Advanced Health Care Practice Master's Program
On behalf of the Faculty of Health Sciences and the Advanced Health Care Practice programs we would like to welcome you to Research Day 2021. This symposium is a unique and exciting opportunity for our students, faculty, alumni and industry experts to interact, disseminate knowledge and network, especially during this challenging time.
The day includes a keynote lecture, research poster sessions and opportunities to network and showcase our student’s research accomplishments as well as review the research currently being conducted by their peers.
Thank you so much to the students, faculty and partners for your generosity and time dedicated to making this event a success.
Paul Parikh, PhD
Assistant Professor, School of Physical Therapy
9 a.m.: Poster Evaluation and Judging
11 a.m.: Poster Open House (click on appropriate link below to join session)
For all students, faculty, research and industry partners
- Trends in Chronic Ankle Instability Outcomes Over Time: A Systematic Review and Meta-Analysis
- Chronic neck pain of 3 years treated with physiotherapy
- Link TBA
- Exploring the footcare and footwear practices of persons living with type 2 diabetes and spousal influences – A research proposal for a qualitative descriptive inquiry
- Zoom link (passcode: 074100)
- Joint Management: A Knowledge Synthesis for a web-based Platform for Individuals with Mild to Moderate Knee Osteoarthritis (KOA)
- Collating Estimates of Wound Prevalence from Clinicians Leading Wound Care Programs in Healthcare Organizations Across Canada: A Proposal
- Zoom link (passcode: 118449)
- Acupuncture in the Treatment of Chronic Pain Due to Endometriosis: A Case Study
- Zoom link (passcode: 063714)
- Exercise for Mechanical Neck Pain
- Zoom link (passcode: 941642)
- Return to sport guidelines following total knee arthroplasty: A systematic review
- A Systematic Review of Existing Core Outcome Sets to Identify Consistencies for Axial Musculoskeletal Pain
- Case Study on Traditional Chinese Medicine Style Acupuncture for Jaw Clenching and Pain
- Experiences and Perceptions of Leadership Characteristics and Leadership Development of Advanced Musculoskeletal Physiotherapists in Canada
- Increased Dentin Hypersensitivity Following Fluoride Treatment
- Link TBA
- Case Report: Visual Phenomena Experienced After Neck and Shoulder Massage
- Zoom link (passcode: 192928)
Noon: BREAK (30 minutes)
Afternoon Session: Keynote Address and Research Presentations
12:30 p.m.: Welcome Remarks (Paul Parikh, PhD) and Keynote Address (Alison Rushton, EdD)
About the Keynote Speaker
Alison Rushton, EdD
Director - School of Physical Therapy, Western University
Alison Rushton is Professor and Director of the School of Physical Therapy at Western University. Alison is an advocate for advanced practice internationally, informing multi-professional research, policy, teaching and practice.
Alison has a strong research profile, with more than £2M funding, £11M research centre funding, more than 170 publications in high impact journals. Alison has supervised 13 PhDs (7 in progress), more than 15 MRes, and more than 200 MSc students.
Her research is at the forefront of understanding assessment and management of musculoskeletal disorders, focused on precision rehabilitation; and in particular advanced practice rehabilitation. Alison is on the Editorial Board of the Musculoskeletal Science and Practice journal, and a fellow of the MACP in the UK and an Honorary Member of CAMPT in Canada.
Alison chaired the IFOMPT Standards Committee from 2004 to 2020 setting and evaluating international musculoskeletal advanced practice standards. Alison has been awarded a fellowship of the MACP and Honorary membership of the OMT Espana Terapia Manual Ortopedica, Fellowship of the Chartered Society of Physiotherapy and Life Membership of IFOMPT for her national and international contribution to the development of advanced practice musculoskeletal physiotherapy through the development of education and research.
