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Ponzano M, Buren R, Adams NT, Jun J, Jetha A, Mack DE, Ginis KAM. Effect of Exercise on Mental Health and Health-related Quality of Life in Adults With Spinal Cord Injury: A Systematic Review and Meta-Analysis. Arch Phys Med Rehabil 2024:S0003-9993(24)00900-6. [PMID: 38556188 DOI: 10.1016/j.apmr.2024.02.737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 02/08/2024] [Accepted: 02/11/2024] [Indexed: 04/02/2024]
Abstract
OBJECTIVES To determine the effect of exercise interventions on mental health and health-related quality of life (HRQoL) in individuals with SCI. DATA SOURCES We searched Embase, CINAHL, Medline, PsychINFO, and SPORTDiscus from inception to September 2023. STUDY SELECTION We included randomized controlled trials that (1) involved participants ≥18 years old with a SCI; (2) administered an exercise intervention; and (3) measured subjective well-being, psychological well-being, social well-being, and/or HRQoL as outcomes. We reported standardized means differences (d) with a 95% confidence interval (CI), assessed the risk of bias by using the Revised Cochrane Risk-of-bias Tool for Randomized Trials (RoB 2), and the certainty of the evidence using GRADE. DATA SYNTHESIS Nineteen studies (797 participants, mean age <65 years in every study) were included. Exercise improved overall well-being (d=0.494; 95% CI 0.268, 0.720; low certainty evidence), subjective well-being (d=0.543; 95% CI 0.270, 0.816; low certainty evidence), psychological well-being (d=0.499; 95% CI 0.193, 0.805; low certainty evidence), social well-being (d=0.452; 95% CI 0.151, 0.752; low certainty evidence), and HRQoL (d=0.323; 95% CI 0.072, 0.574; low certainty evidence). Four serious adverse events probably attributable to the interventions were reported in 3 studies. CONCLUSIONS Exercise interventions can improve well-being and HRQoL in adults with SCI <65 years of age. Additional research is needed to determine effectiveness in adults ≥65 years of age.
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Affiliation(s)
- Matteo Ponzano
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, Canada; International Collaboration on Repair Discoveries (ICORD), Blusson Spinal Cord Centre (BSCC), University of British Columbia, Vancouver, Canada.
| | - Robert Buren
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, Canada; International Collaboration on Repair Discoveries (ICORD), Blusson Spinal Cord Centre (BSCC), University of British Columbia, Vancouver, Canada
| | - Nathan T Adams
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, Canada; International Collaboration on Repair Discoveries (ICORD), Blusson Spinal Cord Centre (BSCC), University of British Columbia, Vancouver, Canada
| | - Jane Jun
- Division of Physical Medicine & Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Arif Jetha
- Institute for Work & Health, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Diane E Mack
- Department of Kinesiology, Brock University, St Catharines, Canada
| | - Kathleen A Martin Ginis
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, Canada; International Collaboration on Repair Discoveries (ICORD), Blusson Spinal Cord Centre (BSCC), University of British Columbia, Vancouver, Canada; Division of Physical Medicine & Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, Canada; Centre for Chronic Disease Prevention and Management, University of British Columbia, Kelowna, Canada
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Beratto L, Bressy L, Agostino S, Malandrone F, Brichetto G, Ponzano M. The effect of exercise on mental health and health-related quality of life in individuals with multiple sclerosis: A Systematic review and meta-analysis. Mult Scler Relat Disord 2024; 83:105473. [PMID: 38320418 DOI: 10.1016/j.msard.2024.105473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 01/16/2024] [Accepted: 01/24/2024] [Indexed: 02/08/2024]
Abstract
BACKGROUND A large body of evidence has tested the effect of exercise interventions on mental health and health-related quality of life (HRQoL) in individuals with multiple sclerosis (PwMS). OBJECTIVE To determine the effect of exercise interventions on mental health and HRQoL in PwMS. METHODS We searched four databases up to April 2023, and included randomized controlled trials that: 1) involved PwMS ≥18 years old; 2) delivered an exercise intervention; 3) measured subjective well-being, psychological well-being, social well-being, or HRQoL as outcomes. We reported standardized differences in means (d) with a 95 % confidence interval (CI), for continuous outcomes and an incidence rate ratio (IRR) with a 95 % CI for dichotomous outcomes. RESULTS Forty-nine studies (n = 2,057 participants) were included. Exercise improved overall well-being (d = 0.78; 95 % CI 0.483, 1.077; moderate certainty evidence), subjective well-being (d = 0.666; 95 % CI 0.405, 0.928; moderate certainty evidence), social well-being (d = 1.046; 95 % CI 0.569, 1.523; low certainty evidence), and HRQoL (d = 0.568; 95 % CI 0.396, 0.74; moderate certainty evidence). CONCLUSION Exercise interventions can improve well-being and HRQoL in PwMS. Future studies should focus on PwMS ≥ 65 years or with higher level of impairments.
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Affiliation(s)
- Luca Beratto
- Department of Medical Sciences, University of Turin, Italy; School of Exercise and Sport Science, University of Turin, Italy
| | - Lara Bressy
- School of Exercise and Sport Science, University of Turin, Italy
| | - Samuel Agostino
- Department of Clinical and Biological Sciences, University of Turin, Italy
| | | | | | - Matteo Ponzano
- School of Health and Exercise Sciences, The University of British Columbia, Kelowna, BC, Canada; International Collaboration on Repair Discoveries (ICORD), Blusson Spinal Cord Centre (BSCC), The University of British Columbia, Vancouver, BC, Canada.
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Puthenparampil M, Marin A, Zanotelli G, Mauceri VA, De Napoli F, Gaggiola M, Miscioscia A, Ponzano M, Bovis F, Perini P, Rinaldi F, Molon B, Gallo P. Blood-brain barrier damage associates with glia-related cytokines in the cerebrospinal fluid of patients with Multiple Sclerosis. Mult Scler Relat Disord 2024; 82:105403. [PMID: 38184910 DOI: 10.1016/j.msard.2023.105403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 12/21/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND The presence of Blood-Brain Barrier (BBB) dysfunction is defined by albumin quotient (QALB) and characterize a group of Multiple Sclerosis (MS) patients at clinical onset. We evaluated the concentration in cerebrospinal fluid (CSF) of 87 cytokines, to better characterize the CSF inflammatory pattern in presence of BBB damage. MATERIALS AND METHOD In an exploratory cohort, CSF cytokines were evaluated by means of Multiplex technology (Bio-Plex Pro-Human Cytokine, GF and Diabetes 27-Plex Panel, Bio-Plex Pro-Human Chemokines 40-Plex Panel, Bio-Plex Pro-Human Inflammation Assays 37-Plex Panel) in a cohort of Other Not Inflammatory Neurological Disorders (ONIND) and in cohort of patients with MS, stratified according to BBB damage into QALB+ and QALB- MS patients. In the validation cohort, we evaluated the relevant molecules in a cohort of MS patients, stratified again into QALB+ and QALB-, including also Neurofilament Light (NfL) and Chitinase 3-like 1 (CHI3L1) CSF concentration. RESULTS While MIP-1α, CXCL-13, and CCL-22 CSF concentrations were higher in both MS groups compared to ONIND, in QALB+ MS CSF concentrations of CXCL-9 (17.85 ± 4.69 pg/mL), CXCL-10 (476.5 ± 324.3 pg/mL), and IL-16 (96.08 ± 86.17 pg/mL) were higher than in QALB- MS (8.98 ± 5368 pg/mL, p < 0.005, 281.0 ± 180.9 pg/mL, p < 0.05, and 47.35 ± 36.87 pg/mL, p < 0.005, respectively) and ONIND (8.98 ± 5368 pg/mlL, p < 0.005, 281.0 ± 180.9 pg/mL, p < 0.005, and 47.35 ± 36.87 pg/mL, p < 0.001, respectively). A strong correlation was observed between CXCL-9 and CXCL-10 in all MS groups (all r>0.75, all p < 0.001). In the validation cohort again CXCL-10 CSF concentration were higher in QALB+ MS than in QALB- MS (94.25 ± 64.75 vs 153.8 ± 99.52, p < 0.05), while no difference was observed in serum. CSF NfL (1642 ± 1963 vs 3231 ± 3492 pg/mL, p < 0.05) and CHI3L1 (183.9 ± 86.62 vs 262 ± 137.5 ng/mL, p < 0.05) were increased in QALB+ MS. CONCLUSIONS BBB damage in MS is linked to a specific CSF cytokines pattern (CXCL-9, CXCL-10, IL-16), that are also involved in astrocyte-microglia interaction. To what extent their continuous production in the CNS may mark a more severe disease course merits to be investigated.
