Physiotherapists Description Of Patient-Centered Care, And Barriers And Facilitators Experienced To Implementation, Maclean Jordan

Electronic Thesis and Dissertation Repository

Patient-centered care (PCC) is a growing standard for healthcare delivery due to the benefits to patient autonomy. Lacking a cohesive definition in the physiotherapy literature, it is also lacking in implementation. Employing interpretive description with semi-structured interviews, the goal was to understand how physiotherapists drawn from private for-profit clinics in Canada describe PCC, and barriers and facilitators to providing it. Results included requiring person-centered communication in PCC, seeing Health holistically, centering the patient in care, and being a skill that becomes clearer with practice experience. Barriers included: lack of practitioner reflexivity, patient not desiring self-directed care, and limited access to …

Evaluation Of Conservative And Operative Treatments In Active Patients With Acromioclavicular (Ac) And Rotator Cuff (Rc) Injuries, Jesse Singh

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Abstract

Introduction: Shoulder pain and disability, particularly acromioclavicular joint (ACJ) and rotator cuff (RC) injuries, are common in a physically active population. Determining operative or rehabilitative treatment plans involve multiple treatment choices influenced by the injury grade and treatment goals, such as return to sport. This thesis investigates the management of treatment for AC and RC injuries

Method: The first study is a scoping review that uses the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) to synthesize 32 studies involving athletes who have undergone conservative or operative treatment for their Rockwood grade III …

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

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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 …

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

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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 …

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

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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, …

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

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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 …

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

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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 …

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

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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 …

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

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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 …

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

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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. …

Assessment Of Landing Biomechanics And Rehabilitation After Anterior Cruciate Ligament Reconstruction, Sheila S. Gagnon

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Aberrant landing biomechanics increase the risk of anterior cruciate ligament (ACL) injury and are a focus of rehabilitation after ACL reconstruction. The purpose of the present thesis was to develop and evaluate methods of assessing landing mechanics and investigate the effects of different rehabilitation strategies after ACL reconstruction. Three studies were conducted. The first study used a Delphi process to develop the content of a Clinician-Rated Drop Vertical Jump Scale to evaluate jump landing mechanics during rehabilitation after ACL reconstruction. Twenty experts participated in four rounds of questioning, resulting in 92% agreement for knee valgus collapse, lateral trunk lean, insufficient …

Cardiovascular Effects Of Exercise And Use Of Abdominal Binder In Patients Of Parkinson’S Disease With Orthostatic Hypotension, Faizan Ahmed

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Orthostatic hypotension (OH) is a common manifestation of autonomic dysfunction in Parkinson’s Disease. It can adversely affect a patient’s functional capacity, exercise tolerance and quality of life, while increasing the risk of falls, cerebrovascular disease and overall mortality. Use of an abdominal binder (AB) can help counter OH; however, this has not been sufficiently studied in patients with Parkinson’s Disease (PwPD). Moreover, the hemodynamic effects of upper and lower extremity exercise are unclear in PwPD with OH. Although OH can impair the cerebral circulation, the consequences on the cerebral hemodynamics of wearing an AB or performing exercise are unknown in …

Joint Protection Programs For People With Hand Arthritis, Pavlos Bobos

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The fact that Joint Protection Programs (JPP) can reduce pain and improve function is based on small, but definitive Randomized Controlled Trials (RCTs), conducted in the 1980s. However, changes over time in the nature of hand use, the rapid expansion of technology, and improvements in our understanding of health literacy mean that these programs are now outdated. Further, problems with adherence to JPP are well documented. The purpose of this thesis was 1) to conduct a scoping review to map all the available evidence around joint protection programs in published and unpublished studies 2) to evaluate the effectiveness of joint …

Therapeutic Interventions For Managing Diabetic Shoulder, Sanaa A. Alsubheen

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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 …

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 …

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

Electronic Thesis and Dissertation Repository

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 …

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

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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 …

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 …

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 …

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

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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

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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) …

Inter-Rater Reliability Of The Mckenzie System Of Mechanical Diagnosis And Therapy In The Examination Of The Knee, Sean Willis

