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Crites S, Neto K, Lee M, Louie K, Boone S, Fitzpatrick B, Silva D, Carvalho do Nascimento P, Bakaa N, Macedo L. Experiences and perceptions of adults pre- and/or post-lumbar spine surgery: a meta-ethnography. Disabil Rehabil 2023:1-17. [PMID: 37475154 DOI: 10.1080/09638288.2023.2233895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
STUDY DESIGN Qualitative meta-ethnography. Pre-registered with OSF:10.17605/OSF.IO/UTZE6. PURPOSE To understand the patient experience pre- and/or post-lumbar spine surgery. METHODS Literature search: A literature search was conducted in MEDLINE, EMBASE, EmCare and CINAHL from inception to October 17, 2022. Study selection criteria: Peer-reviewed qualitative or mixed-method studies of English text investigating the beliefs, perceptions, or experiences of adults (≥18 years old) pre- and/or post-lumbar spine surgery for degenerative, non-traumatic or non-infectious concerns. Data synthesis: The eMERGE meta-ethnography reporting guidelines were followed to create themes and subthemes from the original themes of the included studies. A quality appraisal was performed using the McMaster Quality Appraisal tool. RESULTS We included 18 studies and identified five themes that were separated into pre- and post-operative categories. The two pre-operative themes included [1]: the influence of physiotherapy interventions on patients' experiences, and [2] the importance of education/the power of communication, and the three post-operative themes included [1]: psychosocial coping [2], redefining oneself post-operatively, and [3] experience with the healthcare system. CONCLUSIONS These findings emphasize the complexity of the peri-operative experience for individuals undergoing lumbar spine surgery. Future research should focus on addressing psychosocial factors that may optimize patient experiences and recovery following LSS.
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Affiliation(s)
- Stephanie Crites
- Faculty of Health Sciences, School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Kajal Neto
- Faculty of Health Sciences, School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Meaghan Lee
- Faculty of Health Sciences, School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Kristen Louie
- Faculty of Health Sciences, School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Stephanie Boone
- Faculty of Health Sciences, School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Barrett Fitzpatrick
- Faculty of Health Sciences, School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Diego Silva
- Faculty of Health Sciences, School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
| | | | - Nora Bakaa
- Faculty of Health Sciences, School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Luciana Macedo
- Faculty of Health Sciences, School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
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Bakaa N, Southerst D, Côté P, Macedo L, Carlesso LC, MacDermid J, Mior S. Assessing cultural competency among Canadian chiropractors: a cross-sectional survey of Canadian Chiropractic Association members. Chiropr Man Therap 2023; 31:1. [PMID: 36635694 PMCID: PMC9835226 DOI: 10.1186/s12998-023-00474-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 01/03/2023] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND There is a paucity of research assessing cultural competency among Canadian chiropractors. Therefore, the aims of this study were to (1) measure cultural competency among Canadian chiropractors, (2) understand chiropractors' perspectives of challenges and attitudes regarding the delivery of chiropractic services to equity-seeking communities, and (3) assess contextual factors associated with cultural competency. METHODS We conducted a cross-sectional survey of members of the Canadian Chiropractic Association (CCA) (May-July 2021). The survey instrument consisted of 57 questions related to demographics, cultural competency, perceptions about health disparities, and challenges in delivery of rehabilitation. Cultural competency was measured using the Cultural Awareness and Sensitivity and Cultural Competence Behaviours subscales of the Cultural Competence Assessment Instrument. We conducted a multivariate linear regression to assess factors that may be associated with cultural competency. RESULTS A total of 3143 CCA members responded (response rate of 41%). Mean scores for the Cultural Awareness and Sensitivity subscale were 5.8/7 (95% CI 5.7; 5.8) and 4.2/7 (95% CI 4.1; 4.2) for the Cultural Competence Behaviour subscale. Most chiropractors (72-78%) reported observing important cultural health disparities across various care-related outcomes. Cost of services and language were identified as barriers to providing care to equity-seeking communities. Cultural Awareness and Sensitivity scores were weakly associated with gender (men), years of clinical practice, cultural health disparities, the statement "I think some people have an agenda to look for discrimination even where it does not exist (DEI attitudes)," race (Caucasian), and prior DEI training, (R2 = 0.15, p < 0.0001). Cultural Competence Behaviour scores were weakly associated with race (Caucasian), cultural health disparities, prior DEI training, increased years of clinical experience, and higher Cultural Awareness and Sensitivity scores (R2 = 0.19, p < 0.0001). CONCLUSION This study provides the first description of cultural competency within the chiropractic profession in Canada. Findings suggest a gap between knowledge and behaviour and uncover several barriers and challenges that may inform the development of profession-specific training in cultural competence.
