Digital Commons Network^™

To Develop A Clinically Friendly Multi-Segment Kinematic And Kinetic Foot Model And Test It On Pre-/Post-Hto Patients With Medial Knee Osteoarthritis And Knee Varus, Songlin Zhu

Electronic Thesis and Dissertation Repository

This study aims to develop a clinically useful multi-segment foot model that will enable the analysis of foot kinematics and kinetics in an optical motion capture laboratory setting. This study will also test the new multi-segment foot model on patients with knee osteoarthritis and varus knee alignment that is corrected by high tibial osteotomy (HTO). The multi-segment foot model divides the foot into four functional segments: the hindfoot, midfoot, forefoot and hallux. An X-Z-Y-Cardan angle rotation convention was used to determine intersegmental dorsi/plantar flexion, inversion/eversion, and internal/external rotation. Joint moments, joint powers and medio-longitudinal arch (MLA) height/length ratio were also …

Implications Of Race On Post-Concussion Neurocognitive Performance And Symptom Presentation, Taia B.B. Maceachern

Electronic Thesis and Dissertation Repository

The objective of this thesis was to examine the impact of race on post-concussion symptoms and neurocognitive performance. This was achieved through a systematic review and meta-analysis (Chapter 2), and a retrospective study (Chapter 3). From 15 published studies, it was found that Whites (70.11%) reported a higher prevalence of concussion then Black/African American (13.65%). A small effect (g = 0.3) of race was found on neurocognitive measures, indicating that Whites performed better. Using a database of concussion outcomes, it was found that Black/African American reported significantly higher symptom severities (p <0.05), but this was dependent on the …

Non-Pharmacological Management Of Community Dwelling Individuals With Osteoporosis Or At Risk Of Developing Osteoporosis, Christina Ziebart

Electronic Thesis and Dissertation Repository

Background:

Osteoporosis is a bone disease that increases the risk of fractures. In adults aged 50-65 years, a wrist fracture is usually the first sign of osteoporosis. Fracture risk increases if these individuals are not taught to exercise, eat properly, and/or identify fall risk factors early in their diagnosis.

Methods:

A meta-analysis was conducted to determine whether a home fall hazard identification program could reduce the risk of falls in community dwelling adults and an overview of exercise in individuals with a distal radius fracture (DRF). CINHAL, PubMed, EMBASE, Scopus, and Psych INFO were used to identify articles. A survey …

Caregiver Experience With The Applied Coaching Model On Supporting Adherence To Home Exercise Programs For Children With Developmental Delays: A Mixed Methods Research Study, Mackenzie Cheng

Electronic Thesis and Dissertation Repository

Home exercise programs (HEP) are a form of treatment for children with delayed motor, sensory, cognitive, or speech skills. Studies show improvement in developmental and barriers that affect adherence, there is still a lack of standardized rehabilitation models that can address this issue. This interpretive phenomenology study explores the lived experiences of caregivers of children with developmental delays regarding adherence to HEPs. Participating caregivers interacted with therapists using an Applied Coaching Model (ACM), a model of multiple theories focusing on holistic rehabilitative care. Qualitative results of this mixed-methods study identified specific factors that affect adherence to HEPs. Quantitative results found …

Language-Based Strategies That Support Person-Centered Communication In Formal Home Care Interactions With Persons Living With Dementia, Reanne G. Mundadan

Electronic Thesis and Dissertation Repository

Background. Several studies recommend language-based strategies for communication with persons living with dementia. Language-based strategies improve coherence, clarity, reciprocity, and continuity of interactions. Person-centered communication (PCC) strategies are the gold standard, including facilitation, recognition, validation, and negotiation. Only one study has examined the overlap between language-based strategies and PCC in long-term care. Little is known about which language-based strategies support PCC in home care. Accordingly, this study investigated the overlap between language-based strategies and PCC in home care interactions. Method. Conversation analysis of 30 audio-recorded routine care interactions between home care workers and persons living with dementia was conducted. The …

Lived Experience Of Having Difficult Conversations Among Care Partners Of Individuals With Parkinson's: An Occupational Science Perspective, Helen A. Reid

