Purpose: Functional dependence affects well-being and life expectancy. We identified baseline variables that best predict future limitations in basic and instrumental activities of daily living. Method: Using a filtering approach, we selected the best predictors from 4,248 candidate predictors for 39,927 Canadian Longitudinal Study on Aging participants aged 44–88 years and compared machine learning models trained on baseline data (2010–2015) on their ability to classify functional status (independent vs. dependent people) at follow-up (2018–2021) in a training set ( n = 31,941). We then tested the best model in a separate test set ( n = 7,986). Results: Eighteen variables best predicted functional status at follow-up. Logistic regression performed best, achieving 81.9% balanced accuracy in the test set. Protective factors included no baseline limitations, stronger grip, absence of pain or chronic conditions, female sex, having a driver’s license, and good memory. Risk factors included older age, psychological distress, slow walking, retirement, chronic conditions, and physical inactivity. Conclusion: Functional status can be predicted up to 6 years in advance using health, demographic, cognitive, and physical activity variables. Early identification may enable timely interventions to delay functional decline.

Purpose: Despite the health benefits for people with mobility limitations of participating in community-based exercise programmes (CBEPs), accessing and implementing in-person CBEPs can be challenging. We describe a theory-based approach to adapting a group task-oriented, in-person CBEP targeting balance and mobility to a virtual format. Method: We used the Knowledge-to-Action and Medical Research Council frameworks to guide adaptation of an established CBEP for virtual delivery. We undertook consultations with knowledge users (i.e., CBEP providers, health care professionals, managers, policy-makers) and researchers on adapting programme components to optimize the feasibility of virtual delivery and retain benefits of the in-person CBEP. Concurrently, we conducted three feasibility studies involving post-programme participant surveys to evaluate and refine programme components. Results: Programme components, including a pre-programme safety video and use of trained facilitators to stream exercise videos via videoconferencing and facilitate social times, met safety, feasibility, and acceptability benchmarks. In studies 1, 2, and 3, the majority of participants described benefit to physical function (59%, 64%, and 79%, respectively) and emotional well-being (64%, 62%, and 75%, respectively). Conclusions: Theoretical frameworks were useful to guide adaptation of an established in-person CBEP to a virtual format. This theoretical approach may inform virtual programme development for other populations and targeted outcomes.

Purpose: Self-leadership, or leading oneself, is a critical component of leadership linked to improved individual performance, team effectiveness, and patient and organizational outcomes. This qualitative study explores physical therapist clinicians’ perceived value of self-leadership in their clinical practice and their interactions with inter-professional team members. Method: Purposeful sampling was used to recruit participants via the maximum variation strategy. Eleven licensed physical therapist clinicians with 2–39 years of clinical experience in five different clinical settings participated. Participants engaged in individual, semi-structured interviews that were audio-recorded and transcribed verbatim. Study rigour was addressed through the use of multiple coders, memoing, and member checking. Results: Four main themes emerged: developing expertise, pursuing professional growth, discovering and amplifying voice, and advocacy. The “why” behind the actions of those interviewed was to influence patient outcomes and quality of care and to address role identity as a physical therapist across multiple contexts. Conclusions: This is the first known exploration of the perceived value of self-leadership capacity in physical therapist clinicians. The study results suggest that leadership must be reframed as self-leadership, the precursor to leading others, so physical therapist clinicians can lead at all levels in everyday practice.

Purpose: The hyperventilation syndrome (HVS) is a dysfunctional breathing disorder with significant consequences on quality of life. HVS treatment involves an educational approach and breathing exercises. Although better understanding of HVS is needed, it is also relevant to provide evidence of the HVS physiotherapy treatment efficiency. This study aimed to assess the effects of respiratory physiotherapy in HVS patients. Method: Patients referred by a physician to a physiotherapist for HVS-related symptoms were included in this prospective observational study. They received six respiratory physiotherapy sessions (1/wk) composed of therapeutic education and breathing exercises. The primary objective was to assess the pre-post change on HVS symptoms, using the Nijmegen Questionnaire, between baseline and 5 weeks. Secondary objectives assessed anxiety, depression, dyspnoea, quality of life, and respiratory rate at 5 weeks. Results: Of 46 patients, 42 were analyzed. Compared to baseline, after five weeks, anxiety, dyspnoea, respiratory rate, and most quality of life subscores significantly improved. The Nijmegen score decreased by 11.6 points ( p < 0.001) and this decrease was maintained after three months. Conclusions: HVS symptoms have significantly decreased while anxiety, depression, dyspnoea, and quality of life substantially improved after six respiratory physiotherapy sessions.

