Research Day

Advanced Health Care Practice Master's Program

Elborn College

On behalf of the Faculty of Health Sciences and the Advanced Health Care Practice programs we would like to welcome you to Research Day 2022. 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
Western University

Schedule of Events

Poster Evaluation and Judging

  • 11 a.m.

Welcome and Keynote Address

Research Presentations

Keynote Address

Alison Rushton photoAlison Rushton, EdD
Director - School of Physical Therapy, Western University

Join via Zoom

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.

Research Presentations

Group 1: SEM/UE/CMP

1:00 p.m. - Investigating the understanding and knowledge of 2SLGBTQIPA+ health education and inclusiveness of sport physiotherapists working in Canada

STUDENTS: Lunny, K., Rajput, R., Sullivan, N., Zettel, M.

SUPERVISORS: Birmingham, T., Primeau, C., MacDermid, J., Unger, J.

BACKGROUD: Athletes identifying as 2SLGBTQIPA+ report avoiding sport participation because of negative experiences, feeling unsafe disclosing their sexuality, and fear of discrimination from healthcare providers. No studies have evaluated 2SLGBTQIPA+ knowledge and inclusiveness in sport physiotherapists (SPT).

PURPOSE: Evaluate 2SLGBTQIPA+ health knowledge and inclusiveness in SPT in Canada.

METHODS: We completed a cross-sectional survey of physiotherapists in Canada. We recorded demographics, behaviours/perceptions, and training/education. Data is from self-identified SPT.

RESULTS: 239 physiotherapists completed the survey, 112 (47%) work in sport. Among SPTs,17 (15%) self-identified as 2SLGBTQIPA+. Fifty-nine (54%) SPTs believe their work setting(s) in sport promote sex/gender inclusiveness. Forty-one (37%) reported some 2SLBGTQIPA+ training (median 4.5 hrs, IQR:2-10); nine (9%) received continuing education in 2SLGBTQIPA+ health/inclusiveness in sports, 34(33%) felt prepared to support 2SLGBTQIPA+-specific health needs (e.g., binding). Eighty-six (77%) believe 2SLGBTQIPA+ training should be mandatory in entry-level physiotherapy and 91 (82%) in SPT. Ninety-nine (89%) are open to more training.

CONCLUSION: More 2SLGBTQIPA+ education is needed in physiotherapy, including sport-related practice. Exposure to 2SLGBTQIPA+ health needs is perceived as insufficient by physiotherapists in Canada. Positive attitudes exist for attention to knowledge/skills for meeting the health needs of 2SLGBTQIPA+ athletes.

KEY WORDS: Sport, physiotherapist, 2SLGBTQIPA+, healthcare.

1:10 p.m. - A systematic review to identify and evaluate the quality and effectiveness of web-based platforms for individuals with hip or knee osteoarthritis and those undergoing total hip or knee arthroplasty

STUDENTS: Desrosiers, A; Famojuro, A; Fassett, H; Knox, F

SUPERVISORS: Barton, K; Churchill, L

BACKGROUD: In response to the COVID-19 pandemic, the use of web-based platforms to access health information has increased. It is unclear what platforms are available to those with hip and knee OA and whether they improve outcomes for these individuals.

PURPOSE: To outline web-based platforms that are available to those with hip/ knee OA or total joint replacement; and to determine their effectiveness.

METHODS: We conducted an electronic search for studies published in the English language in four major databases (MEDLINE, CINAHL, EMBASE, Sportdiscus) using search terms for hip and knee OA and joint arthroplasty in combination with web-based rehabilitation or telehealth terms. Two researchers reviewed all titles and abstracts independently; conducted full-screening and data extraction independently according to specified inclusion/exclusion criteria. Grey literature searching to identify available web-based programs was performed by one researcher.

RESULTS: We identified 20 studies that met inclusion criteria: 15 RCTs and 5 non-RCTs. Two researchers separately assessed the Risk of Bias using the Cochrane RoB 2 or the ROBIN-I Tool. The data will be descriptively reported to outline the various platforms and their use. The grey literature search found 1 health consumer web-based platform for knee OA; 6 for knee or hip OA; 6 app-platforms for TKA and/or THA; 2 for TKA; 1 for knee OA and/or TKA; and 1 for knee and/or hip OA.

CONCLUSION: More 2SLGBTQIPA+ education is needed in physiotherapy, including sport-related practice. Exposure to 2SLGBTQIPA+ health needs is perceived as insufficient by physiotherapists in Canada. Positive attitudes exist for attention to knowledge/skills for meeting the health needs of 2SLGBTQIPA+ athletes.

KEY WORDS: online platforms, knee osteoarthritis, hip osteoarthritis, total knee arthroplasty, total hip arthroplasty

1:20 p.m. - Perceptions of physical activity prescription amongst final year physiotherapy and medical students

STUDENTS: Agnihotri K; Moulden D; Roberge J; Saint-Amour MC

SUPERVISORS: Rushton, A; Thornton, J

BACKGROUD: Physical activity (PA) has known benefits for chronic health and musculoskeletal conditions. However, few studies have investigated how healthcare students value PA prescription for prevention/management of musculoskeletal conditions (MSK) and chronic disease.