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Objective: The purpose of this thesis was to investigate the inter-rater reliability of the McKenzie System of Mechanical Diagnosis and Therapy (MDT) when classifying patients with musculoskeletal knee pain using clinical vignettes. Methods: This study was divided into two phases. First, ten clinicians experienced in the use of MDT were randomly recruited to write a total of 60 clinical vignettes based upon the initial assessment of past patients with knee pain. Second, six different MDT raters were recruited to rate 53 selected vignettes and reliability was determined using Fleiss Kappa. Results: There was “substantial agreement” among six MDT raters …

A Randomized Clinical Trial To Compare The Effect Of Non Operative Treatment With And Without Autologous Conditioned Plasma (Acp) On Healing And Function In Patients With Achilles Tendon Ruptures, Tyler M. Pratt

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The purpose of this study was to determine whether there is evidence to support conducting a larger randomized control trial (RCT) to compare the non-operative treatment of Achilles tendon (AT) ruptures with or without Autologous Conditioned Plasma (ACP®). Twenty-four patients were randomized to receive an ACP® or saline injection within seven days and again at two weeks post-rupture. Tendon healing was longitudinally evaluated using ultrasound (US) and magnetic resonance imaging (MRI). Functional and patient-reported quality of life measures were also assessed. A small sample size limited our ability to detect statistically significant differences. The mean rankings of healing were slightly …

Take 2 Steps And Call Me In The Morning: Prescribing Physical Activity Through Primary Care, Emily Knight

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Objectives: Physical activity guidelines for older adults target high-intensity activities (i.e. increasing exercise), with less attention on low-intensity activities (i.e. reducing/interrupting sedentary behaviours) to improve health. Mobile health (mHealth) holds promise for engaging patients in self-management of chronic diseases. The purpose of this research was to prescribe physical activity of various intensities (i.e. sedentary through exercise) in primary care paired with mHealth for self-management.

Methods: 60 older adults (55-75yr) were randomly assigned to four groups: one control, and three receiving mHealth kits plus prescription for a specific intensity of physical activity (exercise, sedentary or both). Clinical measures (anthropometrics, …

Psychometric Evaluation Of Self-Report Pain And Disability Measures For Elbow Disorders, Joshua Vincent

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Elbow disorders are one of the commonest musculoskeletal problems with a prevalence of 9% in men and 8.1% in women. Patient centered care is the goal of current healthcare delivery models; but optimizing treatment outcome and clinical research is hampered by a lack of outcome measures. Since pain and disability resulting from elbow disorders are experienced differently across individuals, they are best captured by patient reported outcome measures (PROM).

PROMs like the Patient-rated Elbow Evaluation (PREE); American Shoulder and Elbow surgeons – Elbow form (pASES-e) have been developed for use in elbow disorders, but important questions remain about their measurement …

Examining The Shift In Occupational Identity After A Brain Injury, Mikelle Bryson-Campbell

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Occupational identity is defined by Kielhofner (2002) as a sense of who we are as an occupational being, based on our past, current, and future occupational roles. When a life disruption occurs such as a brain injury (BI) and the disruption impacts the ability to conduct an occupation deemed meaningful an important process of transition occurs (Muenchberger, Kendall, & Neal, 2008). In turn occupational identity may shift to reflect the current health and economic status of the individual and what occupations are judged as meaningful.

The current study examined the shift in occupational identity in BI survivors in a two …

Prognosis And Movement Patterns In Patients After Rotator Cuff Repair, Jayaprakash Raman

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Rotator cuff repairs are done in patients who failed to achieve functional improvement with conservative management for rotator cuff tears. This thesis focuses on prognostic factors that predict outcomes after rotator cuff repair (RCR) and change in functional range of motion (ROM) and muscle endurance before and after RCR. A meta-analysis was performed to statistically analyze all available evidence in the literature concerning prognostic factors that determine outcome after RCR. Based on this study, several factors were identified that had significant and moderate effects on outcomes after RCR. Two prospective studies were conducted to analyze change in functional ROM and …