Effect of acute ankle experimental pain on lower limb motor control assessed by the modified star excursion balance test

IntroductionFollowing most musculoskeletal injuries, motor control is often altered. Acute pain has been identified as a potential contributing factor. However, there is little evidence of this interaction for acute pain following ankle sprains. As pain is generally present following this type of injury, it would be important to study the impact of acute pain on ankle motor control. To do so, a valid and reliable motor control test frequently used in clinical settings should be used. Therefore, the objective of this study was therefore to assess the effect of acute ankle pain on the modified Star Excursion Balance Test reach distance.MethodsUsing a cross-sectional design, 48 healthy participants completed the modified Star Excursion Balance Test twice (mSEBT1 and mSEBT2). Following the first assessment, they were randomly assigned to one of three experimental groups: Control (no stimulation), Painless (non-nociceptive stimulation) and Painful (nociceptive stimulation). Electrodes were placed on the right lateral malleolus to deliver an electrical stimulation during the second assessment for the Painful and Painless groups. A generalized estimating equations model was used to compare the reach distance between the groups/conditions and assessments.ResultsPost-hoc test results: anterior (7.06 ± 1.54%; p < 0.0001) and posteromedial (6.53 ± 1.66%; p < 0.001) directions showed a significant reach distance reduction when compared to baseline values only for the Painful group. Regarding the anterior direction, this reduction was larger than the minimal detectable change (5.87%).ConclusionThe presence of acute pain during the modified Star Excursion Balance Test can affect performance and thus might interfere with the participant's lower limb motor control. As none of the participants had actual musculoskeletal injury, this suggests that pain and not only musculoskeletal impairments could contribute to the acute alteration in motor control

Le projet 1820-1905@ ou la cocréation d’activités de littératie numérique en classe d’univers social

Inscrite dans une étude souhaitant documenter les enjeux, les besoins et les meilleures pratiques de production, de diffusion et de réception d’oeuvres numériques pour la jeunesse (FRQSC 2017-2020), l’expérience de cocréation dont traite le présent article s’est réalisée auprès d’élèves de 5e année du primaire. L’équipe, constituée des coauteur·rice·s, a développé un projet pédagogique mobilisant la plateforme de prêts numériques, Biblius, ainsi que des activités de littératie numérique en classe d’univers social. Les élèves y ont été invités à explorer, par l’entremise d’oeuvres numériques pour la jeunesse et de dossiers documentaires, la société canadienne de 1820, puis ceux de 1905 pour ultimement présenter en réalité virtuelle un personnage représentatif du début du 20e siècle. L’article qui suit témoigne de la cocréation du projet 1820-1905@ et des constats qui émergent de son expérimentation en classe au regard du développement des compétences de littératie dans le contexte de l’enseignement-apprentissage de l’univers social.Involved in a study aiming to document the issues, needs and best practices of production, distribution, and reception of digital works for youth (FRQSC 2017-2020), the co-creation experience discussed in this article was carried out with 5th grade elementary school students. The team, made up of the co-authors, has developed an educational project involving the digital loan platform, Biblius, as well as digital literacy activities in social sciences classrooms. Students were invited to explore, through digital works for youth and documentary records, the Canadian society of 1820 and those of 1905 to finally present in virtual reality a representative character of the early 20th century. The following article attests of the co-creation of the 1820-1905@ project and the findings that emerge from its experimentation in the classroom regarding the development of literacy skills in the context of teaching-learning in social sciences

Systematic review of motor control and somatosensation assessment tests for the ankle

Background/Aim Ankle sprains are frequent musculoskeletal injuries that can lead to sensorimotor deficits provoking long-term instability at the ankle joint. A broad variety of clinical tests currently exist to assess sensorimotor processing, and are commonly clinically referred to as proprioceptive tests. However, there is a discrepancy in the use of the term proprioception when looking at the main outcome of these tests. As identifying specific deficits is important for motor recovery, it is critical for clinicians to select the most appropriate tests.Methods A systematic review of four databases was performed to provide an up-to-date review of the psychometric properties of available tests referred to as proprioceptive tests. Seventy-nine articles on eight ankle proprioceptive tests were included and critically appraised. Data on validity, reliability and responsiveness were extracted from the included articles and synthesised. The tests reviewed were then divided into two categories based on their main outcome: motor control or somatosensation.Results Strong evidence showed that the Star Excursion Balance Test, a motor control test, is capable of differentiating between stable and unstable ankles. Moderate evidence suggests that somatosensation tests, such as Joint Position Sense, are also valid and reliable, but their responsiveness has yet to be evaluated.Conclusions Together, these findings indicate that the Star Excursion Balance Test can be used in the clinic to assess motor control based on its excellent psychometric properties. However, as ankle stability control involves complex sensorimotor interactions, care has to be taken regarding the use of this test as a specific tool for proprioception assessment