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Affiliation(s)
- M Puthenparampil
- Department of Neurosciences, University of Padua, Padua, Italy; Multiple Sclerosis Centre, Azienda Ospedaliera di Padova, Padua, Italy.
| | - A Marin
- Department of Biomedical Sciences, University of Padua, Padua, Italy
| | - G Zanotelli
- Department of Neurosciences, University of Padua, Padua, Italy; Multiple Sclerosis Centre, Azienda Ospedaliera di Padova, Padua, Italy
| | - V A Mauceri
- Department of Neurosciences, University of Padua, Padua, Italy; Multiple Sclerosis Centre, Azienda Ospedaliera di Padova, Padua, Italy
| | - F De Napoli
- Department of Neurosciences, University of Padua, Padua, Italy; Multiple Sclerosis Centre, Azienda Ospedaliera di Padova, Padua, Italy
| | - M Gaggiola
- Department of Neurosciences, University of Padua, Padua, Italy; Multiple Sclerosis Centre, Azienda Ospedaliera di Padova, Padua, Italy
| | - A Miscioscia
- Department of Neurosciences, University of Padua, Padua, Italy
| | - M Ponzano
- Department of Health Sciences, Section of Biostatistics, University of Genova, Genova, Italy
| | - F Bovis
- Department of Health Sciences, Section of Biostatistics, University of Genova, Genova, Italy
| | - P Perini
- Department of Neurosciences, University of Padua, Padua, Italy; Multiple Sclerosis Centre, Azienda Ospedaliera di Padova, Padua, Italy
| | - F Rinaldi
- Department of Neurosciences, University of Padua, Padua, Italy; Multiple Sclerosis Centre, Azienda Ospedaliera di Padova, Padua, Italy
| | - B Molon
- Department of Biomedical Sciences, University of Padua, Padua, Italy
| | - P Gallo
- Department of Neurosciences, University of Padua, Padua, Italy; Multiple Sclerosis Centre, Azienda Ospedaliera di Padova, Padua, Italy
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Ponzano M, Tibert N, Brien S, Funnell L, Gibbs JC, Keller H, Laprade J, Morin SN, Papaioannou A, Weston ZJ, Wideman TH, Giangregorio LM. Development, Acceptability, and Usability of a Virtual Intervention for Vertebral Fractures. Phys Ther 2023; 103:pzad098. [PMID: 37555708 DOI: 10.1093/ptj/pzad098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 03/30/2023] [Accepted: 05/31/2023] [Indexed: 08/10/2023]
Abstract
OBJECTIVE This project aimed to develop a virtual intervention for vertebral fractures (VIVA) to implement the international recommendations for the nonpharmacological management of osteoporotic vertebral fractures and to test its acceptability and usability. METHODS VIVA was developed in accordance with integrated knowledge translation principles and was informed by the Behavioral Change Wheel, the Theoretical Domains Framework, and the affordability, practicability, effectiveness and cost-effectiveness, acceptability, side effects/safety, and equity (APEASE) criteria. The development of the prototype of VIVA involved 3 steps: understanding target behaviors, identifying intervention options, and identifying content and implementation options. The VIVA prototype was delivered to 9 participants to assess its acceptability and usability. RESULTS VIVA includes 7 1-on-1 virtual sessions delivered by a physical therapist over 5 weeks. Each session lasts 45 minutes and is divided in 3 parts: education, training, and behavioral support/goal setting. Four main themes emerged from the acceptability evaluation: perceived improvements in pain, increased self-confidence, satisfaction with 1-on-1 sessions and resources, and ease of use. All of the participants believed that VIVA was very useful and were very satisfied with the 1-on-1 sessions. Four participants found the information received very easy to practice, 4 found it easy to practice, and 1 found it somewhat difficult to practice. Five participants were satisfied with the supporting resources, and 4 were very satisfied. Potential for statistically significant improvements was observed in participants' ability to make concrete plans about when, how, where, and how often to exercise. CONCLUSION VIVA was acceptable and usable to the participants, who perceived improvements in pain and self-confidence. IMPACT The virtual implementation of the recommendations for the nonpharmacological management of vertebral fractures showed high acceptability and usability. Future trials will implement the recommendations on a larger scale to evaluate their effectiveness.
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Affiliation(s)
- Matteo Ponzano
- School of Health and Exercise Sciences, University of British Columbia, Kelowna BC, Canada
- International Collaboration on Repair Discoveries (ICORD), Blusson Spinal Cord Centre (BSCC), University of British Columbia, Vancouver, British Columbia, Canada
| | - Nicholas Tibert
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Sheila Brien
- Canadian Osteoporosis Patient Network, Osteoporosis, Toronto, ON, Canada
| | - Larry Funnell
- Canadian Osteoporosis Patient Network, Osteoporosis, Toronto, ON, Canada
| | - Jenna C Gibbs
- Department of Kinesiology and Physical Activity, McGill University, Montreal, QC, Canada
| | - Heather Keller
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada
- Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada
| | - Judi Laprade
- Division of Anatomy, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Suzanne N Morin
- Department of Medicine, McGill University, Montreal, QC, Canada
| | - Alexandra Papaioannou
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Zachary J Weston
- Canadian Society for Exercise Physiology (CSEP), Ottawa Ontario, Canada
- Faculty of Human and Social Sciences, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Timothy H Wideman
- School of Physical & Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Lora M Giangregorio
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada
- Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada
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Ponzano M, Giangregorio L. Exercise and physical activity after an osteoporotic vertebral fracture. Br J Sports Med 2023; 57:1533-1534. [PMID: 37775126 DOI: 10.1136/bjsports-2023-107157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2023] [Indexed: 10/01/2023]
Affiliation(s)
- Matteo Ponzano
- School of Health and Exercise Sciences, The University of British Columbia Okanagan, Kelowna, British Columbia, Canada
- International Collaboration on Repair Discoveries (ICORD), Blusson Spinal Cord Centre (BSCC), The University of British Columbia, Vancouver, British Columbia, Canada
| | - Lora Giangregorio
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
- Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada
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Morin SN, Feldman S, Funnell L, Giangregorio L, Kim S, McDonald-Blumer H, Santesso N, Ridout R, Ward W, Ashe MC, Bardai Z, Bartley J, Binkley N, Burrell S, Butt D, Cadarette SM, Cheung AM, Chilibeck P, Dunn S, Falk J, Frame H, Gittings W, Hayes K, Holmes C, Ioannidis G, Jaglal SB, Josse R, Khan AA, McIntyre V, Nash L, Negm A, Papaioannou A, Ponzano M, Rodrigues IB, Thabane L, Thomas CA, Tile L, Wark JD. Actualisation 2023 des lignes directrices de pratique clinique pour la prise en charge de l’ostéoporose et la prévention des fractures au Canada. CMAJ 2023; 195:E1585-E1603. [PMID: 38011931 PMCID: PMC10681677 DOI: 10.1503/cmaj.221647-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023] Open
Abstract
Contexte: Au Canada, plus de 2 millions de personnes vivent avec l’ostéoporose, une maladie qui accroît le risque de fracture, ce qui fait augmenter la morbidité et la mortalité, et entraîne une perte de qualité de vie et d’autonomie. La présente actualisation des lignes directrices vise à accompagner les professionnelles et professionnels de la santé au Canada dans la prestation de soins visant à optimiser la santé osseuse et à prévenir les fractures chez les femmes ménopausées et les hommes de 50 ans et plus. Méthodes: Le présent document fournit une actualisation des lignes directrices de pratique clinique de 2010 d’Ostéoporose Canada sur le diagnostic et la prise en charge de l’ostéoporose au pays. Nous avons utilisé l’approche GRADE (Grading of Recommendations Assessment, Development and Evaluation) et effectué l’assurance de la qualité conformément aux normes de qualité et de présentation des rapports de la grille AGREE II (Appraisal of Guidelines for Research & Evaluation). Les médecins de premier recours et les patientes et patients partenaires ont été représentés à tous les niveaux des comités et des groupes ayant participé à l’élaboration des lignes directrices, et ont participé à toutes les étapes du processus pour garantir la pertinence des informations pour les futurs utilisateurs et utilisatrices. Le processus de gestion des intérêts concurrents a été entamé avant l’élaboration des lignes directrices et s’est poursuivi sur toute sa durée, selon les principes du Réseau international en matière de lignes directrices. Dans la formulation des recommandations, nous avons tenu compte des avantages et des risques, des valeurs et préférences de la patientèle, des ressources, de l’équité, de l’acceptabilité et de la faisabilité; la force de chacune des recommandations a été déterminée en fonction du cadre GRADE. Recommandations: Les 25 recommandations et les 10 énoncés de bonne pratique sont répartis en sections : activité physique, alimentation, évaluation du risque de fracture, instauration du traitement, interventions pharmacologiques, durée et séquence du traitement, et monitorage. La prise en charge de l’ostéoporose devrait se fonder sur le risque de fracture, établi au moyen d’une évaluation clinique réalisée avec un outil d’évaluation du risque de fracture validé. L’activité physique, l’alimentation et la pharmacothérapie sont des éléments essentiels à la stratégie de prévention des fractures, qui devraient être personnalisés. Interprétation: Les présentes lignes directrices ont pour but d’outiller les professionnelles et professionnels de la santé et la patientèle afin qu’ensemble ils puissent parler de l’importance de la santé osseuse et du risque de fracture tout au long de la vie adulte avancée. La détection et la prise en charge efficace de la fragilité osseuse peuvent contribuer à réduire les fractures et à préserver la mobilité, l’autonomie et la qualité de vie.
