Debbie Ehrmann Feldman

Smoking. A risk factor for development of low back pain in adolescents.

STUDY DESIGN A prospective, repeated-measures cohort design with high school students from Montreal, Canada. OBJECTIVES To determine whether smoking was a risk factor for the development of low back pain or other musculoskeletal pain in a cohort of adolescents. SUMMARY OF BACKGROUND DATA Smoking has been associated with low back pain in adults. Many adolescents smoke, and the prevalence of low back pain in this age group is 30%. A history of low back pain is predictive of future problems. METHODS A total of 502 students from grades 7 to 9 were assessed from 3 schools. Data were collected at 3 times: at the beginning of the study, at 6 months, and at the end of a 12-month period. Students responded to a questionnaire addressing musculoskeletal health and life-style factors, which included smoking. Measurements of height, weight, trunk and leg flexibility, and trunk strength were obtained. Low back pain occurring at a frequency of at least once a week in the past 6 months was defined as the outcome. Multivariate methods were used to model the repeated-measures dichotomous outcome as a function of smoking and other covariates. RESULTS Smokers experienced low back pain more than nonsmokers (odds ratio, 2.4; 95% confidence interval, 1.3-6.0). There was also a dose-response relationship between amount smoked and development of low back pain. Smokers tended to experience more upper limb or lower limb pain than nonsmokers, although this result was not significant. CONCLUSIONS Smoking was found to increase the risk for low back pain in this cohort of adolescents.

Mealtime problems in children with Autism Spectrum Disorder and their typically developing siblings: A comparison study

Many children with autism spectrum disorders (ASD) have mealtime problems. Diagnosis and the social environment may influence eating behaviours. We examined whether children with ASD have more mealtime problems than their typically developing siblings, and whether age and sex are associated with mealtime problems. Forty-eight families participated in this cross sectional study by completing a questionnaire (Eating Profile) for their child with ASD, 3 to 12 years of age. A second Eating Profile was completed for the sibling nearest in age without ASD. Children with ASD had a mean of 13.3 eating problems, with lack of food variety predominating. Siblings had 5.0 problems. Children with ASD had more eating problems as infants. Older children tended to have fewer problems than younger children. This study points to the importance of screening for mealtime problems. Children with ASD had significantly more mealtime problems than their sibling living in the same social environment.

Clinical methods for quantifying body segment posture: a literature review

Purpose. 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.

Association of sensory processing and eating problems in children with autism spectrum disorders.

“Selective” or “picky eating” is a frequent problem in children with autism spectrum disorders (ASD). Many of these children do not treat sensory input, particularly olfactory, auditory, visual, and tactile information in the same manner as their typically developing peers of the same age. The purpose of this paper was to examine the relationship between problems of sensory processing and the number of eating problems in children with ASD. Of 95 children with ASD, 3 to 10 years of age, 65 percent showed a definite difference and 21 percent a probable difference in sensory processing on the total score of the Short Sensory Profile. These results were significantly related to an increase in the number of eating problems measured by the Eating Profile. These results could not be explained by age, sex, mental retardation, attention deficit disorder, or hyperactivity. Timely interventions focusing on the sensory components of eating must now be developed.

Adolescent growth is not associated with changes in flexibility.

OBJECTIVE To determine whether adolescent growth is associated with a decrease in flexibility. DESIGN Longitudinal cohort study of urban high school students. MAIN OUTCOME MEASURES Flexibility of hamstring muscles (popliteal angle), quadriceps muscles (quadriceps angle), lumbar extensor muscles (Schober test), and combined lower extremity-trunk muscles (Sit and Reach test). RESULTS There was no relation between growth and changes in flexibility for the lumbar flexor muscles, hamstring muscles, or muscles involved in the Sit and Reach test. Although there was a slight decrease in flexibility of the quadriceps muscle with increases in growth, the very low r2adj value (0.01-0.06) strongly suggests that growth plays only a small role in determining the flexibility of individuals. CONCLUSION These results strongly suggest that growth is not a cause of decreased flexibility during the peripubescent period.