Connaissances et compétences des pharmaciens communautaires et qualité de la pharmacothérapie des patients atteints d’insuffisance rénale chronique : Résultats provisoires du programme ProFiL

Résumé Objectif : Dans le cadre d’une analyse provisoire comprenant l’Hôpital de la Cité-de-la Santé de Laval et l’Hôpital Maisonneuve- Rosemont, évaluer les retombées d’un programme de formation et de liaison en néphrologie (ProFiL) sur les connaissances et compétences des pharmaciens, leurs pratiques cliniques et la qualité de la pharmacothérapie de leurs patients. Méthodologie : Des patients de cliniques de prédialyse et leur pharmacie ont été répartis aléatoirement dans les groupes ProFiL et Soins habituels. Les connaissances et compétences des pharmaciens ont été évaluées au moment de l’inclusion des patients dans l’étude et après une année. La qualité de la pharmacothérapie et les pratiques cliniques des pharmaciens ont été évaluées au cours des années précédant et suivant le recrutement. Résultats : Après un an de suivi, les pharmaciens ProFiL (n = 55) ont obtenu une amélioration plus importante de leurs scores de connaissances (différence avant-après entre les groupes : 5,6 % [IC 95 % : 0,08 % à 11,1 %]) et de compétences (10,8 % [5,5 % à 16,1 %]) que les pharmaciens du groupe Soins habituels (n = 27). Le nombre de problèmes liés à la pharmacothérapie des patients ProFiL (n = 117) est passé de 3,2 à 1,7 problèmes par patient, comparativement au groupe Soins habituels, qui n’est passé que de 2,6 à 2,1 par patient (n = 51), soit une diminution incrémentale de -1,1 problème par patient (-1,8 à -0,4), notamment pour les médicaments nécessitant un ajustement en insuffisance rénale chronique (-0,3 problème lié à la pharmacothérapie par patient [-0,5 à -0,02]) et l’adhésion au traitement (-0,5 problème lié à la pharmacothérapie par patient [-0,9 à -0,2]). Un nombre supérieur de recommandations aux patients et aux médecins, nommées opinions pharmaceutiques, et de refus d’exécuter une ordonnance ont été émis pour les patients ProFiL (0,4 opinion par patient versus 0,1 opinion par patient). Conclusion : Après une année, ProFiL améliore les connaissances et compétences des pharmaciens communautaires, leurs pratiques cliniques et la qualité de la pharmacothérapie de leurs patients. Abstract Objective: To evaluate the impact of a training and liaison program in nephrology (ProFil) on the knowledge and competencies of pharmacists, their clinical practice, and the quality of their patient pharmacotherapy. Methods: Patients in predialysis clinics in two academic medical centers and their community pharmacy were randomly assigned either to the ProFiL group or the Usual Care group. The knowledge and competencies of pharmacists were evaluated at the time of patient inclusion in the study and after one year. The quality of pharmacotherapy and the clinical practice of pharmacists were evaluated prior to and following patient recruitment. Results: After one year of follow-up, pharmacists from the ProFiL group (n=55) had significant improvement in their scores for knowledge (before-after difference between groups: 5.6% [CI 95 %: 0.08 % to 11.1 %]) and competency (10.8 % [5.5 % to 16.1 %]) than pharmacists in the Usual Care group (n=27). The number of drug-related problems in the ProFiL group patients (n=117) decreased from 3.2 to 1.7 problems per patient, compared to the patients in the Usual Care group where drug-related problems decreased from 2.6 to 2.1 per patient (n=51), an incremental decrease of -1.1 problems per patient (-1.8 to -0.4), primarily for medications requiring dosage adjustment in chronic renal failure (-0.3 drug-related problems per patient [-0.5 to -0.02]) and treatment adherence (-0.5 drug-related problems [-0.9 to -0.2]). A greater number of recommendations to patients and physicians, either as pharmaceutical opinions or refusal to fill a prescription, were made for patients in the ProFiL group (0.4 opinions per patient versus 0.1 opinions per patient). Conclusion: After one year, the ProFil program improved the knowledge and competencies of community pharmacists, their clinical practice, and the quality of patient pharmacotherapy. Key words: Chronic renal failure, community pharmacy, continuing education, drug-related problems, knowledge and competencies, pre-dialysis clinic