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Affiliation(s)
- Suzanne N Morin
- Université McGill (Morin), Montréal, Qc; Université de Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patientes et patients partenaires (Funnell, McIntyre, Bartley, Thomas); Université de Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Université Brock (Ward, Gittings), St. Catharines, Ont.; Université McMaster (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; Université du Wisconsin (Binkley), Madison, Wisc.; Université Dalhousie (Burrell], Halifax, N.-É.; Centre médical Menzies (Holmes), Morden, Man.; Université de Calgary (Negm), Calgary, Alb.; Université de la Colombie-Britannique (Ashe), Vancouver, C.-B.; Université de la Saskatchewan (Chilibeck), Saskatoon, Sask.; Université de la Colombie-Britannique (Ponzano), Kelowna, C.-B.; Université de Melbourne (Wark), Melbourne, Australie; Université du Manitoba (Falk, Frame), Winnipeg, Man.; Université Brown (Hayes), Providence, R.I
| | - Sidney Feldman
- Université McGill (Morin), Montréal, Qc; Université de Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patientes et patients partenaires (Funnell, McIntyre, Bartley, Thomas); Université de Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Université Brock (Ward, Gittings), St. Catharines, Ont.; Université McMaster (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; Université du Wisconsin (Binkley), Madison, Wisc.; Université Dalhousie (Burrell], Halifax, N.-É.; Centre médical Menzies (Holmes), Morden, Man.; Université de Calgary (Negm), Calgary, Alb.; Université de la Colombie-Britannique (Ashe), Vancouver, C.-B.; Université de la Saskatchewan (Chilibeck), Saskatoon, Sask.; Université de la Colombie-Britannique (Ponzano), Kelowna, C.-B.; Université de Melbourne (Wark), Melbourne, Australie; Université du Manitoba (Falk, Frame), Winnipeg, Man.; Université Brown (Hayes), Providence, R.I
| | - Larry Funnell
- Université McGill (Morin), Montréal, Qc; Université de Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patientes et patients partenaires (Funnell, McIntyre, Bartley, Thomas); Université de Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Université Brock (Ward, Gittings), St. Catharines, Ont.; Université McMaster (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; Université du Wisconsin (Binkley), Madison, Wisc.; Université Dalhousie (Burrell], Halifax, N.-É.; Centre médical Menzies (Holmes), Morden, Man.; Université de Calgary (Negm), Calgary, Alb.; Université de la Colombie-Britannique (Ashe), Vancouver, C.-B.; Université de la Saskatchewan (Chilibeck), Saskatoon, Sask.; Université de la Colombie-Britannique (Ponzano), Kelowna, C.-B.; Université de Melbourne (Wark), Melbourne, Australie; Université du Manitoba (Falk, Frame), Winnipeg, Man.; Université Brown (Hayes), Providence, R.I
| | - Lora Giangregorio
- Université McGill (Morin), Montréal, Qc; Université de Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patientes et patients partenaires (Funnell, McIntyre, Bartley, Thomas); Université de Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Université Brock (Ward, Gittings), St. Catharines, Ont.; Université McMaster (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; Université du Wisconsin (Binkley), Madison, Wisc.; Université Dalhousie (Burrell], Halifax, N.-É.; Centre médical Menzies (Holmes), Morden, Man.; Université de Calgary (Negm), Calgary, Alb.; Université de la Colombie-Britannique (Ashe), Vancouver, C.-B.; Université de la Saskatchewan (Chilibeck), Saskatoon, Sask.; Université de la Colombie-Britannique (Ponzano), Kelowna, C.-B.; Université de Melbourne (Wark), Melbourne, Australie; Université du Manitoba (Falk, Frame), Winnipeg, Man.; Université Brown (Hayes), Providence, R.I
| | - Sandra Kim
- Université McGill (Morin), Montréal, Qc; Université de Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patientes et patients partenaires (Funnell, McIntyre, Bartley, Thomas); Université de Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Université Brock (Ward, Gittings), St. Catharines, Ont.; Université McMaster (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; Université du Wisconsin (Binkley), Madison, Wisc.; Université Dalhousie (Burrell], Halifax, N.-É.; Centre médical Menzies (Holmes), Morden, Man.; Université de Calgary (Negm), Calgary, Alb.; Université de la Colombie-Britannique (Ashe), Vancouver, C.-B.; Université de la Saskatchewan (Chilibeck), Saskatoon, Sask.; Université de la Colombie-Britannique (Ponzano), Kelowna, C.-B.; Université de Melbourne (Wark), Melbourne, Australie; Université du Manitoba (Falk, Frame), Winnipeg, Man.; Université Brown (Hayes), Providence, R.I
| | - Heather McDonald-Blumer
- Université McGill (Morin), Montréal, Qc; Université de Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patientes et patients partenaires (Funnell, McIntyre, Bartley, Thomas); Université de Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Université Brock (Ward, Gittings), St. Catharines, Ont.; Université McMaster (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; Université du Wisconsin (Binkley), Madison, Wisc.; Université Dalhousie (Burrell], Halifax, N.-É.; Centre médical Menzies (Holmes), Morden, Man.; Université de Calgary (Negm), Calgary, Alb.; Université de la Colombie-Britannique (Ashe), Vancouver, C.-B.; Université de la Saskatchewan (Chilibeck), Saskatoon, Sask.; Université de la Colombie-Britannique (Ponzano), Kelowna, C.-B.; Université de Melbourne (Wark), Melbourne, Australie; Université du Manitoba (Falk, Frame), Winnipeg, Man.; Université Brown (Hayes), Providence, R.I
| | - Nancy Santesso
- Université McGill (Morin), Montréal, Qc; Université de Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patientes et patients partenaires (Funnell, McIntyre, Bartley, Thomas); Université de Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Université Brock (Ward, Gittings), St. Catharines, Ont.; Université McMaster (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; Université du Wisconsin (Binkley), Madison, Wisc.; Université Dalhousie (Burrell], Halifax, N.-É.; Centre médical Menzies (Holmes), Morden, Man.; Université de Calgary (Negm), Calgary, Alb.; Université de la Colombie-Britannique (Ashe), Vancouver, C.-B.; Université de la Saskatchewan (Chilibeck), Saskatoon, Sask.; Université de la Colombie-Britannique (Ponzano), Kelowna, C.-B.; Université de Melbourne (Wark), Melbourne, Australie; Université du Manitoba (Falk, Frame), Winnipeg, Man.; Université Brown (Hayes), Providence, R.I
| | - Rowena Ridout
- Université McGill (Morin), Montréal, Qc; Université de Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patientes et patients partenaires (Funnell, McIntyre, Bartley, Thomas); Université de Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Université Brock (Ward, Gittings), St. Catharines, Ont.; Université McMaster (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; Université du Wisconsin (Binkley), Madison, Wisc.; Université Dalhousie (Burrell], Halifax, N.-É.; Centre médical Menzies (Holmes), Morden, Man.; Université de Calgary (Negm), Calgary, Alb.; Université de la Colombie-Britannique (Ashe), Vancouver, C.-B.; Université de la Saskatchewan (Chilibeck), Saskatoon, Sask.; Université de la Colombie-Britannique (Ponzano), Kelowna, C.-B.; Université de Melbourne (Wark), Melbourne, Australie; Université du Manitoba (Falk, Frame), Winnipeg, Man.; Université Brown (Hayes), Providence, R.I
| | - Wendy Ward
- Université McGill (Morin), Montréal, Qc; Université de Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patientes et patients partenaires (Funnell, McIntyre, Bartley, Thomas); Université de Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Université Brock (Ward, Gittings), St. Catharines, Ont.; Université McMaster (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; Université du Wisconsin (Binkley), Madison, Wisc.; Université Dalhousie (Burrell], Halifax, N.-É.; Centre médical Menzies (Holmes), Morden, Man.; Université de Calgary (Negm), Calgary, Alb.; Université de la Colombie-Britannique (Ashe), Vancouver, C.-B.; Université de la Saskatchewan (Chilibeck), Saskatoon, Sask.; Université de la Colombie-Britannique (Ponzano), Kelowna, C.-B.; Université de Melbourne (Wark), Melbourne, Australie; Université du Manitoba (Falk, Frame), Winnipeg, Man.; Université Brown (Hayes), Providence, R.I
| | - Maureen C Ashe
