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A Long-Term Follow-Up Of The Stability Study: Multicenter Rct Comparing Anterior Cruciate Ligament Reconstruction With And Without Lateral Extra-Articular Tenodesis In Individuals At High Risk Of Graft Failure, Katelyn M. Inch

Electronic Thesis and Dissertation Repository

One hundred and ninety-six patients at the Fowler Kennedy Sport Medicine Clinic (FKSMC) undergoing anterior cruciate ligament (ACL) reconstruction (ACLR) were randomized as part of the multi-center STABILITY study to receive either an isolated ACLR or ACLR with a lateral extra-articular tenodesis (LET). The STABILITY study followed these patients up to two years postoperative, and a long-term follow-up protocol was initiated afterwards. Eighty-two patients from this center were seen at three, five and seven years postoperative as part of a long-term follow-up. Our primary outcome was a composite outcome of instability and graft failure. Secondary outcomes included patient-reported outcome measures …

Mindfulness With Children And Youth: A Hermeneutic Phenomenological Inquiry Into Paediatric Therapists' Experiences, Kirsten S. Smith

Electronic Thesis and Dissertation Repository

Background: Mindfulness has become popular as a treatment approach for many health conditions and has been taken up by diverse health practitioners in recent years. While research into mindfulness-based interventions is on the rise, much of this research originates in the field of psychology and is aimed toward adult populations. Occupational therapists, including those working with children and youth, have begun to take up mindfulness to support their clients to participate in daily activities, and there is evidence that clinical uptake has outpaced research in this area.

Method: A scoping review was undertaken to understand the breadth of literature regarding …

The Clinical Value Of Oculomotor Assessments Across The Continuum Of Concussion, Dillon Richards

Electronic Thesis and Dissertation Repository

Concussions are complex conditions that are difficult to manage medically. Variations in symptom presentation, intricate neurophysiological processes, and the availability of a variety of possible assessment tools may contribute to this complexity. Clinicians must use a broad approach, employing both subjective symptom assessment and objective assessments to confirm a diagnosis and/or monitor progression and recovery. Oculomotor function after concussion may be an important indicator of injury, given the interconnectedness of oculomotor function, vestibulo-ocular and visual systems, and even cognition. Oculomotor function may be assessed objectively or indirectly using patient-reported symptom checklists as part of subjective assessments. One way of objectively …

The Lived Experiences Of Pain And Fatigue In Persons Living With Neurological Conditions: A Phenomenological Study, Lauren L. Kane

Electronic Thesis and Dissertation Repository

Purpose: The aim of the study was to understand the experiences and impact of pain and fatigue and to further explore the relationship between participants' descriptions of their lived experiences with these phenomena within and across multiple sclerosis, Parkinson's disease, and cerebral palsy. Methods: Semi-structured interviews were used to interview nine participants about their experiences of living with pain and fatigue in their respective conditions. A new phenomenological approach was adopted, and data was analyzed inductively using interpretive phenomenological analysis. Results: Three final themes including a lack of understanding, negative perceptions of pain and fatigue, and coping strategies used to …

Adaptation With Injury, Family Role Responsibilities, & Social Support After Distal Radius Fracture (Drf), Hajra Batool

Electronic Thesis and Dissertation Repository

This study is a qualitative interpretive descriptive study aimed at elucidating the impact of distal radius fracture (DRF) on patients' activities of daily living (ADLs), professional and familial duties, and social support during the healing process. The study focuses on fracture healing during the immobilization phase of injury. This study lies in the constructivist paradigm employing the interpretive description method. A total of 20 participants with DRF in casts were recruited by purposeful sampling from the Hand & Upper limb Centre, St. Joseph’s Hospital enrolled and interviewed over the telephone. Data was analyzed by Braun and Clarke’s Thematic Analysis Approach. …

Reframing Childhood Disability: Pushing Boundaries In The Rehabilitation Sciences, Emily J. Cox

