Publications by authors named "Dina Brooks"

315 Publications

Measuring intensity during free-living physical activities in people with chronic obstructive pulmonary disease: a systematic literature review.

Ann Phys Rehabil Med 2021 Nov 21:101607. Epub 2021 Nov 21.

Lab3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal; iBiMED - Institute of Biomedicine, Department of Medical Sciences, University of Aveiro, Aveiro, Portugal. Electronic address:

Background: Measuring intensity of physical activity (PA) is important to ensure safety and the effectiveness of PA interventions in chronic obstructive pulmonary disease (COPD).

Objective: This systematic review identified which outcomes, outcome measures and instruments have been used to assess single free-living PA-related intensity in people with COPD and compared the intensity level (light, moderate, vigorous) obtained by different outcome measures.

Methods: PubMed, Scopus, Web of Science, Cochrane Library and EBSCO were searched for original studies of COPD and assessing single free-living PA-related intensity were included. Agreement was calculated as the number of agreements between 2 measures [same intensity level]/ number of comparisons using both measures*100.

Results: We included 43 studies (1282 people with COPD, mean age 66 years, 65% men, 49% FEV) and identified 13 outcomes, 46 outcome measures and 22 instruments. The most-reported outcomes, outcome measures and instruments were dyspnoea with the Borg scale 0-10; cardiac function, via heart rate (HR) using HR monitors; and pulmonary gas exchange, namely oxygen consumption (VO), using portable gas analysers, respectively. The most frequently assessed PAs were walking and lifting, changing or moving weights/objects. Agreement between the outcome measures ranged from 0 (%VO vs metabolic equivalent of task [MET]; %HR vs Fatigue Borg; MET vs walking speed) to 100% (%HR vs dyspnoea Borg; fatigue and exertion Borg vs walking speed). %VO elicited the highest intensity. Hence, Borg scores, %HR and MET may underestimate PA-related intensity.

Conclusions: Various methodologies are used to assess single free-living PA-related intensity and yield different intensity levels for the same PA. Future studies, further exploring the agreement between the different outcome measures of PA-related intensity and discussing their advantages, disadvantages and applicability in real-world settings, are urgent. These would guide future worldwide recommendations on how to assess single free-living PA-related intensity in COPD, which is essential to optimise PA interventions and ensure patient safety.
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http://dx.doi.org/10.1016/j.rehab.2021.101607DOI Listing
November 2021

Systematic review of psychometric properties and cross-cultural adaptation of the University of California and Los Angeles loneliness scale in adults.

Curr Psychol 2021 Nov 12:1-15. Epub 2021 Nov 12.

School of Rehabilitation Science, McMaster University, 1400 Main Street West, IAHS Building Room 430, Hamilton, ON L8S 1C7 Canada.

This systematic review assessed the psychometric properties and the cross-cultural adaptation of the University of California and Los Angeles Loneliness scale (UCLA-LS) in adults. A systematic search of four electronic databases (PubMed, EMBASE, Scopus, and PsycINFO) was conducted from inception until March 2021. We followed the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) guidelines for data extraction and evidence synthesis. Eighty-one studies assessed the validity and reliability of the UCLA-LS, translated into many languages, and applied across several countries/societies. Three versions of the 20-item and nine short versions of the UCLA-LS with 3 to 20 questions were identified. High-quality evidence supported the internal structure of the UCLAs: 4, 6, 7 and 10, while low-to moderate-quality evidence supported the construct validity of the UCLAs: 3, 4, 6, 8, 16 and 20. Moderate-quality evidence supported the test-retest reliability of version 3 UCLA-20 with excellent interclass coefficients values of 0.76-0.93. The UCLAs: 4, 6, 7 and 10 had the most robust internal structure and may therefore be the most useful for informing clinicians and social psychologists engaged in assisting those with loneliness.

Supplementary Information: The online version contains supplementary material available at 10.1007/s12144-021-02494-w.
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http://dx.doi.org/10.1007/s12144-021-02494-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8586628PMC
November 2021

Embedding a Behavior Change Program Designed to Reduce Sedentary Time Within a Pulmonary Rehabilitation Program Is Feasible in People With COPD.

J Cardiopulm Rehabil Prev 2021 Sep 13. Epub 2021 Sep 13.

Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada (Drs Wshah, Selzler, Brooks, and Goldstein); Rehabilitation Sciences Institute (Drs Wshah, Brooks, and Goldstein) and Department of Medicine (Drs Brooks and Goldstein), University of Toronto, Toronto, Ontario, Canada; Department of Physical and Occupational Therapy, Hashemite University, Zarqa, Jordan (Dr Wshah); School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia (Dr Hill); and School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada (Dr Brooks).

Purpose: This study examined the feasibility of embedding a 4-wk intervention, which sought to reduce sedentary time (SED), into a pulmonary rehabilitation program (PRP) in people with chronic obstructive pulmonary disease.

Methods: This was an intervention study that comprised one face-to-face session and three follow-up visits. Primary outcomes related to feasibility and included adherence to data completion undertaken before and during the intervention period, participant satisfaction with the intervention (out of 100%), and participant achievement of intervention goals. Secondary outcomes, collected before and after the intervention period, included SED and daily step count.

Results: Of 28 eligible individuals approached to participate, 21 (75%) were enrolled and 19 (90%) completed the program (13 females; age 69.1 ± 8.7 yr). Sixteen participants (84%) were adherent to wearing a physical activity monitor before and during the intervention period. The satisfaction score was 90 ± 12%. Over the intervention period, a total of 73 intervention goals were set, of which 41 (56%) were achieved. The effect of the intervention on SED was unclear.

Conclusions: Embedding this intervention in a PRP appears to be feasible; however, its impact on SED should be further evaluated.
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http://dx.doi.org/10.1097/HCR.0000000000000624DOI Listing
September 2021

Clinician-Led Balance Training in Pulmonary Rehabilitation.

Physiother Can 2021 ;73(3):235-243

Respiratory Research, West Park Healthcare Centre, Toronto, Ontario, Canada.

Guidelines for pulmonary rehabilitation (PR) include balance training but lack specific parameters. After a knowledge translation project at our site, clinicians modified the physiotherapy programme to facilitate the sustainability of balance training as part of PR. The purpose of this study was to explore whether the modified programme resulted in improved balance and balance confidence. A secondary aim was to provide information on the way in which balance training was operationalized as part of PR for clinicians wanting to incorporate it into an existing PR programme. We conducted a retrospective study of patients with chronic obstructive pulmonary disease, enrolled in a 4- to 6-week inpatient PR programme over a 1-year period. Balance training was provided biweekly with a staff-to-patient ratio of 2:11. Participants completed the brief Balance Evaluation Systems Test (brief-BESTest) and Activities-Specific Balance Confidence (ABC) scale at the beginning and end of PR. The 85 participants had a mean age of 69.5 (SD 9.0) years. After completing an average of 7.6 balance sessions (min-max 2-13), participants showed improvements in brief-BESTest (mean difference 3.2 [95% CI: 2.5, 3.9] points) and ABC (mean difference 7.8 [95% CI: 4.1, 11.5] percent). A staff-to-patient ratio of 2:11 and a training frequency of twice per week for 4-6 weeks improved balance. This result will inform how we incorporate balance training into existing PR programmes.
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http://dx.doi.org/10.3138/ptc-2019-0111DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8370697PMC
January 2021

Updating the Evidence: Suctioning Practices of Physiotherapists in Ontario.