PURPOSE: To understand the factors that influence students’ prescription of PA and their self-efficacy in prescribing PA.

METHODS: A national Canadian cross-sectional online survey was piloted and distributed to final year physiotherapy and medical students from June 2022 in both English and French. Survey sections/questions were informed by validated questionnaires and existing evidence for PA prescription. Data regarding demographics, level of PA, self-efficacy in prescribing PA, factors influencing prescription, and value of PA in preventing/managing chronic disease and MSK problems were collected. Descriptive statistics and cross tabulation enabled exploration of associations between PA levels and key variables e.g., self-efficacy (p<0.05).

RESULTS: Preliminary results (n=30) were analyzed (9 medical, 21 physiotherapy participants). Of the participants who answered the Godin-Shephard questionnaire, 75% were considered active, 12.5% moderately active and 12.5% insufficiently active. 97% participants strongly agreed that PA is an essential component of preventive medicine.

DISCUSSION: Findings will inform curricula/resources for prescription of PA for physiotherapy/medical students. Data collection will continue, and the full analysis will be published.

CONCLUSION: Findings may identify areas of refinement in the medical/physiotherapy curricula in Canada.

KEY WORDS: physiotherapy, medicine, physical activity prescription, exercise prescription, sports medicine

1:30 p.m. - Longitudinal changes in peripheral adiposity in young adults following anterior cruciate ligament reconstruction

STUDENTS: Koskoletos, C; Michaud, A

SUPERVISORS: Birmingham, T; Hart, H

BACKGROUD: Injuries to the anterior cruciate ligament (ACL), regardless of surgical reconstruction, can lead to impairments in knee function and subsequently joint disease. Individuals may adopt a sedentary lifestyle after sustaining ACL injuries due to factors such as pain, fear of re-injury, reduced strength, and instability, and this may further increase the risk of joint disease in this patient-population and changes in peripheral adiposity.

PURPOSE: We aimed to (i) compare peripheral adiposity between individuals one-year post ACLR and uninjured controls, and (ii) evaluate changes in adiposity among individuals post-ACLR over 4 years using axial knee magnetic resonances (MR) images.

METHODS: In 111 individuals one-year post-ACLR and 20 uninjured controls peripheral adiposity cross-sectional area (CSA) and thickness were measured on the most proximal axial knee MR images. Two investigators independently measured CSA of knee adiposity by manually tracing around subcutaneous fat on axial MR images using the 3D slicer software. On the same axial knee MR images, the thickest portion of the subcutaneous fat was determined by measuring the distance. In the post-ACLR group, measurements were also repeated at the 4-year follow-up. We used univariate analysis to compare CSA and thickness between individuals one-year post ACLR and uninjured controls and repeated measures to compare CSA and thickness in individuals post-ACLR at baseline and follow-up. All analyses were adjusted for age and sex.

RESULTS: Relative to controls, individuals one-year post ACLR had significantly greater knee adiposity CSA (mean difference [95% CI]: 962mm2 [182 to 1742]), but not thickness (1.67mm [-1.04 to 4.37]). Individuals post-ACLR had lower knee adiposity CSA (-724mm2 [-965 to -482] and thickness (-1.29mm [-2.05 to -0.53]) at follow-up compared with baseline.

CONCLUSION: While individuals one-year post-ACLR had greater knee adiposity than uninjured controls at baseline, they did have a decrease in knee adiposity at the 4-year follow-up. Individuals with ACL injuries may reduce their level of physical activity in the early stages post-ACLR and thus increase adiposity, but then likely return to a more active lifestyle over time.

KEY WORDS: Knee adiposity, MRI, ACL, rehabilitation, subcutaneous fat

1:40 p.m. - The Impact of COVID-19 on Canadian Varsity Athletes

STUDENTS: Cyr, S; Kwolek, T; Walsh, K.

SUPERVISORS: Dickey, J., Humphreys, D.

BACKGROUD: The COVID-19 pandemic and associated lockdowns caused interruptions to student-athletes' academic year and sporting seasons. Student-athletes faced issues associated with isolation, career disruption, qualification process uncertainty, and limited access to training and learning environments. (Schinke et al., 2020). In addition, those who contracted COVID-19 may have sustained ongoing health issues. With a goal of supporting a successful post-restriction and post-lockdown return to sport, it is important to understand these effects so that the physical, social and psychological needs of student-athletes can be appropriately addressed.

PURPOSE: To determine the impact of the COVID-19 pandemic on the physical, psychological and social functioning of Canadian University varsity athletes.

METHODS: A survey was conducted of USport varsity athletes currently enrolled in universities across Canada. 129 athletes were included in this study. Participants completed a RESTQ-52 questionnaire for 2 time periods - present day and prior to the onset of COVID-19 lockdowns. All dependent variables were analyzed using a two-way ANOVA model.

