Physiotherapy - Research Publications
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ItemThe sit-to-stand test as a patient-centered functional outcome for critical care research: a pooled analysis of five international rehabilitation studies(BMC, 2022-06-13)BACKGROUND: With ICU mortality rates decreasing, it is increasingly important to identify interventions to minimize functional impairments and improve outcomes for survivors. Simultaneously, we must identify robust patient-centered functional outcomes for our trials. Our objective was to investigate the clinimetric properties of a progression of three outcome measures, from strength to function. METHODS: Adults (≥ 18 years) enrolled in five international ICU rehabilitation studies. Participants required ICU admission were mechanically ventilated and previously independent. Outcomes included two components of the Physical Function in ICU Test-scored (PFIT-s): knee extensor strength and assistance required to move from sit to stand (STS); the 30-s STS (30 s STS) test was the third outcome. We analyzed survivors at ICU and hospital discharge. We report participant demographics, baseline characteristics, and outcome data using descriptive statistics. Floor effects represented ≥ 15% of participants with minimum score and ceiling effects ≥ 15% with maximum score. We calculated the overall group difference score (hospital discharge score minus ICU discharge) for participants with paired assessments. RESULTS: Of 451 participants, most were male (n = 278, 61.6%) with a median age between 60 and 66 years, a mean APACHE II score between 19 and 24, a median duration of mechanical ventilation between 4 and 8 days, ICU length of stay (LOS) between 7 and 11 days, and hospital LOS between 22 and 31 days. For knee extension, we observed a ceiling effect in 48.5% (160/330) of participants at ICU discharge and in 74.7% (115/154) at hospital discharge; the median [1st, 3rd quartile] PFIT-s difference score (n = 139) was 0 [0,1] (p < 0.05). For STS assistance, we observed a ceiling effect in 45.9% (150/327) at ICU discharge and in 77.5% (79/102) at hospital discharge; the median PFIT-s difference score (n = 87) was 1 [0, 2] (p < 0.05). For 30 s STS, we observed a floor effect in 15.0% (12/80) at ICU discharge but did not observe a floor or ceiling effect at hospital discharge. The median 30 s STS difference score (n = 54) was 3 [1, 6] (p < 0.05). CONCLUSION: Among three progressive outcome measures evaluated in this study, the 30 s STS test appears to have the most favorable clinimetric properties to assess function at ICU and hospital discharge in moderate to severely ill participants.
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ItemYoung children's footwear taxonomy: An international Delphi survey of parents, health and footwear industry professionals.(Public Library of Science (PLoS), 2022)OBJECTIVE: There is little consistency between commercial grade footwear brands for determining shoe sizing, and no universally accepted descriptors of common types or features of footwear. The primary aim of this research was to develop a footwear taxonomy about the agreed types of footwear commonly worn by children under the age of six. Secondary aims were to gain consensus of the common footwear features, when different types of footwear would be commonly worn, common terms for key footwear parts, and how movement at some of these footwear parts should be described. MATERIALS AND METHODS: Opinions were collected through a three-round modified Delphi international online survey from parents, health professionals, researchers, and footwear industry professionals. The first survey displayed generic pictures about different footwear types and asked participants to provide a grouping term, when the footwear would be worn (for what type of activity) and any grouping features. The second and third rounds presented consensus and gathered agreement on statements. RESULTS: There were 121 participants who provided detailed feedback to open-ended questions. The final round resulted in consensus and agreement on the names of 14 different footwear types, when they are commonly worn and their common features. Participants also reached consensus and agreement on the terms heel counter to describe the back part of footwear and fixtures as the collective term for features allowing footwear adjustability and fastening. They also agreed on terms to quantify the flexibility at footwear sole (bend or twist) or the heel counter. CONCLUSION: This first taxonomy of children's footwear represents consensus amongst different stakeholders and is an important step in promoting consistency within footwear research. One shoe does not fit all purposes, and the recommendations from this work help to inform the next steps towards ensuring greater transparency and commonality with footwear recommendations.