- Université McGill (Morin), Montréal, Qc; Université de Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patientes et patients partenaires (Funnell, McIntyre, Bartley, Thomas); Université de Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Université Brock (Ward, Gittings), St. Catharines, Ont.; Université McMaster (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; Université du Wisconsin (Binkley), Madison, Wisc.; Université Dalhousie (Burrell], Halifax, N.-É.; Centre médical Menzies (Holmes), Morden, Man.; Université de Calgary (Negm), Calgary, Alb.; Université de la Colombie-Britannique (Ashe), Vancouver, C.-B.; Université de la Saskatchewan (Chilibeck), Saskatoon, Sask.; Université de la Colombie-Britannique (Ponzano), Kelowna, C.-B.; Université de Melbourne (Wark), Melbourne, Australie; Université du Manitoba (Falk, Frame), Winnipeg, Man.; Université Brown (Hayes), Providence, R.I
| | - Zahra Bardai
- Université McGill (Morin), Montréal, Qc; Université de Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patientes et patients partenaires (Funnell, McIntyre, Bartley, Thomas); Université de Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Université Brock (Ward, Gittings), St. Catharines, Ont.; Université McMaster (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; Université du Wisconsin (Binkley), Madison, Wisc.; Université Dalhousie (Burrell], Halifax, N.-É.; Centre médical Menzies (Holmes), Morden, Man.; Université de Calgary (Negm), Calgary, Alb.; Université de la Colombie-Britannique (Ashe), Vancouver, C.-B.; Université de la Saskatchewan (Chilibeck), Saskatoon, Sask.; Université de la Colombie-Britannique (Ponzano), Kelowna, C.-B.; Université de Melbourne (Wark), Melbourne, Australie; Université du Manitoba (Falk, Frame), Winnipeg, Man.; Université Brown (Hayes), Providence, R.I
| | - Joan Bartley
- Université McGill (Morin), Montréal, Qc; Université de Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patientes et patients partenaires (Funnell, McIntyre, Bartley, Thomas); Université de Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Université Brock (Ward, Gittings), St. Catharines, Ont.; Université McMaster (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; Université du Wisconsin (Binkley), Madison, Wisc.; Université Dalhousie (Burrell], Halifax, N.-É.; Centre médical Menzies (Holmes), Morden, Man.; Université de Calgary (Negm), Calgary, Alb.; Université de la Colombie-Britannique (Ashe), Vancouver, C.-B.; Université de la Saskatchewan (Chilibeck), Saskatoon, Sask.; Université de la Colombie-Britannique (Ponzano), Kelowna, C.-B.; Université de Melbourne (Wark), Melbourne, Australie; Université du Manitoba (Falk, Frame), Winnipeg, Man.; Université Brown (Hayes), Providence, R.I
| | - Neil Binkley
- Université McGill (Morin), Montréal, Qc; Université de Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patientes et patients partenaires (Funnell, McIntyre, Bartley, Thomas); Université de Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Université Brock (Ward, Gittings), St. Catharines, Ont.; Université McMaster (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; Université du Wisconsin (Binkley), Madison, Wisc.; Université Dalhousie (Burrell], Halifax, N.-É.; Centre médical Menzies (Holmes), Morden, Man.; Université de Calgary (Negm), Calgary, Alb.; Université de la Colombie-Britannique (Ashe), Vancouver, C.-B.; Université de la Saskatchewan (Chilibeck), Saskatoon, Sask.; Université de la Colombie-Britannique (Ponzano), Kelowna, C.-B.; Université de Melbourne (Wark), Melbourne, Australie; Université du Manitoba (Falk, Frame), Winnipeg, Man.; Université Brown (Hayes), Providence, R.I
| | - Steven Burrell
- Université McGill (Morin), Montréal, Qc; Université de Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patientes et patients partenaires (Funnell, McIntyre, Bartley, Thomas); Université de Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Université Brock (Ward, Gittings), St. Catharines, Ont.; Université McMaster (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; Université du Wisconsin (Binkley), Madison, Wisc.; Université Dalhousie (Burrell], Halifax, N.-É.; Centre médical Menzies (Holmes), Morden, Man.; Université de Calgary (Negm), Calgary, Alb.; Université de la Colombie-Britannique (Ashe), Vancouver, C.-B.; Université de la Saskatchewan (Chilibeck), Saskatoon, Sask.; Université de la Colombie-Britannique (Ponzano), Kelowna, C.-B.; Université de Melbourne (Wark), Melbourne, Australie; Université du Manitoba (Falk, Frame), Winnipeg, Man.; Université Brown (Hayes), Providence, R.I
| | - Debra Butt
- Université McGill (Morin), Montréal, Qc; Université de Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patientes et patients partenaires (Funnell, McIntyre, Bartley, Thomas); Université de Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Université Brock (Ward, Gittings), St. Catharines, Ont.; Université McMaster (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; Université du Wisconsin (Binkley), Madison, Wisc.; Université Dalhousie (Burrell], Halifax, N.-É.; Centre médical Menzies (Holmes), Morden, Man.; Université de Calgary (Negm), Calgary, Alb.; Université de la Colombie-Britannique (Ashe), Vancouver, C.-B.; Université de la Saskatchewan (Chilibeck), Saskatoon, Sask.; Université de la Colombie-Britannique (Ponzano), Kelowna, C.-B.; Université de Melbourne (Wark), Melbourne, Australie; Université du Manitoba (Falk, Frame), Winnipeg, Man.; Université Brown (Hayes), Providence, R.I
| | - Suzanne M Cadarette
- Université McGill (Morin), Montréal, Qc; Université de Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patientes et patients partenaires (Funnell, McIntyre, Bartley, Thomas); Université de Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Université Brock (Ward, Gittings), St. Catharines, Ont.; Université McMaster (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; Université du Wisconsin (Binkley), Madison, Wisc.; Université Dalhousie (Burrell], Halifax, N.-É.; Centre médical Menzies (Holmes), Morden, Man.; Université de Calgary (Negm), Calgary, Alb.; Université de la Colombie-Britannique (Ashe), Vancouver, C.-B.; Université de la Saskatchewan (Chilibeck), Saskatoon, Sask.; Université de la Colombie-Britannique (Ponzano), Kelowna, C.-B.; Université de Melbourne (Wark), Melbourne, Australie; Université du Manitoba (Falk, Frame), Winnipeg, Man.; Université Brown (Hayes), Providence, R.I
| | - Angela M Cheung
- Université McGill (Morin), Montréal, Qc; Université de Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patientes et patients partenaires (Funnell, McIntyre, Bartley, Thomas); Université de Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Université Brock (Ward, Gittings), St. Catharines, Ont.; Université McMaster (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; Université du Wisconsin (Binkley), Madison, Wisc.; Université Dalhousie (Burrell], Halifax, N.-É.; Centre médical Menzies (Holmes), Morden, Man.; Université de Calgary (Negm), Calgary, Alb.; Université de la Colombie-Britannique (Ashe), Vancouver, C.-B.; Université de la Saskatchewan (Chilibeck), Saskatoon, Sask.; Université de la Colombie-Britannique (Ponzano), Kelowna, C.-B.; Université de Melbourne (Wark), Melbourne, Australie; Université du Manitoba (Falk, Frame), Winnipeg, Man.; Université Brown (Hayes), Providence, R.I
| | - Phil Chilibeck
- Université McGill (Morin), Montréal, Qc; Université de Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patientes et patients partenaires (Funnell, McIntyre, Bartley, Thomas); Université de Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Université Brock (Ward, Gittings), St. Catharines, Ont.; Université McMaster (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; Université du Wisconsin (Binkley), Madison, Wisc.; Université Dalhousie (Burrell], Halifax, N.-É.; Centre médical Menzies (Holmes), Morden, Man.; Université de Calgary (Negm), Calgary, Alb.; Université de la Colombie-Britannique (Ashe), Vancouver, C.-B.; Université de la Saskatchewan (Chilibeck), Saskatoon, Sask.; Université de la Colombie-Britannique (Ponzano), Kelowna, C.-B.; Université de Melbourne (Wark), Melbourne, Australie; Université du Manitoba (Falk, Frame), Winnipeg, Man.; Université Brown (Hayes), Providence, R.I
| | - Sheila Dunn