1:05 p.m. - Trends in Chronic Ankle Instability Outcomes Over Time: A Systematic Review and Meta-Analysis
Bell S, Kovacevic L, Taylor K, Alcock G, Sadi J, Day T
BACKGROUND: Chronic ankle instability (CAI) develops in 40% of individuals after an acute lateral ankle sprain and is characterized by injury recurrence and persistent symptoms. It can lead to early onset post-traumatic ankle osteoarthritis, decreased physical activity, participation and health-related quality of life.
PURPOSE: To determine if and when a clinical pattern exist with failure to respond to conservative treatment for individuals with CAI that may serve to differentiate copers from non-copers.
METHODS: Following the PRISMA guidelines a systematic search of eight databases was conducted. Using pre-determined inclusion and exclusion criteria, data was extracted by two authors (T.D., K.T). Risk of bias (ROB2) was performed by two authors (S.B., L.K.) to determine study quality.
RESULTS: The literature search yielded 8478 articles with 20 RCTs (n=784). The scores for patient-reported and performance-based outcomes were examined at various time points for constructs based on the International Classification of Functioning, Disability and Health (ICF) model.
CONCLUSION: It is difficult to discern copers from non-copers in individuals with CAI. It appears that individuals who may go on to become copers, should demonstrate early change within the Body Structure and Function domain of the ICF model, which may distinguish them from those who likely do not improve.
CLINICAL RELEVANCE: Individuals with CAI improve in surrogate outcome measures of function which may not translate to sustained improvement in patient-reported outcomes. Clinicians should be aware of these trends to limit the sequelae of associated injuries and participation restrictions in non-copers.
KEY WORDS: Chronic Ankle Instability, Systematic Review, Rehabilitation, Outcome Measures
Gaurab Subedi, Dave Walton
BACKGROUND: Neck pain is one of the leading causes of worldwide disability. It can have adverse effect in people’s quality of life, potentially restricting activity of daily living and cause absence from work. There are numerous treatments for non-specific chronic neck pain, evidence suggests neck exercises to have moderate effect on neck pain whereas education/advice and psychological treatment has small effect.
PURPOSE: To report on a case of a 68-year-old woman with a 3-year history of unremitting neck pain treated by a physiotherapist following a cognitive behavioural model.
METHODS: A 68-year-old female who presented with non-specific chronic neck pain since 2019 was evaluated in physiotherapy clinic. She reported pain 8/10 in numeric pain scale (NPRS), Neck disability index (NDI) was 28%, her central sensitization inventory (CSI) was 49 and Depression anxiety and stress scale (DASS) was insignificant. Patient was re-evaluated in 3 weeks using NPRS. She was re-assessed in 6 weeks using NPRS, NDI and CSI.
RESULTS: With physiotherapy treatment, her pain declined from 8/10 to 3/10 in 3 weeks along with increase in activities which patient was not able to do in past few years.
CONCLUSION: Despite a long history of chronic neck pain, a comprehensive and psychologically informed assessment and physiotherapy treatment protocol has shown promising results. More research is needed to evaluate effectiveness compared to other interventions and to determine what types of patients are most suited to this intervention.
KEY WORDS: Chronic neck pain, physiotherapy, cognitive-behaviour therapy, Non-specific neck pain
1:15 p.m. - Exploring the footcare and footwear practices of persons living with type 2 diabetes and spousal influences – A research proposal for a qualitative descriptive inquiry
Jahnke, D., Noland, I., Velasco, J., Williams, T., Kuhnke, J.
BACKGROUND: Complications of the diabetic foot, including diabetic foot ulcer (DFU) and amputation, result in a high cost to persons with diabetes, affecting their mortality and quality of life (QoL). Effective self-management, including footcare practices, are key to the prevention of DFUs yet many persons with type 2 Diabetes Mellitus (T2DM) do not engage preventative footcare. Further research to determine the importance of self-efficacy, belief systems, spousal support and depression in self-management is required.
PURPOSE: To explore the footcare and footwear practices of people with T2DM focusing on illness beliefs, self-efficacy, depression, and spousal influence on self-care decisions.
