Purpose: Sex- and gender-based factors can act as barriers to stroke recovery. The primary objective of this study was to describe and explore potential sex- and gender-based characteristics that may be associated with the clinical responses of six participants to a 4-week telerehabilitation programme. Method: Using a multiple case study design and purposeful sampling (age and stroke severity), we contrasted and compared responses of three male and three female participants. Participants completed four assessments: pre- and post-intervention, 3- and 6-month follow-ups. Outcome measures were the Stroke Impact Scale-3 (SIS-3), 30-second sit-to-stand (30sSTS) test, and Activity-Specific Balance Confidence Scale. Sex- and gender-based characteristics were reported, and individual trajectories were described. Results: Female participants had more favourable trajectories in emotion, memory and thinking, mobility, participation domains of the SIS-3, and activity-specific balance confidence. Female participants also had sustained improvements in 30sSTS. Stroke type and marital status are among the personal characteristics of female participants that may explain the responses observed. Conclusion: The more favourable trajectories in many domains demonstrated by women could be explained by sex- and gender-based characteristics. Men possessed personal characteristics often associated with poorer functional recovery, contradicting sex- and gender-based disparities generalized to women with stroke. Objectif : des facteurs li & eacute;s au sexe et au genre peuvent compromettre le r & eacute;tablissement apr & egrave;s un accident vasculaire c & eacute;r & eacute;bral (AVC). Cette & eacute;tude avait comme objectif primaire de d & eacute;crire et d'explorer les caract & eacute;ristiques relatives au sexe et au genre susceptibles d'& ecirc;tre associ & eacute;es aux r & eacute;ponses cliniques de six participants & agrave; un programme de t & eacute;l & eacute;r & eacute;adaptation de quatre semaines. M & eacute;thodologie : & agrave; partir d'une m & eacute;thodologie de multiples & eacute;tudes de cas et d'un & eacute;chantillonnage raisonn & eacute; (& acirc;ge et gravit & eacute; des AVC), les auteurs ont contrast & eacute; et compar & eacute; les r & eacute;ponses de trois hommes et de trois femmes. Les participants ont effectu & eacute; quatre & eacute;valuations : avant et apr & egrave;s l'intervention, suivi au bout de trois mois, puis suivi au bout de six mois. Les mesures de r & eacute;sultats suivantes ont & eacute;t & eacute; privil & eacute;gi & eacute;es : la Stroke Impact Scale-3 (SIS-3 ou & eacute;chelle d'impact des AVC-3), le test du lever de chaise en 30 secondes (TLC30) et l'& eacute;chelle de confiance en l'& eacute;quilibre pendant l'activit & eacute;. Les caract & eacute;ristiques propres au sexe et au genre ont & eacute;t & eacute; d & eacute;clar & eacute;es, et les trajectoires individuelles, d & eacute;crites. R & eacute;sultats : les participantes avaient des trajectoires plus favorables sur le plan de l'& eacute;motion, de la m & eacute;moire et de la r & eacute;flexion, des domaines de participation de la SIS-3 et de la confiance en l'& eacute;quilibre pendant l'activit & eacute;. Elles ont & eacute;galement obtenu de meilleurs r & eacute;sultats au TLC30. Le type d'AVC et la situation familiale faisaient partie des caract & eacute;ristiques des participantes susceptibles d'expliquer les r & eacute;ponses observ & eacute;es. Conclusion : les trajectoires plus favorables des femmes dans bien des domaines pourraient s'expliquer par des caract & eacute;ristiques propres au sexe et au genre. Les hommes poss & eacute;daient des caract & eacute;ristiques personnelles souvent associ & eacute;es & agrave; un moins bon r & eacute;tablissement fonctionnel, qui contredisent les disparit & eacute;s li & eacute;es au sexe et au genre g & eacute;n & eacute;ralis & eacute;es chez les femmes qui ont v & eacute;cu un AVC.