Electronic Thesis and Dissertation Repository

Difficult conversations, which can be challenging co-occupations, play an important role in the lives of care partners of individuals living with Parkinson’s disease. In our first study for this integrated-article thesis, we used a critical interpretive synthesis to explore how informal caregiving had been conceptualized in occupation-focused research. We found that an occupational perspective illuminated otherwise overlooked aspects of caregiving. In our second study, we used an occupational science lens to explore how seven care partners of individuals with PD experienced having difficult conversations within the caring role. We conducted two rounds of in-depth semi-structured interviews and used an American …

A Comparison Of Voice Amplifiers And Personal Communication Systems In Individuals With Hypophonia: An Exploration Of Communicative Participation, Jessi-Rae A. Schroeder

Electronic Thesis and Dissertation Repository

Hypophonia is one of the most prevalent speech impairments in hypokinetic dysarthria. Unfortunately, behavioral interventions for hypophonia often fail to generalize beyond the clinic. An alternative approach to management is the use of speech amplification devices. This study evaluated how 17 individuals with hypophonia (HP) and their primary communication partners (PCPs) rated communicative participation across three, one-week device trial periods at home. Amplification devices included: a wired belt pack amplifier, wireless stationary amplifier, and personal FM system. Patient-reported outcome measures included the CES, VAPP and PIADS. Results indicated HPs rated participation higher following device use in comparison no device. Further, …

Searching For The 'Good' In Physiotherapist Practice: Toward An Ethic Of Care, Michelle J. Kleiner

Electronic Thesis and Dissertation Repository

The qualities and practices of a ‘good’ physiotherapist have not been systematically reviewed nor have practitioners’ perspectives been empirically investigated. Understanding what constitutes a ‘good’ physiotherapist has potentially profound implications that may inform professional priorities including education curricula, professional practices, competency profiles, and patient interactions. The research purpose was to examine perceptions of what constitutes a ‘good’ physiotherapist. This dissertation includes four integrated manuscripts. The first is an integrative review to critically examine how physiotherapists and patients describe the qualities of a ‘good’ MSK physiotherapist as depicted in peer-reviewed literature. Six qualities were identified as: responsive, ethical, communicative, caring, competent, …

The Natural History Of Modic Changes - A 5- And 15-Year Follow-Up Study, Parnian Saremi

Electronic Thesis and Dissertation Repository

Modic changes (MCs), defined as bone marrow lesions adjacent to the vertebral endplate seen on MRI, have been associated with back pain. There are different types of MCs, with different histopathological correlates. This community-based study sample comprised 110 men from the Twin Spine Study, with baseline, 5-year, and 15-year follow-up MRIs. Following training and reliability testing, 1320 endplates (T12-S1) were evaluated for MC presence, type, and dimensions at each time point. Results demonstrated that Type 2 Modic Changes (MC2) were the most common type, with approximately half located at the two lowest disc levels. However, Type 1 Modic Changes (MC1) …

The Genetics Of Pain: An Exploration Of Gene-By-Environment Interactions And Their Effects On Pain, Mohamad F. Fakhereddin

Electronic Thesis and Dissertation Repository

The findings presented in this dissertation are part of the bigger SYMBIOME project which aims to use the biopsychosocial model of pain to develop a prognostic clinical phenotype for people that experience musculoskeletal (MSK) trauma. Chapter 2 presents an exploratory analysis to assess the relationships between genetic polymorphisms and pain severity and interference. Early childhood trauma was also explored as a moderator between genetic polymorphisms and pain outcomes. For pain severity, major allele carriers (A/A and G/A) of FKBP5 rs9394314 reported significantly higher scores than minor allele carriers (G/G). Further, major allele carriers who had at least one adverse childhood …

Consideration Of Executive Functioning For Physiotherapy Rehabilitation: Studies Of Physiotherapists’ Knowledge, Normative Data, And A Practice Application, Nicole A. Guitar

Electronic Thesis and Dissertation Repository

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 …

Exploring The Perspectives Of Older Adults And Health Care Providers On Patient Participation In Transitional Care From Hospital To Cardiac Rehabilitation During The Covid-19 Pandemic, Cecilia Flores Sandoval

Electronic Thesis and Dissertation Repository

Older adults who transition from hospital to cardiac rehabilitation settings often are vulnerable and at risk of experiencing adverse health care outcomes. Given the complexities of transitional care, it is crucial to engage older adults in the clinical decision-making process and to promote their active participation in their medical care. Older adults have unique ways of understanding their participation in the transitional care process. Gaining an in-depth understanding of their specific needs during this process can help inform clinical practice and interventions aiming to improve care for older adults living with cardiovascular disease. Focused ethnography methodology was used to explore …

