechanical measures of bone strength. There were 880 abstracts related to the laser irradiation and bone issues (healing, surgery and assessment). Five studies met our inclusion criteria and were critically appraised by two raters independently using a structured tool designed for rating the quality of animal research studies. After full text review, two articles were deemed ineligible for meta-analysis because of the type of injury method and biomechanical variables used, leaving three studies for meta-analysis. Maximum bone tolerance force before the point of fracture during the biomechanical test, 4 weeks after bone deficiency was our main biomechanical bone properties for the Meta analysis.
RESULTS: Studies indicate that low power laser irradiation can enhance biomechanical properties of bone during fracture healing in animal models. Maximum bone tolerance was statistically improved following low level laser irradiation (average random effect size 0.726, 95% CI 0.08 - 1.37, p 0.028). While conclusions are limited by the low number of studies, there is concordance across limited evidence that laser improves the strength of bone tissue during the healing process in animal models.
2010-01-04T08:00:00Z
article
https://ir.lib.uwo.ca/ptpub/4
info:doi/10.1186/1749-799X-5-1
http://www.josr-online.com/content/5/1/1
Physical Therapy Publications
Scholarship@Western
Low Power Laser Irradiation
Bone Healing
Animals
Physical Therapy
Surgery
oai:ir.lib.uwo.ca:healthstudiespub-1004
2020-04-21T16:16:32Z
publication:pt
publication:geography
publication:pmid
publication:faculties
publication:medpub
publication:healpub
publication:med
publication:healthstudies
publication:epidem
publication:geographypub
publication:healthstudiespub
publication:institutes
publication:ptpub
publication:epidempub
Hip Fracture Types in Men and Women Change Differently with Age
Tanner, David A.
Kloseck, Marita
Crilly, Richard G.
Chesworth, Bert
Gilliland, Jason
BACKGROUND: Hip fractures are expensive and a frequent cause of morbidity and mortality in the elderly. In most studies hip fractures have been viewed as a unitary fracture but recently the two main types of fracture (intertrochanteric and subcapital) have been viewed as two fractures with a different etiology and requiring a different approach to prevention. The relative proportion of intertrochanteric fractures increases with age in women. In previous studies no particular pattern in men has been noted. In this study, we explored changes in the relative proportion of the two fracture types with age in the two genders. METHODS: Patients of 50 years and older, with a diagnosis of hip fracture, discharged from two local acute care hospitals over a 5 year period (n = 2150) were analyzed as a function of age and gender to explore the relative proportions of intertrochanteric and subcapital fractures, and the change in relative proportion in the two genders with age. RESULTS: Overall, for the genders combined, the proportion of intertrochanteric fractures increases with age (p = .007). In women this increase is significant (p < .001), but in men the opposite pattern is observed, with the proportion of intertrochanteric fractures falling significantly with age (p = .025). CONCLUSIONS: The pattern of hip fractures is different in men and women with aging. It is likely that the pattern difference reflects differences in type and rate of bone loss in the genders, but it is conjectured that the changing rate and pattern of falling with increasing age may also be important. The two main hip fracture types should be considered distinct and different and be studied separately in studies of cause and prevention.
2010-03-09T08:00:00Z
article
application/pdf
https://ir.lib.uwo.ca/healthstudiespub/4
info:doi/10.1186/1471-2318-10-12
https://ir.lib.uwo.ca/context/healthstudiespub/article/1004/viewcontent/2010_Hip_fracture_types_in_men_and_women_change_differently_with_age.pdf
Health Studies Publications
Scholarship@Western
Hip fracture
Aging
Gender
Geriatrics
Public Health
oai:ir.lib.uwo.ca:ptpub-1004
2010-07-22T22:28:44Z
publication:pt
publication:faculties
publication:ptpub
Postural Control in Children Born Preterm
Fallang, Bjørg
Bartlett, Doreen
2008-01-01T08:00:00Z
book_contribution
https://ir.lib.uwo.ca/ptpub/5
Physical Therapy Publications
Scholarship@Western
Postural control
Children
Preterm birth
Pediatrics
Physical Therapy
oai:ir.lib.uwo.ca:ptpub-1005
2010-07-22T22:39:31Z
publication:pt
publication:pmid
publication:faculties
publication:ptpub
Description of Exercise Participation of Adolescents With Cerebral Palsy Across a 4-Year Period
Brunton, Laura K.
Bartlett, Doreen J.
PURPOSE: The purposes of this study were to describe (1) the types of exercise participation of adolescents with cerebral palsy; (2) the weekly duration of stretching, strengthening, and cardiovascular exercise; (3) how the level of activity compares with national health guidelines; and (4) the change in participation over 4 years.
METHODS: Participants included 126 males and 104 females (mean age = 14.7 years, SD = 1.7 years) who reported physical activities in the previous week. Analyses included frequency counts and proportions, stacked bar graphs, and 2-way analyses of variance of exercise participation by Gross Motor Function Classification System (GMFCS) and sex.
RESULTS: A significant main effect of GMFCS level was detected for light and moderate exercise. A significant interaction of GMFCS level and sex was found for stretching; females stretched more. An average of 9.4% and 11.4% of our sample participated in weekly levels of moderate and vigorous exercise, respectively.
CONCLUSIONS: Pediatric physical therapists should promote increased exercise participation rates among youths with cerebral palsy.
2010-07-01T07:00:00Z
article
https://ir.lib.uwo.ca/ptpub/6
info:doi/10.1097/PEP.0b013e3181db8aaa
http://dx.doi.org/10.1097/PEP.0b013e3181db8aaa
Physical Therapy Publications
Scholarship@Western
Exercise
Adolescents
Cerebral palsy
Pediatrics
Physical Therapy
oai:ir.lib.uwo.ca:ptpub-1007
2010-07-22T22:52:18Z
publication:pt
publication:pmid
publication:faculties
publication:ptpub
Distribution of Contractures and Spinal Malalignments in Adolescents with Cerebral Palsy: Observations and Influences of Function, Gender and Age
Wright, Marilyn
Bartlett, Doreen J.
OBJECTIVE: To describe distributions of contracture and spinal malalignment in adolescents with cerebral palsy (CP) and determine associations with age, gender and function.
METHODS: Data were collected using the Spinal Alignment and Range of Motion Measure (SAROMM), the Gross Motor Function Classification System (GMFCS) and the Activity Scale for Kids (ASK).
RESULTS: Two hundred and twenty-five adolescents (122 males; mean age 14 years 8 months; SD 1 year 8 months) participated. SAROMM scores by GMFCS levels and item scores in various body regions are presented. Correlations between indices of function and SAROMM total score were >0.70 (p<0.001). Males in GMFCS levels I/V obtained higher total SAROMM scores than females. Age was significantly associated with SAROMM scores for GMFCS levels IV/V participants.
CONCLUSIONS: These data provide benchmarks for evaluating impairments in adolescents with CP and support the role of function in contracture development and possibly prevention. Gender and age were factors that modified outcomes.
2010-02-01T08:00:00Z
article
https://ir.lib.uwo.ca/ptpub/8
info:doi/10.3109/17518420903267101
http://dx.doi.org/10.3109/17518420903267101
Physical Therapy Publications
Scholarship@Western
Adolescent
Age Factors
Analysis of Variance
Cerebral Palsy
Contracture
Female
Humans
Male
Range of Motion
Articular
Regression Analysis
Sex Factors
Spinal Diseases
Spine
Range of Motion, Articular
Pediatrics
Physical Therapy
oai:ir.lib.uwo.ca:ptpub-1006
2010-07-22T22:45:37Z
publication:pt
publication:pmid
publication:faculties
publication:ptpub
The Prevalence, Distribution, and Effect of Pain Among Adolescents with Cerebral Palsy
Doralp, Samantha
Bartlett, Doreen J.
PURPOSE:: To describe the prevalence, distribution, and intensity of pain and determine the relationship between pain intensity and effect on daily activities in adolescents with cerebral palsy.
METHODS:: A sample of 104 girls and 126 boys, mean ages 14.7 (SD = 1.7) and 14.8 (SD = 1.7) years, were asked "Have you experienced physical pain in the past month?"
RESULTS:: Sixty-four percent of girls and 50% of boys reported pain. Pain was most frequent in the feet and ankles, knees, and lower back of girls and boys at Gross Motor Function Classification System levels I to IV. Foot and ankle and knee pain were also frequent at level V. The Spearman rho value between intensity and effect on daily activities was 0.75 (p < 0.01) and 0.82 (p < 0.01) for girls and boys.
CONCLUSIONS:: The high prevalence of pain and its effect on daily activities suggests a need for greater focus on health promotion.
2010-04-01T07:00:00Z
article
https://ir.lib.uwo.ca/ptpub/7
info:doi/10.1097/PEP.0b013e3181ccbabb
http://dx.doi.org/10.1097/PEP.0b013e3181ccbabb
Physical Therapy Publications
Scholarship@Western
Activities of Daily Living
Adolescent
Back Pain
Cerebral Palsy
Humans
Lower Extremity
Pain
Prevalence
Prospective Studies
Quality of Life
Severity of Illness Index
Sex Factors
Pediatrics
Physical Therapy
oai:ir.lib.uwo.ca:ptpub-1008
2010-07-23T00:05:17Z
publication:pt
publication:pmid
publication:faculties
publication:ptpub
Development and Validation of Item Sets to Improve Efficiency of Administration of the 66-item Gross Motor Function Measure in Children with Cerebral Palsy
Russell, Dianne J.
Avery, Lisa M.
Walter, Stephen D.
Hanna, Steven E.
Bartlett, Doreen J.
Rosenbaum, Peter L.
Palisano, Robert J.
Gorter, Jan Willem
AIM: To develop an algorithmic approach to identify item sets of the 66-item version of the Gross Motor Function Measure (GMFM-66) to be administered to individual children, and to examine the validity of the algorithm for obtaining a GMFM-66 score.
METHOD: An algorithmic approach was used to identify item sets of the GMFM-66 (GMFM-66-IS) using data from 95 males and 79 females with cerebral palsy (CP; mean age 14y 7mo, SD 1y 8mo, range 12y 7mo to 17y 8mo). The GMFM-66-IS scores were then validated using combined data from three Dutch studies involving 134 males and 92 females with CP (mean age 7y, SD 4y 6mo, range 1y 4mo to 13y 8mo), representing all levels of the Gross Motor Function Classification System.
RESULTS: The final algorithm contains three decision items from the GMFM-66 that determine which one of four item sets to administer. The GMFM-66-IS has excellent agreement with the full GMFM-66 both at a single assessment (intraclass correlation coefficient [ICC]=0.994, 95% confidence intervals [CI] 0.993-0.996) and across repeat assessments (ICC=0.92, 95% CI 0.89-0.95).
INTERPRETATION: The GMFM-66-IS is a promising alternative to the full GMFM-66. Users should be consistent in their choice of measure (GMFM-66 or GMFM-66-IS) on repeat testing and clearly identify which method was used.
2010-02-01T08:00:00Z
article
https://ir.lib.uwo.ca/ptpub/9
info:doi/10.1111/j.1469-8749.2009.03481.x
http://dx.doi.org/10.1111/j.1469-8749.2009.03481.x
Physical Therapy Publications
Scholarship@Western
Age Factors
Algorithms
Analysis of Variance
Cerebral Palsy
Child Development
Child
Preschool
Cross-Sectional Studies
Disability Evaluation
Female
Humans
Infant
Longitudinal Studies
Male
Movement Disorders
Quality of Life
Reproducibility of Results
Severity of Illness Index
Child, Preschool
Physical Therapy
oai:ir.lib.uwo.ca:ptpub-1010
2010-07-23T03:28:49Z
publication:pt
publication:pmid
publication:faculties
publication:ptpub
Reference Curves for the Gross Motor Function Measure: Percentiles for Clinical Description and Tracking Over Time Among Children With Cerebral Palsy
Hanna, Steven E.
Bartlett, Doreen J.
Rivard, Lisa M.
Russell, Dianne J.
BACKGROUND AND PURPOSE: Physical therapists frequently use the 66-item Gross Motor Function Measure (GMFM-66) with the Gross Motor Function Classification System (GMFCS) to examine gross motor function in children with cerebral palsy (CP). Until now, reference percentiles for this measure were not available. The aim of this study was to improve the clinical utility of this gross motor measure by developing cross-sectional reference percentiles for the GMFM-66 within levels of the GMFCS.
SUBJECTS AND METHODS: A total of 1,940 motor measurements from 650 children with CP were used to develop percentiles. These observations were taken from a subsample, stratified by age and GMFCS, of those in a longitudinal cohort study reported in 2002. A standard LMS (skewness-median-coefficient of variation) method was used to develop cross-sectional reference percentiles.
RESULTS: Reference curves were created for the GMFM-66 by age and GMFCS level, plotted at the 3rd, 5th, 10th, 25th, 50th, 75th, 90th, 95th, and 97th percentiles. The variability of change in children's percentiles over a 1-year interval also was investigated.
DISCUSSION AND CONCLUSION: The reference percentiles extend the clinical utility of the GMFM-66 and GMFCS by providing for appropriate normative interpretation of GMFM-66 scores within GMFCS levels. When interpreting change in percentiles over time, therapists must carefully consider the large variability in change that is typical among children with CP. The use of percentiles should be supplemented by interpretation of the raw scores to understand change in function as well as relative standing.
2008-05-01T07:00:00Z
article
https://ir.lib.uwo.ca/ptpub/11
info:doi/10.2522/ptj.20070314
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2390723/
Physical Therapy Publications
Scholarship@Western
Adolescent
Cerebral Palsy
Child
Child Development
Child
Preschool
Female
Humans
Infant
Infant
Newborn
Longitudinal Studies
Male
Motor Skills
Reference Values
Severity of Illness Index
Child, Preschool
Infant, Newborn
Pediatrics
Physical Therapy
oai:ir.lib.uwo.ca:ptpub-1009
2010-07-23T02:49:03Z
publication:pt
publication:pmid
publication:faculties
publication:ptpub
Exploring Assessment Tools and the Target of Intervention for Children with Developmental Coordination Disorder
Missiuna, Cheryl
Rivard, Lisa
Bartlett, Doreen
PURPOSE: We reviewed current practice for children with Developmental Coordination Disorder (DCD) using research evidence and the International Classification of Functioning, Disability and Health (ICF). Characteristics of children with DCD can be described at the levels of body function (impairments), whole body movements (activities) and involvement in life situations (participation).
SUMMARY OF KEY POINTS: Descriptive instruments measuring the extent of motor impairments or activity limitations can be used to: (1) identify children who might benefit from intervention; and (2) determine the optimal type of intervention and model of service delivery. Evaluative tools that measure activities or participation, but not primary impairments, should be used to determine change over time. Commonly used measures for describing children with DCD and evaluating outcomes are reviewed and discussed in the context of the ICF framework. Intervention approaches are then outlined for children with DCD that are targeted to the levels of activity, participation, and prevention of secondary impairments.
CONCLUSIONS: Outcomes of children with DCD will be optimized with the use of current research evidence and the appropriate ICF level guiding both assessment and intervention.
2006-01-01T08:00:00Z
article
https://ir.lib.uwo.ca/ptpub/10
info:doi/10.1080/J006v26n01_06
http://dx.doi.org/10.1080/J006v26n01_06
Physical Therapy Publications
Scholarship@Western
Child
Disability Evaluation
Disabled Children
Humans
Motor Skills Disorders
Pediatrics
Physical Therapy
oai:ir.lib.uwo.ca:ptpub-1014
2010-07-24T01:55:00Z
publication:pt
publication:pmid
publication:faculties
publication:ptpub
Development of the Gross Motor Function Classification System for Cerebral Palsy
Rosenbaum, Peter L.
Palisano, Robert J.
Bartlett, Doreen J.
Galuppi, Barbara E.
Russell, Dianne J.
The Gross Motor Function Classification System (GMFCS) for cerebral palsy has been widely used internationally for clinical, research, and administrative purposes. This paper recounts the ideas and work behind the creation of the GMFCS, reports on the lessons learned, and identifies some philosophical challenges inherent in trying to develop an ordered, valid, and consistent system to describe function in children and adolescents with developmental differences. It is hoped that these ideas will be useful to others who choose to expand the field with additional systems in other areas of childhood neurodisability.
2008-04-01T07:00:00Z
article
https://ir.lib.uwo.ca/ptpub/15
info:doi/10.1111/j.1469-8749.2008.02045.x
http://dx.doi.org/10.1111/j.1469-8749.2008.02045.x
Physical Therapy Publications
Scholarship@Western
Activities of Daily Living
Adolescent
Child
Child
Preschool
Humans
Multiple Sclerosis
Neurologic Examination
Quality of Life
Reproducibility of Results
Child, Preschool
Physical Therapy
oai:ir.lib.uwo.ca:ptpub-1013
2010-07-24T01:36:27Z
publication:pt
publication:pmid
publication:faculties
publication:otpub
publication:ptpub
publication:ot
Development of the Daily Activities of Infants Scale: A Measure Supporting Early Motor Development
Bartlett, Doreen J.
Fanning, Jamie Kneale
Miller, Linda
Conti-Becker, Angela
Doralp, Samantha
We describe the development and preliminary psychometric testing of the Daily Activities of Infants Scale (DAIS), a parent-completed measure of opportunities parents provide infants for development of postural control and movement. First we obtained 1300 photographs of typical activities from 17 families with infants aged 4 to 11 months. Through consensus we established nine dimensions of activities, graded across three levels of opportunity for development. Pilot testing supported content validity of the DAIS. Subsequently, 50 parents of infants born preterm aged 4 to 11 months participated in psychometric testing. There were 25 male and 25 female infant participants with a mean gestational age of 29.4 weeks (SD 3.6) and a mean birthweight of 1266 grams (SD 635). We found that completion of the DAIS over 1 day was representative of data collected over 3 sequential days. Older infants obtained significantly higher DAIS scores than younger infants, providing preliminary evidence for discriminant validity. The DAIS scores demonstrated a part-correlation of 0.20 (p<0.01) with scores on the Alberta Infant Motor Scale obtained concurrently, providing some evidence for convergent validity. The intraclass correlation coefficients reflecting interrater reliability and test-retest reliability of the total DAIS score were 0.76 (95% confidence interval [CI] 0.60-0.86) and 0.77 (95% CI 0.60-0.87) respectively. The DAIS has sufficient reliability and validity for use in clinical practice and research.
2008-08-01T07:00:00Z
article
https://ir.lib.uwo.ca/ptpub/14
info:doi/10.1111/j.1469-8749.2008.03007.x
http://dx.doi.org/10.1111/j.1469-8749.2008.03007.x
Physical Therapy Publications
Scholarship@Western
Activities of Daily Living
Developmental Disabilities
Female
Gestational Age
Humans
Infant
Male
Motor Skills Disorders
Prevalence
Psychometrics
Questionnaires
Reproducibility of Results
Severity of Illness Index
Physical Therapy
oai:ir.lib.uwo.ca:ptpub-1015
2010-07-24T02:04:03Z
publication:pt
publication:pmid
publication:faculties
publication:ptpub
Understanding the Professional Socialization of Canadian Physical Therapy Students: A Qualitative Investigation
Bartlett, Doreen J.
Lucy, S. Deborah
Bisbee, Leslie
Conti-Becker, Angela
Purpose: To understand the professional socialization of physical therapy (PT) students.
Method: Forty-two students enrolled in our newly developed master's degree programme wrote three-page reflective journals on a critical learning incident after each of three selected clinical experiences. The journals were coded and analyzed, and major themes were identified and described. A separate cohort of 44 students participated in focus groups after the same three clinical experiences to check the trustworthiness of the results.
Results: Following the first placement, the main themes coded were emotions, self-confidence, professionalism in the real world, communication, and learning by doing. After the intermediate placement, major themes were idealism versus realism, depth of communication with clients, and breadth of communication with family members and colleagues. Aspects of clinical learning were variable, and self-confidence remained an issue. After the final placement, most students were deeply engaged with their clients and self-confidence had developed to the point of self-efficacy. Tensions increased between the concept of ideal practice and the pragmatics of actual practice, and the concept of self as protégé (rather than as object of the supervisor's evaluation) emerged. The themes were subsequently assembled in a booklet with representative quotations.
Conclusion: These results contribute to foundational knowledge required by PT educators, including clinical instructors, by explicitly describing the professional socialization of PT students.
2009-01-01T08:00:00Z
article
https://ir.lib.uwo.ca/ptpub/16
info:doi/10.3138/physio.61.1.15
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2788322/
Physical Therapy Publications
Scholarship@Western
Physical therapy students
Professional socialization
Qualitative investigation
Physical Therapy
oai:ir.lib.uwo.ca:ptpub-1011
2010-07-24T01:24:02Z
publication:pt
publication:pmid
publication:faculties
publication:ptpub
Stability and Decline in Gross Motor Function among Children and Youth with Cerebral Palsy Aged 2 to 21 Years
Hanna, Steven E.
Rosenbaum, Peter L.
Bartlett, Doreen J.
Palisano, Robert J.
Walter, Stephen D.
Avery, Lisa
Russell, Dianne J.
This paper reports the construction of gross motor development curves for children and youth with cerebral palsy (CP) in order to assess whether function is lost during adolescence. We followed children previously enrolled in a prospective longitudinal cohort study for an additional 4 years, as they entered adolescence and young adulthood. The resulting longitudinal dataset comprised 3455 observations of 657 children with CP (369 males, 288 females), assessed up to 10 times, at ages ranging from 16 months to 21 years. Motor function was assessed using the 66-item Gross Motor Function Measure (GMFM-66). Participants were classified using the Gross Motor Function Classification System (GMFCS). We assessed the loss of function in adolescence by contrasting a model of function that assumes no loss with a model that allows for a peak and subsequent decline. We found no evidence of functional decline, on average, for children in GMFCS Levels I and II. However, in Levels III, IV, and V, average GMFM-66 was estimated to peak at ages 7 years 11 months, 6 years 11 months, and 6 years 11 months respectively, before declining by 4.7, 7.8, and 6.4 GMFM-66 points, in Levels III, IV, and V respectively, as these adolescents became young adults. We show that these declines are clinically significant.
2009-04-01T07:00:00Z
article
https://ir.lib.uwo.ca/ptpub/12
info:doi/10.1111/j.1469-8749.2008.03196.x
http://dx.doi.org/10.1111/j.1469-8749.2008.03196.x
Physical Therapy Publications
Scholarship@Western
Adolescent
Adolescent Development
Age Factors
Cerebral Palsy
Child
Child Development
Child
Preschool
Cohort Studies
Female
Humans
Infant
Longitudinal Studies
Male
Models
Biological
Motor Skills
Motor Skills Disorders
Psychomotor Performance
Young Adult
Child, Preschool
Models, Biological
Physical Therapy
oai:ir.lib.uwo.ca:ptpub-1012
2010-07-24T01:31:41Z
publication:pt
publication:pmid
publication:faculties
publication:ptpub
Content Validity of the Expanded and Revised Gross Motor Function Classification System
Palisano, Robert J.
Rosenbaum, Peter
Bartlett, Doreen
Livingston, Michael H.
The aim of this study was to validate the expanded and revised Gross Motor Function Classification System (GMFCS-E&R) for children and youth with cerebral palsy using group consensus methods. Eighteen physical therapists participated in a nominal group technique to evaluate the draft version of a 12- to 18-year age band. Subsequently, 30 health professionals from seven countries participated in a Delphi survey to evaluate the revised 12- to 18-year and 6- to 12-year age bands. Consensus was defined as agreement with a question by at least 80% of participants. After round 3 of the Delphi survey, consensus was achieved for the clarity and accuracy of the descriptions for each level and the distinctions between levels for both the 12- to 18-year and 6- to 12-year age bands. Participants also agreed that the distinction between capability and performance and the concept that environmental and personal factors influence methods of mobility were useful for classification of gross motor function. The results provide evidence of content validity of the GMFCS-E&R. The GMFCS-E&R has utility for communication, clinical decision making, databases, registries, and clinical research.
2008-10-01T07:00:00Z
article
https://ir.lib.uwo.ca/ptpub/13
info:doi/10.1111/j.1469-8749.2008.03089.x
http://dx.doi.org/10.1111/j.1469-8749.2008.03089.x
Physical Therapy Publications
Scholarship@Western
Activities of Daily Living
Adolescent
Cerebral Palsy
Child
Delphi Technique
Disability Evaluation
Disabled Children
Health Status Indicators
Humans
Motor Skills
Motor Skills Disorders
Neurologic Examination
Physical Therapy
oai:ir.lib.uwo.ca:ptpub-1016
2010-07-24T02:16:48Z
publication:pt
publication:faculties
publication:healthstudies
publication:epidem
publication:healthstudiespub
publication:ptpub
publication:epidempub
Cervical Manipulation and Informed Consent: Canadian Manipulative Physiotherapists' Opinions on Communicating Risk
Carlesso, Lisa
Bartlett, Doreen J.
Padfield, Beverley
Chesworth, Bert M.
Purpose: The study objective was to generate an information sheet for Canadian manipulative physical therapists (CMPTs) to use when seeking informed consent for high-velocity, low-amplitude cervical manipulation.