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Affiliation(s)
- Nora Bakaa
- grid.25073.330000 0004 1936 8227School of Rehabilitation Sciences, McMaster University, Hamilton, Canada
| | - Danielle Southerst
- grid.266904.f0000 0000 8591 5963Institute for Disability and Rehabilitation Research, Ontario Tech University, Oshawa, Canada
| | - Pierre Côté
- grid.266904.f0000 0000 8591 5963Institute for Disability and Rehabilitation Research, Ontario Tech University, Oshawa, Canada
| | - Luciana Macedo
- grid.25073.330000 0004 1936 8227School of Rehabilitation Sciences, McMaster University, Hamilton, Canada
| | - Lisa C. Carlesso
- grid.25073.330000 0004 1936 8227School of Rehabilitation Sciences, McMaster University, Hamilton, Canada
| | - Joy MacDermid
- grid.25073.330000 0004 1936 8227School of Rehabilitation Sciences, McMaster University, Hamilton, Canada ,grid.39381.300000 0004 1936 8884School of Physical Therapy, Western University, London, Canada
| | - Silvano Mior
- Institute for Disability and Rehabilitation Research, Ontario Tech University, Oshawa, Canada. .,Division of Research and Innovation, Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, ON, M2H 3J1, Canada.
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Bakaa N, Gross DP, Carlesso LC, MacDermid J, Thomas K, Slomp F, Rushton A, Miciak M, Smeets R, Rampersaud R, Nataraj A, Drew B, Markian P, Guha D, Cenic A, Macedo L. Presurgical rehabilitation program for patients with symptomatic lumbar spinal stenosis: A pilot randomized controlled trial protocol. Can J Pain 2022. [DOI: 10.1080/24740527.2022.2137009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Affiliation(s)
- Nora Bakaa
- School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Douglas P. Gross
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Lisa C. Carlesso
- School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Joy MacDermid
- School of Physical Therapy, Western University, London, Ontario, Canada
| | - Kenneth Thomas
- Surgery and Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Florence Slomp
- Faculty of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Alison Rushton
- School of Physical Therapy, Western University, London, Ontario, Canada
| | - Maxi Miciak
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Rob Smeets
- Maastricht, the Netherlands and CIR Revalidatie, Maastricht University, Eindhoven, The Netherlands
| | - Raja Rampersaud
- Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Andrew Nataraj
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Brian Drew
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Pahuta Markian
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Daipayan Guha
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Aleks Cenic
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Luciana Macedo
- School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
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Southerst D, Bakaa N, Côté P, Macedo L, Carlesso L, MacDermid J, Mior S. Diversity of the chiropractic profession in Canada: a cross-sectional survey of Canadian Chiropractic Association members. Chiropr Man Therap 2022; 30:52. [PMID: 36494690 PMCID: PMC9733254 DOI: 10.1186/s12998-022-00463-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 11/11/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Little is known about the diversity of the chiropractic profession with respect to gender, sexual orientation, race, ethnicity and community of practice. This knowledge is important as profession representation of key equity seeking groups may impact quality of care and access for vulnerable communities. The aim of this cross-sectional survey was to explore the diversity of the chiropractic profession in Canada. METHODS All registered members of the Canadian Chiropractic Association (N = 7721) were invited to participate in a web-based survey between May and June 2021. Survey questions explored diversity with respect to personal demographics (age, sex, gender, sexual orientation, race, ethnicity, language) and practice characteristics (community setting, practice type). Where possible, survey data was compared to data from the 2016 Census of the Canadian population. RESULTS We received a total of 3143 survey responses (response rate-41%). The average age