Physiother Can 2021 ;73(2):147-156

Department of Physical Therapy.

The purpose of this article is to describe current tracheal suctioning practices of physiotherapists in the province of Ontario and to determine what factors influence these practices. A cross-sectional online survey was conducted. An online survey link and quick response code were mailed to Ontario physiotherapists who were actively providing patient care and were authorized to perform tracheal suctioning as identified by the College of Physiotherapists of Ontario. Ninety physiotherapists participated in the survey (23% response rate). Most (66%) suctioned in an intensive care setting, and many (41%) reported frequently using a closed endotracheal suctioning system. Hyperoxygenation was frequently performed before suctioning by 48% of participants, and only 18% frequently hyperoxygenated after suctioning. Most participants reported infrequently performing saline instillation (52%) and infrequently hyperinflating before suctioning (79%). Clean gloves were reported as the personal protective equipment most frequently worn across all suctioning approaches, and goggles and sterile gloves were least often worn while suctioning. Previous suctioning experience had the most influence on suctioning practices, and limited access to equipment had the least influence. Some of the tracheal suctioning practices of physiotherapists in Ontario vary from evidence-based clinical guidelines.
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http://dx.doi.org/10.3138/ptc-2019-0113DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8370724PMC
January 2021

Analyzing the Eye Gaze Behaviour of Students and Experienced Physiotherapists during Observational Movement Analysis.

Physiother Can 2021 ;73(2):129-135

Department of Physical Therapy.

Physiotherapists use observational movement analysis (OMA) to inform clinical reasoning. This study aimed to (1) determine the feasibility of characterizing eye gaze behaviour during OMA with eye-tracking technology, (2) characterize experienced neurological physiotherapists' and physiotherapy students' eye gaze behaviour during OMA, and (3) investigate differences in eye gaze behaviour during OMA between physiotherapy students and experienced physiotherapists. Eight students and eight physiotherapists wore an eye-tracking device while watching a video of a person with a history of stroke and subsequent concussion perform sit to stand. Feasibility criteria were (1) successful calibration of the eye tracker, and successful collection of data, for 80% of the participants and (2) moderate interrater reliability of the investigators, measured by intra-class correlation coefficients (ICCs). Three investigators independently recorded the participants' foveal fixations. Differences between physiotherapists and students in number of fixations, duration per fixation, and total duration of fixations were evaluated using unpaired -tests, mean differences, and 95% CIs. Data were collected for all participants. ICCs ranged from 0.64 to 0.78. Fixations by physiotherapists were shorter (mean 368.5 [SD 80.8] ms) and greater in number (mean 18.9 [SD 2.2]) than those by students (mean 459.0 [SD 64.2] ms,  = 0.03, and mean 15.9 [SD 2.7],  = 0.03), respectively. Measuring eye gaze behaviour during OMA using eye tracker technology is feasible. Physiotherapists made more fixations of shorter duration than students. Further investigation of how experienced therapists perform OMA and apply it to clinical reasoning may inform the instruction of OMA.
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http://dx.doi.org/10.3138/ptc-2019-0047DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8370730PMC
January 2021

Cranial Nerve Noninvasive Neuromodulation in Adults With Neurological Conditions: Protocol for a Scoping Review.

JMIR Res Protoc 2021 Jul 28;10(7):e29965. Epub 2021 Jul 28.

Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.

Background: Cranial nerve noninvasive neuromodulation (CN-NINM) via translingual nerve stimulation (TLNS) is a promising new intervention combined with neurological rehabilitation to improve outcomes for persons with neurological conditions. A portable neuromodulation stimulation (PoNS) device rests on the tongue and stimulates cranial nerves V and VII (trigeminal and facial nerves, respectively). Emerging evidence suggests that CN-NINM using the PoNS device, combined with targeted physical therapy, improves balance and gait outcomes but has not yet been comprehensively reviewed.

Objective: This review will describe CN-NINM via TLNS and its applications, effects, and implications for rehabilitation science in adult populations with neurological conditions. We will identify how CN-NINM via TLNS is currently being incorporated into neurological rehabilitation and identify gaps in evidence with respect to this novel technology.

Methods: Joanna Briggs Institute methodology will be used to conduct this scoping review. Electronic databases MEDLINE, AMED, CINAHL, Embase, and Web of Science will be searched, as well as gray literature databases ProQuest, DuckDuckGo, and Google. Studies published in English and French between 2000 and 2021 will be included. Two reviewers will independently screen all titles and abstracts and full-text papers that meet the inclusion criteria. Data will be extracted and collated in a table to synthesize the results. Extracted data will be reported in a comprehensive summary.

Results: The final manuscript is intended for submission to an indexed journal in September 2021.

Conclusions: This scoping review will be the first, to our knowledge, to address the current evidence on CN-NINM. The results will inform the use of CN-NINM in neurological rehabilitation and the development of recommendations for future research.

Trial Registration: Open Science Framework 10.17605/OSF.IO/XZQFM; https://osf.io/xzqfm.

International Registered Report Identifier (irrid): PRR1-10.2196/29965.
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http://dx.doi.org/10.2196/29965DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8367107PMC
July 2021

The Role of Occupational Therapy in Pulmonary Rehabilitation Programs: Protocol for a Scoping Review.

JMIR Res Protoc 2021 Jul 26;10(7):e30244. Epub 2021 Jul 26.

School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.

Background: Chronic respiratory diseases are highly prevalent and compromise an individual's ability to perform activities of daily living (ADLs) and participate in meaningful life roles. Pulmonary rehabilitation (PR) is a well-established intervention aimed at restoring an individual's exercise capacity and improving their ability to complete their ADLs. Occupational therapists help individuals engage in meaningful "occupations," improving their health and well-being. Given the concordance in the aims of PR and the occupational therapy (OT) scope of practice, occupational therapists appear to be well suited as key players in PR programs. However, the benefits of adding OT to PR programs have been sparsely reported in the literature and the role of OT in PR has never been synthesized or reported in national and international guidelines.

Objective: The aim of this review is to explore the role of OT in PR programs, the current guideline recommendations for the inclusion of OT in PR programs, the estimated prevalence of OT in PR programs, and the reported or anticipated effects of OT interventions in PR programs.

Methods: The review will be conducted following the Joanna Briggs Institute (JBI) methodology for scoping reviews. A comprehensive search will be undertaken in the Cochrane Database of Systematic Reviews, EMBASE, MEDLINE, and CINAHL (EBSCO) to identify and retrieve relevant literature published in English, French, or Portuguese. Gray literature on international OT association websites will also be identified, including position statements and guidelines relevant to PR programs. All literature published since the establishment of the effectiveness of PR for chronic respiratory disease in 1994 that explores OT in PR programs for these patients will be included. Search results will be exported to Covidence for title, abstract, and full-text screening by two independent reviewers. Data will be extracted by two independent reviewers using a pilot-tested template including the following: the number of PR programs including OT (specifically from surveys), the purpose of the study, the study design, patient characteristics, respiratory conditions included, PR components, OT role, outcomes, and results. Findings will be presented using a narrative summary, supplemented by figures and/or tables. Key themes will be displayed in an infographic or schematic.