Methods: A cervical manipulation information sheet (CMIS) was created with five sections: Introduction, Benefits, Risks, Procedures and Effectiveness. The content of the information sheet was generated using the Delphi method, followed by a mail-out survey to a random sample of CMPTs (N = 307) to determine the information sheet's acceptability and clinical utility. The proportion of CMPTs who agreed with the content of the information sheet and the proportion of CMPTs who indicated a willingness to use the sheet clinically were calculated.
Results: The survey response rate was 74 per cent. The proportion (95 per cent confidence interval) of respondents who agreed with the content of the CMIS and approved its clinical acceptability was 0.95 (0.94-0.96) and 0.61 (0.58-0.64), respectively. Written comments from the CMPTs reflected concern about wording in the Risks section.
Conclusions: Our results suggest that CMPTs agreed with the content of the CMIS but not how it was written. Physical therapists should consider the CMIS a proposed guideline for clinician use. Ideally, a patient version should also be created.
2008-03-01T08:00:00Z
article
https://ir.lib.uwo.ca/ptpub/17
info:doi/10.3138/ptc.59.2.86
http://dx.doi.org/10.3138/ptc.59.2.86
Physical Therapy Publications
Scholarship@Western
Cervical manipulation
Conveying risk
Informed consent
Canadian manipulative physiotherapy
Information sheet
Physical Therapy
oai:ir.lib.uwo.ca:ptpub-1017
2010-07-31T06:53:17Z
publication:pt
publication:pmid
publication:faculties
publication:ptpub
The Development of Expertise in Pediatric Rehabilitation Therapists: Changes in Approach, Self-knowledge, and Use of Enabling and Customizing Strategies
King, Gillian
Currie, Melissa
Bartlett, Doreen J.
Gilpin, Michelle
Willoughby, Colleen
Tucker, Mary Ann
Strachan, Deborah
Baxter, Donna
PURPOSE: To examine the clinical decision making of novice, intermediate, and expert pediatric rehabilitation therapists from various disciplines.
METHODS: Two qualitative studies were conducted. Thirteen therapists took part in a study using the critical incident interview technique and 11 therapists took part in a study using the 'think aloud' technique. Therapists were classified as novice, intermediate, or expert in developmental level based on a cluster analysis of data collected using a multifaceted battery of assessment tools. Data were analyzed using a grounded theory approach.
RESULTS: Expert and intermediate therapists differed from novices with respect to content, self-, and procedural knowledge.
CONCLUSION: With increasing expertise, therapists use a supportive, educational, holistic, functional, and strengths-based approach; have heightened humility yet increased self-confidence; and understand how to facilitate and support client change and adaptation by using principles of engagement, coherence, and manageability. Expert therapists use enabling and customizing strategies to ensure a successful therapeutic session, optimize the child's functioning in the mid-term, and ensure child and family adaptation and accommodation over the longer-term.
2007-07-01T07:00:00Z
article
https://ir.lib.uwo.ca/ptpub/18
info:doi/10.1080/17518420701302670
http://dx.doi.org/10.1080/17518420701302670
Physical Therapy Publications
Scholarship@Western
Adolescent
Adult
Attitude of Health Personnel
Behavior Therapy
Child
Child
Preschool
Clinical Competence
Cognition
Decision Making
Emotions
Humans
Interviews as Topic
Occupational Therapy
Physical Therapy (Specialty)
Professional-Family Relations
Professional-Patient Relations
Recreation
Rehabilitation
Retrospective Studies
Self Concept
Speech-Language Pathology
Task Performance and Analysis
Thinking
Videotape Recording
Child, Preschool
Physical Therapy (Specialty)
Physical Therapy
oai:ir.lib.uwo.ca:ptpub-1019
2010-07-31T07:12:47Z
publication:pt
publication:faculties
publication:ptpub
The Development of Expertise in Paediatric Rehabilitation Therapists: The Roles of Motivation, Openness to Experience, and Types of Caseload Experience
King, Gillian
Currie, Melissa
Bartlett, Doreen J.
Strachan, Deborah
Tucker, Mary Ann
Willoughby, Colleen
Background/aim: A transdisciplinary approach was taken to study the nature of variables associated with the development of expertise in 71 paediatric rehabilitation therapists (i.e. physical, occupational, speech, behavioural, and recreational therapists).
Methods: Six groups of practising therapists were identified based on expertise status (novice, intermediate, and expert, as determined by a multifaceted assessment battery), and their level of clinical experience (10 years or less, more than 10 years). Scores for these six therapist groups were examined on three variables generally considered to be associated with the development of expertise — motivation, openness to experience (as defined by the critical-thinking dispositions of truth-seeking, open-mindedness, and cognitive maturity), and features of their clinical caseload experience (i.e. breadth of experience as measured by number of different client age groups worked with, the complexity of clients' needs, and experience in delivering services to adolescents, school-age children, preschoolers, and infants).
Results: Low-experience experts ('young stars') had the highest motivation, truth-seeking, and open-mindedness scores of all groups, the highest percentage of clients with complex service needs, and were more likely to work with adolescents.
Conclusions: The major differences between therapists who attain expertise quickly versus those who remain novices after many years of experience appear to be motivation and complexity of work experiences. Implications for supporting the development of expertise in practising therapists are discussed.
2008-06-01T07:00:00Z
article
https://ir.lib.uwo.ca/ptpub/19
info:doi/10.1111/j.1440-1630.2007.00681.x
http://dx.doi.org/10.1111/j.1440-1630.2007.00681.x
Physical Therapy Publications
Scholarship@Western
Childhood
Disability
Expertise
Rehabilitation
Therapist
Physical Therapy
oai:ir.lib.uwo.ca:ptpub-1018
2010-07-31T07:03:22Z
publication:pt
publication:faculties
publication:ptpub
Measuring the Expertise of Paediatric Rehabilitation Therapists
King, Gillian
Bartlett, Doreen J.
Currie, Melissa
Gilpin, Michelle
Baxter, Donna
Willoughby, Colleen
Tucker, Mary Ann
Strachan, Deborah
This article describes the development of a classification system to measure the expertise levels of practicing paediatric rehabilitation therapists. Seventy-five therapists from five disciplines (physical, occupational, speech-language, behaviour, and recreational therapy) were involved, along with 170 peers, and 188 parents of children with disabilities. A cluster analysis of 10 indicators of expertise (derived from a battery of self-completed, peer-completed, and parent-completed measures) indicated three levels of therapist expertise—novice, intermediate, and expert. Expertise level was related to various aspects of experience but not to therapy discipline. The classification system will be useful for the education and professional development of paediatric therapists, and for research on expertise in paediatric rehabilitation.
2008-03-01T08:00:00Z
article
https://ir.lib.uwo.ca/ptpub/20
info:doi/10.1080/10349120701654522
http://dx.doi.org/10.1080/10349120701654522
Physical Therapy Publications
Scholarship@Western
Childhood
Disability
Expertise
Measurement
Rehabilitation
Therapist
Physical Therapy
oai:ir.lib.uwo.ca:ptpub-1021
2010-08-07T21:32:20Z
publication:pt
publication:pmid
publication:faculties
publication:otpub
publication:healthstudies
publication:epidem
publication:healthstudiespub
publication:ptpub
publication:ot
publication:epidempub
Advancing Rehabilitation Research: An Interactionist Perspective to Guide Question and Design
Bartlett, Doreen J.
Macnab, Jennifer
Macarthur, Colin
Mandich, Angie
Magill-Evans, Joyce
Young, Nancy L.
Beal, Deryk
Conti-Becker, Angela
Polatajko, Helene J.
The purpose of this position statement is to propose an interactionist framework to bring together the existing literature and provide a unifying direction for rehabilitation research. The framework comprises three components: the conceptual model, the research question, and the research design. The interactionist conceptual model has been adapted from the World Health Organization International Classification of Functioning, Disability, and Health. The model forms the starting point that guides the specification of the research question, which, in turn, guides the selection of research design. This approach demands that the question takes precedence and that there be an extensive repertoire of research designs, each of which is valued for its 'goodness-of-fit' with the question, rather than an a priori, single hierarchical ordering of designs. Research designs must be appropriate for questions that examine the disability experience, development over the lifespan, multifaceted interventions, low incidence conditions, and development of new interventions. Analytical challenges include dealing with confounding, mediating, and moderating variables. Rehabilitation researchers--and those who fund their work--should consider and value the use of diverse research methods to best answer the questions posed from the interactionist perspective.
2006-10-15T07:00:00Z
article
https://ir.lib.uwo.ca/ptpub/22
info:doi/10.1080/09638280600551567
http://dx.doi.org/10.1080/09638280600551567
Physical Therapy Publications
Scholarship@Western
Biomedical Research
Disability Evaluation
Disabled Persons
Humans
Rehabilitation
Research Design
Epidemiology
Occupational Therapy
Physical Therapy
oai:ir.lib.uwo.ca:ptpub-1023
2010-08-07T21:49:41Z
publication:pt
publication:physpharmpub
publication:faculties
publication:physpharm
publication:ptpub
Influence of Age and Gender of Healthy Adults on Scoring Patterns on the Community Balance and Mobility Scale
Rocque, Rohini
Bartlett, Doreen
Brown, Janet
Garland, S. Jayne
Purpose: The purpose of the study was to describe and compare scoring patterns on the Community Balance and Mobility Scale (CB&M) in healthy men and women between 30 and 59 years of age.
Methods: Following criterion testing on 5 individuals, 90 healthy volunteers who met the inclusion criteria and consented to participate in the study were tested on the CB&M. The subjects were recruited through quota sampling in three age categories: 30 to 39 years, 40 to 49 years, and 50 to 59 years, with 15 men and 15 women in each age category. The groups were not matched for any anthropometric variables.
Results: Women within the age category of 50 to 59 years had significantly lower scores on the CB&M compared with all other age and gender categories.
Conclusions: The results from this study indicate that although the items on the CB&M were appropriate for the 30- to 59-year age categories, some items still posed a challenge to healthy participants because most were unable to score full points on the CB&M. The normative data from the present study could help clinicians put the CB&M scores of middle-aged patients into context. These data may also be useful in making recommendations regarding the safe integration of patients back into the community following mild stroke.
2005-01-01T08:00:00Z
article
https://ir.lib.uwo.ca/ptpub/24
info:doi/10.3138/ptc.57.4.285
http://dx.doi.org/10.3138/ptc.57.4.285
Physical Therapy Publications
Scholarship@Western
Age
Balance
Gender
Mobility
Outcome measure
Physical Therapy
oai:ir.lib.uwo.ca:ptpub-1020
2010-08-07T21:21:41Z
publication:pt
publication:pmid
publication:faculties
publication:scsdpub
publication:scsd
publication:ptpub
Measurement Practices in Pediatric Rehabilitation A Survey of Physical Therapists, Occupational Therapists, and Speech-Language Pathologists in Ontario
Hanna, Steven E.
Russell, Dianne J.
Bartlett, Doreen J.
Kertoy, Marilyn
Rosenbaum, Peter L.
Wynn, Kerry
We investigated measurement practices in pediatric rehabilitation. We conducted a survey of 63 physical, 72 occupational, and 74 speech-language therapists working in one of 16 children's rehabilitation programs in Ontario, Canada. Therapists were surveyed about their measurement practices, and their confidence, beliefs, and attitudes about measurement. Results showed that standardized clinical measures were used frequently, but were often modified. Clinicians rated themselves as least comfortable with statistical concepts related to the uncertainty in test scores, and rated factors related to finding appropriate measures as the most important influences on their measurement practices. Some variance in measurement attitudes and practices was associated with treatment centre of practice, suggesting that there may be organizational or peer influences on measurement behaviour. The results have implications for continuing education, measurement development, and interventions designed to facilitate sound measurement practices.
2007-01-01T08:00:00Z
article
https://ir.lib.uwo.ca/ptpub/21
info:doi/10.1080/J006v27n02_03
http://dx.doi.org/10.1080/J006v27n02_03
Physical Therapy Publications
Scholarship@Western
Adult
Analysis of Variance
Attitude of Health Personnel
Child
Disability Evaluation
Disabled Children
Focus Groups
Humans
Occupational Therapy
Ontario
Physical Therapy (Specialty)
Professional Practice
Questionnaires
Speech-Language Pathology
Physical Therapy (Specialty)
Communication Sciences and Disorders
Physical Therapy
oai:ir.lib.uwo.ca:ptpub-1022
2010-08-07T21:41:08Z
publication:pt
publication:pmid
publication:faculties
publication:ptpub
Item Generation and Pilot Testing of the Comprehensive Professional Behaviours Development Log
Bartlett, Doreen J.
Lucy, S. Deborah
Bisbee, Leslie
The purpose of this project was to generate and refine criteria for professional behaviors previously identified to be important for physical therapy practice and to develop and pilot test a new instrument, which we have called the Comprehensive Professional Behaviours Development Log (CPBDL). Items were generated from our previous work, the work of Warren May and his colleagues, a competency profile for entry-level physical therapists, our regulatory code of ethics, and an evaluation of clinical performance. A group of eight people, including recent graduates, clinical instructors and professional practice leaders, and faculty members, refined the items in two iterations using the Delphi process. The CPBDL contains nine key professional behaviors with a range of nine to 23 specific behavioral criteria for individuals to reflect on and to indicate the consistency of performance from a selection of "not at all," "sometimes," and "always" response options. Pilot testing with a group of 42 students in the final year of our entry-to-practice curriculum indicated that the criteria were clear, the measure was feasible to complete in a reasonable time frame, and there were no ceiling or floor effects. We believe that others, including health care educators and practicing professionals, might be interested in adapting the CPBDL in their own settings to enhance the professional behaviors of either students in preparation for entry to practice or clinicians wishing to demonstrate continuing competency to professional regulatory bodies.
2006-07-01T07:00:00Z
article
https://ir.lib.uwo.ca/ptpub/23
http://www.ingentaconnect.com/content/asahp/jah/2006/00000035/00000002/art00005?token=004712a305573d257025707b23562f2d737b425e6b637c4e75477e4324576b642738ebf
Physical Therapy Publications
Scholarship@Western
Behavior
Data Collection
Delphi Technique
Educational Measurement
Ethics
Professional
Humans
Physical Therapy (Specialty)
Pilot Projects
Professional Competence
Professional Practice
Staff Development
Ethics, Professional
Physical Therapy (Specialty)
Physical Therapy
oai:ir.lib.uwo.ca:ptpub-1024
2010-12-12T23:29:42Z
publication:pt
publication:pmid
publication:faculties
publication:epidem
publication:ptpub
publication:epidempub
Development of the InterRAI Pressure Ulcer Risk Scale (PURS) for Use in Long-term Care and Home Care Settings
Poss, Jeff
Murphy, Katharine M.
Woodbury, M. Gail
Orsted, Heather
Stevenson, Kimberly
Williams, Gail
Macalpine, Shirley
Curtin-Telegdi, Nancy
Hirdes, John P.
BACKGROUND: In long-term care (LTC) homes in the province of Ontario, implementation of the Minimum Data Set (MDS) assessment and The Braden Scale for predicting pressure ulcer risk were occurring simultaneously. The purpose of this study was, using available data sources, to develop a bedside MDS-based scale to identify individuals under care at various levels of risk for developing pressure ulcers in order to facilitate targeting risk factors for prevention.
METHODS: Data for developing the interRAI Pressure Ulcer Risk Scale (interRAI PURS) were available from 2 Ontario sources: three LTC homes with 257 residents assessed during the same time frame with the MDS and Braden Scale for Predicting Pressure Sore Risk, and eighty-nine Ontario LTC homes with 12,896 residents with baseline/reassessment MDS data (median time 91 days), between 2005-2007. All assessments were done by trained clinical staff, and baseline assessments were restricted to those with no recorded pressure ulcer. MDS baseline/reassessment samples used in further testing included 13,062 patients of Ontario Complex Continuing Care Hospitals (CCC) and 73,183 Ontario long-stay home care (HC) clients.
RESULTS: A data-informed Braden Scale cross-walk scale using MDS items was devised from the 3-facility dataset, and tested in the larger longitudinal LTC homes data for its association with a future new pressure ulcer, giving a c-statistic of 0.676. Informed by this, LTC homes data along with evidence from the clinical literature was used to create an alternate-form 7-item additive scale, the interRAI PURS, with good distributional characteristics and c-statistic of 0.708. Testing of the scale in CCC and HC longitudinal data showed strong association with development of a new pressure ulcer.
CONCLUSIONS: interRAI PURS differentiates risk of developing pressure ulcers among facility-based residents and home care recipients. As an output from an MDS assessment, it eliminates duplicated effort required for separate pressure ulcer risk scoring. Moreover, it can be done manually at the bedside during critical early days in an admission when the full MDS has yet to be completed. It can be calculated with established MDS instruments as well as with the newer interRAI suite instruments designed to follow persons across various care settings (interRAI Long-Term Care Facilities, interRAI Home Care, interRAI Palliative Care).
2010-09-20T07:00:00Z
article
https://ir.lib.uwo.ca/ptpub/25
info:doi/10.1186/1471-2318-10-67
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2955034/
Physical Therapy Publications
Scholarship@Western
Pressure Ulcer Risk Scale
PURS
Long-term care
Home care
Geriatrics
Physical Therapy
oai:ir.lib.uwo.ca:ptpub-1025
2011-03-12T02:00:16Z
publication:pt
publication:pmid
publication:faculties
publication:ptpub
Using Knowledge Brokers to Facilitate the Uptake of Pediatric Measurement Tools into Clinical Practice: A Before-after Intervention Study
Russell, Dianne J.
Rivard, Lisa M.
Walter, Stephen D.
Rosenbaum, Peter L.
Roxborough, Lori
Cameron, Dianne
Darrah, Johanna
Bartlett, Doreen J.
Hanna, Steven E.
Avery, Lisa M.
BACKGROUND: The use of measurement tools is an essential part of good evidence-based practice; however, physiotherapists (PTs) are not always confident when selecting, administering, and interpreting these tools. The purpose of this study was to evaluate the impact of a multifaceted knowledge translation intervention, using PTs as knowledge brokers (KBs) to facilitate the use in clinical practice of four evidence-based measurement tools designed to evaluate and understand motor function in children with cerebral palsy (CP). The KB model evaluated in this study was designed to overcome many of the barriers to research transfer identified in the literature.
METHODS: A mixed methods before-after study design was used to evaluate the impact of a six-month KB intervention by 25 KBs on 122 practicing PTs' self-reported knowledge and use of the measurement tools in 28 children's rehabilitation organizations in two regions of Canada. The model was that of PT KBs situated in clinical sites supported by a network of KBs and the research team through a broker to the KBs. Modest financial remuneration to the organizations for the KB time (two hours/week for six months), ongoing resource materials, and personal and intranet support was provided to the KBs. Survey data were collected by questionnaire prior to, immediately following the intervention (six months), and at 12 and 18 months. A mixed effects multinomial logistic regression was used to examine the impact of the intervention over time and by region. The impact of organizational factors was also explored.
RESULTS: PTs' self-reported knowledge of all four measurement tools increased significantly over the six-month intervention, and reported use of three of the four measurement tools also increased. Changes were sustained 12 months later. Organizational culture for research and supervisor expectations were significantly associated with uptake of only one of the four measurement tools.
CONCLUSIONS: KBs positively influenced PTs' self-reported knowledge and self-reported use of the targeted measurement tools. Further research is warranted to investigate whether this is a feasible, cost-effective model that could be used more broadly in a rehabilitation setting to facilitate the uptake of other measurement tools or evidence-based intervention approaches.
2010-11-23T08:00:00Z
article
https://ir.lib.uwo.ca/ptpub/26
info:doi/10.1186/1748-5908-5-92
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3004810/
Physical Therapy Publications
Scholarship@Western
Knowledge broker
Pediatric measurement
Clinical practice
Pediatrics
Physical Therapy
oai:ir.lib.uwo.ca:fammedpub-1009
2011-04-30T00:51:33Z
publication:pt
publication:kin
publication:fammedpub
publication:fammed
publication:rwkex_researcharticles
publication:brescia
publication:pmid
publication:affiliates
publication:faculties
publication:rwkex
publication:kinpub
publication:bresciafoodnutritionalsciences
publication:foodpub
publication:ptpub
Efficacy of a Family Practice-based Lifestyle Intervention Program to Increase Physical Activity and Reduce Clinical and Physiological Markers of Vascular Health in Patients with High Normal Blood Pressure and/or High Normal Blood Glucose (SNAC): Study Protocol for a Randomized Controlled Trial
Petrella, Robert J.
Aizawa, Kuni
Shoemaker, Kevin
Overend, Tom
Piché, Leonard
Marin, Mauricio
Shapiro, Sheree
Atkin, Sophie
BACKGROUND: Previous interventions to increase physical activity and reduce cardiovascular risk factors have been targeted at individuals with established disease; less attention has been given to intervention among individuals with high risk for disease nor has there been determination of the influence of setting in which the intervention is provided. In particular, family practice represents an ideal setting for the provision and long-term maintenance of lifestyle interventions for patients at risk (ie high-normal blood pressure or impaired glucose tolerance).
METHODS/DESIGN: The Staged Nutrition and Activity Counseling (SNAC) study is a randomized clustered design clinical trial that will investigate the effectiveness and efficacy of a multi-component lifestyle intervention on cardiovascular disease risk factors and vascular function in patients at risk in primary care. Patients will be randomized by practice to either a standard of care lifestyle intervention or a behaviourally-based, matched prescriptive physical activity and diet change program. The primary goal is to increase physical activity and improve dietary intake according to Canada's Guides to Physical Activity Healthy Eating over 24 months. The primary intention to treat analysis will compare behavioral, physiological and metabolic outcomes at 6, 12 and 24 months post-randomization including estimation of incident hypertension and/or diabetes.
DISCUSSION: The design features of our trial, and the practical problems (and solutions) associated with implementing these design features, particularly those that result in potential delay between recruitment, baseline data collection, randomization, intervention, and assessment will be discussed. Results of the SNAC trial will provide scientific rationale for the implementation of this lifestyle intervention in primary care.
TRIAL REGISTRATION: ISRCTN: ISRCTN:42921300.
2011-02-16T08:00:00Z
article
https://ir.lib.uwo.ca/fammedpub/10
info:doi/10.1186/1745-6215-12-45
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3048556/
Family Medicine Publications
Scholarship@Western
Lifestyle intervention
Physical activity
Vascular health
SNAC
Randomized controlled trial
Kinesiology
Public Health
oai:ir.lib.uwo.ca:ptpub-1027
2017-10-02T17:54:13Z
publication:pt
publication:pmid
publication:faculties
publication:ptpub
Vitamin D and Brain Imaging in the Elderly: Should we Expect Some Lesions Specifically Related to Hypovitaminosis D?
Annweiler, Cédric
Montero-Odasso, Manuel
Muir, Susan W
Beauchet, Olivier
Hypovitaminosis D is associated with cognitive decline in the elderly, but the issue of causality remains unresolved. Definitive evidence would include the visualization of brain lesions resulting from hypovitaminosis D. The aim of the present article is to determine, through a literature review, the location and nature of possible brain disorders in hypovitaminosis D. We found limited brain-imaging data, which reported ischemic infarcts and white matter hyperintensities in hypovitaminosis D, though did not provide their specific location or report any focal atrophy. Based on the finding of executive dysfunctions (i.e., mental shifting and information updating impairments) in the presence of hypovitaminosis D, we suggest that hypovitaminosis D is associated with a dysfunction of the frontal-subcortical neuronal circuits, particularly the dorsolateral circuit. Further imaging studies are required to corroborate this assumption and to determine whether hypovitaminosis D results in degenerative and / or vascular lesions.
2012-02-28T08:00:00Z
article
application/pdf
https://ir.lib.uwo.ca/ptpub/30
info:doi/10.2174/1874440001206010016
https://ir.lib.uwo.ca/context/ptpub/article/1027/viewcontent/TONIJ_6_16.pdf
Physical Therapy Publications
Scholarship@Western
Vitamin D
brain mapping
cognition
older adults
Adult
Exercise Test
Heart Rate
Humans
Physical Endurance
Reproducibility of Results
Running
Soccer
Physical Therapy
oai:ir.lib.uwo.ca:ptpub-1028
2017-10-02T17:58:04Z
publication:pt
publication:pmid
publication:faculties
publication:ptpub
Motoric Cognitive Risk Syndrome: Multicountry Prevalence and Dementia Risk
Verghese, Joe
Annweiler, Cedric
Ayers, Emmeline
Barzilai, Nir
Beauchet, Olivier
Bennett, David A
Bridenbaugh, Stephanie A
Buchman, Aron S
Callisaya, Michele L
Camicioli, Richard
Capistrant, Benjamin
Chatterji, Somnath
De Cock, Anne-Marie
Ferrucci, Luigi
Giladi, Nir
Guralnik, Jack M
Hausdorff, Jeffrey M
Holtzer, Roee
Kim, Ki Woong
Kowal, Paul
Kressig, Reto W
Lim, Jae-Young
Lord, Susan
Meguro, Kenichi
Montero-Odasso, Manuel
Hunter, Susan W
Noone, Mohan L
Rochester, Lynn
Srikanth, Velandai
Wang, Cuiling
OBJECTIVES: Our objective is to report prevalence of motoric cognitive risk syndrome (MCR), a newly described predementia syndrome characterized by slow gait and cognitive complaints, in multiple countries, and its association with dementia risk.
