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Dupuis F, Perreault K, Hébert LJ, Perron M, Fredette A, Desmeules F, Roy JS. Group Physical Therapy Programs for Military Members With Musculoskeletal Disorders: A Pragmatic Randomized Controlled Trial. J Orthop Sports Phys Ther 2024; 54:1-10. [PMID: 38530230 DOI: 10.2519/jospt.2024.12342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
OBJECTIVE: To compare the effects of personalized, supervised group-based programs (ie, group physical therapy programs) and usual one-on-one physical therapy care (ie, usual physical therapy care) on disability for military personnel suffering from low back pain, rotator cuff-related shoulder pain, patellofemoral pain syndrome, or lateral ankle sprain. Secondary outcomes were pain severity, pain-related fear, health-related quality of life, and patients' satisfaction with their condition and care. DESIGN: Non-inferiority pragmatic randomized clinical trial. METHODS: One hundred twenty military personnel from the Canadian Armed Forces, experiencing 1 of 4 targeted musculoskeletal disorders, were consecutively recruited and randomly assigned to group physical therapy programs or usual physical therapy care. Disability, pain severity, pain-related fear, and health-related quality-of-life outcomes were measured at 6, 12, and 26 weeks after baseline. Satisfaction with treatment was evaluated at the end of the intervention. Intention-to-treat analyses using linear mixed models with random effects were used to compare the effects of interventions. Chi-square tests were used to compare satisfaction. RESULTS: There were no significant Time × Group interactions for any of the primary and secondary outcomes (Time × Group: P>.67). Satisfaction with treatment also did not differ between groups (P>.05). Statistically significant and clinically important improvements were observed in both groups for all outcomes after 12 weeks (Time effect: P<.01), except for health-related quality of life (P = .13). CONCLUSION: Group physical therapy programs were not inferior to usual physical therapy care for managing pain, functional capacity, and patients' satisfaction with care of military personnel presenting with various musculoskeletal disorders. Both interventions led to clinical and statistical improvement in pain and function in the mid and long term. Group physical therapy could be an effective strategy to enhance access to care. J Orthop Sports Phys Ther 2024;54(6):1-10. Epub 26 Mar 2024. doi:10.2519/jospt.2024.12342.
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Brochu A, Kairy D, Alos N, Laverdière C, Sinnett D, Sultan S, Curnier D, Miron MC, El-Jalbout R, Fiscaletti M, Hébert LJ. Physical impairments, activity limitations, and participation restrictions of childhood acute lymphoblastic leukemia survivors with and without hip osteonecrosis: a PETALE cohort study. J Cancer Surviv 2024:10.1007/s11764-024-01585-4. [PMID: 38787491 DOI: 10.1007/s11764-024-01585-4] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 04/02/2024] [Indexed: 05/25/2024]
Abstract
PURPOSE Long-term musculoskeletal complications represent a growing burden for survivors of childhood acute lymphoblastic leukemia (cALL). This study aimed to describe physical impairments, activity limitations, and participation restrictions in a high-risk subgroup of cALL survivors of the PETALE cohort. METHODS This cross-sectional study, using observational data from the PETALE cohort, included a subgroup of survivors who presented high-risk criteria for late effects. Outcomes measures consisted of hip magnetic resonance imaging, maximal isometric muscle strength (MIMS) or torque (MIMT), range of motion (ROM), Near Tandem Balance (NTB), 6-Minute Walk Test (6MWT), Five Time Sit-to-Stand Test (FTSST), and health-related quality of life. Descriptive statistics and regression analyses were performed. RESULTS Survivors (n = 97, 24.2 ± 6.7 years old) showed limited grip strength, FTSST, and NTB performance compared to reference values (p < 0.001). Thirteen participants (14.6%, 18 hips) had hip osteonecrosis (ON) (53.8% male). Higher severity hip ON was found in female survivors (66.7% vs. 22.2%). Survivors with hip ON had reduced hip external rotation ROM compared to those without (p < 0.05). Relationships were found between MIMS and ROM outcomes (r = 0.32, p < 0.01) and with 6MWT (r = 0.39-0.41, p < 0.001). Our multiple linear regression model explained 27.6% of the variance of the 6MWT. CONCLUSIONS Survivors in our subgroup had clinically significant physical impairments and activity limitations, and those with hip ON showed worst hip impairment outcomes. IMPLICATIONS FOR CANCER SURVIVORS These findings emphasize the importance of long-term follow-up including physical therapy assessment to help early identification and management of physical impairments and activity limitations in survivors of cALL.
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Affiliation(s)
- Annie Brochu
- CHU Sainte-Justine, Montréal, Canada.
- Université de Montréal, Montréal, Canada.
| | - Dahlia Kairy
- Université de Montréal, Montréal, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montréal, Canada
| | - Nathalie Alos
- CHU Sainte-Justine, Montréal, Canada
- Université de Montréal, Montréal, Canada
| | - Caroline Laverdière
- CHU Sainte-Justine, Montréal, Canada
- Université de Montréal, Montréal, Canada
| | - Daniel Sinnett
- CHU Sainte-Justine, Montréal, Canada
- Université de Montréal, Montréal, Canada
| | - Serge Sultan
- CHU Sainte-Justine, Montréal, Canada
- Université de Montréal, Montréal, Canada
| | - Daniel Curnier
- CHU Sainte-Justine, Montréal, Canada
- Université de Montréal, Montréal, Canada
| | - Marie-Claude Miron
- CHU Sainte-Justine, Montréal, Canada
- Université de Montréal, Montréal, Canada
| | - Ramy El-Jalbout
- CHU Sainte-Justine, Montréal, Canada
- Université de Montréal, Montréal, Canada
| | - Melissa Fiscaletti
- CHU Sainte-Justine, Montréal, Canada
- Université de Montréal, Montréal, Canada
| | - Luc J Hébert
- Université Laval, Québec, Canada
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Québec, Canada
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Meilleur-Durand M, Dubé MO, Hébert LJ, Mercier C, Léonard G, Roy JS. Conditioned pain modulation, kinesiophobia, and pain catastrophizing as prognostic factors for chronicity in a population with acute low back pain: An exploratory prospective study. Musculoskelet Sci Pract 2024; 70:102920. [PMID: 38340576 DOI: 10.1016/j.msksp.2024.102920] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 01/14/2024] [Accepted: 02/05/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Psychosocial factors and alteration of the somatosensory functions have been associated with persistent low back pain (LBP). A decreased capacity of the central nervous system to modulate pain has been suggested as a potential contributor to the persistence of pain. OBJECTIVE To investigate whether conditioned pain modulation (CPM), initial symptoms/disability, kinesiophobia, and pain catastrophizing is associated with the transition from acute to chronic LBP. DESIGN Prospective cohort study. METHOD Fifty participants presenting with acute LBP (<6 weeks) took part in three evaluation sessions (baseline, 3 and 6 months). At baseline and 3-month evaluations, all participants completed self-administered questionnaires (Oswestry Disability Index [ODI], Short Form of Brief Pain Inventory [BPI-SF], Tampa Scale of Kinesiophobia [TSK] and Pain Catastrophizing Scale [PCS]) and CPM was assessed. At the 6-month evaluation, questionnaires were readministered, and participants were dichotomized according to their status (Non-chronic LBP [NCLBP] or chronic LBP [CLBP]). Univariate tests were used to compare baseline variables between NCLBP and CLBP. RESULTS No significant baseline difference was found for TSK (p = 0.48), PCS (p = 0.78), CPM (p = 0.82), ODI (p = 0.78), BPI-SF severity (p = 0.50), and interference subscales (p = 0.54) between those categorized as NCLBP or CLBP at 6 months. CONCLUSIONS This exploratory study failed to support the hypothesis that inefficient CPM mechanisms and the presence of psychological factors could be factors associated with the transition to chronic pain in individuals with acute LBP.
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Affiliation(s)
- Melody Meilleur-Durand
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec, Quebec, Canada; Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec, Quebec, Canada.
| | - Marc-Olivier Dubé
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec, Quebec, Canada; Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec, Quebec, Canada; La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia.
| | - Luc J Hébert
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec, Quebec, Canada; Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec, Quebec, Canada; Department of Radiology and Nuclear Medicine, Faculty of Medicine, Université Laval, Quebec, Quebec, Canada.
| | - Catherine Mercier
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec, Quebec, Canada; Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec, Quebec, Canada.
| | - Guillaume Léonard
- Research Center on Aging, CIUSSS de l'Estrie-CHUS, Sherbrooke, Quebec, Canada; Faculty of Medicine and Health Sciences, School of Rehabilitation, Université de Sherbrooke, Sherbrooke, Quebec, Canada.
| | - Jean-Sébastien Roy
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec, Quebec, Canada; Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec, Quebec, Canada.
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Lessard I, Côté I, St-Gelais R, Hébert LJ, Brais B, Mathieu J, Rodrigue X, Gagnon C. Natural History of Autosomal Recessive Spastic Ataxia of Charlevoix-Saguenay: a 4-Year Longitudinal Study. Cerebellum 2024; 23:489-501. [PMID: 37101017 DOI: 10.1007/s12311-023-01558-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/18/2023] [Indexed: 04/28/2023]
Abstract
Autosomal recessive spastic ataxia of Charlevoix-Saguenay (ARSACS) is a neurologic disorder with generally well-known clinical manifestations. However, few studies assessed their progression rate using a longitudinal design. This study aimed to document the natural history of ARSACS over a 4-year period in terms of upper and lower limb functions, balance, walking capacity, performance in daily living activities, and disease severity. Forty participants were assessed on three occasions over 4 years. Participant performance was reported in raw data as well as in percentage from reference values to consider the normal aging process. Severe balance and walking capacity impairments were found, with a significant performance decrease over the 4 years. Balance reached a floor score of around 6 points on the Berg Balance Scale for participants aged >40 years, while other participants lost about 1.5 points per year. The mean loss in walking speed was 0.044 m/s per year and the mean decrease in the distance walked in 6 min was 20.8 m per year for the whole cohort. Pinch strength, balance, walking speed, and walking distance decreased over time even when reported in percentage from reference values. Major impairments and rapid progression rates were documented in the present study for upper limb coordination, pinch strength, balance, and walking capacity in the ARSACS population. A progression rate beyond the normal aging process was observed. These results provide fundamental insights regarding the disease prognosis that will help to better inform patients, develop specific rehabilitation programs, and improve trial readiness.
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Affiliation(s)
- Isabelle Lessard
- Groupe de recherche interdisciplinaire sur les maladies neuromusculaires (GRIMN), Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean, Québec, Canada
| | - Isabelle Côté
- Groupe de recherche interdisciplinaire sur les maladies neuromusculaires (GRIMN), Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean, Québec, Canada
| | - Raphaël St-Gelais
- Groupe de recherche interdisciplinaire sur les maladies neuromusculaires (GRIMN), Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean, Québec, Canada
| | - Luc J Hébert
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (CIRRIS), Institut de réadaptation en déficience physique de Québec, Québec, Canada
- Départements de réadaptation et de radiologie et médecine nucléaire, Faculté de médecine, Université Laval, Québec, Canada
| | - Bernard Brais
- Neurological Institute, McGill University, Quebec, Canada
| | - Jean Mathieu
- Groupe de recherche interdisciplinaire sur les maladies neuromusculaires (GRIMN), Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean, Québec, Canada
| | - Xavier Rodrigue
- Institut de réadaptation en déficience physique de Québec, Québec, Canada
| | - Cynthia Gagnon
- Groupe de recherche interdisciplinaire sur les maladies neuromusculaires (GRIMN), Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean, Québec, Canada.
- Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Québec, Canada.
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Lessard I, Hébert LJ, St-Gelais R, Côté I, Mathieu J, Brais B, Gagnon C. Toward a Better Understanding of Walking Speed in Ataxia of Charlevoix-Saguenay: a Factor Exploratory Study. Cerebellum 2023:10.1007/s12311-023-01646-x. [PMID: 38133849 DOI: 10.1007/s12311-023-01646-x] [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] [Subscribe] [Scholar Register] [Accepted: 12/02/2023] [Indexed: 12/23/2023]
Abstract
Mobility limitations, including a decrease in walking speed, are major issues for people with autosomal recessive spastic ataxia of Charlevoix-Saguenay (ARSACS). Improving our understanding of factors influencing walking speed in ARSACS may inform the development of future interventions for gait rehabilitation and contribute to better clinical practices. The objective of the study was to identify the factors influencing the self-selected walking speed in adults with ARSACS. The dependent variable of this cross-sectional study was the self-selected speed and the factors (independent variables) were age, sex, balance, balance confidence, knee flexion and extension cocontraction indexes, lower limb coordination, passive range of motion of ankle dorsiflexion, knee and hip extension, and global spasticity. Multiple regression models were used to assess the relationships between walking speed and each factor individually. Six factors were significantly associated with walking speed and thus included in regression models. The models explained between 42.4 and 66.5% of the total variance of the self-selected walking speed. The factors that most influence self-selected walking speed are balance and lower limb coordination. In order of importance, the other factors that also significantly influence self-selected walking speed are ankle dorsiflexion range of motion, lower limb spasticity, knee extension range of motion, and confidence in balance. Balance and lower limb coordination should be targeted in rehabilitation interventions to maintain walking ability and functional independence as long as possible. The six factors identified should also be included in future studies to deepen our understanding of walking speed.
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Affiliation(s)
- Isabelle Lessard
- Centre ÉCOBES-Recherche et Transfert, Cégep de Jonquière, Québec, Canada
- Groupe de recherche interdisciplinaire sur les maladies neuromusculaires (GRIMN), Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean, Québec, Canada
| | - Luc J Hébert
- Groupe de recherche interdisciplinaire sur les maladies neuromusculaires (GRIMN), Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean, Québec, Canada
- Départements de réadaptation et de radiologie, Faculté de médecine, Université Laval, Québec, Canada
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (CIRRIS), Institut de réadaptation en déficience physique de Québec, Québec, Canada
| | - Raphaël St-Gelais
- Centre de recherche du Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean, Quebec, Canada
| | - Isabelle Côté
- Groupe de recherche interdisciplinaire sur les maladies neuromusculaires (GRIMN), Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean, Québec, Canada
| | - Jean Mathieu
- Groupe de recherche interdisciplinaire sur les maladies neuromusculaires (GRIMN), Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean, Québec, Canada
- Centre de recherche du Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean, Quebec, Canada
| | - Bernard Brais
- Montreal Neurological Institute and Hospital, McGill University, Quebec, Canada
| | - Cynthia Gagnon
- Groupe de recherche interdisciplinaire sur les maladies neuromusculaires (GRIMN), Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean, Québec, Canada.