Results: The study was initiated in January 2021 and registered with the Open Science Framework (OSF) in February 2021, prior to title and abstract screening. Data collection and analysis and drafting of the manuscript will occur throughout 2021, with expected publication in 2022.

Conclusions: The results of this scoping review will help health care professionals improve patient care by broadening their understanding and awareness of the role of OT in PR programs. This role clarification may help to inform program development and clinical decision making and will serve to optimize the delivery of multidisciplinary care for patients in PR programs, ultimately improving patient outcomes.

Trial Registration: OSF Registries ZH63W; https://osf.io/zh63w.

International Registered Report Identifier (irrid): DERR1-10.2196/30244.
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http://dx.doi.org/10.2196/30244DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8367120PMC
July 2021

Interventions to Support Informal Caregivers of People with Chronic Obstructive Pulmonary Disease: A Systematic Literature Review.

Respiration 2021 Jul 14:1-13. Epub 2021 Jul 14.

Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada.

Background: Chronic obstructive pulmonary disease (COPD) imposes tremendous challenges for both patients and informal caregivers. Caregivers are key players in the management of COPD. Recently, COVID-19 further increased reliance on informal caregivers who urgently need specific support. This systematic literature review aimed to systematically describe the content and explore the effects of interventions to support informal caregivers of people with COPD.

Methods: A mixed-methods systematic review was conducted. PubMed, Scopus, Web of Science, and EBSCO were searched. Studies implementing interventions supporting informal caregivers of people with COPD were included. Data were extracted and analysed in outcome domains and categories using framework analysis.

Results: Twenty (14 quantitative, 4 mixed-methods, and 2 qualitative) studies were included. Informal caregivers were mainly female (86%). Caregiving context was poorly/never described. Interventions included patient-caregiver dyads and never caregivers only. Informal caregivers were invited to participate if available. Interventions were delivered across all COPD phases (acute/stable/advanced) and settings (inpatient/outpatient/home), with a wide range of total length, frequency, and duration of sessions. All included education about the disease and its management. Discharge/action plans (n = 12); adherence to therapy and healthy lifestyles (n = 9); and family concerns and psychosocial issues (n = 7) were also commonly addressed. Only 9 (45%) studies reported caregiver-related outcomes, and overall positive effects were observed in 7/9 outcome domains, using a high variety of qualitative and qualitative methods. Often categories were addressed but not assessed.

Conclusion: Interventions have a narrow scope (i.e., education) and have not been specifically designed to support informal caregivers. Current evidence showed positive effects, but high methodological heterogeneity exists. Future studies need to explore caregiver-tailored, taking into consideration gender differences; multicomponent; and flexibly administered interventions to effectively support COPD caregivers.
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http://dx.doi.org/10.1159/000517032DOI Listing
July 2021

Rapid access rehabilitation after exacerbations of COPD - A qualitative study.

Respir Med 2021 09 8;186:106532. Epub 2021 Jul 8.

Westpark Healthcare Centre, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Ontario, Canada. Electronic address:

Purpose: Rehabilitation after acute exacerbations of chronic obstructive pulmonary disease (AECOPD) is beneficial, but its feasibility is questionable. Feasibility is potentiated by stakeholder involvement during program development. We aimed to explore the perspectives of various stakeholders towards an innovative rapid access rehabilitation (RAR) program for patients immediately following hospitalization for an AECOPD.

Method: Semi-structured interviews were conducted with patients recently hospitalized for AECOPD, healthcare professionals (HCP) and policymakers providing care for such patients. Thematic analysis was performed.

Results: Three patients (1 female; 62-89 years; GOLD D), ten HCP (3 females, 31-71 years) and three policymakers (3 females, 38-55 years) participated. Patients, HCP and policymakers shared similar visions for the development of a RAR program. Five main themes and ten subthemes were identified. They comprised: Pre-RAR aspects (Management properties, Eligibility), RAR program (Outcomes, Structure, Components), RAR optimization (Referral, Uptake), Partnership (Collaboration, Dedicated Coordinator) and COVID-19 (Adaptations). Essential elements included: identifying clear eligibility criteria, addressing patients' needs at the time of hospital discharge, having a structured education and self-management program and modifying to respond to unexpected events (e.g., COVID). Suggestions to optimize referrals included a clear referral pathway, improving program awareness, assigning dedicated care coordinators to provide patient support throughout the program and establishing strong partnerships among different care settings and providers.

Conclusions: Identifying the essential program elements and approaches to optimize referrals, were considered to be key design approaches for success in establishing RAR.
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http://dx.doi.org/10.1016/j.rmed.2021.106532DOI Listing
September 2021

Feasibility of a 6-Month Home-Based Fall Prevention Exercise Program in Older Adults with COPD.

Int J Chron Obstruct Pulmon Dis 2021 3;16:1569-1579. Epub 2021 Jun 3.

Firestone Institute for Respiratory Health, St. Joseph's Healthcare, Hamilton, ON, Canada.

Purpose: Older adults with chronic obstructive pulmonary disease (COPD) have a high risk and rate of falls. Home-based fall prevention exercise programs reduce falls in older adults and may be an alternative approach for people with COPD without access to hospital-based rehabilitation. Therefore, we aimed to determine the feasibility of a home-based fall prevention exercise program in older adults with COPD and to examine the effect of the program on fall-related outcomes at baseline, 3 and 6 months.

Patients And Methods: Adults ≥60 years with COPD at risk for falls participated in a single group study. The intervention was a 6-month home-based fall prevention program which included 40 minutes of independent exercise three times per week, four physiotherapist home visits, bimonthly phone calls, and an optional booster session post-exacerbation. An independent assessor collected outcome measures at home at baseline, 3- and 6-months. Primary feasibility criteria were recruitment and retention rates (≥70%) and exercise adherence (≥60%). Functional outcomes included the Berg Balance Scale (BBS), the Balance Evaluation Systems Test (BESTest), the Activities-Specific Balance Confidence (ABC) scale, the repeated chair-stand test, self-reported function, and fall history.

Results: Thirty-six patients (female 63.8%, mean age 74.4 ± 6.1 years; mean FEV 45.0 ± 13.8% predicted) were enrolled. The recruitment rate was 46.8%, participant retention rate was 69.4%, and exercise adherence rate was 73.6%. Repeated measures ANOVA showed improvements at 3- and 6-months compared to baseline in the BBS (0.001) and the BESTest total scores and sub-scores (0.001).

Conclusion: The home-based fall prevention exercise program met one of the three pre-specified feasibility criteria (exercise adherence), and improved balance-related measures of fall risk in older adults with COPD. Our findings highlight important opportunities for refinement of the study design prior to undertaking a full-scale trial.
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http://dx.doi.org/10.2147/COPD.S309537DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8184142PMC
August 2021

Psychometric Properties of Patient-Reported Outcome Measures Assessing Self-Efficacy in Patients with Chronic Obstructive Pulmonary Disease (COPD): A Systematic Review.

COPD 2021 04 12;18(2):254-263. Epub 2021 Mar 12.

School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada.