Purpose: Physiotherapists can use point-of-care lung and thoracic ultrasonography (POCLTUS) to guide the diagnostic process and select appropriate interventions. Currently, there is limited information on how physiotherapists incorporate POCLTUS into clinical practice. This scoping review explores physiotherapist-performed POCLTUS and available evidence on physiotherapist training in POCLTUS for respiratory care. Method: Joanna Briggs Institute methodology and PRISMA-ScR guidelines were followed. MEDLINE, CINAHL, Emcare, Embase, and AMED were searched from inception to February 2024. Studies were excluded if they included therapeutic ultrasound, POCLTUS performed by non-physiotherapist health care providers, grey literature, or non-cardiorespiratory conditions. Data extracted included study design, population(s), purpose of POCLTUS, respiratory condition(s), and training. Results: Of 11,297 citations screened, 10 studies met inclusion criteria, involving 481 patients aged 7 days to 76 years. Most studies were conducted in adult (7) versus paediatric (3) populations. Physiotherapist-led POCLTUS is reported to be used to diagnose, assess, and guide treatment of conditions such as atelectasis, consolidation, pneumothorax, and pleural effusion. It is also used to measure diaphragmatic thickness and excursion, and as a biofeedback tool during treatment. Few studies described physiotherapist training. Conclusion: POCLTUS is increasingly integrated into cardiorespiratory physiotherapy practice. Further research is needed on physiotherapist training in POCLTUS use. Objectif : les physioth & eacute;rapeutes peuvent utiliser l'& eacute;chographie pulmonaire et thoracique au point d'intervention (POCLTUS) pour orienter le processus diagnostique et s & eacute;lectionner les interventions appropri & eacute;es. & Agrave; l'heure actuelle, l'information sur la mani & egrave;re dont les physioth & eacute;rapeutes int & egrave;grent la POCLTUS & agrave; leur pratique clinique est limit & eacute;e. Cette revue exploratoire porte sur les POCLTUS effectu & eacute;es par des physioth & eacute;rapeutes et sur les donn & eacute;es probantes disponibles & agrave; l'& eacute;gard de la formation des physioth & eacute;rapeutes en POCLTUS pour les soins respiratoires. M & eacute;thodologie : la m & eacute;thodologie du Joanna Briggs Institute et les directives PRISMA-ScR ont & eacute;t & eacute; respect & eacute;es. Les bases de donn & eacute;es MEDLINE, CINAHL, Emcare, Embase et AMED ont & eacute;t & eacute; fouill & eacute;es & agrave; compter de leur cr & eacute;ation jusqu'en f & eacute;vrier 2024. Les & eacute;tudes & eacute;taient exclues si elles portaient sur une & eacute;chographie th & eacute;rapeutique, une POCLTUS effectu & eacute;e par un prestataire de soins non physioth & eacute;rapeute, de la documentation parall & egrave;le ou des affections non cardiorespiratoires. Les donn & eacute;es extraites incluaient la m & eacute;thodologie des & eacute;tudes, les populations, l'objectif de la POCLTUS, les affections respiratoires et la formation. R & eacute;sultats : des 11 295 & eacute;tudes examin & eacute;es, dix respectaient les crit & egrave;res d'inclusion et touchaient 481 patients de sept & agrave; 76 ans. La plupart des & eacute;tudes (sept) ont & eacute;t & eacute; r & eacute;alis & eacute;es aupr & egrave;s d'adultes, et les autres, aupr & egrave;s de populations p & eacute;diatriques (trois). Les POCLTUS effectu & eacute;es par des physioth & eacute;rapeutes sont utilis & eacute;es pour diagnostiquer, & eacute;valuer et orienter le traitement d'affections comme l'at & eacute;lectasie, la consolidation, le pneumothorax et l'& eacute;panchement pleural. Elles servent & eacute;galement & agrave; mesurer l'& eacute;paisseur et l'excursion du diaphragme et repr & eacute;sentent un outil de r & eacute;troaction biologique utile pendant le traitement. Peu d'& eacute;tudes d & eacute;crivaient la formation des physioth & eacute;rapeutes. Conclusion : la POCLTUS est de plus en plus int & eacute;gr & eacute;e & agrave; la pratique de la physioth & eacute;rapie cardiorespiratoire. D'autres recherches devront & ecirc;tre r & eacute;alis & eacute;es sur la formation des physioth & eacute;rapeutes en POCLTUS.
