Friday April 5 5:00pm – 6:30pm & Saturday April 6 8:30am – 1:30pm
Presenter: Erica Zurawski, MScPT BScE
Purpose: To estimate the inter-rater reliability of the Modified Ashworth Scale (MAS) using consistent movement speeds guided by a metronome for measuring wrist flexor and ankle plantar flexor spasticity in patients with an upper motor neuron (UMN) lesion. The MAS has been found to have inconsistent inter-rater reliability for scoring the degree of spasticity.
Methods: Quantitative cross-sectional pilot study occurred in the outpatient spasticity clinic of a community rehabilitation hospital. Participants included a convenience sample of 20 patients with UMN lesions receiving botulinum toxin type A injections for focal spasticity. For each of the muscle groups tested, different pairs of evaluators measured MAS scores at a velocity of 130 degrees/second. Evaluators were physical therapy students trained by an experienced physical therapist in MAS assessment. Weighted kappa values were calculated to measure the inter-rater reliability for each muscle group.
Results:The weighted kappa values for the wrist flexors and ankle plantar flexors were moderate (κw= 0.54, 95% CI [0.21, 0.87]) and slight (κw=0.08, 95% CI [-0.34, 0.50]), respectively.
Conclusion: Using a consistent movement velocity, novice evaluators were able to score spasticity with reasonable inter-rater reliability when assessing the wrist flexors, but not the ankle plantar flexors.
Presenter: Erin Miller, PT PhD Candidate
Background/Purpose: Airway suctioning is a healthcare intervention that has been associated with serious adverse effects. Given the risks involved, it is important to ensure the competency of healthcare professionals who perform it. A scoping review was conducted to identify the nature and extent of research related to airway suctioning competency assessment for healthcare professionals working with adults.
Methods: Four scientific electronic databases (MEDLINE, EMBASE, CINAHL and the Cochrane Library) were searched from inception to March, 2018. A grey literature search was also performed. Two reviewers independently screened records for inclusion and data were extracted using a form created by the authors.
Results: Thirty-six articles/resources were included. Endotracheal was the most common type of suctioning and intensive or critical care units were the primary setting of interest. Competency or a component of competency for nurses, nursing students, nursing assistants and/or nurse technicians was specifically addressed in 97% (35/36) of the included articles/resources. Four (11%) also included physiotherapists, one (3%) included respiratory therapists and one (3%) was aimed towards all clinicians who perform suctioning. Nine (25%) used questionnaire-based assessments, eleven (31%) used checklists or other observational tools, and sixteen (44%) used both. Directed content analysis revealed three major themes: consistency across overarching evaluation frameworks, inconsistency across detailed components and inconsistency in the evaluation or reporting of assessment tool measurement properties.
Conclusions: Researchers, clinicians and educators will need to consider if current tools can be used or adapted for use within their individual contexts or if the creation of new tools is required.
Presenters: Tom Doulas, Jordan Miller, Rupa Patel, Kyle Vader, PT
Rationale/Purpose: Physical activity and exercise is commonly recommended for adults with chronic pain; however, it is unclear what specific barriers and facilitators to physical activity are experienced by this population.
Objectives: To explore in-depth perspectives on factors that influence participation in physical activity and exercise among adults living chronic pain.
Relevance to the Physiotherapy Profession: Physiotherapists play a key role in delivering evidence-based care (e.g. prescribing physical activity and exercise) for adults with chronic pain and are well positioned to contribute positively to patient outcomes in the context of chronic pain management.
Methods and Materials: We conducted an interpretive descriptive qualitative study to explore in-depth perspectives on barriers and facilitators to physical activity and exercise among adults with chronic pain.
Analysis: We conducted a thematic analysis of participant transcripts which included: familiarization with the data, generating initial codes, searching for themes, reviewing themes, defining and naming themes, and producing a report.
Results: A total of 16 participants took part in an interview (approximately 1 hour in length) between October 2017 and January 2018. The majority of participants identified as female (11/16) and had a median age of 53. Key themes related to barriers and facilitators to physical activity and exercise included: pain, fatigue, perceived risks, beliefs about physical activity, competing demands, social support, motivation, other health conditions, and access to supports for physical activity or exercise.