METHODS: Four persons with T2DM and their spouses, living in community, will be recruited. Qualitative semi-structured interviews will be conducted by telephone or virtually. Interviews will be typed verbatim, and data will be organized by thematic analysis. We will identify and organize patterns of meaning or themes across the data sets.
RESULTS: Results will potentially influence the design and delivery of educational programs for patients and spouses.
CONCLUSION: Findings will contribute to understanding participants’ decisions around preventative footcare and footwear based on illness beliefs, perceived self-efficacy, depression, and spousal support.
CLINICAL RELEVANCE: An understanding of why and how people with diabetes and their spouses engage in footcare and footwear practices can lead to individualized, effective education strategies improving clinical outcomes.
KEY WORDS: diabetic foot, footcare, footwear, self-care, self-efficacy, spousal influence, illness beliefs, depression
1:20 p.m. - Joint Management: A Knowledge Synthesis for a web-based Platform for Individuals with Mild to Moderate Knee Osteoarthritis (KOA)
Guay, S; Kahlon, S; Quinn, K; Churchill, L; Barton, K
BACKGROUND: There is inconsistent and often conflicting information given to individuals with KOA regarding physical activity, particularly running, from healthcare providers (HCPs) and other public mediums. Education regarding running and self-management is fundamental in managing symptomatic KOA. Infographics are an effective medium to translate evidence-based information to a target audience.
PURPOSE: This project aims to: 1) Identify the effects of running on mild to moderate KOA through a scoping review of current literature. 2) Develop two evidence-based infographics to address a) common misconceptions regarding running and KOA b) running recommendations for those with KOA; and obtain stakeholder (ie. relevant patients and HCPs) feedback on the infographics.
METHODS: We conducted an electronic database search and reviewed 229 articles to identify the effects of exercise and running on knee OA. The information gathered was used to develop two infographics: 1) debunking myths regarding running and KOA, and 2) recommendations on running strategies to best manage and reduce KOA symptoms.
RESULTS: Two main themes were developed after the literature review including the benefits of running with knee OA, and best practice recommendations on how to run with knee OA. Two infographics were created: 1) “True or False: Running is Harmful to Knees with Osteoarthritis” and 2) “Is Running Knee Friendly?”
CONCLUSION: Two infographics were developed and are available for distribution by healthcare providers within clinical settings and to be accessed online via web-based platform for individuals with mild to moderate KOA.
KEY WORDS: Running, runner, run, knee, osteoarthritis, OA
1:25 p.m. - Collating Estimates of Wound Prevalence from Clinicians Leading Wound Care Programs in Healthcare Organizations Across Canada: A Proposal
Cameron, J; Catching, A; Lohnes, K; Sistoso, K; Houghton, PE; LeBlanc, K
BACKGROUND: Chronic wounds are associated with decreased quality of life and poor patient outcomes. The prevalence of chronic wounds in the Canadian healthcare system is unknown and the methods used to obtain prevalence estimates vary across the country.
PURPOSE: To generate a network of contributors able to share or collect wound prevalence data across Canada.
METHODS: The first step in this large project was the creation of an online survey that will identify potential wound care leaders who could contribute to a nationwide estimate of wound prevalence. This survey will determine to what extent prevalence data is currently available and the methods used to collect the data.. A focus group (n=6) developed survey questions through sequential iterations which will be sent to 8-10 wound care experts to ascertain content validity. An online, user-friendly, secure, survey will be created and refined based on feedback from 20-30 clinicians. The final survey will be sent to over 1000 wound experts nationwide to determine those willing to participate and able to share anonymized prevalence data collected from their organization.
RESULTS: The survey will identify interested clinicians and contributing healthcare organizations. The survey will reveal the wound etiologies, methods for collecting prevalence, type of healthcare setting, and geographical locations represented in the sample.
CLINICAL RELEVANCE: The network of contributors will be used to seek funding to create a secure national online database that will produce reliable estimates of the prevalence of wounds in the Canadian Healthcare system.