- Centre de recherche du Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean, Quebec, Canada.
- Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Québec, Canada.
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Perron M, Brosseau R, Maltais DB, Piette V, Godbout A, Corriveau H, Hébert LJ. A proposal for a universal physical therapy diagnostic concept. Braz J Phys Ther 2023; 27:100560. [PMID: 37979247 PMCID: PMC10692659 DOI: 10.1016/j.bjpt.2023.100560] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 03/25/2023] [Accepted: 10/25/2023] [Indexed: 11/20/2023] Open
Abstract
BACKGROUND In Canada, as in other countries, the physical therapist (PT) must make a diagnosis to comply with direct access responsibilities. This means making a diagnosis is an entry-to-practice essential competency. However, there is no consensus across physical therapy practice domains and contexts regarding the diagnostic concept, i.e., the classification system, labelling and diagnostic format that should be used. OBJECTIVE To propose a universal diagnostic concept, one a PT could use regardless of their practice domain or context. METHODS The relevant scientific and grey literature (1986-2022) were searched and key information was synthesized. RESULTS Information from 194 retained documents (8506 identified) was synthesized to a list of seven essential criteria that were then used to develop a universal physical therapy diagnostic concept (PT-Dx-C). The PT-Dx-C format consists of three labels in the following order: (1) health problem, (2) primary impairment, and (3) primary activity limitation or participation restriction. Label definitions are those used by the World Health Organization. The specific health problem, impairment, and limitation or restriction making up the diagnosis are determined for each patient using valid tests and measures. CONCLUSIONS The PT-Dx-C is consistent with best practices and could be applied to all patients, in all PT practice domains and contexts. It reflects the PT's expertise in the human movement system and their unique contribution to health care. Furthermore, its use may allow for communication of the PT's conclusions in a manner that can be understood by others thereby facilitating collaborative practice.
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Affiliation(s)
- Marc Perron
- École des sciences de la réadaptation, Université Laval, Quebec City, Canada.
| | - Rachel Brosseau
- École de réadaptation, Université de Montréal, Montreal, Canada; Institut de Cardiologie de Montréal, Montreal, Canada
| | - Désirée B Maltais
- École des sciences de la réadaptation, Université Laval, Quebec City, Canada; Centre interdisciplinaire de recherche en réadaptation et intégration sociale (CIRRIS), Quebec City, Canada
| | - Vincent Piette
- École des sciences de la réadaptation, Université Laval, Quebec City, Canada; Centre Hospitalier Universitaire de Québec, CHUL, Quebec City, Canada
| | - Alain Godbout
- Institut de réadaptation Gingras-Lindsay de Montréal, Montreal, Canada
| | - Hélène Corriveau
- École de réadaptation, Université de Sherbrooke, Sherbrooke, Canada; Centre de recherche sur le vieillissement du Centre intégré universitaire de santé et services sociaux de l'Estrie - Centre hospitalier universitaire de Sherbrooke (CIUSSS de l'Estrie - CHUS), Sherbrooke, Canada
| | - Luc J Hébert
- École des sciences de la réadaptation, Université Laval, Quebec City, Canada; Centre interdisciplinaire de recherche en réadaptation et intégration sociale (CIRRIS), Quebec City, Canada; Département de radiologie et de médecine nucléaire, Université Laval, Quebec City, Canada
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Gagnon R, Hébert LJ, Guertin JR, Berthelot S, Desmeules F, Perreault K. Integration of primary contact physiotherapists in the emergency department for individuals presenting with minor musculoskeletal disorders: Protocol for an economic evaluation. PLoS One 2023; 18:e0277369. [PMID: 37708179 PMCID: PMC10501643 DOI: 10.1371/journal.pone.0277369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 08/08/2023] [Indexed: 09/16/2023] Open
Abstract
OBJECTIVES 1) To compare the average cost of an emergency department (ED) visit for various minor musculoskeletal disorders between two models of care (physiotherapist and ED physician or ED physician alone); 2) To evaluate the incremental cost-effectiveness ratio (ICER) of these two models of care over a 3-month period post-initial visit; and 3) To estimate the ICER of three ED models of care (physiotherapist and ED physician, ED physician alone, physiotherapist alone) over a two-year period. METHODS Obj.1: The costs incurred by participants in the two groups during their ED visit will be calculated using the Time-Driven Activity-Based Costing (TDABC) method. These costs will be compared using generalized linear models. Obj. 2: The ICER of the two models will be evaluated over three months via a cost-utility analysis that will combine costs and effectiveness data (quality-adjusted life years) using both Health system and Societal perspectives (patient + health system costs). Obj. 3: The 2-year ICER of the three above-mentioned models will be estimated using a mathematical model including a decision tree (0-3 months post-visit) and a Markov model (3-24 months post-visit), also using both Health system and Societal perspectives. Data to answer the three objectives will come from data collected during a randomized clinical trial (n = 78, CHU de Québec)which will be supplemented with data obtained via some of the CHU de Québec administrative databases (nominative data; SIURGE (ED management software), Cristal-Net (patient electronic record), and the ED's pharmacy transactions directory; administrative data: drug costs repository), the literature, and public cost repositories. CONCLUSION This study will help to determine which model of care is most efficient for the management of individuals who come to the ED with minor musculoskeletal disorders. The increased involvement of various health professionals in the management of patients in the ED paves the way for the development of new avenues of practice and more efficient organization of services.
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Affiliation(s)
- Rose Gagnon
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Quebec, Quebec, Canada
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec, Quebec, Canada
| | - Luc J. Hébert
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Quebec, Quebec, Canada
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec, Quebec, Canada
- Department of Radiology and Nuclear Medicine, Faculty of Medicine, Université Laval, Quebec, Quebec, Canada
| | - Jason R. Guertin
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec, Quebec, Canada
- Axe Santé des Populations et Pratiques Optimales en Santé, Centre de Recherche du Centre Hospitalier Universitaire de Québec, Université Laval, Quebec, Quebec, Canada
| | - Simon Berthelot
- Axe Santé des Populations et Pratiques Optimales en Santé, Centre de Recherche du Centre Hospitalier Universitaire de Québec, Université Laval, Quebec, Quebec, Canada
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, Quebec, Canada
- Centre Hospitalier Universitaire de Québec, Université Laval, Quebec, Quebec, Canada
| | - François Desmeules
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
- Orthopaedic Clinical Research Unit, Maisonneuve-Rosemont Hospital Research Centre, Centre Intégré Universitaire de Santé et de Services Sociaux de l’Est-de-l’Île-de-Montréal, Montreal, Quebec, Canada
| | - Kadija Perreault
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Quebec, Quebec, Canada
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec, Quebec, Canada
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Ager AL, Roy JS, Hébert LJ, Roos M, Borms D, Cools AM. Measuring upper limb active joint position sense: Introducing a new clinical tool - The Upper Limb Proprioception Reaching Test. Musculoskelet Sci Pract 2023; 66:102829. [PMID: 37473497 DOI: 10.1016/j.msksp.2023.102829] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 07/12/2023] [Accepted: 07/12/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND Proprioception is our sense of body awareness, including the sub-category of active joint position sense (AJPS). AJPS is fundamental to joint stability and movement coordination. Despite its importance, there remain few confident ways to measure upper limb AJPS in a clinic. OBJECTIVE To assess a new AJPS clinical tool, the Upper Limb Proprioception Reaching Test (PRO-Reach; seven targets), for discriminant validity, intra-rater and absolute reliability. DESIGN Cross-sectional measurement study. METHODS Seventy-five healthy participants took part in a single session with 2 consecutive evaluations (E1 and E2) (within-day reliability). Twenty participants were randomly selected to perform a dominant shoulder fatigue protocol (discriminant validity), whereafter a third evaluation was repeated (E3). The PRO-Reach was analyzed with paired t tests (discriminant validity), intra-class correlation coefficients (ICCs) and minimal detectable change [MDC]) (intra-rater: within-day and between-trial relative and absolute reliability). RESULTS The PRO-Reach supports moderate (mostly superior targets) to excellent (mostly inferior targets) reliability. Between-trial ICCs (T1/T2/T3) varied between 0.72 and 0.90, and within-day (E1/E2) ICCs between 0.45 and 0.72, with associated MDC95 values (3.9-5.0 cm). The overall scores (seven targets) supported the strongest within-day reliability (ICC = 0.77). The inferior targets demonstrated the highest between-trial and within-day reliability (ICCs = 0.90 and 0.72). A fatigue effect was found with the superior and superior-lateral targets (P < .05). CONCLUSIONS The inferior targets and overall scores demonstrate the strongest reliability. The use of the PRO-Reach tool may be suitable for clinical use upon further psychometric testing amongst pathological populations. LEVEL OF EVIDENCE Level III cross-sectional study.
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Affiliation(s)
- Amanda L Ager
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Rehabilitation Institute (Cirris), Québec City, Québec, Canada; Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
| | - Jean-Sébastien Roy
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Rehabilitation Institute (Cirris), Québec City, Québec, Canada; Department of Rehabilitation, Faculty of Medicine, Université Laval, Québec City, Canada
| | - Luc J Hébert
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Rehabilitation Institute (Cirris), Québec City, Québec, Canada; Departments of Rehabilitation and Radiology/Nuclear Medicine, Faculty of Medicine, Université Laval, Québec, Canada
| | - Marianne Roos
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Rehabilitation Institute (Cirris), Québec City, Québec, Canada; Department of Rehabilitation, Faculty of Medicine, Université Laval, Québec City, Canada
| | - Dorien Borms
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Ann M Cools
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
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Morin M, Hébert LJ, Perron M, Petitclerc É, Lake SR, Duchesne E. Psychometric properties of a standardized protocol of muscle strength assessment by hand-held dynamometry in healthy adults: a reliability study. BMC Musculoskelet Disord 2023; 24:294. [PMID: 37060020 PMCID: PMC10103411 DOI: 10.1186/s12891-023-06400-2] [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] [Received: 12/05/2022] [Accepted: 04/04/2023] [Indexed: 04/16/2023] Open
Abstract
BACKGROUND Maximal isometric muscle strength (MIMS) assessment is a key component of physiotherapists' work. Hand-held dynamometry (HHD) is a simple and quick method to obtain quantified MIMS values that have been shown to be valid, reliable, and more responsive than manual muscle testing. However, the lack of MIMS reference values for several muscle groups in healthy adults with well-known psychometric properties limits the use and the interpretation of these measures obtained with HHD in clinic. OBJECTIVE To determine the intra- and inter-rater reliability, standard error of measurement (SEM) and minimal detectable change (MDC) of MIMS torque values obtained with HHD. METHODS Intra and Inter-rater Reliability Study. The MIMS torque of 17 muscle groups was assessed by two independent raters at three different times in 30 healthy adults using a standardized HHD protocol using the MEDup™ (Atlas Medic, Québec, Canada). Participants were excluded if they presented any of the following criteria: 1) participation in sport at a competitive level; 2) degenerative or neuromusculoskeletal disease that could affect torque measurements; 3) traumatic experience or disease in the previous years that could affect their muscle function; and 4) use of medication that could impact muscle strength (e.g., muscle relaxants, analgesics, opioids) at the time of the evaluation. Intra- and inter-rater reliability were determined using two-way mixed (intra) and random effects (inter) absolute agreement intraclass correlation coefficients (ICC: 95% confidence interval) models. SEM and MDC were calculated from these data. RESULTS Intra- and inter-rater reliability were excellent with ICC (95% confidence interval) varying from 0.90 to 0.99 (0.85-0.99) and 0.89 to 0.99 (0.55-0.995), respectively. Absolute SEM and MDC for intra-rater reliability ranged from 0.14 to 3.20 Nm and 0.38 to 8.87 Nm, respectively, and from 0.17 to 5.80 Nm and 0.47 to 16.06 Nm for inter-rater reliability, respectively. CONCLUSIONS The excellent reliability obtained in this study suggest that the use of such a standardized HHD protocol is a method of choice for MIMS torque measurements in both clinical and research settings. And the identification of the now known metrological qualities of such a protocol should encourage and promote the optimal use of manual dynamometry.
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Affiliation(s)
- Marika Morin
- Department of Health Sciences, Université du Québec à Chicoutimi, 555 Bd de l'Université, Chicoutimi, QC, G7H 2B1, Canada
| | - Luc J Hébert
- Department of Rehabilitation, and Department of Radiology and Nuclear Medicine, Faculty of Medicine, Université Laval, Quebec City, QC, Canada
- Interdisciplinary Research Group On Neuromuscular Diseases (GRIMN), Integrated University Center of Health and Social Services of Saguenay-Lac-St-Jean, Jonquiere, Canada
- Interdisciplinary Research Centre for Rehabilitation and Social Integration (CIRRIS), Integrated University Center of Health and Social Services of the Capitale-Nationale, Quebec City, QC, Canada
| | - Marc Perron
- Department of Rehabilitation, and Department of Radiology and Nuclear Medicine, Faculty of Medicine, Université Laval, Quebec City, QC, Canada
| | - Émilie Petitclerc
- Interdisciplinary Research Centre for Rehabilitation and Social Integration (CIRRIS), Integrated University Center of Health and Social Services of the Capitale-Nationale, Quebec City, QC, Canada
| | - Shanna-Rose Lake
- Interdisciplinary Research Centre for Rehabilitation and Social Integration (CIRRIS), Integrated University Center of Health and Social Services of the Capitale-Nationale, Quebec City, QC, Canada
| | - Elise Duchesne
- Department of Health Sciences, Université du Québec à Chicoutimi, 555 Bd de l'Université, Chicoutimi, QC, G7H 2B1, Canada.
- Interdisciplinary Research Group On Neuromuscular Diseases (GRIMN), Integrated University Center of Health and Social Services of Saguenay-Lac-St-Jean, Jonquiere, Canada.
- Intersectoral Center for Sustainable Health, Université du Québec À Chicoutimi, Chicoutimi, QC, Canada.
- Research Center of Charles-Le Moyne (CRCLM), Sherbrooke, QC, Canada.