- Université McGill (Morin), Montréal, Qc; Université de Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patientes et patients partenaires (Funnell, McIntyre, Bartley, Thomas); Université de Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Université Brock (Ward, Gittings), St. Catharines, Ont.; Université McMaster (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; Université du Wisconsin (Binkley), Madison, Wisc.; Université Dalhousie (Burrell], Halifax, N.-É.; Centre médical Menzies (Holmes), Morden, Man.; Université de Calgary (Negm), Calgary, Alb.; Université de la Colombie-Britannique (Ashe), Vancouver, C.-B.; Université de la Saskatchewan (Chilibeck), Saskatoon, Sask.; Université de la Colombie-Britannique (Ponzano), Kelowna, C.-B.; Université de Melbourne (Wark), Melbourne, Australie; Université du Manitoba (Falk, Frame), Winnipeg, Man.; Université Brown (Hayes), Providence, R.I
| | - Jamie Falk
- Université McGill (Morin), Montréal, Qc; Université de Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patientes et patients partenaires (Funnell, McIntyre, Bartley, Thomas); Université de Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Université Brock (Ward, Gittings), St. Catharines, Ont.; Université McMaster (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; Université du Wisconsin (Binkley), Madison, Wisc.; Université Dalhousie (Burrell], Halifax, N.-É.; Centre médical Menzies (Holmes), Morden, Man.; Université de Calgary (Negm), Calgary, Alb.; Université de la Colombie-Britannique (Ashe), Vancouver, C.-B.; Université de la Saskatchewan (Chilibeck), Saskatoon, Sask.; Université de la Colombie-Britannique (Ponzano), Kelowna, C.-B.; Université de Melbourne (Wark), Melbourne, Australie; Université du Manitoba (Falk, Frame), Winnipeg, Man.; Université Brown (Hayes), Providence, R.I
| | - Heather Frame
- Université McGill (Morin), Montréal, Qc; Université de Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patientes et patients partenaires (Funnell, McIntyre, Bartley, Thomas); Université de Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Université Brock (Ward, Gittings), St. Catharines, Ont.; Université McMaster (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; Université du Wisconsin (Binkley), Madison, Wisc.; Université Dalhousie (Burrell], Halifax, N.-É.; Centre médical Menzies (Holmes), Morden, Man.; Université de Calgary (Negm), Calgary, Alb.; Université de la Colombie-Britannique (Ashe), Vancouver, C.-B.; Université de la Saskatchewan (Chilibeck), Saskatoon, Sask.; Université de la Colombie-Britannique (Ponzano), Kelowna, C.-B.; Université de Melbourne (Wark), Melbourne, Australie; Université du Manitoba (Falk, Frame), Winnipeg, Man.; Université Brown (Hayes), Providence, R.I
| | - William Gittings
- Université McGill (Morin), Montréal, Qc; Université de Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patientes et patients partenaires (Funnell, McIntyre, Bartley, Thomas); Université de Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Université Brock (Ward, Gittings), St. Catharines, Ont.; Université McMaster (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; Université du Wisconsin (Binkley), Madison, Wisc.; Université Dalhousie (Burrell], Halifax, N.-É.; Centre médical Menzies (Holmes), Morden, Man.; Université de Calgary (Negm), Calgary, Alb.; Université de la Colombie-Britannique (Ashe), Vancouver, C.-B.; Université de la Saskatchewan (Chilibeck), Saskatoon, Sask.; Université de la Colombie-Britannique (Ponzano), Kelowna, C.-B.; Université de Melbourne (Wark), Melbourne, Australie; Université du Manitoba (Falk, Frame), Winnipeg, Man.; Université Brown (Hayes), Providence, R.I
| | - Kaleen Hayes
- Université McGill (Morin), Montréal, Qc; Université de Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patientes et patients partenaires (Funnell, McIntyre, Bartley, Thomas); Université de Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Université Brock (Ward, Gittings), St. Catharines, Ont.; Université McMaster (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; Université du Wisconsin (Binkley), Madison, Wisc.; Université Dalhousie (Burrell], Halifax, N.-É.; Centre médical Menzies (Holmes), Morden, Man.; Université de Calgary (Negm), Calgary, Alb.; Université de la Colombie-Britannique (Ashe), Vancouver, C.-B.; Université de la Saskatchewan (Chilibeck), Saskatoon, Sask.; Université de la Colombie-Britannique (Ponzano), Kelowna, C.-B.; Université de Melbourne (Wark), Melbourne, Australie; Université du Manitoba (Falk, Frame), Winnipeg, Man.; Université Brown (Hayes), Providence, R.I
| | - Carol Holmes
- Université McGill (Morin), Montréal, Qc; Université de Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patientes et patients partenaires (Funnell, McIntyre, Bartley, Thomas); Université de Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Université Brock (Ward, Gittings), St. Catharines, Ont.; Université McMaster (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; Université du Wisconsin (Binkley), Madison, Wisc.; Université Dalhousie (Burrell], Halifax, N.-É.; Centre médical Menzies (Holmes), Morden, Man.; Université de Calgary (Negm), Calgary, Alb.; Université de la Colombie-Britannique (Ashe), Vancouver, C.-B.; Université de la Saskatchewan (Chilibeck), Saskatoon, Sask.; Université de la Colombie-Britannique (Ponzano), Kelowna, C.-B.; Université de Melbourne (Wark), Melbourne, Australie; Université du Manitoba (Falk, Frame), Winnipeg, Man.; Université Brown (Hayes), Providence, R.I
| | - George Ioannidis
- Université McGill (Morin), Montréal, Qc; Université de Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patientes et patients partenaires (Funnell, McIntyre, Bartley, Thomas); Université de Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Université Brock (Ward, Gittings), St. Catharines, Ont.; Université McMaster (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; Université du Wisconsin (Binkley), Madison, Wisc.; Université Dalhousie (Burrell], Halifax, N.-É.; Centre médical Menzies (Holmes), Morden, Man.; Université de Calgary (Negm), Calgary, Alb.; Université de la Colombie-Britannique (Ashe), Vancouver, C.-B.; Université de la Saskatchewan (Chilibeck), Saskatoon, Sask.; Université de la Colombie-Britannique (Ponzano), Kelowna, C.-B.; Université de Melbourne (Wark), Melbourne, Australie; Université du Manitoba (Falk, Frame), Winnipeg, Man.; Université Brown (Hayes), Providence, R.I
| | - Susan B Jaglal
- Université McGill (Morin), Montréal, Qc; Université de Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patientes et patients partenaires (Funnell, McIntyre, Bartley, Thomas); Université de Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Université Brock (Ward, Gittings), St. Catharines, Ont.; Université McMaster (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; Université du Wisconsin (Binkley), Madison, Wisc.; Université Dalhousie (Burrell], Halifax, N.-É.; Centre médical Menzies (Holmes), Morden, Man.; Université de Calgary (Negm), Calgary, Alb.; Université de la Colombie-Britannique (Ashe), Vancouver, C.-B.; Université de la Saskatchewan (Chilibeck), Saskatoon, Sask.; Université de la Colombie-Britannique (Ponzano), Kelowna, C.-B.; Université de Melbourne (Wark), Melbourne, Australie; Université du Manitoba (Falk, Frame), Winnipeg, Man.; Université Brown (Hayes), Providence, R.I
| | - Robert Josse
- Université McGill (Morin), Montréal, Qc; Université de Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patientes et patients partenaires (Funnell, McIntyre, Bartley, Thomas); Université de Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Université Brock (Ward, Gittings), St. Catharines, Ont.; Université McMaster (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; Université du Wisconsin (Binkley), Madison, Wisc.; Université Dalhousie (Burrell], Halifax, N.-É.; Centre médical Menzies (Holmes), Morden, Man.; Université de Calgary (Negm), Calgary, Alb.; Université de la Colombie-Britannique (Ashe), Vancouver, C.-B.; Université de la Saskatchewan (Chilibeck), Saskatoon, Sask.; Université de la Colombie-Britannique (Ponzano), Kelowna, C.-B.; Université de Melbourne (Wark), Melbourne, Australie; Université du Manitoba (Falk, Frame), Winnipeg, Man.; Université Brown (Hayes), Providence, R.I
| | - Aliya A Khan
- Université McGill (Morin), Montréal, Qc; Université de Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patientes et patients partenaires (Funnell, McIntyre, Bartley, Thomas); Université de Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Université Brock (Ward, Gittings), St. Catharines, Ont.; Université McMaster (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; Université du Wisconsin (Binkley), Madison, Wisc.; Université Dalhousie (Burrell], Halifax, N.-É.; Centre médical Menzies (Holmes), Morden, Man.; Université de Calgary (Negm), Calgary, Alb.; Université de la Colombie-Britannique (Ashe), Vancouver, C.-B.; Université de la Saskatchewan (Chilibeck), Saskatoon, Sask.; Université de la Colombie-Britannique (Ponzano), Kelowna, C.-B.; Université de Melbourne (Wark), Melbourne, Australie; Université du Manitoba (Falk, Frame), Winnipeg, Man.; Université Brown (Hayes), Providence, R.I
