ptc.2022.74.issue-3

https://www.utpjournals.press${contentReq.requestUri} - Horizon College Physiotherapy <[email protected]> - Thursday, January 26, 2023 9:57:02 PM - IP Address:43.246.243.147

https://www.utpjournals.press${contentReq.requestUri} - Horizon College Physiotherapy <[email protected]> - Thursday, January 26, 2023 9:57:02 PM - IP Address:43.246.243.147

https://www.utpjournals.press${contentReq.requestUri} - Horizon College Physiotherapy <[email protected]> - Thursday, January 26, 2023 9:57:02 PM - IP Address:43.246.243.147 Physiotherapy Canada Advancing health through scientific inquiry and knowledge translation Pour l’avancement de la santé par l’enquête scientifique et la transmission du savoir Volume 74 • Number 3 • August 2022 • ISSN 0300-0508 • E-ISSN 1708-8313 TABLE OF CONTENTS 227 The Search for Justice: Developing a Collaborative Understanding of Health Justice in Physiotherapy GUEST EDITORIAL J. Dhir, T. Blake, S. Cleaver, J. Smith-Turchyn, P. Miller, M. Smith, M. Udarbe Han, K. Gasparelli, and S. Wojkowski ARTICLES 229 La recherche de la justice : acquérir une compréhension intégrative de la justice en santé en physiothérapie J. Dhir, T. Blake, S. Cleaver, J. Smith-Turchyn, P. Miller, M. Smith, M. Udarbe Han, K. Gasparelli, et S. Wojkowski 232 Immediate Effect of Dry Needling on the Viscoelastic Properties of a Trigger Point on the Infraspinatus Muscle Measured with MyotonPro M. Roch, M. Morin, and N. Gaudreault 240 Physiotherapists’ and Physiotherapy Assistants’ Perspectives on Using Three Physical Function Measures in the Intensive Care Unit: A Mixed-Methods Study S. Hiser, E. Mantheiy, A. Toonstra, L.A. Friedman, P. Ramsay, and D.M. Needham 247 Clinician’s Commentary S. Gruenig 249 Navigating the Grey Zone of Physiotherapy Assistant Autonomy in Home Care: Perspectives of Physiotherapists and Physiotherapy Assistants M. Jensen, C. Junod, N. Fatemi, K. Liew, E. Ulaj, C.C. Bean, S.A. Nixon, and S.M. McKay 257 Priorities in Pulmonary Rehabilitation Research: The Patient Perspective S. O’Hoski, L. Ellerton, A.-M. Selzler, R. Goldstein, and D. Brooks 265 Clinician’s Commentary P. Singh 267 Factors Associated with Intermittent, Constant, and Mixed Pain in People with Knee Osteoarthritis F. Hoteit, D.E. Feldman, and L.C. Carlesso 276 Clinician’s Commentary S.M. Robbins and A. Teoli

https://www.utpjournals.press${contentReq.requestUri} - Horizon College Physiotherapy <[email protected]> - Thursday, January 26, 2023 9:57:02 PM - IP Address:43.246.243.147 TECHNOLOGY IN REHABILITATION 278 Experiences of Physiotherapy Students, Health Care Providers, and SERIES Patients with a Role-Emerging Student Clinical Placement in an Emergency Department: A Qualitative Study COCHRANE COLLABORATION J. Withers, C. Zavitz, T. Nguyen, J. Baglole, N. Kashetsky, E. Graham, R. Brison, M. Law, R. Booth, and J. Miller 287 Physiotherapists’ Perspectives on Professional Practice Leadership Models: Key Features to Enhance Physiotherapy Practice E. Chinn, J. Dealy, J. Stepien, C. Negin, D. Le, K. Knott, M. Quesnel, and B. Mori 297 Clinician’s Commentary L. Graham 298 Inclusion of Exercise Prescription in Solid Organ Transplant in Physical Therapy Curricula Across Canadian Universities: A National Survey K. Negreanu, Z.Q. Wang, J. Campanelli, A. Zappia, D. Massierer, J. Spahija, and T. Janaudis-Ferreira 306 Safety, Effectiveness, and Professional Judgment: A Survey of Training-Related Perspectives Among Physiotherapists Who Practise Acupuncture in Ontario N. Ijaz, Q. Zhang, S. Welsh, and H. Boon 316 Investigation of the Kinematic Upper-Limb Movement Assessment (KUMA): A Pilot Study P. Eftekhar, M.H. Li, M.J. Semple, D. Richardson, D. Brooks, G. Mochizuki, and T. Dutta 324 What Does Cochrane Say About … Physiotherapy Management for the Knee?

https://www.utpjournals.press${contentReq.requestUri} - Horizon College Physiotherapy <[email protected]> - Thursday, January 26, 2023 9:57:02 PM - IP Address:43.246.243.147 Physiotherapy Canada Advancing health through scientific inquiry and knowledge translation Pour l’avancement de la santé par l’enquête scientifique et la transmission du savoir SCIENTIFIC CO-EDITORS Sharon Gabison, PhD, MSc, BScPT, BSc Assistant Professor, Teaching Stream, Department of Physical Dina Brooks, PhD, MSc, BSc (PT) Therapy, University of Toronto, Toronto, ON Professor, Vice-Dean & Executive Director School of Rehabilitation Science, McMaster University, Hamilton, ON Julie Richardson, PhD Professor Emeritus, Rehabilitation Science, McMaster University, Marilyn MacKay-Lyons, BSc(PT), MSc(PT), PhD Hamilton, ON Professor, School of Physiotherapy, Dalhousie University, Halifax, NS Virginia Wright, PhD ASSOCIATE EDITORS Senior Scientist, Chair in Pediatric Rehabilitation, Bloorview Children's Hospital Foundation, Toronto, ON Denise Connelly, PhD, BScPT Associate Professor, School of Physical Therapy, University of Western EDITORIAL OFFICE Ontario, London, ON University of Toronto Press - Journals Division Isabelle Gagnon, pht, PhD 5201 Dufferin St., North York, ON M3H 5T8 Canada Tel.: 416­ Assistant Professor, School of Physical and Occupational Therapy, 667-7777 ext. 7751, Fax: 416-667-7832 or 1-800-221-9985 McGill University, Montreal, QC E-mail: [email protected], www.utpjournals.press S. Jayne Garland, PhD, PT INTERNATIONAL ADVISORY BOARD Professor and Department Head, Department of Physical Therapy, University of British Columbia, Vancouver, BC Rik Gosselink, PhD, PT Professor, Department of Rehabilitation Sciences, Katholieke Crystal MacKay, PhD, PT Universiteit Leuven, Leuven University, Belgium Scientist, West Park Healthcare Centre Assistant Professor, Department of Physical Therapy, University of Toronto, Toronto, ON Karen Grimmer-Somers, PhD, MMedSci, BPhty, CertHealthEc, LMusA Maxi Miciak, PhD, PT Professor, School of Health Sciences Director, Centre for Allied Health Adjunct Associate Professor, Faculty of Rehabilitation Medicine, Evidence, University of South Australia, Australia University of Alberta; Principal, Maxi Miciak Consulting, Edmonton, AB Meg E. Morris, BAppSC(Physio), MAppSc, Grad Dip(Geron), PhD, FACP Brenda Mori, BScPT, MSc, PhD Professor and Chair, School of Physiotherapy, University of Associate Program Director, Director of Clinical Education & Melbourne, Australia Community Affairs, Associate Professor, Continuing Teaching Stream, Department of Physical Therapy, University of Toronto, Kenneth J. Ottenbacher, OT, PhD Toronto, ON Russel Shearn Moody Distinguished Chair in Neurological Rehabilitation, Senior Associate Dean for Graduate Research Education, School of Allied Kathleen E. Norman, BScPT, PhD Health Sciences, University of Texas Medical Branch, USA Associate Professor and Associate Director (Research and Post- Professional Programs), School of Rehabilitation Therapy, Queen’s Carol L. Richards, PhD, PT, FCAHS University, Kingston, ON Professor and Canada Research Chair in Rehabilitation, Department of Rehabilitation Medicine, Laval University, Quebec City, QC Brenda O’Neill, BScPT, Fellow HEA, PhD Centre for Health and Rehabilitation Technologies (CHART), Institute Peter Rosebaum, MD, CM, FRCP(C) Nursing and Health Research, Sch Health Sciences, Ulster University, Professor, Department of Pediatrics, McMaster University Hamilton, ON Northern Ireland Julius Sim, BA, MSc(Soc), MSc(Stat), PhD Marco Pang, BScPT, PhD Primary Care Musculoskeletal Research Centre, Keele University, UK Assistant Professor, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong METHODOLOGICAL AND STATISTICAL CONSULTANTS Michelle Ploughman, PhD, PT Luciana Macedo, PT, PhD Associate Professor of Medicine and Canada Research Chair, Associate Professor, School of Rehabilitation Science, McMaster Memorial University of Newfoundland, St. John’s, NL University, Hamilton, ON Didier Saey, Pht, PhD Paul Stratford, PT, MSc Adjunct Professor, Department of Rehabilitation, Laval University, Professor Emeritus, School of Rehabilitation Science, McMaster Quebec City, QC University, Hamilton, ON James Shaw, PT, PhD PUBLISHER Scientist, Women’s College Hospital; Research Director and Assistant Professor, University of Toronto, Toronto, ON Canadian Physiotherapy Association 955 Green Valley Crescent, Suite 270, Ottawa, ON Sarah Wojkowski, MScPT, PhD K2C 3V4 Canada Associate Professor, Rehabilitation Science, McMaster University, Tel.: 613-564-5454 or 800-387-8679, Fax: 613-564-1577 Hamilton, ON E-mail: [email protected] www.physiotherapy.ca SPECIAL SERIES EDITORS Competing Interest Statements for Physiotherapy Canada Editorial Board members are available online at Tilak Dutta, PhD https://www.utpjournals.press/journals/ptc/editorial-board Adjunct Professor, Rehabilitation Sciences Institute, University of Toronto, Toronto, ON

