Intimate Partner Violence (Ipv): Clinical And Societal Perspectives, Marudan Sivagurunathan

Electronic Thesis and Dissertation Repository

Intimate Partner Violence (IPV) can have a lasting impact on survivors’ emotional, physical, and psychological wellbeing. IPV is multifaceted and can influence survivors’ interactions across various institutions, including healthcare settings. This PhD project consists of both qualitative and quantitative studies aimed at exploring the clinical and societal perspectives around IPV.

Study #1 sought to explore the discourses around male IPV drawn from a social networking site (Reddit.com). While some areas related to IPV are well researched, studies on male intimate partner violence survivors are limited. The results from study #1 show that male IPV disclosure is a complex process. While …

Therapeutic Interventions For Managing Diabetic Shoulder, Sanaa A. Alsubheen

Electronic Thesis and Dissertation Repository

Shoulder pain is a common complaint of diabetic patients that causes motion limitations and functional disability. Adhesive capsulitis (AC) is the most common disabling shoulder disorder. There is no optimal non-surgical treatment for managing AC in diabetic patients. Furthermore, the impact of diabetes on shoulder recovery and factors predicting shoulder function following shoulder arthroplasty is not well investigated.

Purpose and Methods

The main purpose of this thesis was to inform clinical practice about the best intervention for managing AC in diabetic patients, and to assess the impact of diabetes on functional outcomes after shoulder arthroplasty, with the following objectives: 1) …

The Symbiome Project: An Exploratory Investigation Of The Biological, Psychological, And Social Mechanisms That Contribute To The Transition From Acute To Chronic Musculoskeletal Pain, Joshua Y. Lee

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This dissertation presents the initial findings of the SYMBIOME project; which attempts to combine the objective and subjective aspects of musculoskeletal pain to develop a prognostic clinical phenotype. Chapter 2 presents a moderator analysis of functional outcomes (pain interference and pain severity). Psychosocial moderators can affect the relationship between biomarkers and pain. For pain severity, TNF-α, TGF-β1, and CRP were moderated by employment status, pre-existing psychopathology, and sex. For pain interference, IL-1β, cortisol, TGF-β1, CRP, and IL-6 were moderated by pre-existing pain, peri-traumatic fear, region of injury, and peri-traumatic stress. Chapter 3 presents a latent growth curve analysis in determining …

Assessment Of Intrinsic Hand Neuromuscular Physiology, Philemon Tsang

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Alterations to the peripheral nervous system and neuromuscular physiology may impact hand function in a typical or clinical population, such as individuals with ulnar neuropathy. The mechanisms that influence these positive and negative changes are still not well understood. The three studies within my thesis aim to validate the reliability of decomposition-based quantitative electromyography (DQEMG) measurements and explore the changes in intrinsic hand neuromuscular physiology in a typical aging population and individuals recovering from a surgical intervention for severe ulnar neuropathy.

The purpose of the first study was to determine the test-retest reliability of near-fibre (NF) jiggle, a measure of …

Recovery Following Proximal Humerus Fracture, Azar Varahrami Vigeh

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There is currently a glaring gap in the existing knowledge to address individuals’ experiences while recovering from a proximal humeral fracture (PHF). The main objective of this dissertation was to understand better how recovery is perceived by individuals after PHF. This overarching objective aligned well with the broad conceptualization of the issue at hand as those provided by the International Classification of Functioning, Disability and Health (ICF). Three inter-linked studies were conducted to provide a broader picture of recovery after PHF. The first study was a systematic review of prognostic factors predicting recovery after PHF in adults. This review demonstrated …

The Nature And Consistency Of Exercise Reporting In Rehabilitation Following Rotator Cuff Repair, Dinesh Balachandran

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Abstract

Purpose:

Rotator cuff repair is conventional surgery, and postoperative rehabilitation programs are routine. Optimization and implementation of evidence-based exercise are dependent on comprehensive reporting of intervention content and dosage. The purpose of this study is to examine the content and consistency of reporting of postoperative exercise programs following arthroscopic rotator cuff repairs.