of our sample was 44.7 years (standard deviation 12.7). Forty-five percent were female with the same proportion (45.2%) self-identifying as women. Ninety-one percent of the sample self-identified as heterosexual. With respect to race, 80% of respondents were Caucasian. Seventy percent of chiropractors in our sample identified with Canadian ancestry and 29% with European ancestry. In comparison to the Canadian population, some visible minorities were underrepresented. The greatest discrepancy between the Canadian population and our sample was in the proportion of Black and Indigenous chiropractors. With respect to ethnicity, chiropractors identifying themselves with Canadian ancestry were overrepresented in our sample compared to others, specifically those with North American Indigenous and South, Central and Latin American ancestry. Sixty-one percent of chiropractors practiced in major cities and most work in interdisciplinary clinics (42% Complementary and Alternative Medicine and 33% rehabilitation). CONCLUSIONS This study provides an initial description of diversity within the chiropractic profession in Canada. Women represent less than 50% of the profession nationally. Overall, there is little racial and ethnic diversity in the chiropractic profession compared to the Canadian population, with Black and Indigenous peoples being underrepresented. Future work should focus strategies to foster the development of a more diverse chiropractic workforce.
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Affiliation(s)
- Danielle Southerst
- grid.266904.f0000 0000 8591 5963Institute for Disability and Rehabilitation Research, Ontario Tech University, Oshawa, Canada
| | - Nora Bakaa
- grid.25073.330000 0004 1936 8227School of Rehabilitation Sciences, McMaster University, Hamilton, Canada
| | - Pierre Côté
- grid.266904.f0000 0000 8591 5963Institute for Disability and Rehabilitation Research, Ontario Tech University, Oshawa, Canada
| | - Luciana Macedo
- grid.25073.330000 0004 1936 8227School of Rehabilitation Sciences, McMaster University, Hamilton, Canada
| | - Lisa Carlesso
- grid.25073.330000 0004 1936 8227School of Rehabilitation Sciences, McMaster University, Hamilton, Canada
| | - Joy MacDermid
- grid.39381.300000 0004 1936 8884School of Physical Therapy, Western University, London, Canada
| | - Silvano Mior
- Institute for Disability and Rehabilitation Research, Ontario Tech University, Oshawa, Canada. .,Division of Research, Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, ON, M2H 3J1, Canada.
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Macedo LG, Noguchi KS, de Oliveira LA, Bakaa N, Di Pelino S, Battié MC. The association between whole body vibration exposure and spine degeneration on imaging: A systematic review. J Back Musculoskelet Rehabil 2022; 35:691-700. [PMID: 34744062 DOI: 10.3233/bmr-181350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Low frequency vibrations from motorized vehicles and heavy equipment have been associated with musculoskeletal disorders. Spine degeneration on diagnostic imaging provides direct and objective measures of the possible effects of such exposures on the spine. OBJECTIVE The objective of this systematic review was to evaluate the association of exposure to whole-body vibration (WBV) with spine degeneration on imaging. METHODS We conducted electronic searches in MEDLINE, CINAHL, EMBASE, and Web of Science to July 2021. Two reviewers independently screened search results, assessed quality, and extracted data. Studies evaluating the exposure to WBV and lumbar spine degeneration on imaging were included. RESULTS Fifteen studies (16 manuscripts) were included. Seven studies including a meta-demonstrated moderate quality evidence of no association between WBV and disc degeneration. There was also moderate quality evidence of no association between WBV and disc height narrowing and osteophytes. Overall, there was low level evidence of no association between WBV and other degenerations findings. CONCLUSIONS There was moderate to low quality evidence suggesting no association between WBV exposures with spine degeneration on imaging. The results of this study currently do not support assertion that motorized vehicle and WBV exposure accelerates degeneration and causes structural damage to the spine.