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Gagnon R, Hébert LJ, Guertin JR, Berthelot S, Desmeules F, Perreault K. L’évaluation économique en physiothérapie ou comment en avoir pour son argent. Physiother Can 2022. [DOI: 10.3138/ptc-2022-0079] [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: 12/15/2022]
Affiliation(s)
- Rose Gagnon
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (Cirris), Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale
- Faculté de médecine, Université Laval
| | - Luc J. Hébert
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (Cirris), Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale
- Faculté de médecine, Université Laval
| | - Jason R. Guertin
- Faculté de médecine, Université Laval
- Axe santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec – Université Laval
| | - Simon Berthelot
- Faculté de médecine, Université Laval
- Axe santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec – Université Laval
- CHU de Québec – Université Laval
| | | | - Kadija Perreault
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (Cirris), Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale
- Faculté de médecine, Université Laval
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11
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Gallais B, Roussel MP, Laberge L, Hébert LJ, Duchesne E. Impact of a 12-week strength training program on fatigue, daytime sleepiness, and apathy in men with myotonic dystrophy type 1. J Neuromuscul Dis 2022; 9:629-639. [DOI: 10.3233/jnd-221503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Myotonic dystrophy type 1 (DM1) is a multisystemic neuromuscular disorder causing a plea of impairments, of which fatigue and apathy are some of the most frequent non-muscular symptoms. No curative treatment exists to date, and patients only have access to limited effective care, which are intended to decrease the burden of specific symptoms in daily life. Objective: This study aimed to assess whether a 12-week strength-training program has an impact on fatigue/daytime sleepiness, apathy, and patient-reported health in men with DM1. Methods: Eleven participants completed the Fatigue and Daytime Sleepiness Scale (FDSS) and the Myotonic Dystrophy Health Index (MDHI) at baseline, at 6 and 12 weeks, and 6 and 9 months. Also, the Apathy Evaluation Scale (AES) was filled out at baseline, at 12 weeks, and 6 and 9 months. Results: Results show significant effects of the training program both on apathy and fatigue/daytime sleepiness, effects that are respectively greater at three and six months after the end of the program than at its very end. However, no difference was observed regarding the overall disease burden. Conclusion: These findings are promising for patients with DM1 considering that few non-pharmacological treatments are available.
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Affiliation(s)
- Benjamin Gallais
- ÉCOBES – Recherche et transfert, Cégep de Jonquière, Saguenay, Québec, Canada
- Groupe de recherche interdisciplinaire sur lesmaladies neuromusculaires (GRIMN), Centre intégréuniversitaire de santé et de services sociaux duSaguenay–Lac-St-Jean, Saguenay, Québec, Canada
- Centre de recherche Charles-Le Moyne – Saguenay–Lac-Saint-Jean sur les innovations en santé(CR-CSIS), Faculté de médecine et des sciences de lasanté de l’Université de Sherbrooke, Site Saguenay, Saguenay, Québec, Canada
| | - Marie-Pier Roussel
- Groupe de recherche interdisciplinaire sur lesmaladies neuromusculaires (GRIMN), Centre intégréuniversitaire de santé et de services sociaux duSaguenay–Lac-St-Jean, Saguenay, Québec, Canada
- Centre de recherche Charles-Le Moyne – Saguenay–Lac-Saint-Jean sur les innovations en santé(CR-CSIS), Faculté de médecine et des sciences de lasanté de l’Université de Sherbrooke, Site Saguenay, Saguenay, Québec, Canada
- Département dessciences fondamentales, Université du Québec à Chicoutimi, Saguenay, Québec, Canada
| | - Luc Laberge
- ÉCOBES – Recherche et transfert, Cégep de Jonquière, Saguenay, Québec, Canada
- Groupe de recherche interdisciplinaire sur lesmaladies neuromusculaires (GRIMN), Centre intégréuniversitaire de santé et de services sociaux duSaguenay–Lac-St-Jean, Saguenay, Québec, Canada
- Centre de recherche Charles-Le Moyne – Saguenay–Lac-Saint-Jean sur les innovations en santé(CR-CSIS), Faculté de médecine et des sciences de lasanté de l’Université de Sherbrooke, Site Saguenay, Saguenay, Québec, Canada
| | - Luc J. Hébert
- Groupe de recherche interdisciplinaire sur lesmaladies neuromusculaires (GRIMN), Centre intégréuniversitaire de santé et de services sociaux duSaguenay–Lac-St-Jean, Saguenay, Québec, Canada
- Centreinterdisciplinaire de recherche en réadaptation etintégration sociale (CIRRIS), Québec, Québec, Canada
- Départements de réadaptation et deradiologie et médecine nucléaire, Faculté demédecine, Université Laval, Québec, Québec, Canada
| | - Elise Duchesne
- Groupe de recherche interdisciplinaire sur lesmaladies neuromusculaires (GRIMN), Centre intégréuniversitaire de santé et de services sociaux duSaguenay–Lac-St-Jean, Saguenay, Québec, Canada
- Centre de recherche Charles-Le Moyne – Saguenay–Lac-Saint-Jean sur les innovations en santé(CR-CSIS), Faculté de médecine et des sciences de lasanté de l’Université de Sherbrooke, Site Saguenay, Saguenay, Québec, Canada
- Unité d’enseignement en physiothérapie, département des sciences de la santé, Université duQuébec à Chicoutimi, Saguenay, Québec, Canada
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12
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Dupuis F, Perreault K, Hébert LJ, Perron M, Fredette MA, Desmeules F, Roy JS. Group-based exercice training programs for military members presenting musculoskeletal disorders - protocol for a pragmatic randomized controlled trial. BMC Musculoskelet Disord 2022; 23:366. [PMID: 35436907 PMCID: PMC9016952 DOI: 10.1186/s12891-022-05317-6] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 04/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Musculoskeletal disorders are a leading cause of morbidity and the most prevalent source of disability among soldiers. Their high prevalence in armed forces and limited ressources have led to problems related to access to physical rehabilitation care. To increase access, supervised group-based exercise programs for the most prevalent musculoskeletal disorders (low back pain, patellofemoral pain, rotator cuff-related shoulder pain or lateral ankle sprain) have been developed at a Canadian Armed forces (CAF) base, but their effectiveness has not been evaluated. The primary objective of this randomized controlled trial is to evaluate the mid- and long-term effects of these group-based training programs on pain severity and functional limitations, in comparison with usual individual physiotherapy care. Secondary objectives include comparing both interventions in terms of health-related quality of life, pain-related fear, and patients' satisfaction. METHODS One hundred and twenty soldiers with a new medical referral for physiotherapy services for one of the four targeted musculoskeletal disorders will be consecutively recruited. They will be randomly assigned to either group-based training program or usual individual physiotherapy care, and will take part in the assigned 12-week intervention. There will be four evaluation sessions over 26 weeks (baseline, week 6, 12 and 26). At each follow-up, functional limitations, pain severity, health-related quality of life and pain-related fears will be assessed. Patients satisfaction with treatment will also be evaluated at the end of the intervention period. Either two-way repeated measures ANOVA will be used to analyse and compare the effects of the interventions. DISCUSSION This RCT will determine the effectiveness of group-based training programs compared to usual individual physiotherapy care. This new intervention model could represent an efficient, and more pro-active approach to manage a higher number of soldiers with musculoskeletal disorders. It could improve access to physical rehabilitation care and improve the health of soldiers. TRIAL REGISTRATION ClinicalTrials.gov ( NCT05235152 ), February 11th 2022.
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Affiliation(s)
- F Dupuis
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Québec, Canada
- Département de réadaptation, Faculté de médecine, Université Laval, Québec, Canada
| | - K Perreault
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Québec, Canada
- Département de réadaptation, Faculté de médecine, Université Laval, Québec, Canada
| | - L J Hébert
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Québec, Canada
- Département de réadaptation, Faculté de médecine, Université Laval, Québec, Canada
- Département de radiologie et médecine nucléaire, Faculté de médecine, Université Laval, Québec, Canada
- Canadian Armed Forces, BFC USS Valcartier, Québec, Canada
| | - M Perron
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Québec, Canada
- Département de réadaptation, Faculté de médecine, Université Laval, Québec, Canada
| | - Maj A Fredette
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Québec, Canada
- Département de réadaptation, Faculté de médecine, Université Laval, Québec, Canada
- Canadian Armed Forces, BFC USS Valcartier, Québec, Canada
| | - F Desmeules
- École de réadaptation, Faculté de médecine, Université de Montréal, Montréal, Canada
- Centre de recherche de l'Hôpital Maisonneuve-Rosemont (CRHMR), Montréal, Canada
| | - J S Roy
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Québec, Canada.
- Département de réadaptation, Faculté de médecine, Université Laval, Québec, Canada.
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13
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Dupuis F, Déry J, Lucas de Oliveira FC, Pecora AT, Gagnon R, Harding K, Camden C, Roy JS, Lettre J, Hudon A, Beauséjour M, Pinard AM, Bath B, Deslauriers S, Lamontagne MÈ, Feldman D, Routhier F, Desmeules F, Hébert LJ, Miller J, Ruiz A, Perreault K. Strategies to reduce waiting times in outpatient rehabilitation services for adults with physical disabilities: A systematic literature review. J Health Serv Res Policy 2022; 27:157-167. [DOI: 10.1177/13558196211065707] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective Identifying effective strategies to reduce waiting times is a crucial issue in many areas of health services. Long waiting times for rehabilitation services have been associated with numerous adverse effects in people with disabilities. The main objective of this study was to conduct a systematic literature review to assess the effectiveness of service redesign strategies to reduce waiting times in outpatient rehabilitation services for adults with physical disabilities. Methods We conducted a systematic review, searching three databases (MEDLINE, CINAHL and EMBASE) from their inception until May 2021. We identified studies with comparative data evaluating the effect of rehabilitation services redesign strategies on reducing waiting times. The Mixed Methods Appraisal Tool was used to assess the methodological quality of the studies. A narrative synthesis was conducted. Results Nineteen articles including various settings and populations met the selection criteria. They covered physiotherapy ( n = 11), occupational therapy ( n = 2), prosthetics ( n = 1), exercise physiology ( n = 1) and multidisciplinary ( n = 4) services. The methodological quality varied ( n = 10 high quality, n = 6 medium, n = 3 low); common flaws being missing information on the pre-redesign setting and characteristics of the populations. Seven articles assessed access processes or referral management strategies (e.g. self-referral), four focused on extending/modifying the roles of service providers (e.g. to triage) and eight changed the model of care delivery (e.g. mode of intervention). The different redesign strategies had positive effects on waiting times in outpatient rehabilitation services. Conclusions This review highlights the positive effects of many service redesign strategies. These findings suggest that there are several effective strategies to choose from to reduce waiting times and help better respond to the needs of persons experiencing physical disabilities.
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Affiliation(s)
- Frédérique Dupuis
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale, Québec, Canada
| | - Julien Déry
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale, Québec, Canada
| | - Fabio Carlos Lucas de Oliveira
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale, Québec, Canada
| | - Ana Tereza Pecora
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale, Québec, Canada
| | - Rose Gagnon
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale, Québec, Canada
| | - Katherine Harding
- Allied Health Clinical Research Office, Eastern Health, Victoria, Australia
| | - Chantal Camden
- École de réadaptation, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Jean-Sébastien Roy
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale, Québec, Canada
| | - Josiane Lettre
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale, Québec, Canada
| | - Anne Hudon
- École de Réadaptation, Université de Montréal, Montreal, QC, Canada
| | - Marie Beauséjour
- Département des Sciences de la santé communautaire, Université de Sherbrooke, Longueuil, QC, Canada
| | - Anne-Marie Pinard
- Département D’anesthésiologie et de Soins Intensifs, Faculté de Médecine, Université Laval, Québec, QC, Canada
| | - Brenna Bath
- School of Rehabilitation Science, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Simon Deslauriers
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale, Québec, Canada
| | - Marie-Ève Lamontagne
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale, Québec, Canada
| | - Debbie Feldman
- École de Réadaptation, Université de Montréal, Montreal, QC, Canada
| | - François Routhier
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale, Québec, Canada
| | | | - Luc J. Hébert
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale, Québec, Canada
| | - Jordan Miller
- School of Rehabilitation Therapy, Physical Therapy Program, Queen’s University, Kingston, ON, Canada
| | - Angel Ruiz
- Département d’opérations et systèmes de décision, Faculté des sciences de l’administration, Université Laval, Québec, QC, Canada
| | - Kadija Perreault
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale, Québec, Canada
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Gagnon R, Perreault K, Guertin JR, Berthelot S, Achou B, Hébert LJ. Health-Related Quality of Life of Patients Presenting to the Emergency Department with a Musculoskeletal Disorder. CEOR 2022; 14:91-103. [PMID: 35221700 PMCID: PMC8865860 DOI: 10.2147/ceor.s348138] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 01/27/2022] [Indexed: 11/23/2022] Open
Abstract
Background Musculoskeletal disorders (MSKDs) are among the most disabling and costly non-fatal health conditions. They may lead to long-term consequences such as chronic pain, physical limitations, and poorer quality of life. They also account for a significant proportion of emergency department visits, representing between 18% and 25% of all visits, depending on country. Purpose To assess the health-related quality of life of patients presenting to the emergency department with a MSKD, to convert their answers to utility scores and to explore the association between diverse socio-demographic and clinical variables and patients’ health-related quality of life. Patients and Methods This is an analysis of cross-sectional data obtained during the baseline assessment performed as part of a 6-month pragmatic randomized controlled trial conducted in an academic emergency department. We included patients aged 18–80 years with a minor MSKD. The main outcome measures were health-related quality of life (five dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression) and utility scores (−0.148 – worse than death, 0 – dead, 0.949 – perfect health) measured with the EQ-5D-5L. Possible associations were explored by comparing scores across subgroups based on certain socio-demographic (eg, age, gender, triage score) and clinical factors (eg, pain interference on function, pain intensity) and with reference values using descriptive statistics (mean, median), rankFD ANOVAs, and χ2 tests. Results Sixty-nine participants completed the EQ-5D-5L. Mean and median utility scores were, respectively, 0.536 (95% CI: 0.479–0.594) and 0.531 (IQR: 0.356–0.760). Participants with higher levels of pain (<4/10: 0.741, 95% CI: 0.501–0.980; 4–7/10: 0.572, 0.500–0.644; >7/10: 0.433, 0.347–0.518) or pain interference on function (<4/10: 0.685, 95% CI: 0.605–0.764; 4–7/10: 0.463, 0.394–0.533; >7/10: 0.294, 0.126–0.463) presented significantly lower utility scores. No significant differences were found for other socio-demographic characteristics. Conclusion In patients with MSKDs who present to the emergency department, higher levels of pain or pain interference are associated with decreased health-related quality of life. These findings need to be confirmed on a larger scale.