Femoroacetabular Impingement Syndrome: Evaluating Postoperative Rehabilitation Progress And Return To Sport Readiness, Trevor A. Day

Electronic Thesis and Dissertation Repository

Femoroacetabular impingement syndrome (FAIS) is a common cause of non-arthritic hip pain and reduced physical activity in active young adults. It is defined as a motion-related disorder of the hip with a triad of symptoms, clinical signs, and imaging findings that represents symptomatic premature contact between the proximal femur and the acetabulum. There are two anatomical morphologies that can cause FAIS, cam, and pincer, and is a challenging clinical pathology. Patients typically undergo hip arthroscopy to repair damage to the joint and recess the bone causing the impingement. These procedures can result in positive outcomes for the patient, like reduced …

Troubling Service User Involvement In Health Professional Education: Toward Epistemic Justice, Stephanie Leblanc-Omstead

Electronic Thesis and Dissertation Repository

It has become increasingly popular in health professional education to solicit the contributions and involvement of people who have firsthand or ‘lived’ experiences of using mental health services – a practice hereafter referred to as service user involvement (SUI). SUI is founded on the premise that service users ought to be involved in the development and evaluation of services and systems they experience, which includes the education of future health professionals. Despite the momentum this practice has gained in a range of international contexts, SUI is often conceptualized, organized, and implemented uncritically, and with tremendous inconsistency across health professional education …

Chronic Pain Following Musculoskeletal Injuries: Where Do Familial Factors, Depression, And Distress Fit In?, Shirin Modarresi

Electronic Thesis and Dissertation Repository

Background: Currently, there is a paucity of effective therapeutic options for chronic pain. A better understanding of the factors that can contribute to chronic pain development and maintenance can lead to more informed prevention and management strategies.

Purpose: The driving force for this thesis comes from the biopsychosocial model of pain. The main purpose was to investigate the contribution of various psychosocial factors to chronic pain with the following objectives: 1) to systematically review the literature on the existence of a familial sub-type of complex regional pain syndrome (fCRPS); 2) CRPS can follow injuries such as distal radius fractures (DRFs), …

A Transformative Journey: The Lived Experience Of Healthcare Learners Participating In Pain Management Education, Zoe A. Leyland

Electronic Thesis and Dissertation Repository

There is little emphasis on pain management education for healthcare providers. In September 2019, the Master of Clinical Science (MClSc) program in Advanced Healthcare Practice at Western University in London, Ontario introduced a new, “Interprofessional Pain Management” (IPM) field. The program follows a competency-based framework, and the learners are all practicing healthcare providers with a special interest in pain. Part of the purpose of this thesis is to describe the process of development and implementation. The objective is to provide educators and healthcare providers an in-depth look at how the pain education is experienced. This includes exploring the lived experience …

Creation Of A Virtual Interface For Stress-Trauma Investigations Through Open World Navigation: An Exploration Of Tolerability And Physiological Reactions, Michael J. Lukacs

Electronic Thesis and Dissertation Repository

It is estimated that as many as 50% of people suffering from Whiplash Associated Disorders (WAD) may experience chronic alterations of their activities of daily living as much as 1-year post injury. Despite their burden, there is little to evidence to suggest why some people may be more likely to acquire WAD or develop chronic symptomology. Additionally, the link between biomechanical forces at the time of impact and symptom development or recovery is poor. As a result, interest in alternative theories such as stress system reactivity have received interest in recent literature, but empirical methods to test them has been …

Evaluating A Concern For Falling Among People With A Lower Extremity Amputation, Kristin Elizabeth Nugent

Electronic Thesis and Dissertation Repository

The purpose of these studies was to evaluate a concern for falling (CFF) among people with a lower extremity amputation (PLEA). Study 1 evaluated relative and absolute test-retest reliability of five standardized scales which have not been previously evaluated among PLEA. Twenty-two participants completed Study 1, an online survey that was administered twice. Study 2 assessed the inter-relationship of the multiple dimensions in a CFF using nine standardized scales of measurement and open-ended questions, and the association on quality of life (QOL). Forty-eight participants completed Study 2, a onetime online survey. Study 1 provided support for the reliable use of …

