Candice L. Schachter

The Case for Integrating Grounded Theory and Participatory Action Research: Empowering Clients to Inform Professional Practice

Grounded theory and participatory action research methods are distinct approaches to qualitative inquiry. Although grounded theory has been conceptualized in constructivist terms, it has elements of positivist thinking with an image of neutral search for objective truth through rigorous data collection and analysis. Participatory action research is based on a critique of this image and calls for more inclusive research processes. It questions the possibility of objective social sciences and aspires to engage people actively in all stages of generating knowledge. The authors applied both approaches in a project designed to explore the experiences of female survivors of childhood sexual abuse with physical therapy and subsequently develop a handbook on sensitive practice for clinicians that takes into consideration the needs and perspectives of these clients. Building on this experience, they argue that the integration of grounded theory and participatory action research can empower clients to inform professional practice.

An exploratory study of two measures of free-living physical activity for people with multiple sclerosis

Objective: To examine the ability of two measures of physical activity (tri-axial accelerometer and activity diary) to discriminate among groups of inactive, moderately active and active individuals with multiple sclerosis and to explore the relationship between these two measures. Design: Exploratory, descriptive study. Subjects: Thirty individuals with multiple sclerosis and nine controls. Protocol: Individuals with multiple sclerosis were recruited to inactive, moderately active and active groups as defined by Adjusted Activity Scores from the Human Activity Profile. Control participants were recruited to an active group. Free-living physical activity was recorded over four consecutive days. Main measures: A TriTrac RT3 accelerometer and a self-report physical activity diary were used to measure activity. Results: Thirty-six participants completed data collection. For the participants with multiple sclerosis, both the accelerometer (P = 0.004) and the diary (P = 0.006) detected significant differences between inactive and active groups. The accelerometer also detected a significant difference between moderately active and active groups (P = 0.04). In contrast, the diary detected a significant difference between inactive and moderately active groups (P = 0.05). Accelerometer and diary scores were significantly correlated (r = 0.59). Accelerometer scores were significantly correlated with neurological status (rs = -0.64). Conclusions: Both measures readily differentiated least active from most active groups. The accelerometer also differentiated moderately active from active groups, suggesting suitability for use in detecting change in more active client groups, while the diary differentiated inactive from moderately active groups, suggesting suitability for use in detecting change in less active groups.

Best practice: E-Model—Prescribing physical activity and exercise for individuals with fibromyalgia

Fibromyalgia (FM) is a serious and debilitating condition, encompassing a wide range of symptoms. Physical therapists often advocate the incorporation of leisure time physical activity (exercise training or recreational physical activity) as an important management strategy for individuals with FM. Decisions about physical activity prescription in clinical practice are informed by a variety of sources. This topical review considers physical activity prescription using the E-Model as a framework for best practice decision making. We examine findings from randomized trials, published experts, and qualitative studies through the lens of the models five Es: 1) evidence, 2) expectations, 3) environment, 4) ethics, and 5) experience. This approach provides a robust foundation from which to make best practice decisions. Application of this model also facilitates the identification of gaps and discrepancies in the literature, future opportunities for knowledge exchange and translation, and future research.

Fibromyalgia and Exercise Training: A Systematic Review of Randomized Clinical Trials

Abstract Objective. This review evaluates the effects of exercise training for individuals with fibromyalgia syndrome (FMS). Methods. Seven bibliographic indices (1966–2000) were searched for experimental studies containing physical exercise training for FMS. The methodological quality and adequacy of training stimulus were rated. Studies meeting ≥50% of the quality criteria and applying adequate exercise training stimulus were classified as High Quality Training Studies (HQTS). Results. Fourteen experimental trials were found; six were HQTS of aerobic exercise. In the HQTSs, improvements reported were: tender points =4 of 4 of the HQTS using this outcome measure; cardiorespiratory fitness =3 of 4; global well-being =3 of 5; and fatigue and sleep =2 of 5. There is moderate benefit in FMS from supervised aerobic exercise training. Details about dosage for muscle strengthening or flexibility training were insufficient to evaluate the adequacy of the training stimulus. Further research is needed to describe the long term effects of all types of exercise training and to examine strengthening and flexibility training in FMS.