https://www.utpjournals.press${contentReq.requestUri} - Horizon College Physiotherapy <[email protected]> - Thursday, January 26, 2023 9:57:02 PM - IP Address:43.246.243.147 STATEMENT OF PURPOSE OBJECTIF Physiotherapy Canada is the official, scholarly, refereed journal of the Canadian Physiotherapy Association, giving direction to excellence in Physiotherapy Canada est la publication scientifique officielle révisée en clinical science and reasoning, knowledge translation, therapeutic skills profondeur de l’Association canadienne de physiothérapie. and patient-centred care. Son objectif est de fournir des orientations à l’excellence en sciences et en Recognized as one of the top five evidence-based journals of raisonnement clinique, transmission du savoir, compétences physiotherapy worldwide, Physiotherapy Canada publishes the results of thérapeutiques et soins centrés sur le patient. qualitative and quantitative research including systematic reviews, meta analyses, meta syntheses, public/health policy research, clinical practice Reconnu comme l’un des cinq grands journaux de physiothérapie guidelines, and case reports. Key messages, clinical commentaries, case reposant sur des faits scientifiques dans le monde, Physiotherapy Canada studies, evidence-based practice articles, brief reports, and book reviews publie les résultats de recherches qualitatives et quantitatives, notamment support knowledge translation to clinical practice. des revues systématiques, des méta-analyses, des métasyntheses, des recherches en politiques de la santé ou en politiques publiques, des Founded in 1923, Physiotherapy Canada meets the diverse needs of directives en pratique clinique et des études de cas. Ses messages clés, national and international readers and serves as a key repository of commentaires cliniques, études de cas, articles fondés sur des faits inquiries, evidence and advances in the practice of physiotherapy. scientifiques, résumés de discussions et comptes-rendus de livres favorisent la transmission du savoir à la pratique clinique. Physiotherapy Canada (ISSN 0300-0508) is published four times per year in Fspebrirnuga,rsyu, Mmamy,eAru, fgaullsta,nadndwNinotveermbbyetrhbeyUthneivUenrsiivteyrsoiftyTofronto Fondée en 1923, Physiotherapy Canada répond aux divers besoins de PTorerossntforPtrhesesCfoarntahdeiaCnanPahdyisainotPhheyrsaipotyhAersasopyciAastisoonc.iation. lecteurs canadiens et étrangers et se positionne comme un véritable recueil sur la recherche, les faits scientifiques et les progrès dans la EDITORIAL SUBMISSIONS pratique de la physiothérapie. Physiotherapy Canada welcomes manuscripts reporting results of qualitative or quantitative research. Systematic reviews, meta analyses La revue Physiotherapy Canada (ISSN 0300-0508) est publiée par les Presses (quantitative), meta syntheses (qualitative), public/health policy de l’Université de Toronto quatre fois l’an, en février, en mai, en août et en research, clinical practice guidelines, case reports (quantitative), case novembre, pour le compte de l’Association canadienne de physiothérapie. studies (qualitative), evidence-based practice articles and brief reports are also welcomed. Submissions are now being accepted online via PRESENTATIONS D’ARTICLES Physiotherapy Canada’s online peer-review system ScholarOne. To log in or see submission guidelines, please go to https://mc04. Physiotherapy Canada accepte les articles qui font état de résultats de manuscriptcentral.com/ptc. For technical support information or recherche qualitative ou quantitative. Les examens systématiques, les méta­ questions regarding the editorial process please contact us at analyses (quantitatives), les métasynthèses (qualitatives), les recherches sur [email protected]. les politiques publiques et de santé, les guides de pratique clinique, les rapports de cas (quantitatifs), les études de cas (qualitatives), les articles sur la Physiotherapy Canada is indexed by Allied and Complementary pratique factuelle et les rapports de mémoire sont aussi les bienvenus. Vous Medicine Database (AMED), CrossRef, Cumulative Index to Nursing pouvez présenter vos articles en ligne grâce au système électronique and Allied Health Literature (CINAHL), Google Scholar, National d’examen par les pairs ScholarOne de Physiotherapy Canada. 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https://www.utpjournals.press${contentReq.requestUri} - Horizon College Physiotherapy <[email protected]> - Thursday, January 26, 2023 9:57:02 PM - IP Address:43.246.243.147 GUEST EDITORIAL / COLLABORATION SPÉCIALE The Search for Justice: Developing a Collaborative Understanding of Health Justice in Physiotherapy Jasdeep Dhir, BSc(PT), MClSc(MT);* Tracy Blake, MSc(PT), PhD;*†‡ Shaun Cleaver, BSc (PT), PhD;§ Jenna Smith-Turchyn, MSc(PT), PhD;* Patricia Miller, Dipl(PT), PhD;* Meredith Smith, MScPT;¶**†† Mari Udarbe Han, BMR(PT), BSc; ‡‡§§¶¶ Katie Gasparelli, BSc(PT), MSc(RS);*** Sarah Wojkowski, MSc(PT), PhD* There is a real and present need for the physiother­ must cultivate environments that align with the concepts apy (PT) profession to confront injustices. This need and practices of health justice. As a profession, we must requires a clear understanding of health justice.1–3 In this work to build capacity in the community of learners and editorial, we reflect on health justice in PT and propose health care workers to disrupt and dismantle unjust sys­ an operational definition and next steps for Canadian PT tems, and build and reinforce just systems. entry-level programmes, professional associations, and regulators to consider. There are resources that explore concepts and frame­ works for social justice,8 the social determinants of The World Health Organization defines “health” as a health/health disparities,9–11 and health equity.4,9,10,12 “state of complete physical, mental and social well-being However, there is a paucity of literature contextualized and not merely the absence of disease or infirmity.”4 This to PT that explores health justice, and there is a lack of definition reflects an integrative understanding of health models and frameworks that can guide application to PT as opposed to the predominant biomedical paradigm, practice. While Borras noted that the pursuit of health which treats body, mind, and spirit as separate entities. justice require analyses, strategies, and interventions that Justice can be described as a system or structure predi­ integrate the economic, cultural, and political spheres of cated on parity in access, utilization, and the leveraging of redistribution, recognition, and representation,13 there is resources, opportunities, and voice.5,6 Health equity can little direction on how to achieve this goal. only be achieved when each individual can attain their full potential for health and well-being.4 Justice and health PURSUING A COLLABORATIVE UNDERSTANDING OF equity are the crux of an optimally operating society.7 HEALTH JUSTICE IN PT The current systemic and structural barriers that con­ It’s necessary to have an understanding of health jus­ tribute to health inequity are a global crisis and contrib­ tice through identified themes, frameworks, initiatives, ute to health outcome disparities.2,8,9 Health profession and evaluations. It is integral that these interpretations programmes need to invest the time, attention, and are responsive and reflective of the myriad contexts to resources to ensure that learners across the health care which they can be applied. To begin this work in PT, we sector are taught in inclusive environments, and develop propose the following operational definition of “health the cultural humility and competencies needed to deliver justice.” It is based on the available literature that can be high-quality patient-centred care. Training programmes used to ground collaborative discussions. From the: *School of Rehabilitation Science, Physiotherapy, McMaster University, Hamilton, Ontario, Canada; †Sport Scientist Canada; ‡Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada; §Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada; ¶Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada; **Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada; ††Black Physiotherapy Association, Canada; ‡‡519Physio, London, Ontario, Canada; §§London Health Sciences Centre; London, Ontario, Canada; ¶¶Black, Brown, Indigenous, Person of Colour (BBIPOC) Physiotherapy Student Collective in collaboration with the National Student Assembly, Canadian Physiotherapy Association, Canada; ***Healthcare Excellence Canada, Ottawa, Ontario, Canada. Correspondence to: Jasdeep Dhir, McMaster University, Institute for Applied Health Sciences, 1400 Main Street West, Hamilton, ON L8S 1C7, Canada; dhirj@ mcmaster.ca. Contributors: All authors designed the study; or collected, analyzed, or interpreted the data; and drafted or critically revised the article and approved the final draft. Competing Interests: None declared. Note from the Authors: We acknowledge power and privilege associated with our identified affiliations and our personal lived experiences, which influence the lens through which we present this paper. Physiotherapy Canada 2022; 74(3); 227–229; doi:10.3138/ptc-74-3-gee 227

