Physiotherapy Canada最新文献

Purpose: This study modified established clinical balance and walking measures and estimated the reliability, validity, and feasibility of using these measures to assess people post-stroke via videoconferencing.

Method: Twenty-eight people with chronic stroke were recruited and completed the in-person balance and mobility tests. Five clinical measures were modified as virtual assessments over videoconferencing. Feasibility was evaluated by task completion rate, occurrence of adverse events, and technical difficulties. Test-retest reliability and agreement were examined by intra-class correlations and standard error of measurement between two testing days. Convergent validity was examined by the magnitude of associations between in-person and virtual assessments using Pearson or Spearman rank correlation.

Results: Twenty-one participants (52% female) participated in both in-person and virtual assessments. No adverse events occurred. Technical challenges were experienced by eight participants. Test-retest reliability for timed up and go test, 30-seconds sit-to-stand, five-times sit-to-stand, functional reach test, and tandem stance resulted in intra-class coefficients of 0.97, 0.90, 0.77, 0.54, and 0.50 respectively. The standard error of measurement was low across all virtual assessments. The timed up and go test, five-times sit-to-stand, and 30-seconds sit-to-stand showed relationship with in-person assessments (r = -0.55 to -0.81).

Conclusions: Virtual assessment of walking and balance function in ambulatory people post-stroke is feasible; however, technical challenges were experienced. The test-retest reliability of virtual assessments of timed up and go test and sit-to-stand tasks for people with stroke, together with strong convergent validity of the measures compared to in-person assessments is promising.

Purpose: The objective was to synthesize outdoor winter walking programmes and resources for older adults, identified as a priority by the Winter Walk team comprised of older adults and researchers and trainees from the rehabilitation and geography sciences.

Method: A scoping review of web-based grey literature was conducted. Teams of two reviewers independently assessed eligibility and extracted data. Web-based resources were included if their content dealt with adults ≥65 years of age; an outdoor winter walking programme, intervention, or general resource; and was written in English.

Results: Twenty-seven website resources were eligible and included in the review. Resources were from Canada or the United States and included information provided by government, non-profit organizations, media, and businesses. All resources focused on some aspect of winter walking safety and only one mentioned a winter walking programme.

Conclusions: Web-based resources for outdoor winter walking were synthesized to assist older adults and clinicians with access to safe outdoor winter walking information.

Purpose: To describe the impact of COVID-19 on the adoption and use of telerehabilitation (TR), and to identify facilitators and barriers of the provision in Ontario physiotherapy outpatient/community settings.

Method: A cross-sectional design, web-based survey was disseminated to Ontario physiotherapists working in outpatient/community settings. Descriptive statistics were used for data analysis.

Results: Responses from 243 physiotherapists were included in the analysis. Respondents reported increasing and initiating TR to maintain continuity of care and limit patient COVID-19 exposure. Facilitators for adopting TR were physiotherapists' attitudes and access to technology, convenience and ease of scheduling sessions, and perceived patient satisfaction and comfort in their home environment compared with in-person care. Patient-related barriers for adopting TR perceived by respondents included patients' attitude, suitability and ability to address their needs, ease of adoption, and Internet connectivity. More than 50% of respondents perceived that financial factors did not influence TR adoption.

Conclusions: Physiotherapists increased their use of TR through the COVID-19 pandemic. Effective implementation of TR should include both patient and physiotherapist education, and best practice guidelines on implementation of TR in order to create a hybrid model of care that would better address the patient's needs.

Purpose: We explored the current and potential role of physiotherapists in the management of people with type 2 diabetes (T2D) and T2D as a primary condition for physiotherapy referral.

Methods: We conducted a qualitative descriptive study. Participants were physiotherapists practicing in community and outpatient settings across Canada. One-on-one telephone interviews were completed to explore provision of physiotherapy care for people with T2D, including current practices and readiness of physiotherapists to provide direct care. We employed thematic analysis for generation of themes from interviews.