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Affiliation(s)
- Luciana Gazzi Macedo
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Kenneth S Noguchi
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Lisandra A de Oliveira
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Nora Bakaa
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Stephanie Di Pelino
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Michele C Battié
- School of Physical Therapy, Faculty of Health Sciences, and Western Bone and Joint Institute, Western Ontario University, London, ON, Canada
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Noguchi KS, Nguyen L, Mehdipour A, Wiley E, Saunders S, Moncion K, Reid JC, Bakaa N, Garcia Diaz L, Van Damme J, D'Amore C, Kumurenzi A, Lu Z, Knobl E, Beauchamp MK, Macedo LG, Vrkljan B, Moll SE, Carlesso LC, Letts LJ, Kho ME, Richardson J. Undertaking Rehabilitation Research During the COVID-19 Pandemic: Emergent Strategies From a Trainee-Faculty Workshop. Front Rehabil Sci 2022; 3:881606. [PMID: 36188942 PMCID: PMC9397764 DOI: 10.3389/fresc.2022.881606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 04/20/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The COVID-19 pandemic has disrupted everyday rehabilitation research. Many academic institutions have halted in-person human research including rehabilitation sciences. Researchers are faced with several barriers to continuing their research programs. The purpose of this perspective article is to report the results of an interdisciplinary workshop aimed at understanding the challenges and corresponding strategies for conducting rehabilitation research during the COVID-19 pandemic. METHODS Twenty-five rehabilitation researchers (17 trainees and eight faculty) attended a 2-h facilitated online workshop in to discuss challenges and strategies they had experienced and employed to conduct rehabilitation research during the COVID-19 pandemic. RESULTS Rehabilitation researchers reported challenges with (1) pandemic protocol adjustments, (2) participant accessibility, and (3) knowledge dissemination, along with corresponding strategies to these challenges. Researchers experienced disruptions in study outcomes and intervention protocols to adhere to public health guidelines and have suggested implementing novel virtual approaches and study toolkits to facilitate offsite assessment. Participant accessibility could be improved by engaging community stakeholders in protocol revisions to ensure equity, safety, and feasibility. Researchers also experienced barriers to virtual conferences and publication, suggested opportunities for smaller networking events, and revisiting timeframes for knowledge dissemination. CONCLUSION This perspective article served as a catalyst for discussion among rehabilitation researchers to identify novel and creative approaches that address the complexities of conducting rehabilitation research during the COVID-19 pandemic and beyond.
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Bakaa N, Chen LH, Carlesso L, Richardson J, Shanthanna H, Macedo L. Understanding barriers and facilitators of exercise adherence after total-knee arthroplasty. Disabil Rehabil 2021; 44:6348-6355. [PMID: 34397309 DOI: 10.1080/09638288.2021.1965232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE The purpose of this qualitative study is to understand the perceived patient barriers and facilitators of post-surgical exercise adherence in patients undergoing TKA. MATERIAL AND METHODS We used an interpretive description approach. Data was gathered using semi-structured qualitative interviews. Participants were interviewed at 8 weeks post-operatively to capture physical, psychological, social and contextual changes and information. Topics that were explored included participants' experience with physical activity and exercise, motivation to perform physical activity, beliefs that exercise will reduce pain, factors that limit their ability to engage in exercise, and the importance of self-regulation in exercise adherence. RESULTS This study identified 4 themes within the WHO adherence framework: patient-related factors, condition-related factors, health care system, and social support. In particular, self-regulation, knowledge of exercise, post-operative complications, comorbidities, social support, and lack of guidance from health care providers were identified as personal and environmental characteristics that influence exercise adherence. CONCLUSION Exercise adherence is a multidimensional, interconnected construct and future research should focus on understanding the factors, particularly health care system, that impact adherence.IMPLICATIONS FOR REHABILITATIONRehabilitation therapists should aim to foster competence and confidence in post-operative rehabilitation by implementing strategies such as positive-reinforcement, goal setting, and increased education regarding the benefits of exercise.Clinical strategies to improve exercise adherence should be implemented both pre-and-post-operatively.Health care providers should clearly discuss post-operative outcomes and expectations (e.g., complications, etc.) with patients prior to surgery.