This systematic review aimed to synthesize the evidence of the psychometric properties of self-efficacy patient-reported outcome measures (PROMs) in patients with chronic obstructive pulmonary disease (COPD). We conducted a systematic search of MEDLINE and other common databases from inception until September 2020. Studies that reported psychometric properties of self-efficacy outcome measures in COPD patients were included. We used the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) 2018 guidelines for data extraction and evidence synthesis. Eighteen studies that assessed nine self-efficacy PROMs were eligible for inclusion. The assessment of structural validity indicated sufficient results rating for the Exercise Self-Regulatory Efficacy Scale and the Self-Care-Self-Efficacy Scale, and insufficient rating for the COPD Self-Efficacy Scale and the Pulmonary Rehabilitation Adaptation Index for Self-Efficacy (PRAISE). Construct validity measures displayed sufficient results rating with correlations ranging from -0.48 to - 0.71 between self-efficacy PROMs and other PROMs such as St. George's Respiratory Questionnaire, Hospital Anxiety and Depression Scale and Chronic Respiratory Questionnaire. Internal consistency measures indicated sufficient rating for all self-efficacy PROMs with a Cronbach's alpha range of 0.71 - 0.98. Responsiveness was assessed for the PRAISE with an overall sufficient rating (effect sizes of 0.21 - 0.37). The evidence regarding the psychometric properties of self-efficacy PROMs in COPD is variable. The PRAISE is responsive to changes in self-efficacy in COPD patients attending a pulmonary rehabilitation program. When using self-efficacy PROMs in clinical practice or research, clinicians and researchers should consider the psychometric properties and choose the appropriate outcome measure based on the purpose.
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http://dx.doi.org/10.1080/15412555.2021.1897559DOI Listing
April 2021

Feasibility of a rhythmic auditory stimulation gait training program in community-dwelling adults after TBI: A case report.

NeuroRehabilitation 2021 ;48(2):221-230

Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.

Background: Traumatic brain injury has multiple impacts on gait including decreased speed and increased gait variability. Rhythmic auditory stimulation (RAS) gait training uses the rhythm and timing structure of music to train and ultimately improve slow and variable walking patterns.

Objective: To describe the feasibility of RAS gait training in community-dwelling adults with traumatic brain injury (TBI). A secondary objective is to report changes in spatiotemporal gait parameters and clinical measures of balance and walking endurance.

Methods: Two individuals with a TBI participated in nine sessions of gait training with RAS over a 3-week period. At baseline, post-training and 3-week follow-up, spatiotemporal parameters of walking were analyzed at preferred pace, maximum pace and dual-task walking conditions. Secondary outcomes included the Community Balance and Mobility Scale and the 6-Minute Walk Test. Feasibility was assessed using reports of physical fatigue, adverse event reporting, and perceived satisfaction.

Results: Both participants completed all 9 planned intervention sessions. The sessions were well tolerated with no adverse events. Participant 1 and 2 exhibited different responses to the intervention in line with the therapeutic goals set with the therapist. Participant 1 exhibited improved speed and decreased gait variability. Participant 2 exhibited reduced gait speed but less fatigue during the 6MWT.

Conclusions: RAS was found to be a safe and feasible gait intervention with the potential to improve some aspects of gait impairments related to gait speed, gait variability, dynamic balance and walking endurance. Further investigation including a pilot randomized controlled trial is warranted.
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http://dx.doi.org/10.3233/NRE-208016DOI Listing
May 2021

Inclusion of People With Peripheral Artery Disease in Cardiac Rehabilitation Programs: A Pan-Canadian Survey.

Heart Lung Circ 2021 Jul 13;30(7):1031-1043. Epub 2021 Feb 13.

Department of Physical Therapy, University of Toronto, Toronto, ON, Canada; KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada; Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada; Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Toronto, ON, Canada. Electronic address:

Purpose: To determine the proportion of cardiac rehabilitation programs (CRPs) in Canada that accept referrals for individuals with peripheral artery disease (PAD), eligibility criteria, and barriers/facilitators to inclusion.

Methods: CRPs across Canada were sent a web-based questionnaire.

Results: Of 180 questionnaires sent, 98 CRP managers representing 114 CRPs (62.6% of CRPs in Canada) responded. Of respondents, 81.6% accepted referrals for people with PAD; however 44.6% reported that ≤10 patients participated in the previous calendar year; two CRPs had no participants. Of CRPs accepting PAD, 23.7% accepted patients only with coexisting cardiac disease, 68.4% accepted post-lower limb amputees with prosthesis and 53.9% without prosthesis (non-ambulatory). Further, 32.2% did not provide formal/informal PAD-specific education to patients and only 14.3% provided education to staff regarding PAD in the previous 3 years. Three (3) numerical pain scales were used to guide exercise intensity. Within these scales up to four pain thresholds were used. Most frequently cited barriers to participation included lack of referrals (61.6%), and programs being at capacity (59.3%). Frequently cited facilitators were providing information on benefits of CRPs to referral sources (88.3%) and patients (88.3%), providing PAD-specific education to staff (85.5%), and PAD-toolkits for prescribing aerobic/resistance training (81.5%, both).

Conclusion: Most CRPs accept individuals with PAD, however, few are referred. Inclusion of PAD with and without cardiac disease, collaboration between referral source and CRPs to improve the referral process, and PAD-specific education for staff and information/brochures on benefits of CRPs for patients and referral sources should improve participation and delivery of secondary prevention strategies.
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http://dx.doi.org/10.1016/j.hlc.2020.12.018DOI Listing
July 2021

Reducing sedentary behavior in individuals with COPD: healthcare professionals' perspectives.

Physiother Theory Pract 2021 Feb 15:1-12. Epub 2021 Feb 15.

Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada.

: Reducing sedentary behavior (SB) in individuals with chronic obstructive pulmonary disease (COPD) is being increasingly recognized as a novel health target. Understanding healthcare professionals (HCPs) behavior that influences a reduction in SB in this population could facilitate achieving this target. : To explore the determinants of behavior related to HCPs targeting a reduction in SB in people with COPD. : We used a qualitative semi-structured interview approach informed by the Theoretical Domains Framework (TDF). Sixteen HCPs were interviewed. Interview transcripts were mapped against the relevant TDF domain(s) and then higher order themes were generated. : Directed content analysis resulted in mapping 949 quotes to the TDF domains with environmental context and resources being the most coded domain. Three higher order themes were identified: 1) HCPs need more knowledge on reducing SB; 2) Strategies suggested to include in pulmonary rehabilitation (PR) to reduce SB; and 3) Barriers to adding SB to PR. Domains of environmental context and resources, knowledge, social/professional role and identity, reinforcement, social influences, skills and beliefs about capabilities were relevant to the study population to reduce SB in people with COPD. : Knowledge of SB varied across participants. This study provided information on potential behavioral targets for future interventions that involve HCPs and aim to reduce SB among people with COPD.
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http://dx.doi.org/10.1080/09593985.2021.1885088DOI Listing
February 2021

Handgrip Strength in People With Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis.

Phys Ther 2021 06;101(6)

School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.

Objective: The purpose of this study was to systematically review the association between handgrip strength (HGS) and mortality, morbidity, and health-related quality of life (HRQL) in individuals with chronic obstructive pulmonary disease (COPD).