Methods:

Keyword search of PUBMED, EMBASE, Scopus, SPORTDiscuss, AMED, CINAHL, and Cochrane were performed from January 1950 to March 2019. All the studies that discussed rehabilitation following rotator cuff repairs of human adults were included. A Proforma Consensus on Exercise Reporting Template (CERT) assessment form was used …

Psychometric Properties Of The Brief Pain Inventory-Short Form And Revised Short Mcgill Pain Questionnaire Version-2 In Musculoskeletal Conditions, Samuel Ugochukwu Jumbo

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Introduction: Comprehensive pain assessment depends on the use of psychometrically valid patient-reported outcome measures (PROMs). The Brief Pain Inventory-Short Form (BPI-SF) and Revised Short McGill Pain Questionnaire Version-2 (SF-MPQ-2) are general-use multidimensional pain assessment tools commonly used in musculoskeletal conditions. Understanding all relevant measurement properties supports stronger decisions about PROMs.

Thesis Objectives: The overarching objective of this thesis was to determine the sufficiency of measurement evidence backing the use of the BPI-SF and SF-MPQ-2 in musculoskeletal conditions. Specifically, a systematic review was conducted to locate, summarize and compare the quality and content of psychometric evidence backing the BPI-SF and …

Quantifying The Outcomes Of A Virtual Reality (Vr)-Based Gamified Neck Rehabilitation, Shahan Salim

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Neck pain is a major global public health concern and adds a significant financial burden to both the healthcare system as well as people suffering from it. Additionally, it presents measurement and evaluation challenges for clinicians as well as adherence challenges and treatment barriers for the patients. We have developed a virtual reality (VR)-based video game that can be used to capture outcomes that may aid in the assessment and treatment of neck pain. We investigated: (i) performance metrics of overall accuracy, accuracy based on movement difficulty, duration, and total envelope of movement; (ii) stability across sessions; (iii) accuracy across …

Optimizing Gait Outcomes In Parkinson's Disease With Auditory Cues: The Effects Of Synchronization, Groove, And Beat Perception Ability, Emily A. Ready

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This dissertation explores a common, rehabilitative strategy for mitigating gait impairments in Parkinson’s disease (PD) called Rhythmic Auditory Stimulation (RAS). The effects of this intervention on gait in PD are well documented but highly variable, which poses difficulty for appropriate therapeutic application. Part of this variability may be related to individual musical abilities, such as beat perception accuracy, as most RAS interventions involve synchronizing with a beat. However, music is complex and variable. Therefore, factors inherent in the music itself may play a role in these differences, such as how much the music makes you want to move (groove), or …

Measuring Quality Of Life In Patients With Rotator Cuff Disorders, Rochelle Furtado

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Rotator cuff disorders (RCDs) are a common musculoskeletal problem with a higher prevalence in women and after the age of 60. Due to the increasing need for patient-centered care, researchers have been directed towards the use of patient reported outcomes (PROs) to evaluate the progress of patient recovery, as the experience varies across individuals.

Recently, the Western Ontario Rotator Cuff Index was reduced in items to create the shortened version of the Western Ontario Rotator Cuff Index (Short-WORC). However, the Short-WORC’s psychometrics have yet to be evaluated. Therefore, this mixed-methods thesis aimed to evaluate the psychometric properties of the Short-WORC …

The Development And Evaluation Of Resources To Improve The Quality Of Care For Patients With Knee Osteoarthritis, Laura K. Churchill

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Purpose: The non-operative management of patients with knee osteoarthritis (OA) is often considered suboptimal. Sub-optimal management includes inadequate use of non-surgical treatments, misuse of diagnostic imaging, and non-operative referrals to surgeons in consideration of total knee replacement (TKR). These inefficiencies result from an interplay of factors involving primary care physicians, patients, and the systems in which they function. The overall purpose of this thesis is to develop a means to optimize the management of patients with knee OA, and the timing and quality of referrals to TKR.

Methods: This thesis includes three studies. In study 1, we identified and cross-validated …

Understanding The Process Of Recovery From Critical Illness From The Patient Perspective: A Constructivist Grounded Theory, Tania Larsen

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Critical illness creates long-term physical, psychological and cognitive deficits that negatively impact quality of life, persisting well beyond hospital discharge. The purpose of this constructivist grounded theory study is to understand and develop theoretical propositions on factors that patient’s perceive influence the process of recovery from critical illness in order to inform more comprehensive patient care management strategies.