Reliability of a quantitative clinical posture assessment tool among persons with idiopathic scoliosis

OBJECTIVE To determine overall, test-retest and inter-rater reliability of posture indices among persons with idiopathic scoliosis. DESIGN A reliability study using two raters and two test sessions. SETTING Tertiary care paediatric centre. PARTICIPANTS Seventy participants aged between 10 and 20 years with different types of idiopathic scoliosis (Cobb angle 15 to 60°) were recruited from the scoliosis clinic. MAIN OUTCOME MEASURES Based on the XY co-ordinates of natural reference points (e.g., eyes) as well as markers placed on several anatomical landmarks, 32 angular and linear posture indices taken from digital photographs in the standing position were calculated from a specially developed software program. Generalisability theory served to estimate the reliability and standard error of measurement (SEM) for the overall, test-retest and inter-rater designs. Bland and Altmans method was also used to document agreement between sessions and raters. RESULTS In the random design, dependability coefficients demonstrated a moderate level of reliability for six posture indices (ϕ=0.51 to 0.72) and a good level of reliability for 26 posture indices out of 32 (ϕ≥0.79). Error attributable to marker placement was negligible for most indices. Limits of agreement and SEM values were larger for shoulder protraction, trunk list, Q angle, cervical lordosis and scoliosis angles. The most reproducible indices were waist angles and knee valgus and varus. CONCLUSIONS Posture can be assessed in a global fashion from photographs in persons with idiopathic scoliosis. Despite the good reliability of marker placement, other studies are needed to minimise measurement errors in order to provide a suitable tool for monitoring change in posture over time.

Validity of a quantitative clinical measurement tool of trunk posture in idiopathic scoliosis.

Study Design. Concurrent validity between postural indices obtained from digital photographs (two-dimensional [2D]), surface topography imaging (three-dimensional [3D]), and radiographs. Objective. To assess the validity of a quantitative clinical postural assessment tool of the trunk based on photographs (2D) as compared to a surface topography system (3D) as well as indices calculated from radiographs. Summary of Background Data. To monitor progression of scoliosis or change in posture over time in young persons with idiopathic scoliosis (IS), noninvasive and nonionizing methods are recommended. In a clinical setting, posture can be quite easily assessed by calculating key postural indices from photographs. Methods. Quantitative postural indices of 70 subjects aged 10 to 20 years old with IS (Cobb angle, 15°–60°) were measured from photographs and from 3D trunk surface images taken in the standing position. Shoulder, scapula, trunk list, pelvis, scoliosis, and waist angles indices were calculated with specially designed software. Frontal and sagittal Cobb angles and trunk list were also calculated on radiographs. The Pearson correlation coefficients (r) was used to estimate concurrent validity of the 2D clinical postural tool of the trunk with indices extracted from the 3D system and with those obtained from radiographs. Results. The correlation between 2D and 3D indices was good to excellent for shoulder, pelvis, trunk list, and thoracic scoliosis (0.81 > r < 0.97; P < 0.01) but fair to moderate for thoracic kyphosis, lumbar lordosis, and thoracolumbar or lumbar scoliosis (0.30 > r < 0.56; P < 0.05). The correlation between 2D and radiograph spinal indices was fair to good (−0.33 to −0.80 with Cobb angles and 0.76 for trunk list; P < 0.05). Conclusion. This tool will facilitate clinical practice by monitoring trunk posture among persons with IS. Further, it may contribute to a reduction in the use of radiographs to monitor scoliosis progression.

Validation of an advanced practice physiotherapy model of care in an orthopaedic outpatient clinic.

