Allison M. Ezzat

Are Joint Injury, Sport Activity, Physical Activity, Obesity, or Occupational Activities Predictors for Osteoarthritis? A Systematic Review

STUDY DESIGN Systematic review with meta-analysis. OBJECTIVES To identify risk factors for osteoarthritis (OA) of the knee, hip, and ankle, including joint injury, sport, physical activity, overweight/obesity, and occupational activity, in all age groups. BACKGROUND OA is a significant health problem worldwide, affecting up to 10% of men and 18% of women over 60 years of age. There has not been a comprehensive review examining modifiable physical risk factors associated with the onset of OA. This evidence is important to inform the physiotherapy management of individuals following onset of OA. METHODS Twelve electronic databases were systematically reviewed. The studies selected met the following criteria: (1) original data; (2) joint injury, sport activity, physical activity, overweight/obesity, and/or occupational activity investigated as risk factors; (3) outcomes included OA (hip, knee, and/or ankle); and (4) analytic component of study design. The data extracted included study design, years of follow-up, study population, OA definition, risk factors, and results (effect estimates reported or calculated where available). The quality of evidence was assessed based on a modified version of the Downs and Black checklist. RESULTS Joint injury, obesity, and occupational activity were associated with an increased risk of OA of the knee and hip. Sport and physical activity produced inconsistent findings. Joint injury was identified as a significant risk factor for knee OA (combined odds ratio = 3.8; 95% confidence interval: 2.0, 7.2) and hip OA (combined odds ratio = 5.0; 95% confidence interval: 1.4, 18.2), as was previous meniscectomy with or without anterior cruciate ligament injury for knee OA (combined odds ratio = 7.4; 95% confidence interval: 4.0, 13.7). There is a paucity of research examining risk factors associated with ankle OA; this review identified only 2 studies with this outcome. CONCLUSION Joint injury, obesity, and occupational activity are associated with an increased risk of knee and hip OA. Some findings remain inconclusive, including levels of physical activity and sport specificity in individuals who do not suffer an injury. Early identification of individuals at risk for OA provides an opportunity for physiotherapy management or other interventions to modify risk-related behavior. There is a need in the literature for additional high-quality studies, such as prospective cohort studies, that minimize potential bias in examining the relationship between physical risk factors and OA. LEVEL OF EVIDENCE Prognosis, level 2a-.

Reliability of Hip Examination Tests for Femoroacetabular Impingement

To assess the interrater reliability of hip examination tests used to assess femoroacetabular impingement (FAI) among clinicians from different disciplines.

Association Between Cumulative Joint Loading From Occupational Activities and Knee Osteoarthritis

To determine the associations between cumulative occupational physical load (COPL) and 3 definitions of knee osteoarthritis (OA).

Building Passion Develops Meaningful Mentoring Relationships among Canadian Physiotherapists

PURPOSE To describe the meaning of mentorship among Canadian orthopaedic physiotherapists. METHODS As part of a phenomenological qualitative study, 14 registered physiotherapists (13 women, 1 man) each participated in a single 60-minute, semi-structured face-to-face interview. Participants reflected on their experiences in receiving and providing mentorship and described the impact of mentorship on their careers. Interviews were transcribed verbatim and analyzed using a phenomenological approach. RESULTS Participants described mentorship as any nurturing process in which they used their skills and experience to guide, teach, and encourage a less skilled or less experienced colleague for the purpose of promoting professional and personal development. Participants experienced mentorship as a positive, reflective phenomenon. According to participants, the true essence of mentorship in physiotherapy consists of building passion, keeping fresh, making us stronger, and promoting deeper learning. CONCLUSIONS Building a shared passion for learning, as well as a mentors commitment to the mentees success, forms the foundation of meaningful mentorship in physiotherapy. These mentoring relationships enable physiotherapists to adapt to the changing health care system, advance patient care, and develop the profession.

The effects of interventions to increase exercise adherence in people with arthritis: a systematic review.