RESULTS: Data analysis in progress.

CONCLUSION: Preliminary data analysis indicates following a period of isolation, scores evaluating physical, social and psychological well-being compared to prior to the pandemic were statistically significant when comparing males to females.

KEY WORDS: athletes, varsity, sport, COVID-19, mental, physical, psychological

1:50 p.m. - Expert Opinion Regarding Return to Sport Following Total Knee Arthroplasty – A Delphi Study

STUDENTS: Goodman, L; Khan, J; St. George, L; Wong, M

SUPERVISORS: Gillis, H; Churchill, L; VanBussel, J; Primeau, C; Goheen, C

BACKGROUD: Current evidence suggests patient expectations are unmet for return to sport (RTS) and activity following total knee arthroplasty (TKA). Based on a recent systematic review, there is limited high-quality evidence and considerable variation in the literature regarding healthcare providers’ recommendations following TKA.

PURPOSE: To develop guidelines regarding RTS and activity recommendations following TKA through consensus from a diverse panel of orthopaedic experts.

METHODS: We conducted the first round of a Delphi survey. We surveyed healthcare professionals with expertise in TKA. An “expert” was defined as one who routinely performs, treats or advises on TKAs (minimum 50 cases per year or ~10% of their caseload). Questions with ≥70% agreement achieved consensus. We reported results as frequencies of response. 

RESULTS: Participants (n=43) included physiotherapists (n=24), orthopaedic surgeons (n=15), sport medicine physicians (n=2), an occupational therapist (n=1), and one unreported provider. Most experts recommended patients can return to low-impact sports after TKA (n=40; 93%) and many recommended patients can return to ADLs/iADLs (n=33; 76%). Experts discouraged return to high impact sports (n= 30, 73%). Most orthopaedic surgeons (n=10, 91%) agreed high impact sports or activities could adversely affect implant survivorship.

CONCLUSION: Experts agree that patients can return to low-impact sports and ADLs/iADLs following TKA, while return to high-impact activity is not recommended. Additional questions related to RTS after TKA will be answered in subsequent rounds of this Delphi survey.

KEY WORDS: Total knee arthroplasty, return to sport, recommendations

2:00 p.m. - The Effectiveness of Backwards Walking as an Intervention for Lower Extremity Rehabilitation: A Scoping Review

STUDENTS: Albines D., Leger L., Oliver A., Yamali, M.

SUPERVISORS: Hart H. Alcock G., Birmingham T.

BACKGROUD: Backwards walking has gained recent popularity for lower extremity rehabilitation training. However, the evidence of backward walking for lower extremity pathologies has not been summarized.

PURPOSE: This scoping review aimed to summarize the evidence on the effectiveness of backward walking in lower extremity pathologies.

METHODS: We searched Medline, EMBASE, CINAHL and Scopus for original studies. In total 92 studies were identified and screened for eligibility. Two researchers independently completed full-text reviews and the other two researchers completed the data extraction. In total 12 studies met the eligibility criteria.

RESULTS: A total of 3 different lower extremity pathologies were studied (osteoarthritis n=8, anterior cruciate ligament injuries n=2 and patellofemoral pain syndrome n=2), with a total of 452 participants. These studies reported 10 different categories of effectiveness including pain (10 studies), balance (2), proprioception (3), strength (3), function/functional disability (10), performance (3), endurance (1), quality of life (1) and range of motion (1). The backward walking intervention showed a superior outcome compared to other interventions or control groups in all categories.

CONCLUSION: The evidence indicates backward walking can be an effective rehabilitation intervention to improve lower extremity pathologies. Intervention parameters varied amongst studies. Future research is needed to evaluate the effectiveness of backward walking in other lower extremity pathologies, as well as to develop clinical practice guidelines.

KEY WORDS: Backwards walking, retro-walking, lower extremity, rehabilitation, scoping review

2:10 p.m. - An Evidence-Informed Rehabilitation Management Framework for Posterior Shoulder Tightness: A Scoping Review

STUDENTS: Avilineni, M; Fukushima, Y; Kao, M; Tirmizey, H

SUPERVISORS: Faber, K; Furtado, R; Sadi, J; Watson, L

BACKGROUD: Posterior shoulder tightness (PST) is a common impairment found in athletic and nonathletic populations that limits shoulder range of motion (ROM). There is lack of synthesized evidence for practical PST management.

PURPOSE: To systematically scope the current literature on PST to define a rehabilitation management framework for myofascial and muscular causes of PST.

METHODS: We conducted an electronic search for studies published in 5 electronic databases (MEDLINE, EMBASE, CINAHL, Scopus, and Google Scholar) from inception to December 18, 2021, and reviewed reference lists from relevant studies. Of 2777 articles obtained from our search, 21 articles (13 randomized trials, 7 cohort studies, 1 case report) met the inclusion criteria. Relevant data extracted included authors, title, study year, location, study design; participant number, age, sex; interventions and parameters; outcomes. Results were extracted and analyzed to identify themes.