228 Physiotherapy Canada, Volume 74, Number 3 https://www.utpjournals.press${contentReq.requestUri} - Horizon College Physiotherapy <[email protected]> - Thursday, January 26, 2023 9:57:02 PM - IP Address:43.246.243.147 Health justice is achieved when systems and structures SUMMARY exist to ensure all people have access to the resources Entry-level PT programmes and practising physiother­ and opportunities they need to attain, maintain, and sustain physical, mental, and emotional well-being, apists must be intentional about integrating concepts regardless of previous or current health status. Health related to justice, particularly health justice, into curric­ justice requires the development of strategies and ulum and practice. Without a consensus-derived under­ interventions that integrate and promote parity in the standing, measuring and determining progress toward availability, accessibility, affordability, and quality of addressing health justice will be difficult to coordinate services/resources. As well, health justice needs a voice and consolidate. The co-creation of an understanding of in economic, social, cultural, and political systems or health justice has the potential to influence the evolution structures.4,5,8,13–15 of the PT profession in Canada and beyond. The time for our profession to act is now. It is critical to understand and apply the tenets of health justice in the context of the PT profession.1–3,16–19 REFERENCES Many of the articles included in the United Nations Dec­ laration on the Rights of Indigenous Peoples (UNDRIP),20 1. Matthews ND, Rowley KM, Dusing SC, et al. Beyond a statement and the Truth and Reconciliation Commission (TRC) of of support: changing the culture of equity, diversity, and inclusion Canada Calls to Action21 are relevant to the PT profession in physical therapy. Phys Ther. 2021;101(12):pzab212. http://doi. and include a mandate to act. The TRC specifically calls org/10.1093/ptj/pzab212. Medline:34499177 for health care profession education to include skills- based training in intercultural competency, conflict reso­ 2. Beavis A, Flett P. Magnifying inequities: reflections on Indigenous lution, human rights, and anti-racism.21 health and physiotherapy in the context of COVID-19. https:// physiotherapy.ca/blog/magnifying-inequities-reflections­ In 2020, Physiotherapy Education Accreditation Canada indigenous-health-and-physiotherapy-context-covid-19 (PEAC) revised the accreditation standards for Canadian PT education programmes. The revised standards man­ 3. Cobbing S. Decoloniality in physiotherapy education, research and date that Canadian entry-level PT programmes embed practice in South Africa. S Afr J Physiother. 2021;77(1):1556. http:// concepts, topics, and tools related to anti-oppression, doi.org/10.4102/sajp.v77i1.1556. Medline:34192212 decolonization, and justice throughout their organiza­ tions (e.g., admissions, faculty recruitment, development 4. World Health Organization. Governance/constitution, health topics. opportunities, curriculum).14 These competencies will Cited April 22, 2022. https://www.who.int. equip PT students and practising physiotherapists to intentionally act to dismantle and disrupt the current sys­ 5. Blake T. April 21, 2021. Physiotherapy: the power to help, the power to tems that hinder and limit equity-deserving groups and harm. Personal Collection of Dr. Tracy Blake. McMaster University, will promote systems predicated on parity. Hamilton, Ontario. PROPOSED DIRECTION 6. Massachusetts Public Health Association (MPHA). MHPA’s 2020 To actively address the UNDRIP and the TRC Calls to virtual breakfast honouring Dr. Camara Jones [recorded September 18, 2020]. Cited April 22, 2022. https://mapublichealth.org/ Action, and to meet PEAC standards, Canadian PT pro­ mphas-2020-virtual-breakfast/. grammes need to integrate health justice tenets in their educational structures and systems to support learners, 7. Benfer EA. Health justice: a framework (and call to action) for the faculty, staff and affiliated health care workers. elimination of health inequity and social injustice. Am Univ Law Rev. 2015;65(2):275–351 https://pubmed.ncbi.nlm.nih.gov/28221739/. To begin developing a collaborative understanding Medline:28221739 of health justice in PT, we invite members of PT entry- level programmes, researchers, regulatory bodies, and 8. Stronks K, Toebes B, Hendriks A, et al. Social justice and human rights professional associations to delegate participants for a as a framework for addressing social determinants of health. World national consensus exercise that builds on the proposed Health Organization; 2016. https://www.euro.who.int/__data/assets/ operational definition. A process is needed to identify the pdf_file/0006/334356/HR-task-report.pdf major concepts and themes related to health justice that can inform the development of justice-driven curricular 9. Braveman PA, Kumanyika S, Fielding J, et al. Health disparities and reviews, policies, procedures, and practices by stakehold­ health equity: the issue is justice. Am J Public Health. 2011;101(S1):S149– ers in Canadian PT education and practice. To solidify the 55. http://doi.org/10.2105/AJPH.2010.300062. Medline:21551385 next steps in this project, we have secured funding from the McMaster Education Research, Innovation and The­ 10. National Collaborating Centre for Determinants of Health. Let’s talk: ory/Physician Services Incorporated Foundation through health equity. Antigonish, NS: National Collaborating Centre for a network starter grant and acknowledge the Canadian Determinants of Health, St. Francis Xavier University; 2013. Cited Physiotherapy Association for its commitment of “in April 22, 2022. https://nccdh.ca/resources/entry/health-equity. kind” support. 11. Greenwood M, de Leeuw S, Lindsay NM. Eds. Determinants of Indigenous Peoples’ health in Canada: beyond the social. Toronto, ON: Canadian Scholar’s Press; 2018. 12. Peterson A, Charles V, Yeung D, et al. The health equity framework: a science-and justice-based model for public health researchers and practitioners. Health Promot Pract. 2021;22(6):741–6. http://doi. org/10.1177/1524839920950730. 13. Borras AM. Toward an intersectional approach to health justice. Int J Health Serv. 2021;51(2):206–25. http://doi. org/10.1177/0020731420981857. Medline:33356774 14. Physiotherapy Education Accreditation Canada (PEAC). Accreditation standards for Canadian entry-to practice physiotherapy education programs. Cited April 22, 2022. https://peac-aepc.ca/pdfs/Accreditation/ Accreditation%20Standards/Accreditation-Standards-for-Canadian- Entry-to-Practice-Physiotherapy-Education-Programs-(2020).pdf. 15. Venkatapuram S. Health justice: an argument from the capabilities approach. John Wiley & Sons; Hoboken, New Jersey.2013.