| | - Virginia McIntyre
- Université McGill (Morin), Montréal, Qc; Université de Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patientes et patients partenaires (Funnell, McIntyre, Bartley, Thomas); Université de Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Université Brock (Ward, Gittings), St. Catharines, Ont.; Université McMaster (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; Université du Wisconsin (Binkley), Madison, Wisc.; Université Dalhousie (Burrell], Halifax, N.-É.; Centre médical Menzies (Holmes), Morden, Man.; Université de Calgary (Negm), Calgary, Alb.; Université de la Colombie-Britannique (Ashe), Vancouver, C.-B.; Université de la Saskatchewan (Chilibeck), Saskatoon, Sask.; Université de la Colombie-Britannique (Ponzano), Kelowna, C.-B.; Université de Melbourne (Wark), Melbourne, Australie; Université du Manitoba (Falk, Frame), Winnipeg, Man.; Université Brown (Hayes), Providence, R.I
| | - Lynn Nash
- Université McGill (Morin), Montréal, Qc; Université de Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patientes et patients partenaires (Funnell, McIntyre, Bartley, Thomas); Université de Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Université Brock (Ward, Gittings), St. Catharines, Ont.; Université McMaster (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; Université du Wisconsin (Binkley), Madison, Wisc.; Université Dalhousie (Burrell], Halifax, N.-É.; Centre médical Menzies (Holmes), Morden, Man.; Université de Calgary (Negm), Calgary, Alb.; Université de la Colombie-Britannique (Ashe), Vancouver, C.-B.; Université de la Saskatchewan (Chilibeck), Saskatoon, Sask.; Université de la Colombie-Britannique (Ponzano), Kelowna, C.-B.; Université de Melbourne (Wark), Melbourne, Australie; Université du Manitoba (Falk, Frame), Winnipeg, Man.; Université Brown (Hayes), Providence, R.I
| | - Ahmed Negm
- Université McGill (Morin), Montréal, Qc; Université de Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patientes et patients partenaires (Funnell, McIntyre, Bartley, Thomas); Université de Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Université Brock (Ward, Gittings), St. Catharines, Ont.; Université McMaster (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; Université du Wisconsin (Binkley), Madison, Wisc.; Université Dalhousie (Burrell], Halifax, N.-É.; Centre médical Menzies (Holmes), Morden, Man.; Université de Calgary (Negm), Calgary, Alb.; Université de la Colombie-Britannique (Ashe), Vancouver, C.-B.; Université de la Saskatchewan (Chilibeck), Saskatoon, Sask.; Université de la Colombie-Britannique (Ponzano), Kelowna, C.-B.; Université de Melbourne (Wark), Melbourne, Australie; Université du Manitoba (Falk, Frame), Winnipeg, Man.; Université Brown (Hayes), Providence, R.I
| | - Alexandra Papaioannou
- Université McGill (Morin), Montréal, Qc; Université de Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patientes et patients partenaires (Funnell, McIntyre, Bartley, Thomas); Université de Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Université Brock (Ward, Gittings), St. Catharines, Ont.; Université McMaster (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; Université du Wisconsin (Binkley), Madison, Wisc.; Université Dalhousie (Burrell], Halifax, N.-É.; Centre médical Menzies (Holmes), Morden, Man.; Université de Calgary (Negm), Calgary, Alb.; Université de la Colombie-Britannique (Ashe), Vancouver, C.-B.; Université de la Saskatchewan (Chilibeck), Saskatoon, Sask.; Université de la Colombie-Britannique (Ponzano), Kelowna, C.-B.; Université de Melbourne (Wark), Melbourne, Australie; Université du Manitoba (Falk, Frame), Winnipeg, Man.; Université Brown (Hayes), Providence, R.I
| | - Matteo Ponzano
- Université McGill (Morin), Montréal, Qc; Université de Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patientes et patients partenaires (Funnell, McIntyre, Bartley, Thomas); Université de Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Université Brock (Ward, Gittings), St. Catharines, Ont.; Université McMaster (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; Université du Wisconsin (Binkley), Madison, Wisc.; Université Dalhousie (Burrell], Halifax, N.-É.; Centre médical Menzies (Holmes), Morden, Man.; Université de Calgary (Negm), Calgary, Alb.; Université de la Colombie-Britannique (Ashe), Vancouver, C.-B.; Université de la Saskatchewan (Chilibeck), Saskatoon, Sask.; Université de la Colombie-Britannique (Ponzano), Kelowna, C.-B.; Université de Melbourne (Wark), Melbourne, Australie; Université du Manitoba (Falk, Frame), Winnipeg, Man.; Université Brown (Hayes), Providence, R.I
| | - Isabel B Rodrigues
- Université McGill (Morin), Montréal, Qc; Université de Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patientes et patients partenaires (Funnell, McIntyre, Bartley, Thomas); Université de Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Université Brock (Ward, Gittings), St. Catharines, Ont.; Université McMaster (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; Université du Wisconsin (Binkley), Madison, Wisc.; Université Dalhousie (Burrell], Halifax, N.-É.; Centre médical Menzies (Holmes), Morden, Man.; Université de Calgary (Negm), Calgary, Alb.; Université de la Colombie-Britannique (Ashe), Vancouver, C.-B.; Université de la Saskatchewan (Chilibeck), Saskatoon, Sask.; Université de la Colombie-Britannique (Ponzano), Kelowna, C.-B.; Université de Melbourne (Wark), Melbourne, Australie; Université du Manitoba (Falk, Frame), Winnipeg, Man.; Université Brown (Hayes), Providence, R.I
| | - Lehana Thabane
- Université McGill (Morin), Montréal, Qc; Université de Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patientes et patients partenaires (Funnell, McIntyre, Bartley, Thomas); Université de Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Université Brock (Ward, Gittings), St. Catharines, Ont.; Université McMaster (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; Université du Wisconsin (Binkley), Madison, Wisc.; Université Dalhousie (Burrell], Halifax, N.-É.; Centre médical Menzies (Holmes), Morden, Man.; Université de Calgary (Negm), Calgary, Alb.; Université de la Colombie-Britannique (Ashe), Vancouver, C.-B.; Université de la Saskatchewan (Chilibeck), Saskatoon, Sask.; Université de la Colombie-Britannique (Ponzano), Kelowna, C.-B.; Université de Melbourne (Wark), Melbourne, Australie; Université du Manitoba (Falk, Frame), Winnipeg, Man.; Université Brown (Hayes), Providence, R.I
| | - Christine A Thomas
- Université McGill (Morin), Montréal, Qc; Université de Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patientes et patients partenaires (Funnell, McIntyre, Bartley, Thomas); Université de Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Université Brock (Ward, Gittings), St. Catharines, Ont.; Université McMaster (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; Université du Wisconsin (Binkley), Madison, Wisc.; Université Dalhousie (Burrell], Halifax, N.-É.; Centre médical Menzies (Holmes), Morden, Man.; Université de Calgary (Negm), Calgary, Alb.; Université de la Colombie-Britannique (Ashe), Vancouver, C.-B.; Université de la Saskatchewan (Chilibeck), Saskatoon, Sask.; Université de la Colombie-Britannique (Ponzano), Kelowna, C.-B.; Université de Melbourne (Wark), Melbourne, Australie; Université du Manitoba (Falk, Frame), Winnipeg, Man.; Université Brown (Hayes), Providence, R.I
| | - Lianne Tile
- Université McGill (Morin), Montréal, Qc; Université de Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patientes et patients partenaires (Funnell, McIntyre, Bartley, Thomas); Université de Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Université Brock (Ward, Gittings), St. Catharines, Ont.; Université McMaster (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; Université du Wisconsin (Binkley), Madison, Wisc.; Université Dalhousie (Burrell], Halifax, N.-É.; Centre médical Menzies (Holmes), Morden, Man.; Université de Calgary (Negm), Calgary, Alb.; Université de la Colombie-Britannique (Ashe), Vancouver, C.-B.; Université de la Saskatchewan (Chilibeck), Saskatoon, Sask.; Université de la Colombie-Britannique (Ponzano), Kelowna, C.-B.; Université de Melbourne (Wark), Melbourne, Australie; Université du Manitoba (Falk, Frame), Winnipeg, Man.; Université Brown (Hayes), Providence, R.I
| | - John D Wark
