Medicine and Health Sciences Commons^™

Acromial Insufficiency Fractures In Reverse Total Shoulder Arthroplasty: A Biomechanical Study, Alicia Kerrigan

Electronic Thesis and Dissertation Repository

Reverse total shoulder arthroplasty (RTSA) is increasingly utilized in the aging population, with a growing list of surgical indications including rotator cuff tear arthropathy, proximal humerus fractures, and revision arthroplasty. Acromial insufficiency fractures following RTSA are poorly understood, difficult to diagnose, and associated with inferior clinical outcomes. There is limited knowledge in the literature regarding the etiology of post-operative acromial fractures. The purpose of this study is to evaluate the role of implant parameters on acromial strain following RTSA.

Using a cadaveric model, a custom designed modular RTSA system was implanted that allowed for evaluation of modifiable parameters including glenoid …

Prognostic Predictive Model To Estimate The Risk Of Multiple Chronic Diseases: Constructing Copulas Using Electronic Medical Record Data, Jason E. Black

Electronic Thesis and Dissertation Repository

Introduction: Multimorbidity, the presence of two or more chronic diseases in an individual, is a pressing medical condition. Novel prevention methods are required to reduce the incidence of multimorbidity. Prognostic predictive models estimate a patient’s risk of developing chronic disease. This thesis developed a single predictive model for three diseases associated with multimorbidity: diabetes, hypertension, and osteoarthritis.

Methods: Univariate logistic regression models were constructed, followed by an analysis of the dependence that existed using copulas. All analyses were based on data from the Canadian Primary Care Sentinel Surveillance Network.

Results: All univariate models were highly predictive, as demonstrated by their …

Examining Eshift Through The Caregiver Policy Lens: A Content Analysis, Ashlee A. Worrall

Electronic Thesis and Dissertation Repository

Purpose: This research study intended to understand how a new model of palliative home care in Ontario, Canada called eShift aligned with the needs of caregivers who cared for a family member at the end-of-life.

Methods: A qualitative secondary analysis using a deductive content analysis of 14 caregiver interviews, three decision-maker interviews, and six home care agency documents collected in a three-year study and were analyzed using The Caregiver Policy Lens framework.

Findings: The eShift model of care met caregivers’ needs through timely access to respite, education, collaborating with the health care team, and physical and psychological support. Caregivers were …

Evaluation Of The Construct Validity Of The Questionnaire To Identify Knee Symptoms Among Individuals Across Canada With Chronic Knee Pain, James Young

Electronic Thesis and Dissertation Repository

The primary purpose of this study was to evaluate the construct validity of the Questionnaire to Identify Knee Symptoms (QuIKS) measurement scale among individuals with chronic knee symptoms consistent with osteoarthritis. Construct validity was assessed using tests of convergent and discriminative validity on 15 pre-specified hypotheses. The secondary objective was to determine the internal consistency reliability of the QuIKS. One hundred and five individuals recruited in select physiotherapy clinics from across Canada were mailed the QuIKS and five other health questionnaires. Fifty-five individuals completed the questionnaire package. While none of the pre-specified construct validity hypotheses were met, nine of the …

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

Electronic Thesis and Dissertation Repository

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 …

A Collaborative Approach To Decision Making Through Developmental Monitoring To Provide Individualized Services For Children With Cerebral Palsy., Doreen J Bartlett, Sarah W Mccoy, Lisa A Chiarello, Lisa Avery, Barbara Galuppi, On Track Study Team

Physical Therapy Publications

In this Perspective, we suggest a process to improve physical and occupational therapists’ and families’ collaboration to provide appropriate, efficient, and effective evidence-based services to improve motor function, self-care performance, and participation in family and recreation activities for children with cerebral palsy (CP). This process is informed by 2 multisite prospective cohort studies (Move & PLAY and On Track). The heterogeneity of children with CP is described, limiting the utility of evidence from randomized controlled trials and systematic reviews to inform service planning for children with CP. An evidence-based alternative using prospective cohort studies that produce knowledge of determinants of …

Wait Times, Resource Use And Patient-Reported Outcomes For Patients Referred For Total Knee Replacement Surgery, Kate Lebedeva