Facilitating Effective Relationships Between Survivors of Childhood Sexual Abuse and Health Care Professionals

Clients in psychotherapy related to childhood sexual abuse often consult a variety of health care professionals, including physical therapists, massage therapists, and chiropractors. On the basis of interviews with 27 women survivors of childhood sexual abuse, this article offers suggestions for facilitating the relationships between survivors and physical therapists. Awareness of the difficulties that many survivors face when receiving therapy involving touch will increase the ability of psychotherapists to help clients receive the maximum benefits from these therapies.

Mobile Medical Data Synchronization on Cloud-Powered Middleware Platform

Our research focuses on supporting patients (persons with mild hemophilia) to self-manage injuries in cases of minor incidents. This involves bi-directional exchanges of the Electronic Health Record (EHR) between patients and the care facility. However, mobile devices rely on wireless communication channels (e.g., Wi-Fi, 3.5/4G, etc.) to transmit data and these channels can experience sporadic disconnections due to bandwidth fluctuations and user mobility. As a result, the collected medical data may not be transmitted back to the Health Information system (HIS) in soft-real time. Further, when new updates are submitted by the patients who are disconnected (remote and offline), synchronization can fail; leading to decision-making based on outdated or incomplete information. In this work, we focus on how to ensure efficient synchronization of the EHR in unreliable mobile environments. This work took advantage of the ubiquitous nature of mobile cloud computing and proposes a middleware, which facilitates efficient process of medical data synchronization, and with minimal latency. The work details state-of-the-art architecture of the cloud-based middleware that is built and tested for real-world use following four methodologies namely: reflective, tuple space, context-awareness, and event-based.

Mobile self-management guide for young men with mild hemophilia in cases of minor injuries

Hemophilia is a group of inherited disorders where a defect or absence of a clotting factor protein limits the ability of the blood to clot following injury. The most common form is Hemophilia A; it is classified as severe, moderate or mild. Those with severe and moderate Hemophilia are likely to experience bleeding into joints and muscles following minor injury and are advised to limit participation in rough activities. Those with milder disorders usually experience bleeds only after significant injury, and may participate in vigorous sports with few consequences. As a result, they sometimes ‘forget’ that they have Hemophilia, and are slow to recognize injuries which may require treatment. In our ongoing project, we designed a mobile app which is a self-assessment guide for young men with mild hemophilia. The mobile application guides the user in assessing suspected bleeds, applying appropriate first aid, and locating the nearest hemophilia treatment center. In this paper, we detail the architectural design of the mobile app (“HIRT?”). We proposed a three-layered distributed system architecture comprised of the mobile devices, a cloud-oriented proxy and a database server where user feedback is stored for further analysis. The proxy framework is designed to address the challenges of network latency in mobile environments since the primary means of communication is over wireless media. Preliminary evaluation of the proposed system shows high performance boost in terms of the minimization of latency. Furthermore, the usability test shows that the application is convenient to use by both mobile techies and non-techies.

Mobile Aid for Haemophilia Injury Recognition

Haemophilia is a bleeding condition that prevents blood clot during injuries. Previous studies suggest that some persons with the condition often do not report the problem and in some cases, there is the need to take certain critical actions when injuries occur. This has created the need to investigate best approaches that can encourage people with the condition to seek medical help or in the case where the injury is minor, users can assess the injury themselves by following some guidelines. To this effect, our ongoing project seeks to explore the issue through the adoption of mobile computing technology. Thus, an App is developed called, Haemophilia Injury Recognition Tool (HIRT?), which provides the users (especially young men) with a set of instructions on how to assess minor injuries. In cases where the injury is severe, the user is asked to go to the emergency room or contact the nearest Haemophilia Treatment Center which is provided in the App. The paper discusses the architectural flow of the App as well as the user feedback. Overall, the initial group of people who tested the App found it very useful in terms of its content, reminders, and clarity of steps. KeywordsMobile Devices; Haemophilia; Proxy; Cloud Computing; Distributed System; NoSQL Database; Injury Assessment