METHODS: Pooled MCR prevalence analysis of individual data from 26,802 adults without dementia and disability aged 60 years and older from 22 cohorts from 17 countries. We also examined risk of incident cognitive impairment (Mini-Mental State Examination decline ≥4 points) and dementia associated with MCR in 4,812 individuals without dementia with baseline Mini-Mental State Examination scores ≥25 from 4 prospective cohort studies using Cox models adjusted for potential confounders.
RESULTS: At baseline, 2,808 of the 26,802 participants met MCR criteria. Pooled MCR prevalence was 9.7% (95% confidence interval [CI] 8.2%-11.2%). MCR prevalence was higher with older age but there were no sex differences. MCR predicted risk of developing incident cognitive impairment in the pooled sample (adjusted hazard ratio [aHR] 2.0, 95% CI 1.7-2.4); aHRs were 1.5 to 2.7 in the individual cohorts. MCR also predicted dementia in the pooled sample (aHR 1.9, 95% CI 1.5-2.3). The results persisted even after excluding participants with possible cognitive impairment, accounting for early dementia, and diagnostic overlap with other predementia syndromes.
CONCLUSION: MCR is common in older adults, and is a strong and early risk factor for cognitive decline. This clinical approach can be easily applied to identify high-risk seniors in a wide variety of settings.
2014-08-19T07:00:00Z
article
application/pdf
https://ir.lib.uwo.ca/ptpub/29
info:doi/10.1212/WNL.0000000000000717
https://ir.lib.uwo.ca/context/ptpub/article/1028/viewcontent/NEUROLOGY2014580183.pdf
Physical Therapy Publications
Scholarship@Western
Age Factors
Aged
Aged
80 and over
Cognition
Cognition Disorders
Dementia
Female
Humans
Male
Middle Aged
Neuropsychological Tests
Prevalence
Prospective Studies
Risk
Risk Assessment
Aged, 80 and over
Physical Therapy
oai:ir.lib.uwo.ca:ptpub-1030
2019-04-29T21:14:05Z
publication:pt
publication:pmid
publication:faculties
publication:ptpub
Association of Dual-Task Gait With Incident Dementia in Mild Cognitive Impairment
Montero-Odasso, Manuel M.
Sarquis-Adamson, Yanina
Speechley, Mark
Borrie, Michael J.
Hachinski, Vladimir C.
Wells, Jennie
Riccio, Patricia M.
Schapira, Marcelo
Sejdic, Ervin
Camicioli, Richard M.
Bartha, Robert
McIlroy, William E.
Muir-Hunter, Susan
Importance Gait performance is affected by neurodegeneration in aging and has the potential to be used as a clinical marker for progression from mild cognitive impairment (MCI) to dementia. A dual-task gait test evaluating the cognitive-motor interface may predict dementia progression in older adults with MCI.
Objective To determine whether a dual-task gait test is associated with incident dementia in MCI.
Design, Setting, and Participants The Gait and Brain Study is an ongoing prospective cohort study of community-dwelling older adults that enrolled 112 older adults with MCI. Participants were followed up for 6 years, with biannual visits including neurologic, cognitive, and gait assessments. Data were collected from July 2007 to March 2016.
Main Outcomes and Measures Incident all-cause dementia was the main outcome measure, and single- and dual-task gait velocity and dual-task gait costs were the independent variables. A neuropsychological test battery was used to assess cognition. Gait velocity was recorded under single-task and 3 separate dual-task conditions using an electronic walkway. Dual-task gait cost was defined as the percentage change between single- and dual-task gait velocities: ([single-task gait velocity – dual-task gait velocity]/ single-task gait velocity) × 100. Cox proportional hazard models were used to estimate the association between risk of progression to dementia and the independent variables, adjusted for age, sex, education, comorbidities, and cognition.
Results Among 112 study participants with MCI, mean (SD) age was 76.6 (6.9) years, 55 were women (49.1%), and 27 progressed to dementia (24.1%), with an incidence rate of 121 per 1000 person-years. Slow single-task gait velocity (P = .05)while high dual-task gait cost while counting backward (HR, 3.79; 95% CI, 1.57-9.15; P = .003) and naming animals (HR, 2.41; 95% CI, 1.04-5.59; P = .04) were associated with dementia progression (incidence rate, 155 per 1000 person-years). The models remained robust after adjusting by baseline cognition except for dual-task gait cost when dichotomized.
Conclusions and Relevance Dual-task gait is associated with progression to dementia in patients with MCI. Dual-task gait testing is easy to administer and may be used by clinicians to decide further biomarker testing, preventive strategies, and follow-up planning in patients with MCI.
2017-05-15T07:00:00Z
article
application/pdf
https://ir.lib.uwo.ca/ptpub/27
info:doi/10.1001/jamaneurol.2017.0643
http://doi.org/10.1001/jamaneurol.2017.0643
Physical Therapy Publications
Scholarship@Western
Physical Therapy
oai:ir.lib.uwo.ca:ptpub-1029
2019-05-15T16:33:50Z
publication:pt
publication:pmid
publication:faculties
publication:ptpub
Mobility and Cognition in Seniors. Report from the 2008 Institute of Aging (CIHR) Mobility and Cognition Workshop
Montero-Odasso, Manuel
Bherer, Louis
Studenski, Stephanie
Gopaul, Karen
Oteng-Amoako, Afua
Woolmore-Goodwin, Sarah
Stoole, Paul
Wells, Jennie
Doherty, Timothy
Zecevic, Aleksandra A.
Galinsky, David
Rylett, R. Jane
Jutai, Jeffrey
Muir-Hunter, Susan W
Speechley, Mark
Camicioli, Richard
Background
The annual Scientific Meeting of the Canadian Association on Gerontology was held on October 24 and 25, 2008 in London, Ontario. Prior to the annual meeting, mobility and cognition experts met on October 23, 2008 to engage in a pre-conference workshop.
Methods
Discussions during the workshop addressed novel areas of research and knowledge and research gaps pertaining to the interaction between mobility and cognition in seniors.
Results
Workshop presenters moved from the neuromuscular, biomechanics, and neurology of gait impairments, and falls through the role of cognition and mood on mobility regulation to the whole person in the environment. Research gaps were identified.
Conclusions
Despite a consensus that mobility and cognition are increasingly correlated as people age, several gaps in our understanding of mechanisms and how to assess the interaction were recognized. The gaps originally identified in 2008 are still pertinent today. Common and standardized assessments for “mobility and cognition” are still not in place in current practice. Interventions that target mobility and cognitive decline as a single entity are still lacking.
2015-09-01T07:00:00Z
article
application/pdf
https://ir.lib.uwo.ca/ptpub/28
info:doi/10.5770/cgj.18.188
https://ir.lib.uwo.ca/context/ptpub/article/1029/viewcontent/188_2591_3_PB.pdf
Physical Therapy Publications
Scholarship@Western
mobility
executive function
dual-task gait
exercises
gait variability
falls
MCI
Parkinson’s disease
Physical Therapy
oai:ir.lib.uwo.ca:ptpub-1031
2017-12-11T18:30:00Z
publication:pt
publication:pmid
publication:faculties
publication:ptpub
The Attentional Demands of Ambulating with an Assistive Device in Older Adults with Alzheimer's Disease
Hunter, Susan W
Montero-Odasso, M
Ambulation with a mobility aid is a unique real-life situation of multi-tasking. These simultaneous motor tasks place increased demands on executive function in healthy young and older adults, but the demands have not been evaluated in people with Alzheimer's disease (AD). Mobility problems are common among adults with AD, leading to provision of a mobility aid to optimize independent activity. The study objectives were: (i) to determine the dual-task cost (DTC) associated with the use of a mobility aid in straight and complex path walking, and (ii) to evaluate the association between executive function and ambulation with a mobility aid in older adults with AD and age-sex matched cognitively normal controls. Fourteen people (mean age±SD, 72.6±9.9years) with a diagnosis of probable AD (MMSE range 12-25) and controls (mean age±SD, 72.9±9.5) walked at a self-selected pace and using a 4-wheeled walker in a 6m straight path and a Figure of 8 Test. Ambulation with the walker in a straight path produced a low DTC that was not different between the groups. Ambulation with the 4-wheeled walker in the complex path produced a significantly different DTC in the group with AD at -38.1±23.5% compared to -19.7±21.4% (p=0.041). Lower scores on executive function were associated with longer times across test conditions. Ambulation with a 4-wheeled walker, in particular maneuvering around obstacles, requires greater attentional costs in dementia. Future research should explore the timing for safely introducing mobility aids in AD and the role of improving executive function.
2017-05-01T07:00:00Z
article
application/pdf
https://ir.lib.uwo.ca/ptpub/31
info:doi/10.1016/j.gaitpost.2017.03.011
https://ir.lib.uwo.ca/context/ptpub/article/1031/viewcontent/G_P2017_attentional_load_with_walker_in_AD_final.pdf
Physical Therapy Publications
Scholarship@Western
aged
gait
assistive devices
walkers
dementia
Physical Therapy
oai:ir.lib.uwo.ca:ptpub-1032
2018-06-05T19:48:23Z
publication:pt
publication:pmid
publication:faculties
publication:ptpub
Validity and reliability of two abbreviated versions of the Gross Motor Function Measure.
Brunton, Laura K
Bartlett, Doreen J
Aim: The “gold standard” to measure gross motor functioning for children with cerebral palsy (CP) is the Gross Motor Function Measure (GMFM-66). The purpose of this study was to estimate the validity and reliability of two abbreviated versions (item set (GMFM-66 IS) and basal and ceiling (GMFM-66 B&C) approaches) of the GMFM-66.
Methods: Twenty-six children with CP aged 2 to 6 years across all GMFCS levels participated. At session one, both abbreviated versions were administered by two independent raters, followed by the full GMFM-66. In the subsequent session, only the abbreviated versions were administered, by the same raters. Concurrent validity, comparability between versions and test-retest reliability were determined using intraclass correlation coefficients (ICC 2,1).
Results: Both versions demonstrated high levels of validity with ICCs reflecting associations with the GMFM-66 of 0.99 (95% CIs ranging from 0.972-0.997). Both versions were also shown to be highly reliable with ICCs greater than 0.98 (95% CIs ranging from 0.965-0.994).
Interpretation: Both versions can be used in clinical practice or research. However, the GMFM-66-B&C is recommended as the preferred abbreviated version.
2011-04-01T07:00:00Z
article
application/pdf
https://ir.lib.uwo.ca/ptpub/32
info:doi/10.2522/ptj.20100279
https://ir.lib.uwo.ca/context/ptpub/article/1032/viewcontent/auto_convert.pdf
Physical Therapy Publications
Scholarship@Western
Cerebral Palsy
Child
Child
Preschool
Female
Health Status Indicators
Humans
Infant
Male
Psychometrics
Reproducibility of Results
Child, Preschool
Physical Therapy
oai:ir.lib.uwo.ca:ptpub-1034
2018-06-05T20:25:46Z
publication:pt
publication:pmid
publication:faculties
publication:ptpub
Fatigue in cerebral palsy: a critical review.
Brunton, Laura Kristine
Rice, Charles L
Objective: Fatigue contributes to the deterioration or cessation of walking ability in adults with cerebral palsy (CP). However, conflict exists as to its role. Studies involving functional tasks reported increased, and earlier onset of, fatigue in CP whereas laboratory studies have reported individuals with CP to be more fatigue resistant than their peers.
Methods: A critical review of the literature related to fatigue in CP was conducted.
Results: This review describes factors that contribute to the observed fatigue resistance in laboratory tasks and how a decreased force-production in CP can result in higher energy expenditure to perform the same amount of work as their peers.
Conclusion: More research regarding the process of fatigue and recovery for individuals with CP is needed; specifically studies that focus on functional movements requiring the integration of the whole body, thereby stressing the neuromuscular system in a different way than previously explored.
2012-01-01T08:00:00Z
article
application/pdf
https://ir.lib.uwo.ca/ptpub/34
info:doi/10.3109/17518423.2011.629633
https://ir.lib.uwo.ca/context/ptpub/article/1034/viewcontent/auto_convert.pdf
Physical Therapy Publications
Scholarship@Western
Cerebral Palsy
Energy Metabolism
Humans
Magnetic Resonance Imaging
Muscle Fatigue
Muscle
Skeletal
Task Performance and Analysis
Muscle, Skeletal
Physical Therapy
oai:ir.lib.uwo.ca:ptpub-1033
2018-06-05T20:10:19Z
publication:pt
publication:pmid
publication:faculties
publication:ptpub
Description of exercise participation of adolescents with cerebral palsy across a 4-year period.
Brunton, Laura K
Bartlett, Doreen J
Purpose: The primary purposes were to describe: 1) the types of exercise participation of adolescents with cerebral palsy (CP), 2) the weekly duration of stretching, strengthening, and cardiovascular exercise, and 3) how the level of activity compares to national health guidelines.
Methods: Participants were 126 males and 104 females (14.7, SD =1.7 years) who reported on the physical activities in the previous week using a questionnaire designed for this study. Analyses comprised frequency counts and proportions, stacked bar graphs and 2-way ANOVAs of exercise participation by GMFCS and gender.
Results: There was a significant interaction of GMFCS level and gender for stretching; females stretched more than males. A significant main effect of GMFCS level was detected for “light” and “moderate” exercise. An average of 9.4 and 11.4% of our sample participated in weekly levels of “moderate” and “vigorous” exercise, respectively.
Conclusions: Pediatric physical therapists should expend more effort on health promotion to increase exercise participation rates among youth with CP.
2010-01-01T08:00:00Z
article
application/pdf
https://ir.lib.uwo.ca/ptpub/33
info:doi/10.1097/PEP.0b013e3181db8aaa
https://ir.lib.uwo.ca/context/ptpub/article/1033/viewcontent/auto_convert.pdf
Physical Therapy Publications
Scholarship@Western
Activities of Daily Living
Adolescent
Analysis of Variance
Canada
Cerebral Palsy
Exercise
Exercise Therapy
Female
Humans
Male
Mobility Limitation
Motor Activity
Patient Acceptance of Health Care
Physical Therapy Modalities
Prospective Studies
Sex Factors
Surveys and Questionnaires
Time Factors
Treatment Outcome
Physical Therapy
oai:ir.lib.uwo.ca:ptpub-1035
2018-06-05T20:49:02Z
publication:pt
publication:rwkex_researcharticles
publication:pmid
publication:faculties
publication:rwkex
publication:ptpub
Descriptive Report of the Impact of Fatigue and Current Management Strategies in Cerebral Palsy.
Brunton, Laura K
Purpose: Describe the impact of fatigue and self-management practices for adolescents and young adults with cerebral palsy (CP).
Methods: Survey of 124 people with CP with the Fatigue Impact and Severity Self-Assessment (FISSA).
Results: People in GMFCS Level I experienced little impact of fatigue with high proportions of this group disagreeing to statements about fatigue impacting their general activities, mobility and social activities. People in GMFCS Levels II-V reported impact of fatigue on activities. Differences between groups were evident in questions related to fatigue interference with length of time for physical activity and with motivations to participate in social activities. All other items related to management of fatigue were not significantly different between groups.
Conclusions: Fatigue impact is greater for people with more functional limitations. Lack of significant differences between groups on the Management and Activity Modification subscale, indicates more research is needed regarding strategies for fatigue management.
2018-04-01T07:00:00Z
article
application/pdf
https://ir.lib.uwo.ca/ptpub/35
info:doi/10.1097/PEP.0000000000000490
https://ir.lib.uwo.ca/context/ptpub/article/1035/viewcontent/auto_convert.pdf
Physical Therapy Publications
Scholarship@Western
adolescents
cerebral palsy
fatigue
young adults
Physical Therapy
oai:ir.lib.uwo.ca:ptpub-1036
2018-06-05T20:57:38Z
publication:pt
publication:pmid
publication:faculties
publication:ptpub
Construction and validation of the fatigue impact and severity self-assessment for youth and young adults with cerebral palsy.
Brunton, Laura K
Bartlett, Doreen J
Purpose: The Fatigue Impact and Severity Self-Assessment (FISSA) was created to assess the impact, severity and self-management of fatigue for individuals with cerebral palsy (CP) aged 14-31.
Methods Used: Items were generated from a review of measures and interviews with individuals with CP. Focus groups with healthcare professionals were used for item reduction. A mailed survey was conducted (n=163/367) to assess the factor structure, known-groups validity and test-retest reliability.
Results Obtained: The final measure contained 31-items in two factors and discriminated between individuals expected to have different levels of fatigue. Individuals with more functional abilities reported less fatigue (p< 0.002) and those with higher pain reported higher fatigue (p< 0.001). The FISSA was shown to have adequate test-retest reliability, ICC(3,1)=0.74 (95% CI 0.53-0.87).
Conclusions Reached: The FISSA valid and reliable for individuals with CP. It allows for identification of the activities that may be compromised by fatigue to enhance collaborative goal setting and intervention planning.
2017-07-01T07:00:00Z
article
application/pdf
https://ir.lib.uwo.ca/ptpub/36
info:doi/10.1080/17518423.2016.1189974
https://ir.lib.uwo.ca/context/ptpub/article/1036/viewcontent/auto_convert.pdf
Physical Therapy Publications
Scholarship@Western
Activities of Daily Living
Adolescent
Adult
Cerebral Palsy
Fatigue
Female
Humans
Male
Psychometrics
Reproducibility of Results
Self-Assessment
Surveys and Questionnaires
Physical Therapy
oai:ir.lib.uwo.ca:ptpub-1038
2018-06-12T19:43:10Z
publication:pt
publication:pmid
publication:faculties
publication:ptpub
The prevalence, location, severity, and daily impact of pain reported by youth and young adults with cerebral palsy.
Brunton, Laura
Hall, Sarah
Passingham, Adrienne
Wulff, Julie
Delitala, Rich
PURPOSE: To describe the prevalence, location, severity, and daily impact of pain reported by youth and young adults with cerebral palsy (CP). A secondary aim was to identify any significant associations between the constructs of interest.
METHOD: An observational study of 112 participants with CP to understand their experience of pain through a questionnaire. Participants were 56 males and 55 females with a mean age of 18y 9mo (SD 4y 5mo).
RESULTS: Pain was reported by 75% of males and 89% of females. Both severity and impact of pain were significantly greater in females. In addition, severity and impact of pain were significantly different between specific GMFCS levels. There were no significant differences in location of pain by gender or GMFCS level. A strong positive correlation between the severity and impact of pain was observed (rs = 0.80).
CONCLUSION: The gender differences in the severity and impact of pain and the overall and high prevalence of pain reported here provide healthcare practitioners with an increased awareness of pain distribution/characteristics among young adults with CP. Understanding the impact of pain on daily life can assist practitioners to efficiently manage pain and improve the quality of life for individuals with CP.
2016-09-02T07:00:00Z
article
application/pdf
https://ir.lib.uwo.ca/ptpub/37
info:doi/10.3233/PRM-160379
https://ir.lib.uwo.ca/context/ptpub/article/1038/viewcontent/auto_convert.pdf
Physical Therapy Publications
Scholarship@Western
Adolescent
Adult
Cerebral Palsy
Cross-Sectional Studies
Female
Humans
Male
Pain
Self Report
Severity of Illness Index
Sex Characteristics
Surveys and Questionnaires
Young Adult
Physical Therapy
oai:ir.lib.uwo.ca:ptpub-1037
2018-06-12T19:37:58Z
publication:pt
publication:faculties
publication:ptpub
Profiles of Fatigue Severity and Variability Among Adolescents and Young Adults with Cerebral Palsy
Brunton, Laura K
Bartlett, Doreen J
Background: Individuals with cerebral palsy (CP) experience progressive changes in functional status with the development of secondary impairments such as fatigue. Detailed accounts of the fatigue experience in CP are lacking.
Purpose: This study describes the severity and variability of fatigue in CP using the Fatigue Impact and Severity Self-Assessment.
Methods: This was a descriptive cross-sectional study surveying 130 (61 males) individuals (mean age 18 years, 11 months; SD four years, six months) with CP. Analyses comprised comparisons between two groups (Gross Motor Function Classification System (GMFCS) I and II-V), frequency counts and proportions.
Results: Significant differences exist between GMFCS groups for all fatigue severity questions. In addition, 38% of individuals classified as GMFCS level I reported their average fatigue as moderate to severe and 53% experienced fatigue on three or more days in the previous week. Sixty-eight percent of individuals classified as GMFCS II-V reported their average fatigue to be moderate to severe and 78% were fatigued on three or more days in the previous week.
Conclusions: Fatigue is a highly individualized phenomenon with significant burden for individuals with CP regardless of functional ability. Individuals in GMFCS Levels II-V reported increased fatigue severity and would benefit from specific management interventions.
2016-12-07T08:00:00Z
article
application/pdf
https://ir.lib.uwo.ca/ptpub/38
info:doi/10.1080/21641846.2017.1264950
https://ir.lib.uwo.ca/context/ptpub/article/1037/viewcontent/auto_convert.pdf
Physical Therapy Publications
Scholarship@Western
Fatigue
severity
variability
cerebral palsy
adolescents
young adults
Physical Therapy
oai:ir.lib.uwo.ca:ptpub-1039
2018-06-12T19:51:29Z
publication:pt
publication:pmid
publication:faculties
publication:ptpub
The bodily experience of cerebral palsy: a journey to self-awareness.
Brunton, Laura K
Bartlett, Doreen J
PURPOSE: The aim of the study was to describe the lived bodily experience of cerebral palsy (CP).
METHOD: This was a descriptive phenomenological inquiry. Ten participants were interviewed about their bodily experiences of living with CP. Interviews were semi-structured around pain and fatigue. Inductive thematic analysis was used to identify themes.
RESULTS: The bodily experience of CP centered on issues of fatigue and pain as a feeling of muscle soreness. An overwhelming amount of the discussion on fatigue emphasized the fatigue that occurs with walking and prolonged activity. Self-awareness of the individuals' own bodies and adapting activity to continue to participate in various aspects of their lives emerged as the most important theme. Some participants used strategies to manage their pain or fatigue; other participants were not yet fully aware of how to recognize signs of fatigue and/or how to adapt their activities.
CONCLUSIONS: Self-awareness appears to be an important process to be fostered by service providers and parents. Specifically, encouraging youth with CP to be aware of their own bodies and the effects (positive and negative) of activity on pain and fatigue should be incorporated into transition programs as the individual becomes responsible for his or her own health care needs. Implications for Rehabilitation Fatigue is a major concern for some youth and young adults with cerebral palsy. Adolescents and young adults with cerebral palsy use a variety of techniques (including adapting or restricting activity and building in rest breaks) to manage fatigue. The process of self-awareness should be fostered by health care professionals leading up to and during transition from pediatric to adult care. Clinical conversations should explore the role of exercise, adaptive equipment, rest and other strategies for dealing with fatigue with a focus on understanding each client's needs individually.
2013-01-01T08:00:00Z
article
application/pdf
https://ir.lib.uwo.ca/ptpub/39
info:doi/10.3109/09638288.2013.770080
https://ir.lib.uwo.ca/context/ptpub/article/1039/viewcontent/auto_convert.pdf
Physical Therapy Publications
Scholarship@Western
Activities of Daily Living
Adaptation
Physiological
Adaptation
Psychological
Adolescent
Adult
Age Factors
Awareness
Body Image
Cerebral Palsy
Fatigue
Female
Gait Disorders
Neurologic
Humans
Interviews as Topic
Pain
Postural Balance
Qualitative Research
Quality of Life
Risk Assessment
Sex Factors
Sickness Impact Profile
Walking
Young Adult
Adaptation, Physiological
Adaptation, Psychological
Gait Disorders, Neurologic
Physical Therapy
oai:ir.lib.uwo.ca:ptpub-1040
2018-12-04T18:04:37Z
publication:pt
publication:pmid
publication:faculties
publication:ptpub
Fatigue in adults with cerebral palsy: A three-year follow-up study.
Oude Lansink, Irene L B
McPhee, Patrick G
Brunton, Laura Kristine
Gorter, Jan Willem
OBJECTIVES: To describe the course of fatigue over a 3-year follow-up period in adults with cerebral palsy and to investigate the association of known determinants of fatigue (i.e. demographic characteristics and/or body composition) with change in fatigue.
METHODS: Forty-one adults with cerebral palsy from a previous study of fatigue were invited to participate in a follow-up study. Twenty-three adults with cerebral palsy (Gross Motor Function Classification System (GMFCS) levels I-V; mean age 38 years 2 months, standard deviation (SD) 14 years 1 month)) agreed to participate (convenience sample). Fatigue was measured with the Fatigue Impact and Severity Self-Assessment (FISSA, range 31-157) questionnaire. The course of fatigue is described at group, subgroup (GMFCS) and individual levels.
RESULTS: The mean FISSA score for all participants was 84.0 (SD 27.7) at baseline and 91.7 (SD 26.7) at follow-up. Despite variations among individuals in the change of fatigue, there was no statistically significant difference in FISSA score over time (p = 0.087, 95% confidence interval (95% CI) -16.7 to 1.22). No known determinants of fatigue predictive of change in FISSA scores were found.
DISCUSSION: Fatigue appears to be relatively stable within adults with cerebral palsy over time, with a variable presentation between individuals and across GMFCS levels. Care providers should monitor and discuss fatigue in young individuals with cerebral palsy in order to attenuate fatigue later in life.
