Electronic Thesis and Dissertation Repository

Thesis Format

Integrated Article

Degree

Doctor of Philosophy

Program

Physical Therapy

Supervisor

Connelly, Denise M.

Abstract

Executive functioning (EF) refers to cognitive abilities involved in decision-making and self-regulation and can be impaired in many patients referred for physiotherapy, including older adults and people living with chronic pain. This dissertation aimed to determine what physiotherapists understood about EF, to summarize normative data for application in physiotherapy practice, and to provide an assessment of feasibility for studying EF impairments in people living with chronic pain. Study one surveyed what physiotherapists understood about EF as a concept, what EF assessments they used, and if this was influenced by their primary area of practice. Respondents (N = 262) subjectively reported that they understood what EF is, but this only moderately correlated with objective understanding, r = 0.43 (p < 0.001).Physiotherapists reported an awareness of some measures of EF; however, were unsure about interpreting patient scores among the multiple sets of available normative data. Study two presented summarized normative data (N = 35) for three assessments of EF in older adults based on a systematic review. Normative data were stratified by age, education, and sex in summary tables for accessible referencing by physiotherapists. Study three described the feasibility of recruitment and data collection in females living with Chronic Pelvic Pain, a musculoskeletal chronic pain condition not examined in previous EF research. Results (N = 35) indicated impaired EF, high central sensitization, pain catastrophizing, depression, anxiety, and stress. These findings demonstrated impaired EF in a patient population treated by physiotherapists, revealing an overlooked variable with the potential to impact physiotherapy rehabilitation outcomes.

Summary for Lay Audience

Executive functioning (EF) is a complex ability of the human brain responsible for decision-making and self-management. Many patients of physiotherapists, such as older adults and people living with chronic pain, potentially have impairments in EF. It is possible that patients may not reach their full potential with physiotherapy rehabilitation if impairment in EF is not considered. This dissertation presents the results of three studies that investigated what physiotherapists understood about EF, summarized scores from three commonly used EF assessments for application by physiotherapists, and a study of EF impairments in people living with chronic pain. The first study surveyed physiotherapists about their understanding of EF as a concept. A total of 262 respondents completed the survey and reported that they understood what EF was, but when they were asked to identify the correct components of EF more specifically, they were only moderately accurate. Respondents also reported an awareness of some assessment tools that measure EF; however, were unsure about how to interpret their patients’ scores. Therefore, in the second study, 35 published papers were reviewed that presented “normal” scores (i.e., scores that characterize what is usual in a defined population) on three assessment tools measuring EF (e.g., tests called trail-making, verbal fluency, and clock drawing tests). Normal scores were found for a trail-making test in 19 studies, 34 studies for a fluency test, and five studies for a clock drawing test. Data were summarized by age, education, and sex. In the third study, a total of 35 females living with a condition called Chronic Pelvic Pain were recruited to participate in an interview and complete several questionnaires. Chronic Pelvic Pain is a condition that has not been examined in previous EF research. The study aimed to describe the feasibility (i.e., the degree to which future studies could be conveniently completed) of virtual recruitment and EF data collection in these participants. Results were indicative of impaired EF, and high central sensitization, pain catastrophizing, depression, anxiety, and stress. These findings demonstrate impaired EF in a patient population treated by physiotherapists, revealing an overlooked variable with the potential to impact physiotherapy rehabilitation outcomes.

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