Purpose: The aim of this case report is to describe the design, implementation, and outcomes of a near peer instructor (NPI) placement for a physiotherapy student. Client Description: Participants included a Year-2 placement student (the NPI), Year-1 students from the McMaster Master of Science (Physiotherapy) Program, the anatomy instructor (AI), and the director of clinical education (DCE). Intervention: The AI and DCE designed a two day/week placement whereby the NPI developed and facilitated clinical application stations during scheduled anatomy and physiology (A&P) sessions with Year-1 physiotherapy students. Measures and Outcomes: Students, the AI and NPI provided feedback through surveys for the purpose of placement evaluation. Implications: Three areas of impact of this placement model were identified: (1) greater perceived ability of learners to integrate A&P knowledge with clinical skills, (2) NPI growth in transferrable skills and the seven essential competencies required of physiotherapists in Canada, and (3) additional clinically relevant A&P curricular resources.

Purpose: We investigated the effects of 1- and 3-week of absolute immobilization duration on pain, range of motion (ROM), shoulder function, and recurrence rate on shoulder arthroscopic anterior capsulolabral repair (AACR) patients. Method: Fifty shoulder AACR patients’ pain intensity, shoulder ROM, and function were evaluated 4, 8, and 12 weeks after surgery (1-week group: 26; 3-week group: 24 patients). Function was assessed with American Shoulder and Elbow Surgeons (ASES) score at postoperative 12 weeks and final follow-up (average of postoperative 30 months). Whether there was a re-dislocation after surgery was also questioned at final follow-up. Results: Similar ROM were observed on both groups at the postoperative 4, 8, and 12 weeks ( p > 0.05). Pain intensities at rest ( p = 0.40), night ( p = 0.22), and during the activity ( p = 0.49) were also similar on both groups. Also, no difference was observed for function between the two groups ( p = 0.99). Only one re-dislocation was in the 3-week immobilization group. Conclusion: Both 1- and 3-week of absolute immobilization demonstrated similar results in terms of shoulder ROM, pain, function, and recurrence rate after the shoulder AACR. Furthermore, earlier mobilization led to higher shoulder flexion at 4 weeks postoperatively. Either of the rehabilitation approaches can be adopted based on the patient's situation.

Purpose: Evaluate the feasibility of transcranial direct current stimulation (tDCS) as an adjunct to inpatient physiotherapy for children and youth with acquired brain injury (ABI). Method: This randomized feasibility trial allocated children (5–18 years of age with moderate to severe ABI) to receive either active or sham anodal tDCS immediately prior to 16 of their existing inpatient physiotherapy sessions. Participants, physiotherapists, assessors, and primary investigators were blinded to treatment allocation. Eligibility, recruitment, retention, tolerance, and preliminary treatment outcomes were evaluated against a priori feasibility targets. Results: Of 232 children admitted over 21 months, six were eligible (2.6%) and four were recruited (66.7%). One participant completed the entire study protocol, two were withdrawn for unrelated changes in medical stability, and one could not commence the study due to COVID-19 restrictions. Participants completed all tDCS sessions that were started with the primary transient side effect being sub-electrode itchiness. Conclusions: While the study was infeasible from eligibility and retention perspectives, study procedures (e.g., assessment, treatment, side effect tracking, physiotherapy documentation) were viable and should be applied to future paediatric tDCS studies.

Purpose: To identify the entry-level curricular content related to Indigenous health recommended for entry-level physiotherapy (PT) programs in Canada and other similar countries. Methods: Design: Scoping review. Procedures: Four electronic databases were searched using the terms physiotherapy, Indigenous health, entry-level curriculum, and their derivatives. Grey literature sources were hand searched and included Canadian PT professional documents, PT Program websites, Truth and Reconciliation Commission (TRC) sources, and a Google search. Data related to curriculum characteristics, methods of delivery, and barriers and facilitators to implementation were extracted from relevant references. Stakeholders reviewed study findings. Results: Forty-five documents were included. Documents focused on Indigenous peoples in Canada, Aboriginal and Torres Strait Islanders in Australia, and Māori in New Zealand. Canadian PT programs appeared to rely on passive teaching methods while programs in Australia and New Zealand emphasized the importance of partnering and engaging with Indigenous people. Barriers to incorporating indigenous health curriculum included an overcrowded curriculum and difficulty establishing relevance of Indigenous content (i.e., meaning). Conclusions: Similarities and differences were found between curricula content and approaches to teaching IH in Canada and the other countries reviewed. Strategies to promote greater engagement of Indigenous people in the development and teaching of IH is recommended.