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Affiliation(s)
- Rose Gagnon
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre intégré universitaire de santé et de services sociaux (CIUSSS) de La Capitale-Nationale, Quebec City, Quebec, Canada
- Department of Rehabilitation, Université Laval, Quebec City, Quebec, Canada
| | - Kadija Perreault
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre intégré universitaire de santé et de services sociaux (CIUSSS) de La Capitale-Nationale, Quebec City, Quebec, Canada
- Department of Rehabilitation, Université Laval, Quebec City, Quebec, Canada
| | - Jason R Guertin
- Department of Social and Preventive Medicine, Université Laval, Quebec City, Quebec, Canada
- Centre de recherche du CHU de Québec – Université Laval, Quebec City, Quebec, Canada
| | - Simon Berthelot
- Centre de recherche du CHU de Québec – Université Laval, Quebec City, Quebec, Canada
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, Quebec, Canada
- CHU de Québec – Université Laval, Quebec City, Quebec, Canada
| | | | - Luc J Hébert
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre intégré universitaire de santé et de services sociaux (CIUSSS) de La Capitale-Nationale, Quebec City, Quebec, Canada
- Department of Rehabilitation, Université Laval, Quebec City, Quebec, Canada
- Department of Radiology and Nuclear Medicine, Université Laval, Quebec City, Quebec, Canada
- Correspondence: Luc J Hébert, Cirris, CIUSSS de la Capitale-Nationale, 525 Boulevard Wilfrid-Hamel, H-1410, Quebec City, Quebec, G1M 2S8, Canada, Tel +1 418 529-9141 ext 6579, Email
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Morin M, Duchesne E, Bernier J, Blanchette P, Langlois D, Hébert LJ. What is Known About Muscle Strength Reference Values for Adults Measured by Hand-Held Dynamometry: A Scoping Review. Arch Rehabil Res Clin Transl 2021; 4:100172. [PMID: 35282144 PMCID: PMC8904874 DOI: 10.1016/j.arrct.2021.100172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Existing literature regarding handheld dynamometer (HHD) strength reference values is scarce. The current literature includes gaps relating to strength units used and well-described protocols. There is a critical need to develop HHD reference values in adults. Considering the increased availability of high quality HHD, this issue is urgent.
Objective Data Sources Study Selection Data Extraction Data Synthesis Conclusion
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Roy O, Levasseur-Moreau J, Renauld E, Hébert LJ, Leblond J, Bilodeau M, Fecteau S. Whole-brain morphometry in Canadian soldiers with posttraumatic stress disorder. Ann N Y Acad Sci 2021; 1509:37-49. [PMID: 34791677 DOI: 10.1111/nyas.14707] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 08/25/2021] [Accepted: 10/04/2021] [Indexed: 01/11/2023]
Abstract
Patients with posttraumatic stress disorder (PTSD) display several structural brain differences when compared with healthy individuals. However, findings are particularly inconsistent for soldiers with PTSD. Here, we characterized the brain morphometry of 37 soldiers from the Canadian Armed Forces with adulthood war-related PTSD using structural magnetic resonance imaging. We assessed time since trauma, as well as PTSD, depressive, and anxiety symptoms with the Modified PTSD Symptoms Scale, Beck Depression Inventory, and Beck Anxiety Inventory, respectively. Whole-brain morphometry was extracted with FreeSurfer and compared with a validated normative database of more than 2700 healthy individuals. Volume and thickness from several regions differed from the norms. Frontal regions were smaller and thinner, particularly the superior and rostral middle frontal gyri. Furthermore, smaller left rostral middle frontal gyrus, left pericalcarine cortex, and right fusiform gyrus were associated with more recent trauma. All subcortical structures were bigger, except the hippocampus. These findings suggest a particular brain morphometric signature of PTSD in soldiers. Smaller and thinner frontal and larger subcortical regions support impaired top-down and/or downregulation of emotional response in PTSD. Finally, the correlation of smaller frontal, temporal, and occipital regions with more recent trauma might inform future therapeutic approaches.
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Affiliation(s)
- Olivier Roy
- CERVO Brain Research Centre, Quebec, Canada.,Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec, Canada.,Department of Psychiatry and Neurosciences, Université Laval, Quebec, Canada
| | - Jean Levasseur-Moreau
- CERVO Brain Research Centre, Quebec, Canada.,Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec, Canada.,Department of Psychiatry and Neurosciences, Université Laval, Quebec, Canada
| | - Emmanuelle Renauld
- CERVO Brain Research Centre, Quebec, Canada.,Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec, Canada.,Department of Psychiatry and Neurosciences, Université Laval, Quebec, Canada
| | - Luc J Hébert
- Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec, Canada.,Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, Quebec, Canada.,Department of Rehabilitation, Université Laval, Quebec, Canada
| | - Jean Leblond
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, Quebec, Canada
| | - Mathieu Bilodeau
- Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec, Canada.,Department of Psychiatry and Neurosciences, Université Laval, Quebec, Canada
| | - Shirley Fecteau
- CERVO Brain Research Centre, Quebec, Canada.,Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec, Canada.,Department of Psychiatry and Neurosciences, Université Laval, Quebec, Canada
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Lessard I, St-Gelais R, Hébert LJ, Côté I, Mathieu J, Brais B, Gagnon C. Functional mobility in walking adult population with ataxia of Charlevoix-Saguenay. Orphanet J Rare Dis 2021; 16:432. [PMID: 34649570 PMCID: PMC8515729 DOI: 10.1186/s13023-021-02054-2] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 09/19/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND This study aimed to describe lower limbs impairments, balance and activity limitations related to indoor mobility in adult walkers with autosomal recessive spastic ataxia of Charlevoix-Saguenay (ARSACS). RESULTS Twenty-five participants were recruited with a mean age of 32.2 (± 10.4) years with 45.7% using a walking aid. There is a significant difference between participants with and without a walking aid in terms of lower limbs coordination, balance and mobility. Although participants who walk without a walking aid perform better than the others and they are below predictive or reference values. Despite significant mobility limitations, only mild spasticity and passive range of motion limitations were observed. However, there is a significant difference between unaffected individuals and participants with ARSACS for lower limb muscle cocontraction. CONCLUSIONS Results show a high level of lower limb impairments, balance and mobility limitation in adults' participants with ARSACS that are still walking, including people not using a walking aid. One of the most original finding is the presence of excessive cocontraction and a relatively mild level of spasticity in the lower limbs muscles. Results of this study better circumscribes the impairments and activities that should be the focus of intervention including rehabilitation in ARSACS.
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Affiliation(s)
- Isabelle Lessard
- Groupe de recherche interdisciplinaire sur les maladies neuromusculaires (GRIMN), Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean, site Jonquière, 2230 de l'Hôpital, C.P. 1200, Jonquière, QC, G7X 7X2, Canada
- Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Raphaël St-Gelais
- Groupe de recherche interdisciplinaire sur les maladies neuromusculaires (GRIMN), Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean, site Jonquière, 2230 de l'Hôpital, C.P. 1200, Jonquière, QC, G7X 7X2, Canada
- Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Luc J Hébert
- Départements de réadaptation et de Radiologie et médecine nucléaire, Faculté de médecine, Université Laval, Quebec, QC, Canada
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (CIRRIS), Institut de réadaptation en déficience physique de Québec, Quebec, QC, Canada
| | - Isabelle Côté
- Groupe de recherche interdisciplinaire sur les maladies neuromusculaires (GRIMN), Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean, site Jonquière, 2230 de l'Hôpital, C.P. 1200, Jonquière, QC, G7X 7X2, Canada
| | - Jean Mathieu
- Groupe de recherche interdisciplinaire sur les maladies neuromusculaires (GRIMN), Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean, site Jonquière, 2230 de l'Hôpital, C.P. 1200, Jonquière, QC, G7X 7X2, Canada
- Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Bernard Brais
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Cynthia Gagnon
- Groupe de recherche interdisciplinaire sur les maladies neuromusculaires (GRIMN), Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean, site Jonquière, 2230 de l'Hôpital, C.P. 1200, Jonquière, QC, G7X 7X2, Canada.
- Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, QC, Canada.
- Centre de recherche Charles-Le Moyne-Saguenay-Lac-Saint-Jean sur les innovations en santé, Université de Sherbrooke, Sherbrooke, QC, Canada.
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18
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Lafrance S, Santaguida C, Perreault K, Bath B, Thavorn K, Feldman D, Hébert LJ, Fernandes J, Desmeules F. Single session compared with multiple sessions of education and exercise for older adults with spinal pain in an advanced practice physiotherapy model of care: protocol for a randomised controlled trial. BMJ Open 2021; 11:e053004. [PMID: 34493525 PMCID: PMC8424421 DOI: 10.1136/bmjopen-2021-053004] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To assess the effectiveness and cost-effectiveness of a single session compared with multiple sessions of education and exercise for older adults with spinal pain treated conservatively in an advanced practice physiotherapy model of care. METHODS AND ANALYSIS In this pragmatic randomised controlled trial, 152 older adults (≥65 years old) with neck or back pain initially referred for a consultation in neurosurgery, but treated conservatively, will be recruited through the advanced practice physiotherapy neurosurgery CareAxis programme in the Montreal region (Quebec, Canada). In the CareAxis programme, older patients with spinal pain are triaged by an advance practice physiotherapist and are offered conservative care and only potential surgical candidates are referred to a neurosurgeon. Participants will be randomised into one of two arms: 1-a single session or 2-multiple sessions (6 sessions over 12 weeks) of education and exercise with the advance practice physiotherapist (1:1 ratio). The primary outcome measure will be the Brief Pain Inventory (pain severity and interference subscales). Secondary measures will include self-reported disability (the Neck Disability Index or Oswestry Disability Index), the Pain Catastrophizing Scale, satisfaction with care questionnaires (9-item Visit-specific Satisfaction Questionnaire and MedRisk), and the EQ-5D-5L. Participants' healthcare resources use and related costs will be measured. Outcomes will be collected at baseline and at 6, 12 and 26 weeks after enrolment. Intention-to-treat analyses will be performed, and repeated mixed-model analysis of variance will assess differences between treatment arms. Cost-utility analyses will be conducted from the perspective of the healthcare system. ETHICS AND DISSEMINATION Ethics approval has been obtained from the Comité d'éthique de la recherche du CIUSS de l'Est-de-l'Île-de-Montréal (FWA00001935 and IRB00002087). Results of this study will be presented to different stakeholders, published in peer-reviewed journals and presented at international conferences. PROTOCOL VERSION V.4 August 2021. TRIAL REGISTRATION NUMBER NCT04868591; Pre-results.
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Affiliation(s)
- Simon Lafrance
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
- Orthopaedic Clinical Research Unit, Maisonneuve-Rosemont Hospital Research Center, Montreal, Quebec, Canada
| | - Carlo Santaguida
- Department of Neurology and Neurosurgery, Faculty of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Kadija Perreault
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, Quebec, Canada
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada
| | - Brenna Bath
- School of Rehabilitation Science, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Kednapa Thavorn
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Debbie Feldman
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
- Centre for Research in Public Health (CReSP), Université de Montréal and Centre for Interdisciplinary Research in Rehabilitation (CRIR), Montreal, Quebec, Canada
| | - Luc J Hébert
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada
| | - Julio Fernandes
- Université de Montréal Affiliated Research Center, Hôpital du Sacré-Cœur de Montréal Research Center, Montreal, Quebec, Canada
- Department of Surgery, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - François Desmeules
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
- Orthopaedic Clinical Research Unit, Maisonneuve-Rosemont Hospital Research Center, Montreal, Quebec, Canada
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Gagnon R, Perreault K, Berthelot S, Matifat E, Desmeules F, Achou B, Laroche M, Van Neste C, Tremblay S, Leblond J, Hébert LJ. Direct-access physiotherapy to help manage patients with musculoskeletal disorders in an emergency department: Results of a randomized controlled trial. Acad Emerg Med 2021; 28:848-858. [PMID: 33617696 DOI: 10.1111/acem.14237] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 02/18/2021] [Accepted: 02/19/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The objective was to evaluate the effects of direct-access physiotherapy on patients presenting with a musculoskeletal disorder (MSKD) to the emergency department (ED) on clinical outcomes and use of health care resources. METHODS We conducted a randomized controlled trial in an academic ED in Québec City, Canada. We included patients aged 18 to 80 years with minor MSKD. The intervention group had direct access to a physiotherapist (PT) in the ED immediately after triage and prior to physician assessment, and the control group received usual care by the emergency physician without PT intervention. The key variables included clinical outcomes (pain, interference of pain on function) and resources use (ED return visit, medications, diagnostic tests, additional consultations). They were analyzed using descriptive statistics and compared between groups using two-way analyses of variance, log-linear analysis, and chi-square tests. RESULTS Seventy-eight patients suffering from MSKDs were included (40.2 ± 17.6 years old; 44% women). For the primary clinical outcome, participants in the PT group (n = 40) had statistically lower levels of pain and pain interference at 1 and 3 months. In terms of resource use, participants in the PT group returned significantly less often to the ED. At baseline and 1 month, less prescription medication was used, including opioids, but there were no differences at 3 months. Although over-the-counter medication was recommended more at baseline in the PT group, there were no differences in use at 1 month, and the PT group had used them less at 3 months. There were no differences between groups at follow-up for imaging tests, other professionals consulted, and hospitalization rates. CONCLUSION Patients presenting with a MSKD to the ED with direct access to a PT had better clinical outcomes and used less services and resources than those in the usual care group after ED discharge and up to 3 months after discharge.