RESULTS: Data from 21 studies were organized into 3 themes. (1) Therapist-instructed interventions included cross-body stretch (CBS), sleeper stretch (SS), a combination of CBS and SS, and general stretching. (2) Therapist-administered interventions included CBS, SS, instrument-assisted soft tissue mobilization (IASTM), muscle energy technique, dry needling, and Faul’s protocol (12 passive stretches). (3) Combined interventions of tape with self-stretching and IASTM with stretching were also identified.

CONCLUSION: Both CBS and SS can be used to improve PST. Stabilizing the scapula during stretching can target the PST and maximize ROM benefits for horizontal adduction.

KEY WORDS: posterior shoulder tightness, cross body stretch, sleeper stretch, overhead athlete, physiotherapy.

2:20 p.m. - Outcomes Following Surgical Interventions for Isolated Lunotriquetral Interosseous Ligament Injuries: A Systematic Review

STUDENTS: Leung, JCK, Munaku, J, Omar-Hossein, M, and Rodzik, D

BACKGROUD: Lunotriquetral interosseous ligament (LTIL) injuries most commonly result from a fall on an outstretched hand. Operative management is indicated if conservative treatment fails, and symptoms persist. To date, there is no systematic review on isolated LTIL injuries.

PURPOSE: To compare patients’ outcomes following surgical interventions for isolated LTIL injuries in adults.

METHODS: Medline, Embase, CINAHL, and Scopus databases were searched on February 11, 2022. We included all study designs for isolated LTIL injuries, without date restriction, except for reviews, case reports, strictly biomechanical, cadaveric studies, and technique papers without reporting patient results. The quality of the studies was evaluated using the Structured Effectiveness Quality Evaluation Scale, and the comparative outcomes (i.e., range of motion, pain, strength, quality of life, complications, return to work, and patient satisfaction) were aggregated and categorized under arthrodesis, capsulodesis, ligament repairs and reconstruction, and ulna shortening osteotomy procedures.

RESULTS: We assessed 202 procedures from nine retrospective case-series studies that matched our inclusion criteria. Comparison of capsulodesis, arthrodesis, ligament reconstruction, ligament repair, and ulnar osteotomy all resulted in no statistically significant differences in comparing surgical techniques and outcomes. Overall, Capsulodesis was analyzed to produce a higher patient satisfaction with diminished pain levels and arthrodesis procedures demonstrated higher complications and reoperation rates than other management techniques.

CONCLUSION: The available studies are retrospective case series of poor to moderate quality with poor internal validity. The evidence suggests that the comparison of patient outcomes post-surgical management is inconclusive due to the heterogeneity and the omission of pre-operative characteristic data. Our study also observed a tendency of higher complications and reoperation rates post LT arthrodesis. It is recommended that all outcomes be standardized and presented in a uniform fashion with best practices be developed to better characterize the severity and integrity of the injury in future studies.

KEY WORDS: Lunotriquetral Interosseous Injuries, Management, Surgical intervention, Patient Outcomes.

2:30 p.m. - Scoping review on the Etiology of Extensor Pollicis Longus (EPL) Tendon Rupture

STUDENTS: Cantin, Merle; Farzad, Maryam; Knezy, Domenica; Jain, Rupal

SUPERVISORS: MacDermid, Joy; Dabbagh, Armaghan

BACKGROUD: EPL ruptures occur due to various etiologies. Preventative steps could be taken if these etiologies are known.

PURPOSE: To summarize the evidence on the etiology of EPL tendon rupture.

METHODS: We conducted a scoping review of the literature published in English using Embase, Ovid, PubMed, and the grey literature. We developed a search strategy combining terms related to EPL tendon rupture. Four investigators screened titles, abstracts and full-text articles and extracted data for the various causes of EPL rupture.

RESULTS: Eighty-one articles met the inclusion criteria to report different causes of EPL rupture. The most common causes are listed as distal radius fracture (45 studies, 51%), hardware causing mechanical disruption around Lister's tubercle (14 studies, 15%), open reduction internal fixation (12 studies, 14%), repetitive strain injuries (8, 0.09%), Rheumatoid Arthritis (5 studies, 0.05%), avulsion of Extensor Carpi Radialis Longus (5 studies, 0.05%) and steroid injections (3 studies).

CONCLUSION: DRF is the most frequently reported cause of EPL rupture. Recognition and early identification of risks may aid in preventing rupture.

KEY WORDS: EPL tendon rupture, etiology, causes, third extensor compartment, adults.

Group 2: WH/Pain

1:00 p.m. - The experience of virtual wound care for patients, their caregivers and health care providers in home care and community settings: a qualitative evidence synthesis

STUDENTS: Francis-Bignall, D; Lin, F; Meloche, K


BACKGROUD: Virtual wound care occurs remotely with the use of different types of communication media, and interaction between patients, their caregivers, and their healthcare providers. A growing body of literature highlights the role of virtual care in the management of wounds, however the lived experience of participants in virtual wound care is unknown.