Dhir et al. Developing a Collaborative Understanding of Health Justice in Physiotherapy 229 https://www.utpjournals.press${contentReq.requestUri} - Horizon College Physiotherapy <[email protected]> - Thursday, January 26, 2023 9:57:02 PM - IP Address:43.246.243.147 16. Edwards I, Delany CM, Townsend AF, et al. New perspectives on the 19. Rentmeester CA, Chapple HS, Haddad AM, et al. Teaching theory of justice: implications for physical therapy ethics and clinical and learning health justice: best practices and recommendations practice. Phys Ther. 2011;91(11):1642–52. http://doi.org/10.2522/ for innovation. Int J Teach Learn High Educ. 2016;28(3): ptj.20100351.10. Medline:21885447 440–50. 17. Blake T. In the fight for racial justice, the sidelines are no longer an 20. United Nations Declaration on the Rights of Indigenous Peoples; option. Br J Sports Med. 2020;54(21):1245–6. http://doi.org/10.1136/ 2007. Cited April 22, 2022. https://www.un.org/development/ bjsports-2020-102894. Medline:32732258 desa/indigenouspeoples/wp-content/uploads/sites/19/2018/11/ UNDRIP_E_web.pdf. 18. Blake T. Progressing past awareness and towards racial justice in physiotherapy. Canadian Physiotherapy Association, Orthopaedic 21. Truth and Reconciliation Commission of Canada. Truth and Division; 2020. https://cpa.embodiaacademy.com/webinars/185­ reconciliation commission of Canada: Calls to action; 2015. the-internet-is-free-progressing-pastawareness-and-towards-racial­ Cited 2022. https://www.rcaanc-cirnac.gc.ca/eng/1524499024614/ justice-in-physiotherapy. 1557512659251. GUEST EDITORIAL / COLLABORATION SPÉCIALE La recherche de la justice : acquérir une compréhension intégrative de la justice en santé en physiothérapie Jasdeep Dhir, B. Sc. pht., MClSc (MT);* Tracy Blake, M. Sc. pht., Ph. D.;*†‡ Shaun Cleaver, B. Sc. pht., Ph. D.;§ Jenna Smith-Turchyn, M. Sc. pht., Ph. D.;* Patricia Miller, Dipl. pht., Ph. D.;* Meredith Smith, M. Sc. pht.;¶** †† Mari Udarbe Han, BMR PT, B. Sc.; ‡‡§§¶¶ Katie Gasparelli, B. Sc. pht., M. Sc. (RS);*** Sarah Wojkowski, M. Sc. pht., Ph. D.* Dans le domaine de la physiothérapie, on constate absence de maladie ou d’infirmité »4. Cette définition un besoin réel et bien présent de dénoncer les injustices. reflète une compréhension intégrative de la santé par rap­ Pour y répondre, il faut bien comprendre la justice en port au paradigme biomédical prédominant, qui traite le santé1-3. Dans le présent éditorial, les auteurs réfléchis­ corps, la pensée et l’esprit comme des entités distinctes. sent à la justice en santé en physiothérapie, en proposent La justice peut être décrite comme un système ou une une définition opérationnelle et suggèrent les prochaines structure prédite selon la parité d’accès, ainsi que selon étapes à envisager pour les programmes d’enseignement l’utilisation et la mobilisation des ressources, des possi­ d’entrée à la pratique canadiens, les associations profes­ bilités et des opinions5,6. L’équité en matière de santé ne sionnelles et les régulateurs. sera atteinte que lorsque chacun aura réalisé son plein potentiel sur le plan de la santé et du bien-être4. La justice L’Organisation mondiale de la Santé définit la santé et l’équité en matière de santé sont au cœur d’une société comme « un état de complet bien-être physique, men­ au fonctionnement optimal7. tal et social et [qui] ne consiste pas seulement en une Affiliation : *École des sciences de la réadaptation, Physiothérapie, Université McMaster, Hamilton, Ontario, Canada; †Sciences du sport Canada; ‡Toronto Western Hospital, Réseau universitaire de santé, Toronto, Ontario, Canada; §Faculté de médecine et des sciences de la santé, Université McGill, Montréal, Québec, Canada; ¶Département de physiothérapie, Université de Toronto, Toronto, Ontario, Canada; **Institut de réadaptation de Toronto, Réseau universitaire de santé, Toronto, Ontario, Canada; ††Black Physiotherapy Association, Canada; ‡‡519Physio, London, Ontario, Canada; §§London Health Sciences Centre; London, Ontario, Canada; ¶¶Black, Brown, Indigenous, Person of Colour (BBIPOC) Physiotherapy Student Collective en collaboration avec l’Assemblée nationale des étudiants, Association canadienne de physiothérapie, Canada; ***Excellence en santé Canada, Ottawa, Ontario, Canada. Correspondance à : Jasdeep Dhir, Université McMaster, Institute for Applied Health Sciences, 1400 Main Street West, Hamilton, ON L8S 1C7, Canada; dhirj@ mcmaster.ca. Collaborateurs : Tous les auteurs ont conçu l’étude ou ont recueilli, analysé ou interprété les données et ont rédigé ou procédé à l’examen critique de l’article et en ont approuvé la version définitive. Conflits d’intérêts : Les auteurs n’ont aucun conflit d’intérêts à déclarer. Physiotherapy Canada 2022; 74(3); 229–231; doi:10.3138/ptc-74-3-gef