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Affiliation(s)
- Rose Gagnon
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS) Quebec Quebec Canada
- Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale‐Nationale Quebec Quebec Canada
- Departments of Rehabilitation, Medicine and Radiology and Nuclear Medicine Faculty of Medicine Université Laval Quebec Quebec Canada
| | - Kadija Perreault
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS) Quebec Quebec Canada
- Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale‐Nationale Quebec Quebec Canada
- Departments of Rehabilitation, Medicine and Radiology and Nuclear Medicine Faculty of Medicine Université Laval Quebec Quebec Canada
| | - Simon Berthelot
- Departments of Rehabilitation, Medicine and Radiology and Nuclear Medicine Faculty of Medicine Université Laval Quebec Quebec Canada
- CHU de Québec–Université Laval Quebec Quebec Canada
- Centre de recherche du CHU de Québec–Université Laval Quebec Quebec Canada
| | - Eveline Matifat
- Faculté de Médecine École de RéhabilitationUniversité de Montréal Montreal Quebec Canada
- Maisonneuve‐Rosemont Hospital Research Centre Orthopaedic Clinical Research Unit Centre de recherche de l’Hôpital Maisonneuve‐RosemontCIUSSS de l’Est‐de‐l’Île‐de‐Montréal Montreal Quebec Canada
| | - François Desmeules
- Faculté de Médecine École de RéhabilitationUniversité de Montréal Montreal Quebec Canada
- Maisonneuve‐Rosemont Hospital Research Centre Orthopaedic Clinical Research Unit Centre de recherche de l’Hôpital Maisonneuve‐RosemontCIUSSS de l’Est‐de‐l’Île‐de‐Montréal Montreal Quebec Canada
| | | | | | | | | | - Jean Leblond
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS) Quebec Quebec Canada
- Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale‐Nationale Quebec Quebec Canada
| | - Luc J. Hébert
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS) Quebec Quebec Canada
- Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale‐Nationale Quebec Quebec Canada
- Departments of Rehabilitation, Medicine and Radiology and Nuclear Medicine Faculty of Medicine Université Laval Quebec Quebec Canada
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20
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Bernard S, Frenette AG, McLean L, Noël P, Froment MA, Hébert LJ, Moffet H. Reliability of ultrasound imaging of pelvic floor morphology and function among females who have undergone pelvic radiotherapy. Neurourol Urodyn 2021; 40:1001-1010. [PMID: 33739537 DOI: 10.1002/nau.24656] [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] [Received: 11/24/2020] [Revised: 02/03/2021] [Accepted: 03/02/2021] [Indexed: 12/27/2022]
Abstract
AIMS To investigate the intra- and inter-rater reliability of two-dimensional (2D) transperineal ultrasound imaging (USI) measures of bladder wall thickness (BWT), urethral length (UL), and parameters related to levator plate length (LP) and transient changes in LP during pelvic floor muscle (PFM) contraction, and on Valsalva in women who received radiation therapy (RT) for treatment of pelvic cancer. METHODS Twenty women with a history of RT for the treatment of pelvic cancer were assessed independently by two raters on the same day. Five outcomes were assessed for reliability: BWT, UL, and LP at rest (LP-R), during a maximal voluntary contraction of the PFMs (LP-MVC), and during a maximal-effort Valsalva maneuver (LP-MVM). Reliability was determined using intra-class correlation coefficients (ICC) and Bland-Altman analyses. Measurement error was determined using standard error of the measurement (SEM) and minimal detectable difference. RESULTS Intra-rater reliability was very good for LP-R, LP-MVC, LP-MVM, and UL (ICC: 0.97 [0.93-0.99], 0.95 [0.88-0.98], 0.84 [0.59-0.94], and 0.96 [0.89-0.98], respectively). Inter-rater reliability was very good for LP-R (ICC: 0.82 [0.55-0.93]), and good for LP-MVC, LP-MVM, and UL (ICC: 0.79 [0.46-0.92], 0.79 [0.49-0.92], and 0.75 [0.36-0.90], respectively). BWT had poor intra- and inter-rater reliability. The variability between measurements was the smallest for LP-R, LP-MVC, and UL for intra-rater assessments, and for LP-R and UL for inter-rater assessments. SEM values for intra-rater assessments were LP-R: 1.5 mm, LP-MVC: 1.84 mm, LP-MVM: 4.33 mm, and UL: 1.16 mm. CONCLUSIONS Although these results support the reliability of 2D-transperineal USI for the evaluation of UL and PFM parameters, they do not support its use for the assessment of BWT.
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Affiliation(s)
- Stéphanie Bernard
- Department of Rehabilitation, Faculté de Médecine, Université Laval, Québec, Québec, Canada
| | - Anne-Gabrielle Frenette
- Departments of Radiology and Radiation Oncology, Centre Hospitalier Université de Québec, Hôtel-Dieu de Québec, Université Laval, Québec, Québec, Canada
| | - Linda McLean
- Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Patricia Noël
- Departments of Radiology and Radiation Oncology, Centre Hospitalier Université de Québec, Hôtel-Dieu de Québec, Université Laval, Québec, Québec, Canada
| | - Marie-Anne Froment
- Departments of Radiology and Radiation Oncology, Centre Hospitalier Université de Québec, Hôtel-Dieu de Québec, Université Laval, Québec, Québec, Canada
| | - Luc J Hébert
- Department of Rehabilitation, Faculté de Médecine, Université Laval, Québec, Québec, Canada
| | - Hélène Moffet
- Department of Rehabilitation, Faculté de Médecine, Université Laval, Québec, Québec, Canada
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Bourassa J, Routhier F, Gagnon C, Rahn C, Hébert LJ, St-Gelais R, Rodrigue X, Brais B, Best KL. Wheelchair mobility, motor performance and participation of adult wheelchair users with ARSACS: a cross-sectional study. Disabil Rehabil Assist Technol 2020; 18:378-386. [PMID: 33307884 DOI: 10.1080/17483107.2020.1858195] [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] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE Although approximately 45% of adults with Autosomal Recessive Spastic Ataxia of Charlevoix-Saguenay (ARSACS) are permanent wheelchair users, this sub population has been less studied. The purpose of this study was to document wheelchair mobility, motor performance, and participation in a cohort of adult wheelchair users with ARSACS. METHODS We recruited 36 manual and powered wheelchair users with ARSACS, aged between 34 and 64 years, for this cross-sectional study. Participants completed measures regarding wheelchair mobility (Wheelchair Skills Test Questionnaire [WST-Q-F], Wheelchair Use Confidence Scale [WheelCon-F] and Wheelchair Outcome Measure [WhOM-F]), motor performance (Scale for the Assessment and Rating of Ataxia [SARA], Disease Severity Index for adults with ARSACS [DSI-ARSACS], Upper Extremity Performance Test for the Elderly [TEMPA], Standardised Finger to Nose Test [SFNT], grip strength, pinch strength, Lower Extremity Motor Coordination Test [LEMOCOT], Berg Balance Scale [BBS], Timed Up and Go [TUG] and 10-meter Walk Test [10mWT]), and participation (Barthel Index, LSA-F and LIFE-H). Results were compared between age groups (≤49 years and ≥50 years), types of wheelchair used, and available reference values. Correlations were computed between wheelchair mobility, upper limb function, and participation. RESULTS Participants presented limitations regarding wheelchair skills, motor performance, and participation in daily activities. Despite preserved upper limb strength, wheelchair skills, upper and lower limb coordination, standing balance, and functional independence were generally more impaired after 50 years of age and among powered wheelchair users. Significant moderate correlations were found between wheelchair skills and self-efficacy, upper limb strength and coordination, and participation in daily and social activities. CONCLUSIONS This study provided the first data sets describing specific characteristics of manual and powered wheelchair users with ARSACS. It supports a need to offer wheelchair skills training interventions to adults with ARSACS, which could increase their daily and social participation.IMPLICATIONS FOR REHABILITATIONAdult wheelchair users with ARSACS present with limited wheelchair skills, significantly impaired motor performance, and reduced participation that generally decreases with age. This profile may serve as comparative data for clinicians to anticipate disease progression.This study provides the first data on distinguishing characteristics between PWC users and MWC users with ARSACS. The main characteristics of PWC users include more severe functional limitations and motor impairments, as well as limited grip strength that contrasts with the general preservation of this function among other adults with ARSACS.There is a need to offer and evaluate wheelchair skills training interventions in the future for adults with ARSACS. The general preservation of grip and pinch strength observed in this population suggests a potential for improvement. Considering the associations found between wheelchair mobility and participation, such interventions may increase users' daily and social participation.
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Affiliation(s)
- Julie Bourassa
- Department of Rehabilitation, Université Laval, Quebec City, Canada.,Center for Interdisciplinary Research in Rehabilitation and Social Integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec City, Canada
| | - François Routhier
- Department of Rehabilitation, Université Laval, Quebec City, Canada.,Center for Interdisciplinary Research in Rehabilitation and Social Integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec City, Canada
| | - Cynthia Gagnon
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada.,Interdisciplinary Research Group on Neuromuscular Disorders, Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean, Saguenay, Canada
| | - Caroline Rahn
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec City, Canada
| | - Luc J Hébert
- Department of Rehabilitation, Université Laval, Quebec City, Canada.,Center for Interdisciplinary Research in Rehabilitation and Social Integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec City, Canada.,Department of Radiology-Nuclear Medicine, Université Laval, Quebec City, Canada
| | - Raphaël St-Gelais
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada.,Interdisciplinary Research Group on Neuromuscular Disorders, Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean, Saguenay, Canada
| | - Xavier Rodrigue
- Institut de réadaptation en déficience physique de Québec, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec City, Canada
| | - Bernard Brais
- Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada
| | - Krista L Best
- Department of Rehabilitation, Université Laval, Quebec City, Canada.,Center for Interdisciplinary Research in Rehabilitation and Social Integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec City, Canada
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Tittley J, Hébert LJ, Roy JS. Should ice application be replaced with neurocryostimulation for the treatment of acute lateral ankle sprains? A randomized clinical trial. J Foot Ankle Res 2020; 13:69. [PMID: 33261633 PMCID: PMC7708120 DOI: 10.1186/s13047-020-00436-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 06/17/2020] [Accepted: 11/16/2020] [Indexed: 02/06/2023] Open
Abstract
Study design Single-blind parallel group randomized clinical trial. Objectives To compare the effects of neurocryostimulation (NCS) with those of traditional ice application on functional recovery, pain, edema and ankle dorsiflexion range of motion (ROM) in individuals receiving physiotherapy treatments for acute lateral ankle sprains (LAS). Background Ankle sprain is a very common injury and its management is often costly, with important short- and long-term impacts on individuals and society. As new methods of therapy using cold (cryotherapy) are emerging for the treatment of musculoskeletal conditions, little evidence exists to support their use. NCS, which provokes a rapid cooling of the skin with the liberation of pressured CO2, is a method believed to accelerate the resorption of edema and recovery in the case of traumatic injuries. Methods Forty-one participants with acute LAS were randomly assigned either to a group that received in-clinic physiotherapy treatments and NCS (experimental NCS group, n = 20), or to a group that received the same in-clinic physiotherapy treatments and traditional ice application (comparison ice group, n = 21). Primary (Lower Extremity Functional Scale - LEFS) and secondary (visual analog scale for pain intensity at rest and during usual activities in the last 48 h, Figure of Eight measurement of edema, and weight bearing lunge for ankle dorsiflexion range of motion) outcomes were evaluated at baseline (T0), after one week (T1), two weeks (T2), four weeks (T4) and finally, after six weeks (T6). The effects of interventions were assessed using two-way ANOVA-type Nonparametric Analysis for Longitudinal Data (nparLD). Results No significant group-time interaction or group effect was observed for all outcomes (0.995 ≥ p ≥ 0.057) following the intervention. Large time effects were however observed for all outcomes (p < 0.0001). Conclusion Results suggest that neurocryostimulation is no more effective than traditional ice application in improving functional recovery, pain, edema, and ankle dorsiflexion ROM during the first six weeks of physiotherapy treatments in individuals with acute LAS. Level of evidence Therapy, level 1b. Trial registration ClinicalTrials.gov, NCT02945618. Registered 23 October 2016 - Retrospectively registered (25 participants recruited prior to registration, 17 participants after).
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Affiliation(s)
- Jean Tittley
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada.,Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec Rehabilitation Institute, Quebec City, Quebec, Canada
| | - Luc J Hébert
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada.,Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec Rehabilitation Institute, Quebec City, Quebec, Canada.,Department of Radiology and Nuclear Medicine, Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada
| | - Jean-Sébastien Roy
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada. .,Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec Rehabilitation Institute, Quebec City, Quebec, Canada.
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Bourassa J, Best KL, Gagnon C, Hébert LJ, Brais B, Routhier F. Measurement properties of wheelchair use assessment tools in adults with autosomal recessive spastic ataxia of Charlevoix-Saguenay. Disabil Rehabil Assist Technol 2020; 17:907-915. [DOI: 10.1080/17483107.2020.1821104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Julie Bourassa
- Department of Rehabilitation, Université Laval, Quebec City, Canada
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec City, Canada
| | - Krista L. Best
- Department of Rehabilitation, Université Laval, Quebec City, Canada
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec City, Canada
| | - Cynthia Gagnon
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
- Interdisciplinary Research Group on Neuromuscular Disorders, Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean, Jonquière, Canada
| | - Luc J. Hébert
- Department of Rehabilitation, Université Laval, Quebec City, Canada
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec City, Canada
- Department of Radiology-Nuclear Medicine, Université Laval, Quebec City, Canada
| | - Bernard Brais
- Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada
| | - François Routhier
- Department of Rehabilitation, Université Laval, Quebec City, Canada
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec City, Canada
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Duchesne E, Hébert LJ, Mathieu J, Côté I, Roussel MP, Gagnon C. Validity of the Mini-BESTest in adults with myotonic dystrophy type 1. Muscle Nerve 2020; 62:95-102. [PMID: 32314404 DOI: 10.1002/mus.26893] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 04/08/2020] [Accepted: 04/08/2020] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Myotonic dystrophy type 1 (DM1) is a multisystemic neuromuscular disease that causes balance problems. The objective of this study was to assess the construct validity of the Mini-BESTest among adults with DM1. METHODS Fifty-nine individuals with late-onset or adult phenotypes of DM1 were recruited. Participants performed the Mini-BESTest, 10-Meter Walk Test (10mWT), 6-Minute Walk Test (6MWT), and Timed Up & Go (TUG) and were questioned on their tendency to lose balance and whether they fell in the past month. RESULTS Scores on the Mini-BESTest were significantly different between phenotypes and CTG repeat numbers (P < .02). Significant correlations were found with the 10mWT, 6MWT, and the TUG (r = 0.77-0.84; P < .001). A cutoff score of 21.5 was found to identify fallers with 90% posttest accuracy. DISCUSSION The Mini-BESTest demonstrates evidence of construct validity when assessing balance in the DM1 population.