Results: We interviewed 21 participants from eight provinces and territories. Three themes were generated from the data: current approach to T2D management; challenges for physiotherapy integration; and merits of physiotherapy and needed evolution. Participants described that physiotherapists are not part of the healthcare team for T2D management. There is a gap in medical management of T2D that physiotherapy would fill, that is, education and prescription for exercise participation.

Conclusions: Our findings support a gap in the management of T2D in Canadian healthcare, particularly in reference to physiotherapy. Further, our findings support the need for greater inclusion of physiotherapists for lifestyle counseling with an emphasis on physical activity and exercise for patients at risk of and with T2D to maximize health and improve/maintain function. Studies focusing on accessibility and funding of physiotherapy services are needed to validate these findings.

Purpose: This systematic review aimed to examine the benefit of combined upper body exercise and compression therapy for breast cancer related lymphedema.

Method: Electronic searches were performed in Medline, EMBASE, CINAHL, SPORTDiscus, and PEDRO. We included randomized and controlled clinical trials that examined the effect of upper body exercise with use of compression therapy on arm lymphedema. Where data were available, effect sizes were calculated. Risk of bias was assessed using the Cochrane risk-of-bias tool. The quality of evidence was rated using Grading of Recommendations Assessment, Development and Evaluation (GRADE).

Results: Of 444 studies, 11 met all inclusion criteria. Two cross-over trials examined single bouts of upper body exercise with or without compression, three intervention trials examined non-resisted upper body exercise and compression, and six intervention trials examined upper body resistance exercise and compression. Only two studies reported statistically significant benefit from the combined intervention for arm lymphedema volume. Seven studies provided adequate data to allow for calculation of effect size; however, heterogeneity precluded pooling of data. The quality of evidence was moderate in intervention trials comparing combined upper body exercise and compression to standard care (n = 1) or to exercise alone (n = 1). For all other trials the grade of evidence was low, with quality ratings downgraded due to small sample sizes and/or high or unclear risk of bias.

Conclusions: No clear conclusions could be made regarding the benefit of combined upper body exercise and compression for breast cancer related lymphedema. Further high-quality trials are warranted.

Purpose: Following mild traumatic brain injury (mTBI), patients are often advised to restrict physical activity until full symptom resolution followed by gradual return to activity. However, extended rest periods may prolong recovery and contribute to persistent symptoms. Emerging evidence suggests early active rehabilitation that increases heart rate without exacerbating symptoms may improve mTBI patient recovery. This review aims to: (1) appraise evidence on active rehabilitation intervention for mTBI recovery within one-month of injury (i.e., exercise type, duration, intensity, etc.); and (2) recommend evidence-based rehabilitation protocols.

Method: Pubmed, CINAHL, PsychARTICLES, SportDISCUS, and AMED databases were searched using key terms "mild Traumatic Brain Injury", "Rehabilitation", "Acute", and their synonyms. Evidence was appraised using Cochrane RoB-2 and ROBINS-I.

Results: 434 citations were initially identified with seven papers systematically reviewed. Within the reviewed articles, only three were randomized controlled trials with low risk of bias, and four were non-randomized trials with low to moderate risk of bias. Findings highlighted that a range of active rehabilitation protocols were used with different exercise modalities (primarily treadmills and static cycling), durations (9-20 min, or until symptomatic, for 30-50 days or symptoms resolved), and intensities (low, moderate or high). Active rehabilitation did not cause any serious adverse events (i.e., death, hospitalisation etc.), and six studies reported that it did not exacerbate mTBI symptoms in any participants (with one participant having symptom worsening in one study). Overall, the majority of reviewed studies (n = 4) showed that active rehabilitation decreased time to mTBI symptom resolution compared to controls (strict rest/stretching exercises).

Conclusions: Individualized active rehabilitation prescribed within one-month post-mTBI appears to be safe and effective at decreasing recovery time to symptom resolution in mTBI. However, there is a lack of consensus regarding specific intervention protocols that needs to be addressed before adoption within clinical practice.