Purpose: To determine the relationship between patient characteristics and treatment fidelity in adult ICU patients enrolled in the CYCLE Pilot randomized controlled trial. Method: We conducted a secondary analysis of a pilot trial in which patients were randomly assigned to in-bed cycling plus usual physiotherapy (PT) or usual PT alone. We calculated protocol fidelity for each patient as the proportion of planned days when the assigned treatment was delivered or did not occur due to medical instability. Using multiple linear regression, we assessed the association of protocol fidelity with admission severity of illness, sex, assigned treatment, baseline comorbidities, and frailty. Results: Sixty-six patients were enrolled in this pilot trial (36 cycling, 30 usual PT) with a median (1st-3rd quartiles) protocol fidelity of 100% (83%-100%), 89% (75%-100%) in cycling and 100% (90%-100%) in usual PT. By regression analysis, assignment to in-bed cycling plus usual PT was associated with a 9.7% (95% CI: -17.8, -1.5) lower protocol fidelity compared to usual PT alone. Conclusions: We found those in the usual PT group had higher protocol fidelity; no other associations were found. This study offers an analytic approach for trialists to assess treatment fidelity for rehabilitation interventions in clinical trials. Objectif : d & eacute;terminer la relation entre les caract & eacute;ristiques des patients et la fid & eacute;lit & eacute; au traitement chez les patients adultes en soins intensifs recrut & eacute;s dans l'& eacute;tude pilote randomis & eacute;e et contr & ocirc;l & eacute;e CYCLE. M & eacute;thodologie : les auteurs ont r & eacute;alis & eacute; l'analyse secondaire d'une & eacute;tude pilote au cours de laquelle les patients ont & eacute;t & eacute; randomis & eacute;s entre le v & eacute;lo de lit et la physioth & eacute;rapie habituelle, d'une part, et la physioth & eacute;rapie seule, d'autre part. Ils ont calcul & eacute; la fid & eacute;lit & eacute; au protocole de chaque patient selon la proportion de jours planifi & eacute;s lorsque le traitement administr & eacute; & eacute;tait donn & eacute; ou ne l'& eacute;tait pas en raison d'une instabilit & eacute; m & eacute;dicale. Selon la r & eacute;gression lin & eacute;aire multiple, les chercheurs ont & eacute;valu & eacute; l'association entre la fid & eacute;lit & eacute; au protocole et la gravit & eacute; de la maladie, le sexe, le traitement administr & eacute;, les maladies connexes au d & eacute;part et la fragilit & eacute;. R & eacute;sultats : au total, 66 patients ont & eacute;t & eacute; recrut & eacute;s dans cette & eacute;tude pilote (36 & agrave; v & eacute;lo, 30 en physioth & eacute;rapie seule), pour une fid & eacute;lit & eacute; au protocole m & eacute;dian (1er au 3e quartiles) de 100 % (83 % & agrave; 100 %), de 89 % (75 % & agrave; 100 %) & agrave; v & eacute;lo et de 100 % (90 % & agrave; 100 %) en physioth & eacute;rapie habituelle. Selon l'analyse de r & eacute;gression, l'affectation au v & eacute;lo de lit en plus de la physioth & eacute;rapie habituelle & eacute;tait associ & eacute;e & agrave; une fid & eacute;lit & eacute; au protocole plus faible de 9,7 % (IC & agrave; 95 %, -17,8, -1,5) que la physioth & eacute;rapie habituelle. Conclusions : les auteurs ont d & eacute;couvert que les sujets dans le groupe de physioth & eacute;rapie habituelle pr & eacute;sentaient une fid & eacute;lit & eacute; au protocole plus & eacute;lev & eacute;e, mais aucune autre association n'a & eacute;t & eacute; constat & eacute;e. Cette & eacute;tude offre une approche analytique pour que les responsables de l'& eacute;tude & eacute;valuent la fid & eacute;lit & eacute; au traitement lors des interventions de r & eacute;adaptation dans les & eacute;tudes cliniques.