- Université McGill (Morin), Montréal, Qc; Université de Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patientes et patients partenaires (Funnell, McIntyre, Bartley, Thomas); Université de Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Université Brock (Ward, Gittings), St. Catharines, Ont.; Université McMaster (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; Université du Wisconsin (Binkley), Madison, Wisc.; Université Dalhousie (Burrell], Halifax, N.-É.; Centre médical Menzies (Holmes), Morden, Man.; Université de Calgary (Negm), Calgary, Alb.; Université de la Colombie-Britannique (Ashe), Vancouver, C.-B.; Université de la Saskatchewan (Chilibeck), Saskatoon, Sask.; Université de la Colombie-Britannique (Ponzano), Kelowna, C.-B.; Université de Melbourne (Wark), Melbourne, Australie; Université du Manitoba (Falk, Frame), Winnipeg, Man.; Université Brown (Hayes), Providence, R.I
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Morin SN, Feldman S, Funnell L, Giangregorio L, Kim S, McDonald-Blumer H, Santesso N, Ridout R, Ward W, Ashe MC, Bardai Z, Bartley J, Binkley N, Burrell S, Butt D, Cadarette SM, Cheung AM, Chilibeck P, Dunn S, Falk J, Frame H, Gittings W, Hayes K, Holmes C, Ioannidis G, Jaglal SB, Josse R, Khan AA, McIntyre V, Nash L, Negm A, Papaioannou A, Ponzano M, Rodrigues IB, Thabane L, Thomas CA, Tile L, Wark JD. Clinical practice guideline for management of osteoporosis and fracture prevention in Canada: 2023 update. CMAJ 2023; 195:E1333-E1348. [PMID: 37816527 PMCID: PMC10610956 DOI: 10.1503/cmaj.221647] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND In Canada, more than 2 million people live with osteoporosis, a disease that increases the risk for fractures, which result in excess mortality and morbidity, decreased quality of life and loss of autonomy. This guideline update is intended to assist Canadian health care professionals in the delivery of care to optimize skeletal health and prevent fractures in postmenopausal females and in males aged 50 years and older. METHODS This guideline is an update of the 2010 Osteoporosis Canada clinical practice guideline on the diagnosis and management of osteoporosis in Canada. We followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework and quality assurance as per Appraisal of Guidelines for Research and Evaluation (AGREE II) quality and reporting standards. Primary care physicians and patient partners were represented at all levels of the guideline committees and groups, and participated throughout the entire process to ensure relevance to target users. The process for managing competing interests was developed before and continued throughout the guideline development, informed by the Guideline International Network principles. We considered benefits and harms, patient values and preferences, resources, equity, acceptability and feasibility when developing recommendations; the strength of each recommendation was assigned according to the GRADE framework. RECOMMENDATIONS The 25 recommendations and 10 good practice statements are grouped under the sections of exercise, nutrition, fracture risk assessment and treatment initiation, pharmacologic interventions, duration and sequence of therapy, and monitoring. The management of osteoporosis should be guided by the patient's risk of fracture, based on clinical assessment and using a validated fracture risk assessment tool. Exercise, nutrition and pharmacotherapy are key elements of the management strategy for fracture prevention and should be individualized. INTERPRETATION The aim of this guideline is to empower health care professionals and patients to have meaningful discussions on the importance of skeletal health and fracture risk throughout older adulthood. Identification and appropriate management of skeletal fragility can reduce fractures, and preserve mobility, autonomy and quality of life.
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Affiliation(s)
- Suzanne N Morin
- McGill University (Morin), Montréal, Que.; University of Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patient partners (Funnell, McIntyre, Bartley, Thomas); University of Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Brock University (Ward, Gittings), St. Catharines, Ont.; McMaster University (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; University of Wisconsin (Binkley), Madison, Wisc.; Dalhousie University (Burrell), Halifax, NS; Menzies Medical Centre (Holmes), Morden, Man.; University of Calgary (Negm), Calgary, Alta.; University of British Columbia (Ashe), Vancouver, BC; University of Saskatchewan (Chilibeck), Saskatoon, Sask.; University of British Columbia (Ponzano), Kelowna, BC; University of Melbourne (Wark), Melbourne, Australia; University of Manitoba (Falk, Frame), Winnipeg, Man.; Brown University (Hayes), Providence, RI.
| | - Sidney Feldman
- McGill University (Morin), Montréal, Que.; University of Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patient partners (Funnell, McIntyre, Bartley, Thomas); University of Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Brock University (Ward, Gittings), St. Catharines, Ont.; McMaster University (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; University of Wisconsin (Binkley), Madison, Wisc.; Dalhousie University (Burrell), Halifax, NS; Menzies Medical Centre (Holmes), Morden, Man.; University of Calgary (Negm), Calgary, Alta.; University of British Columbia (Ashe), Vancouver, BC; University of Saskatchewan (Chilibeck), Saskatoon, Sask.; University of British Columbia (Ponzano), Kelowna, BC; University of Melbourne (Wark), Melbourne, Australia; University of Manitoba (Falk, Frame), Winnipeg, Man.; Brown University (Hayes), Providence, RI
| | - Larry Funnell
- McGill University (Morin), Montréal, Que.; University of Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patient partners (Funnell, McIntyre, Bartley, Thomas); University of Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Brock University (Ward, Gittings), St. Catharines, Ont.; McMaster University (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; University of Wisconsin (Binkley), Madison, Wisc.; Dalhousie University (Burrell), Halifax, NS; Menzies Medical Centre (Holmes), Morden, Man.; University of Calgary (Negm), Calgary, Alta.; University of British Columbia (Ashe), Vancouver, BC; University of Saskatchewan (Chilibeck), Saskatoon, Sask.; University of British Columbia (Ponzano), Kelowna, BC; University of Melbourne (Wark), Melbourne, Australia; University of Manitoba (Falk, Frame), Winnipeg, Man.; Brown University (Hayes), Providence, RI
| | - Lora Giangregorio
- McGill University (Morin), Montréal, Que.; University of Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patient partners (Funnell, McIntyre, Bartley, Thomas); University of Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Brock University (Ward, Gittings), St. Catharines, Ont.; McMaster University (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; University of Wisconsin (Binkley), Madison, Wisc.; Dalhousie University (Burrell), Halifax, NS; Menzies Medical Centre (Holmes), Morden, Man.; University of Calgary (Negm), Calgary, Alta.; University of British Columbia (Ashe), Vancouver, BC; University of Saskatchewan (Chilibeck), Saskatoon, Sask.; University of British Columbia (Ponzano), Kelowna, BC; University of Melbourne (Wark), Melbourne, Australia; University of Manitoba (Falk, Frame), Winnipeg, Man.; Brown University (Hayes), Providence, RI
| | - Sandra Kim
- McGill University (Morin), Montréal, Que.; University of Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patient partners (Funnell, McIntyre, Bartley, Thomas); University of Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Brock University (Ward, Gittings), St. Catharines, Ont.; McMaster University (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; University of Wisconsin (Binkley), Madison, Wisc.; Dalhousie University (Burrell), Halifax, NS; Menzies Medical Centre (Holmes), Morden, Man.; University of Calgary (Negm), Calgary, Alta.; University of British Columbia (Ashe), Vancouver, BC; University of Saskatchewan (Chilibeck), Saskatoon, Sask.; University of British Columbia (Ponzano), Kelowna, BC; University of Melbourne (Wark), Melbourne, Australia; University of Manitoba (Falk, Frame), Winnipeg, Man.; Brown University (Hayes), Providence, RI
| | - Heather McDonald-Blumer