Conclusions: Results may inform the development of future physical activity and exercise interventions for adults with chronic pain.
Presenters: James Datoff, Sawyer Peloso, Homadis Shojaei, Yi Fan Su, Pei-Wen Wang
Background & Purpose: On the topic of falls prevention in hospitals, much of the research has focused on what the program should involve, rather than how the program can be better carried out. Understanding and fine-tuning the implementation process is important to translate knowledge into practice and improve falls outcomes and patient safety. We conducted the study to understand the enablers and barriers of implementing an interprofessional falls prevention program (FPP) from the perspective of frontline healthcare professionals (HCP).
Methods: Our study was conducted at Sunnybrook Health Sciences Centre, using a qualitative descriptive design and focus group methodology. Six focus groups were conducted, consisting of 14 nurses, 11 physiotherapists, and five occupational therapists. The focus groups were face-to-face and facilitated by student researchers. Thematic analysis approach was conducted by the student research team with a Faculty Advisor from the University of Toronto to identify key themes.
Results: 1) Enablers: There was a collaborative culture and identified leader within each inpatient unit to deliver the FPP as an interprofessional team. 2) Barriers: inadequate human resources and equipment, lack of front-line input during program development, and lack of continued dialogue between program directors and frontline staff to improve program.
Conclusions: Our study provides insight on enablers and barriers of falls prevention program implementation in an acute care hospital. To maximize the program’s potential to promote patient safety, it is recommended to improve resources, maintain team communication on inpatient units, and improve communication between different stakeholders in the hospital.
Presenters: Valerie Boyes, MScPT, Calvin Lee, Justin Ma, Christopher Murtha, MScPT, Allison Sharpe, BScKin MScPT, Karen Yoshida, PhD
Background/Purpose: A cardiopulmonary exercise test (CPET) is an underutilized pre-participation screen that can inform optimal and safe aerobic exercise in stroke rehabilitation. Research is limited on the perspectives of physiotherapists and individuals with stroke concerning CPET in this setting. The purpose of this study was to understand the perceived clinical benefits, utility, and challenges of CPET from the perspectives of physiotherapists and patients in stroke rehabilitation. Additionally, this study explored the factors that influence the adoption of CPET in stroke rehabilitation.
Methods: Eight patients who had completed CPET during their rehabilitation participated in interviews to explore their experiences relating to CPET and their rehab. Six referring physiotherapists participated in a semi-structured focus group to discuss the perceived benefits and challenges associated with CPET in practice.
Results: Physiotherapists felt CPET increased confidence with exercise prescription. Having access to local experts was identified as a big facilitator for CPET in this setting. The identified challenges with CPET included medical acuity of patients, obtaining referral information, and therapist confidence interpreting complex results. CPET helped patients understand how to exercise safely, increased their confidence with exercise, and encouraged lifestyle changes. However, many patients desired more information regarding the CPET process, results and its relation to their rehab.
Discussion/Conclusions: This study provides insights into the experiences, benefits, challenges and utility of the CPET in stroke rehabilitation. The issues identified provide information that may assist practitioners as they implement CPET clinics at their facilities or refer elsewhere to appropriately prescribe aerobic exercise.
Presenters: Judith Hunter (Dept. of Physical Therapy, University of Toronto), Gillian Grant (Toronto Academic Pain Medicine Institute,Women’s College Hospital, Toronto), Giulia Mesaroli (The Hospital for Sick Children, Toronto), Celeste Corkery (Toronto Academic Pain Medicine Institute, Women’s College Hospital, Toronto), Kyle Vader (School of Rehabilitation Therapy, Queen’s University, Kingston), Mandy McGlynn (Toronto Rehab Institute, Toronto)
Chronic musculoskeletal pain conditions such as OA, persistent LBP, and fibromyalgia affect an estimated 1 in 5 individuals. Effective evidence-based care for people with pain requires that future physical therapists understand contemporary pain science and better integrate the biopsychosocial model into clinical reasoning. Historically, in MScPT Program at the University of Toronto, these newer concepts were introduced in theory only, and predominately through didactic lecture-style teaching. Our objectives were to develop clinical competencies in pain management by strengthening the content and developing practical clinically applied learning.