Semi-structured interviews were conducted with 17 participants admitted to an ICU. All interviews were audio-recorded and transcribed verbatim. Data collection and analysis occurred concurrently using the constant comparative method. Data were analysed initially with line-by-line coding, then focused coding. Initial codes were …

Validity And Reliability Of The Clinician Rated Drop Vertical Jump Scale In Patients Following Anterior Cruciate Ligament Reconstruction, Morgan Jennings

Electronic Thesis and Dissertation Repository

The purpose of this study was to evaluate the validity and reliability of the Clinician Rated Drop Vertical Jump Scale (CR-DVJS) in a population of patients following anterior cruciate ligament reconstruction (ACLR). Patients completed two drop vertical jump tasks at 6 and/or 12-months post-operative. One task was recorded using a motion capture system. Four individuals of varying clinical experience served as raters for the CR-DVJS. Rater scores of valgus collapse did not correlate strongly with motion capture measures of knee abduction moment or angle. However, CR-DVJS scores of trunk and knee flexion did demonstrate an association with 3D measures of …

Application Of The Mckenzie System Of Mechanical Diagnosis And Therapy In Patients With Shoulder Disorders, Afshin Heidar Abady

Electronic Thesis and Dissertation Repository

Shoulder pain is one of the leading causes of referrals to physiotherapy clinics. The annual prevalence of shoulder complaints is about 100 to 160 per 1000 patients in general population. Complexity of shoulder joint, and lack of uniformity of diagnostic labeling commonly used in clinical practice, makes it difficult to make a precise diagnosis. In addition, issues with reliability and validity exist for the shoulder Orthopedic Special Tests (OSTs), making accurate diagnoses challenging.

The primary aim of this thesis was to investigate usefulness of the McKenzie system of Mechanical Diagnosis and Therapy (MDT) in classifying and treating patients with shoulder …

Lived Experience And Process Of Engagement In Physical Exercise For Older Adults With Chronic Back Pain, Melissa E. Hay

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For older adults, physical exercise is especially important in maintaining functional independence, extending quality of life, and optimizing personal health resources. For patients with chronic pain conditions, exercise participation can significantly improve patient-reported symptoms. Older adults are the most sedentary age group with the majority not meeting the recommended duration and intensity of weekly exercise. Although nonadherence with exercise guidelines may result for a variety of reasons, adverse health conditions including chronic pain are likely of particular concern for older adults. The aim of this research, consisting of two studies employing interpretive phenomenology and constructivist grounded theory, was to understand …

The Effect Of High Baseline Pain On Impairment Outcomes One Year After Distal Radius Fracture, Farrukh Riaz

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Objective

The purpose of this study is to evaluate whether high baseline pain predicts impairment outcomes in grip strength or wrist range of motion (ROM) at one year after a distal radius fracture (DRF). Impairments occur for less than 15% of patients.

Methods:

In this cohort study patients with a DRF were recruited from a hand clinic in London, Ontario. This data was collected at two evaluation time points: at baseline (within the first 10 days after fracture) and at one year after fracture. Baseline pain was assessed using the pain subscale of the Patient-Rated Wrist Evaluation (PRWE) and classified …

Using A Deliberative Dialogue To Facilitate The Uptake Of Research Evidence In Rehabilitation For Children With Cerebral Palsy, Alisiyah Daya

Electronic Thesis and Dissertation Repository

This study explores how to facilitate the use of research evidence to optimize outcomes for children with cerebral palsy (CP) in practice. Findings from two studies were used as the basis for exploring how to comprehensively assess developmental trajectories of children with CP and plan individualized interventions. Seventeen affiliated stakeholders (e.g. physicians, senior leadership, frontline clinicians, families and youth with CP) participated in this study.

Data from a deliberative dialogue and interviews were analyzed using grounded theory methods with a pragmatic perspective. The results highlighted that all areas of practice must engage in knowledge translation to be effective. Stakeholders outlined …

Dynamic Loading And Pain In Knee Osteoarthritis: Effects Of Limb Realignment And Ligament Reconstruction Surgeries, Kendal Marriott

Electronic Thesis and Dissertation Repository

Painful loading of the knee during walking is a key feature of knee osteoarthritis (OA). The external knee moments derived from three-dimensional gait analysis represent dynamic knee loads and may help evaluate surgical interventions. However, the relationships between knee moments and pain and the effects of surgery remain unclear. The overall purpose of this thesis was to investigate knee moments and pain during walking in patients with moderate medial knee OA, including the effects of limb realignment and ligament reconstruction surgeries. This thesis includes three studies investigating knee moments in patients with medial compartment tibiofemoral OA.