The Effects of Interventions to Increase Exercise Adherence in People with Arthritis: A Systematic Review Allison M. Ezzat PT, MClSc, MSc, Katie MacPherson MPT, Jenny Leese MA & Linda C. Li* PT, PhD Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada School of Population and Public Health, University of British Columbia, BC, Canada Port Coquitlam Physiotherapy and Sports Injury Clinic, Port Coquitlam, BC, Canada Arthritis Research Centre of Canada, Richmond, BC, Canada Child and Family Research Institute, Vancouver, BC, Canada

Knee confidence in youth and young adults at risk of post-traumatic osteoarthritis 3–10 years following intra-articular knee injury

OBJECTIVES To examine differences in knee confidence between individuals with a history of youth sport-related knee injury and uninjured controls. DESIGN Historical cohort study. METHODS Participants include 100 individuals who sustained a youth sport-related intra-articular knee injury 3-10 years previously and 100 age-, sex- and sport-matched uninjured controls. Outcomes included: Knee confidence (Knee Osteoarthritis and Outcome Score); fat mass index (FMI; dual-energy X-ray absorptiometry); and weekly physical activity (modified Godin-Shephard Leisure Time Questionnaire). Mean within-pair differences (95% CI) were calculated for all outcomes. Unadjusted and adjusted (FMI and physical activity) conditional (matched-design) logistic regression (OR 95% CI) examined the association between injury history and knee confidence. RESULTS Median age of participants was 22 years (range 15-26) and median age at injury was 16 years (range 9-18). Forty-nine percent (95% CI; 39.0, 59.0) of previously injured participants were bothered by knee confidence, compared to 12% (5.5, 18.5) of uninjured participants. Although there was no between group difference in physical activity, injured participants had higher FMI compared to controls (within-pair difference; (95% CI): 1.05kg/m2; (0.53, 1.57)). Logistic regression revealed that injured participants had 5.0 (unadjusted OR; 95% CI; 2.4, 10.2) and 7.5 times (adjusted OR; 95% CI: 2.7, 21.1) greater odds of being bothered by knee confidence than controls. CONCLUSIONS Knee confidence differs between individuals with a previous youth sport-related knee injury and healthy controls. Knee confidence may be an important consideration for evaluating osteoarthritis risk after knee injury and developing secondary prevention strategies.

'Do as we say, not as we do': A cross-sectional survey of injuries in injury prevention professionals

Background As the leading cause of death and among the top causes of hospitalisation in Canadians aged 1–44 years, injury is a major public health concern. Little is known about whether knowledge, training and understanding of the underlying causes and mechanisms of injury would help with ones own prevention efforts. Based on the Theory of Planned Behaviour, we hypothesised that injury prevention professionals would experience fewer injuries than the general population. Methods An online cross-sectional survey was distributed to Canadian injury prevention practitioners, researchers and policy makers to collect information on medically attended injuries. Relative risk of injury in the past 12 months was calculated by comparing the survey data with injury incidence reported by a comparable subgroup of adults from the (Canadian Community Health Survey (CCHS)) from 2009 to 2010. Results We had 408 injury prevention professionals complete the survey: 344 (84.5%) women and 63 (15.5%) men. In the previous 12 months, 86 individuals reported experiencing at least one medically attended injury (21 235 people per 100 000 people); with sports being the most common mechanism (41, 33.6%). Fully 84.8% individuals from our sample believed that working in the field had made them more careful. After accounting for age distribution, education level and employment status, injury prevention professionals were 1.69 (95% CI 1.41 to 2.03) times more likely to be injured in the past year. Interpretation Despite their convictions of increasing their own safety behaviour and that of others, injury prevention professionals’ knowledge and training did not help them prevent their own injuries.