2018-11-07T08:00:00Z
article
application/pdf
https://ir.lib.uwo.ca/ptpub/40
info:doi/https://www.ingentaconnect.com/contentone/mjl/sreh/2018/00000050/00000010/art00007
https://ir.lib.uwo.ca/context/ptpub/article/1040/viewcontent/3Year_Follow_up_FISSA.pdf
Physical Therapy Publications
Scholarship@Western
Fatigue
adults
cerebral palsy
Physical Therapy
oai:ir.lib.uwo.ca:ptpub-1041
2019-10-04T17:15:52Z
publication:pt
publication:pmid
publication:faculties
publication:ptpub
Moving from parent "consultant" to parent "collaborator": one pediatric research team's experience.
Bartlett, Doreen
Chiarello, Lisa A
Hjorngaard, Tina
Sieck Taylor, Barbara
We share our experiences as academic physical therapists and parents of young people with cerebral palsy working together as a research team, describe and critically review how our working relationship has evolved and propose further enhancements to realize our shared vision. This manuscript is informed by a call for “family-centered research,” transcripts of face-to-face meetings held over a period of 11/2 days, the INVOLVE document and our experiences over almost a decade, as well as other related literature. Authentic collaborative research partnerships between academic researchers and parents embodying trust, mutual respect and shared social responsibility take time and effort to develop and sustain. Rehabilitation research is more meaningful and may be more impactful when strong collaborative partnerships between researchers and health service users are in place.
2017-10-01T07:00:00Z
article
application/pdf
https://ir.lib.uwo.ca/ptpub/51
info:doi/10.1080/09638288.2016.1219402
https://ir.lib.uwo.ca/context/ptpub/article/1041/viewcontent/Bartlett_et_al___Moving_from_parent_consultant__Author_accepted_.pdf
Physical Therapy Publications
Scholarship@Western
Family-centred research
Consumer involvement in research
Biomedical Research
Canada
Cooperative Behavior
Humans
Parents
Pediatrics
Physical Therapists
Professional-Family Relations
Research Personnel
United States
Physical Therapy
oai:ir.lib.uwo.ca:ptpub-1042
2019-10-04T17:23:29Z
publication:pt
publication:pmid
publication:faculties
publication:ptpub
Consensus classifications of gross motor, manual ability, and communication function classification systems between therapists and parents of children with cerebral palsy.
Bartlett, Doreen J
Galuppi, Barbara
Palisano, Robert J
McCoy, Sarah Westcott
2016-01-01T08:00:00Z
letter
application/pdf
https://ir.lib.uwo.ca/ptpub/52
info:doi/10.1111/dmcn.12933
https://ir.lib.uwo.ca/context/ptpub/article/1042/viewcontent/Bartlett_et_al___Consensus_classifications___letter_to_the_editor_accepted_version.pdf
Physical Therapy Publications
Scholarship@Western
Cerebral Palsy
Child
Child, Preschool
Communication
Consensus
Female
Health Personnel
Humans
Longitudinal Studies
Male
Motor Skills
Parents
Severity of Illness Index
Physical Therapy
oai:ir.lib.uwo.ca:ptpub-1043
2019-10-04T17:29:06Z
publication:pt
publication:pmid
publication:faculties
publication:ptpub
Stability of the Gross Motor Function Classification System, Manual Ability Classification System, and Communication Function Classification System.
Palisano, Robert J
Avery, Lisa
Gorter, Jan Willem
Galuppi, Barbara
McCoy, Sarah Westcott
AIM: To determine the stability of the Gross Motor Function Classification System (GMFCS), Manual Ability Classification System (MACS), and Communication Function Classification System (CFCS) over 1-year and 2-year intervals using a process for consensus classification between parents and therapists.
METHOD: Participants were 664 children with cerebral palsy (CP), 18 months to 12 years of age, one of their parents, and 90 therapists. Consensus between parents and therapists on level of function was ≥92% for the GMFCS, MACS, and CFCS. A linearly weighted kappa coefficient of ≥0.75 was the criterion for stability.
RESULTS: Kappa coefficients varied from 0.76 to 0.88 for the GMFCS, 0.59 to 0.73 for the MACS, and 0.57 to 0.77 for the CFCS. For children younger than 4 years of age, level of function did not change for 58.2% on the GMFCS, 30.3% on the MACS, and 39.3% on the CFCS. For children 4 years of age or older, level of function did not change for 72.3% on the GMFCS, 49.1% on the MACS, and 55% on the CFCS.
INTERPRETATION: The findings support repeated classification of children over time. The kappa coefficients for the GMFCS are attributed to descriptions of levels for each age band. Consensus classification facilitates discussion between parents and professionals that has implications for shared decision-making.
WHAT THIS PAPER ADDS: The findings support repeated classification of children over time. Stability was higher for the Gross Motor Function Classification System than the Manual Ability Classification System and Communication Function Classification System. The function of younger children was more likely to be reclassified. Percentage agreement between parents and therapists using consensus classification varied from 92% to 97%. The intraclass correlation coefficient overestimated stability compared with the weighted kappa coefficient.
2018-10-01T07:00:00Z
article
application/pdf
https://ir.lib.uwo.ca/ptpub/53
info:doi/10.1111/dmcn.13903
https://ir.lib.uwo.ca/context/ptpub/article/1043/viewcontent/Palisano_et_al___Stability_of_the_gross_motor_function__Author_accepted_.pdf
Physical Therapy Publications
Scholarship@Western
Cerebral palsy
GMFCS
MACS
CFCS
Stability
Cerebral Palsy
Child
Child, Preschool
Classification
Consensus
Female
Humans
Infant
Longitudinal Studies
Male
Motor Activity
Motor Skills
Parents
Physical Therapists
Reproducibility of Results
Severity of Illness Index
Physical Therapy
oai:ir.lib.uwo.ca:ptpub-1044
2019-10-04T17:36:49Z
publication:pt
publication:rwkex_researcharticles
publication:pmid
publication:faculties
publication:rwkex
publication:ptpub
Longitudinal trajectories and reference centiles for the impact of health conditions on daily activities of children with cerebral palsy.
Bartlett, Doreen J
Gorter, Jan Willem
Jeffries, Lynn M
Avery, Lisa
Hanna, Steven E
On Track Study Team,
AIM: First, to describe the impact of health conditions on daily activities over time in children with cerebral palsy (CP) and to create age-specific reference centiles. Second, to determine the amount of change typical over a 1-year period, across Gross Motor Function Classification System (GMFCS) levels.
METHOD: A prospective, cohort design, with five assessments over 2 years, involved 708 children with a confirmed diagnosis of CP participating in the On Track Study (396 males, 312 females; mean age 6y [SD 2y 7mo]; range 18mo-12y at first assessment; 32.1% in GMFCS level I, 22.7% in GMFCS level II, 11.2% in GMFCS level III, 18.2% in GMFCS level IV, 15.7% in GMFCS level V). The impact of health conditions on daily activities was assessed using the Child Health Conditions Questionnaire. Data were analyzed using mixed-effects models and quantile regression.
RESULTS: Linear longitudinal trajectories describe the relatively stable impact of health conditions over time for each functional level for children aged 2 years to 12 years, with the lowest scores (least impact) in GMFCS level I and the highest scores (highest impact) in GMFCS level V. Centiles were created for children in each GMFCS level. A system to interpret the magnitude of change over time in centiles was developed.
INTERPRETATION: Longitudinal trajectories of co-occurring health conditions assist with understanding children's prognoses. Centiles assist in understanding a child's experience relative to children in similar GMFCS levels. Guidelines are provided to determine if children are progressing 'as expected', 'better than expected' or 'more poorly than expected' in regard to the impact of health conditions on daily activities.
WHAT THIS PAPER ADDS: For children with cerebral palsy, the mean impact of health conditions on daily activities is relatively stable. Significant intraindividual and interindividual variability for the impact of health conditions exists, which complicates prognosis. Centiles enable interpretation of the impact of health conditions relative to Gross Motor Function Classification System level.
2019-04-01T07:00:00Z
article
application/pdf
https://ir.lib.uwo.ca/ptpub/54
info:doi/10.1111/dmcn.14080
https://ir.lib.uwo.ca/context/ptpub/article/1044/viewcontent/Bartlett_et_al___Longitudinal_trajectories__Author_accepted_.pdf
Physical Therapy Publications
Scholarship@Western
Longitudinal trajectories
Reference percentiles
Progress monitoring
Impact of associated health conditions
Cerebral palsy
Activities of Daily Living
Age Factors
Cerebral Palsy
Child
Child Development
Child, Preschool
Cohort Studies
Female
Humans
Male
Motor Skills
Time Factors
Physical Therapy
oai:ir.lib.uwo.ca:ptpub-1045
2019-10-04T17:42:02Z
publication:pt
publication:pmid
publication:faculties
publication:ptpub
Physical, occupational, and speech therapy for children with cerebral palsy.
McCoy, Sarah Westcott
Palisano, Robert
Avery, Lisa
Jeffries, Lynn
Laforme Fiss, Alyssa
Chiarello, Lisa
Hanna, Steve
AIM: To explore the relationship between rehabilitation therapies and development in children with cerebral palsy (CP).
METHOD: We conducted a prospective, longitudinal study involving 656 children with CP (mean age [SD] 6y [2y 8mo] at study entry; 1y 6mo-11y 11mo; 287 females, 369 males), and their parents. Children were assessed two to five times over 2 years by therapists using standardized measures of balance and walking endurance. Parents completed questionnaires on demographics, rehabilitation therapies, and their children's performance in self-care and participation in recreation. Therapists and parents collaboratively classified children's Gross Motor Function Classification System (GMFCS) levels. We created longitudinal graphs for each GMFCS level, depicting change across time using centiles. Using multinomial models, we analyzed the relationship between therapies (amount, focus, family-centeredness, and the extent therapies met children's needs) and whether change in balance, walking endurance, and participation was 'more than' and 'less than' the reference of 'as expected'.
RESULTS: Children were more likely to progress 'more than expected' when participating in recreation when therapies were family-centered, met children's needs, and focused on structured play/recreation. A focus on health and well-being was positively associated with participation and self-care. The amount of therapy did not predict outcomes.
INTERPRETATION: Therapy services that are family-centered, consider the needs of the child, and focus on structured play/recreational activities and health/well-being may enhance the development of children with CP.
2019-07-28T07:00:00Z
article
application/pdf
https://ir.lib.uwo.ca/ptpub/55
info:doi/10.1111/dmcn.14325
https://ir.lib.uwo.ca/context/ptpub/article/1045/viewcontent/McCoy_et_al___Physical__occupational__and_speech_therapy__Author_accepted_.pdf
Physical Therapy Publications
Scholarship@Western
Cerebral palsy
Services
Developmental outcomes
Children
Services amount and focus
Physical Therapy
oai:ir.lib.uwo.ca:ptpub-1046
2019-10-04T17:48:24Z
publication:pt
publication:rwkex_researcharticles
publication:pmid
publication:faculties
publication:rwkex
publication:ptpub
Ease of Caregiving for Children: Re-Validation of Psychometric Properties of the Measure for Children with Cerebral Palsy up to 11 Years of Age.
Alghamdi, Mohammed S
Chiarello, Lisa A
Avery, Lisa
Palisano, Robert J
PURPOSE: To re-validate stability and hierarchal ordering of items, test-retest reliability, and construct validity of the Ease of Caregiving for Children measure for parents of children with cerebral palsy (CP) up to 11 years of age.
METHODS: Participants were 613 parents of children with CP between 1.5 and 11 years of age. Parents completed Ease of Caregiving for Children and both parents and therapists classified children's levels of gross motor, manual and communication functions.
RESULTS: Rasch analysis indicated acceptable fit of items, stable item calibration, and logical ordering of items by difficulty. Test-retest reliability was good: ICC = 0.69 (95% CI 0.52-0.81). For construct validity, ease of caregiving was higher for parents of children with higher functioning compared to parents of children with lower functioning, p < .001.
CONCLUSIONS: Ease of Caregiving for Children is a unidimensional, reliable and valid measure of physical caregiving for parents of children with CP 1.5-11 years.
2019-05-20T07:00:00Z
article
application/pdf
https://ir.lib.uwo.ca/ptpub/56
info:doi/10.1080/17518423.2019.1616844
https://ir.lib.uwo.ca/context/ptpub/article/1046/viewcontent/Alghamdi_et_al___Ease_of_Caregiving__Author_accepted_.pdf
Physical Therapy Publications
Scholarship@Western
Physical caregiving
Family-centred care
Cerebral palsy
Ease of caregiving
Measurement
Physical Therapy
oai:ir.lib.uwo.ca:ptpub-1047
2019-10-04T18:01:42Z
publication:pt
publication:pmid
publication:faculties
publication:ptpub
The Manual Ability Classification System: A Scoping Review
Jeevanantham, Deepa
Dyszuk, Emily
Bartlett, Doreen
PURPOSE: To examine the use of the Manual Ability Classification System (MACS) and to identify gaps in the literature by conducting a thorough search of existing publications from 2006 to March 2013.
METHODS: An extensive literature search included 15 databases, using the search terms "Manual Ability Classification System" or "MACS" to retrieve relevant abstracts.
RESULTS: A total of 161 articles were identified for final inclusion. The review identified literature that supports the reliability, validity, and stability of the MACS.
CONCLUSIONS: The MACS could be considered as a standard classification for children with cerebral palsy on the basis of manual abilities. The MACS can be reliably used for children between 4 and 18 years and adults between 18 and 24 years. The use of the MACS is expected to increase; further work is required to explore the use of the MACS in clinical practice.
2015-01-01T08:00:00Z
article
application/pdf
https://ir.lib.uwo.ca/ptpub/57
info:doi/10.1097/PEP.0000000000000151
https://ir.lib.uwo.ca/context/ptpub/article/1047/viewcontent/Jeevantham_et_al___The_Manual_Ability_Classification_System__author_accepted_.pdf
Physical Therapy Publications
Scholarship@Western
Activities of daily living / classification
Adolescent
Adult
Cerebral palsy / classification
Child
Female
Humans
Male
Motor skills disorders / classification
Preschool
Psychomotor performance
Review article upper extremity / physiopathology
Cerebral Palsy
Child, Preschool
Disability Evaluation
Hand
Motor Skills
Physical Therapy Modalities
Reproducibility of Results
Young Adult
Physical Therapy
oai:ir.lib.uwo.ca:ptpub-1048
2019-10-04T18:06:10Z
publication:pt
publication:rwkex_researcharticles
publication:pmid
publication:faculties
publication:rwkex
publication:ptpub
Interrelationships of Functional Status and Health Conditions in Children With Cerebral Palsy: A Descriptive Study.
Bartlett, Doreen
Dyszuk, Emily
Galuppi, Barbara
Gorter, Jan Willem
PURPOSE: To examine the relationship among the Gross Motor Function Classification System (GMFCS), the Manual Ability Classification System (MACS), and the Communication Function Classification System (CFCS) in children with cerebral palsy (CP) and to determine the average number and effect of health conditions.
METHODS: Participants were 671 children with CP aged 2 to 12 years from Canada and the United States. Cross-tabulation of functional classifications and averages were computed for the number and impact of health conditions and comparisons among groups.
RESULTS: A total of 78 of the 125 possible classification combinations were recorded. Most frequent were GMFCS I, MACS I, CFCS I; GMFCS I, MACS II, CFCS I; and GMFCS II, MACS II, CFCS I. With lower levels of function, the average number and average impact of associated health conditions increased.
CONCLUSIONS: The use of functional profiles across classification systems, with data on the associated health conditions, provides a more comprehensive picture of CP than any single classification or measure.
2018-01-01T08:00:00Z
article
application/pdf
https://ir.lib.uwo.ca/ptpub/58
info:doi/10.1097/PEP.0000000000000469
https://ir.lib.uwo.ca/context/ptpub/article/1048/viewcontent/Bartlett_et_al___Inter_relationships_of_functional_status__author_accepted_.pdf
Physical Therapy Publications
Scholarship@Western
Associated impairments
Cerebral palsy
Functional classifications
Health conditions
Canada
Cerebral Palsy
Child
Child, Preschool
Disability Evaluation
Disabled Children
Female
Humans
Male
Motor Skills
Physical Therapy Modalities
Prospective Studies
Severity of Illness Index
Physical Therapy
oai:ir.lib.uwo.ca:ptpub-1049
2019-10-04T18:14:12Z
publication:pt
publication:rwkex_researcharticles
publication:pmid
publication:faculties
publication:rwkex
publication:ptpub
Developmental Trajectories and Reference Percentiles for the 6-Minute Walk Test for Children With Cerebral Palsy.
Fiss, Alyssa LaForme
Jeffries, Lynn
Bjornson, Kristie
Avery, Lisa
Hanna, Steven
Westcott McCoy, Sarah
PURPOSE: The purposes of this study were to document longitudinal developmental trajectories in 6-minute walk test (6MWT) distances and to develop age-specific reference percentiles for children across different Gross Motor Function Classification System (GMFCS) levels.
METHODS: A TOTAL OF: 456 children with cerebral palsy ages 3 to 12 years of, GMFCS levels I to III participated. Children's motor function was classified on the GMFCS, and children completed the 6MWT 2 to 5 times in 2 years.
RESULTS: Longitudinal developmental trajectories support that 6MWT distances increase with age followed by a tapering, as children approach their functional limit relative to their GMFCS level. Reference percentile graphs were created to monitor change over time.
CONCLUSIONS: The 6MWT longitudinal developmental trajectories, reference percentiles, and interpretation of percentile change should assist collaborative and proactive intervention planning relative to functional walking capacity for children with cerebral palsy.
2019-01-01T08:00:00Z
article
application/pdf
https://ir.lib.uwo.ca/ptpub/59
info:doi/10.1097/PEP.0000000000000552
https://ir.lib.uwo.ca/context/ptpub/article/1049/viewcontent/Fiss_et_al___Developmental_trajectories_for_the_6_minute_walk_test__author_accepted_.pdf
Physical Therapy Publications
Scholarship@Western
Cerebral palsy
6-minute walk test
Cerebral Palsy
Child
Child Development
Child, Preschool
Female
Humans
Longitudinal Studies
Male
Walk Test
Walking
Physical Therapy
oai:ir.lib.uwo.ca:ptpub-1050
2019-10-04T18:26:04Z
publication:pt
publication:rwkex_researcharticles
publication:pmid
publication:faculties
publication:rwkex
publication:ptpub
Validity of the Early Activity Scale for Endurance and the 6-Minute Walk Test for Children With Cerebral Palsy.
Fiss, Alyssa LaForme
Jeffries, Lynn
Yocum, Allison
Westcott McCoy, Sarah
On Track Study Team,
PURPOSE: This study aimed to describe Early Activity Scale for Endurance (EASE) scores and 6-minute walk test (6MWT) distances of children with cerebral palsy (CP) by functional ability level, sex, and age and to examine the convergent validity of the 2 tests.
METHODS: A total of 708 participants with CP, Gross Motor Function Classification System (GMFCS) levels I to V, completed the EASE, and 376 of the study participants (3-12years), GMFCS levels I to III, completed the 6MWT.
RESULTS: Children with CP vary in EASE scores and 6MWT distances based on GMFCS level and, to a lesser extent, age. The EASE and the 6MWT demonstrate a statistically significant but low, positive correlation.
CONCLUSIONS: Understanding the relationship between these outcomes and GMFCS levels and age assists clinicians in establishing plans of care targeted at improving endurance for activity and functional walking capacity for children with CP.
2019-04-01T07:00:00Z
article
application/pdf
https://ir.lib.uwo.ca/ptpub/50
info:doi/10.1097/PEP.0000000000000577
https://ir.lib.uwo.ca/context/ptpub/article/1050/viewcontent/Fiss_et_al___Validity_of_the_Early_Activity_Scale__Author_accepted_.pdf
Physical Therapy Publications
Scholarship@Western
Cerebral palsy
Endurance
6MWT
Activities of Daily Living
Age Factors
Cerebral Palsy
Child
Child, Preschool
Disability Evaluation
Female
Humans
Infant
Male
Physical Endurance
Prospective Studies
Reproducibility of Results
Sex Factors
Walk Test
Walking
Physical Therapy
oai:ir.lib.uwo.ca:ptpub-1051
2019-10-04T18:41:51Z
publication:pt
publication:pmid
publication:faculties
publication:ptpub
Parents' Experiences and Perceptions when Classifying their Children with Cerebral Palsy: Recommendations for Service Providers.
Scime, Natalie V
Bartlett, Doreen J
Brunton, Laura K
Palisano, Robert J
AIMS: This study investigated the experiences and perceptions of parents of children with cerebral palsy (CP) when classifying their children using the Gross Motor Function Classification System (GMFCS), the Manual Ability Classification System (MACS), and the Communication Function Classification System (CFCS). The second aim was to collate parents' recommendations for service providers on how to interact and communicate with families.
METHODS: A purposive sample of seven parents participating in the On Track study was recruited. Semi-structured interviews were conducted orally and were audiotaped, transcribed, and coded openly. A descriptive interpretive approach within a pragmatic perspective was used during analysis.
RESULTS: Seven themes encompassing parents' experiences and perspectives reflect a process of increased understanding when classifying their children, with perceptions of utility evident throughout this process. Six recommendations for service providers emerged, including making the child a priority and being a dependable resource.
CONCLUSIONS: Knowledge of parents' experiences when using the GMFCS, MACS, and CFCS can provide useful insight for service providers collaborating with parents to classify function in children with CP. Using the recommendations from these parents can facilitate family-provider collaboration for goal setting and intervention planning.
2017-08-01T07:00:00Z
article
application/pdf
https://ir.lib.uwo.ca/ptpub/49
info:doi/10.1080/01942638.2016.1185505
https://ir.lib.uwo.ca/context/ptpub/article/1051/viewcontent/Scime_et_al___Parents_experiences_and_perceptions__Author_accepted_.pdf
Physical Therapy Publications
Scholarship@Western
Cerebral palsy
Classification systems
Experiences
Parents
Recommendations
Cerebral Palsy
Child
Child, Preschool
Disability Evaluation
Female
Health Personnel
Humans
Infant
Male
Perception
Physical Therapy
oai:ir.lib.uwo.ca:ptpub-1052
2019-10-04T18:50:54Z
publication:pt
publication:rwkex_researcharticles
publication:pmid
publication:faculties
publication:rwkex
publication:ptpub
Longitudinal Changes in Physical Caregiving for Parents of Children with Cerebral Palsy.
Alghamdi, Mohammed S
Chiarello, Lisa A
Palisano, Robert J
McCoy, Sarah W
Orlin, Margo
Abd-Elkafy, Ehab M
Aims: To determine changes in physical caregiving for parents of children with cerebral palsy (CP) over a two-year period based on children’s gross motor function level and age.
Methods: 153 parents of children with CP rated their physical caregiving using the Ease of Caregiving for Children three times over two years. Parents and assessors classified children’s gross motor function using the Gross Motor Function Classification System (GMFCS). Physical caregiving was compared at three test times among parents of children grouped by GMFCS level (I, II–III, and IV–V) and age (1.7–5.9 and 6–11 years) using a three-way mixed ANOVA.
Results: Among all analyses, a two-way interaction was found between children’s GMFCS level and test time on ease of caregiving, p < 0.01. Change over two-year period was found for parents of children in level I and II–III, p < 0.01, but not parents of children in levels IV–V. At each test time, parents of children in level I reported the greatest ease of caregiving followed by parents of children in levels II–III, and levels IV–V, who reported the lowest ease of caregiving, p < 0.001.
Conclusions: Findings support evaluation and monitoring of physical caregiving for parents of children with CP over time.
2019-07-10T07:00:00Z
article
application/pdf
https://ir.lib.uwo.ca/ptpub/48
info:doi/10.1080/01942638.2019.1637386
https://ir.lib.uwo.ca/context/ptpub/article/1052/viewcontent/Alghamdi_et_al___Longitudinal_Changes_in_Physical_Caregiving__Author_accepted_.pdf
Physical Therapy Publications
Scholarship@Western
Physical caregiving
Cerebral palsy
Motor function
Longitudinal
Physical Therapy
oai:ir.lib.uwo.ca:ptpub-1053
2019-10-04T18:57:25Z
publication:pt
publication:rwkex_researcharticles
publication:pmid
publication:faculties
publication:rwkex
publication:ptpub
Self-Care Trajectories and Reference Percentiles for Children with Cerebral Palsy.
Palisano, Robert J
Chiarello, Lisa A
Avery, Lisa
Hanna, Steven
On Track Study Team,
Aims: To create longitudinal trajectories and reference percentiles for performance in self-care of children with cerebral palsy (CP).
Methods: Participants were 708 children with CP, 18 months through 11 years of age and their parents residing in 10 regions across Canada and the United States. Gross Motor Function Classification System (GMFCS) levels were determined by consensus between parents and therapists. Parents' completed the Performance in Self-Care domain of the Child Engagement in Daily Life Measure two to five times at 6-month intervals. Nonlinear mixed-effects models were used to create longitudinal trajectories. Quantile regression was used to construct cross-sectional reference percentiles.
Results: The trajectories for children in levels I, II, and III are characterized by an average maximum score between 79.6 (level I) and 62.8 (level III) and an average attainment of 90% of the maximum score between 7 and 9 years of age. The trajectories for children in level IV and V show minimal change over time. Extreme variation in performance among children of the same age and GMFCS level complicate interpretation of percentile change of individual children.