Methods: The following databases were used: CENTRAL, CINAHL, EMBASE, MEDLINE Ovid, SPORTDiscus, and PsycINFO. Studies published between 2000 and 2020 in English, Portuguese, or French that examined the association of HGS with mortality, morbidity, and HRQL in individuals with stable COPD were selected. Two authors independently extracted data and assessed the quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation framework. The study effects were pooled using random effects meta-analysis models after assessing heterogeneity. The search generated 710 studies, and 18 were included in the review. Studies evaluated a total of 12,046 individuals with stable COPD (mean percent of the predicted forced expiratory volume in 1 second = 34%-80%) using over 10 diverse protocols for HGS measurement. Statistically significant, small, and negative relationships were found between HGS and mortality (r = -0.03; 95% CI = -0.05 to -0.02). Independent of the outcome measure used to assess morbidity, the estimate of the overall relationship was small to moderate and negative: Body Mass Index, Airflow Obstruction, Dyspnea, and Exercise Index Updated (r = -0.42; 95% CI = -0.61 to -0.03); exacerbations (r = -0.02; 95% CI = -0.04 to -0.00); and hospitalizations (r = -0.69; 95% CI = -1.70 to 0.32). Similarly, for HRQL, independent of the outcome measure, the estimate of the overall relationship was small to fair and negative: COPD Assessment Test (weighted r = -0.22; 95% CI = -0.32 to -0.12), Chronic Respiratory Disease Questionnaire domains (-0.24 < r < -0.14), EuroQol Five-Dimension Questionnaire (utility score) (r = -0.17; 95% CI = -0.26 to -0.07), EuroQol Five-Dimension Questionnaire domains (-0.32 < r < -0.06), and St George Respiratory Questionnaire total (r = -0.26; 95% CI = -0.33 to -0.17). The quality of the evidence ranged from low to very low across outcomes.

Conclusion: Although heterogeneity was present among HGS measurement protocols, small to moderate associations were found, indicating that those with lower HGS have an increased likelihood of death, a higher risk of increased COPD morbidity (as assessed with Body Mass Index, Airflow Obstruction, Dyspnea and Exercise Capacity indexes), and poorer HRQL.
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http://dx.doi.org/10.1093/ptj/pzab057DOI Listing
June 2021

Minimal Clinically Important Difference for Quadriceps Muscle Strength in People with COPD following Pulmonary Rehabilitation.

COPD 2021 02 3;18(1):35-44. Epub 2021 Feb 3.

Lab3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal.

Quadriceps strength training is a key component of pulmonary rehabilitation (PR). Clinical interpretability of changes in muscle strength following PR is however limited due to the lack of cut-off values to define clinical improvement. This study estimated the minimal clinically important difference (MCID) for the isotonic and isometric quadriceps muscle strength assessed with the one-repetition maximum (1RM) and hand-held dynamometry (HHD) in people with chronic obstructive pulmonary disease (COPD) following PR.A secondary analysis of a real life non-randomised controlled study was conducted in people with COPD enrolled in a 12-week community-based PR programme. Anchor and distribution-based methods were used to compute the MCIDs. The anchors explored were the St. George's respiratory questionnaire (SGRQ) and the six-minute walk test (6MWT) using Pearson's correlations. Pooled MCIDs were computed using the arithmetic weighted mean (2/3 anchor, 1/3 distribution-based methods) and reported as absolute and/or percentage of change values.Eighty-nine people with COPD (84% male, 69.9 ± 7.9 years, FEV 49.9 ± 18.9% predicted) were included. No correlations were found between changes in 1RM and the SGRQ neither between changes in HHD and the SGRQ and 6MWT ( > 0.05). Thus, anchor-based methods were used only in the MCID of the 1RM with the 6MWT as the anchor. The pooled MCIDs were 5.7Kg and 26.9% of change for the isotonic quadriceps muscle strength with 1RM and 5.2KgF for isometric quadriceps muscle strength assessed with HHD.The MCIDs found are estimates to improve interpretability of community-based PR effects on quadriceps muscle strength and may contribute to guide interventions.
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http://dx.doi.org/10.1080/15412555.2021.1874897DOI Listing
February 2021

Randomized controlled trial of community-based, post-rehabilitation exercise in COPD.

Respir Med 2020 Nov - Dec;174:106195. Epub 2020 Oct 15.

Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada; Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada; School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada.

Purpose: Although pulmonary rehabilitation (PR) improves function in people with chronic obstructive pulmonary disease (COPD), a community-based exercise program may be necessary to maintain functional capacity. We aimed to determine the effectiveness of a post-rehabilitation, community-based maintenance program on exercise tolerance, functional capacity and quality of life.

Methods: Patients with COPD who completed PR were randomized to receive a community-based maintenance program (intervention) or usual care (control). The primary outcome was 6-min walk distance (6MWD), measured immediately post-PR, 6 months and 12 months later. Secondary outcomes included self-reported functional capacity, health-related quality of life, self-efficacy, program cost, and lower extremity muscle strength.

Results: Ninety-seven patients (69 ± 9 years) were enrolled. There was a non-significant trend of an intervention effect on 6MWD over time (β = 42, 95% CI: 0.06 to 83.93, p = 0.053). There was no significant impact of group on any of the secondary outcomes. Restricting the analysis to those who attended ≥50% of the exercise sessions showed a significant intervention effect for 6MWD (β = 69.19, 95% CI = 10.16 to 128.22, p = 0.03). The cost of participating in the community maintenance program for the intervention group was $374.77 (SD 142.12) and membership renewal was highest at community centres offering twice weekly, supervised exercise classes.

Conclusions: A post rehabilitation, community-based exercise program, will maintain exercise capacity in people with COPD who attend at least 50% of available sessions over one year. An increased focus on factors that determine adherence would help inform improvements in maintenance program design.
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http://dx.doi.org/10.1016/j.rmed.2020.106195DOI Listing
June 2021

Exoskeleton use in post-stroke gait rehabilitation: a qualitative study of the perspectives of persons post-stroke and physiotherapists.

J Neuroeng Rehabil 2020 09 10;17(1):123. Epub 2020 Sep 10.

Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada.

Background: Wearable powered exoskeletons are a new and emerging technology developed to provide sensory-guided motorized lower limb assistance enabling intensive task specific locomotor training utilizing typical lower limb movement patterns for persons with gait impairments. To ensure that devices meet end-user needs it is important to understand and incorporate end-users perspectives, however research in this area is extremely limited in the post-stroke population. The purpose of this study was to explore in-depth, end-users perspectives, persons with stroke and physiotherapists, following a single-use session with a H2 exoskeleton.

Methods: We used a qualitative interpretive description approach utilizing semi-structured face to face interviews, with persons post-stroke and physiotherapists, following a 1.5 h session with a H2 exoskeleton.

Results: Five persons post-stroke and 6 physiotherapists volunteered to participate in the study. Both participant groups provided insightful comments on their experience with the exoskeleton. Four themes were developed from the persons with stroke participant data: (1) Adopting technology; (2) Device concerns; (3) Developing walking ability; and, (4) Integrating exoskeleton use. Five themes were developed from the physiotherapist participant data: (1) Developer-user collaboration; (2) Device specific concerns; (3) Device programming; (4) Patient characteristics requiring consideration; and, (5) Indications for use.

