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Farley C, Newman ANL, Hoogenes J, Brooks D, Duffett M, Kho ME. Treatment Fidelity in 94 Randomized Controlled Trials of Physical Rehabilitation in the ICU: A Scoping Review. Crit Care Med 2024; 52:717-728. [PMID: 38265271 DOI: 10.1097/ccm.0000000000006192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
OBJECTIVES Recent reviews demonstrated discordant effects of ICU-based physical rehabilitation on physical function. These inconsistencies may be related to differences in treatment fidelity-the extent to which a protocol is delivered as planned. Before evaluating the association of fidelity with outcomes, we must first understand the extent of treatment fidelity reporting in ICU-based physical rehabilitation randomized controlled trials (RCTs). DATA SOURCES Six electronic databases from inception to December 2022. STUDY SELECTION We included RCTs enrolling adults or children admitted to the ICU, if greater than or equal to 50% were invasively mechanically ventilated greater than 24 hours, and underwent an ICU-based physical rehabilitation intervention, with no limitation to comparators or outcomes. DATA EXTRACTION We screened and extracted data independently and in duplicate, with a third reviewer as needed. Extracted data included study characteristics, treatment descriptions, and the presence of National Institutes of Health Behaviour Change Consortium (NIH-BCC) treatment fidelity tool components. Treatment fidelity scores were calculated as the proportion of reported (numerator) out of total NIH-BCC components (denominator). We calculated scores across studies and by treatment group (intervention vs. comparator). We used linear regression to assess for a time trend in study treatment fidelity scores. DATA SYNTHESIS Of 20,433 citations, 94 studies met inclusion criteria. Authors reported a median (first-third quartiles) of 19% (14-26%) of treatment fidelity components across studies. Intervention group scores were higher than comparator groups (24% [19-33%] vs. 14% [5-24%], p < 0.01). We found a mean increase in study treatment fidelity scores by 0.7% (0.3 points) per year. CONCLUSIONS Only 19% of treatment fidelity components were reported across studies, with comparator groups more poorly reported. Future research could investigate ways to optimize treatment fidelity reporting and determine characteristics associated with treatment fidelity conduct in ICU-based physical rehabilitation RCTs.
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Affiliation(s)
- Christopher Farley
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Anastasia N L Newman
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Jen Hoogenes
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Dina Brooks
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Mark Duffett
- Departments of Pediatrics and Health Research, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Michelle E Kho
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Physiotherapy Department, St. Joseph's Healthcare, Hamilton, ON, Canada
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O'Grady HK, Reid JC, Farley C, Hanna QEB, Unger J, Zorko DJ, Bosch J, Turkstra LS, Kho ME. Comparator Groups in ICU-Based Studies of Physical Rehabilitation: A Scoping Review of 125 Studies. Crit Care Explor 2023; 5:e0917. [PMID: 37181539 PMCID: PMC10171473 DOI: 10.1097/cce.0000000000000917] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
Abstract
To characterize comparator groups (CGs) in ICU-based studies of physical rehabilitation (PR), including the type, content, and reporting. DATA SOURCES We followed a five-stage scoping review methodology, searching five databases from inception to June 30, 2022. Study selection and data extraction were completed independently, in duplicate. STUDY SELECTION We screened studies by title and abstract, then full-text. We included prospective studies with greater than or equal to two arms enrolling mechanically ventilated adults (≥ 18 yr), with any planned PR intervention initiated in the ICU. DATA EXTRACTION We conducted a quantitative content analysis of authors' description of CG type and content. We categorized similar CG types (e.g., usual care), classified content into unique activities (e.g., positioning), and summarized these data using counts (proportions). We assessed reporting using Consensus on Exercise Reporting Template (CERT; proportion of reported items/total applicable). DATA SYNTHESIS One hundred twenty-five studies were included, representing 127 CGs. PR was planned in 112 CGs (88.2%; 110 studies), representing four types: usual care (n = 81, 63.8%), alternative treatment than usual care (e.g., different from intervention; n = 18, 14.2%), alternative treatment plus usual care (n = 7, 5.5%), and sham (n = 6, 4.7%). Of 112 CGs with planned PR, 90 CGs (88 studies) reported 60 unique activities, most commonly passive range of motion (n = 47, 52.2%). The remaining 22 CGs (19.6%; 22 studies) reported vague descriptions. PR was not planned in 12 CGs (9.5%; 12 studies), and three CGs (2.4%; three studies) reported no details. Studies reported a median (Q1-Q3) of 46.6% (25.0-73.3%) CERT items. Overall, 20.0% of studies reported no detail to understand planned CG activities. CONCLUSIONS The most common type of CG was usual care. We identified heterogeneity in planned activities and CERT reporting deficiencies. Our results could help guide the selection, design, and reporting of CGs in future ICU-based PR studies.