230 Physiotherapy Canada, Volume 74, Number 3 https://www.utpjournals.press${contentReq.requestUri} - Horizon College Physiotherapy <[email protected]> - Thursday, January 26, 2023 9:57:02 PM - IP Address:43.246.243.147 Les obstacles systémiques et structurels actuels qui Il est capital de comprendre et d’appliquer les principes contribuent à l’iniquité en matière de santé représentent de la justice en santé au sein de la profession de la phys­ une crise mondiale et contribuent aux écarts liés aux résul­ iothérapie1–3,16–19. De nombreux articles de la Déclaration tats cliniques à l’égard de la santé2,8,9. Les programmes des Nations Unies sur les droits des peuples autochtones dans les professions de la santé ont besoin de consacrer le (DNUDPA)20 et des appels à l’action de la Commission de temps, l’attention et les ressources nécessaires pour que les vérité et réconciliation du Canada (CVR)21 s’appliquent à apprenants de tous les secteurs de la santé puissent étudier la profession et incluent un mandat d’agir. La CVR prévoit dans des environnements inclusifs et acquérir l’humilité et expressément que l’enseignement des professions de la les compétences culturelles nécessaires pour prodiguer santé intègre une formation axée sur les compétences des soins de qualité axés sur les patients. Les programmes pour ce qui est de l’aptitude interculturelle, du règlement de formation doivent cultiver des environnements de différends, des droits de la personne et de la lutte con­ respectueux des concepts et des pratiques en matière de tre le racisme21. justice en santé. Dans la profession, nous devons travailler pour renforcer les capacités dans la communauté d’ap­ En 2020, Agrément de l’enseignement de la physio­ prenants et de travailleurs de la santé, de manière à per­ thérapie au Canada (AEPC) a revu les règles d’agrément turber et à démanteler des systèmes injustes, ainsi qu’à des programmes d’enseignement de la physiothérapie construire et renforcer des systèmes justes. au Canada. Selon ces nouvelles normes, les programmes d’enseignement d’entrée à la pratique en physiothérapie Certaines ressources explorent les concepts et les cad­ canadiens intègrent des concepts, des sujets et des outils res relatifs à la justice sociale8, aux déterminants soci­ liés à l’anti-oppression, à la décolonisation et à la justice aux de la santé, ainsi qu’aux disparités9–11 et à l’équité en dans l’ensemble de leur organisation (p. ex., admissions, matière de santé4,9,10,12. Cependant, peu de publications recrutement de professeurs, possibilités de perfectionne­ contextualisées à la physiothérapie explorent la justice en ment, cursus)14. Grâce à ces compétences, les étudiants santé et peu de modèles et de cadre en orientent l’applica­ en physiothérapie et les physiothérapeutes en exercice tion vers l’exercice de la physiothérapie. Borras a souligné seront en mesure d’agir délibérément pour perturber et que la poursuite de la justice en santé a besoin d’analyses, démanteler les systèmes actuels qui entravent et limitent de stratégies et d’interventions qui intègrent les sphères les groupes dignes d’équité et favoriseront des systèmes économiques, culturelles et politiques de redistribution, fondés sur la parité. de reconnaissance et de représentation13, et que très peu de directives visent la réalisation de cet objectif. LA DIRECTION PROPOSÉE Pour donner suite activement à la DNUDPA et aux LA RECHERCHE D’UNE COMPRÉHENSION INTÉGRATIVE DE LA JUSTICE EN SANTÉ EN PHYSIOTHÉRAPIE appels à l’action de la CVR et pour respecter les normes de l’AEPC, les programmes de physiothérapie du Can­ Il faut comprendre la justice en santé au moyen de ada intègrent les principes de justice en santé dans leurs thèmes établis, de cadres, d’initiatives et d’évaluations. structures et leurs systèmes d’éducation pour soutenir Il est essentiel que ces interprétations soient réceptives les apprenants, les professeurs, le personnel et les travail­ et respectueuses des multiples contextes auxquels elles leurs de la santé affiliés à la santé. peuvent être appliquées. Pour entreprendre ce travail en physiothérapie, les auteurs proposent la définition Par ailleurs, pour commencer à acquérir une com­ opérationnelle suivante de la « justice en santé ». Cette préhension intégrative de la justice en santé en phys­ définition s’inspire du contenu des publications scien­ iothérapie, les auteurs invitent les membres des tifiques et peut être utilisée pour corroborer des échanges programmes d’enseignement d’entrée à la pratique en concertés. physiothérapie, les chercheurs, les organismes de régle­ mentation et les associations professionnelles à partici­ La justice en santé est respectée lorsque des systèmes per à un exercice de consensus national qui s’appuie sur et des structures sont en place pour s’assurer de l’ac­ la définition opérationnelle proposée. En effet, un proces­ cès universel aux ressources et aux possibilités néces­ sus s’impose pour déterminer les principaux concepts et saires pour obtenir, maintenir et soutenir un bien-être les principaux thèmes liés à a justice en santé qui peu­ physique, mental et affectif, quel que soit l’état de vent éclairer l’élaboration d’analyses des cursus axés sur santé individuel antérieur ou actuel. La justice en la justice, les politiques, les interventions et les pratiques santé nécessite l’élaboration de stratégies et d’inter­ qu’adoptent les intervenants canadiens de l’enseigne­ ventions qui intègrent et favorisent la parité grâce à ment et de la pratique de la physiothérapie. Afin de bien la disponibilité, à l’accessibilité, à l’abordabilité et à la consolider les prochaines étapes du projet, les auteurs ont qualité des services ou des ressources. Elle doit égale­ obtenu un financement du McMaster Education Research, ment être défendue dans les systèmes ou structures Innovation and Theory Program et de la Physician Services économiques, sociaux, culturels et politiques4,5,8,13–15. Incorporated Foundation sous forme de bourse de démar­ rage de réseau et remercient l’Association canadienne de

Dhir et al. Acquérir une compréhension intégrative de la justice en santé en physiothérapie 231 https://www.utpjournals.press${contentReq.requestUri} - Horizon College Physiotherapy <[email protected]> - Thursday, January 26, 2023 9:57:02 PM - IP Address:43.246.243.147 physiothérapie pour son engagement à offrir un soutien 2011;101(S1):S149–55. http://doi.org/10.2105/AJPH.2010. « en nature ». 300062. Medline:21551385 10. Centre de collaboration nationale des déterminants de la santé. SOMMAIRE L’équité en santé : Parlons-en. Antigonish (N.-É.) : Centre de Les programmes d’enseignement d’entrée à la pra­ collaboration nationale des déterminants de la santé, Université St. Francis Xavier; 2013. Cité le 22 avril 2022. https://nccdh.ca/fr/ tique en physiothérapie doivent intégrer délibérément resources/entry/health-equity. les concepts liés à la justice, notamment la justice en 11. Greenwood M, de Leeuw S, Lindsay NM. éd. Determinants of santé, au cursus et à la pratique. Sans compréhension Indigenous Peoples’ health in Canada: beyond the social. Toronto, consensuelle, il sera difficile de mesurer et de déterminer ON: Canadian Scholar’s Press; 2018. les progrès en vue de satisfaire à la justice en santé. La 12. Peterson A, Charles V, Yeung D et coll. The health equity framework: création conjointe d’une compréhension de la justice en a science-and justice-based model for public health researchers and santé pourrait influer sur l’évolution de la profession de practitioners. Health Promot Pract. 2021;22(6):741–6. http://doi. la physiothérapie au Canada et ailleurs. Le moment pour org/10.1177/1524839920950730. que notre profession agisse, c’est maintenant. 13. Borras AM. Toward an intersectional approach to health justice. Int J Health Serv. 2021;51(2):206–25. http://doi. RÉFÉRENCES org/10.1177/0020731420981857. Medline:33356774 14. Agrément de l’enseignement de la physiothérapie au Canada 1. Matthews ND, Rowley KM, Dusing SC et coll. Beyond a statement (AEPC). Normes d’agrément visant les programmes d’enseignement of support: changing the culture of equity, diversity, and inclusion d’entrée à la pratique en physiothérapie au Canada. Cité le in physical therapy. Phys Ther. 2021;101(12):pzab212. http://doi. 22 avril 2022. https://peac-aepc.ca/pdfs/FRENCH/Accreditation/ org/10.1093/ptj/pzab212. Medline:34499177 Accreditation%20Standards/Normes-dagrement-visant­ les-programmes-denseignement-dentree-a-la-pratique-en­ 2. Beavis A, Flett P. Amplifier les iniquités : Réflexions sur la santé des physiotherapie-au-Canada-2020.pdf. Autochtones et sur la physiothérapie dans le contexte de la COVID-19. 15. Venkatapuram S. Health justice: an argument from the capabilities https://physiotherapy.ca/fr/blog/amplifier-les-iniquites-reflexions­ approach. John Wiley & Sons; Hoboken, New Jersey. 2013. sur-la-sante-des-autochtones-et-sur-la-physiotherapie-dans. 16. Edwards I, Delany CM, Townsend AF et coll. New perspectives on the theory of justice: implications for physical therapy ethics and clinical 3. Cobbing S. Decoloniality in physiotherapy education, research and practice. Phys Ther. 2011;91(11):1642–52. http://doi.org/10.2522/ practice in South Africa. S Afr J Physiother. 2021;77(1):1556. http:// ptj.20100351.10. Medline:21885447 doi.org/10.4102/sajp.v77i1.1556. Medline:34192212 17. Blake T. In the fight for racial justice, the sidelines are no longer an option. Br J Sports Med. 2020;54(21):1245–6. http://doi.org/10.1136/ 4. Organisation mondiale de la Santé. Gouvernance de l’OMS/ bjsports-2020-102894. Medline:32732258 constitution, santé. Cité le 22 avril 2022. https://www.who.int. 18. Blake T. Progressing past awareness and towards racial justice in physiotherapy. Association canadienne de physiothérapie, 5. BlakeT. Le 21 avril 2021. Physiotherapy: the power to help, the power Division d’orthopédie; 2020. https://cpa.embodiaacademy.com/ to harm. Collection personnelle de la Pre Tracy Blake. Université webinars/185-the-internet-is-free-progressing-pastawareness-and­ McMaster, Hamilton, Ontario. towards-racial-justice-in-physiotherapy. 19. Rentmeester CA, Chapple HS, Haddad AM et coll. 6. Massachusetts Public Health Association (MPHA). MHPA’s 2020 Teaching and learning health justice: best practices and virtual breakfast honouring Dr. Camara Jones [enregistré le recommendations for innovation. Int J Teach Learn High Educ. 18 septembre 2020]. Cité le 22 avril 2022. https://mapublichealth. 2016;28(3):440–50. org/mphas-2020-virtual-breakfast/. 20. Déclaration des Nations Unies sur les droits des peuples autochtones; 2007. Cité le 22 avril 2022. https://www.un.org/ 7. Benfer EA. Health justice: a framework (and call to action) for the development/desa/indigenouspeoples/wp-content/uploads/ elimination of health inequity and social injustice. Am Univ Law Rev. sites/19/2018/11/UNDRIP_F_web.pdf. 2015;65(2):275–351. https://pubmed.ncbi.nlm.nih.gov/28221739/. 21. Commission de vérité et réconciliation du Canada. Donner suite aux Medline:28221739 appels à l’action de la Commission de vérité et réconciliation; 2015. Cité en 2022. https://www.rcaanc-cirnac.gc.ca/fra/1524499024614/1 8. Stronks K, Toebes B, Hendriks A et coll. Social justice and human 557512659251. rights as a framework for addressing social determinants of health. Organisation mondiale de la Santé; 2016. https://www.euro.who. int/__data/assets/pdf_file/0006/334356/HR-task-report.pdf 9. Braveman PA, Kumanyika S, Fielding J et coll. Health disparities and health equity: the issue is justice. Am J Public Health.