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Affiliation(s)
- Elise Duchesne
- Health Sciences Department, Université du Québec à Chicoutimi, Québec, Canada.,Groupe de recherche interdisciplinaire sur les maladies neuromusculaires (GRIMN), Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean, Hôpital de Jonquière, Québec, Canada.,Centre de recherche Charles-Le Moyne - Saguenay-Lac-St-Jean sur les innovations en santé (CR-CSIS), Université de Sherbrooke, Québec, Canada
| | - Luc J Hébert
- Groupe de recherche interdisciplinaire sur les maladies neuromusculaires (GRIMN), Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean, Hôpital de Jonquière, Québec, Canada.,Rehabilitation and Radiology Departments, Faculty of Medicine, Université Laval, Québec, Canada.,Center for Interdisciplinary Research in Rehabilitation and Social Integration, (CIRRIS), Institut de réadaptation en déficience physique de Québec, Québec, Canada
| | - Jean Mathieu
- Groupe de recherche interdisciplinaire sur les maladies neuromusculaires (GRIMN), Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean, Hôpital de Jonquière, Québec, Canada.,Centre de recherche Charles-Le Moyne - Saguenay-Lac-St-Jean sur les innovations en santé (CR-CSIS), Université de Sherbrooke, Québec, Canada.,Faculty of Medicine and Health Sciences, Université de Sherbrooke, Québec, Canada
| | - Isabelle Côté
- Groupe de recherche interdisciplinaire sur les maladies neuromusculaires (GRIMN), Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean, Hôpital de Jonquière, Québec, Canada
| | - Marie-Pier Roussel
- Groupe de recherche interdisciplinaire sur les maladies neuromusculaires (GRIMN), Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean, Hôpital de Jonquière, Québec, Canada.,Centre de recherche Charles-Le Moyne - Saguenay-Lac-St-Jean sur les innovations en santé (CR-CSIS), Université de Sherbrooke, Québec, Canada.,Department of Fundamental Sciences, Université du Québec à Chicoutimi, Québec, Canada
| | - Cynthia Gagnon
- Groupe de recherche interdisciplinaire sur les maladies neuromusculaires (GRIMN), Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean, Hôpital de Jonquière, Québec, Canada.,Centre de recherche Charles-Le Moyne - Saguenay-Lac-St-Jean sur les innovations en santé (CR-CSIS), Université de Sherbrooke, Québec, Canada.,Faculty of Medicine and Health Sciences, Université de Sherbrooke, Québec, Canada
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Roussel MP, Hébert LJ, Duchesne E. Strength-training effectively alleviates skeletal muscle impairments in myotonic dystrophy type 1. Neuromuscul Disord 2020; 30:283-293. [PMID: 32340814 DOI: 10.1016/j.nmd.2020.02.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 02/12/2020] [Accepted: 02/24/2020] [Indexed: 12/25/2022]
Abstract
Myotonic dystrophy type 1 (DM1) is a multisystemic disease characterized by progressive muscle weakness. The aim of this project is to evaluate the effects of a 12-week lower limb strength training program in 11 men with DM1. Maximal isometric muscle strength, 30-second sit-to-stand, comfortable and maximal 10-m walk test (10 mwt) were evaluated at baseline, 6 and 12 weeks, and at 6 and 9 months. The one-repetition maximum strength evaluation method of the training exercises was completed at baseline, 6 and 12 weeks. Muscle biopsies were taken in the vastus lateralis at baseline and 12 weeks to evaluate muscle fiber typing and size (including atrophy/hypertrophy factors). Performance in strength and functional tests all significantly improved by week 12. Maximal isometric muscle strength of the knee extensors decreased by month 9, while improved walking speed and 30 second sit-to-stand performance were maintained. On average, there were no significant changes in fiber typing or size after training. Further analysis showed that individual abnormal hypertrophy factor at baseline could explain the different changes in muscle size among participants. Strength training induces maximal isometric muscle strength and lasting functional gains in DM1. Abnormal hypertrophy factor could be a key component to identify high and low responders to hypertrophy in DM1.
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Affiliation(s)
- Marie-Pier Roussel
- Département des Sciences Fondamentales, Université du Québec à Chicoutimi, Saguenay, Québec, Canada; Groupe de Recherche Interdisciplinaire sur les Maladies Neuromusculaires (GRIMN), Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean, Saguenay, Québec, Canada; Centre de recherche Charles-Le Moyne - Saguenay-Lac-Saint-Jean sur les innovations en santé (CR-CSIS), Faculté de médecine et des sciences de la santé de l'Université de Sherbrooke, Site Saguenay, Saguenay, Québec, Canada
| | - Luc J Hébert
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (CIRRIS), Québec, Québec, Canada; Départements de réadaptation et de radiologie et médecine nucléaire, Faculté de médecine, Université Laval, Québec, Québec, Canada
| | - Elise Duchesne
- Groupe de Recherche Interdisciplinaire sur les Maladies Neuromusculaires (GRIMN), Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean, Saguenay, Québec, Canada; Centre de recherche Charles-Le Moyne - Saguenay-Lac-Saint-Jean sur les innovations en santé (CR-CSIS), Faculté de médecine et des sciences de la santé de l'Université de Sherbrooke, Site Saguenay, Saguenay, Québec, Canada; Département des sciences de la santé, Université du Québec à Chicoutimi, 555, boul. de l'Université, Saguenay, Québec G7H 2B1, Canada.
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Ager AL, Roy JS, Gamache F, Hébert LJ. The Effectiveness of an Upper Extremity Neuromuscular Training Program on the Shoulder Function of Military Members With a Rotator Cuff Tendinopathy: A Pilot Randomized Controlled Trial. Mil Med 2020; 184:e385-e393. [PMID: 30423137 DOI: 10.1093/milmed/usy294] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 09/26/2018] [Accepted: 10/15/2018] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Shoulder pain, a leading reason to consult a physician or physiotherapist, continues to be a challenge to rehabilitate, particularly with a military population. A rotator cuff (RC) tendinopathy, the most important source of shoulder pain, is one of the leading reasons for sick leave or a discharge from active military service. Research encourages the use of exercise prescription for the management of a RC tendinopathy, however the ideal method of delivery (group setting versus one-on-one) remains uncertain. The purpose of this single-blind (evaluator) pilot randomized clinical trial was to compare two 6-week rehabilitation programs, a newly developed group-supervised neuromuscular training program and usual one-on-one physiotherapy care, on the pain and symptoms of Canadian soldiers affected by a RC tendinopathy. MATERIALS AND METHODS Thirty-one soldiers with the Canadian Armed Forces were randomly assigned to (1) a group-supervised neuromuscular training program (UPEx-NTP) or; (2) one-on-one usual physiotherapy care (UPC). The primary outcome was the Disability of Arm, Hand and Shoulder (DASH) questionnaire. Secondary outcomes included the Western Ontario Rotator Cuff (WORC) Index, pain levels at rest, and maximum isometric voluntary contractions (MIVC) of the abductors and external (lateral) rotators of the affected shoulder. Both were assessed at baseline (T0), 6 (T6) and 12 (T12) weeks. Analysis included two-way repeated measures of variance for intention-to-treat (ITT) and per-protocol analyses. RESULTS Eighty military members with a RC tendinopathy were contacted, resulting in 31 participants who were randomized for their active intervention, in the UPEx-NTP or UPC, respectively. No significant group (p ≥ 0.16) or group × time interactions (p ≥ 0.11) were found for either ITT or per-protocol analyses. A statistically significant time effect (p < 0.001) was established for the DASH and WORC, showing that both groups improved over time. CONCLUSIONS Our preliminary data demonstrates that both rehabilitation approaches, grounded in active exercises, were not statistically different from each other, and derived similar benefits over time for a military population. This suggests that a group intervention for a RC tendinopathy has potential to be just as effective as a one-on-one approach for a military population, an interesting avenue for an active working population. Larger sample sizes and further investigation are warranted regarding the cost and clinical resource benefits of a supervised group approach.
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Affiliation(s)
- Amanda L Ager
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Rehabilitation Institute, Quebec City, Quebec, Canada.,Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec, Canada
| | - Jean-Sébastien Roy
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Rehabilitation Institute, Quebec City, Quebec, Canada.,Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec, Canada
| | - France Gamache
- Physiotherapy Department, Valcartier Garrison, Canadian Armed Forces, Quebec, Canada
| | - Luc J Hébert
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Rehabilitation Institute, Quebec City, Quebec, Canada.,Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec, Canada.,Department of Radiology/Nuclear Medicine, Faculty of Medicine, Laval University, Quebec, Canada.,1 Canadian Field Hospital, Detachment Ottawa, Ottawa, Ontario, Canada
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Roussel MP, Hébert LJ, Duchesne E. Intra-Rater Reliability and Concurrent Validity of Quantified Muscle Testing for Maximal Knee Extensors Strength in Men with Myotonic Dystrophy Type 1. J Neuromuscul Dis 2019; 6:233-240. [PMID: 31127731 DOI: 10.3233/jnd-190388] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 11/15/2022]
Abstract
BACKGROUND Myotonic dystrophy type 1 (DM1) is the most prevalent degenerative neuromuscular disease in adults. Knee extensor (KE) maximal strength loss is a strong indicator of physical limitations in DM1. A reliable, precise and accessible maximal strength evaluation method needs to be validated for this slowly progressive disease. OBJECTIVE This paper aims to assess the intra-rater reliability, the standard error of measurement (SEM), the minimal detectable change (MDC), and the concurrent validity of quantified muscle testing (QMT) using a handheld dynamometer with a gold standard: the Biodex isokinetic device. METHODS Nineteen men with the adult form of DM1 participated in this study by attending 2 visits spaced by one week. The evaluation of KE muscle strength with QMT was completed on the first visit and the same QMT evaluation in addition to the maximal muscle strength evaluation using an isokinetic device were performed on the second visit. RESULTS The intra-rater reliability was excellent with an intraclass correlation coefficient (ICC) of 0.98 (0.96-0.99 : 95% confidence interval). SEM and MDC values were 1.05 Nm and 2.92 Nm, respectively. Concurrent validity of QMT of KE muscle group with the Biodex was also excellent with a Spearman's correlation of ρ= 0.98. CONCLUSIONS The excellent concurrent validity and intra-rater reliability, and the small SEM and MDC of the QMT make this test a method of choice, in either a clinical or research setting, to precisely evaluate muscle strength impairments of the KE in men with DM1.
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Affiliation(s)
- Marie-Pier Roussel
- Département des sciences fondamentales, Université du Québec à Chicoutimi, Saguenay, Québec, Canada.,Groupe de recherche interdisciplinaire sur les maladies neuromusculaires (GRIMN), Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean, Saguenay, Québec, Canada.,Centre de recherche Charles-Le Moyne - Saguenay-Lac-Saint-Jean sur les innovations en santé, Saguenay, Québec, Canada
| | - Luc J Hébert
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (CIRRIS), Québec, Québec, Canada.,Départements de réadaptation et de radiologie-médecine nucléaire, Faculté de médecine, Université Laval, Québec, Québec, Canada
| | - Elise Duchesne
- Groupe de recherche interdisciplinaire sur les maladies neuromusculaires (GRIMN), Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean, Saguenay, Québec, Canada.,Centre de recherche Charles-Le Moyne - Saguenay-Lac-Saint-Jean sur les innovations en santé, Saguenay, Québec, Canada.,Département des sciences de la santé, Université du Québec à Chicoutimi, Saguenay, Québec, Canada
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Gagnon C, Heatwole C, Hébert LJ, Hogrel JY, Laberge L, Leone M, Meola G, Richer L, Sansone V, Kierkegaard M. Report of the third outcome measures in myotonic dystrophy type 1 (OMMYD-3) international workshop Paris, France, June 8, 2015. J Neuromuscul Dis 2019; 5:523-537. [PMID: 30248061 DOI: 10.3233/jnd-180329] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Cynthia Gagnon
- Groupe de recherche interdisciplinaire sur les maladies neuromusculaires (GRIMN), Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean, Québec, Canada.,Centre de recherche Charles-Le-Moyne Saguenay - Lac-St-Jean sur les innovations en santé, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Québec, Canada
| | - Chad Heatwole
- Department of Neurology, University of Rochester Medical Center, New York, USA
| | - Luc J Hébert
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (CIRRIS), and Faculty of Medicine, Université Laval, Québec, Canada
| | | | - Luc Laberge
- ÉCOBES, Cégep de Jonquière, Québec, Canada.,Department of Health Sciences, Université du Québec á Chicoutimi, Québec, Canada
| | - Mario Leone
- Department of Health Sciences, Université du Québec á Chicoutimi, Québec, Canada
| | - Giovanni Meola
- Department of Biomedical sciences for health, University of Milan, IRCCS Policlinico San Donato, Italy
| | - Louis Richer
- Department of Health Sciences, Université du Québec á Chicoutimi, Québec, Canada
| | - Valeria Sansone
- Centro Clinico NEMO, Neurorehabilitation Unit, University of Milan, Italy
| | - Marie Kierkegaard
- Functional Area Occupational Therapy & Physiotherapy, Allied Health Professionals Function, Karolinska University Hospital, Stockholm, Sweden.,Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden
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Petitclerc É, Hébert LJ, Mathieu J, Desrosiers J, Gagnon C. Relationships between Lower Limb Muscle Strength Impairments and Physical Limitations in DM1. J Neuromuscul Dis 2018; 5:215-224. [PMID: 29865087 DOI: 10.3233/jnd-170291] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 11/15/2022]
Abstract
BACKGROUND Although adult and late-onset DM1 phenotypes DM1 present distinct lower limb weaknesses portraits, resulting physical limitations have never been described separately for each phenotype. OBJECTIVE To characterize the lower limb weaknesses and physical limitations among the DM1 adult and late-onset phenotypes separately and to document the contribution of weaknesses on mobility to optimize the management of this population. METHODS The strength of four muscle groups among 198 participants was quantified. Participants were categorized according to the severity of their muscular involvement using the Muscular Impairment Rating Scale (MIRS). Physical limitations were assessed using the Timed up-and-go (TUG), Berg Balance Scale (BBS) and 10 meters comfortable walking speed (10MWT). Multiple linear regressions were performed to identify the contribution of each muscle group to the mobility tests scores. RESULTS Late-onset demonstrated less weakness and physical limitations (p < 0.001 - 0.002) than the adult phenotype, but 21.9-47.5% of participants with this phenotype showed mobility scores below reference values. Physical limitations were observed in the first two MIRS grades (37.5-42.1% of the participants) for the TUG and 10MWT. Ankle dorsiflexors and knee extensors were the two muscle groups that showed the strongest relationships with mobility scores. CONCLUSION Although less impaired, the late-onset phenotype shows significant lower limb muscle weakness associated with physical limitations. The surprising presence of quantitative lower limb muscle weakness in the first two MIRS grades needs to be considered when using this scale. Both ankle dorsiflexors and knee extensors appear to be good indicators of physical limitations in DM1.