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Affiliation(s)
- Heather K O'Grady
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Julie C Reid
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Christopher Farley
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Quincy E B Hanna
- Physiotherapy Department, St. Joseph's Healthcare, Hamilton, ON, Canada
| | - Janelle Unger
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, ON, Canada
| | - David J Zorko
- Department of Pediatric Critical Care Medicine, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Jackie Bosch
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Lyn S Turkstra
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Michelle E Kho
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Physiotherapy Department, St. Joseph's Healthcare, Hamilton, ON, Canada
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Silay MS, 't Hoen L, Bhatt N, Quaedackers J, Bogaert G, Dogan HS, Nijman RJM, Rawashdeh Y, Stein R, Tekgul S, Radmayr C. Are there any benefits of using an inlay graft in the treatment of primary hypospadias in children? A systematic review and metanalysis. J Pediatr Urol 2021; 17:303-315. [PMID: 33691984 DOI: 10.1016/j.jpurol.2021.02.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 01/16/2021] [Accepted: 02/12/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Dorsal inlay graft urethroplasty (DIGU) has been described as an effective method for hypospadias repair with the proposed advantage of reducing the risk of complications. We aimed to systematically assess whether DIGU has any additional advantages over standard tubularized incised plate urethroplasty (TIPU) repair in children with primary hypospadias. MATERIALS AND METHODS This systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. The a priori protocol is available at the PROSPERO database (CRD42020168305). A literature search was conducted for relevant publications from 1946 until January 10, 2020 in seven different databases. Randomized controlled trials (RCTs), comparative studies (TIPU vs DIGU) and single arm case series (>20 cases) of DIGU were eligible for inclusion. Secondary hypospadias, two-stage repairs, disorders of sex development, significant curvature of >30°, and a mean or median follow-up of less than 12 months were excluded. DISCUSSION A total of 499 articles were screened and 14 studies (3 RCTs, 5 non-randomized studies (NRSs), and 6 case series) with a total of 1753 children (distal: 1334 (76%) and proximal: 419 (24%)) were found eligible. Mean follow-up of the studies was between 16 and 77 months. DIGU was found superior to TIPU in decreasing meatal/neourethral stenosis (p = 0.02, 95% CI 0.02-0.78). All other parameters were found comparable including overall complications, fistula and glans dehiscence rates. Success rates were similar among the groups ranging between 48% and 96% for DIGU and 43-96% in the TIPU group. The lack of standardization in the definition of complications and success was the major limitation of this study. CONCLUSIONS Using an inlay graft during primary hypospadias repair decreases the risk of meatal/neourethral stenosis. However, current evidence does not demonstrate superiority of DIGU over TIPU in terms of treatment success and overall complication rates.
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Affiliation(s)
- Mesrur Selcuk Silay
- Division of Pediatric Urology, Deparment of Urology, Biruni University, Istanbul, Turkey.