PURPOSE: To critically appraise and synthesize the findings of qualitative studies regarding the experience of virtual wound care for patients, their caregivers and health care providers in home care and community settings.

METHODS: We searched six electronic databases – MEDLINE, EMBASE, CINAHL, PsycINFO, SCOPUS and PROQUEST - for relevant studies published in English from 2001 to 2021. Fifty-six studies were assessed by two independent reviewers for relevance and methodological quality using the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI). Discrepancies were resolved in consultation with a third reviewer. Ten studies met the criteria for thematic synthesis and were included in the review.

RESULTS: Meta-synthesis resulted in five syntheses: perceptions of virtual wound care; quality of care delivery; pathways for delivering virtual wound care; interdisciplinary collaboration; and satisfactoriness with virtual wound care.

CONCLUSION: Our findings provide important information about the perceptions and lived experiences of the delivery of virtual wound care. Likewise, they support virtual wound care as a satisfactory adjunct to usual wound care practices, and can influence decision-making, future directions, and research in virtual wound care.

KEY WORDS: virtual wound care, home care, community care, qualitative research, evidence synthesis.

1:10 p.m. - Examining the interplay between virtual wound care and social determinants of health: a scoping review.

STUDENTS: Darlington, K; Mazerolle, K

SUPERVISORS: Babenko-Mould, Y; Kennedy, E

BACKGROUD: A noticeable shift to the use of virtual wound care has occurred since the COVID-19 pandemic. Social determinants of health create barriers or facilitators to achieving wound goals. It is unknown if virtual wound care will support the reduction of health inequalities.

PURPOSE: This scoping review aims to identify how social determinants of health have related to virtual wound care. Highlighting approaches to increasing inclusivity.

METHODS: The authors’ scoping review followed the Arksey and O’Malley methodological framework. Keywords were searched in MEDLINE, Embase, Scopus, and CINAHL for English language studies published between 2019 and May 26, 2022. Relevant studies were selected; data was extracted, charted, collated, and summarized.

RESULTS: Thematic analysis revealed exclusion criteria corresponding to known health inequalities. Income my limit access to needed smartphones and rural regions may not have equivalent internet access. Limited social supports impact ability to take suitable photographs on areas such as the foot.

DISCUSSION: Virtual care has capacity to care for less accessible individuals however, despite time and cost savings this was not found in the literature.

CLINICAL RELEVANCE: Underserved individuals deserve equitable wound expertise. Gaps within the literature include infrequent sustainable solutions for clients and clinicians to access virtual care.

KEY WORDS: social determinants, wound, virtual care, Covid-19

1:20 p.m. - Effects of electrical stimulation (E-Stim) therapy on healing of lower limb ulcers: a systematic review

STUDENTS: Brooks, J; Forbes, SG; Lindsay, J; Stephens, M


BACKGROUD: Numerous clinical trials and systemic reviews have examined the effect of E-Stim on healing of chronic wounds including pressure injuries.

PURPOSE: The objective of this systematic review was to identify clinical studies that evaluated the effect of E-Stim on healing outcomes in lower limb ulcers (LLU) resulting from vascular disease.

METHODS: A systematic search of PubMed, CINHAL, Scopus databases and a manual search of journals and references included in previous systematic reviews was conducted. Paired consensus was used to select articles that met predetermined inclusion/exclusion criteria.

RESULTS: Nine articles involving three hundred and eighty-one participants and four hundred and four LLU’s were selected from forty-five full articles. Eight included studies were controlled clinical trials of moderate-high methodological quality (mean PEDro score=7.25/10). Most research published to date focused on leg ulcers due to venous insufficiency and used monophasic pulsed current applied directly to the wound. Eight of nine (88.9%) included studies concluded E-Stim improved healing outcomes compared to placebo or standard care in LLU’s. Different healing outcomes prevented a meta-analysis.

CONCLUSION: E-Stim has been shown to stimulate healing in LLU’s in several small, moderate quality, controlled clinical trials.

KEY WORDS: electrical stimulation, venous leg ulcers, arterial ulcer, mixed ulcer, wound healing, wound size reduction

1:30 p.m. - The Impact of COVID-19 on Diabetic Foot Ulcer Wound Care Delivery: A Scoping Review

STUDENTS: Cowan, J; Dresser, J; Hayle-Hope, L; Holtz, G.


BACKGROUD: The COVID-19 pandemic altered the delivery of health care throughout the world. Historically, diabetic foot ulcer (DFU) management required regular in person visits and thus restrictions to in person visits caused by the pandemic, impacted DFU care delivery.

PURPOSE: The objective of this scoping review was to identify key concepts from the literature that highlight the impact the pandemic has had on the delivery of wound care to persons experiencing diabetic foot ulcers.

METHODS: A scoping literature search was conducted for publications from 2019-2022. After the relevant articles were identified the key concepts were synthesized into relevant themes.