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Affiliation(s)
- Émilie Petitclerc
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke (Québec), Canada.,Groupe de recherche interdisciplinaire sur les maladies neuromusculaires, NeuromuscularClinic, Centre intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-St-Jean, site Jonquière, rue de l'Hôpital, Jonquière (Québec), Canada
| | - Luc J Hébert
- Faculty of Medicine, Rehabilitation (Physiotherapy) and Department of Radiology, Université Laval, avenue de la Médecine, Pavillon Ferdinand-Vandry, Québec, QC, Canada
| | - Jean Mathieu
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke (Québec), Canada.,Groupe de recherche interdisciplinaire sur les maladies neuromusculaires, NeuromuscularClinic, Centre intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-St-Jean, site Jonquière, rue de l'Hôpital, Jonquière (Québec), Canada
| | - Johanne Desrosiers
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke (Québec), Canada
| | - Cynthia Gagnon
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke (Québec), Canada.,Groupe de recherche interdisciplinaire sur les maladies neuromusculaires, NeuromuscularClinic, Centre intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-St-Jean, site Jonquière, rue de l'Hôpital, Jonquière (Québec), Canada
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Décary S, Hébert LJ, Légaré F. Promoting high-quality physiotherapy to support Choosing Wisely recommendations. Physiotherapy 2018; 105:134-135. [PMID: 30318131 DOI: 10.1016/j.physio.2018.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 08/30/2018] [Indexed: 11/24/2022]
Affiliation(s)
- Simon Décary
- Centre de recherche sur les soins et les services de première ligne de l'Université Laval (CERSSPL-UL), Postdoctoral fellow at Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Quebec, Quebec G1J 0A4, Canada; Department of Family Medicine and Emergency Medicine, Pavillon Ferdinand-Vandry, 1050, Avenue de la Médecine, Université Laval, Quebec, Quebec G1V 0A6, Canada.
| | - Luc J Hébert
- Department of Rehabilitation, Pavillon Ferdinand-Vandry, 1050, Avenue de la Médecine, Université Laval, Quebec, Quebec, G1V 0A6, Canada
| | - France Légaré
- Centre de recherche sur les soins et les services de première ligne de l'Université Laval (CERSSPL-UL), Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Quebec, Quebec, G1J 0A4, Canada; Department of Family Medicine and Emergency Medicine, Pavillon Ferdinand-Vandry, 1050, Avenue de la Médecine, Université Laval, Quebec, Quebec G1V 0A6, Canada
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Abstract
BACKGROUND In Myotonic Dystrophy type 1 (DM1) patients, ankle muscles are affected early and this impairment is reported to be a good biological marker for longitudinal studies. OBJECTIVE To characterize the ankle dorsiflexion (DF) and eversion (EV) maximal isometric muscle strength changes in adult DM1 patients over 5 years using a standardized handheld dynamometer protocol and the Myoankle method, compare the changes measured with both methods and to the standard error of measurement, and verify the relationship between ankle muscle strength and gait performance. METHODS The maximal isometric muscle strength of ankle DF and EV in DM1 patients from Quebec and Lyon was assessed at baseline, 18, 36 and 60 months using a handheld dynamometer (HHD) protocol and the MyoAnkle method. RESULTS There was a decrease of torque in DF/EV of 36.0% /31.3% and 27.7% /35.5% for the Quebec and Lyon cohorts respectively (p≤0.01), but not in a linear way. In most cases (82.5%), the changes observed were greater than the standard error of measurement. DF torque measures taken by the two methods (HHD and MyoAnkle) were highly correlated (rp = 0.97-0.98, p < 0.001). CONCLUSION Muscle strength ankle impairments are clinically meaningful in DM1 and can be accurately monitored using quantitative testing to measure the efficacy of therapeutic trials.
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Affiliation(s)
- Luc J Hébert
- Department of Rehabilitation, Faculty of Medicine, Laval University, QC, Canada.,Department of Radiology-Nuclear Medicine, Faculty of Medicine, Laval University, QC, Canada.,Centre for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), QC, Canada
| | - Christophe Vial
- Neuro-rehabilitation Service, Hôpital Pierre Werteimer (Groupement Hospitalier Est), Lyon, France.,Department of Electro-neurophysiology and Muscular Pathology, Hôpital Pierre Werteimer (Groupement Hospitalier Est), Lyon, France
| | - Jean-Yves Hogrel
- Neuromuscular Physiology and Evaluation Laboratory, Neuromuscular Investigation Center, Institute of Myology, Paris, France
| | - Jack Puymirat
- Unit of Human Genetics, Hôpital de l'Enfant-Jésus, CHU Research Center, QC, Canada
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Kierkegaard M, Petitclerc É, Hébert LJ, Mathieu J, Gagnon C. Responsiveness of performance-based outcome measures for mobility, balance, muscle strength and manual dexterity in adults with myotonic dystrophy type 1. J Rehabil Med 2018; 50:269-277. [PMID: 29260836 DOI: 10.2340/16501977-2304] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To assess changes and responsiveness in outcome measures of mobility, balance, muscle strength and manual dexterity in adults with myotonic dystrophy type 1. DESIGN A 9-year longitudinal study conducted with 113 patients. METHODS The responsiveness of the Timed Up and Go test, Berg Balance Scale, quantitative muscle testing, grip and pinch-grip strength, and Purdue Pegboard Test was assessed using criterion and construct approaches. Patient-reported perceived changes (worse/stable) in balance, walking, lower-limb weakness, stair-climbing and hand weakness were used as criteria. Predefined hypotheses about expected area under the receiver operating characteristic curves (criterion approach) and correlations between relative changes (construct approach) were explored. RESULTS The direction and magnitude of median changes in outcome measures corresponded with patient-reported changes. Median changes in the Timed Up and Go test, grip strength, pinch-grip strength and Purdue Pegboard Test did not, in general, exceed known measurement errors. Most criterion (72%) and construct (70%) approach hypotheses were supported. Promising responsiveness was found for outcome measures of mobility, balance and muscle strength. Grip strength and manual dexterity measures showed poorer responsiveness. CONCLUSION The performance-based outcome measures captured changes over the 9-year period and responsiveness was promising. Knowledge of measurement errors is needed to interpret the meaning of these longitudinal changes.
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Affiliation(s)
- Marie Kierkegaard
- Function Area Occupational therapy and Physiotherapy, Karolinska University Hospital, SE-171 76 Stockholm, Sweden. , ,
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Abstract
STUDY DESIGN Systematic review. INTRODUCTION Constituents of proprioception include our awareness of the position (joint position sense [JPS]) and motion (kinesthesia) of our limbs in space. Proprioceptive deficits are associated with musculoskeletal disorders but remain a challenge to quantify, particularly at the shoulder. PURPOSE OF THE STUDY To report the psychometric values of validity, reliability, and responsiveness for shoulder JPS and/or kinesthesia protocols. METHODS A review of 5 databases was conducted from inception to July 2016 for studies reporting a psychometric property of a shoulder proprioception protocol. The included studies were evaluated using the QualSyst checklist and COSMIN 4-point scale. RESULTS Twenty-one studies were included, yielding 407 participants and 553 evaluated shoulders (n). The included studies support excellent methodological scores using the QualSyst checklist (88.1 ± 9.9%) and good psychometric scores with the COSMIN for reliability (71.1%) and moderate-to-low quality score (50%) for criterion validity. Weighted average intraclass correlation coefficients (ICCs) for intrarater reliability were highest for passive JPS and kinesthesia, ICC = 0.92 ± 0.07 (n = 214) and ICC = 0.92 ± 0.04 (n = 74), respectively. The most reliable movement and tool are internal rotation at 90° of abduction, ICC = 0.88 ± 0.01 (n = 53), and the dynamometer, ICC = 0.92 ± 0.88 (n = 225). Only 2 studies quantify an aspect of validity and no responsiveness indices were reported among the included studies. CONCLUSION Based on the results of the included studies, the evaluation of shoulder proprioception is most reliable when using a passive protocol with an isokinetic dynamometer for internal rotation at 90° of shoulder abduction. Standardized protocols addressing the psychometric properties of shoulder proprioception measures are needed. LEVEL OF EVIDENCE Level 1a: systematic review.
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Affiliation(s)
- Amanda L Ager
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Rehabilitation Institute, Quebec, Canada; Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec, Canada.
| | - Jean-Sébastien Roy
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Rehabilitation Institute, Quebec, Canada; Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec, Canada
| | - Marianne Roos
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Rehabilitation Institute, Quebec, Canada; Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec, Canada
| | - Amélie Fournier Belley
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Rehabilitation Institute, Quebec, Canada; Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec, Canada
| | - Ann Cools
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Luc J Hébert
- Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec, Canada; Department of Radiology and Nuclear Medicine, Faculty of Medicine, Laval University, Quebec, Canada
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Rousseau-Saine N, Williams SR, Girard F, Hébert LJ, Robin F, Duchesne L, Lavoie F, Ruel M. The Effect of Adductor Canal Block on Knee Extensor Muscle Strength 6 Weeks After Total Knee Arthroplasty. Anesth Analg 2018; 126:1019-1027. [DOI: 10.1213/ane.0000000000002338] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Hogrel JY, Ollivier G, Ledoux I, Hébert LJ, Eymard B, Puymirat J, Bassez G. Relationships between grip strength, myotonia, and CTG expansion in myotonic dystrophy type 1. Ann Clin Transl Neurol 2017; 4:921-925. [PMID: 29296622 PMCID: PMC5740258 DOI: 10.1002/acn3.496] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 10/02/2017] [Accepted: 10/02/2017] [Indexed: 02/01/2023] Open
Abstract
In myotonic dystrophy type 1, several studies have suggested causal relationships between CTG repeat length and the severity of symptoms, such as weakness or myotonia. We aimed to explore these relationships in a large population of 144 DM1 patients. All patients underwent clinical and functional assessments using a standardized test for grip strength and myotonia assessment. Myotonia was assessed using a fully automatic software based on mathematical modeling of relaxation force curve. CTG repeat length was statistically correlated with both myotonia and grip strength, which are two major primary neuromuscular symptoms of DM1 patients. However, these relationships are not clinically meaningful and not predictive at the individual level.
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Affiliation(s)
| | | | | | | | - Bruno Eymard
- Institut de Myologie GH Pitié-Salpêtrière Paris France
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Kierkegaard M, Petitclerc E, Hébert LJ, Gagnon C. Is one trial enough for repeated testing? Same-day assessments of walking, mobility and fine hand use in people with myotonic dystrophy type 1. Neuromuscul Disord 2017; 27:153-158. [DOI: 10.1016/j.nmd.2016.11.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 10/05/2016] [Accepted: 11/30/2016] [Indexed: 10/20/2022]
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Petitclerc É, Hébert LJ, Mathieu J, Desrosiers J, Gagnon C. Lower limb muscle strength impairment in late-onset and adult myotonic dystrophy type 1 phenotypes. Muscle Nerve 2016; 56:57-63. [PMID: 27784130 DOI: 10.1002/mus.25451] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2016] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Lower limb strength has never been characterized separately for late-onset and adult myotonic dystrophy type 1 (DM1) phenotypes. METHODS The purpose of this study was to: (1) describe and compare lower limb strength between the 2 DM1 phenotypes; and (2) compare the impairment profiles obtained from 2 assessment methods [manual (MMT) and quantitative (QMT) muscle testing] among 107 patients. RESULTS Both MMT and QMT showed more pronounced weakness in the adult phenotype. In the late-onset phenotype, although MMT showed normal strength, QMT revealed a loss of 11.7%-20.4%. Participants with grade 1 or 2 on the Muscle Impairment Rating Scale had weakness detected using QMT, which suggests earlier muscle impairment than MMT alone would suggest. CONCLUSIONS To avoid muscle wasting, physical activity recommendations should be made for the late-onset phenotype and in the early stages of the disease for the adult phenotype. MMT is not recommended for use in clinical trials. Muscle Nerve 56: 57-63, 2017.
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Affiliation(s)
- Émilie Petitclerc
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Luc J Hébert
- Faculty of Medicine, Rehabilitation (Physiotherapy) and Radiology Department, Université Laval, Québec City, Québec, Canada
| | - Jean Mathieu
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Johanne Desrosiers
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Cynthia Gagnon
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada
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Robitaille N, Jackson PL, Hébert LJ, Mercier C, Bouyer LJ, Fecteau S, Richards CL, McFadyen BJ. A Virtual Reality avatar interaction (VRai) platform to assess residual executive dysfunction in active military personnel with previous mild traumatic brain injury: proof of concept. Disabil Rehabil Assist Technol 2016; 12:758-764. [DOI: 10.1080/17483107.2016.1229048] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Nicolas Robitaille
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale*, Québec, QC, Canada
| | - Philip L. Jackson
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale*, Québec, QC, Canada
- School of Psychology, Laval University, Québec, QC, Canada
| | - Luc J. Hébert
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale*, Québec, QC, Canada
- Department of Rehabilitation, Faculty of Medicine, Laval University, Québec, QC, Canada
- Department of Radiology, Faculty of Medicine, Laval University, Québec, QC, Canada
| | - Catherine Mercier
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale*, Québec, QC, Canada
- Department of Rehabilitation, Faculty of Medicine, Laval University, Québec, QC, Canada
| | - Laurent J. Bouyer
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale*, Québec, QC, Canada
- Department of Rehabilitation, Faculty of Medicine, Laval University, Québec, QC, Canada
| | - Shirley Fecteau
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale*, Québec, QC, Canada
- Department of Rehabilitation, Faculty of Medicine, Laval University, Québec, QC, Canada
- Centre de recherche de l’institut universitaire en santé mentale de Québec*, Québec, QC, Canada
| | - Carol L. Richards
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale*, Québec, QC, Canada
- Department of Rehabilitation, Faculty of Medicine, Laval University, Québec, QC, Canada
| | - Bradford J. McFadyen
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale*, Québec, QC, Canada
- Department of Rehabilitation, Faculty of Medicine, Laval University, Québec, QC, Canada
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Bachasson D, Moraux A, Ollivier G, Decostre V, Ledoux I, Gidaro T, Servais L, Behin A, Stojkovic T, Hébert LJ, Puymirat J, Eymard B, Bassez G, Hogrel JY. Relationship between muscle impairments, postural stability, and gait parameters assessed with lower-trunk accelerometry in myotonic dystrophy type 1. Neuromuscul Disord 2016; 26:428-35. [DOI: 10.1016/j.nmd.2016.05.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 05/10/2016] [Accepted: 05/10/2016] [Indexed: 10/21/2022]
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Perron M, Hébert LJ, McFadyen BJ, Belzile S, Regniére M. The ability of the Biodex Stability System to distinguish level of function in subjects with a second-degree ankle sprain. Clin Rehabil 2016; 21:73-81. [PMID: 17213244 DOI: 10.1177/0269215506071288] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Objective: To assess the capacity of the Biodex Stability System using a one-leg stance protocol to differentiate between injured and non-injured limbs and between level of disabilities. Design: Cross-sectional study. Setting: Military and civilian clinic. Subjects: Thirty-four individuals with a second-degree lateral ankle sprain and 36 healthy subjects. Methods and measures: Subjects were tested on the Stability System 30 days after injury using a one-leg stance protocol in the dynamic limit-of-stability mode. All subjects also filled out a disability questionnaire (Lower Extremity Functional Scale). The groups were compared based on the overall dynamic limit-of-stability score and its relationship with the score on the disability questionnaire was also examined. Results: The overall dynamic limit-of-stability scores (subjects with a lateral ankle sprain: 13.0% (5.5)-26.0% (9.2); healthy subjects: 16.9% (7.9)-27.9% (9.6)) clustered in the lower end of the theoretical range of 0–100%. Statistically significant differences in the overall dynamic limit-of-stability scores were found between the injured and non-injured limbs but group differences were small and clinically not relevant. No significant relationships were found between the overall dynamic limit-of-stability scores and the Lower Extremity Functional Scale scores (58.2 (11.8)) of the subjects with a lateral ankle sprain. Conclusions: The one-leg stance protocol carried out in the dynamic limit-of-stability mode is very challenging and offers a very limited capacity to differentiate between injured and non-injured limbs. The main outcome of the Stability System does not appear to be a good indicator of the functional capacity of people with a lateral ankle sprain.