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ItemPatient and clinician perspectives of pelvic floor dysfunction after gynaecological cancer(ELSEVIER SCIENCE INC, 2022-06-01)Purpose: To explore and compare patient and clinician experiences, knowledge and preferences in relation to screening and management of pelvic floor (PF) dysfunction in the gynaecology-oncology setting. Methods: Semi-structured interviews were conducted with women reporting PF symptoms after gynaecological cancer treatment, and gynaecology-oncology clinicians. Interviews were transcribed and thematically analysed and were conducted until data saturation was reached. Results: We interviewed 12 patients and 13 clinicians. We identified two main themes: (1) Experience with PF symptoms, screening, disclosure and management and (2) Future hope of what should happen to screen and manage PF symptoms. Differences between what participants had experienced and what they felt should happen highlighted a perceived need for improving PF screening and management. A sub-theme that reflected relevant barriers and enablers was also identified. Barriers included time pressure, being focussed on cancer treatment and not side-effects, and patients feeling unwell, emotional, and overwhelmed with the logistics of oncology appointments. Enablers included the patient-clinician relationship, and opportunities for improving management included integrating nursing and PF physiotherapy with oncology appointments. Conclusions: Gynaecological cancer survivors and clinicians perceive a need to improve screening and management for PF symptoms. While barriers and differences in perception exist, there are opportunities to improve how PF symptoms can be screened and managed in this population. Further studies exploring the feasibility of providing integrated multidisciplinary PF therapy services may be warranted.
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ItemFunctional correlates of clinical phenotype and severity in recurrent SCN2A variants(NATURE PORTFOLIO, 2022-05-30)In SCN2A-related disorders, there is an urgent demand to establish efficient methods for determining the gain- (GoF) or loss-of-function (LoF) character of variants, to identify suitable candidates for precision therapies. Here we classify clinical phenotypes of 179 individuals with 38 recurrent SCN2A variants as early-infantile or later-onset epilepsy, or intellectual disability/autism spectrum disorder (ID/ASD) and assess the functional impact of 13 variants using dynamic action potential clamp (DAPC) and voltage clamp. Results show that 36/38 variants are associated with only one phenotypic group (30 early-infantile, 5 later-onset, 1 ID/ASD). Unexpectedly, we revealed major differences in outcome severity between individuals with the same variant for 40% of early-infantile variants studied. DAPC was superior to voltage clamp in predicting the impact of mutations on neuronal excitability and confirmed GoF produces early-infantile phenotypes and LoF later-onset phenotypes. For one early-infantile variant, the co-expression of the α1 and β2 subunits of the Nav1.2 channel was needed to unveil functional impact, confirming the prediction of 3D molecular modeling. Neither DAPC nor voltage clamp reliably predicted phenotypic severity of early-infantile variants. Genotype, phenotypic group and DAPC are accurate predictors of the biophysical impact of SCN2A variants, but other approaches are needed to predict severity.
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ItemTibiofemoral contact force differences between flat flexible and stable supportive walking shoes in people with varus-malaligned medial knee osteoarthritis: A randomized cross-over study(PUBLIC LIBRARY SCIENCE, 2022-01-01)OBJECTIVE: To compare the effect of stable supportive to flat flexible walking shoes on medial tibiofemoral contact force (MTCF) in people with medial knee osteoarthritis and varus malalignment. DESIGN: This was a randomized cross-over study. Twenty-eight participants aged ≥50 years with medial knee osteoarthritis and varus malalignment were recruited from the community. Three-dimensional full-body motion, ground reaction forces and surface electromyograms from twelve lower-limb muscles were acquired during six speed-matched walking trials for flat flexible and stable supportive shoes, tested in random order. An electromyogram-informed neuromusculoskeletal model with subject-specific geometry estimated bodyweight (BW) normalized MTCF. Waveforms were analyzed using statistical parametric mapping with a repeated measures analysis of variance model. Peak MTCF, MTCF impulse and MTCF loading rates (discrete outcomes) were evaluated using a repeated measures multivariate analysis of variance model. RESULTS: Statistical parametric mapping showed lower MTCF in stable supportive compared to flat flexible shoes during 5-18% of stance phase (p = 0.001). For the discrete outcomes, peak MTCF and MTCF impulse were not different between the shoe styles. However, mean differences [95%CI] in loading impulse (-0.02 BW·s [-0.02, 0.01], p<0.001), mean loading rate (-1.42 BW·s-1 [-2.39, -0.45], p = 0.01) and max loading rate (-3.26 BW·s-1 [-5.94, -0.59], p = 0.02) indicated lower measure of loading in stable supportive shoes compared to flexible shoes. CONCLUSIONS: Stable supportive shoes reduced MTCF during loading stance and reduced loading impulse/rates compared to flat flexible shoes and therefore may be more suitable in people with medial knee osteoarthritis and varus malalignment. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registry (12619000622101).