KEY WORDS: Wound prevalence, Chronic wounds, Canada, Proposal, Survey
Dix, A; Walton, D
BACKGROUND: An estimated 7% of adult women of reproductive age in Canada are diagnosed with endometriosis but evidence is sparse regarding effective interventions for pain due to endometriosis.
PURPOSE: A scholarly case report is presented describing the effects of acupuncture for the treatment of chronic pelvic pain due to endometriosis.
METHODS: The patient was evaluated by an experienced Registered Acupuncturist with findings integrated and interpreted to suggest that acupuncture may be effective. Effects of intervention were tracked through self-report of pain medication use, Brief Pain Inventory Questionnaire, Pain Self-Efficacy Questionnaire, and self-report of pain interference in daily activities.
RESULTS: The patient reported decreased use of pain medications, decreased pain interference in daily activities, improved sleep, decreased emotional strain, more moderate menstrual flow, and the treatment was tolerated well.
CONCLUSION: The results of this case suggest that acupuncture may be an effective treatment for chronic pelvic pain due to endometriosis, though further research with more robust designs are required to be confident in these findings.
CLINICAL RELEVANCE: There is currently very little evidence for the treatment of this type of gynaecological pain therefore the intention of describing this case study is to stimulate new thinking on research designs for this phenomenon.
KEY WORDS: Endometriosis, Dysmenorrhea, Pelvic Pain, Acupuncture, Traditional Chinese Medicine
Bajracharya P; Godfrey J; Hubbard A; Soung S; Gross, A
BACKGROUND: Neck pain (NP) is common, disabling and costly and typically treated with exercise. Exercise efficacy for NP is unclear.
PURPOSE: To update a Cochrane review on the effectiveness of exercise vs a control or adjuvant for NP w or w/o radiculopathy; WAD, CGH in adults in RCTs. Primary outcomes: pain and function-disability.
METHODS: We searched MEDLINE, CINAHL, EMBASE, ICL, CENTRAL and ClinicalTrials.gov up to March 03, 2021. Pairs of independent reviewers conducted the study selection, data extraction RoB assessment and GRADE. Meta-analyses using mean differences (MDp) were completed.
RESULTS: 88 studies (n=11618; 30 low RoB) compared exercise against control or as adjuvant to conversative care at short-term (ST). For exercise vs control, pain reduction included a small-moderate ES in the ST (MDp -17.22, 95% CI -23.15 to - 11.29; P < 0.00001, I2 =81%; 12 studies, 728 participants; moderate certainty evidence. Function-disability demonstrated a small but unimportant effect at ST F/U (MDp-9.38, 95% CI -14.39 to -4.37; P < 0.00001, I2=83%; 9 studies, 617 participants; moderate certainty evidence). For exercise vs adjuvant evidence showed the following: Pain reduction had a small but important effect at ST F/U (MDp -10.69, 95% CI -18.38 to -3.00; P < 0.0001, I2=93%; 8 studies, 764 participants; moderate certainty evidence). Function-disability demonstrated a small trivial unimportant effect at ST F/U (MDp -4.91, 95% CI -8.56 to -1.26; P < 0.00001, I2=88%; 10 studies, 4124 participants; moderate certainty evidence).
CONCLUSION: Moderate-low quality evidence suggests the use of exercises for NP in the ST.
KEY WORDS: exercise, neck pain, systematic review
Goettl, T; Goheen, C; Trapeau, J; Churchill, L; Gillis, H; Van Bussel, J
BACKGROUND: With a younger, more active population undergoing total knee arthroplasty (TKA) there are increasing expectations for return to sport (RTS) following surgery.
PURPOSE: This systematic review identifies current evidence and recommendations for RTS after TKA.
METHODS: The following electronic databases were searched to identify relevant studies published within the past 30 years: MEDLINE, CINAHL, Embase, Scopus, and SPORTDiscus. The Quality Assessment Tool for Studies with Diverse Designs (QATSDD) was used to evaluate the methodological quality of the eligible studies. Following this review, a thematic analysis was conducted to compile the most relevant recommendations.