Conclusions: This study provides an interpretive understanding of end-users perspectives, persons with stroke and neurological physiotherapists, following a single-use experience with a H2 exoskeleton. The findings from both stakeholder groups overlap such that four over-arching concepts were identified including: (i) Stakeholder participation; (ii) Augmentation vs. autonomous robot; (iii) Exoskeleton usability; and (iv) Device specific concerns. The end users provided valuable perspectives on the use and design of the H2 exoskeleton, identifying needs specific to post-stroke gait rehabilitation, the need for a robust evidence base, whilst also highlighting that there is significant interest in this technology throughout the continuum of stroke rehabilitation.
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http://dx.doi.org/10.1186/s12984-020-00750-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7488039PMC
September 2020

A Tool to Assess Participation in People With COPD: Validation of the Late Life Disability Instrument.

Chest 2021 01 31;159(1):138-146. Epub 2020 Aug 31.

School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada; Firestone Institute for Respiratory Health, St. Joseph's Health Centre, Hamilton, ON, Canada; Respiratory Medicine, West Park Healthcare Centre, Toronto, ON, Canada. Electronic address:

Background: Participation in life roles is a critical patient-centered health outcome associated with morbidity and mortality in older adults, but it is not measured routinely in people with COPD. We aimed to validate a participation measure, the Late Life Disability Instrument (LLDI), in people with COPD.

Research Question: To what extent does the LLDI demonstrate test-retest measurement error and reliability, internal consistency, construct and face validity, and floor or ceiling effects when applied to people with COPD?

Study Design And Methods: In this cross-sectional study, LLDI scores were compared with scores on measures of theoretically related constructs and between groups based on symptom severity, prognosis, and frailty. A subsample (n = 36) completed the LLDI a second time over the phone within one week. Participants and health-care professionals were asked about the relevance, comprehensiveness, and comprehensibility of the LLDI. Floor and ceiling effects were explored, and the internal consistency (Cronbach's α) of the LLDI was calculated.

Results: Ninety-six older adults with COPD participated. The frequency and limitation domains of the LLDI showed excellent test-retest reliability (two-way random effect intraclass correlation coefficient, 0.90 [standard error of measurement, 1.74 points] and 0.90 [standard error of measurement, 3.16 points], respectively). Both domains showed fair correlations with physical function, depression, and quality of life (r = 0.38-0.59). The relationship with anxiety was poor for the LLDI frequency domain (r = -0.21) and fair for LLDI limitation domain (r = -0.45). Both domains discriminated between people with different symptom severity, prognosis, and frailty (P ≤ .026). Neither domain showed floor or ceiling effects, and Cronbach's α was 0.69 and 0.91 for the LLDI frequency and limitation domains, respectively. All healthcare professionals and most participants agreed that the LLDI measures participation (79%) and that the items were relevant (81%).

Interpretation: The LLDI shows test-retest reliability, internal consistency, and construct and face validity in people with COPD. The LLDI can be used to assess participation in this population.
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http://dx.doi.org/10.1016/j.chest.2020.08.2079DOI Listing
January 2021

Relationship between Distress Related to Caregiver Burden and Physical Activity in Informal Caregivers of Patients with COPD.

COPD 2020 10 5;17(5):562-567. Epub 2020 Aug 5.

Center for Innovative Care and Health Technology (ciTechCare), Polytechnic Institute of Leiria, Leiria, Portugal.

Chronic obstructive pulmonary disease (COPD) can lead to increased dependence on the informal caregiver and, consequently, to distress associated with caregiving burden. In the general population, higher levels of physical activity (PA) are related to lower distress levels; however, this relationship has been scarcely studied in COPD. This study aimed to explore the relationship between distress and PA in informal caregivers of patients with COPD, and the influence of caregivers' (age, sex) and patients' (age, sex, lung function) characteristics and caregiving duration on this relationship.A cross-sectional study was conducted with 50 caregivers (62.7 ± 9.8 years, 88% female; 78% caring for a spouse/partner; 38% caring >40 h/week; patients' FEV=45.2 ± 21.3% predicted). Data collection comprised questions related to the caregiving context, distress related to caregiving burden assessed with the Informal Caregiver Burden Assessment Questionnaire (QASCI; total score, 7 subscales), and self-reported PA with the Habitual Physical Activity Questionnaire (HPAQ). Spearman's correlation coefficient and linear regressions were used.Significant, negative and moderate correlations were found between the QASCI (28.5 ± 19.8) and the HPAQ (5.2 ± 1.3) (ρ=-0.46;  = 0.01); and between the HPAQ and some QASCI subscales (emotional burden ρ=-0.47; implications for personal life ρ=-0.52; financial burden ρ=-0.44; perception of efficacy and control mechanisms ρ=-0.42;  < 0.01). Two linear regression models were tested to predict QASCI total score including as predictors: 1) HPAQ alone ( = 0.001; r=0.23); 2) HPAQ and caregiving h/week ( < 0.001; r=0.34).Higher self-reported PA levels are related to decreased levels of distress associated with caregiver burden in COPD caregivers. Duration of caregiving may negatively influence this relationship.
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http://dx.doi.org/10.1080/15412555.2020.1799964DOI Listing
October 2020

Inclusion of People Poststroke in Cardiac Rehabilitation Programs in Canada: A Missed Opportunity for Referral.

CJC Open 2020 Jul 10;2(4):195-206. Epub 2020 Feb 10.

Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada.

Background: Evidence supports establishing a continuum of care from stroke rehabilitation (SR) to cardiac rehabilitation programs (CRPs). It is not known to what extent people poststroke are being integrated. This study aimed to determine the proportion of CRPs that accept referrals poststroke, barriers/facilitators, and eligibility criteria.

Methods: A web-based questionnaire was sent to CRPs across Canada.

Results: Of 160 questionnaires sent, 114 representatives (71%) of 130 CRPs responded. Of respondents, 65% (n = 74) reported accepting people with a diagnosis of stroke and doing so for a median of 11 years, 11 offering stroke-specific classes and an additional 6 planning inclusion. However, 62.5% of CRPs reported that < 11 patients participated in the last calendar year despite 88.5% reporting no limit to the number they could enroll. Among CRPs, 25% accepted only patients with concurrent cardiac diagnoses, living in the community (47.8%), and without severe mobility (70.1%), communication (80.6%), or cognitive (85.1%) deficits. The 2 most influential barriers and facilitators among all CRPs were funding and staffing. The fourth greatest barrier was lack of poststroke referrals, and third to sixth facilitators were SR/CRP collaboration to ensure appropriate referrals (third) and to increase referrals (sixth), toolkits for prescribing resistance (fourth), and aerobic training (fifth). CRP characteristics associated with accepting stroke were a hybrid program model, a medium program size, and having a falls prevention component.

Conclusions: Most CRPs accept patients poststroke, but few participate. Therefore, establishing SR/CRP partnerships to increase appropriate referrals, using a toolkit to help operationalize exercise components, and allocating funding/resources to CRPs may significantly increase access to secondary prevention strategies.
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http://dx.doi.org/10.1016/j.cjco.2020.01.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7365786PMC
July 2020

Which Balance Subcomponents Distinguish Between Fallers and Non-Fallers in People with COPD?

Int J Chron Obstruct Pulmon Dis 2020 1;15:1557-1564. Epub 2020 Jul 1.

School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada.

Rationale: Chronic obstructive pulmonary disease (COPD) is an increasingly prevalent lung disease linked to dysfunctional balance and an increased risk of falls. The Balance Evaluation Systems Test (BESTest) evaluates the six underlying subcomponents of functional balance. The aim of this study was to determine the specific balance subcomponents and cut-off scores that discriminate between fallers and non-fallers with COPD to guide fall risk assessment and prevention.