Electronic Thesis and Dissertation Repository

The purpose of this study was to critically examine the ways that dominant discourses surrounding childhood disability, as constructed in the neoliberal context, shape knowledge and practice in children’s rehabilitation. I carried out a critical discourse analysis of text within the rehabilitation sciences, including peer-reviewed research, websites, and qualitative interview transcripts. Drawing on disability studies scholarship as well as my Foucauldian conceptual framework, I called attention to complex interactions between discourse, power, and knowledge that shape thought and action in the rehabilitation sciences. My findings suggest that despite a growing recognition of the harms associated with deficit-based understandings of disability, …

Exploring The Inter-Relationship Between Cognitive And Motor Function In People With Lower Limb Amputations, Humberto Adolfo Omaña Moreno

Electronic Thesis and Dissertation Repository

The main objective of the present dissertation was to expand our understanding of the inter-relationship between cognition and mobility in people with lower limb amputations (PLLA). Study 1 systematically reviewed the literature to assess the effects of dual-task testing on the balance and gait of PLLA. A total of twenty-two studies were included. Overall, PLLA demonstrated a disproportionately greater dual-task effect than controls, characterized by increased sway velocity and reduced pace and rhythm, and increased asymmetry when balance or walking was paired with a secondary task. Additionally, the dual-task effect was not influenced by differences in etiology, level of amputation, …

The Investigation Of Prosthetic Rehabilitation Outcomes Following A Lower Limb Amputation In The Oldest Old, Ashvene Sureshkumar

Electronic Thesis and Dissertation Repository

This thesis sought to investigate the changing characteristics of people with lower limb amputations (LLAs) who participate in prosthetic rehabilitation programs and evaluate an under-investigated subgroup; the oldest old (aged 80 years and older). Study 1 included 601 consecutive admissions to a Canadian prosthetic rehabilitation program from 2012 to 2019. Although participant’s age did not increase at admission over time, individuals presented with a higher number of comorbidities each year. Participants were admitted from amputation surgery faster over time. Study 2 assessed functional prosthetic rehabilitation outcomes for the oldest old against participants aged 50 to 79 years old. Despite the …

The Coping Strategies Of Older Adults With Age Related Vision Loss (Arvl) – A Narrative Account, Zakara J. Stampp

Electronic Thesis and Dissertation Repository

The goal of this study was to share the stories of older adults with age-related vision loss (ARVL) and how they have coped to maintain meaningful occupational engagement. Grounded in a constructivist paradigm, data collection and analysis were guided by the narrative inquiry methodology. The participants consisted of six older adults aged 60 or older, diagnosed with one of the following ARVL conditions: macular degeneration, diabetic retinopathy, and/or glaucoma. Participants were recruited from vision loss non-profit organizations such as the Canadian National Institute for the Blind (CNIB) and the Alliance for Equity of Blind Canadians (AEBC). One older adult was …

Advancing Type 2 Diabetes As A Condition For Primary Referral To Physiotherapy In Canada, Sarah M. Janssen

Electronic Thesis and Dissertation Repository

Obesity and sedentary lifestyle are increasingly prevalent risk factors for type 2 diabetes (T2D), characterized by high blood glucose levels. Adoption and maintenance of healthy eating, physical activity, and exercise is recommended for lowering blood glucose and weight management. Physiotherapists are experts in prescribing safe, effective exercise to optimize health for people with co-morbid health conditions. However, T2D is not a primary condition for referral to physiotherapy services in Canada. The overall question guiding a series of three related studies was, What is the current education and perspectives of Canadian physiotherapists about their role in managing T2D? Study one surveyed …

Piloting A Study To Examine Children’S Understandings Of Chronic Pain And Coping, Kristina P. Ferreira

Electronic Thesis and Dissertation Repository

Many of our understandings of how children conceptualize and cope with chronic pain are drawn from adult accounts or extrapolated from research in adult populations. Accordingly, there is scant knowledge relating to children’s own experiences of chronic pain and coping. This study begins to address this gap by piloting a methodology combining arts-based methods with semi-structured interviews to generate data with children aged 6-13 years. Participants with chronic pain were invited to draw and/or photograph what represents a ‘good pain day’ and ‘a bad pain day’, before engaging in a tailored, semi-structured interview. Results, interpreted using a constructivist lens, contribute …

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 …