The Psychosocial And Physical Effects Of Therapeutic Horseback Riding For Children With Cerebral Palsy, Karen M. Pratt

Electronic Thesis and Dissertation Repository

Background: Participation in specialized adapted activities such as therapeutic horseback riding (THR) is critical for children with cerebral palsy (CP) as they are at increased risk for lower habitual physical activity levels, social exclusion and mental health conditions. The benefits of THR for children CP are unclear despite positive anecdotal evidence. Purpose: The aim of the study is to explore the effects of THR participation for children with CP across multiple domains of health (psychological, social and physical) from the children themselves. Specifically, this study explored overall wellbeing including mental health, perceived independence, social inclusion and presence of fatigue and …

Investigating Physiological Determinants Of Mental Health In Children With Cerebral Palsy, Daniela A. Testani

Electronic Thesis and Dissertation Repository

Background

Fifty-seven percent of children with cerebral palsy (CP) experience mental health symptoms including symptoms of anxiety and depression. Although CP is non progressive, secondary conditions can have progressive effects on an individuals’ functional abilities. Particularly, untreated mental health symptoms can negatively affect a child’s quality of life. Children with CP also experience fatigue, pain, poor physical activity, and sleep disturbances. The presence of these physiological symptoms, separate and in combination, may impact mental health; however, it has not been systematically examined. Identifying factors that contribute to mental health symptoms may prevent the maintenance of these issues into adulthood.

Objectives …

Health Concerns Of Adolescents And Adults With Spina Bifida, Jessica A. Starowicz

Electronic Thesis and Dissertation Repository

The Transitional and Lifelong Care (TLC) program is a multidisciplinary clinical service providing comprehensive, coordinated care to adolescents and adults with spina bifida (SB). This study sought to identify the most common health concerns among this population at initial consultation and identify patient factors related to these concerns to ultimately improve health care delivery. A retrospective chart review was performed. Descriptive analyses were completed and associations between concerns and patient factors were determined using Spearman’s rho correlation coefficients. A multiple linear regression was performed to estimate the relationship between patient factors and total number of concerns reported. Ninety-four patient charts …

The Problem Of Operational Stress Injuries In An Ontario Fire & Rescue Organization, Megan Edgelow

The Dissertation in Practice at Western University

The purpose of this Organizational Improvement Plan (OIP) is to assist public safety leaders in understanding the human and financial costs of operational stress injuries (OSIs) and possible solutions to this issue. OSIs, including posttraumatic stress disorder (PTSD), are a growing problem for public safety organizations, requiring new and innovative solutions. This OIP is applied to a fire and rescue organization in a small urban centre in Ontario that faces similar OSI challenges to many other public safety organizations. The Problem of Practice (PoP) is a lack of implementation of effective practices to mitigate the impact of OSIs. The foundation …

Nature, Nurture, Or Both? Study Of Sex And Gender And Their Effects On Pain, Maryam Ghodrati

Electronic Thesis and Dissertation Repository

As a pain researcher, in order to have a better understanding of pain, we should adopt a multidimensional view, such as the biopsychosocial (BPS) model and consider physical, psychological, and social elements altogether. The studies in this dissertation are part of the bigger project of SYMBIOME in which the aim is to help to create and develop a prognostic clinical phenotype in people post musculoskeletal (MSK) trauma. Chapter 2 presents a Confirmatory Factor Analysis (CFA) in order to assess the structural validity of the first section of the new Gender Pain and Expectation Scale (GPES). Our analysis indicated a 3-factor …

Functional Performance Testing In Ice Hockey: The Role Of The Single Leg, Medial Countermovement Jump, Anthony S. Donskov

Electronic Thesis and Dissertation Repository

Due to the physical nature of the game, injuries are common in ice hockey. Injury rates have been difficult to interpret due to the inconsistencies in the definitions of injury and athlete exposure. Consensus statements on injury definitions have been developed for sports such as soccer and rugby but have not been established in ice hockey. Furthermore, many different off-ice tests are performed, but a hockey-specific performance test has not been promoted. Accordingly, the objective for this thesis was to investigate injury rates, injury definition, athlete exposure and injury type in men’s ice hockey, and providing information on a practical …

Collaborative Coaching In Pediatric Rehabilitation: An Effectiveness-Implementation Study Of The Applied Coaching Model, Zoe Daviault