Conclusion: The findings are useful for monitoring self-care of children with CP and evaluating change for children in GMFCS levels I-III.
2019-07-18T07:00:00Z
article
application/pdf
https://ir.lib.uwo.ca/ptpub/47
info:doi/10.1080/01942638.2019.1642288
https://ir.lib.uwo.ca/context/ptpub/article/1053/viewcontent/Palisano_et_al___Self_care_Trajectories_and_Reference_Percentiles_resubmit_June2019.pdf
Physical Therapy Publications
Scholarship@Western
Cerebral palsy
Population
Self-care
Longitudinal trajectories
Reference percentiles
Child Engagement in Daily Life measure
Physical Therapy
oai:ir.lib.uwo.ca:ptpub-1054
2019-10-04T19:10:24Z
publication:pt
publication:faculties
publication:ptpub
Longitudinal trajectories and reference percentiles for participation in family and recreational activities of children with cerebral palsy
Chiarello, Lisa
Palisano, Robert
Avery, Lisa
Hanna, Steven
On Track Study Team,
Aims: To create longitudinal trajectories and reference percentiles for performance in self-care of children with cerebral palsy (CP).
Methods: Participants were 708 children with CP, 18 months through 11 years of age and their parents residing in 10 regions across Canada and the United States. Gross Motor Function Classification System (GMFCS) levels were determined by consensus between parents and therapists. Parents’ completed the Performance in Self-Care domain of the Child Engagement in Daily Life Measure two to five times at 6-month intervals. Nonlinear mixed-effects models were used to create longitudinal trajectories. Quantile regression was used to construct cross-sectional reference percentiles.
Results: The trajectories for children in levels I, II, and III are characterized by an average maximum score between 79.6 (level I) and 62.8 (level III) and an average attainment of 90% of the maximum score between 7 and 9 years of age. The trajectories for children in level IV and V show minimal change over time. Extreme variation in performance among children of the same age and GMFCS level complicate interpretation of percentile change of individual children.
Conclusion: The findings are useful for monitoring self-care of children with CP and evaluating change for children in GMFCS levels I–III.
2019-07-18T07:00:00Z
article
https://ir.lib.uwo.ca/ptpub/46
Physical Therapy Publications
Scholarship@Western
Participation
Cerebral palsy
Longitudinal trajectories
Reference percentiles
Progress monitoring
Physical Therapy
oai:ir.lib.uwo.ca:ptpub-1055
2019-10-04T19:16:14Z
publication:pt
publication:rwkex_researcharticles
publication:pmid
publication:faculties
publication:rwkex
publication:ptpub
A Collaborative Approach to Decision Making Through Developmental Monitoring to Provide Individualized Services for Children With Cerebral Palsy.
Bartlett, Doreen J
McCoy, Sarah W
Chiarello, Lisa A
Avery, Lisa
Galuppi, Barbara
On Track Study Team,
In this Perspective, we suggest a process to improve physical and occupational therapists’ and families’ collaboration to provide appropriate, efficient, and effective evidence-based services to improve motor function, self-care performance, and participation in family and recreation activities for children with cerebral palsy (CP). This process is informed by 2 multisite prospective cohort studies (Move & PLAY and On Track). The heterogeneity of children with CP is described, limiting the utility of evidence from randomized controlled trials and systematic reviews to inform service planning for children with CP. An evidence-based alternative using prospective cohort studies that produce knowledge of determinants of outcomes important to children and families and methods for developmental monitoring using longitudinal developmental and reference percentile curves to inform individualized care is suggested. Guiding questions are provided to explore how knowledge of determinants and developmental monitoring can inform family-centered, collaborative, strengths-based, and focused service programs to support early development and function. Although this perspective paper is focused on children with CP, the research approach described for collection of useful information and the clinical method of data use may be helpful for people with other heterogeneous chronic health conditions in which physical and occupational therapists face similar challenges.
2018-10-01T07:00:00Z
article
application/pdf
https://ir.lib.uwo.ca/ptpub/45
info:doi/10.1093/ptj/pzy081
https://ir.lib.uwo.ca/context/ptpub/article/1055/viewcontent/Bartlett_et_al___A_collaborative_approach_to_decision_making__Author_accepted_.pdf
Physical Therapy Publications
Scholarship@Western
Cerebral Palsy
Child
Clinical Decision-Making
Disabled Children
Female
Humans
Interdisciplinary Communication
Male
Patient Care Team
Physical Therapy Modalities
Precision Medicine
Physical Therapy
oai:ir.lib.uwo.ca:ptpub-1056
2019-10-04T19:21:49Z
publication:pt
publication:rwkex_researcharticles
publication:pmid
publication:faculties
publication:rwkex
publication:ptpub
Developmental Trajectories for the Early Clinical Assessment of Balance by Gross Motor Function Classification System Level for Children With Cerebral Palsy.
LaForme Fiss, Alyssa
McCoy, Sarah Westcott
Bartlett, Doreen
Avery, Lisa
Hanna, Steven E
On Track Study Team,
Background: Children with cerebral palsy (CP) characteristically present with impairments in balance. Currently, the pattern and timing of the development of balance ability have not been described for children with CP of varying Gross Motor Function Classification System (GMFCS) levels.
Objective: The purpose of this study was to document longitudinal developmental trajectories in a measure of balance, the Early Clinical Assessment of Balance (ECAB) scores, along with age-specific reference percentiles and the amount of change typical over a 1-year period for children within different GMFCS levels.
Design: The design was a longitudinal cohort study.
Methods: Participants included 708 children with CP, aged 18 months through their 12th birthday, and their families. Children participated in 2 to 5 assessments using the GMFCS and ECAB.
Results: Longitudinal trajectories describing the average change in the ECAB score with respect to age were created by fitting separate nonlinear mixed-effect models for children in each GMFCS level. Reference percentiles were constructed using quantile regression of ECAB data from the first visit (baseline) and 12-month and 24-month visits. Using these reference points, the amount of change in percentiles was calculated for all children by subtracting the baseline percentile score from the 12-month percentile score. Children whose percentile changes are within the 80% limits can usually be described as "developing as expected" for their age and GMFCS levels.
Limitations: Limitations of this study included use of a convenience sample, a ceiling effect of the ECAB for some children in GMFCS levels I and II, and the use of both a 12-month and 24-month study protocol that impacted the number of children available for each assessment session.
Conclusions: When used appropriately to monitor development and change over time for children with CP, the ECAB longitudinal trajectories, reference percentiles, and the associated change scores presented here should assist therapists and families in collaborative interaction to proactively plan services and interventions relative to balance ability.
2019-02-01T08:00:00Z
article
application/pdf
https://ir.lib.uwo.ca/ptpub/44
info:doi/10.1093/ptj/pzy132
https://ir.lib.uwo.ca/context/ptpub/article/1056/viewcontent/Fiss_et_al___Developmental_Trajectories_for_the_Early_Clinical_Assessment__Author_accepted_.pdf
Physical Therapy Publications
Scholarship@Western
Balance
Cerebral palsy
Early Clinical Assessment of Balance
Development
Children
Physical Therapy
oai:ir.lib.uwo.ca:ptpub-1057
2019-10-04T19:25:39Z
publication:pt
publication:rwkex_researcharticles
publication:pmid
publication:faculties
publication:rwkex
publication:ptpub
Developmental Trajectories and Reference Percentiles for Range of Motion, Endurance, and Muscle Strength of Children With Cerebral Palsy.
Jeffries, Lynn M
LaForme Fiss, Alyssa
Westcott McCoy, Sarah
Bartlett, Doreen
Avery, Lisa
Hanna, Steven
BACKGROUND: Children with cerebral palsy (CP) frequently present with secondary impairments in spinal alignment and extremity range of motion, endurance for activity, and muscle strength. Creation of developmental trajectories for these impairments will help guide clinical decision-making.
OBJECTIVE: For children in each level of the Gross Motor Function Classification System (GMFCS) this study aimed to: (1) create longitudinal developmental trajectories for range of motion (Spinal Alignment and Range of Motion Measures [SAROMM]), endurance (Early Activity Scale for Endurance [EASE]), and functional strength (Functional Strength Assessment [FSA]); and (2) develop age-specific reference percentiles and amount of change typical over 1 year for these outcomes.
DESIGN: This study used a longitudinal cohort design.
METHODS: Participants comprised 708 children with CP across GMFCS levels, aged 18 months up to the 12th birthday, and their families. In 2 to 5 assessments every 6 months over 2 years, trained therapists performed the SAROMM and FSA, and parents completed the EASE questionnaire. For children in each GMFCS level, longitudinal trajectories using linear and nonlinear mixed-effects models from all visits, and reference percentiles using quantile regression from the first, 12-month, and 24-month visits were created for each measure.
RESULTS: Longitudinal trajectories and percentile graphs for SAROMM, FSA, and EASE were primarily linear, with different performance scores among GMFCS levels. There was much variability in both longitudinal trajectories and percentiles within GMFCS levels.
LIMITATIONS: Limitations included a convenience sample and varying numbers of participants assessed at each visit.
CONCLUSIONS: The longitudinal trajectories and percentile graphs have application for monitoring how children with CP are performing and changing over time compared with other children with CP. The resources presented allow therapists and families to collaboratively make decisions about intervention activities targeted to children's unique needs.
2019-01-02T08:00:00Z
article
application/pdf
https://ir.lib.uwo.ca/ptpub/43
info:doi/10.1093/ptj/pzy160
https://ir.lib.uwo.ca/context/ptpub/article/1057/viewcontent/Jeffries_et_al___Developmental_Trajectories_and_reference_percentiles__author_accepted_.pdf
Physical Therapy Publications
Scholarship@Western
Cerebral palsy
Range of motion
Endurance
Strength
Physical Therapy
oai:ir.lib.uwo.ca:ptpub-1058
2019-10-04T19:33:49Z
publication:pt
publication:pmid
publication:faculties
publication:ptpub
Understanding participation of children with cerebral palsy in family and recreational activities.
Alghamdi, Mohammed S
Chiarello, Lisa A
Palisano, Robert J
McCoy, Sarah W
AIMS: The primary aim of this study was to determine the effect of age, sex, gross motor, manual ability, and communication functions on the frequency and enjoyment of children's participation in family and recreational activities. The secondary aim was to determine the relationships between motor and communication functions and participation.
METHODS: Participants were 694 children, 1.5-12 years old, with cerebral palsy (CP) and their parents across the US and Canada. Parents rated children's frequency and enjoyment of participation using the Child Engagement in Daily Life measure. Parents and therapists identified children's level of function using Gross Motor Function Classification System (GMFCS), Manual Ability Classification System (MACS), and Communication Function Classification System (CFCS).
RESULTS: Differences in frequency and enjoyment of participation were found based on children's GMFCS, MACS, and CFCS levels but not age or sex. Children with higher gross motor, manual, and communication functions had higher frequency and enjoyment of participation, compared to children with lower functions. Frequency of participation was associated with GMFCS and CFCS levels whereas enjoyment of participation was only associated with CFCS level.
IMPLICATIONS: Knowledge of child's gross motor, manual ability, and communication functions of children with CP is important when setting goals and planning interventions for participation.
2017-10-01T07:00:00Z
article
application/pdf
https://ir.lib.uwo.ca/ptpub/42
info:doi/10.1016/j.ridd.2017.07.006
https://ir.lib.uwo.ca/context/ptpub/article/1058/viewcontent/Algmadi_et_al___Understanding_Participation_of_Children__Author_accepted_.pdf
http://creativecommons.org/licenses/by/4.0/
Physical Therapy Publications
Scholarship@Western
Family and recreational participation
Communication function
Gross motor function
Manual ability
Enjoyment of participation
Cerebral palsy
Adolescent
Canada
Cerebral Palsy
Child
Child, Preschool
Disability Evaluation
Family Health
Female
Humans
Male
Motor Skills
Parents
Patient Participation
Recreation
Severity of Illness Index
Social Skills
United States
Physical Therapy
oai:ir.lib.uwo.ca:ptpub-1059
2019-10-04T19:44:17Z
publication:pt
publication:faculties
publication:ptpub
Monitoring development of children with cerebral palsy: The On Track Study. Protocol of a longitudinal study of development and services
Westcott McCoy, Sarah
Bartlett, Doreen
Smersh, Monica
Gallupp, Barbara
Hanna, Steven
BACKGROUND: The purpose of the On Track study is to determine how children with cerebral palsy (CP) progress in their physical development and participation in daily life. Study aims are to create longitudinal trajectories and percentile graphs for physical development and participation to help health care professionals and parents monitor development and track if children are progressing ‘as expected,’ ‘more than expected,’ or ‘less than expected.’ Services received will be explored in children within each developmental category.
METHODS: On Track used a prospective cohort design, in which 708 children with CP were followed; 656 were assessed at least twice (baseline, 12- month) over 1 year and 424 were assessed up to 5 times (baseline, 6-, 12-, 18-, 24-months) over 2 years. Children, aged 1.5-11.9 years, and their families were from Canada and the United States. Children were assessed on standardized measures of body functions and structures, health conditions, activity, and participation. Trained physical and occupational therapists measured balance, range of motion, strength, endurance, and physical activity using valid and reliable tests. Parents completed questionnaires about their family demographics and about their children’s endurance, health, participation in recreation and self-care, and health care services. Therapists and parents collaborated to classify children within five functional levels for gross motor, manual, and communication functions. Body function and participation data from all visits will be analyzed by linear and nonlinear mixed-effects modeling to create longitudinal trajectories by functional classification levels. Data from baseline, 12-month, and 24-month visits will be analyzed via quantile regression to construct cross-sectional reference percentile graphs for each measure by functional classification levels. Using separate multinomial models, service amount, focus, and family-centeredness, controlling for country, will be explored to understand how services relate to children’s development.
DISCUSSION: Developmental results including longitudinal trajectories and percentile ranks on children with CP by functional classification levels and exploration of services will assist health care professionals and families to monitor development and collaborate on service planning. These results will facilitate conversations to improve family-centered care in order to provide the most efficient and effective interventions for children with CP and their families.
2018-03-01T08:00:00Z
report
https://ir.lib.uwo.ca/ptpub/41
https://www.canchild.ca/en/resources/294-monitoring-development-of-children-with-cerebral-palsy-the-on-track-study-protocol-of-a-longitudinal-study-of-development-and-services
Physical Therapy Publications
Scholarship@Western
Cerebral palsy
Longitudinal development
Percentiles
Prognosis
Rehabilitation services
Parent researchers
Physical Therapy
oai:ir.lib.uwo.ca:ptpub-1060
2019-10-17T13:23:32Z
publication:pt
publication:faculties
publication:ptpub
The Comprehensive Professional Behaviours Development Log
Lucy, Deb
Bartlett, Doreen J
Deluzio, Tianna D. B.
2017-01-01T08:00:00Z
article
application/pdf
https://ir.lib.uwo.ca/ptpub/60
https://ir.lib.uwo.ca/context/ptpub/article/1060/viewcontent/CPBDL_Version_2_2017.pdf
Physical Therapy Publications
Scholarship@Western
professional behaviours
physical therapy students
. self-assessment
self-evaluation
Physical Therapy
oai:ir.lib.uwo.ca:ptpub-1061
2019-10-10T17:12:56Z
publication:pt
publication:faculties
publication:ptpub
Longitudinal Change in Common Impairments in Children with Cerebral Palsy from age 1.5 to 11 years
Jeffries, Lynn M
Laforme Fiss, Alyssa
Westcott McCoy, Sarah
Avery, Lisa
Purpose: This project aimed to determine if change occurs over time for impairments of balance, range of motion (ROM), endurance, and strength of children with cerebral palsy (CP), by Gross Motor Function Classification System (GMFCS) levels.
Methods: Measurements were completed in 77 children at two sessions (T1, T2) on average 5.8 years apart. Mean ages were 2.9 years (SD .9) and 8.7 years (SD 1.1) at T1 and T2, respectively.
Results: Significant differences were noted from T1 to T2 for some children (GMFCS levels I, II, and III/IV: balance increased, GMFCS levels I and II: strength increased, and GMFCS levels III/IV and V: ROM decreased). Endurance scores were not different. Endurance scores did not change.
Conclusions: Longitudinal changes in most impairments occurred in children with CP. Monitoring and targeted interventions should support each child’s development.
2019-10-07T07:00:00Z
article
application/pdf
https://ir.lib.uwo.ca/ptpub/61
https://ir.lib.uwo.ca/context/ptpub/article/1061/viewcontent/Jeffries_et_al.___Longitudinal_change_impariments.pdf
Physical Therapy Publications
Scholarship@Western
Impairments
Cerebral palsy
Longitudinal change
Physical Therapy
oai:ir.lib.uwo.ca:ptpub-1062
2021-04-28T15:26:53Z
publication:pt
publication:pmid
publication:faculties
publication:ptpub
A framework for secondary cognitive and motor tasks in dual-task gait testing in people with mild cognitive impairment.
Hunter, Susan W
Divine, Alison
Frengopoulos, Courtney
Montero Odasso, Manuel
BACKGROUND: Cognition is a key factor in the regulation of normal walking and dual-task gait assessment is an accepted method to evaluate the relationship. The objective of this study was to create a framework for task complexity of concurrent motor and cognitive tasks with gait in people with mild cognitive impairment (MCI).
METHODS: Community-dwelling people with MCI (n = 41, mean age = 76.20 ± 7.65 years) and cognitively normal controls (n = 41, mean age = 72.10 ± 3.80 years) participated in this study. Gait velocity was collected using an instrumented walkway under one single task and six combined tasks of motor and cognitive activities. The cognitive cost was the difference between the single gait task and each of the concurrent motor and cognitive challenges. A repeated two-way measure ANOVA assessed the effect of cognitive group and walking test condition for each gait task test.
RESULTS: Gait velocity was significantly slower in the MCI group under all tasks. For both groups, the concurrent motor task of carrying a glass of water conferred a challenge not different from the cognitive task of counting backwards by ones. Performance of the complex cognitive task of serial seven subtractions reduced gait velocity in both groups, but produced a greater change in the MCI group (31.8%).
CONCLUSIONS: Not all concurrent tasks challenge cognition-motor interaction equivalently. This study has created a framework of task difficulty which allows for the translation of dual-task test conditions to future research and clinical practice to ensure the accuracy of assessing patient deficits and risk.
2018-09-03T07:00:00Z
article
application/pdf
https://ir.lib.uwo.ca/ptpub/63
info:doi/10.1186/s12877-018-0894-0
https://ir.lib.uwo.ca/context/ptpub/article/1062/viewcontent/R15_Hunter_Divine_BMCGeriatrics_2018_framework_for_secondary_cognitive_and_motor_task_in_dual_task_gait_testing_in_MCI.pdf
http://creativecommons.org/licenses/by/4.0/
Physical Therapy Publications
Scholarship@Western
Accident Prevention
Accidental Falls
Aged
Aged
80 and over
Cognitive Dysfunction
Cross-Sectional Studies
Female
Gait
Humans
Independent Living
Male
Task Performance and Analysis
Walk Test
Aged, 80 and over
Physical Therapy
oai:ir.lib.uwo.ca:ptpub-1063
2021-04-28T15:31:48Z
publication:pt
publication:pmid
publication:faculties
publication:ptpub
Development, reliability and validity of the Safe Use of Mobility Aids Checklist (SUMAC) for 4-wheeled walker use in people living with dementia.
Hunter, Susan W
Divine, Alison
Omana, Humberto
Madou, Ed
Holmes, Jeffrey
BACKGROUND: Balance and gait problems are common and progressive in dementia. Use of a mobility aid provides physical support and confidence. Yet, mobility aid use in people with dementia increases falls three-fold. An assessment tool of mobility aid safety in people with dementia does not currently exist. The objectives of this study were: 1) to develop a tool for the evaluation of physical function and safe use of a 4-wheeled walker in people with dementia, and 2) to evaluate its construct and criterion validity, inter-rater and test-retest reliability and minimal detectable change.
METHODS: Healthcare professionals (HCP) experienced in rehabilitation of people with dementia participated in focus groups for item generation of the new tool, The Safe Use of Mobility Aid Checklist (SUMAC). The SUMAC evaluates physical function (PF) and safe use of the equipment (EQ) on nine tasks of daily life. Reliability was evaluated by HCP (n = 5) scored participant videos of people with dementia (n = 10) using a 4-wheeled walker performing the SUMAC. Inter-rater and test-retest reliability was assessed using intra-class correlation coefficients (ICC). Construct validity evaluated scores of the HCPs to a consensus HCP panel using Spearman's rank-order correlations. Criterion validity evaluated SUMAC-PF to the Performance-Oriented Mobility Assessment (POMA) gait subscale using Spearman's rank-order correlations.
RESULTS: Three focus groups (n = 17) generated a tool comprised of nine tasks and the components within each task for physical function and safe use. Inter-rater reliability was statistically significant for SUMAC-PF (ICC = 0.92, 95%CI (0.81, 0.98), p < 0.001) and SUMAC-EQ. (ICC = 0.82, 95%CI (0.54, 0.95), p < 0.001). Test-retest reliability was statistically significant for SUMAC-PF (ICC = 0.89, 95%CI (0.81, 0.94), p < 0.001) and SUMAC-EQ. (ICC = 0.88, 95%CI (0.79, 0.93), p < 0.001). As hypothesized, the POMA gait subscale correlated strongly with the SUMAC-PF (r
CONCLUSIONS: The focus groups and research team developed a tool of nine tasks with evaluation on physical function and safe use of a 4-wheeled walker for people with dementia. The SUMAC tool has demonstrated content validity for the whole scale and good construct and criterion validity for the SUMAC-PF and SUMAC-EQ. The subscores of the SUMAC demonstrated excellent to good inter-rater and test-retest reliability.
2020-11-11T08:00:00Z
article
application/pdf
https://ir.lib.uwo.ca/ptpub/62
info:doi/10.1186/s12877-020-01865-5
https://ir.lib.uwo.ca/context/ptpub/article/1063/viewcontent/R04_Hunter_BMCGeriatrics2020_SUMAC_development_reliability___validation.pdf
http://creativecommons.org/licenses/by/4.0/
Physical Therapy Publications
Scholarship@Western
Checklist
Dementia
Humans
Physical Therapy Modalities
Reproducibility of Results
Rhus
Physical Therapy
oai:ir.lib.uwo.ca:ptpub-1065
2021-04-28T17:14:01Z
publication:pt
publication:pmid
publication:faculties
publication:ptpub
Reliability, validity, and agreement of the short-form Activities-specific Balance Confidence Scale in people with lower extremity amputations.
Fuller, Katherine
Omaña Moreno, Humberto Adolfo
Frengopoulos, Courtney
Payne, Michael W
Viana, Ricardo
Hunter, Susan W
BACKGROUND: Clinicians use the Activities-specific Balance Confidence Scale to understand balance confidence. A short-form Activities-specific Balance Confidence scale, was developed using the six most difficult tasks from the original Activities-specific Balance Confidence scale; however, short-form the short-form scale psychometrics and agreement with the original scale have yet to be explored in people with lower extremity amputations.
OBJECTIVE: To determine the relative and absolute reliability, construct validity, and agreement of the short-form Activities-specific Balance Confidence scale.
STUDY DESIGN: Test-retest with a 2-week interval.
METHODS: Analysis for relative reliability and internal consistency was intraclass correlation coefficient and Cronbach's
RESULTS: The short-form Activities-specific Balance Confidence (intraclass correlation coefficient = 0.92) and Activities-specific Balance Confidence (intraclass correlation coefficient = 0.91) scales had excellent relative reliability. Both scales demonstrated good internal consistency. Worse absolute reliability was observed in the short-form Activities-specific Balance Confidence scale. Construct validity against the L Test was confirmed. Bland-Altman plots indicated poor agreement between scales.
CONCLUSION: Both scales exhibit excellent relative reliability and good internal consistency and construct validity. Poor agreement between short-form Activities-specific Balance Confidence and Activities-specific Balance Confidence indicates the scales should not be used interchangeably. Inadequate absolute reliability of the short-form Activities-specific Balance Confidence scale suggests the Activities-specific Balance Confidence should be the balance confidence scale of choice.
CLINICAL RELEVANCE: Balance confidence is an important metric for our understanding of rehabilitation and community re-integration in people with lower extremity amputations. Due to inferior absolute reliability and a lack of appropriate items composing the short-form Activities-specific Balance Confidence scale, the full-scale Activities-specific Balance Confidence is recommended for the assessment of balance confidence in this population.
2019-01-01T08:00:00Z
article
application/pdf
https://ir.lib.uwo.ca/ptpub/71
info:doi/10.1177/0309364619875623
https://ir.lib.uwo.ca/context/ptpub/article/1065/viewcontent/R13_Fuller_Hunter_ProsOrthotInt2019_Reliability_validity__and_agreement_of_the_ABC6_in_PLEA.pdf
http://creativecommons.org/licenses/by/4.0/
Physical Therapy Publications
Scholarship@Western
Adult
Aged
Amputees
Artificial Limbs
Disability Evaluation
Female
Humans
Lower Extremity
Male
Middle Aged
Postural Balance
Psychometrics
Reproducibility of Results
Self Efficacy
Physical Therapy
oai:ir.lib.uwo.ca:ptpub-1064
2021-04-28T17:04:37Z
publication:pt
publication:pmid
publication:faculties
publication:ptpub
Effect of Learning to Use a Mobility Aid on Gait and Cognitive Demands in People with Mild to Moderate Alzheimer's Disease: Part II - 4-Wheeled Walker.