Electronic Thesis and Dissertation Repository

This prospective cohort study evaluated the usual care pathway for patients referred to total knee arthroplasty (TKA). We measured healthcare resource use, costs and health-related quality of life (HRQoL) over the continuum of care. We also determined the proportion of inappropriate referrals and estimated wait times for initial surgical consultation and TKA. We found that two in five patients referred to specialty care were deemed inappropriate surgical candidates. Prior to referral, few conservative treatment options were tried, and many imaging tests ordered by referring providers were unjustified. Overall, the greatest proportion of costs were borne by the patient or private …

A Framework For Secondary Cognitive And Motor Tasks In Dual-Task Gait Testing In People With Mild Cognitive Impairment., Susan W Hunter, Alison Divine, Courtney Frengopoulos, Manuel Montero Odasso

Physical Therapy Publications

BACKGROUND: Cognition is a key factor in the regulation of normal walking and dual-task gait assessment is an accepted method to evaluate the relationship. The objective of this study was to create a framework for task complexity of concurrent motor and cognitive tasks with gait in people with mild cognitive impairment (MCI).

METHODS: Community-dwelling people with MCI (n = 41, mean age = 76.20 ± 7.65 years) and cognitively normal controls (n = 41, mean age = 72.10 ± 3.80 years) participated in this study. Gait velocity was collected using an instrumented walkway under one single task and six combined …

A Qualitative Examination Of Women's Self-Presentation And Social Physique Anxiety During Injury Rehabilitation, Molly V. Driediger, Craig R. Hall, Carly D. Mckay

Paediatrics Publications

No abstract provided.

Effectiveness Of 4-Aminopyridine For The Management Of Spasticity In Spinal Cord Injury: A Systematic Review, Joshua Weiner, Jane Hsieh, Amanda Mcintyre, Robert Teasell

Epidemiology and Biostatistics Publications

Background: Spasticity is a common secondary complication of spinal cord injury (SCI), which can severely impact functional independence and quality of life. 4-Aminopyridine (4-AP) is a potassium channel blocker that has been studied as an intervention for spasticity in individuals with SCI. Objective: To conduct a systematic review of the available evidence regarding the effectiveness of 4-AP for the management of spasticity in individuals with SCI. Methods: A comprehensive literature search was conducted on five electronic databases for articles published in English up to January 2017. Studies were included if (1) the sample size was three or more subjects, (2) …

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 …

Electrical Stimulation For Treating Pressure Injuries: Evaluation Of A Knowledge Mobilization Project, Lyndsay Orr

Electronic Thesis and Dissertation Repository

Pressure ulcers (PrU) are a secondary health complication that cause increased morbidity, mortality and decreased quality of life. PrUs have also been shown to have a significant financial burden on the healthcare system. Current best practice guidelines strongly recommend the use of Electrical Stimulation (E-Stim) to increase healing rates of PrUs. Unfortunately, there has been lack of uptake for the use of E-Stim in clinical practice. To address this gap in practice, a knowledge mobilization project called the E-Stim Collaboration Project was developed. The aim of this dissertation was to 1) determine if an education program can change knowledge, attitudes …

Tomographic And Histological Analyses Of Ectopic Calcification Associated With Diffuse Idiopathic Skeletal Hyperostosis (Dish), Dale Edward Fournier

Electronic Thesis and Dissertation Repository

Diffuse idiopathic skeletal hyperostosis (DISH) is a non-inflammatory spondyloarthropathy characterised by the formation of ectopic calcifications of the ligaments/enthuses along the anterolateral aspect of the vertebral column. Despite affecting 15-25% of North Americans over the age of 50, the aetiology of DISH is poorly understood and there are no disease modifying treatments. Our discovery-based approach implemented a transdisciplinary research team to study the basic biology, imaging science, clinical anatomy and significance of DISH in humans. Our novel characterisation defined distinct morphological presentations of ectopic calcifications associated with DISH in cadaveric specimens using micro-computed tomography imaging. Subsequent histopathological analyses demonstrated that …

Health Professional Students' Understanding Of Oral Health In Traumatic Brain Injury, Samira Omar