Based on the IASP Core Competency consensus for pain management (Fishman et al 2013) and its application to Physical Therapy (Hoeger Bement et al 2014), we took the following steps:
1) Revised the delivery format for existing didactic content from lecture to mandatory online interactive learning modules.
2) Revised the musculoskeletal physical therapy clinical reasoning support guide to reflect a biopsychosocial model and not solely a pathoanatomic model.
3) Developed four new practical labs or small group sessions, each building skills on the previous lab as follows:
- Biopsychosocial interview and reasoning;
- Recognizing nociceptive vs Neuropathic vs Nociplastic components of a person’s pain,
- Pain Science education (when where and how);
- Planning individualized physical activity-based interventions
- Finally, we developed an interprofessional small group task with occupational therapy students to practice communication skills that address physical activity and behaviour change for people with persistent pain.
We will present our plan and our iterative design/future plans based on our experience.
Presenters: Nilofar Fatemi, Christiane Junod, Kieran Liew, Sandra McKay, Meaghan Jensen, Stephanie Nixon, Endrit Ulaj
Purpose: To explore the perspectives of physiotherapists and physiotherapy assistants providing homecare services in Ontario regarding their experiences since the 2013 introduction of PTAs into homecare rehabilitation teams.
Methods: We used a qualitative descriptive methodology involving semi-structured interviews with 10 PTs and 5 PTAs working in homecare. Interviews were transcribed and analyzed using the DEPICT model.
Results: In order to achieve optimal patient outcomes, practitioners in homecare must navigate a grey zone in which there is a lack of clarity around how much autonomy PTAs may practice with. In the absence of a clear consensus on the acceptable level of PTA autonomy, four inter-relating factors determine how much autonomy PTAs practice with: the PT/PTA relationship (trust, communication), system influences (number of physiotherapy visits, professional guidelines), perceived PTA competency (skills, training), and the complexity of the client (status, comorbidities).
Conclusions: The unique nature of homecare has resulted in an expansion of the traditional PTA role and would likely benefit from being more clearly defined.
Presenters: Robyn Daviesa, b, Dean Lisingb, c, Elizabeth Hannad, e, Voula Christofilosf, g, Darlene Hubleyh, i, Vera Gueorguievaj, k
Authors are all members of the Centre for Interprofessional Education Leads (IPEL) committee; a Sinai Health System, b Department of Physical Therapy, University of Toronto, c Centre for Interprofessional Education, University of Toronto, d University Health Network, e Department of Speech, Language Pathology, University of Toronto, f North York General Hospital, g Yeates School of Graduate Studies, Ryerson University, h Holland Bloorview Kid’s Rehabilitation, i Department of Occupational Science & Occupational Therapy, University of Toronto, j The Hospital for Sick Children, k Bloomberg Faculty of Nursing, University of Toronto.
Background: Interprofessional education (IPE) structured placements are defined in the University of Toronto curriculum as longitudinal experiences where students from two or more professions engage in dialogue, share reflections and collaborate on a presentation while on clinical placement. Evaluation tools and methodology for these placements vary across the system. There is a need to understand the intention of the evaluation to align measures; allowing for collection of common data.
Methods: A ten item web-based survey was created and sent to the IPE lead at organizations known to run Structured IPE placements. The survey remained open for three weeks and completion reminders were sent weekly. Recipients were also asked to share their evaluation tools. Questions from these tools were mapped using the four levels of the Kirkpatrick1 model.
Results: Twenty individuals responded from 11 organizations with multiple sites. Sixty percent of sites reported that they use a customized tool to evaluate the placements. Upon analysis, most individual questions in the IPE evaluation tools fall under Kirkpatrick levels ‘Reaction’ and ‘Learning’, which is in line with other studies. Variability in IPE evaluation tools was noted across practice organizations but some common evaluation themes and questions emerged.