https://www.utpjournals.press${contentReq.requestUri} - Horizon College Physiotherapy <[email protected]> - Thursday, January 26, 2023 9:57:02 PM - IP Address:43.246.243.147 ARTICLE Immediate Effect of Dry Needling on the Viscoelastic Properties of a Trigger Point on the Infraspinatus Muscle Measured with MyotonPRO Mélanie Roch, MSc, PT; Mélanie Morin, PhD, PT; Nathaly Gaudreault, PhD, PT ABSTRACT Purpose : This article investigates the immediate effects of a dry needling (DN) puncture on the viscoelastic properties (tone, stiffness, elasticity) of a trigger point (TP) in the infraspinatus muscle in non-traumatic chronic shoulder pain. Method : Forty-eight individuals with non-traumatic chronic shoulder pain were recruited. The presence of a TP in the infraspinatus muscle was confirmed by a standardized palpatory exam. The viscoelastic properties were measured with a MyotonPRO device at baseline (T1), immediately after DN (T2), and 30 minutes later (T3). A DN puncture was applied to the TP to obtain a local twitch response while performing the technique. Results: Analyses of variance showed significant decreases in tone (p < 0.001) and stiffness (p = 0.003) across time after the DN technique. Post hoc tests revealed a significant reduction in tone and stiffness from T1 to T2 (p ≤ 0.004) and no significant changes from T2 to T3 (p ≥ 0.10). At T3, only stiffness remained significantly lower compared to T1 (p = 0.013). Conclusions: This study brings new insights on the immediate mechanical effect of DN on tone and stiffness of TPs. Whether these effects are associated with symptom improvement and long-term effects still needs to be verified. Key Words: elasticity; measurement; muscle tonus; myofascial trigger point. RÉSUMÉ Objectif : examiner les effets immédiats de la puncture avec aiguille sèche (AS) sur les propriétés viscoélastiques (tonus, raideur, élasticité) d’un point gâchette (PG) du muscle infra-épineux dans des cas de douleur chronique d’origine non traumatique de l’épaule. Méthodologie : les chercheurs ont recruté 48 personnes avec présence de douleur chronique d’origine non traumatique à l’épaule. Ils ont confirmé la présence d’un PG dans le muscle infra-épineux avec un examen palpatoire standardisé. Au moyen de l’appareil MyotonPRO, ils ont mesuré les propriétés viscoélastiques en début d’étude (T1), immédi­ atement après l’intervention par AS (T2), puis 30 minutes plus tard (T3). Durant l’application de la technique de AS, des manoeuvres étaient effectuées avec l’aiguille dans le but d’obtenir une contraction musculaire réflexe involontaire. Résultats : les analyses de variance ont révélé une diminution importante du tonus (p < 0,001) et de la rigidité (p = 0,003) au travers les différents temps de mesure. Les analyses post hoc ont révélé une importante diminution significative au niveau du tonus et de la raideur entre les temps de mesure T1 et T2 (p ≤ 0,004) et aucun changement entre T2 et T3 ( p ≥ 0,10). À T3, seule la raideur est demeurée significativement plus basse qu’au temps de mesureT1 (p = 0,013). Conclusions : la présente étude apporte de nouvelles évidences sur les effets mécaniques immédiats de l’AS sur le tonus et la raideur des PG. Les prochaines études devront vérifier si ces effets sont associés à l’amélioration des symptômes et sur des effets à plus long terme. Mots-clés : élasticité; mesure; tonus musculaire; points gâchette, douleur myofasciale Myofascial pain syndrome (MPS) is a major cause of muscle painful on compression, stretch, overload or con- morbidity and musculoskeletal (MSK) pain with a prev- traction and may cause local or referred pain, and motor alence ranging from 9% to 85% in clinical populations. dysfunction.”4(p. 5) The associated financial burden in the United States is approximately $50.4 billion (US) to $57.15 billion (US) Dry needling (DN), which consists of inserting a thin per year.1 MPS is characterized by MSK pain in which the filiform needle into a TP, has gained popularity among cli­ muscle and fascia can present with pain.2 Studies show nicians5 for the treatment of TPs. Several recent systematic that a myofascial trigger point (TP) could be the primary reviews have revealed that DN decreases pain in the short source of this pain.3 The commonly accepted definition of to medium term and improves pressure pain threshold, TP is “a hyper-irritable spot within a taut band of skeletal range of motion, and quality of life.6,7 The effectiveness of this treatment in the shoulder is also supported by two From the: Université de Sherbrooke, Faculté de médecine et des sciences de la santé, École de Réadaptation, Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Quebec, Canada. Correspondence to: Nathaly Gaudreault, School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, QC J1H 5N4, Canada; [email protected]. Contributors: All authors designed the study; or collected, analyzed, or interpreted the data; and drafted or critically revised the article and approved the final draft. Competing Interests: The Physiotherapy Foundation of Canada funded this research through an Acupuncture Division Research Grant. Physiotherapy Canada 2022; 74(3); 232–239; doi:10.3138/ptc-2020-0095 232























































