ABSTRACT
AIM: To assess the Canadian Occupational Performance Measure's (COPM) ability to document change over 3 years in children with cerebral palsy (CP). METHOD: This was a prospective study with ambulatory children with CP, aged 2 to 6 years. Caregivers set one to three COPM goals which were rescored annually over 3 years. A ceiling effect for performance goals was operationalized as a score of 8. A Wald χ2 generalized estimating equations model adjusted for age, sex, and Gross Motor Function Classification System (GMFCS) level, evaluated change over time. RESULTS: In total, 124 children (47 [37.9%] females, 77 [62.1%] males; mean age 3y 11mo [SD 1y 1mo]; GMFCS level I [n=78, 62.9%], II [n=21, 16.9%], and III [n=25, 20.2%]) were set 345 COPM goals at baseline. By Year 3, 106 participants (85.5%) rescored 287 of the goals (83.2%). Performance scores increased between baseline mean (SD) 2.93 (0.56), Year 1 5.98 (0.58) with 34.8% at ceiling; Year 2 6.74 (0.60) 48.3% at ceiling; and Year 3 7.37 (0.60) 59.6% at ceiling (Wald χ2 [3]=607.18, p<0.001). Satisfaction scores increased between baseline 4.42 (0.59), Year 1 6.82 (0.60) with 48% at ceiling; Year 2 7.53 (0.60) with 62.2% at ceiling (Wald χ2 [3]=208.48, p<0.001); with no significant increase by Year 3 7.82 (0.62) with 66.9% at ceiling. INTERPRETATION: COPM performance scores increased steadily over 3 years. By Year 2, a ceiling effect was seen in about half of the goals. The COPM may have utility to measure change over 3 years; periodic resetting of the descriptors of goal success are required to minimize ceiling.
Subject(s)
Activities of Daily Living , Cerebral Palsy/physiopathology , Disability Evaluation , Age Factors , Canada , Cerebral Palsy/diagnosis , Child , Child, Preschool , Female , Humans , Male , Prospective Studies , Severity of Illness Index , Sex FactorsABSTRACT
OBJECTIVE: Does group physiotherapy methods produce different results when compared with individual physiotherapy in persons with surgically repaired rotator cuff tears? No studies to date have examined the feasibility or effectiveness of such therapy formats. Given the prevalence of rotator cuff tears, a study examining group format therapy is warranted and can produce evidence to transform care for rotator cuff tear rehabilitation. METHODS: We analyzed the electronic medical records of persons that underwent rotator cuff repair surgery followed by the prescribedpost-surgical physiotherapy at Southlake Regional Health Centre. Both groups were provided standard physiotherapy intervention protocol for post-operative rotator cuff tear. Active range of motion (AROM), quick disabilities of the arm, shoulder and hand (Q-DASH) measures, and efficiency measures were examined for differences between groups. RESULTS: No significant differences between AROM (abduction p = .92, lateral rotation p = .64, and flexion p = 1.00) and Q-DASH (p = .62) measures between groups were observed at discharge. Overall, group therapy participants required a greater number of visits (p = .000); however, when separated by age groups, only the 60- to 69-year-old participants significantly differed in number of visits between groups (p = .000), whereas no difference was observed in the 50- to 59-year-old participants (p = .14). CONCLUSION: Group format physiotherapy may be equally effective as individual formats in improving AROM and functional outcomes of participants with surgically repaired rotator cuff tears. Further research is needed to determine the optimal age range for group therapy interventions in this population.
Subject(s)
Physical Therapy Modalities , Range of Motion, Articular , Rotator Cuff Injuries/rehabilitation , Adult , Aged , Female , Humans , Male , Middle Aged , Rotation , Rotator Cuff , Shoulder/physiopathology , Shoulder Joint/physiopathology , Treatment OutcomeABSTRACT
Background: Fatigue and depressive symptoms are common and often inter-related stroke sequelae. This study investigates how they are related, directly or indirectly, to mobility and cognitive outcomes within 6 months of stroke. Methods: Participants were recruited from 4 stroke centers in Ontario, Canada. Post-stroke fatigue was assessed using the Fatigue Assessment Scale (FAS). Depressive symptoms were screened using the Center for Epidemiological Studies Scale for Depression (CES-D). Factor analyses were used to construct scores from mobility (distance traveled during a 2-min walk test, Chedoke-McMaster Stroke Assessment leg score, and Berg Balance Scale total score) and cognitive (Montreal Cognitive Assessment, Trail-Making Tests A and B, and five-word free recall) tests. Direct associations were assessed in linear regression models and indirect effects were assessed in path models. Covariates were age, sex, education, antidepressant use, days since stroke, and stroke severity (National Institute of Health Stroke Severity Scale score). Results: Fatigue and depressive symptoms were highly correlated (r > 0.51, p < 0.0001). Depressive symptoms were associated with cognition (ß = -0.184, p = 0.04) and indirectly with mobility, mediated by fatigue (indirect effect = -0.0142, 95% CI: -0.0277 to -0.0033). Fatigue was associated with mobility (ß = -0.253, p = 0.01), and indirectly with cognition, mediated by depressive symptoms (indirect effect = -0.0113, 95% CI: -0.0242 to -0.0023). Conclusions: Fatigue and depressive symptoms are related distinctly to cognitive and mobility impairments post-stroke. Fatigue was associated with poorer lower limb motor function, and with cognition indirectly via depressive symptoms.