| | - Lisette 't Hoen
- Erasmus MC, Department of Urology, Rotterdam, the Netherlands
| | - Nikita Bhatt
- Urology Registrar, East of England Deanery, Cambridge, United Kingdom
| | - Josine Quaedackers
- Department of Urology and Pediatric Urology, University Medical Centre Groningen, University of Groningen, the Netherlands
| | - Guy Bogaert
- Department of Urology, University of Leuven, Belgium
| | - Hasan Serkan Dogan
- Division of Pediatric Urology, Department of Urology, Hacettepe University, Ankara, Turkey
| | - Rien J M Nijman
- Department of Urology and Pediatric Urology, University Medical Centre Groningen, University of Groningen, the Netherlands
| | | | - Raimund Stein
- Department of Pediatric, Adolescent and Reconstructive Urology, University of Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Serdar Tekgul
- Division of Pediatric Urology, Department of Urology, Hacettepe University, Ankara, Turkey
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Albersheim J, Smith DW, Pariser JJ, Dahm P. The reporting quality of randomized controlled trials and experimental animal studies for urethroplasty. World J Urol 2020; 39:2677-2683. [PMID: 33175208 DOI: 10.1007/s00345-020-03501-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 10/14/2020] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES To assess the reporting quality of randomized controlled trials and experimental animal studies examining urethroplasty in reconstructive urological surgery literature. METHODS We performed a comprehensive literature search to identify all urethroplasty-related RCTs examining humans as well as animal models. We used the Consolidated Standards of Reporting Trials (CONSORT) and the Animals in Research: Reporting in vivo Experiments (ARRIVE) guidelines to assess reporting quality. Two reviewers performed data abstraction independently and in duplicate. We then generated descriptive statistics including CONSORT (0-25) and ARRIVE (0-20) summary scores using the median and interquartile range. RESULTS Twenty studies were ultimately included; 14 randomized controlled trials and 6 experimental animal studies. All studies were two-armed, parallel group studies. Median sample sizes (and interquartile range) of the human and animal studies were 48.5 (31.8-53.8) and 18 (15.3-27.5), respectively. The median CONSORT and ARRIVE scores were 10.0 (8.75-12.63) and 7.97 (6.79-8.64), respectively. Human randomized controlled trials did not consistently report the method of allocation concealment (6/14; 42.9%), blinding (2/14; 14.3%), or discuss the generalizability of the results (6/14; 42.9%). Animal studies infrequently reported why a given animal model was used (1/6; 16.7%), how they were allocated to groups (0/6; 0%) or what the experimental primary and secondary outcomes were (0/6; 0%). CONCLUSIONS Urethroplasty literature is marked by a paucity of both randomized controlled trials and experimental design animal studies. The existing studies are inconsistently reported and are therefore of uncertain methodological quality.
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Affiliation(s)
- Jacob Albersheim
- Urology Section, Minneapolis VA Health Care System, 112D, One Veterans Drive, Minneapolis, MN, 55417, USA.,Department of Urology, University of Minnesota, Minneapolis, MN, USA
| | - Daniel W Smith
- Urology Section, Minneapolis VA Health Care System, 112D, One Veterans Drive, Minneapolis, MN, 55417, USA.,Department of Urology, University of Minnesota, Minneapolis, MN, USA
| | - Joseph J Pariser
- Department of Urology, University of Minnesota, Minneapolis, MN, USA
| | - Philipp Dahm
- Urology Section, Minneapolis VA Health Care System, 112D, One Veterans Drive, Minneapolis, MN, 55417, USA. .,Department of Urology, University of Minnesota, Minneapolis, MN, USA.