Electronic Thesis and Dissertation Repository

Oral health is a significant consideration in recovery following severe traumatic brain injury (TBI) as it is associated with overall health. Health-care providers play an essential role in rehabilitation following TBI. Thus, using qualitative descriptive research and focus groups, this thesis examined the experiences and perceptions of eight final-year health-professional students in nursing, occupational therapy, and speech-language pathology with respect to oral health in TBI. Results suggest that health-professional students lack a deep understanding of i) what constitutes oral health, ii) common oral health challenges that may be faced by persons with TBI, and iii) optimal oral care in persons …

Assessing The Risk Of Falling In Adults One-Year After Total Hip Arthroplasty, William Janes

Electronic Thesis and Dissertation Repository

The purpose of this study was to examine falls prevalence, falls risk factors and knowledge of falls in individuals who have undergone a total hip arthroplasty. There were 135 patients examined at their one-year follow-up appointment for total hip arthroplasty. Our primary outcome, falls prevalence and falls circumstances, found a falls prevalence of 21.5% with identical circumstances to that of average community-dwelling older adults. Female sex, number of prescription medications and multiple joint replacements were found to be significantly associated with the occurrence of falls in the previous year. The Falls Risk for Older People in a Community Setting Questionnaire …

Appraisal Of Clinical Practice Guideline: American Academy Of Orthopaedic Surgeons Clinical Practice Guideline On The Management Of Osteoarthritis Of The Hip, Ze Lu, Joy C. Macdermid

Bone and Joint Institute

No abstract provided.

Methadone For Analgesia In Children With Life-Limiting Illness: Experience From A Tertiary Children's Health Service., Christine Mott, Amrita Sarpal, Krista Moss, Anthony Herbert

Paediatrics Publications

Methadone has the potential to assist in the management of pain in children with life-limiting illness, but its use is limited by its complex pharmacokinetic profile and limited research on its use in children. This is a retrospective review of the use of methadone as an analgesic in 16 children with life-limiting illness. Efficacy, dosing and side effect profile were analysed. Fifteen (94%) patients had improvements in their analgesia with minimal observed adverse effects. Patients were either rapidly converted from a prior opioid in one change or received methadone as an adjunct medication. Conversions were calculated using ratios frequently in …

A Mapping Review Of Randomized Controlled Trials In The Spinal Cord Injury Research Literature, Amanda Mcintyre, Brooke Benton, Shannon Janzen, Jerome Iruthayarajah, Joshua Weiner, Janice J. Eng, Robert Teasell, Spinal Cord Injury Research Evidence Team

Epidemiology and Biostatistics Publications

Study design

Mapping Review.

Objective

The objective of this study was to map out and characterize the quantity and quality of all published spinal cord injury (SCI) randomized controlled trials (RCTs) with respect to number, sample size, and methodological quality between January 1970 and December 2016.

Setting

Not applicable.

Methods

A literature search of multiple research databases was conducted. Studies adhering to the following criteria were included: the research design was an RCT; written in English; participants were >18 years; and the sample was >50% SCI. Data were extracted pertaining to author(s), year of publication, country of origin, initial and …

Efficacy Of Rhythmic Acquisition On Gait Performance Among Individuals With Parkinson’S Disease, Demian L. Kogutek

Electronic Thesis and Dissertation Repository

The purpose of this study was to identify the ability of individuals with Parkinson’s disease (PD) to acquire different rhythmic complexity levels through individual home-based Improvised Active Music Therapy (IAMT) sessions. The study aimed to identify whether higher acquisition of rhythmic complexity levels improved gait performance, as well as beat perception and production abilities. In this single subject multiple baseline design, the study measured the ability of four right-handed participants with PD to acquire greater density of syncopation, as a measure of rhythmic complexity levels, while playing uninterrupted improvised music on a simplified electronic drum-set. An accredited music therapist led …

The ‘Meanings’ And ‘Enactments’ Of Science And Technology: Ant-Mobilities’ Analysis Of Two Cases, Farrukh Chishtie

Electronic Thesis and Dissertation Repository

In this work I study two cases involving practices of science and technology in the backdrop of related and recent curricular reforms in both settings. The first case study is based on the 2005 South Asian earthquake in Muzaffarabad, Pakistan which led to massive losses including large scale injuries and disabilities. This led to reforms at many levels ranging from disaster management to action plans on disability, including educational reforms in rehabilitation sciences. Local efforts to deal with this disaster led to innovative approaches such as the formation of a Community Based Rehabilitation (CBR) model by a local NGO, which …

Clinimetrics: Upper Extremity Functional Index, Vanitha Arumugam, Joy C. Macdermid

Bone and Joint Institute

No abstract provided.