Conclusion: Common SIPE placement themes and questions were present in the analysis of evaluation tools. It is recommended that a standardized pool of questions be created for greater consistency and ability to compare learning experiences across Structured IPE placements and sites. The created pool of standardized questions should consider the Kirkpatrick model.
Presenters: Faizan Ahmed, Rasha Alsubaie, Mandar Jog, Kurt Kimpinski, Tom Overend, Lindsay Robinson, Kevin Shoemaker
Background/Purpose: Autonomic Failure (AF) in patients of Parkinson’s Disease (PD), manifesting as orthostatic hypotension, may seriously impair patients’ ability to stand and perform activities of daily living. This study investigated the effects of upper limb and lower limb exercise and wearing an abdominal binder on blood pressure and cerebral oxygenation in this patient population.
Methods: 20 patients with PD were recruited at University Hospital, London, ON. Based on results of autonomic reflex screening for AF, participants were allocated to either group A (PD+AF; n=11) or group B (PD; n=9). All participants undertook head-up tilt of 70° with and without abdominal binder for 5 minutes, performed shoulder elevation exercise (1 minute) and stationary bicycle exercise (12 minutes). Dependent variables including beat-to-beat recordings of mean arterial pressure (MAP) and frontal cortical oxyhemoglobin saturation (CrSO2) were obtained.
Results: An abdominal binder could partly, but not significantly, control decline in MAP in the AF group. Subsequent removal of the binder resulted in significant (p<0.05) fall in both the dependent variables. One minute of upper limb exercise caused a significant increase (p<0.05) in both the dependent variables in both groups. Twelve minutes of aerobic cycling exercise led to a significant increase (p<0.05) in MAP in both groups. Exercise-induced hypotension was more prevalent in the AF group and it led to lower (non-significant) values in the dependent variables.
Conclusion: Patients of PD with AF may variably benefit from these treatment options. Exercise-induced hypertension is a possible complication during aerobic cycling exercise in patients of PD.
Presenters: Amanda Benaim, MScPT, Kiera McDuff, MScPT
Purpose: Observational movement analysis (OMA) is commonly used by physiotherapists to inform clinical reasoning in neurorehabilitation. Little is known about how OMA is performed. The purpose of this study was to investigate the eye gaze behaviour of physiotherapy students and experienced neurological physiotherapists during OMA of a patient with a neurological condition performing sit to stand (STS).
Method: Eight physiotherapy students and eight experienced neurological physiotherapists participated in a cross-sectional descriptive pilot study using an eye tracker system to record foveal fixations as a measure of eye gaze behaviour. Participants watched a video of a patient with a neurological condition performing STS whilst wearing an eye tracker system. Investigators recorded the number and duration of collections of fixations (COFs) made by each participant and the means were used for analysis.
Results: The experienced group made more COFs (p = 0.03) that spanned the patient’s body more broadly relative to the student group. The experienced group also made shorter COFs (p = 0.03) relative to the student group.
Conclusions: There are significant differences in the eye gaze behaviour of student and experienced physiotherapists when performing OMA of STS. Understanding these differences will inform the instruction of OMA in physiotherapy programs.
Presenters: Vanina Dal Bello-Haas, PT PhD, Michael Kalu, BMR.PT, MSc, PhD, Henrietha Nwankwo, BMR.PT, MSc, Ada Tang, PT PhD
Objective: To describe the association between socioeconomic status (SES) and mobility in older adults.
Method: A state-of-the-art review of 36 articles (68 analyses) published from 2000-2018 that examined the association between SES and mobility in older adults
Results: Fifty-five (81%) of the 68 analyses reported that better mobility was associated with higher education (n=28 analyses, p<0.001-0.05), higher income (n=23 analyses, p<0.001-0.05), and holding skilled jobs (n=4 analyses, p<0.001-0.05). Positive associations were consistently reported between SES and walking outcomes when walking was measured over longer distances (e.g. 400 or 800 m) [18 of 19 analyses (95%)] but not over shorter distances (e.g. 2.4 m) [11 of 18 analyses (60%)].