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Thompson E, Lai A, Morrey L, Borofsky MS, Dahm P. A Longitudinal Assessment of the Reporting Quality of Randomized Controlled Trials for Surgical Interventions to Treat Nephrolithiasis Over 16 Years (2002 to 2017). J Endourol 2020; 34:502-508. [PMID: 31984770 DOI: 10.1089/end.2019.0649] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Purpose: Transparently reported, high-quality randomized controlled trials (RCTs) play a critical role in guiding evidence based clinical practice and informing evidence-based guidelines in patients with nephrolithiasis. Prior studies have found reporting quality to be low. We performed this study to assess whether the reporting of RCTs has improved over time. Materials and Methods: This study was governed by an a priori protocol. We performed a systematic literature search for RCTs analyzing nephrolithiasis treatment. Selection of eligible studies and data abstraction were performed by two of three reviewers independently and in duplicate. We developed and pilot tested a data extraction checklist based on the Consolidated Standards of Reporting Trials (CONSORT) criteria on a scale of 0 to 25. Our primary outcome measure was the mean CONSORT score. We performed statistical hypothesis testing to compare scores between 2002-2006, 2007-2011, and 2012-2017. Results: A total of 203 studies (2002-06: 38; 2007-11: 64; 2012-17: 101) met inclusion criteria. The most common procedure types studied were percutaneous nephrolithotomy (35.1%), shockwave lithotripsy (25.4%), and ureteroscopy (22.9%). Asia contributed an increasing proportion of studies (25.6%, 44.6%, and 74.3%, respectively) in these three time periods. The main journals of publication were the Journal of Endourology (23.9%), the Journal of Urology (19.5%), and Urology (8.3%). The mean ± standard error of the CONSORT summary scores was 11.4 ± 0.4, (2002 to 2006), 12.1 ± 0.3, (2007 to 2011), and 13.3 ± 0.4 (p = 0.003) reflecting an increase by 1.92 (95% confidence interval: 0.86 - 2.98). Conclusions: The number of RCTs investigating the use of urologic devices to treat stone disease has substantially increased overtime. There has been a small improvement in reporting quality; however, this remains suboptimal overall. Increased efforts to promote the transparent reporting of RCTs in endourology are warranted.
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Affiliation(s)
- Ellen Thompson
- Department of Urology, University of Minnesota, Minneapolis, Minnesota, USA.,Urology Section, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA
| | - Andrew Lai
- Department of Urology, University of Illinois, Chicago, Illinois, USA
| | - Luke Morrey
- Department of Urology, University of Illinois, Chicago, Illinois, USA
| | - Michael S Borofsky
- Department of Urology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Philipp Dahm
- Department of Urology, University of Minnesota, Minneapolis, Minnesota, USA.,Urology Section, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA
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Zorko DJ, Reid JC, Unger J, McCaskell D, Saddik M, Choong K, Kho ME. Measurement and reporting of physical rehabilitation interventions in pediatric critical care: a scoping review. Disabil Rehabil 2020; 43:3417-3424. [PMID: 32180464 DOI: 10.1080/09638288.2020.1735538] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Purpose: To describe and evaluate physical rehabilitation research in critically ill children, including physical rehabilitation intervention reporting.Methods: We searched five electronic databases to 31 December 2018 for prospective physical rehabilitation studies conducted in pediatric intensive care units (PICU). Screening was conducted independently in duplicate. Study characteristics, outcomes, and interventions were extracted from included studies. Quality of study reporting was assessed using standardized tools. Completeness of physical rehabilitation intervention reporting was assessed using the Consensus on Exercise Reporting Template (CERT).Results: We included 20 studies enrolling a total of 2644 patients. Median (Q1,Q3) sample size was 57 (44,104). Seven studies (35%) were randomized controlled trials. Eleven studies (55%) evaluated respiratory interventions, most commonly multicomponent chest physiotherapy (73%). Nine studies (45%) evaluated physical activity interventions, most commonly progressive mobility (56%). The majority of stated outcomes (92.5%) were limited to the PICU setting. Median [Q1,Q3] quality of study reporting was good (77.2% [66.7%,87.4%]), and completeness of physical rehabilitation intervention reporting was moderate (61.9% [45.9%,71.5%]).Conclusion: Physical rehabilitation studies in critically ill children were small, and focused on evaluating respiratory-based interventions and short-term PICU-based outcomes. Reporting of physical rehabilitation interventions was suboptimal. Use of CERT may improve design and reporting in future studies.Implications for rehabilitationWhile physical rehabilitation research in critically ill children is a growing field, there are currently few studies evaluating physical rehabilitation interventions in this population.Physical rehabilitation studies to date have been small, focused on evaluating respiratory-based interventions and short-term outcomes limited to the PICU setting.The reporting of physical rehabilitation interventions in this population is suboptimal, making it challenging for clinicians to reproduce interventions and appraise their efficacy or safety.