Abstract Purpose: To explore participant characteristics of exercise oncology trials in Canada over the past 10 years for individuals with a current or past diagnosis of breast cancer. Method: Six databases were searched from 2014 to January 2024. Studies that involved adults ≥18 years old with a current or past diagnosis of breast cancer and a physical activity/exercise clinical trial of any kind and took place in Canada in the last 10 years were included. Two independent reviewers completed all screening and data extraction. Data were summarized narratively, and descriptive statistics were provided where applicable. Results: Forty studies were included in the review. Most participants were White women, diagnosed with stage II breast cancer, with a mean age of 51.7 years. The remaining participants identified as Asian, Hispanic, Indigenous, Black, or other. Most studies excluded participants with stage IV breast cancer. A combination of resistance and aerobic based interventions were most common. Conclusions: Disparities in access to exercise oncology trials for individuals with breast cancer result in a consistent demographic being represented, while many populations remain excluded from the research. These findings highlight the need for future research to address the gaps in accessibility present in Canada.
Purpose: Dry needling (DN) regulations among the Canadian physiotherapy colleges were compiled to make recommendations toward a national guideline. Method: DN regulatory data extracted from regulatory body websites using an environmental scan framework was checked by an independent reviewer. Colleges were contacted to fill gaps identified from the web. Extracted content was compared to recommendations from two Canadian DN reviews to identify gaps in regulation. Results: DN regulation is done through legislation (two colleges), practice guidelines (one), or both (seven), depending on the college and its provincial or territorial jurisdiction. Three colleges have prerequisites for DN courses, four have approved DN courses, nine require specific course content, three require minimum course hours, nine require registration or rostering, and three have continued competency expectations. No colleges have evidence-based guidelines to inform requirements or meet all DN recommendations. Conclusions: Heterogeneity in regulation likely represents gaps that may potentially expose the public to risk. Physiotherapy colleges could review their regulatory process, address these gaps if they are deemed related to increase risk, and ultimately come to a consensus on what are the safest regulations of practice for Canadian physiotherapists. Objectif : la r & egrave;glementation sur les aiguilles s & egrave;ches au sein des ordres de physioth & eacute;rapie canadiens a & eacute;t & eacute; compil & eacute;e pour formuler des recommandations en vue de directives nationales. M & eacute;thodologie : un analyste ind & eacute;pendant a examin & eacute; les donn & eacute;es de r & egrave;glementation sur les aiguilles s & egrave;ches tir & eacute;es des sites Web des organismes de r & egrave;glementation au moyen d'un cadre d'analyse environnementale. Les ordres ont & eacute;t & eacute; sollicit & eacute;s pour compl & eacute;ter l'information de leur site Web. Le contenu extrait a & eacute;t & eacute; compar & eacute; aux recommandations de deux analyses canadiennes sur les aiguilles s & egrave;ches afin de relever les lacunes en mati & egrave;re de r & egrave;glementation. R & eacute;sultats : la r & egrave;glementation sur les aiguilles s & egrave;ches provient de la l & eacute;gislation (deux ordres), de directives cliniques (un ordre) ou de ces deux volets (sept ordres) selon l'ordre et les champs d'application provinciaux ou territoriaux. Trois ordres avaient & eacute;tabli des conditions pr & eacute;alables aux cours sur les aiguilles s & egrave;ches, quatre imposaient des cours approuv & eacute;s sur les aiguilles s & egrave;ches, neuf exigeaient de couvrir de la mati & egrave;re particuli & egrave;re dans les cours, trois requ & eacute;raient un nombre minimal d'heures de cours, neuf pr & eacute;voyaient une inscription et trois avaient des attentes en mati & egrave;re de comp & eacute;tences continues. Aucun ordre ne disposait de directives fond & eacute;es sur des donn & eacute;es probantes pour & eacute;clairer les exigences ou le respect de toutes les recommandations relatives aux aiguilles s & egrave;ches. Conclusion : selon toute probabilit & eacute;, l'h & eacute;t & eacute;rog & eacute;n & eacute;it & eacute; de la r & egrave;glementation repr & eacute;sente des lacunes susceptibles d'exposer le public & agrave; des risques. Les ordres de physioth & eacute;rapie pourraient revoir leur processus de r & egrave;glementation, corriger les lacunes si elles sont consid & eacute;r & eacute;es comme susceptibles d'accro & icirc;tre les risques et en venir & agrave; un consensus sur la r & egrave;glementation la plus s & eacute;curitaire relative & agrave; la pratique pour les physioth & eacute;rapeutes canadiens.