260 Physiotherapy Canada, Volume 74, Number 3 Table 1 Topics Patients Identified as Research Priorities in Pulmonary Rehabilitation https://www.utpjournals.press${contentReq.requestUri} - Horizon College Physiotherapy <[email protected]> - Thursday, January 26, 2023 9:57:02 PM - IP Address:43.246.243.147 Meeting Prioritized topic Summary in member checking questionnaire no. (no. of participants) 1 (n = 3) More information pre- Providing information on topics such as what patients can expect, what to bring on admission, 2 (n = 3) admission (handout or meeting) and what providers expect of patients throughout the PR programme. Physiotherapists could set Different exercises for different up a meeting to evaluate patients’ knowledge of their condition and symptoms. Researchers could people evaluate the effect of this information session on patients’ enjoyment of and participation in PR Music as a motivator sessions. Researchers could also evaluate patients’ knowledge at the beginning and end of PR. After-maintenance programme Making exercise programmes more individualized – for example, doing a balance assessment with each patient on admission to determine whether to incorporate balance training into their Death of a friend from the programme. Researchers could study whether making exercise programmes more individualized programme improves patient outcomes. Exercise—what, why, and how Evaluating the effect of listening to music (either individually or over the exercise room speaker) on Additional support patient outcomes. Researchers could study whether music can make exercise more enjoyable and Checking progress act as a distraction allowing patients to push themselves further than those not listening to music. Monitoring patients following discharge from the maintenance programme. An after-maintenance Tracking after maintenance programme could allow patients to stay in contact with people they met through the programme and encourage patients to continue exercising. The programme could run every other week, for Ongoing motivation example. Researchers could evaluate whether these sessions help patients maintain the benefits of PR longer. Evaluating the effects on patients of losing a loved one or a close friend from the PR or maintenance programme. Researchers could look at the effect of the loss on patients’ motivation, mood, participation, or outcomes. Study results could inform efforts to support patients when someone they are close to passes away. Providing more detailed explanations of the reasons physiotherapists prescribe each exercise. The why may help patients understand the benefits of their exercise programme and make progress. Researchers could see whether this additional education improves patient outcomes. Providing additional (i.e., non-clinical) support as part of PR. This support could be in the form of peer mentorship, regular check-ins from physiotherapists or other health care professionals, and emotional and psychological support. Researchers could determine whether this support provides a more enjoyable patient experience and improves patient outcomes. Making changes to the frequency and content of follow-up visits and monitoring patients during the maintenance programme to ensure ongoing progression of individual exercise programmes. The PR programme uses standard admission and discharge assessments, but assessment is lacking in the maintenance programme. Patients who are self-motivated and know how to progress their exercise programmes may do so, but it is unclear whether the patient or the physiotherapist is responsible for progressing the exercises. The physiotherapist could administer standard assessments (for example, at 3 and 6 months after the maintenance programme begins) to determine whether the patient is progressing, staying the same, or declining and make adjustments to the exercises as necessary. Researchers could evaluate the maintenance programme to see whether participants maintain the improvements in outcomes achieved during PR. Making changes to the frequency and content of follow-up visits and monitoring patients after discharge from the maintenance programme to ensure they are managing, continuing to exercise, and progressing. For example, physiotherapists could see patients a few months after discharge to keep patients accountable, motivate them to continue exercising, and allow them to be readmitted to PR if they are struggling. Researchers could study the effect of this ongoing monitoring on patient health outcomes. Finding ways to increase patients’ motivation to continue exercising and managing their disease at home. The PR programme provides patients with a breathing exercise DVD; videos of other exercises (e.g., the weightlifting programme) could also be helpful. By viewing videos, patients can exercise at home as if they are part of a class (i.e., in a group atmosphere). Researchers could see whether access to exercise videos increases the amount of exercise patients do at home and improves their health outcomes. (Continued )

O’Hoski et al. Priorities in Pulmonary Rehabilitation Research 261 Table 1 (Continued) https://www.utpjournals.press${contentReq.requestUri} - Horizon College Physiotherapy <[email protected]> - Thursday, January 26, 2023 9:57:02 PM - IP Address:43.246.243.147 Meeting Prioritized topic Summary in member checking questionnaire no. (no. of participants) 3 (n = 4) Tracking rates and reasons for Some PR patients are self-motivated and want to work hard to improve their health, while others 4 (n = 2) dropouts from PR attend the programme only because their doctor has recommended it. Researchers could identify Programme expectations characteristics of the patients who can benefit most from the PR programme to help reduce dropout and ensure that patients who are admitted are willing to work effectively. Extending the duration of PR Providing pre-admission information sessions to patients that address what to expect in the Preparing for emergencies programme, day-to-day scheduling, what patients are expected to do, and what to bring. This information could help patients feel more knowledgeable, confident, and comfortable when they Strategies for managing in are admitted. Researchers could look at whether these sessions increase patient knowledge and uncontrolled environments confidence at admission, raise the programme’s completion rate, and improve patient outcomes. Providing PR for longer periods. Researchers could study different programme lengths to see Coping at home after discharge whether longer programmes lead to greater improvements in physical function and knowledge and to determine the ideal programme length. One-on-one support Preparing for emergencies in different settings (the centre, home, community) – for example, how Exercise and education for non- to respond to a fire in the home when patients move slowly and smoke inhalation exacerbates COPD conditions their symptoms. Physiotherapists can provide emergency preparation guidelines in a pamphlet or an education session. Researchers could look at changes in knowledge and patient comfort in COPD action plans responding to an emergency before and after reading the pamphlet or attending the session. Providing more strategies to cope with shortness of breath and anxiety in uncontrollable Knowledge of condition and environments such as humid or cold weather. Researchers could identify strategies that are new management or different from those clinicians already teach in the programme by looking at recent studies, surveying physiotherapists who work with people with lung disease, and asking patients what strategies they use. Providing patients with more information on how to cope at home and make needed adjustments to their exercise and self-management programme. Physiotherapists could use a discharge meeting to assess patients’ knowledge about managing their disease and their exercise programme. Researchers could look at whether providing more information at discharge improves patient health outcomes (e.g., exacerbations, hospitalizations, physical function and fitness). Changing the staff-to-patient ratio to provide more one-on-one attention for each patient. Researchers could evaluate the effects of increased individual attention on patients’ progression of exercise programmes and health outcomes. Providing education to patients with diagnoses other than COPD about their lung condition – for example, how to manage symptoms and what exercises are suited to their particular diagnosis. Physiotherapists could provide pamphlets about different conditions, explain appropriate exercises at the beginning of the programme, or set up additional or separate education sessions for patients with conditions other than COPD. Researchers could look at the diagnoses of the people admitted to the centre’s programmes, explore differences in the management of different lung conditions, update educational materials, and examine the effects of PR on patients with diagnoses other than COPD. Having an action plan to access medications without having to see a doctor can help decrease patients’ recovery time after COPD exacerbations. Researchers could survey patients to find out what they know about COPD action plans, how many patients have one, and how patients with and without an action plan differ in terms of exacerbation recovery time and other health outcomes. Conducting a preadmission assessment of patients’ knowledge of their condition, medications, and symptom management. Researchers could compare the results to a pre-discharge assessment to see what knowledge patients gained through the programme. (Continued )