Purpose: Brachial plexus birth injury (BPBI) is a neonatal injury occurring in 1.24 in 1000 live births. The result of this injury on arm function is highly variable and has been the subject of many studies. However, the effect of BPBI on the development of overall gross motor function is less well studied. We aimed to synthesize the available literature on posture, balance and coordination, and gait in children with BPBI. Method: A scoping review was conducted by searching five databases (MEDLINE, EMBASE, CINAHL, PEDro, and Web of Science) and the grey literature for all study types related to our question. Studies unrelated to birth injuries, animal studies, and literature reviews were excluded. Three researchers independently screened the studies during two rounds of review (title/abstract and full-text). Results: Of the 2728 articles found, 16 articles were included. Overall, the average study quality was 0.90 out of 1.00. These studies suggest that observed postural deficits in BPBI are secondary to asymmetry rather than true scoliosis. Further, the asymmetrical nature of the injury results in both balance deficits and gait abnormalities when compared to healthy age-matched populations. Conclusions: The scoping review demonstrates that while there are obvious consequences to overall motor function and development in BPBI, these effects are likely under-studied. Further research should focus on understanding overall developmental differences in children with BPBI. Expanding on this information could possibly allow for earlier intervention, extended scope of physiotherapy, and better functional outcomes.

Purpose: This study examined the differential pattern of obesity between men and women with severe OA of the knee or hip joint. The relationship between creatinine, a pro-inflammatory parameter and obesity, sex, and site of joint involvement was examined. Design: This study involved a secondary analysis of prospectively collected data of patients who underwent hip or knee arthroplasty. Results: Data of 5,130 patients (1,989 males, 39%, 3,141 females, 62%), mean age: 66 (11) were used for data analysis. Of these patients, 2,038 patients underwent hip and 3,092 patients underwent knee arthroplasty. Prevalence of obesity (grade I and II) was higher in the TKA group as compared with THA group (55% vs. 38%) with the prevalence of morbid obesity (Grade II) being twice as many in the TKA group (27% vs. 14%), p < 0.001. There was a statistically significant association between obesity and site of joint involvement ( p < 0.001) and for the interaction between sex of the patient and site of arthritis ( p < 0.001). In the TKA group, the sex factor was the only factor that was related to the pre-op creatinine level ( p < 0.001). In THA group, both sex ( p < 0.001) and obesity ( p = 0.002) showed an association with pre-op creatinine. Conclusion: This study provides further evidence that obesity has a multifaceted interaction with osteoarthritis with a differential pattern in hip and knee joints. Creatinine considered as a pro-inflammatory factor appears to have a differential role in hip and knee OA.

Objectives: To verify the 6–minute peg board and ring test (6PBRT) validity for functional evaluation in hemodialysis patients and upper limb (UL) functional capacity by the 6PBRT. Methods: In a cross–sectional study, patients on hemodialysis three times a week for at least 6 months performed the 6PBRT as well as handgrip strength and endurance. Health–related quality of life (HRQoL) by KDQOL–SF questionnaire, Human Activities Profile (HAP), and level of social participation were also evaluated. Convergent validity was verified by correlation analysis. Results: Thirty–seven individuals were evaluated, predominantly adult males (67.6%). The mean age was 50.1 ± 16.4 years old. The average number of rings moved during the 6PBRT was 306.2 ± 68.2. The 6PBRT correlated with handgrip strength ( r = 0.37; p = 0.025), the domain “Functional Capacity” ( r = 0.49; p = 0.008) of the KDQOL–SF questionnaire, and with HAP score ( r = 0.43; p = 0.01). There was no correlation between handgrip endurance ( r = 0.18; p = 0.281) and social participation ( r = −0.12; p = 0.48). Heart rate and dyspnea (modified Borg scale) increased by 13.3 bpm (95% CI: 9.8, 16.8) and 0.5 points (95% CI: 0.1, 0.9) during the 6PBRT. Conclusion: The 6PBRT is associated with UL strength, physical aspects related to HRQoL, and daily activity level, which accounts for its construct validity. Therefore, the test has potential value in the functional evaluation of the ULs in hemodialysis patients. However, in this population, the level of social participation seems to depend on other factors than the functional capacity of the UL itself.