Conclusion: Older adults with higher education, higher income and holding skilled jobs had better mobility outcomes. Using outcomes that assess walking over longer distances may be useful in capturing multiple components of mobility in older adults.
Presenters: Jennifer Withers*, Caitlyn Zavitz*, Tony Nguyen*, Jessica Baglole*, Nadia Kashetsky*, Evelyn Graham*, Rob Brison**, Melanie Law*, Randy Booth*, Jordan Miller*
*School of Rehabilitation Therapy, Queen’s University, Kingston, Ontario, Canada
**Department of Emergency Medicine, Queen’s University, Kingston, Ontario, Canada
Background: Musculoskeletal injuries are among the most common reasons for seeking care in an emergency department. Physiotherapy (PT) students from Queen’s University completed a placement within an Urgent Care Centre (UCC) that usually does not have physiotherapy. The objectives of this study were to: 1) Understand the experiences and perspectives of PT students, clinical instructor, physicians, nurses, and patients with a new PT student placement in the UCC; 2) Identify the barriers and facilitators to PT student placements in the UCC.
Methods: Qualitative interviews with PT students (n=6), PT clinical instructor (n=1), nurses
(n=15), physicians (n=12), and patients (n=17) were conducted using a semi-structured interview guide. Interviews continued until saturation was achieved. The transcribed interviews were independently coded by researchers and thematic analysis was performed in an interpretive description tradition.
Results: All participants suggested the PT student placement was a positive experience. Students and the clinical instructor suggested the placement provided a unique learning opportunity. UCC team members and patients suggested students provided more thorough musculoskeletal assessments and self-management advice. Barriers included students not being able to chart in the electronic medical record, limited beds, and lack of clarity of PT student scope and abilities. Facilitators to a UCC placement included positive perceptions of PT student supervision and PT student impact.
Conclusions: All participants reported positive experiences with the PT student placement in the UCC and suggested offering similar placements in the future. An understanding of the barriers and facilitators to UCC student placements will inform future placements.
Presenter: Olivia Manning, MScPT, BKin (Honors)
Purpose/Rationale: The Oasis Senior Supporting Living program is an aging-in-place created by seniors to respond to the needs of residents of a specific apartment building. It emphasizes programs and activities that promote social connectedness, physical wellness and activity, and nutrition. The purpose of the Oasis Project is to scale-up this aging-in-place model to seven additional naturally-occurring retirement communities (e.g. apartment buildings), and evaluate the model using a mixed-methods, participatory action research approach.
Objectives: 1) Describe the Oasis model; 2) describe research methods, 3) present preliminary evaluation results related to functional mobility and participation outcomes; and 4) discuss implications to physiotherapy practice.
Methods and Materials: The Oasis Project uses a participatory action research approach engaging older adults at all stages in the research process. Specific methods include both qualitative (e.g. interviews) and quantitative (e.g. self-report and performance-based measures, health utilization data) data collection and analysis techniques.
Analysis: Resident interviews were transcribed and underwent thematic analysis. Preliminary results of self-report and physical performance measures were summarized using descriptive analysis.
Results: Oasis members reported a variety of benefits of the program including: increased time spent outside of their apartment, engagement in exercise and physical activity, and maintenance of functional abilities. Quantitative data collection is ongoing and preliminary results will be presented including: physical performance measures including strength, gait speed, functional mobility (Timed up and go), self-efficacy (Modified Falls Efficacy), self-reported mobility participation (Life Space Mobility Assessment); and physical activity (ActivPAL activity monitor).
Conclusions: Oasis is a seniors-driven model of aging-in-place that has great potential for broad application in other naturally occurring retirement communities. Self-report and objective measures of mobility, physical function, and mobility-related participation will allow description and evaluation of this novel model of aging-in-place.
Presenter: Andresa Marinho Buzelli, Postdoctoral Fellow
Background/purpose: Although there is promising evidence that aquatic physical therapy may improve balance and mobility after incomplete spinal cord injury (iSCI), how immersion in water can directly influence balance control is a current knowledge gap. Our goal was to describe the direct influence of the aquatic environment on balance control during standing and gait initiation in individuals with iSCI.