Background: Physiotherapy entry-level programs are designed to equip graduates with the skills required to be autonomous practitioners. Innovative teaching methods, such as role-play simulation, are designed to support students' transition into practice. This study aimed to investigate whether a simulated patient experience could influence student confidence when facilitating behavioural change using a shared decision-making approach. Method: A mixed methods design comprising online pre- and post-surveys of student physiotherapists at one UK higher education institution, followed by an invitation to participate in a follow-up semi-structured focus group. Pre- and post-simulation surveys were completed in addition to the Modified Satisfaction with Simulation Experience (MSSE) survey. Likert scale data were treated as numeric variables with the median and Interquartile (IQR) range calculated for combined responses across potential answers. Focus groups included semi-structured questions with thematic analysis generating themes. Results: All 39 respondents “Strongly Agreed” that they were satisfied with the simulated experience, which could be transferred to clinical practice (5, IQR 4–5). The stimulation developed both confidence (5, IQR 4–5) and developed participants’ perception of their shared decision-making skills (4, IQR 4–5). Three key emergent themes from the focus groups included (1) Bridging the gap between clinical practice, (2) Authenticity, and (3) Psychological safety. Conclusion: The simulated role-play patient experience improved the confidence and participants’ perception of their ability to use shared decision-making to facilitate behavioural change. Themes from the semi-structured interviews suggested increased authenticity and psychological safety during the task, which could bridge the gap between theoretical teaching and clinical practice.

Purpose: Studies have demonstrated that medication and diagnostic imaging (DI) use and, more broadly, health care resource utilization, are not necessarily concordant with clinical practice guidelines. However, these studies did not evaluate the concurrent presence of clinical manifestations. This study therefore aimed to investigate the association between medication intake and DI, and health outcomes including pain, disability, physical, and mental health-related quality of life in people with chronic whiplash-associated disorders (WADs). We also aimed to evaluate whether medication intake and DI use differed based on specific presenting clinical manifestations (pain classification category [nociceptive, nociplastic, or neuropathic], psychologic features, pain cognitions, and sleep). Method: This cross-sectional study investigated people attending a multidisciplinary chronic pain centre in Calgary, Canada, between October 2019 and December 2021 who attended for evaluation of chronic symptoms arising from a motor vehicle collision. Participants completed a series of questionnaires that evaluated various health domains (pain intensity/interference; disability; physical and mental health-related quality of life; depression, anxiety, and stress; post-traumatic stress; pain catastrophizing; and sleep) at intake, and anonymized results were entered into a registry database with their informed consent. Results: Different classes of medication intake, use of multiple medications, receiving computed tomography, ultrasound or magnetic resonance imaging scans and multiple DI utilization were associated with worse health outcomes. Increased medication intake was also associated with increased DI utilization. In concert, these results suggest that increased health care resource utilization was associated with worse health outcomes – both physically and psychologically – in chronic WAD. Conclusions: Our results indicate that medication intake and DI were not matched to clinical manifestations, and thus further education of health care providers is warranted to assist with appropriate health care resource utilization. These results also suggest that chronic WAD guidelines are required inclusive of recommendations for appropriate utilization of medication and referral for DI.

Further investigation into the feasibility of using videoconferencing and activity tracking devices to provide high-intensity home-based exercise programmes for people with a moderate or severe traumatic brain injury (TBI) is needed to inform clinical implementation and patient adoption. This study aimed to (1) determine if home-based telerehabilitation exercise programmes were feasible for people with a moderate or severe TBI and (2) better understand the lived experience of people with a TBI and their family partners with this programme. A mixed-methods approach consisting of measures of feasibility and semi-structured interviews was used. Five participants with moderate to severe TBI and their family partners completed two high-intensity home-based exercise programmes delivered remotely by a physiotherapist (i.e., daily and weekly). Telerehabilitation services in home-based settings were feasible for this population. Adherence and engagement were high. Dyads were satisfied with the use of technology to deliver physiotherapy sessions. Telerehabilitation provides a delivery option that allows people with TBI to spend energy on therapy rather than on travelling. A pre-programme training on key components, such as the use of technology, safety precautions, and communication methods, likely improved the overall feasibility. Further research is needed to better understand the effectiveness of such a programme on balance, mobility, and physical activity levels.

This study examined what physiotherapists and physiotherapy students understand and know about executive functioning (EF), what EF outcome measures they use clinically, and whether their primary area of practice influences their assessment practices. An open online survey was distributed to registered members of the Canadian Physiotherapy Association, its various divisions, and colleges of physiotherapy within Canada that took approximately 15 minutes to complete and was available for 13 months. Pearson correlation was used to assess the relationship between subjective and objective understanding and knowledge of EF (UKEF) and a one-way multivariate analysis of variance was used to analyze differences in survey responses based on respondents' primary area of practice. A total of 335 respondents consented to participate (completion rate=78.4%). There was a significant moderate positive correlation between subjective and objective UKEF (r=0.43; 95% CI: 0.32, 0.54; n=260; p<0.001). Significant differences in survey responses were related to physiotherapists' primary areas of practice (i.e., musculoskeletal, neurological, cardiorespiratory, or multi-systems; F12,555.89=2.29, p=0.008; Wilks Λ=0.880; partial η2=0.042). Respondents reported that they had good subjective UKEF, but this was only moderately correlated with objective UKEF.