Purpose: Pelvic health physiotherapy is an emerging and sensitive area of practice that offers effective conservative treatment for pelvic health conditions. Canadian entry-to-practice curriculum guidelines accord programs considerable flexibility regarding incorporating pelvic health content, which may lead to differences between programs and diverse levels of competence among new graduates. The purpose of this study was to determine the nature and extent to which pelvic health content is incorporated in entry-to-practice physiotherapy programs in Canada. Method: We conducted a descriptive cross-sectional e-survey of representatives from Canadian entry-to-practice physiotherapy programs. Results: Ten out of 15 Canadian programs participated. Programs incorporated pelvic health content throughout the required curriculum ( n = 9) and in optional courses ( n = 6). All participating programs covered musculoskeletal-related conditions, urinary incontinence, and pelvic pain conditions, and included anatomy and physiology, clinical reasoning, subjective assessment and pelvic floor muscle training topics. Three programs trained students in internal pelvic floor techniques in elective courses. All programs covered cisgender women populations, however, transgender populations were seldom covered. Conclusions: This study provides an understanding of pelvic health curricular content that can serve as a first step towards standardizing and improving entry-level pelvic health training in Canada.

Purpose: This study is the second part of a cross-sectional questionnaire aiming to identify Canadian physiotherapists needs and strategies for physiotherapy associations to improve cultural competence in physiotherapy. Methods: We conducted a descriptive qualitative analysis of one open-ended question of a cross-sectional questionnaire. We used inductive thematic analysis to develop and modify codes as concepts emerged. Inductive analysis was used to develop the codebook from the qualitative finding of the research study. Results: We received a total of 806 responses, and of those individuals, 485 provided one to three suggestions as part of the open-ended question. We identified two major themes from our open-ended question: (1) education and (2) institutional change. There were four subthemes categorized under education: (1) Diversity, Equity, Inclusion (DEI) training opportunities, (2) resources, (3) accessibility to education, and (4) representation within educational resources. Institutional change was categorized into three subthemes: (1) advocacy, (2) support, and (3) representation in leadership. Conclusions: The results of this questionnaire act as a meaningful and necessary call to action to key stakeholders in the physiotherapy profession. Clinical Impact: There is a need for educational institutions, regulatory bodies, and associations to re-evaluate policies surrounding cultural competence to improve the delivery of culturally safe healthcare.

Purpose: To describe the impact of COVID-19 on the adoption and use of telerehabilitation (TR), and to identify facilitators and barriers of the provision in Ontario physiotherapy outpatient/community settings. Methods: A cross-sectional design, web-based survey was disseminated to Ontario physiotherapists working in outpatient/community settings. Descriptive statistics were used for data analysis. Results: Responses from 243 physiotherapists were included in the analysis. Respondents reported increasing and initiating TR to maintain continuity of care and limit patient COVID-19 exposure. Facilitators for adopting TR were physiotherapists’ attitudes and access to technology, convenience and ease of scheduling sessions, and perceived patient satisfaction and comfort in their home environment compared with in-person care. Patient related barriers for adopting TR perceived by respondents included patients’ attitude, suitability and ability to address their needs, ease of adoption, and internet connectivity. More than 50% of respondents perceived that financial factors did not influence TR adoption. Conclusion: Physiotherapists increased their use of TR through the COVID-19 pandemic. Effective implementation of TR should include both patient and physiotherapist education, and best practice guidelines on implementation of TR in order to create a hybrid model of care that would better address the patient’s needs.