Methods: A secondary analysis of cross-sectional data from two prior studies in COPD was performed. Independent samples -tests were used to explore the differences in the BESTest sub-system scores between fallers and non-fallers. Receiver operating characteristic curves were used to determine the optimal subcomponent cut-off scores that identified fallers, and the area under the curve (AUC) was used to assess test accuracy.

Results: Data from 72 subjects with COPD (mean age, 70.3 ± 7.4y; mean forced expiratory volume in 1 second, 38.9 ± 15.8% predicted) were analyzed. Two BESTest subcomponents, stability limits/verticality (fallers: 75.4%, non-fallers: 83.8%; p=0.002) and postural responses (fallers: 67.5%, non-fallers: 79.7%; p=0.008) distinguished between fallers and non-fallers. Stability limits/verticality had an AUC of 0.70 and optimal cut-off score of 73.8% for identifying fallers; postural responses had an AUC of 0.67 and optimal cut-off score of 69.4%.

Conclusion: The stability limits/verticality and postural responses subcomponents of the BESTest distinguished between fallers and non-fallers with COPD. The stability limits/verticality subcomponent can also be used to identify whether an individual with COPD is at risk of falling using a cut-off score of 73.8%. These findings suggest that specific subcomponents of balance could be targeted to optimize fall risk assessment and prevention in COPD.
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http://dx.doi.org/10.2147/COPD.S253561DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7335868PMC
June 2021

The Relationship between Self-Efficacy, Functional Exercise Capacity and Physical Activity in People with COPD: A Systematic Review and Meta-Analyses.

COPD 2020 08 7;17(4):452-461. Epub 2020 Jul 7.

Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, Canada.

The purpose of this study was to investigate the strength of the relationships between self-efficacy and (i) functional exercise capacity and (ii) physical activity in chronic obstructive pulmonary disease (COPD), and whether self-efficacy assessment type (i.e., COPD symptoms, exercise-task, exercise-barrier, general, falls) and physical activity assessment type (i.e., self-report vs. objective) are moderators. A systematic search of COPD and self-efficacy concepts was conducted using eight databases from inception to 23 January 2019. Studies were included if they provided correlation coefficients of the relationship between self-efficacy and functional exercise capacity or physical activity, were conducted in adults diagnosed with COPD, and were published in English-language journals. A total of 14 correlation coefficients were included in the self-efficacy and functional exercise capacity meta-analysis, and 16 in the self-efficacy and physical activity meta-analysis. Data were screened, reviewed, and extracted independently by two reviewers, with discrepancies resolved by a third reviewer. Stronger self-efficacy was associated with better functional exercise capacity (weighted  = 0.38, 95%CI [0.25, 0.50]), and greater physical activity (weighted  = 0.25, 95%CI [0.17, 0.34]). Exercise-task self-efficacy had the strongest relationship to functional exercise capacity (weighted  = 0.64, 95% CI [0.51, 0.73]). For physical activity, the type of self-efficacy most strongly related was inconclusive. In COPD, self-efficacy has a relationship to functional exercise capacity and physical activity, the strength of which is influenced by the choice of self-efficacy measure. An understanding of these relationships will assist clinicians in selecting the self-efficacy measure most closely related to the outcome of interest.
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http://dx.doi.org/10.1080/15412555.2020.1782866DOI Listing
August 2020

Using Expert Consensus to Develop a Tool to Assess Physical Therapists' Knowledge, Skills, and Judgement in Performing Airway Suctioning.

Physiother Can 2020 ;72(2):137-146

Department of Physical Therapy, University of Toronto, Toronto.

The aim of this study was to develop a tool to assess physical therapists' knowledge, skills, and judgement in performing airway suctioning with intubated and non-intubated adults. A modified Delphi methodology was used to develop the tool and to evaluate its sensibility (i.e., common-sense nature). Participants were experienced cardiorespiratory physical therapists who perform airway suctioning and physical therapists employed in academic positions related to cardiorespiratory physical therapy at Canadian universities. Round 1 focused on refining which items to include in the tool, Round 2 focused on finalizing the items, and Round 3 focused on evaluating a preliminary version of the tool. A total of 34 individuals participated in Round 1, 30 participated in Round 2, and 25 participated in Round 3. A literature review identified 11 relevant domains and 69 supporting competencies. In Round 1, consensus was achieved for all domains; however, it was borderline for the professionalism domain. Multiple participants suggested that it was redundant because it is a global requirement for all physical therapists. Consensus was also achieved for 64 of the 69 supporting competencies; however, it was borderline for 5 of these items, and 5 achieved no consensus. In Round 2, participants rated a series of recommendations related to items requiring further consideration, as well as 9 new items suggested by the participants in Round 1. In Round 3, the preliminary tool was found to be globally sensible, but concerns were expressed about the inclusion of redundant factors and the tool's length. The tool was revised, resulting in a tool with 4 domains, 6 sub-domains and 43 supporting competencies, as well as an item rating the individual's overall performance. The final-round sensibility questionnaire provided preliminary evidence of the tool's face and content validity. We will investigate the tool's measurement properties in a future study.
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http://dx.doi.org/10.3138/ptc-2018-0101DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7238934PMC
January 2020

Investigating Visual-Spatial Abilities in Students and Expert Physical Therapists.

Physiother Can 2020 ;72(2):132-136

Department of Physical Therapy.

Visual-spatial abilities (VSAs) - the aptitude for mentally processing, retaining, and manipulating visual input - are used by physical therapists in movement analysis. Superior VSAs have been demonstrated in experts compared with novices in other fields, including surgery, anatomy, and aviation, but no literature has investigated VSAs in physical therapy. The purpose of this study was to quantify VSAs in expert and student physical therapists and investigate the differences between the two groups. Our results could assist future researchers in identifying areas for skill development and improved clinical competency in students and novice therapists. Expert physical therapists and first-year PT students completed four computerized VSA tests in the Psychology Experiment Building Language programme: Four-Choice Response, Sequential Pattern Comparison, Mental Rotation, and Situation Awareness. A total of 16 participants were recruited for each group. Expert physical therapists responded more accurately to the Four-Choice Response test, but not significantly so ( = 0.06), and with a significantly slower response time than student physical therapists ( = 0.03). No other differences were found. These findings suggest that expert physical therapists use selective attention more effectively and may value accuracy over speed. No differences were found in other measures of VSAs. Further studies are required to confirm and expand our findings.
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http://dx.doi.org/10.3138/ptc-2018-0091DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7238925PMC
January 2020

Evolving Trends in Physiotherapy Research Publications between 1995 and 2015.

Physiother Can 2020 ;72(2):122-131

Rehabilitation Sciences Institute.