262 Physiotherapy Canada, Volume 74, Number 3 Table 1 (Continued) https://www.utpjournals.press${contentReq.requestUri} - Horizon College Physiotherapy <[email protected]> - Thursday, January 26, 2023 9:57:02 PM - IP Address:43.246.243.147 Meeting Prioritized topic Summary in member checking questionnaire no. (no. of participants) 5 (n = 2) Ongoing follow-up during the Tracking patients’ follow-up care. Physiotherapists could ensure they know when patients need maintenance programme to see a doctor next to avoid large gaps between follow-up appointments. Rehabilitation team members could better communicate among themselves and with external sites to ensure that Information about the centre everyone involved in the patient’s care is up to date on the patient’s status. Physiotherapists could conduct ongoing assessment of patients’ progress in the maintenance programme. Researchers Assessment and exercise – the could review maintenance programme patients’ follow-up history to find out when they last saw a why respirologist and evaluate the centre’s follow-up processes. Modification of education Providing patients with more information about the centre’s PR programme before admission – sessions for example, the location of the hospital and transportation options. More information could help patients choose whether to attend the PR programme at our centre and feel more comfortable Flexibility in assessments when entering the programme. Researchers could track patients’ reasons for choosing not to attend our programme and see whether providing additional information to patients at the beginning makes a difference in participation rates. Providing more detailed explanation of exercises and progression throughout the PR programme – for example, why patients should do each exercise, how it can help them, and how individual patients’ programmes may differ (e.g., why some people do a balance assessment and others do not). Researchers could study how describing the why impacts patients’ motivation to exercise. Updating education sessions to incorporate more real-life patient experiences, new strategies for managing symptoms, and ways to adapt to life with lung disease. Physiotherapists could provide more detailed pamphlets and printed materials to patients to read on their own. Researchers could study ways to make education sessions more engaging for patients and the effect of different types of education on patients’ knowledge. Modifying assessments according to patients’ needs. For example, physiotherapists commonly use the 6-minute walk test on admission to and discharge from PR to measure patients’ exercise capacity. The physiotherapist usually sets up a course with cones and asks the patient to walk around them in a loop. Having the patient walk in a larger loop or without a course could provide a more realistic picture of the walking patients do every day. Researchers could study how the modified and unmodified versions compare and whether a 6-minute walk without a set course is a valid way to measure exercise capacity. COPD = chronic obstructive pulmonary disease; PR = pulmonary rehabilitation. identified research priorities for patients with asthma,11 outlined in the most recent Cochrane systematic review our participants prioritized topics related to successful of PR for COPD; topics included exploring the opti­ self-management (i.e., ongoing motivation, COPD action mal PR duration, degree of supervision, and long-term plans,21 and coping at home post-discharge), manage­ patient follow-up.22 The Cochrane review authors identi­ ment of respiratory symptom triggers (i.e., coping with fied several priority topics that our participants did not symptom triggers in uncontrolled environments), and mention, including essential components of PR, differ­ psychological interventions (i.e., psychological check- ences in PR by location (e.g., hospital vs. community), ins during PR). Unlike participants in previous studies, and optimal training intensity.22 Likewise, our partici­ our participants showed little focus on pharmacological pants prioritized components of PR the Cochrane review management, with the COPD action plan21 the only med­ authors did not mention, such as personalization (e.g., ication-related topic they prioritized. Medication may providing education for patients with conditions other have been less of a focus for our participants given that than COPD, choosing exercise type based on patient they had already received self-management education need) and knowledge related to the what, why, and how during PR. Additionally, their participation in the weekly of various exercises. programme may have been an indicator that their disease and symptoms were well controlled. Regarding general rehabilitation research, the National Institutes of Health (NIH) has recommended six areas of Many of the research priorities our participants iden­ focus.23 Our participants prioritized topics related to four tified overlap with the key future research directions of these areas: addressing symptom burden (NIH area

O’Hoski et al. Priorities in Pulmonary Rehabilitation Research 263 https://www.utpjournals.press${contentReq.requestUri} - Horizon College Physiotherapy <[email protected]> - Thursday, January 26, 2023 9:57:02 PM - IP Address:43.246.243.147 “rehabilitation across the lifespan”), self-management in only two participants. The small group sizes limited the the community (“community and family”), ongoing mon­ number of ideas the participants generated. However, itoring and support (“technology use and development,” previous research using the NGT included 2–14 people although our participants did not target technology spe­ per group,19 and given that we reached data saturation, cifically), and the impact of various programme elements it is unlikely that larger groups would have affected our on patient outcomes (i.e., effectiveness trials; “research results. Another limitation relates to the representative­ design and methodology”). None of the topics our partici­ ness of our sample. While it was necessary to recruit pants prioritized related to the NIH areas of “translational participants who had completed PR, including only science” and “building research capacity and infrastruc­ patients currently in the maintenance programme (i.e., ture.” Given that researchers and clinicians were involved who attended one exercise session per week at the cen­ in developing the NIH research plan, topics related to tre) may have impacted the results: patients who did not these areas may emerge in the next phase of our study, enter the maintenance programme after completing PR meetings with health care professionals. may have had a different impression of the programme or may have lived too far from the centre, and they might While the modified NGT process allowed us to engage have chosen different research priorities. Additionally, multiple patients equally, some participants found the our sample comprised mainly patients with COPD. first phase, silent generation of ideas, to be difficult. They While this proportion is reflective of patients in our PR preferred to make suggestions verbally, either because programme, the small sample size meant that only three they were not confident about writing (e.g., poor spelling, people without COPD participated. To mitigate this lim­ non-native English) or because they wanted feedback itation, in the next phase of the study we will attempt to on possible ideas to make sure they were on the right reach a larger group of former PR patients. Finally, given track. We reminded participants that they would have the that we asked participants to identify research topics opportunity to discuss their ideas aloud in the second related to PR, the priorities in our results cannot be gen­ phase of the meeting, round robin idea presentation. We eralized to other research areas. encourage researchers looking to use the NGT process to bear this patient preference in mind. CONCLUSION In this study, we identified 25 patient priorities related An additional factor to note in using small group NGT meetings is that the topics each participant identifies and to several aspects of the PR programme, including prioritizes may be specific to the individual participants assessment, treatment (exercise, education, and behaviour and their present situation. Further, because we did not change), and promotion of motivation and adherence to require participants in this study to reach consensus, exercise after discharge. Many of the topics our partici­ some topics were chosen as a priority by a single par­ pants identified are included in guidelines for both gen­ ticipant. For example, one participant who had experi­ eral and PR-specific rehabilitation research. Some topics enced the death of a friend in the programme prioritized were consistent with previously identified patient priori­ research exploring this topic. This finding highlights the ties in the respiratory field, the primary difference being need to consult a larger group of participants to deter­ our participants’ lack of focus on the pharmacological mine whether each topic is important to the majority of management of their conditions. Including patients in patients. In the next phase of this study, we will recruit generating research priorities is an important step in con­ post-PR patients to complete a survey in which they ducting research that is meaningful and relevant to those will prioritize the 25 topics identified in these meetings. it aims to help. This survey will allow us to identify a smaller list of top­ ics that are important to the majority of a larger group of KEY MESSAGES participants. What is already known on this topic The NGT is an effective way to generate stakeholders’ Engaging patients in various stages of the research pro­ views of research priorities, and researchers can use this technique to consult stakeholders other than patients cess, including priority setting, can have a positive impact about their priorities in PR research. To that end, we plan on patients, researchers, and communities: patients feel to conduct similar NGT meetings with health care profes­ empowered and valued, researchers gain fresh insight sionals who have experience in PR. Following these meet­ into issues, research agendas are broadened, and research ings, we will combine and categorize topics that both is more relevant to stakeholders. Patient engagement has patients and clinicians have prioritized, form research the potential to increase study enrolment and retention questions, and divide these questions into those that and to improve dissemination of results in the commu­ require further research and those that researchers have nity. Researchers have identified patient priorities in answered but that require knowledge translation efforts. several respiratory populations but not in the context of pulmonary rehabilitation. A potential limitation of our study is that because of scheduling difficulties, two of the five meetings had

264 Physiotherapy Canada, Volume 74, Number 3 https://www.utpjournals.press${contentReq.requestUri} - Horizon College Physiotherapy <[email protected]> - Thursday, January 26, 2023 9:57:02 PM - IP Address:43.246.243.147 What this study adds 10. Michalovic E, Jensen D, Bishop EG, et al. Healthcare and research Patients with chronic lung disease who had com­ priorities of adults with mild-to-very severe COPD. Am J Respir Crit Care Med. 2018; 197: A2511. Available from: https://www. pleted our pulmonary rehabilitation programme pri­ atsjournals.org/doi/abs/10.1164/ajrccm-conference.2018.197.1_ oritized 25 topics for research that were related to the MeetingAbstracts.A2511. exercise, education, and behaviour change aspects of the programme and that were relevant from pre-admission 11. Elwyn G, Crowe S, Fenton M, et al. Identifying and prioritizing to post-discharge. These topics included factors that uncertainties: patient and clinician engagement in the identification influence motivation or adherence, such as using music of research questions. J Eval Clin Pract. 2010; 16(3): 627–31. https:// as a motivator and tracking rates and reasons for dropout; doi.org/10.1111/j.1365-2753.2009.01262.x. Medline:20482747 ongoing assessment and follow-up both during the rehabilitation programme and after discharge; and more 12. Rowbotham NJ, Smith S, Leighton PA, et al. The top 10 research personalized programming that incorporates educa­ priorities in cystic fibrosis developed by a partnership between tion on non-COPD conditions and different exercises for people with CF and healthcare providers. Thorax. 2018; 73(4): different people. 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