Chapter 2 describes a …

A Cross- Sectional Study Of Stress Biomarkers And Their Associations With Post-Trauma Complaints, And How Those Associations Are Moderated By Early Life Adversity, Sadia Siraj

Electronic Thesis and Dissertation Repository

Chronic musculoskeletal pain results in significant personal, economic, and social burden. Early identification and intervention in those people with acute pain that are likely to transition into a state of chronicity can prevent the onset of chronic pain before it emerges and becomes resistant to treatment. This study investigated the potential stress biomarkers associated with acute pain and disability and how those associations are influenced by early life adversities.

Stress level was determined according to the plasma level of stress biomarkers (cortisol, BDNF, TGFB1) and self-report measures of stress following musculoskeletal traumatic events. The magnitude and direction of associations of …

How Do Individuals With Cerebral Palsy And Their Families Prefer To Receive And Use Evidence-Based Information To Individualize Services To Optimize Outcomes?, Tianna D. B. Deluzio

Electronic Thesis and Dissertation Repository

The main objectives of this study were to: (1) describe the format in which children with cerebral palsy (CP) and their parents prefer to receive information pertaining to development; (2) understand how children with CP and their parents intend to use this information; and (3) gain insight on how children with CP wish to be represented in the information in terms of being both comprehensive and respectful. Ten children with CP and their parent(s) or guardian(s) participated. Semi-structured interviews were conducted and analyzed using constant comparative analysis. Eight themes were created related to the type and format of information preferred …

Assessing The Impact Of Caregiver Outcomes On Function And Reintegration Of Stroke Survivors Participating In A Community Stroke Rehabilitation Program., Spencer R. Thompson

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There is a limited amount of literature evaluating the relationship between caregivers, and the stroke survivors’ function and reintegration. The objectives were to evaluate the association between caregivers’ lifestyle changes on function and the role of functioning as a moderator between caregiving and reintegration among stroke survivors receiving community-based rehabilitation. Data were collected from January 2011 to January 2016. A one-way repeated measures analysis of variance and multivariable linear regression were performed on Functional Independence Measure, Bakas Caregiving Outcomes Scale, Reintegration to Normal Living Index across admission, discharge, and follow-up. Mean age was 70.2±13.17 years with 58% males (n=200). A …

Optimizing The Composition And Delivery Of Assessment And Treatment Following Distal Radius Fracture, Michael L. Szekeres

Electronic Thesis and Dissertation Repository

Distal radius fracture (DRF) is the most common fracture.¹ The most recent Cochrane review indicated “The available evidence from randomized controlled trials is insufficient to establish the relative effectiveness of the various interventions used in the rehabilitation of adults with fractures of the distal radius”.²

Since the relative effectiveness of the various interventions used for rehabilitation after DRF is unknown, the main goal of this thesis is to focus on one aspect of both assessment and treatment to add to the current literature base. The first paper (Chapter 2) describes a new method using a modified finger goniometer …

Evaluating Factors That Affect Hand Dexterity After Distal Radius Fracture, Pavlos Bobos

Electronic Thesis and Dissertation Repository

Abstract

Objectives: The primary objective of this study was to determine the effect of age and gender on hand dexterity after distal radius fracture (DRF). The second aim of this study was to evaluate the recovery of hand dexterity in 1-year follow-up of DRF. The third purpose of this study was to determine the extent to which loss of range of motion (ROM) and grip strength predicts hand dexterity 6-months after injury

Methods: A prospective cohort study of 242 patients with DRF examined the recovery of hand dexterity across 3 time-points (3, 6 and 12 months). Dexterity testing was performed …

A Longitudinal Study To Investigate Changes In Functional Ability And Concerns In Head Neck Cancer Patients Undergoing Neck Dissection, Mariya Ehsan

Electronic Thesis and Dissertation Repository

Introduction:

The study investigated changes of shoulder/neck range of motion (ROM), shoulder strength, patient concerns and quality of life at pre-surgery and 1 month following neck dissection surgery.

Method:

Participants were 30 head and neck cancer patients selected for unilateral neck dissection. Shoulder/neck ROM and shoulder strength were measured at pre-surgery and 1 month post-surgery. The Patient Concerns Inventory-Level of Importance, University of Washington Quality of Life, Shoulder Pain and Disability Index and Neck Dissection Impairment Index were completed at the same time periods.