Hunter, Susan W
Divine, Alison
Omana, Humberto
Wittich, Walter
Hill, Keith D
Johnson, Andrew M
Holmes, Jeffrey D
BACKGROUND: Cognitive deficits and gait problems are common and progressive in Alzheimer's disease (AD). Prescription of a 4-wheeled walker is a common intervention to improve stability and independence, yet can be associated with an increased falls risk.
OBJECTIVES: 1) To examine changes in spatial-temporal gait parameters while using a 4-wheeled walker under different walking conditions, and 2) to determine the cognitive and gait task costs of walking with the aid in adults with AD and healthy older adults.
METHODS: Twenty participants with AD (age 79.1±7.1 years) and 22 controls (age 68.5±10.7 years) walked using a 4-wheeled walker in a straight (6 m) and Figure of 8 path under three task conditions: single-task (no aid), dual-task (walking with aid), and multi-task (walking with aid while counting backwards by ones).
RESULTS: Gait velocity was statistically slower in adults with AD than the controls across all conditions (all p values
CONCLUSION: Learning to use a 4-wheeled walker is cognitively demanding and any additional tasks increases the demands, further adversely affecting gait. The increased cognitive demands result in a decrease in gait velocity that is greatest in adults with AD. Future research needs to investigate the effects of mobility aid training on gait performance.
2019-01-01T08:00:00Z
article
application/pdf
https://ir.lib.uwo.ca/ptpub/72
info:doi/10.3233/JAD-181170
https://ir.lib.uwo.ca/context/ptpub/article/1064/viewcontent/R11_Hunter_Holmes_JAlzDis2019_novice_walker_use_in_AD.pdf
http://creativecommons.org/licenses/by/4.0/
Physical Therapy Publications
Scholarship@Western
Accidental Falls
Aged
Aged
80 and over
Alzheimer Disease
Attention
Cognition
Female
Gait
Humans
Learning
Male
Middle Aged
Neuropsychological Tests
Severity of Illness Index
Spatio-Temporal Analysis
Walkers
Aged, 80 and over
Physical Therapy
oai:ir.lib.uwo.ca:ptpub-1067
2021-04-28T17:22:57Z
publication:pt
publication:pmid
publication:faculties
publication:ptpub
Comparison of functional and patient-reported outcomes between direct anterior and lateral surgical approach one-year after total hip arthroplasty in a Canadian population: A cross-sectional study.
Hunter, Susan W
Bobos, Pavlos
Somerville, Lyndsay
Howard, James
Vasarhelyi, Edward
Lanting, Brent
Background: From a clinical perspective, it is important to understand the outcomes that occur after total hip arthroplasty (THA) and do these vary with surgical approach. The objective of the study was to compare physical performance-based and patient-report outcomes between the Direct Anterior (DA) and Direct Lateral (DL) surgical approach at one-year after THA surgery.
Methods: We evaluated patients attending their one-year follow-up assessment after primary elective unilateral THA surgery for osteoarthritis of the hip. The Activities-specific Balance Confidence Scale, Falls Risk in Older People in a Community Setting, Timed Up and Go Test, 30-Second Chair Stand Test, Step Test, 6-Meter Walk Test, Harris Hip Score (HHS), Short-form 12 and the Western Ontario and McMaster Osteoarthritis Index (WOMAC) were assessed. The standardized mean difference (SMD) and 95% confidence intervals (CI) was calculated to evaluate the statistical difference between groups and the magnitude of the effects.
Results: In total, 135 individuals met the inclusion criteria and participated in the study. A statistically significant and clinically important difference in favor of the DA was found for the WOMAC (0.60, 95% CI (0.25, 0.95), p = .004), SF-12 Physical component (0.42, 95% CI (0.07, 0.76), p = .01) and 6-Meter Walk Test (0.52, 95% CI (-0.86, -0.17), p = .009). Small effect sizes, though not statistically significant differences, were found in favor of the DA approach for the other patient-report and physical performance-based measures.
Conclusion: The WOMAC, gait speed and SF-12 Physical component scores were significantly different in favor of the DA procedure at one-year after THA. However, only the WOMAC scores exceeded a clinically important threshold in favor of DA approach. The other self-report and physical performance measures were not significantly different between the two procedures at one-year postoperatively.
2019-11-13T08:00:00Z
article
application/pdf
https://ir.lib.uwo.ca/ptpub/69
info:doi/https://doi.org10.1016/j.jor.2019.11.004
https://ir.lib.uwo.ca/context/ptpub/article/1067/viewcontent/R08_Hunter_JOrthopaedics2019_Comparison_of_direct_anterior_and_lateral_THA_in_Canadian_population_final.pdf
http://creativecommons.org/licenses/by-nc-nd/4.0/
Physical Therapy Publications
Scholarship@Western
Total hip arthroplasty
Outcomes
Surgery
Functional tests
Physical Therapy
oai:ir.lib.uwo.ca:ptpub-1066
2021-04-28T17:17:21Z
publication:pt
publication:pmid
publication:faculties
publication:ptpub
Cognition Predicts Mobility Change in Lower Extremity Amputees Between Discharge From Rehabilitation and 4-Month Follow-up: A Prospective Cohort Study.
Hunter, Susan W
Bobos, Pavlos
Frengopoulos, Courtney
Macpherson, Austin
Viana, Ricardo
Payne, Michael W
OBJECTIVES: To assess (1) the effect of task (single and dual task), time (discharge and 4mo), and their interaction for mobility; (2) task prioritization during dual-task testing; and (3) the association between cognition on change in mobility between discharge from rehabilitation and 4 months' follow-up.
DESIGN: Prospective cohort study.
SETTING: Rehabilitation hospital.
PARTICIPANTS: People with lower extremity amputations (N=22) were consecutively recruited at discharge from an inpatient prosthetic rehabilitation program.
INTERVENTIONS: Not applicable.
MAIN OUTCOME MEASURES: Gait velocity and the L Test of Functional Mobility, single and dual task (serial subtractions by 3), were the primary outcomes. Montreal Cognitive Assessment and Trail Making Test quantified cognition as secondary outcomes. Repeated measures analysis of variance evaluated the effects of task (single task and dual task) and time (at discharge and 4 months' follow-up) and their interaction on each outcome. A performance-resource operating characteristic graph evaluated gait and cognitive task prioritization. Multivariable linear regression evaluated the association between cognition and change in mobility over time.
RESULTS: No significant interactions between task and time were found (all P>.121) for L Test and gait velocity. The L Test single task (P=.001) and dual task (P=.004) improved over time. Gait velocity improved over time for both single task and dual task (P
CONCLUSIONS: Gait velocity and L Test single and dual task improved over time. No significant interactions indicated that cognitive task did not differentially affect performance over time. Lower executive function scores at discharge were independently associated with lower gains in all gait velocity and dual-task L Test outcomes at follow-up.
2019-01-01T08:00:00Z
article
application/pdf
https://ir.lib.uwo.ca/ptpub/70
info:doi/10.1016/j.apmr.2019.05.030
https://ir.lib.uwo.ca/context/ptpub/article/1066/viewcontent/R09_Hunter_Bobos_ArchPhysMedRehabil2019_Mobility_change_over_time_in_amps.pdf
http://creativecommons.org/licenses/by-nc-nd/4.0/
Physical Therapy Publications
Scholarship@Western
Accidental Falls
Age Factors
Aged
Amputation
Amputees
Body Mass Index
Cognition
Female
Humans
Lower Extremity
Male
Mental Status and Dementia Tests
Middle Aged
Mobility Limitation
Patient Discharge
Physical Therapy Modalities
Prospective Studies
Sex Factors
Time Factors
Walking Speed
Physical Therapy
oai:ir.lib.uwo.ca:ptpub-1069
2021-04-28T17:33:16Z
publication:pt
publication:pmid
publication:faculties
publication:ptpub
Evaluating knowledge of falls risk factors and falls prevention strategies among lower extremity amputees after inpatient prosthetic rehabilitation: a prospective study
Hunter, Susan W
Higa, Jordan
Frengopoulos, Courtney
Viana, Ricardo
Payne, Michael
Purpose: Falls are prevalent among people with lower extremity amputations. A knowledge of risk factors is important in preventing falls, though no research has evaluated patient understanding of falls in this population. The study objective was to evaluate knowledge of falls risk factors and falls prevention strategies at discharge and 4-months after inpatient prosthetic rehabilitation.
Methods: Participants completed a falls questionnaires with four sections: (1) falls during rehabilitation and after discharge, (2) falls self-efficacy using the Activities-specific Balance Confidence scale, (3) knowledge of falls risk factors, and (4) falls prevention strategies. Questionnaire responses were quantified using means and standard deviations or frequencies and percentages. Data were analyzed using paired t-tests for the Activities-specific Balance Confidence scale and the knowledge of falls risk factors, and using chi-square analyses for fall prevention strategies.
Results: Twenty-seven individuals (aged 62.6 ± 8.4; 55.6% male) were included. Unsafe or risky behaviours and not paying attention to surroundings were perceived as the top two falls risk factors. Although these factors are modifiable, only 5.9% of participants listed preventative behavioural modifications. No significant differences were found in Activities-specific Balance Confidence scale scores (p = 0.404) or knowledge of falls risk factors (p = 0.361) between discharge and follow-up.
Conclusion: This study highlights a gap between knowledge of falls risk factors and the application of knowledge to prevent falls. Follow-up data suggest that lived experience does not affect the knowledge of falls risk factors.
2019-01-27T08:00:00Z
article
application/pdf
https://ir.lib.uwo.ca/ptpub/67
info:doi/10.1080/09638288.2018.1555721
https://ir.lib.uwo.ca/context/ptpub/article/1069/viewcontent/R05_Hunter_Higa_DisabilRehabil2020_Knowledge_of_falls___fall_prevention_strategies_in_LLA_final.pdf
http://creativecommons.org/licenses/by-nc/4.0/
Physical Therapy Publications
Scholarship@Western
Amputation
Falls
Lower extremity
Rehabilitation
Fall prevention
Physical Therapy
oai:ir.lib.uwo.ca:ptpub-1068
2021-04-28T17:27:21Z
publication:pt
publication:pmid
publication:faculties
publication:ptpub
Effect of dual-tasking on walking and cognitive demands in adults with Alzheimer's dementia experienced in using a 4-wheeled walker
Hunter, Susan W
Omana, Humberto
Madou, Edward
Wittich, Walter
Hill, Keith D
Johnson, Andrew M
Divine, Alison
Holmes, Jeffrey D
BACKGROUND: Learning to walk with a 4-wheeled walker increases cognitive demands in people with Alzheimer's dementia (AD). However, it is expected that experience will offset the increased cognitive demand. Current research has not yet evaluated gait in people with AD experienced in using a 4-wheeled walker under complex gait situations.
RESEARCH QUESTION: What is the effect of dual-task testing on the spatial-temporal gait parameters and cognitive performance of people with AD experienced with a 4-wheeled walker?
METHODS: Twenty-three adults with mild to moderate AD (87.4 ± 6.2 years, 48 % female) and at least 6 months of walker use experience participated. Three walking configurations: 1) straight path (SP), 2) Groningen Meander Walking Test (GMWT), and 3) Figure of 8 path (F8) were tested under two walking conditions: 1) single-task (walking with aid) and 2) dual-task (walking with aid and completing a cognitive task). Tri-axial accelerometers collected velocity, cadence and stride time variability (STV). Gait and cognitive task cost were the percentage difference between single-task and dual-task conditions. Two-way repeated measures ANOVAs were used to answer the study question.
RESULTS: A significant interaction between walking configuration and condition was found for velocity (p = 0.002, ω
SIGNIFICANCE: Dual-task testing in experienced users results in slower walking, fewer steps and increased STV, which increases falls risk in people with mild to moderate AD and becomes most pronounced in complex environments.
2020-03-01T08:00:00Z
article
application/pdf
https://ir.lib.uwo.ca/ptpub/68
info:doi/10.1016/j.gaitpost.2020.01.024
https://ir.lib.uwo.ca/context/ptpub/article/1068/viewcontent/R06_Hunter_Gait_Posture2020_Effect_of_dualtask_on_gait_AD_experienced_walker_users_final.pdf
http://creativecommons.org/licenses/by-nc-nd/4.0/
Physical Therapy Publications
Scholarship@Western
Alzheimer Disease
Assistive devices
Gait
Multitasking Behavior
Walkers
Aged
Aged, 80 and over
Cognition
Female
Humans
Male
Middle Aged
Walk Test
Walking
Physical Therapy
oai:ir.lib.uwo.ca:ptpub-1071
2021-04-28T17:40:45Z
publication:pt
publication:pmid
publication:faculties
publication:ptpub
Prevalence and Risk Factors of Falls in Adults 1 Year After Total Hip Arthroplasty for Osteoarthritis: A Cross-Sectional Study
Hunter, Susan W
Bobos, Pavlos
Somerville, Lyndsay
Howard, James
Vasarhelyi, Edward M
Lanting, Brent
Total hip arthroplasty is very successful in alleviating the pain from osteoarthritis. However, deficits in lower limb strength, gait, and balance after surgery has identified this group at risk of falls. Considering the high number of people annually receiving a total hip arthroplasty, further elaboration of factors associated with falls is needed to refine fall prevention guidelines. The objective was to examine the prevalence and circumstances of falling and the risk factors associated with falling in older adults in the first year after total hip arthroplasty surgery. This was a cross-sectional study involving 108 individuals (age of 72.4 ± 6.5 yrs, 60% females) who had unilateral total hip arthroplasty. The primary outcome was falls and their circumstances during the 12 mos after the total hip arthroplasty. Twenty-five people (23.1%) had at least one fall and most falls (56%) occurred 6-12 mos after surgery. Falls resulted in minor injuries for 44% and 12% reported major injuries. The strongest independent predictor for falls was a history of a previous joint replacement with odds ratio of 7.38 (95% CI = 2.41-22.62, P < 0.001). Overall, the information highlights that falls are common after total hip arthroplasty, yet considering the older age of people having this surgery screening for falls risk should follow established guidelines.
2020-04-23T07:00:00Z
article
application/pdf
https://ir.lib.uwo.ca/ptpub/65
info:doi/10.1097/PHM.0000000000001456
https://ir.lib.uwo.ca/context/ptpub/article/1071/viewcontent/R02_Hunter_AmJPhysMedRehabil2020_Prevalence_and_risk_factors_for_falls_one_year_after_THA_final.pdf
http://creativecommons.org/licenses/by-nc/4.0/
Physical Therapy Publications
Scholarship@Western
Accidental Falls
Aged
Aged
80 and over
Arthroplasty
Replacement
Hip
Cross-Sectional Studies
Female
Humans
Male
Odds Ratio
Osteoarthritis
Hip
Postoperative Period
Prevalence
Risk Factors
Aged, 80 and over
Arthroplasty, Replacement, Hip
Osteoarthritis, Hip
Physical Therapy
oai:ir.lib.uwo.ca:ptpub-1070
2021-04-28T17:36:42Z
publication:pt
publication:pmid
publication:faculties
publication:ptpub
Executive function as a mediating factor between visual acuity and postural stability in cognitively healthy adults and adults with Alzheimer's dementia
Hunter, Susan W
Divine, Alison
Madou, Edward
Omana, Humberto
Hill, Keith D
Johnson, Andrew M
Holmes, Jeffrey D
Wittich, Walter
BACKGROUND: Falls in older adults, notably those with Alzheimer's dementia (AD), are prevalent. Vision and balance impairments are prominent falls risk factors in older adults. However, recent literature in the cognitively impaired suggests that executive function (EF) is important for falls risk assessments. The study objectives were to: 1) to compare balance among people with AD, healthy older adults (OA), and healthy young adults (YA) and 2) to quantify the interaction of visual acuity and EF on postural stability.
METHODS: We recruited 165 individuals (51 YA, 48 OA, and 66 AD). Trail Making Tests (A and B) quantified EF and the Colenbrander mixed contrast chart measured high and low contrast visual acuity. Accelerometers recorded postural sway during the Modified Test for Sensory Integration. A two-way repeated measures ANOVA examined postural sway differences across groups. Mediation analysis quantified the association of EF in the relationship between contrast sensitivity and postural sway.
RESULTS: Significant EF and visual acuity between-group differences were observed (p < 0.001). For postural sway, a significant interaction existed between group and balance condition (p < 0.001). In general, EF was a significant mediator between visual acuity and postural sway. Visual acuity, EF and postural sway was worse with increased age, particularly in the AD group.
CONCLUSIONS: Mediation analysis revealed that individuals with poorer visual acuity had poorer EF, and those with poorer executive function had poorer balance control. These results highlight the importance of assessing not only vision and balance but also EF, especially in older individuals living with AD.
2020-04-19T07:00:00Z
article
application/pdf
https://ir.lib.uwo.ca/ptpub/66
info:doi/10.1016/j.archger.2020.104078
https://ir.lib.uwo.ca/context/ptpub/article/1070/viewcontent/R03_Hunter_ArchGeriatrGerontol2020_Executive_function_in_vision_and_balance_in_AD_final.pdf
http://creativecommons.org/licenses/by-nc-nd/4.0/
Physical Therapy Publications
Scholarship@Western
Accidental Falls
Aged
Alzheimer Disease
Executive Function
Humans
Postural Balance
Posture
Visual Acuity
Physical Therapy
oai:ir.lib.uwo.ca:ptpub-1072
2021-04-28T17:45:57Z
publication:pt
publication:pmid
publication:faculties
publication:ptpub
Association Between Changes in Subjective and Objective Measures of Mobility in People With Lower Limb Amputations After Inpatient Rehabilitation
Cieslak, Gabrielle
Omana, Humberto
Madou, Edward
Frengopoulos, Courtney
Viana, Ricardo
Payne, Michael W
Hunter, Susan W
Functional recovery for people with lower limb amputations is quantified using objective or subjective measures of performance. In this brief report, the prospective relationship between objective and subjective mobility after rehabilitation was evaluated in people with lower limb amputations. Adults undergoing inpatient prosthetic rehabilitation for a first unilateral transtibial or transfemoral level lower limb amputation were recruited. Assessment times: discharge and 4-mo follow-up. Gait velocity and the L Test under single- and dual-task conditions measured objective mobility. The Prosthetic Evaluation Questionnaire (section 4 and question 5b) measured subjective mobility. Paired t tests and Pearson correlation analysis evaluated change over time and the association between mobility types, respectively. Twenty-one people with lower limb amputations (61.6 ± 8.2 yrs) participated. Gait velocity significantly improved (single- and dual-task: P < 0.001). L Test significantly improved for single-task (P = 0.002) but not dual-task conditions. No statistically significant Prosthetic Evaluation Questionnaire changes were observed. One subjective mobility question (sidewalk walking) correlated with objective mobility at follow-up (L Test single- and dual-task: r = -0.77; P < 0.001). Objective mobility improved after discharge; however, subjective reporting had no change. Lack of association may represent a mismatch between quantitative outcomes and subjective self-assessment. Both subjective and objective measures of mobility should be collected to provide a holistic picture of clinical and patient-relevant outcomes in people with lower limb amputations.
2020-06-09T07:00:00Z
article
application/pdf
https://ir.lib.uwo.ca/ptpub/64
info:doi/https://doi.org./10.1097/phm.0000000000001490
https://ir.lib.uwo.ca/context/ptpub/article/1072/viewcontent/R01_Cieslak_Hunter_AmJPhysMedRehabil2020_Obj_vs_Sub_mobility_in_PLLA_FINAL.pdf
http://creativecommons.org/licenses/by-nc/4.0/
Physical Therapy Publications
Scholarship@Western
Gait
Lower Extremity
Prosthesis and implants
Self-assessment
Aged
Amputation
Amputees
Disability Evaluation
Female
Humans
Inpatients
Male
Middle Aged
Mobility Limitation
Patient Reported Outcome Measures
Prospective Studies
Recovery of Function
Treatment Outcome
Physical Therapy
oai:ir.lib.uwo.ca:ptpub-1073
2021-04-29T14:01:24Z
publication:pt
publication:pmid
publication:faculties
publication:ptpub
Effect of Learning to Use a Mobility Aid on Gait and Cognitive Demands in People with Mild to Moderate Alzheimer's Disease: Part I - Cane
Hunter, Susan W
Divine, Alison
Omana, Humberto
Wittich, Walter
Hill, Keith D
Johnson, Andrew M
Holmes, Jeffrey D
BACKGROUND: People with Alzheimer's disease (AD) exhibit balance and walking impairments that increase falls risk. Prescription of a mobility aid is done to improve stability, yet also requires increased cognitive resources. Single-point canes require unique motor sequencing for safe use. The effect of learning to use a single-point cane has not been evaluated in people with AD.
OBJECTIVES: In people with AD and healthy adult controls: 1) examine changes in gait while using a cane under various walking conditions; and 2) determine the cognitive and gait costs associated with concurrent cane walking while multi-tasking.
METHODS: Seventeen participants with AD (age 82.1±5.6 years) and 25 healthy controls (age 70.8±14.1 years) walked using a single-point cane in a straight (6 meter) and a complex (Figure of 8) path under three conditions: single-task (no aid), dual-task (walking with aid), and multi-task (walking with aid while counting backwards by ones). Velocity and stride time variability were recorded with accelerometers.
RESULTS: Gait velocity significantly slowed for both groups in all conditions and stride time variability was greater in the AD group. Overall, multi-tasking produced a decrease in gait and cognitive demands for both groups, with more people with AD self-prioritizing the cognitive task over the gait task.
CONCLUSION: Learning to use a cane demands cognitive resources that lead to detrimental changes in velocity and stride time variability. This was most pronounced in people with mild to moderate AD. Future research needs to investigate the effects of mobility aid training on gait performance.
2019-05-20T07:00:00Z
article
application/pdf
https://ir.lib.uwo.ca/ptpub/76
info:doi/10.3233/JAD-181169
https://ir.lib.uwo.ca/context/ptpub/article/1073/viewcontent/R10_Hunter_Holmes_JAlzDis2019_novice_cane_use_in_AD.pdf
http://creativecommons.org/licenses/by/4.0/
Physical Therapy Publications
Scholarship@Western
Aged
assistive devices
cane
dementia
gait
Aged, 80 and over
Alzheimer Disease
Attention
Canes
Cognition
Female
Gait
Humans
Learning
Male
Neuropsychological Tests
Severity of Illness Index
Physical Therapy
oai:ir.lib.uwo.ca:ptpub-1074
2021-04-29T14:07:14Z
publication:pt
publication:faculties
publication:ptpub
Physiotherapy Students’ Attitudes Toward Working With People With Dementia: A Cross-Sectional Survey
Hunter, Susan W
Armstrong, Jessica
Silva, Mark
Devine, Alison
Aims: To understand personal, educational and clinical experiences and the attitudes of physiotherapy students towards people with dementia.
Methods: Online survey questionnaire. Physiotherapy students in the last year of a two-year Masters of Physical Therapy (MPT) entry-to-practice degree program (n = 59) were surveyed. Descriptive statistics were used to analyze the data.
Results: Fifty-five students participated (93%). The majority of students (n = 52/55, 77%) had at least one clinical placement working with people with dementia. Overall, 53% (n = 29/55) felt their academic training was sufficient to effectively work with people with dementia. Moreover, 82% (n = 45/55) reported their confidence was greatest working with people who could communicate well verbally.
Conclusions: Disease-based knowledge was strong, yet just over half felt their academic training was sufficient to effectively work with people with dementia. The findings support the need for more training, particularly in communication strategies, to support students to effectively work with client with dementia upon graduation.
2019-01-01T08:00:00Z
article
application/pdf
https://ir.lib.uwo.ca/ptpub/75
info:doi/10.1080/02703181.2019.1690088
https://ir.lib.uwo.ca/context/ptpub/article/1074/viewcontent/R07_Hunter_POTGeriatr2020_PT_students_attitude_to_PLWD_final.pdf
http://creativecommons.org/licenses/by-nc/4.0/
Physical Therapy Publications
Scholarship@Western
attitudes
dementia
students
survey and questionnaires
Physical Therapy
oai:ir.lib.uwo.ca:ptpub-1075
2021-04-29T14:16:05Z
publication:pt
publication:pmid
publication:faculties
publication:ptpub
Risk Factors for Falls in Individuals With Lower Extremity Amputations During the Pre-Prosthetic Phase: A Retrospective Cohort Study
Vu, Kimberly
Payne, Michael W C
Hunter, Susan W
Viana, Ricardo
BACKGROUND: Falls in individuals with lower limb amputations (LLAs) pose significant health concerns. The literature is limited regarding falls during the preprosthetic phase of rehabilitation for persons with LLAs.
OBJECTIVE: To determine the incidence of falls and identify factors associated with falls during the preprosthetic recovery phase.
DESIGN: Retrospective chart audit.
SETTING: Inpatient rehabilitation program.
PARTICIPANTS: Four hundred forty individuals with LLAs (age ± SD = 61.93 ± 14.53 years, 73.18% male) who attended inpatient rehabilitation from 26 July 2011 to 21 August 2017.
INTERVENTIONS: Not applicable.