RESULTS: Based on our exclusion criteria; 42 articles were chosen for inclusion. Four themes emerged from the review: Communication, prioritization, self-management, and health care utilization.

CONCLUSION: The volatile and unpredictable course of the COVID-19 pandemic brought challenges to the delivery of care of the diabetic foot. Several lessons can be learned from the evaluation of the themes that were identified by this scoping review. Within each of these themes, there were positive innovations in care and negative implications. Further studies are required to learn how diabetic foot care will evolve in the future.

CLINICAL RELEVANCE: Health care systems must adapt to lessons learned from within the themes identified.

KEY WORDS: COVID-19, “wound care delivery”, “diabetic foot ulcer”

1:40 p.m. - Improved chronic bilateral knee pain resulting from strength training: a case report

STUDENTS: North, Megan


BACKGROUD: Strength training is commonly used to treat chronic bilateral knee pain. However, there is some controversy about the appropriate knee flexion to elicit optimal results.

PURPOSE: To evaluate the function and range of motion of a client after four weeks of consistent strength training focusing on complete knee flexion movements.

METHODS: Over four weeks, a general strength training approach was used in addition to the Knees Over Toes Method created by Ben Patrick to recruit the vastus medialis oblique (VMO). Patient-reported outcomes were given, including the Brief Pain Inventory, Brief Illness Perception Questionnaire, the Tampa Scale for Kinesiophobia and the Patient Health Questionnaire 9, and baseline functional fitness testing included but was not limited to a push, pull, hinge, squat and core.

RESULTS: This client experience overall improvements in all functional movement patterns, excluding the core. Most significantly improving in pushing pattern and squatting pattern. At the end of four weeks, this client improved in each patient-reported outcome, but most significantly, the Brief Pain Inventory.

CONCLUSION: Full knee flexion movements paired with a strength training regimen can significantly improve chronic knee pain, self-efficacy, and functional strength, leading to an improved quality of life.

KEY WORDS: knees over toes, knee flexion, vastus medialis oblique, chronic bilateral knee pain, patient-reported outcomes

1:50 p.m. - A Case study and analysis on Biopsychosocial challenges in providing person-centred care in the context of complex cases.



BACKGROUD: This case presents a patient with many multimorbid & biopsychosocial challenges that influence complex pain management.

SYMPTOMS: The patient experiences worsening lower back pain, complicated with bilateral leg ulcers that significantly interfere with her ability to complete daily activities. As a result, she has experienced ongoing frustration with her rehabilitation progress, due to her complex medical history, alongside a decline in her psychosocial wellbeing, due to a lack of financial and social support.

CLINICAL FINDINGS/INTERVENTIONS: The patient had paraspinal muscle spasms on L4-S2 bilaterally, diffuse tenderness across the spine, and background history of lumbar lordosis. She had a loss of sensation to light touch, temperature, and pinprick below the knees bilaterally, because of diabetic neuropathy. She sustained a left ankle fracture from a fall that lead to a stage 3 calcaneal ulcer on the left side, furthermore impairing ambulation. As a result of her ongoing difficulties ambulating, her depression worsened, and there was an increasing lack of interest as manifested by her reluctance to engage in physiotherapy. Poor adherence to a diabetic regimen, due to complex financial, social, and familial factors, also predisposed her to a poor prognosis prior to her admission to LTC. Upon her arrival to an LTC, she was managed through a biopsychosocial framework. A radar plot was used to identify her primary drivers of pain experience and was rated highly on emotional/ affective, socioenvironmental and nociceptive factors. For her physiotherapy needs, she was recommended modifications to her back-rest on the power chair and was offered intermediate use of hot packs for pain management. She also received 1-on-1 strengthening exercises for her upper extremities and assisted exercises for her lower extremities and she was put on a repositioning schedule every two hours. To manage her diabetic complications, she was referred to a specialized wound clinic, however, due to geographical limitations, a nurse was deployed to the LTC to provide care instead. The Ontario Disability Program was re-instigated after a functional cognitive assessment was conducted, and was also referred to a social worker to address her diagnosis of depressive disorder.

CONCLUSION: Multimorbid patients require an interdependent focus of care that addresses biological, psychological, and social needs in order to promote rehabilitation and recovery.

KEY WORDS: Diabetes, Comorbidity, back pain, foot ulcer, psychosocial needs, prognosis, poor rehabilitation.

2:00 p.m. - Intralesional sodium thiosulfate in the treatment of dermatomyositis with severe calcinosis cutis to improve patient's function, promote independence, and pain management: A case report.

STUDENTS: Hibi-Galbraith, N

BACKGROUD: Calcinosis cutis occurs when calcium salts are deposited into the skin and subcutaneous tissue. It is classified into five main types: dystrophic, metastatic, idiopathic, iatrogenic, and calciphylaxis. Dystrophic calcification is the most common cause of calcinosis cutis. Dystrophic calcification is typically associated with a systemic disease such as dermatomyositis. Dermatomyositis is a rare acquired immune-mediated muscle disease characterized by muscle weakness and skin rash. It is classified as one of the idiopathic inflammatory myopathies. Treatment for calcinosis cutis can be challenging. Dermatomyositis with severe calcinosis cutis is a condition with very few studies of high-level evidenced treatment options. Sodium thiosulfate is one of the treatments used to improve function, promote independence, and pain management.