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Affiliation(s)
- Marc Perron
- Physiotherapy Clinic, Valcartier Garrison, 5th Field Ambulance, Canadian Forces Health Services and Rehabilitation Department, Faculty of Medicine, Laval University, Quebec City, Canada.
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Demers I, Moffet H, Hébert LJ, Maltais DB. Are Children At Risk For Developmental Coordination Disorder Weak? Med Sci Sports Exerc 2016. [DOI: 10.1249/01.mss.0000488069.81473.57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Robitaille E, Agur A, Hébert LJ, Switzer-McIntyre S. 31 A pragmatic pilot study of ankle mobilizations and exercise in canadian armed forces members with lateral ankle sprain. Br J Sports Med 2015. [DOI: 10.1136/bjsports-2015-095573.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Gagnon C, Meola G, Hébert LJ, Laberge L, Leone M, Heatwole C. Report of the second Outcome Measures in Myotonic Dystrophy type 1 (OMMYD-2) international workshop San Sebastian, Spain, October 16, 2013. Neuromuscul Disord 2015; 25:603-16. [DOI: 10.1016/j.nmd.2015.01.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 01/13/2015] [Accepted: 01/20/2015] [Indexed: 11/15/2022]
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Roosink M, McFadyen BJ, Hébert LJ, Jackson PL, Bouyer LJ, Mercier C. Assessing the perception of trunk movements in military personnel with chronic non-specific low back pain using a virtual mirror. PLoS One 2015; 10:e0120251. [PMID: 25799009 PMCID: PMC4370585 DOI: 10.1371/journal.pone.0120251] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Accepted: 01/31/2015] [Indexed: 12/19/2022] Open
Abstract
Chronic pain, including chronic non-specific low back pain (CNSLBP), is often associated with body perception disturbances, but these have generally been assessed under static conditions. The objective of this study was to use a "virtual mirror" that scaled visual movement feedback to assess body perception during active movement in military personnel with CNSLBP (n = 15) as compared to military healthy control subjects (n = 15). Subjects performed a trunk flexion task while sitting and standing in front of a large screen displaying a full-body virtual mirror-image (avatar) in real-time. Avatar movements were scaled to appear greater, identical, or smaller than the subjects' actual movements. A total of 126 trials with 11 different scaling factors were pseudo-randomized across 6 blocks. After each trial, subjects had to decide whether the avatar's movements were "greater" or "smaller" than their own movements. Based on this two-alternative forced choice paradigm, a psychophysical curve was fitted to the data for each subject, and several metrics were derived from this curve. In addition, task adherence (kinematics) and virtual reality immersion were assessed. Groups displayed a similar ability to discriminate between different levels of movement scaling. Still, subjects with CNSLBP showed an abnormal performance and tended to overestimate their own movements (a right-shifted psychophysical curve). Subjects showed adequate task adherence, and on average virtual reality immersion was reported to be very good. In conclusion, these results extend previous work in patients with CNSLBP, and denote an important relationship between body perception, movement and pain. As such, the assessment of body perception during active movement can offer new avenues for understanding and managing body perception disturbances and abnormal movement patterns in patients with pain.
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Affiliation(s)
- Meyke Roosink
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale (CIRRIS), Québec, Québec, Canada
| | - Bradford J. McFadyen
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale (CIRRIS), Québec, Québec, Canada
- Department of Rehabilitation, Faculty of Medicine, Laval University, Québec, Québec, Canada
| | - Luc J. Hébert
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale (CIRRIS), Québec, Québec, Canada
- Department of Rehabilitation, Faculty of Medicine, Laval University, Québec, Québec, Canada
- Canadian Forces Health Services Group Headquarters, Directorate of Medical Policy (Physiotherapy), Valcartier Garrison, Québec, Québec, Canada
- Department of Radiology, Faculty of Medicine, Laval University, Québec, Québec, Canada
| | - Philip L. Jackson
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale (CIRRIS), Québec, Québec, Canada
- School of Psychology, Laval University, Québec, Québec, Canada
| | - Laurent J. Bouyer
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale (CIRRIS), Québec, Québec, Canada
- Department of Rehabilitation, Faculty of Medicine, Laval University, Québec, Québec, Canada
| | - Catherine Mercier
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale (CIRRIS), Québec, Québec, Canada
- Department of Rehabilitation, Faculty of Medicine, Laval University, Québec, Québec, Canada
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Petitclerc É, Hébert LJ, Desrosiers J, Gagnon C. Lower limb muscle impairment in myotonic dystrophy type 1: the need for better guidelines. Muscle Nerve 2015; 51:473-8. [PMID: 25399769 DOI: 10.1002/mus.24521] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2014] [Indexed: 11/11/2022]
Abstract
In myotonic dystrophy type 1 (DM1), leg muscle weakness is a major impairment. There are challenges to obtaining a clear portrait of muscle strength impairment. A systematic literature review was conducted on lower limb strength impairment in late-onset and adult phenotypes to document variables which affect strength measurement. Thirty-two articles were reviewed using the COSMIN guidelines. Only a third of the studies described a reproducible protocol. Only 2 muscle groups have documented reliability for quantitative muscle testing and only 1 total score for manual muscle testing. Variables affecting muscle strength impairment are not described in most studies. This review illustrates the variability in muscle strength assessment in relation to DM1 characteristics and the questionable validity of the results with regard to undocumented methodological properties. There is therefore a clear need to adopt a consensus on the use of a standardized muscle strength assessment protocol.
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Affiliation(s)
- Émilie Petitclerc
- Faculty of Medecine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
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Roosink M, Robitaille N, McFadyen BJ, Hébert LJ, Jackson PL, Bouyer LJ, Mercier C. Real-time modulation of visual feedback on human full-body movements in a virtual mirror: development and proof-of-concept. J Neuroeng Rehabil 2015; 12:2. [PMID: 25558785 PMCID: PMC4326499 DOI: 10.1186/1743-0003-12-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 12/22/2014] [Indexed: 11/29/2022] Open
Abstract
Background Virtual reality (VR) provides interactive multimodal sensory stimuli and biofeedback, and can be a powerful tool for physical and cognitive rehabilitation. However, existing systems have generally not implemented realistic full-body avatars and/or a scaling of visual movement feedback. We developed a “virtual mirror” that displays a realistic full-body avatar that responds to full-body movements in all movement planes in real-time, and that allows for the scaling of visual feedback on movements in real-time. The primary objective of this proof-of-concept study was to assess the ability of healthy subjects to detect scaled feedback on trunk flexion movements. Methods The “virtual mirror” was developed by integrating motion capture, virtual reality and projection systems. A protocol was developed to provide both augmented and reduced feedback on trunk flexion movements while sitting and standing. The task required reliance on both visual and proprioceptive feedback. The ability to detect scaled feedback was assessed in healthy subjects (n = 10) using a two-alternative forced choice paradigm. Additionally, immersion in the VR environment and task adherence (flexion angles, velocity, and fluency) were assessed. Results The ability to detect scaled feedback could be modelled using a sigmoid curve with a high goodness of fit (R2 range 89-98%). The point of subjective equivalence was not significantly different from 0 (i.e. not shifted), indicating an unbiased perception. The just noticeable difference was 0.035 ± 0.007, indicating that subjects were able to discriminate different scaling levels consistently. VR immersion was reported to be good, despite some perceived delays between movements and VR projections. Movement kinematic analysis confirmed task adherence. Conclusions The new “virtual mirror” extends existing VR systems for motor and pain rehabilitation by enabling the use of realistic full-body avatars and scaled feedback. Proof-of-concept was demonstrated for the assessment of body perception during active movement in healthy controls. The next step will be to apply this system to assessment of body perception disturbances in patients with chronic pain.
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Affiliation(s)
| | | | | | | | | | | | - Catherine Mercier
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale (CIRRIS), 525 Boul Hamel, Québec, QC G1M 2S8, Canada.
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Perron M, Moffet H, Nadeau S, Hébert LJ, Belzile S. Persistence of long term isokinetic strength deficits in subjects with lateral ankle sprain as measured with a protocol including maximal preloading. Clin Biomech (Bristol, Avon) 2014; 29:1151-7. [PMID: 25451862 DOI: 10.1016/j.clinbiomech.2014.09.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [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] [Received: 02/13/2014] [Revised: 09/19/2014] [Accepted: 09/23/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND The assessment of muscle function is a cornerstone in the management of subjects who have sustained a lateral ankle sprain. The ankle range of motion being relatively small, the use of preloading allows to measure maximal strength throughout the whole amplitude and therefore to better characterize ankle muscles weaknesses. This study aimed to assess muscle strength of the injured and uninjured ankles in subjects with a lateral ankle sprain, to document the timeline of strength recovery, and to determine the influence of sprain grade on strength loss. METHODS Maximal torque of the periarticular muscles of the ankle in a concentric mode using a protocol with maximal preloading was tested in 32 male soldiers at 8 weeks and 6 months post-injury. FINDINGS The evertor muscles of the injured ankles were weaker than the uninjured ones at 8 weeks and 6 months post-injury (P<0.0001, effect size=0.31-0.42). Muscle weaknesses also persisted in the plantarflexors of the injured ankles at 8 weeks (P=0.0014, effect size=0.52-0.58) while at 6 months, only the subjects with a grade II sprain displayed such weaknesses (P<0.0001, effect size 0.27-0.31). The strength of the invertor and dorsiflexor muscles did not differ between sides. INTERPRETATION The use of an isokinetic protocol with preloading demonstrates significant but small strength deficits in the evertor and plantarflexor muscles. These impairments may contribute to the high incidence of recurrence of lateral ankle sprain in very active individuals.
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Affiliation(s)
- Marc Perron
- Department of Rehabilitation, Faculty of Medicine, Laval University, Canada; Centre de santé Valcartier, Valcartier, Canada.
| | - Hélène Moffet
- Department of Rehabilitation, Faculty of Medicine, Laval University, Canada; Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec Rehabilitation Institute, Canada.
| | - Sylvie Nadeau
- School of Rehabilitation, Faculty of Medicine, University of Montreal, Canada; Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Canada.
| | - Luc J Hébert
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec Rehabilitation Institute, Canada; Department of Radiology, Faculty of Medicine, Laval University, Canada; National Defense of Canada, CFHS HQ-D Med Pol, Canada.
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Gagnon C, Meola G, Hébert LJ, Puymirat J, Laberge L, Leone M. Report of the first Outcome Measures in Myotonic Dystrophy type 1 (OMMYD-1) international workshop. Neuromuscul Disord 2013; 23:1056-68. [DOI: 10.1016/j.nmd.2013.07.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 07/09/2013] [Indexed: 10/26/2022]
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Hiba B, Richard N, Hébert LJ, Coté C, Nejjari M, Vial C, Bouhour F, Puymirat J, Janier M. Quantitative assessment of skeletal muscle degeneration in patients with myotonic dystrophy type 1 using MRI. J Magn Reson Imaging 2011; 35:678-85. [PMID: 22069222 DOI: 10.1002/jmri.22849] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Accepted: 09/21/2011] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To identify MRI biomarkers that could be used to follow disease progression and therapeutic efficacy in one individual muscle in patients with myotonic dystrophy type 1 (DM1). MATERIALS AND METHODS Lower limb MRI and maximal ankle dorsiflexor strength assessment, using a hand-held dynamometer, were performed in 19 DM1 patients and 6 control subjects. The volume of residual muscle tissue of Tibialis Anterior (TA) muscle was chosen as an index for muscle atrophy, and the T2-relaxation-time of the residual muscle tissue was measured to evaluate edema-like lesions. The fat-to-water ratio was assessed using three-point Dixon images to quantify fat infiltration in the entire muscle. RESULTS The intra-observer variability of MRI indices (∼5.2% for the residual muscle tissue volume and 2.5% for the fat-to-water ratio) was lower than that of the dorsiflexor torque measurement (∼11.5%). A high correlation (r = 0.91) was found between maximal ankle dorsiflexor strength and residual TA muscle tissue volume in DM1 patients. Increases in the fat-to-water ratio and T2-relaxation-time were associated with a decrease in maximal ankle dorsiflexor strength. CONCLUSION MRI appears as a noninvasive method which can be used to follow disease progression and therapeutic efficacy.
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Affiliation(s)
- Bassem Hiba
- Université de Lyon, Université Lyon 1, Faculté de médecine Lyon Est, Lyon, France.
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