72 research outputs found
Supplementary_file_Questions_Interview_-_copie – Supplemental material for Tensions Living Out Professional Values for Physical Therapists Treating Injured Workers
No full textSupplemental material, Supplementary_file_Questions_Interview_-_copie for Tensions Living Out Professional Values for Physical Therapists Treating Injured Workers by Anne Hudon, Debbie Ehrmann Feldman and Matthew Hunt in Qualitative Health Research</p
Risk factors for the development of low back pain in adolescents
No full textA previous history and earlier age of onset of low back pain are associated with chronic low back pain in adults. As such, preventing low back pain in adolescence may have a positive impact in adulthood. The objectives of this study were to determine the incidence of low back pain in a cohort of adolescents and to ascertain whether it was associated with increased growth spurt, decreased muscle flexibility and trunk strength, physical activity, and work. A prospective cohort design with urban high school students was conducted in Montreal, Canada; 502 students were evaluated at three separate times, six months apart. The students completed a questionnaire which addressed health issues of a musculoskeletal nature as well as lifestyle and psychosocial variables. They were also measured for: height, weight, leg and back flexibility, and trunk strength. Questions on low back pain referred to the previous six months and a frequency of occurrence of at least once a week was considered to represent positive reporting. Cumulative incidence of low back pain was then defined as the sum of incident reporting in the two six-month periods, excluding those who reported low back pain at study entry. A multivariate analysis (general estimating equations analysis) was used to model the repeated measures dichotomous outcome as a function of age, gender, smoking status and the repeated measures exposure variables: increased growth, flexibility, strength, activity, work. Of the 377 adolescents who did not complain of low back pain at the initial evaluation, 65 developed substantial back pain over the course of the year (cumulative incidence 17%). Risk factors associated with development of low back pain were: high growth (relative risk 3.00, 95% confidence interval (C.I.) 1.47--6.11), smoking (relative risk 2.47, C.I. 1.31--4.66), working (relative risk 2.19, C.I. 1.12--4.28), and tight quadriceps femoris (relative risk 1.04, C.I. 1.01--1.07). We conclude that low back pain in adol
Discontinuation of Methotrexate Therapy in Older Patients with Newly Diagnosed Rheumatoid Arthritis
No full textThe incidence of juvenile rheumatoid arthritis in Quebec: a population data-based study
Get PDFAbstract Objective To determine the population incidence of juvenile rheumatoid arthritis (JRA) in Quebec. Methods We obtained data from Quebec's physician claims database. Incident cases were defined as having a visit for JRA in 2000, no visit in the previous 3 years, a confirmed diagnosis by an arthritis specialist, or having ≥ 2 visits to any physician for JRA, ≥ 2 months apart but within 2 years. Results Cumulative incidence of JRA was 17.8/100,000. Mean age at diagnosis was 9.8 ± 4.6 years, 68% were female and more persons were diagnosed in winter. Subjects had a median of 10 medical visits over the first year. Conclusion Our population based incidence estimate was similar to others. Children and adolescents with JRA are heavy users of medical care. Additional study of environmental or climate- related triggers may be warranted.</p
Tensions living out professional values for physical therapists treating injured workers
No full textHealth care services provided by workers’ compensation systems aim to facilitate recovery for injured workers. However, some features of these systems pose barriers to high quality care and challenge health care professionals in their everyday work. We used interpretive description methodology to explore ethical tensions experienced by physical therapists caring for patients with musculoskeletal injuries compensated by Workers’ Compensation Boards. We conducted in-depth interviews with 40 physical therapists and leaders in the physical therapy and workers’ compensation fields from three Canadian provinces and analyzed transcripts using concurrent and constant comparative techniques. Through our analysis, we developed inductive themes reflecting significant challenges experienced by participants in upholding three core professional values: equity, competence, and autonomy. These challenges illustrate multiple facets of physical therapists’ struggles to uphold moral commitments and preserve their sense of professional integrity while providing care to injured workers within a complex health service system
Physiotherapy for injured workers in Canada: are insurers’ and clinics’ policies threatening good quality and equity of care? Results of a qualitative study
No full textAbstract Background In recent years, significant efforts have been made to improve the provision of care for compensated injured workers internationally. However, despite increasing efforts at implementing best practices in this field, some studies show that policies overseeing the organisation of care for injured workers can have perverse influences on healthcare providers’ practices and can prevent workers from receiving the best care possible. The influence of these policies on physiotherapists’ practices has yet to be investigated. Our objectives were thus to explore the influence of 1) workers’ compensation boards’ and 2) physiotherapy clinics’ policies on the care physiotherapists provide to workers with musculoskeletal injuries in three large Canadian provinces. Methods The Interpretive Description framework, a qualitative methodological approach, guided this inquiry. Forty participants (30 physiotherapists and 10 leaders and administrators from physiotherapy professional groups and workers’ compensation boards) were recruited in British Columbia, Ontario and Quebec to participate in an in-depth interview. Inductive analysis was conducted using constant comparative techniques. Results