BackgroundIn Canada, new models of orthopaedic care involving advanced practice physiotherapists (APP) are being implemented. In these new models, aimed at improving the efficiency of care for patients with musculoskeletal disorders, APPs diagnose, triage and conservatively treat patients. Formal validation of the efficiency and appropriateness of these emerging models is scarce. The purpose of this study is to assess the diagnostic agreement of an APP compared to orthopaedic surgeons as well as to assess treatment concordance, healthcare resource use, and patient satisfaction in this new model.Methods120 patients presenting for an initial consult for hip or knee complaints in an outpatient orthopaedic hospital clinic in Montreal, Canada, were independently assessed by an APP and by one of three participating orthopaedic surgeons. Each health care provider independently diagnosed the patients and provided triage recommendations (conservative or surgical management). Proportion of raw agreement and Cohen’s kappa were used to assess inter-rater agreement for diagnosis, triage, treatment recommendations and imaging tests ordered. Chi-Square tests were done in order to compare the type of conservative treatment recommendations made by the APP and the surgeons and Student t-tests to compare patient satisfaction between the two types of care.ResultsThe majority of patients assessed were female (54%), mean age was 54.1 years and 91% consulted for a knee complaint. The raw agreement proportion for diagnosis was 88% and diagnostic inter-rater agreement was very high (κ=0.86; 95% CI: 0.80-0.93). The triage recommendations (conservative or surgical management) raw agreement proportion was found to be 88% and inter-rater agreement for triage recommendation was high (κ=0.77; 95% CI: 0.65-0.88). No differences were found between providers with respect to imaging tests ordered (p≥0.05). In terms of conservative treatment recommendations made, the APP gave significantly more education and prescribed more NSAIDs, joint injections, exercises and supervised physiotherapy (p<0.05). Patient satisfaction was significantly higher for APP care than for the surgeons care (p<0.05).ConclusionThe diagnoses and triage recommendations for patients with hip and knee disorders made by the APP were similar to the orthopaedic surgeons. These results provide evidence supporting the APP model for orthopaedic care.

Work is a risk factor for adolescent musculoskeletal pain.

The study objectives were to determine the incidence of musculoskeletal pain in a cohort of adolescents and whether work is a risk factor for its development. 502 students in the seventh to ninth grades responded to a questionnaire at three times over a 12-month period, addressing musculoskeletal health and lifestyle factors. Annual incidence of musculoskeletal pain was 38%. Adolescents who worked developed pain more than those who did not work (adjusted odds ratio (OR): 1.62, 95% confidence interval (CI): 0.96, 2.76). Those who worked in white-collar jobs were at a higher risk of developing pain than those in blue-collar jobs or childcare. The conclusion that work is associated with musculoskeletal pain development in adolescents implies that implementation of prevention strategies in the workplace should include adolescents who work.

What place for ethics? An overview of ethics teaching in occupational therapy and physiotherapy programs in Canada

Abstract Purpose: The recent introduction of master’s level curricula for Occupational Therapy (OT) and Physiotherapy (PT) training programs in Canada raises both challenges and opportunities to address ethical issues during professional training. This study evaluated the inclusion of ethics content in course descriptions and course calendars in order to develop a preliminary understanding of how rehabilitation ethics is taught in Canadian universities. Method: We reviewed the ethics content in the online curricula of 27 Canadian rehabilitation programs (OT & PT). Courses addressing ethical issues were identified through keyword searches, and were then subjected to both quantitative and textual descriptive analyses. Results: The mean proportion of credits allotted to courses that included ethics terminology was 5.9% (SD = 1.4) for OT and 6.5% (SD = 4.8) for PT (p = 0.69). The most common terms in the course descriptions were “ethics/ethical” followed by “legal”, “professionalism”, “deontology” and “regulatory”. Textual analysis revealed eight course topics, the most frequent being: standards of practice, ethical decision-making, clinical courses and mediation/communication. Conclusion: With the growing recognition and status of OT and PT in the healthcare system, and corresponding shifts in how professionals are being trained, it is crucial to assess and reflect upon the place accorded to and manner of teaching ethics. Implications for Rehabilitation Ethics training in rehabilitation programs With the evolving recognition of OT and PT professions within the healthcare system, and corresponding shifts in how future professionals are trained, it is crucial to assess the place accorded to teaching ethics. In Canadian OT and PT programs, ethics content is most commonly included in broad courses related to standards of practice and not in specific ethics courses. Careful attention is needed to ensure that OT and PT students receive sufficient ethics training that is well aligned with their future practice context to support them to competently address the ethical issues that they will encounter in clinical practice. In addition, OT and PT professionals would benefit from the development of continuing education activities that target ethical issues relevant to their practice.