Methods: Six participants with iSCI performed 10 one-minute trials of quiet standing in a hydrotherapy pool and on land and 10 trials of gait initiation, in both environments. We used a multiple approach to assess balance control: neurological assessment of iSCI (ASIA scores), clinical measures of balance (Berg Balance Scale, Mini-BESTest), biomechanical parameters of balance control (center of pressure – COP, and trunk acceleration), and participants’ perceptions during standing and initiating gait in water and on land.
Results: Postural sway increased in water when compared to land, as revealed by the COP and participants’ perceptions. The COP velocity was slower during stepping, indicating the action of the water drag force; length of the COP trajectory was longer suggesting the support by buoyancy force. During standing and gait initiation, the acceleration of the lower trunk was much less in water, suggesting a new postural strategy to maintain balance control.
Conclusion: This study informs physical therapists by determining how water immersion influences balance control in individuals with iSCI. Pool hydrotherapy can be used as a therapeutic approach to train postural control by challenging the trunk postural strategy during standing and gait initiation.
Presenters: Sierra Norville, MScPT, Nicole Hughes, MScPT
Purpose: To explore the experiences of everyday racism among students in Canadian physical therapy (PT) programs and how they manage these experiences.
Methods: This descriptive qualitative study involved in-depth, semi-structured interviews with current students or recent graduates of Canadian Master’s of Science in Physical Therapy (MScPT) programs who identify as racialized. Data was coded and collaboratively analyzed according to the DEPICT model.
Results: Twelve students reported experiences of primarily personally-mediated and institutional racism throughout their MScPT program. The impact of their experiences and their response to situations were influenced by perceived intent and understanding of racism. Participants reported feelings of frustration and resignation; the creation of barriers to connecting with white peers, faculty, and patients; feeling that their skills and abilities were undervalued because of their race; and pressure due to feeling they are seen as representative of their entire race. Participants responded to their experiences of racism by neutralizing situations, assimilating to the dominant culture to fit in, addressing racism by speaking up or educating others, and overachieving to be seen as competent.
Conclusion: Understanding the experiences of racialized students in MScPT programs is the first step towards making positive change in their experiences. This study highlights the importance of educational institutions and policy moving beyond just valuing diversity and towards equity, inclusion, and nurturing a sense of belonging for all individuals.
Presenters: Samuel Jumbo, MScPT Candidate, Tara Packham, OTReg(Ont), PhD
Purpose: The short forms of the Brief Pain Inventory (BPI-SF) and revised McGill Pain Questionnaire (SF-MPQ-2) are self-report outcomes commonly used for multidimensional pain assessment in musculoskeletal (MSK) conditions. This study summarizes the quality and content of measurement evidence for their use in musculoskeletal conditions.
Methods: Four databases were systematically searched to identify studies reporting measurement evidence performed in musculoskeletal populations (>70%) for inclusion. Two reviewers independently extracted data, assessed risk of bias and synthesized the quality of the evidence in line with the updated COSMIN methodology.
Results: Twenty-five articles were included (BPI-SF, n=17; SF-MPQ-2, n=8). Both tools lack evidence on cross-cultural validity and absolute reliability. High-quality evidence supports their internal consistency (α = 0.83-0.96) and relationship with similar outcomes (r = 0.3-0.69). The BPI-SF conforms to its two-dimensional structure; the SF-MPQ-2 four-factor structure has not been clearly established. High-moderate quality evidence supports the BPI-SF known group validity (n=2 studies) and responsiveness (n=5); the quality of evidence was very low for the SF-MPQ-2.
Conclusion: Although the SF-MPQ-2 presents potential, a greater volume of better-quality evidence was found supporting the BPI-SF measurement properties, including its responsiveness, retest reliability, known group validity and structural validities, suggesting it is currently better for pain assessment in MSK conditions. The need remains for further investigation of the BPI-SF severity subscale retest reliability; the SF-MPQ-2 structural validity, known group validity, retest reliabilities, and responsiveness; and the two questionnaires cross-cultural validities, clinically important differences, and measurement error indices in multiple MSK studies of high quality.