The aim of this study was to comparatively analyze evolving trends in physiotherapy (PT) research publications (excluding case reports and epidemiological and qualitative studies) between 1995 and 2015, inclusively in terms of research design, funding support, age groups, and health conditions. This was an observational study using PubMed-indexed data. Combinations of medical subject headings identified yearly research publications for PT and comparator fields: human-based health and physical rehabilitation. Yearly publications data were extracted, relative percentages were computed, and linear or exponential regressions examined the yearly growth in the proportion of research publications over these 2 decades. As a percentage of human-based health research publications, PT research publications grew exponentially: from 0.54% in 1995 to 2.37% in 2015 (² = 0.97;  < 0.01). As a percentage of physical rehabilitation research publications, PT research grew from 38.2% in 1995 to 58.7% in 2015 (² = 0.89;  < 0.01). Randomized controlled trials (RCTs) resulted in the majority of PT research publications (from 45.1% in 1995 to 59.4% in 2015; ² = 0.79;  < 0.01). Rates of declared funding increased (from 29.7% in 1995 to 57% in 2015; ² = 0.83;  < 0.01), but the comparator fields had similar growth. The percentage of PT research publications remained stable for most health conditions and age groups, decreased for those aged 0-18 years ( = 0.012) and for cardiovascular and pulmonary conditions (both  < 0.01), and increased for neoplasms ( < 0.01). PT research publications have become more prevalent among health and physical rehabilitation research publications; the majority of publications report on RCTs.
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http://dx.doi.org/10.3138/ptc-2018-0065DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7238935PMC
January 2020

Comparison of end-of-life care in people with chronic obstructive pulmonary disease or lung cancer: A systematic review.

Palliat Med 2020 09 2;34(8):1030-1043. Epub 2020 Jun 2.

Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, ON, Canada.

Background: Palliative care has been widely implemented in clinical practice for patients with cancer but is not routinely provided to people with chronic obstructive pulmonary disease.

Aim: The study aims were to compare palliative care services, medications, life-sustaining interventions, place of death, symptom burden and health-related quality of life among chronic obstructive pulmonary disease and lung cancer populations.

Design: Systematic review with meta-analysis (PROSPERO: CRD42019139425).

Data Sources: MEDLINE, EMBASE, PubMed, CINAHL and PsycINFO were searched for studies comparing palliative care, symptom burden or health-related quality of life among chronic obstructive pulmonary disease, lung cancer or populations with both conditions. Quality scores were assigned using the QualSyst tool.

Results: Nineteen studies were included. There was significant heterogeneity in study design and sample size. A random effects meta-analysis ( = 3-7) determined that people with lung cancer had higher odds of receiving hospital (odds ratio: 9.95, 95% confidence interval: 6.37-15.55, < 0.001) or home-based palliative care (8.79, 6.76-11.43, < 0.001), opioids (4.76, 1.87-12.11, = 0.001), sedatives (2.03, 1.78-2.32, < 0.001) and dying at home (1.47, 1.14-1.89, = 0.003) compared to people with chronic obstructive pulmonary disease. People with lung cancer had lower odds of receiving invasive ventilation (0.26, 0.22-0.32, < 0.001), non-invasive ventilation (0.63, 0.44-0.89, = 0.009), cardiopulmonary resuscitation (0.29, 0.18-0.47, < 0.001) or dying at a nursing home/long-term care facility (0.32, 0.16-0.64, < 0.001) than people with chronic obstructive pulmonary disease. Symptom burden and health-related quality of life were relatively similar between the two populations.

Conclusion: People with chronic obstructive pulmonary disease receive less palliative measures at the end of life compared to people with lung cancer, despite a relatively similar symptom profile.
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http://dx.doi.org/10.1177/0269216320929556DOI Listing
September 2020

Capturing the perspectives of women with coronary artery disease regarding interval training or continuous exercise in cardiac rehabilitation.

Disabil Rehabil 2020 Apr 28:1-11. Epub 2020 Apr 28.

Cardiovascular Prevention and Rehabilitation Program, University Health Network/Toronto Rehabilitation Institute, Toronto, Canada.

Motivators and barriers to exercise participation in women with coronary artery disease remain poorly understood. With evidence suggesting that women with coronary artery disease are less likely to adhere to exercise during cardiac rehabilitation and are more likely to drop out, it is important to understand these factors in order to optimize cardiac rehabilitation programs for women. We contribute to the discussion by presenting findings from a qualitative study using two focus groups with nine women with coronary artery disease sharing their experiences with attending cardiac rehabilitation and exercising in this setting, in addition to their perceived motivators and barriers to performing aerobic interval training. Focus group transcripts were analysed using a deductive thematic approach with Bandura's Social Cognitive Theory as the guiding conceptual framework. Four themes were identified regarding the attitudes and experiences of attending and exercising at cardiac rehabilitation, while five themes capturing the motivators and barriers for these women to perform aerobic interval training were identified for the first time. These novel themes encompassed the daunting nature of it, the physical discomfort associated with it, and conversely, the potential sense of enjoyment and accomplishment that it could bring. This study demonstrates the complexity of implementation of aerobic interval training into clinical practice, and suggests that further research is warranted to explore this domain.IMPLICATIONS FOR REHABILITATIONDespite challenges in feasibility of conducting a randomised controlled trial in female patients with coronary artery disease examining the effects of aerobic interval training versus moderate-intensity continuous exercise on aerobic exercise capacity, there was a significant per protocol treatment effect of 0.95 ml·kg·min in favour of aerobic interval training.The cardiac rehabilitation environment provides key facilitators and perceived benefits for exercising and attending cardiac rehabilitation for women, and thus emphasises the need for improving referral and enrolment processes specifically for women into cardiac rehabilitation programs.Aerobic interval training may elicit feelings of fear and physical discomfort, or may be precluded by comorbid conditions, therefore, judicious consideration must be taken in examining the suitability of implementation into clinical practice for each female patient.
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http://dx.doi.org/10.1080/09638288.2020.1756469DOI Listing
April 2020

The Impact of Pulmonary Rehabilitation on Chronic Pain in People with COPD.

COPD 2020 04 5;17(2):165-174. Epub 2020 Mar 5.

Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada.

Chronic pain affects up to 88% of people with chronic obstructive pulmonary disease (COPD) and has been associated with comorbidities. However, with pain not evaluated during pulmonary rehabilitation (PR) assessments, it is unclear whether PR impacts pain intensity and coping ability. This study aimed to 1) determine the effect of PR on pain qualities, coping behavior and psychological symptoms in those with COPD and chronic pain; and 2) assess the impact of PR on exercise capacity and quality of life in individuals with COPD and chronic pain compared to those without pain. Patients with COPD and comorbidities enrolling in outpatient PR were assessed for chronic pain. Those with chronic pain completed the Brief Pain Inventory, Coping Strategies Questionnaire-24, Fear Avoidance Behavior Questionnaire and measures of anxiety and depression. Changes in HRQOL and 6-minute walk distance (6MWD) following PR were compared between participants with and without chronic pain. Thirty-four participants with chronic pain and 34 participants without pain were included (mean ± SD, FEV 47 ± 19% predicted). In those with chronic pain, PR did not affect pain intensity (median[IQR] pre/post PR 3[2-5] vs. 4[2-6] points,  = 0.21), anxiety (7[2-9] vs. 5[3-8] points,  = 0.82) or depression (4[2-8] vs. 3[1-6] points,  = 0.38) and did not change pain coping strategies. Both groups improved in 6MWD (mean difference [95% CI] 17[-39 to 72] m), and those without pain had greater improvement in mastery ( = 0.013). PR was effective in patients with moderate to severe COPD whether or not they reported chronic pain at the time of their initial assessment.
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http://dx.doi.org/10.1080/15412555.2020.1733952DOI Listing
April 2020
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