CASE PRESENTATION: A pleasant 54-year-old woman presented with dermatomyositis with extensive calcinosis and associated interstitial lung disease who has been intermittently bedbound for a year. About 2 years ago, she started developing calcinosis cutis in her upper and lower extremities, resulting in repeated Emergency Department visits for skin infections due to subcutaneous calcinosis, as well as immobilization due to calcinotic lesions in various tendons and joints. She has a positive ANA and a positive PM/Scl75/100. The patient has previously trialed methotrexate and Imuran. The treatment used intralesional sodium thiosulfate in hopes to improve her mobility, maintain her ability to perform activities of daily living, and decrease her pain.

OUTCOMES: The patient received a total of 7 intralesional injections of sodium thiosulfate over a three-year span in various areas of concern. There was a noted softening of lesions with improved function, increased range of motion and decrease in pain. Patient had multiple hospital admissions for various falls and fractures as well as other complications. Sadly, patient passed away in 2021.

CONCLUSION: This case report is presented to encourage more high-level evidenced studies on effective treatment of dermatomyositis with sever calcinosis cutis. The patient reported functional gains and a decrease in pain from the proposed treatment. She was hopeful, remained positive in regaining some independence and improved pain control.

KEY WORDS: intralesional sodium thiosulfate; dermatomyositis; calcinosis cutis, improved patient function; promote independence; pain management; case report

2:10 p.m. - A Person-Centered Approach to Treatment of Painful Axillary Web Syndrome: A Case Report

STUDENTS: Obljubek, T.


BACKGROUD: Axillary web syndrome (AWS) is a painful and functionally debilitating condition that has been described in the literature as prevalent but under-reported. It generally occurs after breast cancer surgery following lymph node removal. To date, there is a lack of evidence-based research to guide physical therapists in the treatment of AWS. Person-centered care has been shown to increase health outcomes and quality of care by engaging a patient in their care. For this reason, a co-operatively designed care approach to physical therapy treatment for those with AWS may optimize outcomes better aligned with what matters most to patients.

CASE PRESENTATION: A 54-year-old woman presented with pain-limited right shoulder movement and palpable cords in the axilla, arm, elbow, and forearm three weeks post lumpectomy and sentinel lymph node dissection. Outcome scores reveal mild to moderate anxiety and decreased function. The patient valued her family and health and wanted to return to functional activities, walking, and yoga practice. After seven sessions of physical therapy care over five weeks, there was a resolution of pain, normalization of shoulder movement and functional outcome scores, and a return to activities important to the patient. Using a person-centered approach, treatment included specialized education, soft tissue mobilization, manual lymphatic drainage, mindfulness, and home-based progressive exercise prescription to work towards mutually developed goals.

CONCLUSION: This case provides preliminary evidence that early diagnosis and treatment of AWS using a person-centered approach to physical therapy can support a patient in mediating pain and functional disability in the short term. Future research needs to review the impact of this approach to empower patients with the knowledge and resources to prevent long-term pain and disability due to cancer treatments such as AWS that are underrecognized and undertreated.

KEY WORDS: Axillary web syndrome, person-centered care, pain, breast cancer, case study

2:20 p.m. - Application of a clinical reasoning framework to guide chronic pain assessment and interprofessional multimodal intervention: a case report



BACKGROUD: Chronic pain is a complex condition requiring interprofessional collaborative interventions to optimize treatment. Here, a clinical reasoning framework is used to identify drivers of chronic pain in a patient with a remote history of spinal injury. These chronic pain drivers were used to guide multimodal interventions by a pharmacist and a social worker working in a primary care setting.

CASE PRESENTATION: The case is of a 61-year-old male who had a serious workplace accident in 1997 resulting in a crush injury to his lumbosacral spine. After spinal surgery, physiotherapy, decades of opioid and adjuvant pain medication use, and implantation of a spinal cord stimulator, the patient remained in significant pain and felt he had poor quality of life. He sought to reduce his dependence on opioids and learn new ways of coping with his chronic pain.

CONCLUSION: This case highlights how the identification of drivers of chronic pain during assessment can guide clinicians to targeted interventions that yield not only improvements in scores on multiple validated pain measures, but also improve a patient’s self-reported quality of life.

KEY WORDS: chronic pain, interprofessional, opioids, primary care, case report

2:30 p.m. - Primary Synovial Chondromatosis: An unusual case of a locking elbow in an adolescent female: a case report.


BACKGROUD: Primary synovial chondromatosis (PSC) is a rare, benign condition where multiple loose bodies are formed within a joint capsule. It most commonly occurs in adult males; it is extremely rare in children. Signs and symptoms are a painful swollen joint with possible locking or catching sensations.