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Affiliation(s)
- Nora Bakaa
- School of Rehabilitation Sciences, Faculty of Health Sciences, Institute of Applied Health Sciences, McMaster University, Hamilton, Canada
| | - Lu Hsi Chen
- School of Rehabilitation Sciences, Faculty of Health Sciences, Institute of Applied Health Sciences, McMaster University, Hamilton, Canada
| | - Lisa Carlesso
- School of Rehabilitation Sciences, Faculty of Health Sciences, Institute of Applied Health Sciences, McMaster University, Hamilton, Canada
| | - Julie Richardson
- School of Rehabilitation Sciences, Faculty of Health Sciences, Institute of Applied Health Sciences, McMaster University, Hamilton, Canada
| | - Harsha Shanthanna
- Anesthesia, St. Joseph's Hospital, McMaster University, Hamilton, Canada
| | - Luciana Macedo
- School of Rehabilitation Sciences, Faculty of Health Sciences, Institute of Applied Health Sciences, McMaster University, Hamilton, Canada
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Bakaa N, Chen LH, Carlesso L, Richardson J, Macedo L. Reporting of post-operative rehabilitation interventions for Total knee arthroplasty: a scoping review. BMC Musculoskelet Disord 2021; 22:602. [PMID: 34193139 PMCID: PMC8247251 DOI: 10.1186/s12891-021-04460-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 06/08/2021] [Indexed: 12/17/2022] Open
Abstract
Objective The aim of this study was to evaluate the completeness of reporting of exercise adherence and exercise interventions delivered as part of clinical trials of post-operative total knee replacement (TKA) rehabilitation. Design: Scoping review Literature search A literature search was conducted in PubMed, EMBASE, AMED, CINAHL, SPORTDiscus and Cochrane Library. Study selection criteria All randomized controlled trials (RCT) that examined post-operative exercise-based interventions for total knee arthroplasty were eligible for inclusion. Studies that were multifactorial or contained exercise interventions for both hip and knee arthroplasty were also included. Data synthesis The definition, type of measurement used and outcome for exercise adherence were collected and analyzed descreptively. Quality of reporting of exercise interventions were assessed using the Consensus for Exercise Reporting Tool (CERT) and the Cochrane Risk of Bias Tool. Results There were a total of 112 RCTs included in this review. The majority of RCTs (63%, n = 71) did not report exercise adherence. Only 23% (n = 15) of studies provided a definition of adherence. RCTs were of poor quality, with 85% (n = 95) of studies having high or unclear risk of bias. Reporting of exercise interventions was poor, with only 4 items (of 19) (21%) of the CERT adequately reported (88–99%), with other items not fulfilled on at least 60% of the RCTs. There were no RCTs that had fulfilled all the criteria for the CERT. Conclusion The RCTs included in this study poorly reported exercise adherence, as well as description of the post-operative TKA rehabilitation intervention. Future RCTs should use valid and reliable measures of adherence and a proper tool for reporting of exercise interventions (e.g., CERT, TiDER). Pre-registration OSF:https://osf.io/9ku8a/ Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04460-w.
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Affiliation(s)
- Nora Bakaa
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Institute of Applied Health Sciences, Room 403, 1400 Main St. W., Hamilton, ON, L8S 1C7, Canada.
| | - Lu Hsi Chen
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Institute of Applied Health Sciences, Room 403, 1400 Main St. W., Hamilton, ON, L8S 1C7, Canada
| | - Lisa Carlesso
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Institute of Applied Health Sciences, Room 403, 1400 Main St. W., Hamilton, ON, L8S 1C7, Canada
| | - Julie Richardson
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Institute of Applied Health Sciences, Room 403, 1400 Main St. W., Hamilton, ON, L8S 1C7, Canada
| | - Luciana Macedo
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Institute of Applied Health Sciences, Room 403, 1400 Main St. W., Hamilton, ON, L8S 1C7, Canada
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