Narratives from participants show that policies of workers’ compensation boards and individual physiotherapy clinics have significant impacts on physiotherapists’ clinical practices. Policies found at both levels often place physiotherapists in uncomfortable positions where they cannot always do what they believe to be best for their patients. Because of these policies, treatments provided to compensated injured workers markedly differ from those provided to other patients receiving physiotherapy care at the same clinic. Workers’ compensation board policies such as reimbursement rates, end points for treatment and communication mechanisms, and clinic policies such as physiotherapists’ remuneration schemes and restrictions on the choice of professionals had negative influences on care. Policies that were viewed as positive were board policies that recognize, promote and support physiotherapists’ duties and clinics that provide organisational support for administrative tasks. Conclusion In Canada, workers’ compensation play a significant role in financing physiotherapy care for people injured at work. Despite the best intentions in promoting evidence-based guidelines and procedures regarding rehabilitation care for injured workers, complex policy factors currently limit the application of these recommendations in practice. Research that targets these policies could contribute to significant changes in clinical settings
Clinical methods for quantifying body segment posture: a literature review
Get PDFPurpose. Clinicians commonly assess posture in persons with musculoskeletal disorders and tend to do so subjectively. Evidence-based practice requires the use of valid, reliable and sensitive tools to monitor treatment effectiveness. The purpose of this article was to determine which methods were used to assess posture quantitatively in a clinical setting and to identify psychometric properties of posture indices measured from these methods or tools.
Methods. We conducted a comprehensive literature review. Pertinent databases were used to search for articles on quantitative clinical assessment of posture. Searching keywords were related to posture and assessment, scoliosis, back pain, reliability, validity and different body segments.
Results. We identified 65 articles with angle and distance posture indices that corresponded to our search criteria. Several studies showed good intra- and inter-rater reliability for measurements taken directly on the persons (e.g., goniometer, inclinometer, flexible curve and tape measurement) or from photographs, but the validity of these measurements was not always demonstrated.
Conclusion. Taking measurements of all body angles directly on the person is a lengthy process and may affect the reliability of the measurements. Measurement of body angles from photographs may be the most accurate and rapid way to assess global posture quantitatively in a clinical setting.CIHR / IRS
Primary care management for isolated limb injury: Referral to orthopedic surgery in a trauma center
No full textIntroduction: Musculoskeletal injuries affect up to 13% of adults annually. Despite this high incidence, quality of primary care, including analgesia, may be sub-optimal. The goal of this study is to describe the quality of primary care for ambulatory patients with isolated limb injury and to identify related factors.
Methods: A cross sectional study was undertaken prospectively on 166 consecutive ambulatory adult patients with isolated limb injury who presented to orthopedics service in a Level one Trauma Centre. Quality of care was assessed by evaluating analgesia, walking aids, immobilization, and quality of referral diagnosis according to actual expert recommendations.
Results: This study revealed low quality of primary care for 82 (53.2%) of injured patients. Seventy-three patients (50.3%) had pain level over 5/10 and 45 cases (28.5%) had insufficient/absent analgesia prescriptions. Fifty-one (32.3%) had unacceptable immobilization and 21/59 (35.6%) patients with a lower limb injury did not receive a walking aid prescription. A total of 61 patients (36.7%) had an absent or inadequate referral diagnosis. Factors associated with lower quality depended on the specific quality indicator and included: living further away from the hospital, younger age, initially consulting at another health care center, having a fracture, and being a smoker.
Conclusion: The high frequency of low quality of care underlines the necessity for orthopedic surgeons to be involved in primary care education. Identifying factors associated with lower quality of care will orient efforts to improve medical care of patients with isolated traumatic injury
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No full textABSTRACT. Objective. To describe leisure activities of children and adolescents with juvenile idiopathic arthritis (JIA) in terms of diversity, intensity, and enjoyment, and to identify potential determinants. Methods. One hundred seven children and adolescents aged 8-17 years diagnosed with JIA and their families participated in this cross-sectional study. Participants answered the Children's Assessment of Participation and Enjoyment, which measures involvement in leisure (recreation, active physical, social, skill-based, self-improvement). Disease characteristics and sociodemographic factors were abstracted from the child's medical file. Results. In terms of intensity, individuals with JIA were more often engaged in informal rather than formal leisure activities [t(106) = 45.5, p < 0.0001]. When intensity scores were compared across activity type, results showed that participants with JIA were most often involved in social and recreational activities (p < 0.001). The level of enjoyment was highest for social activities and lowest for self-improvement activities (p < 0.001). Those with active arthritis displayed less diverse (p = 0.016) and less intense (p = 0.011) participation in active physical activities, and less frequent involvement in informal activities (p = 0.043) compared with those who were asymptomatic
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