RESULTS: A total of 18 articles were included for evaluation. Using QATSDD, the majority of studies (12/18) were evaluated as low quality (score <25%), while the remaining studies (6/18) were rated as moderate quality (score 25- 75%). Recommendations consisted of a return to low to moderate impact sports given concerns surrounding higher impact sports on implant survivorship. Identification of patient qualities influenced recommendations for RTS and associated timelines; those who were motivated and had preoperative sport experience had fewer restrictions.
CONCLUSION: While recommendations for RTS following TKA exist, there remains a lack of high-quality evidence or consensus to generate clinical guidelines.
CLINICAL RELEVANCE: A high quality Delphi survey with clinical experts is needed to achieve an evidence-based clinical consensus regarding patient RTS recommendations following TKA.
KEY WORDS: total knee arthroplasty, return to sport, rehabilitation, guidelines, implant survivorship
1:55 p.m. - A Systematic Review of Existing Core Outcome Sets to Identify Consistencies for Axial Musculoskeletal Pain
Boileau, A; Brown, K; Lanthier-Plante, J; Sharma, R; Walton, D
BACKGROUND: Axial musculoskeletal pain is becoming increasingly prevalent with several core outcome sets developed but no set of essential universal domains accepted.
PURPOSE: To systematically review the literature to identify consistent domains that are included in spinal pain core outcome sets (COSs) to inform an essential universal set that is relevant to researchers and rehabilitation providers.
METHODS: An electronic search was conducted for studies published in English or French from 2000-2020. The COS-STAR scale was modified and applied to each article individually. Those that rated 25 and above on the 50-point scale were considered to have high reporting quality, and consistency criteria was defined as domains appearing in greater than 50% of the articles (>4/9). Pairs of authors conducted quality scoring and data extraction. COS domains were then thematically grouped to identify consistencies.
RESULTS: 11 COSs met the inclusion criteria. Two COSs (White et al. (2004) and Rebbeck et al. (2007)) used a COS tool adapted from Deyo et al. (1998), so those were considered a single COS, leaving 9 total sets. From those 24 domains were identified, with 7 being the most consistent: pain symptoms and intensity, patient rated functional outcomes, participation (activities of daily living), participation (work or school), generic health status, quality of life, and emotional functioning.
CONCLUSION: The 7 domains, included in a majority (>50%) of COSs for spinal pain, could represent an essential universal set applicable across contexts and spinal regions.
KEY WORDS: core outcome, core domain, minimum data set, musculoskeletal, axial spine, and pain.
Montgomery, K; Walton, D
BACKGROUND: Jaw clenching/pain are very common problems. Mouth guards prescribed by dentist protect the teeth but do little to help the jaw pain. I am exploring the use of acupuncture for this problem.
PURPOSE: To track the treatment of a patient suffering from jaw pain using TCM style acupuncture.
METHODS: Acupuncture was given 1/week for 4 weeks. A patient reported pain scale of 1 – 10 was used to evaluate her pain before the treatment, immediately after the treatment, and in the time between treatments.
RESULTS: Her pain increased slightly immediately after the first treatment (+1/10), although less than the MCD of 2. It then decreased by 2/10 by the next treatment. In the subsequent treatments her pain would decrease by an average of 2.66/10 immediately following each treatment. 2 days post treatment the pain would creep up again by an average of 2/10. By the end of 4 weeks her pain went from 9/10 to 5/10.
CONCLUSION: Acupuncture relieved her jaw pain by 4/10 with 4 weekly treatments. As this is double the MCD for the BPI pain scale, this is a significant decrease in pain.