Descriptive Report Of The Impact Of Fatigue And Current Management Strategies In Cerebral Palsy., Laura K Brunton

Physical Therapy Publications

Purpose: Describe the impact of fatigue and self-management practices for adolescents and young adults with cerebral palsy (CP).

Methods: Survey of 124 people with CP with the Fatigue Impact and Severity Self-Assessment (FISSA).

Results: People in GMFCS Level I experienced little impact of fatigue with high proportions of this group disagreeing to statements about fatigue impacting their general activities, mobility and social activities. People in GMFCS Levels II-V reported impact of fatigue on activities. Differences between groups were evident in questions related to fatigue interference with length of time for physical activity and with motivations to participate in social …

Appraisal Of Clinical Practice Guideline: Management Of Neck Pain, Pavlos Bobos, Joy C. Macdermid

Bone and Joint Institute

No abstract provided.

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 …

An Evaluation Of The Structural Validity Of The Shoulder Pain And Disability Index (Spadi) Using The Rasch Model, Christina Jerosch-Herold, Rachel Chester, Lee Shepstone, Joshua I. Vincent, Joy C. Macdermid

Bone and Joint Institute

© 2017, Springer International Publishing AG, part of Springer Nature. Purpose: The shoulder pain and disability index (SPADI) has been extensively evaluated for its psychometric properties using classical test theory (CTT). The purpose of this study was to evaluate its structural validity using Rasch model analysis. Methods: Responses to the SPADI from 1030 patients referred for physiotherapy with shoulder pain and enrolled in a prospective cohort study were available for Rasch model analysis. Overall fit, individual person and item fit, response format, dependence, unidimensionality, targeting, reliability and differential item functioning (DIF) were examined. Results: The SPADI pain subscale initially demonstrated …

The Contribution Of Health And Psychological Factors In Patients With Chronic Neck Pain And Disability: A Cross-Sectional Study, Pavlos Bobos, Goris Nazari, Stephania Palimeris, Evdokia Billis, Joy C. Macdermid

Bone and Joint Institute

© 2018, Journal of Clinical and Diagnostic Research. All rights reserved. Introduction: One approach to reduce the burden of neck pain is the management of the prognostic factors that are associated with greater disability. Studies which quantify these predictors can support interventions that attempt to modify these trajectories. Aim: The aim of the present study to determine the contribution of psychological and health factors that are commonly associated with neck pain and disability levels. Materials and Methods: Patients between 18-65 years old were recruited to participate in the present study if they had neck pain for more than three months, …

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

Electronic Thesis and Dissertation Repository

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 …

Comparing The Anterior, Posterior And Lateral Approach: Gait Analysis In Total Hip Arthroplasty, Stephen Petis, James Howard, Brent Lanting

Bone and Joint Institute

No abstract provided.

Physical Rehabilitation Interventions In The Intensive Care Unit: A Scoping Review Of 117 Studies., Julie C Reid, Janelle Unger, Devin Mccaskell, Laura Childerhose, David J Zorko, Michelle E Kho

Physical Therapy Publications

BACKGROUND: Physical rehabilitation (PR) interventions in the intensive care unit (ICU) can improve patients' functional outcomes, yet systematic reviews identified discordant effects and poor reporting. We conducted a scoping review to determine the extent of ICU PR interventions and how they were reported and measured.

METHODS: We searched five databases from inception to December 2016 for prospective studies evaluating adult ICU PR interventions. Two independent reviewers screened titles, abstracts, and full texts for inclusion. We assessed completeness of reporting using the Consolidated Standards of Reporting Trials, Strengthening the Reporting of Observational Studies in Epidemiology, or Standards for Quality Improvement Reporting …

Appraisal Of: Management Of Neck Pain And Associated Disorders: A Clinical Practice Guideline From The Ontario Protocol For Traffic Injury Management (Optima) Collaboration, Saravanan Esakki, Joy C. Macdermid

Bone and Joint Institute

No abstract provided.