WEIGHTY PROBLEMS: SPORT INJURIES IN OVERWEIGHT OR OBESE ACTIVE CANADIAN ADOLESCENTS

Background Despite the multitude of benefits of sport participation, it is the leading cause of injury requiring medical attention in Canadian youth. Previous research found both increased exposure to sport and body mass index (BMI) are injury risk factors. As a modifiable risk factor, further examination of the association between being obese or overweight and sport injury is warranted, accounting for sport exposure level. Objective To examine the relationship between sport injury and overweight and obese weight, versus normal weight, among a sub-sample of adolescents. It is hypothesized that overweight and obese adolescents will have increased odds of sport injury. Design Cross-sectional analysis of the national population-based Canadian Community Health Survey (2009/10) by Statistics Canada. Setting Canada. Participants Nationally representative sample (n=6163) of Canadian adolescents aged 12–19 years, classified ‘active’ by daily energy expenditure in physical activity minimum 3 METS (Kcal/kg/day). Risk factor assessment BMI was calculated using self-report data. Using Coles Classification System, participants were grouped: normal, overweight, or obese categories. Other variables (sex, ethnicity, daily physical activity, socio-economic status) were included in the multivariable logistic regression analysis to control for confounding. Main outcome measurements Sport injury: an injury in the past 12 months while engaged in sport or exercise. Results Among the sample of active adolescents, 25% (n=1 529) reported a sport injury in the past 12 months. In the final adjusted model, no significant relationship was found between being overweight and sport injury (OR=1.05 95% CI=0.90–1.22). A significantly reduced odds of sport injury was observed among obese adolescents (OR=0.72 95% CI=0.53–0.99) compared to their normal weight counterparts. Conclusions Overweight or obese active adolescents do not appear to be at increased risk of sports injury in this sample. The decreased odds among obese adolescents may be because of differences in intensity of sport participation or type of sporting activity.

A cross-sectional evaluation examining the use of the Achilles tendinopathy toolkit by physiotherapists in British Columbia, Canada.

Abstract Purpose: To evaluate the awareness and use of the Achilles tendinopathy toolkit (ATT), a knowledge translation (KT) strategy supporting evidence-informed management of midportion Achilles Tendinopathy (AT), by British Columbian physiotherapists (PTs). Secondarily, to assess PTs strategies for AT management by examining the association between exploring the ATT and following best practice in clinical care as recommended by the ATT. Methods: Members of the Physiotherapy Association of British Columbia (BC) completed an online cross-sectional survey collecting information on demographics; awareness and exposure; perceptions, usability and applicability to clinical practice; knowledge; and attitudes. A clinical vignette assessed if respondents adhered to recommendations made by the ATT. Multi-variable logistic regression examined the association between exploring the ATT and following its recommendations. Results: Of 238 participants, 81% (n = 154) were aware of the ATT and of those 53% (n = 81) explored its contents. Time was the most frequent barrier. Bi-variable analyses showed those who explored the ATT had over double the odds of following the best practice (odds ratio = OR = 2.8; 95% confidence interval = 95% CI = 1.3–6.0). This did not remain significant in the final adjusted model (OR = 2.2; 95% CI = 0.9–5.4). Conclusions: Evaluation of KT strategies is critical. This study revealed high awareness and moderate use of the ATT. Future work should consider the impact of toolkits on patient outcomes. Implications for Rehabilitation A toolkit is a novel knowledge translation (KT) strategy designed to provide accessibleevidence-informed resources to facilitate best practice by clinicians. The evaluation of the Achilles tendinopathy toolkit (ATT) revealed favourable findingsregarding the impact of this KT strategy on the knowledge and attitudes of British Columbia(BC) PTs and the possibility of a positive impact on best practice in clinical care. This research suggests toolkits are a feasible and meaningful KT strategy to provide clinicianswith valuable synthesized resources that have the potential to benefit patient outcomes.

Association between Body Composition and Sport Injury in Canadian Adolescents

Purpose: To examine the association between overweight or obesity and sport injury in a population-based sample of Canadian adolescents. Methods: Cross-sectional analyses were performed using the Canadian Community Health Survey (2009–2010), a nationally representative sample (n=12,407) of adolescents aged 12–19 years. Body composition was quantified using BMI, grouping participants into healthy weight, overweight, or obese. The outcome of interest was acute or repetitive strain injury sustained during sport in the previous year. We examined the relationship between sport injury and overweight or obesity compared with healthy weight using multivariate logistic regression, controlling for sex, ethnicity, physical activity, and socio-economic status. We also examined the interaction between physical activity and body composition in a secondary analysis with a subset of active adolescents. Results: No significant relationship was found between being overweight and sport injury (odds ratio [OR]=1.04, 95% CI: 0.92, 1.17); however, a protective effect was seen between obesity and sport injury (OR=0.67, 95% CI: 0.53, 0.84). Secondary analysis revealed that overweight youths with the highest activity level (quartile 4) did have increased odds of sport injury (OR=1.38, 95% CI: 1.04, 1.83), yet obese youths with a moderate activity level (quartile 2) were protected compared with healthy-weight youths (OR=0.46, 95% CI: 0.24, 0.91). Conclusions: Further examination of active adolescents is warranted. Studies should consider sport-specific differences and comprehensive measurement of exposure to sport.