MAIN OUTCOME MEASUREMENTS: The number of self-reported falls was recorded from the time of surgery to admission for inpatient rehabilitation. Outcomes of interest were any fall (1+ fall) and recurrent falls (2+ falls). A retrospective chart audit was performed on consecutive admissions to an inpatient rehabilitation program.
RESULTS: The incidence of falls was 8.37 per 1000 patient-days. Falls were sustained by 60.9% of the sample. Unilateral transtibial amputation was independently associated with an increased risk of recurrent falls (relative risk [RR] 1.59, 95% confidence interval [CI] 1.13-2.23, P = .008). Diabetes mellitus was independently associated with an increased risk of any fall (RR 1.18, 95% CI 1.01-.38, P = .03). Finally, bilateral transtibial amputation was independently associated with a reduced risk of any fall (RR 0.59, 95% CI 0.39-0.90, P = .014).
CONCLUSIONS: Consistent with the current literature, diabetes mellitus and a unilateral transtibial amputation were risk factors for falling, whereas a bilateral transtibial amputation and increasing age presented new findings as factors associated with decreased falling.
LEVEL OF EVIDENCE: III.
2019-04-01T07:00:00Z
article
application/pdf
https://ir.lib.uwo.ca/ptpub/74
info:doi/10.1002/pmrj.12046
https://ir.lib.uwo.ca/context/ptpub/article/1075/viewcontent/R12_Vu_Hunter_PM_R_Risk_factors_for_falls_in_LLA_during_preprosthetic_phase_final.pdf
http://creativecommons.org/licenses/by-nc/4.0/
Physical Therapy Publications
Scholarship@Western
Accidental Falls
Age Factors
Aged
Aged, 80 and over
Amputation
Amputees
Artificial Limbs
Cohort Studies
Female
Follow-Up Studies
Humans
Incidence
Inpatients
Logistic Models
Lower Extremity
Male
Middle Aged
Multivariate Analysis
Prognosis
Prosthesis Fitting
Rehabilitation Centers
Retrospective Studies
Risk Assessment
Sex Factors
Tibia
Treatment Outcome
Physical Therapy
oai:ir.lib.uwo.ca:ptpub-1076
2021-04-29T14:23:26Z
publication:pt
publication:faculties
publication:ptpub
Relationship between body image and physical functioning following rehabilitation for lower-limb amputation
Desrochers, Jessica
Frengopoulos, Courtney
Payne, Michael W.C.
Viana, Ricardo
Hunter, Susan W
The aim of the present study was to evaluate change in body image and the association between body image at discharge and mobility 4 months after rehabilitation. A prospective cohort comprising adults older than or equal to 50 years of age undergoing rehabilitation for first major lower-limb amputation at an inpatient prosthetic rehabilitation program were assessed at discharge and 4 months after rehabilitation. Paired t-tests compared total Amputee Body Image Scale (ABIS), gait velocity, and L-test scores between discharge (T1) and 4 months (T2). Multivariable linear regression assessed relationship between ABIS scores and mobility. Nineteen participants completed assessments (mean±SD age=60.86±6.85 years; 63.20% male patients). Body image changed from T1 (43.58±7.83) to T2 (48.26±12.21), but was not statistically significant (P=0.063). Mobility significantly improved at T2. ABIS scores at T1 were not associated with mobility at T2. Mobility improved after discharge but was not related to body image at T1. Additional research on the impact of body image perception on patient outcomes after rehabilitation is needed.
2019-01-01T08:00:00Z
article
application/pdf
https://ir.lib.uwo.ca/ptpub/73
info:doi/10.1097/MRR.0000000000000329
https://ir.lib.uwo.ca/context/ptpub/article/1076/viewcontent/R14_Desrochers_Hunter_IntJRehabilRes2019_Association_of_body_image_on_mobility_after_discharge_final.pdf
http://creativecommons.org/licenses/by-nc/4.0/
Physical Therapy Publications
Scholarship@Western
amputation
body image
lower extremity
rehabilitation
Physical Therapy
oai:ir.lib.uwo.ca:neurosci_inst_pubs-1024
2022-09-16T15:42:03Z
publication:pt
publication:neurosci_inst_pubs
publication:faculties
publication:neurosci_inst
publication:institutes
publication:ptpub
The measurement properties of the Lean-and-Release test in people with incomplete spinal cord injury or disease
Unger, Janelle
Oates, Alison R.
Lanovaz, Joel
Chan, Katherine
Lee, Jae W.
Theventhiran, Pirashanth
Masani, Kei
Musselman, Kristin E.
Objective: To evaluate test-retest reliability, agreement, and convergent validity of the Lean-and-Release test for the assessment of reactive stepping among individuals with incomplete spinal cord injury or disease (iSCI/D). Design: Multi-center cross-sectional multiple test design. Setting: SCI/D rehabilitation hospital and biomechanics laboratory. Participants: Individuals with motor incomplete SCI/D (iSCI/D). Interventions: None. Outcome Measures: Twenty-six participants attended two sessions to complete the Lean-and-Release test and a battery of clinical tests. Behavioral (i.e. one-step, multi-step, loss of balance) and temporal (i.e. timing of foot off, foot contact, swing of reactive step) parameters were measured. Test-retest reliability was determined with intraclass correlation coefficients, and agreement was evaluated with Bland–Altman plots. Convergent validity was assessed through correlations with clinical tests. Results: The behavioral responses were reliable for the Lean-and-Release test (ICC = 0.76), but foot contact was the only reliable temporal parameter using data from a single site (ICC = 0.79). All variables showed agreement according to the Bland–Altman plots. The behavioral responses correlated with scores of lower extremity strength (0.54, P<0.01) and balance confidence (0.55, P < 0.01). Swing time of reactive stepping correlated with step time (0.73, P < 0.01) and cadence (−0.73 P < 0.01) of over ground walking. Conclusions: The behavioral response of the Lean-and-Release test is a reliable and valid measure for people with iSCI/D. Our findings support the use of the behavioral responses to evaluate reactive stepping for research and clinical purposes. Trial registration: ClinicalTrials.gov identifier: NCT02960178.
2022-01-01T08:00:00Z
text
application/pdf
https://ir.lib.uwo.ca/neurosci_inst_pubs/25
info:doi/10.1080/10790268.2020.1847562
https://ir.lib.uwo.ca/context/neurosci_inst_pubs/article/1024/viewcontent/Unger_2022_Measurement.pdf
Neuroscience Institute Publications
Scholarship@Western
Postural balance
Spinal cord injuries
Validation study
oai:ir.lib.uwo.ca:neurosci_inst_pubs-1022
2022-09-16T15:42:03Z
publication:pt
publication:neurosci_inst_pubs
publication:faculties
publication:neurosci_inst
publication:institutes
publication:ptpub
Quantifying the amount of physical rehabilitation received by individuals living with neurological conditions in the community: a scoping review
Saumur, Tyler M.
Gregor, Sarah
Xiong, Yijun
Unger, Janelle
Background: Physical rehabilitation is often prescribed immediately following a neurological event or a neurological diagnosis. However, many individuals require physical rehabilitation after hospital discharge. The purpose of this scoping review was to determine the amount of physical rehabilitation that individuals living in the community with neurological conditions receive to understand current global practices and assess gaps in research and service use. Methods: This scoping review included observational studies that 1) involved adults living with a neurological condition, and 2) quantified the amount of rehabilitation being received in the community or outpatient hospital setting. Only literature published in English was considered. MEDLINE, EMBASE, AMED, CINAHL, Cochrane Library, and PEDro databases were searched from inception. Two independent reviewers screened titles and abstracts, followed by full texts, and data extraction. Mean annual hours of rehabilitation was estimated based on the amount of rehabilitation reported in the included studies. Results: Overall, 18 studies were included after screen 14,698 articles. The estimated mean annual hours of rehabilitation varied greatly (4.9 to 155.1 h), with individuals with spinal cord injury and stroke receiving the greatest number of hours. Participants typically received more physical therapy than occupational therapy (difference range: 1 to 22 h/year). Lastly, only one study included individuals with progressive neurological conditions, highlighting a research gap. Discussion: The amount of rehabilitation received by individuals with neurological conditions living in the community varies greatly. With such a wide range of time spent in rehabilitation, it is likely that the amount of rehabilitation being received by most individuals in the community is insufficient to improve function and quality of life. Future work should identify the barriers to accessing rehabilitation resources in the community and how much rehabilitation is needed to observe functional improvements.
2022-12-01T08:00:00Z
text
application/pdf
https://ir.lib.uwo.ca/neurosci_inst_pubs/23
info:doi/10.1186/s12913-022-07754-4
https://ir.lib.uwo.ca/context/neurosci_inst_pubs/article/1022/viewcontent/Unger_2022_Quantifying.pdf
Neuroscience Institute Publications
Scholarship@Western
oai:ir.lib.uwo.ca:neurosci_inst_pubs-1023
2022-09-16T15:42:03Z
publication:pt
publication:neurosci_inst_pubs
publication:faculties
publication:neurosci_inst
publication:institutes
publication:ptpub
Correction to: The experiences of people with incomplete spinal cord injury or disease during intensive balance training and the impact of the program: A qualitative study (Spinal Cord, (2022), 10.1038/s41393-022-00823-9)
Unger, Janelle
Singh, Hardeep
Mansfield, Avril
Masani, Kei
Musselman, Kristin E.
The original version of this article contained a spelling error in an author name. The last name of the corresponding author, Dr. Kristin Musselman, should be corrected from Mussleman to Musselman. The original article has been corrected.
2022-01-01T08:00:00Z
text
application/pdf
https://ir.lib.uwo.ca/neurosci_inst_pubs/24
info:doi/10.1038/s41393-022-00849-z
https://ir.lib.uwo.ca/context/neurosci_inst_pubs/article/1023/viewcontent/Unger_2022_Correction.pdf
Neuroscience Institute Publications
Scholarship@Western
oai:ir.lib.uwo.ca:neurosci_inst_pubs-1096
2022-09-30T13:48:03Z
publication:pt
publication:neurosci_inst_pubs
publication:faculties
publication:neurosci_inst
publication:institutes
publication:ptpub
Frontal, Sensorimotor, and Posterior Parietal Regions Are Involved in Dual-Task Walking After Stroke
Lim, Shannon B.
Peters, Sue
Yang, Chieh Ling
Boyd, Lara A.
Liu-Ambrose, Teresa
Eng, Janice J.
Background: Walking within the community requires the ability to walk while simultaneously completing other tasks. After a stroke, completing an additional task while walking is significantly impaired, and it is unclear how the functional activity of the brain may impact this. Methods: Twenty individual in the chronic stage post-stroke participated in this study. Functional near-infrared spectroscopy (fNIRS) was used to measure prefrontal, pre-motor, sensorimotor, and posterior parietal cortices during walking and walking while completing secondary verbal tasks of varying difficulty. Changes in brain activity during these tasks were measured and relationships were accessed between brain activation changes and cognitive or motor abilities. Results: Significantly larger activations were found for prefrontal, pre-motor, and posterior parietal cortices during dual-task walking. Increasing dual-task walking challenge did not result in an increase in brain activation in these regions. Higher general cognition related to lower increases in activation during the easier dual-task. With the harder dual-task, a trend was also found for higher activation and less motor impairment. Conclusions: This is the first study to show that executive function, motor preparation/planning, and sensorimotor integration areas are all important for dual-task walking post-stroke. A lack of further brain activation increase with increasing challenge suggests a point at which a trade-off between brain activation and performance occurs. Further research is needed to determine if training would result in further increases in brain activity or improved performance.
2022-06-22T07:00:00Z
text
application/pdf
https://ir.lib.uwo.ca/neurosci_inst_pubs/97
info:doi/10.3389/fneur.2022.904145
https://ir.lib.uwo.ca/context/neurosci_inst_pubs/article/1096/viewcontent/Peters_2022_Frontal.pdf
Neuroscience Institute Publications
Scholarship@Western
dual-task
functional near-infrared spectroscopy
gait
posterior parietal cortex (PPC)
pre-motor cortex (PMC)
prefrontal cortex (PFC)
sensorimotor cortex (SMC)
stroke
oai:ir.lib.uwo.ca:neurosci_inst_pubs-1095
2022-09-30T13:48:03Z
publication:pt
publication:neurosci_inst_pubs
publication:faculties
publication:neurosci_inst
publication:institutes
publication:ptpub
Phase-dependent Brain Activation of the Frontal and Parietal Regions During Walking After Stroke - An fNIRS Study
Lim, Shannon B.
Yang, Chieh Ling
Peters, Sue
Liu-Ambrose, Teresa
Boyd, Lara A.
Eng, Janice J.
Background: Recovery of walking post-stroke is highly variable. Accurately measuring and documenting functional brain activation characteristics during walking can help guide rehabilitation. Previous work in this area has been limited to investigations of frontal brain regions and have not utilized recent technological and analytical advances for more accurate measurements. There were three aims for this study: to characterize the hemodynamic profile during walking post-stroke, to investigate regional changes in brain activation during different phases of walking, and to related brain changes to clinical measures. Methods: Functional near-infrared spectroscopy (fNIRS) along the pre-frontal, premotor, sensorimotor, and posterior parietal cortices was used on twenty individuals greater than six months post-stroke. Individual fNIRS optodes were digitized and used to estimate channel locations on each participant and short separation channels were used to control for extracerebral hemodynamic changes. Participants walked at their comfortable pace several times along a hallway while brain activation was recorded. Exploratory cluster analysis was conducted to determine if there was a link between brain activation and clinical measures. Results: Sustained activation was observed in the pre-frontal cortex with the ipsilesional hemisphere showing greater activation compared to the contralesional side. Sensorimotor cortex was active during the early, acceleration stage of walking only. Posterior parietal cortex showed changes in activation during the later, steady-state stage of walking. Faster gait speeds also related to increased activation in contralesional sensorimotor and posterior parietal cortices. Exploratory analysis clustered participants into two distinct groups based on their brain activation profiles and generally showed that individuals with greater activation tended to have better physical outcomes. Conclusions: These findings can guide future research for obtaining adequate power and determining factors that can be used as effect modifiers to reduce inter-subject variability. Overall, this is the first study to report specific oxygenated and deoxygenated hemoglobin changes in frontal to parietal regions during walking in the stroke population. Our results shed light on the importance of measuring brain activation across the cortex and show the importance of pre-frontal, sensorimotor, and posterior parietal cortices in walking after a stroke.
2022-07-19T07:00:00Z
text
application/pdf
https://ir.lib.uwo.ca/neurosci_inst_pubs/96
info:doi/10.3389/fneur.2022.904722
https://ir.lib.uwo.ca/context/neurosci_inst_pubs/article/1095/viewcontent/Peters_2022_Phase_dependent.pdf
Neuroscience Institute Publications
Scholarship@Western
functional near-infrared spectroscopy (fNIRS)
gait
posterior parietal cortex (PPC)
pre-frontal cortex (PFC)
premotor cortex (PMC)
sensorimotor cortex (SMC)
stroke
oai:ir.lib.uwo.ca:ptpub-1077
2022-11-09T18:10:16Z
publication:pt
publication:faculties
publication:ptpub
Kinematic and Kinetic Gait Characteristics in People with Patellofemoral Pain: A Systematic Review and Meta-analysis
Hart, Harvi, Dr.
Abstract Background
Patellofemoral pain (PFP) is a prevalent knee condition with many proposed biomechanically orientated etiological factors and treatments. Objective
We aimed to systematically review and synthesize the evidence for biomechanical variables (spatiotemporal, kinematic, kinetic) during walking and running in people with PFP compared with pain-free controls, and determine if biomechanical variables contribute to the development of PFP. Design
Systematic review and meta-analysis. Data sources
We searched Medline, CINAHL, SPORTDiscus, Embase, and Web of Science from inception to October 2021. Eligibility criteria for selecting studies
All study designs (prospective, case–control [± interventional component, provided pre-intervention data were reported for both groups], cross-sectional) comparing spatiotemporal, kinematic, and/or kinetic variables during walking and/or running between people with and without PFP. Results
We identified 55 studies involving 1300 people with PFP and 1393 pain-free controls. Overall pooled analysis identified that people with PFP had slower gait velocity [moderate evidence, standardized mean difference (SMD) − 0.50, 95% confidence interval (CI) − 0.72, − 0.27], lower cadence (limited evidence, SMD − 0.43, 95% CI − 0.74, − 0.12), and shorter stride length (limited evidence, SMD − 0.46, 95% CI − 0.80, − 0.12). People with PFP also had greater peak contralateral pelvic drop (moderate evidence, SMD − 0.46, 95% CI − 0.90, − 0.03), smaller peak knee flexion angles (moderate evidence, SMD − 0.30, 95% CI − 0.52, − 0.08), and smaller peak knee extension moments (limited evidence, SMD − 0.41, 95% CI − 0.75, − 0.07) compared with controls. Females with PFP had greater peak hip flexion (moderate evidence, SMD 0.83, 95% CI 0.30, 1.36) and rearfoot eversion (limited evidence, SMD 0.59, 95% CI 0.03, 1.14) angles compared to pain-free females. No significant between-group differences were identified for all other biomechanical variables. Data pooling was not possible for prospective studies. Conclusion
A limited number of biomechanical differences exist when comparing people with and without PFP, mostly characterized by small-to-moderate effect sizes. People with PFP ambulate slower, with lower cadence and a shortened stride length, greater contralateral pelvic drop, and lower knee flexion angles and knee extension moments. It is unclear whether these features are present prior to PFP onset or occur as pain-compensatory movement strategies given the lack of prospective data.
2022-11-05T07:00:00Z
article
application/pdf
https://ir.lib.uwo.ca/ptpub/77
info:doi/10.1007/s40279-022-01781-1
https://ir.lib.uwo.ca/context/ptpub/article/1077/viewcontent/Sports_Medicine_Proofs_82_.pdf
Physical Therapy Publications
Scholarship@Western
Physical Therapy
oai:ir.lib.uwo.ca:ptpub-1080
2023-04-17T15:07:42Z
publication:pt
publication:faculties
publication:ptpub
The Traumatic Injuries Distress Scale: Manual and Questionnaire
Walton, David
2022-12-13T08:00:00Z
article
application/pdf
https://ir.lib.uwo.ca/ptpub/78
https://ir.lib.uwo.ca/context/ptpub/article/1080/viewcontent/The_Traumatic_Injuries_Distress_Scale_user_s_guide_12132022.pdf
http://creativecommons.org/licenses/by-nc-sa/4.0/
Physical Therapy Publications
Scholarship@Western
Prognosis
Musculoskeletal
Trauma
Injury
Chronic Pain
Physical Therapy
oai:ir.lib.uwo.ca:ptpub-1081
2023-05-15T15:05:52Z
publication:pt
publication:faculties
publication:ptpub
The Satisfaction and Recovery Index
Walton, David
User Manual for the Satisfaction and Recover Index, including versions of the tool in English, French-Canadian, Persian, and Japanese translations
2023-03-12T08:00:00Z
manual
application/pdf
https://ir.lib.uwo.ca/ptpub/79
https://ir.lib.uwo.ca/context/ptpub/article/1081/viewcontent/SRI_user_manual_03012023.pdf
http://creativecommons.org/licenses/by-nc-sa/4.0/
Physical Therapy Publications
Scholarship@Western
Recovery
Rehabilitation
Musculoskeletal
Outcomes
Physical Therapy
oai:ir.lib.uwo.ca:ptpub-1085
2023-08-16T15:32:04Z
publication:pt
publication:faculties
publication:ptpub
Association between balance confidence and basic walking abilities in people with unilateral transtibial lower-limb amputations: A cross-sectional study
Omaña, Humberto
Frengopoulos, Courtney
Montero-Odasso, Manuel
Payne, Michael W
Viana, Ricardo
Hunter, Susan W
INTRODUCTION: Falls are common for people with lower-limb amputations (PLLA). Low balance confidence is also prevalent, is worse in PLLA not reporting walking automaticity, and is known to negatively affect prosthesis use, social engagement, and quality of life. Moreover, walking with a prosthesis requires continuous attention. Low balance confidence may act as a distractor imposing an additional cognitive load on the already cognitively demanding task of walking with a prosthesis.
METHODS: Adults with unilateral, transtibial amputations were recruited. The Activities-specific Balance Confidence (ABC) scale quantified balance confidence. The L Test assessed basic walking abilities under single-task (ST) (usual) and dual-task (DT) (walking while counting backwards) conditions. The relative change in gait and secondary task performance between conditions (ie, DT cost) was calculated. Separate multivariable linear regressions examined the association of balance confidence on the L Test.
RESULTS: Forty-four PLLA (56.6 ± 12.6 years) participated. An independent association of the ABC to ST (P < 0.001, R2 = 0.56) and DT (P = 0.008, R2 = 0.43) L Test performance was observed. A 1% ABC increase was related with a 0.24 (95% confidence interval, 0.35-0.14) and 0.23 (95% confidence interval, 0.39-0.06) second reduction with the ST and DT L Test, respectively. No association to DT cost was observed.
CONCLUSIONS: Balance confidence influences basic walking abilities yet does not modulate the added cognitive load associated with DT. Interventions that address balance confidence may be beneficial throughout rehabilitation. This research is novel and offers the possibility for alternative avenues for focus in rehabilitation and falls prevention in a population at high risk for falls.
2023-01-25T08:00:00Z
article
application/pdf
https://ir.lib.uwo.ca/ptpub/81
info:doi/10.1097/PXR.0000000000000207
https://ir.lib.uwo.ca/context/ptpub/article/1085/viewcontent/auto_convert.pdf
http://creativecommons.org/licenses/by-nc/4.0/
Physical Therapy Publications
Scholarship@Western
Amputation
fear
performance anxiety
accidental falls
walking
multitasking behavior
Physical Therapy
oai:ir.lib.uwo.ca:ptpub-1087
2023-08-22T13:46:27Z
publication:pt
publication:faculties
publication:ptpub
Association between measures of cognitive function on physical function in novice users of a lower limb prosthesis
Omana, Humberto
Frengopoulos, Courtney
Montero-Odasso, Manuel
Payne, Michael W
Viana, Ricardo
Hunter, Susan W
BACKGROUND: Cognitive impairment is prevalent in people with lower limb amputations (PLLA) and is associated with adverse outcomes, such as falls and worse rehabilitation outcomes. Physical function tests are essential to examine abilities; however, no research in PLLA has clarified the magnitude of cognitive demands amongst available tests in users novice at walking with a prosthesis.
METHODS: People from inpatient prosthetic rehabilitation were recruited. Inclusion criteria were: age ≥ 50 years, unilateral transtibial amputation and able to walk independently. Gait velocity and the L Test under single-task (usual) and dual-task (walking while counting backwards) conditions assessed functional mobility. The Four Square Step Test (FSST) examined dynamic balance. The Montreal Cognitive Assessment (MoCA) and the Trail Making Test (TMT-B) assessed global cognitive status and executive function, respectively. Multivariable linear regressions evaluated the association of cognition on physical function.
RESULTS: Twenty-two people participated (age: 62.3 ± 8.9 years, male: 68.18%). The mean MoCA score was 26.23 ± 2.90. A 1-point MoCA increase was independently associated with faster gait velocity (cm/s) [single-task: 5.45 (95%CI: 2.35-8.54, AdjR2 =0.46), dual-task: 5.04 (95%CI: 1.33-8.75, AdjR2 =0.20) and a quicker L Test (s) [single-task: - 4.75 (95%CI: 7.22-2.28, AdjR2 =0.45), dual-task: - 5.27 (95%CI: 8.74-1.80, AdjR2 =0.38)]. A 1-second TMT-B increase was also independently associated with worse L Test performance [single-task: 0.21 s (95%CI: 0.03-0.39, AdjR2 =0.20), dual-task: 0.29 s (95%CI: 0.06-0.51, AdjR2 =0.30)]. No association was observed between MoCA or TMT-B on the FSST (p > 0.13).
SIGNIFICANCE: Better global cognitive function and executive function were independently associated with faster gait velocity and improved functional mobility, but not dynamic balance. The present study demonstrates a unique relationship between cognition and physical function that warrants further research on the cognitive demands among clinical tests of physical function in PLLA.
2023-02-01T08:00:00Z
article
application/pdf
https://ir.lib.uwo.ca/ptpub/82
info:doi/10.1016/j.gaitpost.2022.12.012
https://ir.lib.uwo.ca/context/ptpub/article/1087/viewcontent/auto_convert.pdf
http://creativecommons.org/licenses/by-nc/4.0/
Physical Therapy Publications
Scholarship@Western
Humans
Male
Middle Aged
Aged
Artificial Limbs
Cognition
Gait
Walking
Amputation
Surgical
Amputation, Surgical
Physical Therapy
oai:ir.lib.uwo.ca:ptpub-1088
2023-08-22T14:31:38Z
publication:pt
publication:faculties
publication:ptpub
The Effect of Dual-Task Testing on Balance and Gait Performance in Adults with Type 1 or Type 2 Diabetes Mellitus: A Systematic Review
Omana, Humberto
Madou, Edward
Montero-Odasso, Manuel
Payne, Michael
Viana, Ricardo
Hunter, Susan W
BACKGROUND: Individuals with diabetes mellitus (DM) are susceptible to balance, gait and cognitive impairments. Importantly, diabetes affects executive function, a set of cognitive processes critical to everyday cortical function and mobility. Reduced executive function is a risk factor for falls in people with DM. Dual-task testing, the completion of two tasks at once, enables the examination of the cognitive-mobility relationship. A synthesis of the literature on the effects of dual- task testing on the balance and gait of individuals with DM has not been performed.
