The incidence of juvenile rheumatoid arthritis in Quebec: a population data-based study

<p>Abstract</p> <p>Objective</p> <p>To determine the population incidence of juvenile rheumatoid arthritis (JRA) in Quebec.</p> <p>Methods</p> <p>We obtained data from Quebec's physician claims database. Incident cases were defined as having a visit for JRA in 2000, no visit in the previous 3 years, a confirmed diagnosis by an arthritis specialist, or having ≥ 2 visits to any physician for JRA, ≥ 2 months apart but within 2 years.</p> <p>Results</p> <p>Cumulative incidence of JRA was 17.8/100,000. Mean age at diagnosis was 9.8 ± 4.6 years, 68% were female and more persons were diagnosed in winter. Subjects had a median of 10 medical visits over the first year.</p> <p>Conclusion</p> <p>Our population based incidence estimate was similar to others. Children and adolescents with JRA are heavy users of medical care. Additional study of environmental or climate- related triggers may be warranted.</p

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.CIHR / IRS

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 degrees -60 degrees) 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>rr<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.CIHR / IRS

Differences in Standing and Sitting Postures of Youth with Idiopathic Scoliosis from Quantitative Analysis of Digital Photographs

The objective of this study was to explore whether differences in standing and sitting postures of youth with idiopathic scoliosis could be detected from quantitative analysis of digital photographs. Standing and sitting postures of 50 participants aged 10–20-years-old with idiopathic scoliosis (Cobb angle: 15° to 60°) were assessed from digital photographs using a posture evaluation software program. Based on the XY coordinates of markers, 13 angular and linear posture indices were calculated in both positions. Paired t-tests were used to compare values of standing and sitting posture indices. Significant differences between standing and sitting positions (p < 0.05) were found for head protraction, shoulder elevation, scapula asymmetry, trunk list, scoliosis angle, waist angles, and frontal and sagittal plane pelvic tilt. Quantitative analysis of digital photographs is a clinically feasible method to measure standing and sitting postures among youth with scoliosis and to assist in decisions on therapeutic interventions.CIHR / IRS

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 Altman's 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.CIHR / IRS

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

Purpose: The recent introduction of master’s level curricula for Occupational Therapy and Physiotherapy 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 occupational therapy and physiotherapy 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

Ethics teaching in rehabilitation: results of a pan-Canadian workshop with occupational and physical therapy educators

Purpose: Ethical practice is an essential competency for occupational and physical therapists. However, rehabilitation educators have few points of reference for choosing appropriate pedagogical and evaluation methods related to ethics. The objectives of this study were to: 1) identify priority content to cover in ethics teaching in occupational therapy (OT) and physical therapy (PT) programs and 2) explore useful and innovative teaching and evaluation methods. Method: Data for this qualitative descriptive study were collected during a one-day knowledge exchange workshop focused on ethics teaching in rehabilitation. Results: Twenty-three educators from 11 OT and 11 PT Canadian programs participated in the workshop. They highlighted the importance of teaching foundational theoretical/philosophical approaches and grounding this teaching in concrete examples drawn from rehabilitation practice. A wide range of teaching methods was identified, such as videos, blogs, game-based simulations and role-play. For evaluation, participants used written assignments, exams, objective structured clinical examinations and reflective journals. The inclusion of opportunities for student self-evaluation was viewed as important. Conclusion: The CREW day provided ethics educators the opportunity to share knowledge and begin creating an on-line community of practice. This space for dialogue could be expanded to international rehabilitation ethics educators, to facilitate a broader network for sharing of tacit and experiential knowledge.

Supporting ethics educators in Canadian occupational therapy and physical therapy programs: A national interprofessional knowledge exchange project

Ethics education is the cornerstone of professional practice, fostering knowledge and respect for core ethical values among healthcare professionals. Ethics is also a subject well-suited for interprofessional education and collaboration. However, there are few initiatives to gather experiences and share resources among ethics educators in rehabilitation. We thus undertook a knowledge exchange project to 1) share knowledge about ethics training across Canadian occupational and physical therapy programs, and 2) build a community of educators dedicated to improving ethics education. The objectives of this paper are to describe this interprofessional knowledge exchange project involving ethics educators (with a diversity of professional and disciplinary backgrounds) from Canadian occupational and physical therapy programs as well as analyze its outcomes based on participants’ experiences/perceptions. Two knowledge exchange strategies were employed: an interactive one-day workshop and a wiki platform. An immediate post-workshop questionnaire evaluated the degree to which participants’ expectations were met. Structured telephone interviews nine to ten months after the workshop collected participants’ perceptions on whether (and if so, how) the project influenced their teaching or led to further interprofessional collaborations. Open-ended questions from the post-workshop questionnaires and individual interviews were analyzed using qualitative methods. Of 40 ethics educators contacted, 23 participated in the workshop and 17 in the follow-up interview. Only 6 participants logged into the wiki from its launch to the end of data collection. Five themes emerged from the qualitative analysis: 1) belonging and networking; 2) sharing and collaborating; 3) changing (or not) ways of teaching ethics; 4) sustaining the network; and 5) envisioning the future of ethics education. The project attained many of its goals, despite encountering some challenges. While the wiki platform proved to be of limited benefit in advancing the project goals, the interactive format and collaborative nature of the one-day workshop were described as rewarding and effective in bringing together occupational therapy and physical therapy educators to meet, network, and share knowledge.Anne Hudon is supported by a doctoral fellowship from the Fonds de recherche du Québec-Santé (FRQ-S) and was supported by a scholarship from the MENTOR program in collaboration with the Canadian Institutes of Health Research (CIHR) and the Quebec Research Rehabilitation Network (REPAR) at the time of the study. Maude Laliberté held a doctoral fellowship from the FRQ-S. Matthew Hunt is supported by a research scholar award from the FRQ-S. This project was funded by the Canadian Institutes of Health Research (CIHR-EOG-120255), the Edith Strauss Rehabilitation Research Project Foundation, the Canadian Council of Physiotherapy University Programs (CCPUP & CPA), the Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), and the Faculty of Medicine at the University of Montreal

The effectiveness of scoliosis screening programs: methods for systematic review and expert panel recommendations formulation

Background: Literature on scoliosis screening is vast, however because of the observational nature of available data and methodological flaws, data interpretation is often complex, leading to incomplete and sometimes, somewhat misleading conclusions. The need to propose a set of methods for critical appraisal of the literature about scoliosis screening, a comprehensive summary and rating of the available evidence appeared essential. METHODS: To address these gaps, the study aims were: i) To propose a framework for the assessment of published studies on scoliosis screening effectiveness; ii) To suggest specific questions to be answered on screening effectiveness instead of trying to reach a global position for or against the programs; iii) To contextualize the knowledge through expert panel consultation and meaningful recommendations. The general methodological approach proceeds through the following steps: Elaboration of the conceptual framework; Formulation of the review questions; Identification of the criteria for the review; Selection of the studies; Critical assessment of the studies; Results synthesis; Formulation and grading of recommendations in response to the questions. This plan follows at best GRADE Group (Grades of Recommendation, Assessment, Development and Evaluation) requirements for systematic reviews, assessing quality of evidence and grading the strength of recommendations. CONCLUSIONS: In this article, the methods developed in support of this work are presented since they may be of some interest for similar reviews in scoliosis and orthopaedic fields.Canadian Institutes of Health Research (CIHR) by three means: CIHR Research Operating Grants (2004–2007, 2008–2011); Canada Graduate Scholarships Doctoral Awards (MB) and CIHR MENTOR and AnEIS Strategic training programs doctoral awards (MB)