Aggravation de l’insuffisance rénale chronique et de ses facteurs de risque : Résultats provisoires du programme ProFiL

Résumé Objectif : Un essai clinique evalue presentement les retombees d’un Programme de formation et de liaison en nephrologie (ProFiL) sur la qualite de la pharmacotherapie de patients souffrant d’insuffisance renale chronique. L’objectif de cette analyse provisoire vise a evaluer la pertinence d’augmenter le nombre de patients a l’etude de maniere a pouvoir determiner les retombees du Programme sur l’aggravation de la fonction renale et de ses facteurs de risque. Méthodologie : Des patients de deux cliniques de predialyse (Hopital de la Cite-de-la-Sante de Laval et Hopital Maisonneuve- Rosemont) et leur pharmacie communautaire ont ete repartis aleatoirement dans les groupes ProFiL et Soins habituels et suivis pendant une annee. Les variables cliniques ont ete documentees au moment de l’inclusion des patients dans l’etude et un an plus tard. La comparaison de l’evolution des deux groupes a eu lieu a l’aide de modeles lineaires multivaries a effet mixte. Résultats : L’evolution du debit de filtration glomerulaire etait similaire dans les deux groupes. Une baisse additionnelle de -9,8 mmHg (IC 95 % : -15,8 a -3,7) de la tension arterielle systolique a ete observee dans le groupe ProFiL (n = 117) par rapport aux patients Soins habituels (n = 51). Parmi les patients diabetiques (n = 100), une reduction incrementale de l’hemoglobine glyquee de 0,4 % (IC 95 % : -0,9 a -0,1) a ete observee dans le groupe ProFiL alors que parmi les patients dyslipidemiques (n = 96), l’evolution du cholesterol-LDL etait similaire dans les deux groupes. Conclusion : Apres une annee, le Programme ProFiL a un effet positif sur le controle de la tension arterielle et de l’hemoglobine glyquee mais n’aurait pas d’effets significatifs sur le cholesterol-LDL et l’aggravation de l’insuffisance renale. Il n’est donc pas necessaire d’augmenter le nombre de patients recrutes. Abstract Objective: : A clinical trial is presently assessing the impact of a nephrology training and liaison program “ProFiL” on the quality of pharmacotherapy in patients with chronic renal failure. The objective of this interim analysis is to determine the usefulness of increasing the number of study patients to be able to assess the program’s impact on the progression of impaired renal function and of its risk factors. Methods: Patients from two predialysis clinics (Hopital de la Cite-de-la-Sante de Laval and Hopital Maisonneuve- Rosemont) and their community pharmacies were randomized to the ProFiL group or the usual care group and followed for one year. The clinical variables were recorded at study inclusion and one year later, and the changes in the two groups were compared using linear, mixed-effects multivariate models. Results: The changes in the glomerular filtration rate were similar in both groups. There was an additional decrease of -9.8 mm Hg (95% CI: -15.8 to -3.7) in systolic blood pressure in the ProFiL group (n = 117) compared to the patients receiving usual care (n = 51). In the diabetic patients (n = 100), an incremental reduction in the glycosylated hemoglobin concentration of 0.4% (95% CI: -0.9 to -0.1) was observed in the ProFiL group, while in the dyslipidemic patients (n = 96), the changes in the LDL cholesterol levels were similar in both groups. Conclusion: After one year, the ProFil program had a positive effect on blood pressure control and glycosylated hemoglobin control but did not appear to have a significant impact on LDL cholesterol or the progression of renal failure. Therefore, it is not necessary to increase the number of patients recruited. Key words: Chronic renal failure, community pharmacy, diabetes, dyslipidemia, predialysis, renal failure risk facto