OBJECTIVE: To systematically review the literature on the effect of dual-task testing on balance and gait in people with DM.
METHODS: Databases EMBASE, CINAHL, MEDLINE, PsycINFO, Scopus and Web of Science were searched (inception-April 2020).
INCLUSION CRITERIA: participants were adults with a diagnosis of DM, instrumented dual-task balance and/or gait was assessed, and articles were published in English.
RESULTS: Ten articles met inclusion criteria- three examined dual-task balance and seven dual-task gait. In people with DM with or without peripheral neuropathy, dual-task resulted in larger sway velocities during standing tests. Individuals with DM and peripheral neuropathy had impaired dual-- task gait; specifically, and more consistently, reduced pace and rhythm compared to controls or people with DM without peripheral neuropathy.
CONCLUSION: The findings support a compromise in the cognitive-mobility relationship of people with DM, and especially in those with peripheral neuropathy. Future research should continue to examine the cognitive-mobility relationship in order to understand the increased prevalence of falls in this population.
2021-01-01T08:00:00Z
article
application/pdf
https://ir.lib.uwo.ca/ptpub/83
info:doi/10.2174/1573399816999201001203652
https://ir.lib.uwo.ca/context/ptpub/article/1088/viewcontent/auto_convert.pdf
http://creativecommons.org/licenses/by-nc/4.0/
Physical Therapy Publications
Scholarship@Western
Adult
Cognitive Dysfunction
Diabetes Mellitus
Type 2
Gait
Humans
Postural Balance
Task Performance and Analysis
Diabetes Mellitus, Type 2
Physical Therapy
oai:ir.lib.uwo.ca:ptpub-1082
2023-10-24T15:00:20Z
publication:pt
publication:faculties
publication:ptpub
The MultiDimensional Symptom Index: User Manual and Questionnaire
Walton, David
The user manual for the MultiDimensional Symptom Index, including hard copy versions in both English and Canadian French translations.
Click here for a direct link to an online interactive version of the MSI: dwalton5.pythonanywhere.com
2023-05-15T07:00:00Z
article
application/pdf
https://ir.lib.uwo.ca/ptpub/80
https://ir.lib.uwo.ca/context/ptpub/article/1082/viewcontent/The_MultiDimensional_Symptom_Index_user_manual.pdf
http://creativecommons.org/licenses/by-nc-sa/4.0/
Physical Therapy Publications
Scholarship@Western
Outcome Measures
Pain
Prognosis
Depression
Physical Therapy
oai:ir.lib.uwo.ca:ptpub-1095
2024-01-19T20:40:57Z
publication:pt
publication:pmid
publication:faculties
publication:ptpub
The effect of light touch on balance control during overground walking in healthy young adults.
Oates, A R
Unger, Janelle
Arnold, C M
Fung, J
Lanovaz, J L
Balance control is essential for safe walking. Adding haptic input through light touch may improve walking balance; however, evidence is limited. This research investigated the effect of added haptic input through light touch in healthy young adults during challenging walking conditions. Sixteen individuals walked normally, in tandem, and on a compliant, low-lying balance beam with and without light touch on a railing. Three-dimensional kinematic data were captured to compute stride velocity (m/s), relative time spent in double support (%DS), a medial-lateral margin of stability (MOSML) and its variance (MOSMLCV), as well as a symmetry index (SI) for the MOSML. Muscle activity was evaluated by integrating electromyography signals for the soleus, tibialis anterior, and gluteus medius muscles bilaterally. Adding haptic input decreased stride velocity, increased the %DS, had no effect on the MOSML magnitude, decreased the MOSMLCV, had no effect on the SI, and increased activity of most muscles examined during normal walking. During tandem walking, stride velocity and the MOSMLCV decreased, while %DS, MOSML magnitude, SI, and muscle activity did not change with light touch. When walking on a low-lying, compliant balance beam, light touch had no effect on walking velocity, MOSML magnitude, or muscle activity; however, the %DS increased and the MOSMLCV and SI decreased when lightly touching a railing while walking on the balance beam. The decreases in the MOSMLCV with light touch across all walking conditions suggest that adding haptic input through light touch on a railing may improve balance control during walking through reduced variability.
2017-12-01T08:00:00Z
article
application/pdf
https://ir.lib.uwo.ca/ptpub/84
info:doi/10.1016/j.heliyon.2017.e00484
https://ir.lib.uwo.ca/context/ptpub/article/1095/viewcontent/PIIS240584401631475X.pdf
http://creativecommons.org/licenses/by/4.0/
Physical Therapy Publications
Scholarship@Western
Physical Therapy
oai:ir.lib.uwo.ca:ptpub-1094
2024-01-19T20:37:44Z
publication:pt
publication:pmid
publication:faculties
publication:ptpub
Development, Implementation, and Outcomes of an Acute Care Clinician Scientist Clinical Placement: Case Report.
Wojkowski, Sarah
Unger, Janelle
McCaughan, Magda
Cole, Beverley
Kho, Michelle E
Purpose: This article presents the development, implementation, and outcomes of an innovative clinician scientist (CS) placement for a 2nd-year, entry-level MSc(PT) student at McMaster University. Client Description: All physiotherapy students participating in the third 6-week clinical placement at McMaster University were eligible to apply for one CS placement. A placement description and expectations were developed collaboratively by the clinical site and the MSc(PT) programme before placement matching. Intervention: A shared supervisory model between one acute care physiotherapist and a critical care CS was developed to provide supervision in both clinical and research-related activities during the placement. Measures and Outcomes: The first CS clinical placement in the MSc(PT) Program at McMaster was completed between November and December 2015. The student was evaluated using the same process as a traditional student placement. Over 6 weeks, the student gained clinical experience in an acute care setting; accumulated more than 100 cardiorespiratory hours; participated in research activities for a randomized controlled trial, which led to a submission to Physiotherapy Practice; and applied for the Canadian Institutes of Health Research Health Professional Student Research Award. Implications: The CS is a developing role for Canadian physiotherapists. A CS placement gave the physiotherapy student the opportunity to apply traditional skills and knowledge as well as to develop advanced research skills. The success of this placement has established a foundation for future placements.
2017-01-01T08:00:00Z
article
application/pdf
https://ir.lib.uwo.ca/ptpub/85
info:doi/10.3138/ptc.2016-45E
https://ir.lib.uwo.ca/context/ptpub/article/1094/viewcontent/ptc.2016_45e.pdf
http://creativecommons.org/licenses/by/4.0/
Physical Therapy Publications
Scholarship@Western
case report
internship
critical care
clinical research
Physical Therapy
oai:ir.lib.uwo.ca:ptpub-1093
2024-01-12T21:25:53Z
publication:pt
publication:pmid
publication:faculties
publication:ptpub
The experiences of physical rehabilitation in individuals with spinal cord injuries: a qualitative thematic synthesis.
Unger, Janelle
Singh, Hardeep
Mansfield, Avril
Hitzig, Sander L
Lenton, Erica
Musselman, Kristin E
PURPOSE: The purpose of this thematic synthesis review was to identify and synthesise published qualitative research on the perspectives of individuals with spinal cord injuries with respect to physical rehabilitation interventions.
MATERIALS AND METHODS: The peer-reviewed literature was searched across seven databases and identified abstracts were independently screened by two reviewers. A thematic synthesis methodology was used to code and synthesise the results from the included studies.
RESULTS: In total, 7233 abstracts were identified; 31 articles were selected for inclusion, representing 26 physical rehabilitation interventions. The methodological quality of studies was moderate (Standards for Reporting Qualitative Research mean ± standard deviation = 14.39 ± 3.61). The four main themes developed were: (1) Benefits of physical rehabilitation, (2) Challenges of physical rehabilitation, (3) Need for support, and (4) Issue of control.
CONCLUSIONS: This qualitative thematic synthesis provides key insights into the experiences of individuals with spinal cord injuries who received physical rehabilitation. Recommendations for practice, based on the findings, include creating a diverse, encouraging, and educational physical rehabilitation experience with supportive staff who focus on communication and person-centred care. Implications for Rehabilitation Physical rehabilitation provides psychological as well as physical benefits to people with spinal cord injuries, including motivation, hope, improved self-confidence, and acceptance. Challenges identified during physical rehabilitation for people with spinal cord injuries, such as comparisons, negative emotions, recovery expectations, and slow progress, should be addressed by healthcare professionals to ensure person-centred care. People with spinal cord injuries identified a need for support from health care professionals, family, and friends, as well other people with spinal cord injuries. There is an issue of control in physical rehabilitation for people with spinal cord injuries, which can result in a fight with oneself or with healthcare professionals to regain the control that has been lost.
2019-06-01T07:00:00Z
article
application/pdf
https://ir.lib.uwo.ca/ptpub/86
info:doi/10.1080/09638288.2018.1425745
https://ir.lib.uwo.ca/context/ptpub/article/1093/viewcontent/Experiences_of_Physical_Rehab_SCI_revised_FINAL_copy.pdf
Physical Therapy Publications
Scholarship@Western
Activities of Daily Living
Adaptation
Physiological
Motivation
Physical Therapy Modalities
Resilience
Self Efficacy
Social Support
Spinal Cord Injuries
Adaptation, Physiological
Hope
Humans
Resilience, Psychological
Physical Therapy
oai:ir.lib.uwo.ca:ptpub-1110
2024-01-23T17:08:27Z
publication:pt
publication:pmid
publication:faculties
publication:ptpub
Students' attitudes, beliefs and perceptions surrounding 2SLGBTQIA + health education and inclusiveness in Canadian physiotherapy programs
Primeau, Codie A
Philpott, Holly T
Vader, Kyle
Unger, Janelle
Le, Christina Y
Birmingham, Trevor B
MacDermid, Joy C
BACKGROUND: Patients who identify as 2SLGBTQIA + report negative experiences with physiotherapy. The objectives were to evaluate student attitudes, beliefs and perceptions related to 2SLGBTQIA + health education and working with individuals who identify as 2SLGBTQIA + in entry-level physiotherapy programs in Canada and to evaluate physiotherapy program inclusiveness towards 2SLGBTQIA + persons.
METHODS: We completed a nationwide, cross-sectional survey of physiotherapy students from Canadian institutions. We recruited students via email and social media from August-December 2021. Frequency results are presented with percentages. Logistic regression models (odds ratios [OR], 95%CI) were used to evaluate associations between demographics and training hours with feelings of preparedness and perceived program 2SLGBTQIA + inclusiveness.
RESULTS: We obtained 150 survey responses (mean age = 25 years [range = 20 to 37]) from students where 35 (23%) self-identified as 2SLGBTQIA + . While most students (≥ 95%) showed positive attitudes towards working with 2SLGBTQIA + patients, only 20 students (13%) believed their physiotherapy program provided sufficient knowledge about 2SLGBTQIA + health and inclusiveness. Students believed more 2SLGBTQIA + training is needed (n = 137; 92%), believed training should be mandatory (n = 141; 94%) and were willing to engage in more training (n = 138; 92%). Around half believed their physiotherapy program (n = 80, 54%) and clinical placements (n = 75, 50%) were 2SLGBTQIA + -inclusive and their program instructors (n = 69, 46%) and clinical instructors (n = 47, 31%) used sex/gender-inclusive language. Discrimination towards 2SLGBTQIA + persons was witnessed 56 times by students and most (n = 136; 91%) reported at least one barrier to confronting these behaviours. Older students (OR = 0.89 [0.79 to 0.99]), individuals assigned female at birth (OR = 0.34 [0.15 to 0.77]), and students self-identifying as 2SLGBTQIA + (OR = 0.38 [0.15 to 0.94]) were less likely to believe their program was 2SLGBTQIA + inclusive. Older students (OR = 0.85 [0.76 to 0.94]) and 2SLGBTQIA + students (OR = 0.42 [0.23 to 0.76]) felt the same about their placements. Students who reported > 10 h of 2SLGBTQIA + training were more likely to believe their program was inclusive (OR = 3.18 [1.66 to 6.09]).
CONCLUSIONS: Entry-level physiotherapy students in Canada show positive attitudes towards working with 2SLGBTQIA + persons but believe exposure to 2SLGBTQIA + health and inclusiveness is insufficient in their physiotherapy programs. This suggests greater attention dedicated to 2SLGBTQIA + health would be valued.
2023-08-30T07:00:00Z
article
application/pdf
https://ir.lib.uwo.ca/ptpub/87
info:doi/10.1186/s12889-023-16554-2
https://ir.lib.uwo.ca/context/ptpub/article/1110/viewcontent/s12889_023_16554_2.pdf
http://creativecommons.org/licenses/by/4.0/
Physical Therapy Publications
Scholarship@Western
Physiotherapy
Education
Inclusiveness
LGBTQ+
LGBTQ+ health
Survey
EDI
Infant, Newborn
Humans
Female
Young Adult
Adult
Cross-Sectional Studies
Canada
Health Education
Students
Physical Therapy Modalities
Attitude
Physical Therapy
oai:ir.lib.uwo.ca:ptpub-1109
2024-01-23T17:06:20Z
publication:pt
publication:pmid
publication:faculties
publication:ptpub
Knowledge, behaviours, and training related to 2SLGBTQIA+ health education amongst entry-level physiotherapy students in Canada: results of a nationwide, cross-sectional survey
Primeau, Codie A
Philpott, Holly T
Vader, Kyle
Unger, Janelle
Le, Christina Y
Birmingham, Trevor B
MacDermid, Joy C
BACKGROUND: Individuals who identify as 2SLGBTQIA+ report worse health outcomes than heterosexual/cisgender counterparts, in part due to poor experiences with healthcare professionals. This may stem from inadequate 2SLGBTQIA+ health and inclusiveness training in health professional student education. The purpose of the study was to evaluate knowledge, behaviours, and training related to 2SLGBTQIA+ health education and inclusiveness for entry-level physiotherapy students in Canada.
METHODS: We conducted a nationwide, cross-sectional survey with physiotherapy students from accredited Canadian physiotherapy programs. We administered the survey through Qualtrics and recruited students through targeted recruitment emails and social media posts on Twitter and Instagram between August and December 2021. Survey responses are reported as frequencies (percentage). We also completed multivariable logistic regressions to evaluate associations among question responses related to working with 2SLGBTQIA+ individuals (i.e., communication, feeling prepared and assessment competency). Covariates included training hours (< 10/10 + hours) and 2SLGBTQIA+ identity (yes/no).
RESULTS: A total of 150 students responded to the survey, with 35 (23%) identifying as 2SLGBTQIA+ . Many students felt confident in communicating effectively with clients who identify as 2SLGBTQIA+ (69%). However, only half (47%) felt comfortable assessing clients who identify as 2SLGBTQIA+ . Routine practice of inclusive behaviours such as using pronouns, considering identities are fluid and a patient's gender identity and/or sexual orientation may shift from one visit to the next, and considering trauma-informed care practices were reported from less than half of the students (< 45%). Around 29% of students reported no 2SLGBTQIA+ training in their physiotherapy program, while 47% reported 0-10 hours, and 24% reported 10 + hours of training. Students with 10 + hours of training had 92% higher odds of feeling competent in assessing 2SLGBTQIA+ clients, compared to those with < 10 hours of training.
CONCLUSIONS: Entry-level physiotherapy students in Canada show a lack of understanding and awareness for 2SLGBTQIA+ health and inclusive behaviours which can meaningfully impact patient experience. Students report feeling incompetent when working with 2SLGBTQIA+ patients, which may be associated with lack of 2SLGBTQIA+ training in their programs. Greater efforts and attention towards increasing 2SLGBTQIA+ health education and inclusivity in Canadian entry-level physiotherapy programs is critically needed.
2023-07-19T07:00:00Z
article
application/pdf
https://ir.lib.uwo.ca/ptpub/88
info:doi/10.1186/s12909-023-04499-4
https://ir.lib.uwo.ca/context/ptpub/article/1109/viewcontent/s12909_023_04499_4.pdf
http://creativecommons.org/licenses/by/4.0/
Physical Therapy Publications
Scholarship@Western
Physiotherapy
Education
Inclusiveness
LGBTQ+
LGBTQ+ health
Survey
EDI
Humans
Male
Female
Cross-Sectional Studies
Canada
Gender Identity
Students
Health Education
Physical Therapy Modalities
Physical Therapy
oai:ir.lib.uwo.ca:ptpub-1108
2024-01-23T17:00:30Z
publication:pt
publication:pmid
publication:faculties
publication:ptpub
Comparator Groups in ICU-Based Studies of Physical Rehabilitation: A Scoping Review of 125 Studies
O'Grady, Heather K
Reid, Julie C
Farley, Christopher
Hanna, Quincy E B
Unger, Janelle
Zorko, David J
Bosch, Jackie
Turkstra, Lyn S
Kho, Michelle E
OBJECTIVES: To characterize comparator groups (CGs) in ICU-based studies of physical rehabilitation (PR), including the type, content, and reporting.
DATA SOURCES: We followed a five-stage scoping review methodology, searching five databases from inception to June 30, 2022. Study selection and data extraction were completed independently, in duplicate.
STUDY SELECTION: We screened studies by title and abstract, then full-text. We included prospective studies with greater than or equal to two arms enrolling mechanically ventilated adults (≥ 18 yr), with any planned PR intervention initiated in the ICU.
DATA EXTRACTION: We conducted a quantitative content analysis of authors' description of CG type and content. We categorized similar CG types (e.g., usual care), classified content into unique activities (e.g., positioning), and summarized these data using counts (proportions). We assessed reporting using Consensus on Exercise Reporting Template (CERT; proportion of reported items/total applicable).
DATA SYNTHESIS: One hundred twenty-five studies were included, representing 127 CGs. PR was planned in 112 CGs (88.2%; 110 studies), representing four types: usual care (n = 81, 63.8%), alternative treatment than usual care (e.g., different from intervention; n = 18, 14.2%), alternative treatment plus usual care (n = 7, 5.5%), and sham (n = 6, 4.7%). Of 112 CGs with planned PR, 90 CGs (88 studies) reported 60 unique activities, most commonly passive range of motion (n = 47, 52.2%). The remaining 22 CGs (19.6%; 22 studies) reported vague descriptions. PR was not planned in 12 CGs (9.5%; 12 studies), and three CGs (2.4%; three studies) reported no details. Studies reported a median (Q1-Q3) of 46.6% (25.0-73.3%) CERT items. Overall, 20.0% of studies reported no detail to understand planned CG activities.
CONCLUSIONS: The most common type of CG was usual care. We identified heterogeneity in planned activities and CERT reporting deficiencies. Our results could help guide the selection, design, and reporting of CGs in future ICU-based PR studies.
2023-05-01T07:00:00Z
article
application/pdf
https://ir.lib.uwo.ca/ptpub/89
info:doi/10.1097/CCE.0000000000000917
https://ir.lib.uwo.ca/context/ptpub/article/1108/viewcontent/cc9_5_e0917.pdf
http://creativecommons.org/licenses/by/4.0/
Physical Therapy Publications
Scholarship@Western
critical care
critical illness
early ambulation
rehabilitation
review
Physical Therapy
oai:ir.lib.uwo.ca:ptpub-1107
2024-01-23T16:54:57Z
publication:pt
publication:pmid
publication:faculties
publication:ptpub
Perspectives of individuals with chronic spinal cord injury following novel balance training involving functional electrical stimulation with visual feedback: a qualitative exploratory study
Houston, David J
Unger, Janelle
Lee, Jae W
Masani, Kei
Musselman, Kristin E
BACKGROUND: Individuals with an incomplete spinal cord injury (iSCI) are highly susceptible to falls during periods of walking or standing. We recently reported the findings of a novel intervention combining functional electrical stimulation with visual feedback balance training (FES + VFBT) on standing balance abilities among five individuals with motor iSCI. However, the previous publication did not report the perceived impact of the intervention on the participants' lives. In this report, the experiences of these five individuals with incomplete spinal cord injury (iSCI) who had recently completed the four-week balance training program are described.
METHODS: Five individuals with a motor iSCI took part in this study. Each individual was at least 12 months post-injury, capable of unassisted standing for 60 s and had a Berg Balance Scale Score < 46. Participants completed twelve sessions of a novel balance intervention combining closed-loop functional electrical stimulation with visual feedback balance training (FES + VFBT). Participants received visual feedback regarding their centre of pressure position as they completed balance-training exercises while FES was applied to the ankle plantarflexors and dorsiflexors bilaterally. Semi-structured interviews were conducted after completion of the balance training intervention and eight-weeks post-training to understand participant's experiences. Categories and themes were derived from the transcripts using conventional content analysis.
RESULTS: Three themes were identified from the collected transcripts: (1) Perceived benefits across International Classification of Functioning, Disability and Health levels; (2) Change in perceived fall risk and confidence; (3) Motivation to keep going.
CONCLUSIONS: Participation in the FES + VFBT program resulted in perceived benefits that led to meaningful improvements in activities of daily living. Following completion of the training, individuals felt they still had the capacity to improve. Individuals felt they had increased their balance confidence, while a few participants also reported a decrease in their risk of falling. The inclusion of qualitative inquiry allows for the evaluation of the meaningfulness of an intervention and its perceived impact on the lives of the participants.
TRIAL REGISTRATION: NCT04262414 (retrospectively registered February 10, 2020).
2021-04-01T07:00:00Z
article
application/pdf
https://ir.lib.uwo.ca/ptpub/90
info:doi/10.1186/s12984-021-00861-z
https://ir.lib.uwo.ca/context/ptpub/article/1107/viewcontent/s12984_021_00861_z.pdf
http://creativecommons.org/licenses/by/4.0/
Physical Therapy Publications
Scholarship@Western
visual feedback
balance training
functional electrical stimulation
spinal cord injury
neurorehabilitation
Accidental Falls
Activities of Daily Living
Aged
Attitude
Electric Stimulation
Electric Stimulation Therapy
Exercise Therapy
Feedback, Sensory
Humans
Male
Middle Aged
Motivation
Neurological Rehabilitation
Patient Satisfaction
Postural Balance
Qualitative Research
Spinal Cord Injuries
Standing Position
Walking
Physical Therapy
oai:ir.lib.uwo.ca:ptpub-1106
2024-01-23T16:52:14Z
publication:pt
publication:pmid
publication:faculties
publication:ptpub
Co-contraction of ankle muscle activity during quiet standing in individuals with incomplete spinal cord injury is associated with postural instability
Fok, Kai Lon
Lee, Jae W
Unger, Janelle
Chan, Katherine
Musselman, Kristin E
Masani, Kei
Previous findings indicate that co-contractions of plantarflexors and dorsiflexors during quiet standing increase the ankle mechanical joint stiffness, resulting in increased postural sway. Balance impairments in individuals with incomplete spinal cord injury (iSCI) may be due to co-contractions like in other individuals with reduced balance ability. Here we investigated the effect of co-contraction between plantar- and dorsiflexors on postural balance in individuals with iSCI (iSCI-group) and able-bodied individuals (AB-group). Thirteen able-bodied individuals and 13 individuals with iSCI were asked to perform quiet standing with their eyes open (EO) and eyes closed (EC). Kinetics and electromyograms from the tibialis anterior (TA), soleus and medial gastrocnemius were collected bilaterally. The iSCI-group exhibited more co-contractions than the AB-group (EO: 0.208% vs. 75.163%, p = 0.004; EC: 1.767% vs. 92.373%, p = 0.016). Furthermore, postural sway was larger during co-contractions than during no co-contraction in the iSCI-group (EO: 1.405 cm/s2 vs. 0.867 cm/s2, p = 0.023; EC: 1.831 cm/s2 vs. 1.179 cm/s2, p = 0.030), but no differences were found for the AB-group (EO: 0.393 cm/s2 vs. 0.499 cm/s2, p = 1.00; EC: 0.686 cm/s2 vs. 0.654 cm/s2, p = 1.00). To investigate the mechanism, we performed a computational simulation study using an inverted pendulum model and linear controllers. An increase of mechanical stiffness in the simulated iSCI-group resulted in increased postural sway (EO: 2.520 cm/s2 vs. 1.174 cm/s2, p < 0.001; EC: 4.226 cm/s2 vs. 1.836 cm/s2, p < 0.001), but not for the simulated AB-group (EO: 0.658 cm/s2 vs. 0.658 cm/s2, p = 1.00; EC: 0.943 cm/s2 vs. 0.926 cm/s2, p = 0.190). Thus, we demonstrated that co-contractions may be a compensatory strategy for individuals with iSCI to accommodate for decreased motor function, but co-contractions may result in increased ankle mechanical joint stiffness and consequently postural sway.
2021-10-01T07:00:00Z
article
application/pdf
https://ir.lib.uwo.ca/ptpub/91
info:doi/10.1038/s41598-021-99151-w
https://ir.lib.uwo.ca/context/ptpub/article/1106/viewcontent/s41598_021_99151_w.pdf
http://creativecommons.org/licenses/by/4.0/
Physical Therapy Publications
Scholarship@Western
Adult
Aged
Ankle
Biomechanical Phenomena
Case-Control Studies
Computer Simulation
Electromyography
Female
Humans
Male
Middle Aged
Muscle Contraction
Muscle
Skeletal
Postural Balance
Spinal Cord Injuries
Standing Position
Muscle, Skeletal
Physical Therapy
847960/oai_dc/100//