Result:

A significant drop in ROM and strength were found after surgery. Patients’ concerns changed over …

Longitudinal Evaluation Of Patient Concerns After Surgery For Head And Neck Cancer, Isabel Wozniczka

Electronic Thesis and Dissertation Repository

The primary purpose of this study was to investigate and describe the longitudinal effects of shoulder and neck mobility, strength, and quality of life (QOL) following neck dissection (ND) surgery and identify the concerns of head and neck cancer (HNC) patients. ND is one of the standard procedures for treating HNC, which results in many complications and dysfunctions that can have an effect on a patient’s QOL.

The study had 27 eligible HNC participants who underwent ND, of which eight participated in the shoulder range of motion (ROM) and strength and 12 participated in the QOL patient-reported outcomes analysis. The …

The Role Of Postural Stability And Other Factors In Distal Radius Fracture, Sheena Saju Philip

Electronic Thesis and Dissertation Repository

The objective of the thesis was to describe the factors leading to falls in distal radius fracture (DRF) events, explore patient perceived risk of falls, and postural stability. A mixed method study described the type of fall in DRF patients (n= 1454) and patient perceived contributing factors (n=29). A prospective cohort study examined the postural stability and related fall risk of DRF participants (n=137) in Biodex Balance System (BBS) and compared to normative values. Environmental factors were a major contributor to DRF events. Older adults (44 to 65 years) had the highest rate of DRF (female: male ratio of 2:1). …

Constraining Kinematics During Single-Leg Squats And Step-Ups Can Reduce Quadratus Lumborum Activation And Facilitate Gluteal Activation, Shaylyn Kowalchuk

Electronic Thesis and Dissertation Repository

Increased quadratus lumborum activation and decreased gluteal activation may lead to lateral pelvic drop and increased hip adduction and internal rotation during single-leg exercises. These activation patterns and motions are associated with low back pain or lower extremity injuries. The purpose of this study was to evaluate if mechanically restricting hip adduction and internal rotation of the femur affected muscle activation. Twenty female track and field athletes performed single-leg squats and step-ups, and the quadratus lumborum, gluteus medius and maximus muscles activations were measured with surface electromyography. This study tested the hypothesis that mechanically restricted exercises would decrease quadratus lumborum …

Development Of Holistic Classification Systems For Children With Cerebral Palsy, Deepa Jeevanantham

Electronic Thesis and Dissertation Repository

Cerebral palsy (CP) is a complex disorder. There is a gap in the literature in classifying children with CP broadly. The purpose of this thesis was to develop holistic classification systems for children with CP. As a first step, a search was conducted to explore the strategies used to classify children with developmental co-ordination disorder and autism-spectrum disorder. Two versions of holistic classification systems named the body function index in cerebral palsy (BFI-CP) versions I and II were developed using two methods. Then, the relationship and differences among the developed classification systems and the Gross Motor Function Classification System (GMFCS) …

Optimizing The Rehabilitation Of Elbow Lateral Collateral Ligament Injuries, Ranita Harpreet Kaur Manocha

Electronic Thesis and Dissertation Repository

Elbow lateral collateral ligament (LCL) injuries frequently arise following trauma, and can result in disabling instability. Typically such injuries are managed with immobilization followed by a graduated exercise regime; however there is minimal biomechanical evidence to support current treatment protocols. This investigation examines the in vitro effectiveness of several rehabilitation techniques using a custom elbow motion simulator. It was found that active range of motion is safest in the overhead position (n = 7). Early motion in this position may reduce the incidence of elbow stiffness without compromising ligament healing following LCL injury. Forearm pronation and active motion stabilize …

A Study To Understand And Compare Evidence Based Practice Among Health Professionals Involved In Pain Management, Vanitha Arumugam

Electronic Thesis and Dissertation Repository

Pain management is a common concern of multiple health professionals. Evidence-based practice (EBP) in pain management is a recognized approach used to improve health outcomes. EBP tools can facilitate its implementation. PAIN⁺ is a tool that provides access to pre-appraised current best research evidence on pain to support clinical decisions. It is important to understand the knowledge, attitudes and behavior of professionals towards EBP and more specifically how they access research about pain management.

The overarching purpose of this thesis is to better understand how clinicians from different professions involved in pain management view EBP and implement specific strategies …