Electronic Thesis and Dissertation Repository

Learner-centered models have become more prevalent within early childhood interventions. However, it is still unclear which components are being implemented in clinical practice and if therapists are receiving the proper training to implement these strategies (Ward et al., 2020). The primary objective of this study is to evaluate the implementation outcomes of appropriateness, adoption, acceptability, and fidelity of a novel coaching intervention, the Applied Coaching Model (ACM), and practice support tool, the Applied Coaching Tool (ACT). An effectiveness-implementation Hybrid Type 1 design was used to gather information on the ACM and ACT delivery and implementation at the Early Childhood Rehabilitation …

Occupational Engagement Of Older Adults With Age-Related Vision Loss (Arvl): Understanding The Influences Of Social Networks, Ji Won Kang

Electronic Thesis and Dissertation Repository

The present study sought to understand how older adults’ social networks facilitate and constrain their engagement in meaningful occupations after being diagnosed with age-related vision loss (ARVL). A constructivist paradigm and narrative inquiry methodology were used to elicit and make sense of the participants’ unique stories. The participants consisted of five older adults 60 years and older, living with ARVL, including one of the following conditions; macular degeneration, glaucoma, and diabetic retinopathy. Participants were recruited from the Canadian National Institute for the Blind (CNIB) and Society for Learning and Retirement (SLR). Data was collected through three sessions of semi-structured, audio-recorded …

“I Am The Expert” : The Process Of Adolescent Transition In The Self-Management Of Hearing Healthcare. A Constructivist Grounded Theory Study, Christine N. Meston

Electronic Thesis and Dissertation Repository

Adolescence is a time when adult behaviours become established and adolescents are more able to manage aspects of their healthcare. Research has examined adolescent transitions to self-manage their personal healthcare needs associated with chronic diseases. Providing children and adolescents with information about their health is an ongoing process and, as they mature, they should be allowed to take on more responsibility for their healthcare management. The purpose of this study was to explore the transition for adolescents who are deaf and hard of hearing toward the self-management of their hearing healthcare. A constructivist grounded theory approach was used to develop …

Therapist Perception Of The Clarity And Implementability Of Relevant Recommendations From American Academy Of Orthopedic Surgeon’S Distal Radius Fracture Clinical Practice Guidelines, Saravanan Esakki

Electronic Thesis and Dissertation Repository

Fractures of the distal radius are common and can cause substantial either transient or permanent impairment and disability.

Clinical practice guidelines (CPGs) are systematically developed statements or recommendations based on the best available evidence and aimed at assisting health care practitioners in clinical decision-making. Many professional organizations have developed practice guidelines for common clinical conditions. The overall objective of this thesis is to evaluate the therapist's perception of the clarity and implementability of rehabilitation relevant recommendations from The American Academy of Orthopaedic Surgeons (AAOS) CPG for distal radius fractures (DRF) and to identify the quality of CPG related to DRF. …

Exploring The Mental Health Experiences Of African, Caribbean, And Black Youth In London, Ontario, Lily Yosieph

Electronic Thesis and Dissertation Repository

This qualitative study explores the mental health experiences of African, Caribbean, and Black (ACB) youth in London, Ontario, investigating how the factors of race, gender, culture, and place have shaped their perceptions and experiences of mental health. The data collection and analysis were conducted using a phenomenological approach and a critical lens informed by feminist, intersectionality, and critical race theories. These data illuminate the ways in which these young people’s attitudes toward mental health and help-seeking strategies are impacted by broader social constructs and community expectations, which they navigate and often resist in their everyday lives. Their insights can provide …

Predicting Dissatisfaction With Total Knee Arthroplasty, Joseph S. Munn

Electronic Thesis and Dissertation Repository

Total knee arthroplasty (TKA) is a common and effective treatment for end-stage osteoarthritis. However, approximately 20% of patients are consistently found to be dissatisfied or unsure of their satisfaction with their TKA at 1-year post-surgery. Two strategies for reducing dissatisfaction have appeared in the literature. The first aims to reduce the number of dissatisfied patients who will undergo surgery by identifying patients likely to be dissatisfied pre-surgery. The second aims to implement interventions that improve patient satisfaction by generating realistic expectations for outcomes and by association improving met expectations scores. It may be possible to improve the performance of these …