KEY WORDS: acupuncture, Traditional Chinese Medicine, jaw pain, jaw clenching, patient-reported outcomes, bruxism case report
2:05 p.m. - Experiences and Perceptions of Leadership Characteristics and Leadership Development of Advanced Musculoskeletal Physiotherapists in Canada
Ingar, R; Kozman, A; Richard, A; Levesque, L; Rushton, A; Stokes, E; Woodard, T
BACKGROUND: Research investigating Canadian physiotherapists’ perceptions of leadership has identified important characteristics of leaders in the workplace setting, healthcare system and society (e.g., communication and professionalism). However, it is unknown if important characteristics differ for advanced musculoskeletal physiotherapists - Fellows of the Canadian Academy of Manipulative Physiotherapy (FCAMPTs).
PURPOSE: To explore FCAMPTs’ experiences and perceptions of leadership characteristics and development.
METHODS: A mixed methods design used sequential methods of cross-sectional descriptive survey and semi-structured interviews (reported later). All members of CAMPT (n=1132) were invited to complete an online piloted Qualtrics survey, consisting of closed questions to explore demographics and ratings of leadership characteristics, and open-ended reflective questions. Data analyses were descriptive (frequencies) and thematic analysis for the open questions.
RESULTS: 159 FCAMPTs participated (response rate 14.0%) with 141 completed questionnaires (12.5%). 82.7% of participants perceived themselves as leaders and believe there is insufficient representation of physiotherapists in leadership roles. Approximately 30% had formal leadership training. FCAMPTs ranked professionalism, communication, adaptability, and empathy as highly important characteristics.
CONCLUSION: FCAMPTs ranked leadership characteristics differently to all Canadian physiotherapists. Greater leadership opportunities and training are required for the profession.
KEY WORDS: characteristics, development, leadership, perspectives, FCAMPT
Metersky, A; Walton, D
BACKGROUND: Dentin hypersensitivity is a condition with reported prevalence on average of 57% of population and application of fluoride varnish is a common treatment option, but there is little evidence to support that it may produce an adverse reaction by worsening of symptoms.
PURPOSE: A scholarly case report is presented describing the effects of fluoride treatment for dentin hypersensitivity.
METHODS: The patient was evaluated in by an experienced dental hygienist with findings integrated and interpreted to suggest that topical application of fluoride varnish may produce an increase of sensitivity. Effects of intervention were tracked through patient questionnaire.
RESULTS: The patient reported that after an application of topical fluoride the sensitivity worsened from 6/10 to 8/10.
CONCLUSION: The results of this case suggest that application of topical fluoride may be ineffective in treatment of dentin hypersensitivity though further research with more robust designs are required to be confident in these findings.
KEY WORDS: dentin hypersensitivity, topical fluoride application, sodium fluoride varnish, adverse effect, patient-reported outcomes.
Shipton, S; Walton, D
BACKGROUND: Visual Phenomena experienced after neck and shoulder massage is a rare clinical presentation with little research to investigate its occurrence or guide treatment decisions.
PURPOSE: A scholarly case report is presented describing the effects of massage therapy for neck and shoulder pain that resulted in the patient experiencing increased brightness in the visual field.
METHODS: The patient was evaluated by an experienced massage therapist using numeric rating scales for both pain and for brightness.
RESULTS: Over the course of eight treatments, the patient reported a significant reduction in neck and shoulder pain, from 8 out of 10 at its worst to as low as 1 out of 10, while also reporting increased brightness in the visual field by one point on a 0-10 scale after treatment compared to immediately before the treatment.
DISCUSSION: There is no known physiological explanation for an association between gentle manipulation of the soft tissue of the neck and shoulder areas and perceived increased brightness in the visual field following. A literature search yields little research in this area.
CONCLUSION: The visual changes reported by the patient after treatment are curious and, based on a literature review, represent an area in need of further exploration. The intention of presenting this case is to stimulate further work in this area with clear theoretical rationale, more robust designs, and larger sample sizes.
KEY WORDS: case report; visual phenomena; brightness; massage; neck
Dianne Bryant, PhD
Assistant Dean, Graduate Programs
Faculty of Health Sciences