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Affiliation(s)
- David J Zorko
- Department of Pediatrics, McMaster University, Hamilton, Canada
| | - Julie C Reid
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
| | - Janelle Unger
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | - Devin McCaskell
- Department of Physiotherapy, St. Joseph's Healthcare Hamilton, Hamilton, Canada
| | - Maisa Saddik
- Department of Surgery, McMaster University, Hamilton, Canada
| | - Karen Choong
- Department of Pediatrics, McMaster University, Hamilton, Canada.,Department of Pediatric Critical Care, McMaster University, Hamilton, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Michelle E Kho
- School of Rehabilitation Science, McMaster University, Hamilton, Canada.,Department of Physiotherapy, St. Joseph's Healthcare Hamilton, Hamilton, Canada
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Reid JC, Unger J, McCaskell D, Childerhose L, Zorko DJ, Kho ME. Physical rehabilitation interventions in the intensive care unit: a scoping review of 117 studies. J Intensive Care 2018; 6:80. [PMID: 30555705 PMCID: PMC6286501 DOI: 10.1186/s40560-018-0349-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 11/22/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Physical rehabilitation (PR) interventions in the intensive care unit (ICU) can improve patients' functional outcomes, yet systematic reviews identified discordant effects and poor reporting. We conducted a scoping review to determine the extent of ICU PR interventions and how they were reported and measured. METHODS We searched five databases from inception to December 2016 for prospective studies evaluating adult ICU PR interventions. Two independent reviewers screened titles, abstracts, and full texts for inclusion. We assessed completeness of reporting using the Consolidated Standards of Reporting Trials, Strengthening the Reporting of Observational Studies in Epidemiology, or Standards for Quality Improvement Reporting Excellence guidelines, as appropriate. For planned PR interventions, we evaluated reporting with the Consensus on Exercise Reporting Template (CERT) and assessed intervention and control groups separately. We calculated completeness of reporting scores for each study; scores represented the proportion of reported items. We compared reporting between groups using Kruskal-Wallis with Bonferroni corrections and t tests, α = 0.05. RESULTS We screened 61,774 unique citations, reviewed 1429 full-text publications, and included 117: 39 randomized trials, 30 case series, 9 two-group comparison, 14 before-after, and 25 cohort. Interventions included neuromuscular electrical stimulation (NMES) (14.5%), passive/active exercises (15.4%), cycling (6.8%), progressive mobility (32.5%), and multicomponent (29.9%). The median (first,third quartiles) study reporting score was 75.9% (62.5, 86.7) with no significant differences between reporting guidelines. Of 87 planned intervention studies, the median CERT score was 55.6%(44.7,75.0); cycling had the highest (85.0%(62.2,93.8)), and NMES and multicomponent the lowest (50.0% (39.5, 70.3) and 50.0% (41.5, 58.8), respectively) scores. Authors reported intervention groups better than controls (p < 0.001). CONCLUSIONS We identified important reporting deficiencies in ICU PR interventions, limiting clinical implementation and future trial development.
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Affiliation(s)
- Julie C. Reid
- Faculty of Health Sciences, School of Rehabilitation Science, McMaster University, Institute of Applied Health Sciences, Room 403, 1400 Main Street West, Hamilton, ON L8S 1C7 Canada
| | - Janelle Unger
- Rehabilitation Sciences Institute, University of Toronto, Rehabilitation Sciences Building, 500 University Avenue, Suite 160, Toronto, ON M5G 1V7 Canada
| | - Devin McCaskell
- Department of Physiotherapy, St. Joseph’s Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON L8N 4A6 Canada
| | - Laura Childerhose
- Faculty of Health Sciences, School of Rehabilitation Science, McMaster University, Institute of Applied Health Sciences, Room 403, 1400 Main Street West, Hamilton, ON L8S 1C7 Canada
| | - David J. Zorko
- Department of Pediatrics, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1 Canada
| | - Michelle E. Kho
- Faculty of Health Sciences, School of Rehabilitation Science, McMaster University, Institute of Applied Health Sciences, Room 403, 1400 Main Street West, Hamilton, ON L8S 1C7 Canada
- Department of Physiotherapy, St. Joseph’s Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON L8N 4A6 Canada
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