CASE: A 16-year-old female hockey player presented for chiropractic care with a painful, swollen elbow and complaints of locking. Radiographic examination confirmed the presence of primary synovial chondromatosis. Treatment took the form of surgical excision and was successful for the patient.

CONCLUSION: A rare case of PSC is presented in this study. Pediatric cases of PSC are very limited in the literature.

2:40 p.m. - Case Report: An interdisciplinary teams application of the radar plot for pain assessment, to guide individualized pain treatment for a client experiencing chronic pain following a motor vehicle crash.

STUDENTS: Cuconato, A.


BACKGROUD: There is a growing movement towards individualization of treatment approaches for people experiencing pain. Those who are involved in a motor vehicle crash (MVC) have an increased likelihood of developing chronic pain compared to the general population, further necessitating the need to understand how to identify appropriate personalized treatment plans.

PURPOSE: A case study report is presented outlining how an interdisciplinary team used the radar plot for pain assessment to guide individualized pain treatment for a client experiencing chronic pain following a MVC.

METHODS: This patient was assessed by an Occupational Therapist, Physiotherapist, Kinesiologist and Registered Clinical Counsellor, and the clinicians met with the client as a team to review the findings using the Radar Plot. This plot was used to influence the treatment plans and the client was re-assessed 8 weeks later and re-plotted.

RESULTS: At the time of the assessment the radar plot was used and the domains which were rated the highest were central nocioplastic (very high), cognitive beliefs (very high) and emotional affective (high). Following 8 weeks of individualized treatment the radar plot was reapplied and those domains were rated as central nocioplastic (moderate), cognitive beliefs (moderate) and emotional affective (moderate).

DISCUSSION: Interdisciplinary, personalized care is emerging as best practice for chronic pain management and the radar plot offers an assessment tool to inform the evaluation and treatment of painful conditions.

CONCLUSION: Individualized interprofessional pain treatments influenced by the radar plot contributed to decreased global ratings, as well as improvements in subjective pain, function and mood as well as objective measures at 8 week follow up.

KEY WORDS: case report, radar plot, chronic pain, interdisciplinary

2:50 p.m. - Case Report: Physiotherapy to address the central drivers of both overactive bladder and chronic low back pain

STUDENTS: Nelson, F.


BACKGROUD: The cause of overactive bladder remains unknown. It is theorized that it is a result of central mechanisms, similar to the nociplastic changes that occur with chronic pain.

PURPOSE: To explore the relationship between the occurrence of both OAB and chronic pain in a patient’s subjective and clinical exam. To address the central drivers through pelvic and physiotherapy as concurrent treatment for both conditions.

METHODS: The patient was evaluated by a pelvic physiotherapist and diagnosed with both OAB and chronic low back pain. A comparison of central vs peripheral mediators of pain and a radar plot were done regarding the low back pain. Distress questionnaires including CSI, DASS, ACE Q, PCS and FreBAQ were completed.

DISCUSSION: There is little evidence available to confirm that OAB is caused by changes within the central nervous system. There are multiple theories as to the neuroplastic changes that may take place. These all relate to the same central pain mechanisms that occur with chronic pain. Unfortunately, patient compliance and treatment timelines limited the possibility of evaluating the effectiveness of therapy for both conditions by addressing the central drivers of pain.

CONCLUSION: Given the commonalities between chronic pain and OAB, it is worth screening patients with OAB for central nervous system changes. It is also worth asking patients with chronic pain about their bladder function. This would be part of a true biopsychosocial approach to treatment.

KEY WORDS: case report, overactive bladder, low back pain, urgency, central pain mechanisms, chronic pain

3:00 p.m. - Prognostic Indicators Don't Always Get it Right: a Case Report



BACKGROUD: Prognostic indicators and risk factors are commonly used in clinical practice to help determine a patient’s anticipated recovery and response to treatment. One tool used in this assessment is the Brief Illness Perceptions Questionnaire (BIPQ). A high score in the BIPQ is suggestive of delayed recovery and/or poor prognosis. In this case study, a patient with an acute work related low back injury made a full recovery despite several risk factors for low back chronicity and a
BIPQ score indicating poor recovery.

CASE INFORMATION: A 39 year old female patient suffered an acute low back injury at work from lifting. Examination ruled out red flags and neurological injury. BIPQ was administered to help evaluate prognosis and give insight into the patient’s condition. Initial BIPQ scores suggested this patient was high risk for delayed or poor recovery. The Brief Pain Inventory (BPI) was used to monitor the patient’s response to treatment. Chiropractic treatment including manipulation, myofascial release and education was initiated. Brief Pain Inventory (BPI) scores indicated a full or nearfull recovery, from 7.9/10 to 0.4/10 on the pain interference scale over the six weeks of treatment.


CONCLUSION: The patient in this case had multiple risk factors and a BIPQ score suggestive of poor or delayed recovery and high risk of chronicity. Despite these risk factors, she returned to work within one month of injury.