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ItemWhat is real change in submaximal cardiorespiratory fitness in older adults? Retrospective analysis of a clinical trial(SPRINGER, 2022-12-01)OBJECTIVE: To assess the test-retest reliability of submaximal cardiorespiratory fitness in healthy active older adults. METHODS: This was a retrospective analysis of 41 adults enrolled in a clinical trial [mean (sd) aged 59 yrs (7); 29% females; and body mass index 24.5 kg/m2 (3.3)]. Cardiorespiratory fitness was assessed using a cycle ergometer 6 weeks apart. The initial workload was 1 W per kilogram of free fat mass (W/kg FFM) and increased by 0.5 W/kg FFM every 3 min until participants could not maintain the speed at ≥ 60 rpm, they reached a rating of perceived exertion of 15-17, and/or obtained a respiratory exchange ratio (RER) of 1.000. Reliability of [Formula: see text], heart rate and RER was assessed for each workload, and for [Formula: see text], when RER reached 1.00. Reliability was examined as the intraclass correlation coefficient (ICC(2,1)), Bland-Altman plots, standard error of measurement (SEM and SEM%), and the minimal detectable change (MDC). RESULTS: Test-retest agreement ranged between (ICC(2,1) 0.44-0.84) with no discernible systematic differences between assessments. The SEM% for absolute and relative [Formula: see text] ranged between 13.0 to 20.2%, and 13.8 to 26.3%, respectively. The MDC90% for absolute and relative [Formula: see text] ranged between 30.4% to 47.1%, and 32.2% to 61.4%, respectively. The lowest SEMs% and MDCs% for both absolute and relative [Formula: see text] were observed for workloads at 2.5 W kg/FFM (~ 13% and ~ 31%, respectively). CONCLUSIONS: Although at least modest relative reliability was consistently demonstrated, the smaller measurement error associated with absolute and relative [Formula: see text] at 2.5 W kg/FFM may indirectly suggest that submaximal cardiorespiratory fitness can be monitored more confidently at higher workloads. Findings provide critical information to determine how much change is considered 'real change' in repeated measures of cardiorespiratory fitness using a submaximal graded exercise testing protocol in healthy active older adults.
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ItemDelivering multidisciplinary neuromuscular care for children via telehealth(WILEY, 2022-04-29)INTRODUCTION/AIMS: In response to coronavirus disease 2019 (COVID-19) pandemic restrictions int 2020, our face-to-face (F2F) multidisciplinary neuromuscular clinic (NMC) transitioned to widespread use of telehealth (TH). This study aimed to (1) understand parent/guardian, child, and clinician perceptions of TH; (2) examine TH-related changes in clinical activity; and (3) use these findings to inform a future model of care for the NMC. METHODS: A clinical audit was undertaken to examine clinical activity throughout 2018-2020. Online surveys were distributed to clinicians and parents of children attending the NMC via TH in 2020. A working group of clinicians created a checklist to guide a future hybrid model of TH and F2F care. RESULTS: Total clinical activity in 2020 was maintained from previous years; 62.8% of all appointments occurred via TH, and 82.3% of patients attended NMC by TH at least once. Ninety-nine parents (30.6% response rate), 52 children, and 17 clinicians (77% response rate) responded to the survey. All groups reported better interaction when F2F compared to TH. Eighty percent of parents identified advantages of TH and reported lower levels of stress. A lack of "hands-on" physical assessment was identified by parents and clinicians as a TH limitation. Most families (68.1% of parents; 58.8% of children) and all clinicians indicated a preference for a mix of TH and F2F NMC appointments in the future. DISCUSSION: This study has informed a checklist to guide future TH use in a new hybrid model of care. Further investigation is required to assess health impacts of TH use in pediatric neuromuscular care.
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ItemExercise alone impacts short-term adult visual neuroplasticity in a monocular deprivation paradigm(ASSOC RESEARCH VISION OPHTHALMOLOGY INC, 2021-10-01)Adult homeostatic visual plasticity can be induced by short-term patching, heralded by a shift in ocular dominance in favor of the deprived eye after monocular occlusion. The potential to boost visual neuroplasticity with environmental enrichment such as exercise has also been explored; however, the results are inconsistent, with some studies finding no additive effect of exercise. Studies to date have only considered the effect of patching alone or in combination with exercise. Whether exercise alone affects typical outcome measures of experimental estimates of short-term visual neuroplasticity is unknown. We therefore measured binocular rivalry in 20 healthy young adults (20-34 years old) at baseline and after three 2-hour interventions: patching (of the dominant eye) only, patching with exercise, and exercise only. Consistent with previous work, the patching interventions produced a shift in ocular dominance toward the deprived (dominant) eye. Mild- to moderate-intensity exercise in the absence of patching had several effects on binocular rivalry metrics, including a reduction in the dominant eye percept. The proportion of mixed percept and the time to first switch (onset rivalry) did not change from baseline across all interventions. Thus, we demonstrate that exercise alone can impact binocular rivalry outcomes measures. We did not observe a synergistic effect between patching and exercise in our data.
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ItemEarly Detection and Classification of Patient-Ventilator Asynchrony Using Machine Learning(Springer International Publishing, 2022-01-01)