- McGill University (Morin), Montréal, Que.; University of Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patient partners (Funnell, McIntyre, Bartley, Thomas); University of Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Brock University (Ward, Gittings), St. Catharines, Ont.; McMaster University (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; University of Wisconsin (Binkley), Madison, Wisc.; Dalhousie University (Burrell), Halifax, NS; Menzies Medical Centre (Holmes), Morden, Man.; University of Calgary (Negm), Calgary, Alta.; University of British Columbia (Ashe), Vancouver, BC; University of Saskatchewan (Chilibeck), Saskatoon, Sask.; University of British Columbia (Ponzano), Kelowna, BC; University of Melbourne (Wark), Melbourne, Australia; University of Manitoba (Falk, Frame), Winnipeg, Man.; Brown University (Hayes), Providence, RI
| | - Nancy Santesso
- McGill University (Morin), Montréal, Que.; University of Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patient partners (Funnell, McIntyre, Bartley, Thomas); University of Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Brock University (Ward, Gittings), St. Catharines, Ont.; McMaster University (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; University of Wisconsin (Binkley), Madison, Wisc.; Dalhousie University (Burrell), Halifax, NS; Menzies Medical Centre (Holmes), Morden, Man.; University of Calgary (Negm), Calgary, Alta.; University of British Columbia (Ashe), Vancouver, BC; University of Saskatchewan (Chilibeck), Saskatoon, Sask.; University of British Columbia (Ponzano), Kelowna, BC; University of Melbourne (Wark), Melbourne, Australia; University of Manitoba (Falk, Frame), Winnipeg, Man.; Brown University (Hayes), Providence, RI
| | - Rowena Ridout
- McGill University (Morin), Montréal, Que.; University of Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patient partners (Funnell, McIntyre, Bartley, Thomas); University of Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Brock University (Ward, Gittings), St. Catharines, Ont.; McMaster University (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; University of Wisconsin (Binkley), Madison, Wisc.; Dalhousie University (Burrell), Halifax, NS; Menzies Medical Centre (Holmes), Morden, Man.; University of Calgary (Negm), Calgary, Alta.; University of British Columbia (Ashe), Vancouver, BC; University of Saskatchewan (Chilibeck), Saskatoon, Sask.; University of British Columbia (Ponzano), Kelowna, BC; University of Melbourne (Wark), Melbourne, Australia; University of Manitoba (Falk, Frame), Winnipeg, Man.; Brown University (Hayes), Providence, RI
| | - Wendy Ward
- McGill University (Morin), Montréal, Que.; University of Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patient partners (Funnell, McIntyre, Bartley, Thomas); University of Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Brock University (Ward, Gittings), St. Catharines, Ont.; McMaster University (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; University of Wisconsin (Binkley), Madison, Wisc.; Dalhousie University (Burrell), Halifax, NS; Menzies Medical Centre (Holmes), Morden, Man.; University of Calgary (Negm), Calgary, Alta.; University of British Columbia (Ashe), Vancouver, BC; University of Saskatchewan (Chilibeck), Saskatoon, Sask.; University of British Columbia (Ponzano), Kelowna, BC; University of Melbourne (Wark), Melbourne, Australia; University of Manitoba (Falk, Frame), Winnipeg, Man.; Brown University (Hayes), Providence, RI
| | - Maureen C Ashe
- McGill University (Morin), Montréal, Que.; University of Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patient partners (Funnell, McIntyre, Bartley, Thomas); University of Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Brock University (Ward, Gittings), St. Catharines, Ont.; McMaster University (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; University of Wisconsin (Binkley), Madison, Wisc.; Dalhousie University (Burrell), Halifax, NS; Menzies Medical Centre (Holmes), Morden, Man.; University of Calgary (Negm), Calgary, Alta.; University of British Columbia (Ashe), Vancouver, BC; University of Saskatchewan (Chilibeck), Saskatoon, Sask.; University of British Columbia (Ponzano), Kelowna, BC; University of Melbourne (Wark), Melbourne, Australia; University of Manitoba (Falk, Frame), Winnipeg, Man.; Brown University (Hayes), Providence, RI
| | - Zahra Bardai
- McGill University (Morin), Montréal, Que.; University of Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patient partners (Funnell, McIntyre, Bartley, Thomas); University of Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Brock University (Ward, Gittings), St. Catharines, Ont.; McMaster University (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; University of Wisconsin (Binkley), Madison, Wisc.; Dalhousie University (Burrell), Halifax, NS; Menzies Medical Centre (Holmes), Morden, Man.; University of Calgary (Negm), Calgary, Alta.; University of British Columbia (Ashe), Vancouver, BC; University of Saskatchewan (Chilibeck), Saskatoon, Sask.; University of British Columbia (Ponzano), Kelowna, BC; University of Melbourne (Wark), Melbourne, Australia; University of Manitoba (Falk, Frame), Winnipeg, Man.; Brown University (Hayes), Providence, RI
| | - Joan Bartley
- McGill University (Morin), Montréal, Que.; University of Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patient partners (Funnell, McIntyre, Bartley, Thomas); University of Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Brock University (Ward, Gittings), St. Catharines, Ont.; McMaster University (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; University of Wisconsin (Binkley), Madison, Wisc.; Dalhousie University (Burrell), Halifax, NS; Menzies Medical Centre (Holmes), Morden, Man.; University of Calgary (Negm), Calgary, Alta.; University of British Columbia (Ashe), Vancouver, BC; University of Saskatchewan (Chilibeck), Saskatoon, Sask.; University of British Columbia (Ponzano), Kelowna, BC; University of Melbourne (Wark), Melbourne, Australia; University of Manitoba (Falk, Frame), Winnipeg, Man.; Brown University (Hayes), Providence, RI
| | - Neil Binkley
- McGill University (Morin), Montréal, Que.; University of Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patient partners (Funnell, McIntyre, Bartley, Thomas); University of Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Brock University (Ward, Gittings), St. Catharines, Ont.; McMaster University (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; University of Wisconsin (Binkley), Madison, Wisc.; Dalhousie University (Burrell), Halifax, NS; Menzies Medical Centre (Holmes), Morden, Man.; University of Calgary (Negm), Calgary, Alta.; University of British Columbia (Ashe), Vancouver, BC; University of Saskatchewan (Chilibeck), Saskatoon, Sask.; University of British Columbia (Ponzano), Kelowna, BC; University of Melbourne (Wark), Melbourne, Australia; University of Manitoba (Falk, Frame), Winnipeg, Man.; Brown University (Hayes), Providence, RI
| | - Steven Burrell
- McGill University (Morin), Montréal, Que.; University of Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patient partners (Funnell, McIntyre, Bartley, Thomas); University of Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Brock University (Ward, Gittings), St. Catharines, Ont.; McMaster University (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; University of Wisconsin (Binkley), Madison, Wisc.; Dalhousie University (Burrell), Halifax, NS; Menzies Medical Centre (Holmes), Morden, Man.; University of Calgary (Negm), Calgary, Alta.; University of British Columbia (Ashe), Vancouver, BC; University of Saskatchewan (Chilibeck), Saskatoon, Sask.; University of British Columbia (Ponzano), Kelowna, BC; University of Melbourne (Wark), Melbourne, Australia; University of Manitoba (Falk, Frame), Winnipeg, Man.; Brown University (Hayes), Providence, RI
| | - Debra Butt
- McGill University (Morin), Montréal, Que.; University of Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patient partners (Funnell, McIntyre, Bartley, Thomas); University of Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Brock University (Ward, Gittings), St. Catharines, Ont.; McMaster University (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; University of Wisconsin (Binkley), Madison, Wisc.; Dalhousie University (Burrell), Halifax, NS; Menzies Medical Centre (Holmes), Morden, Man.; University of Calgary (Negm), Calgary, Alta.; University of British Columbia (Ashe), Vancouver, BC; University of Saskatchewan (Chilibeck), Saskatoon, Sask.; University of British Columbia (Ponzano), Kelowna, BC; University of Melbourne (Wark), Melbourne, Australia; University of Manitoba (Falk, Frame), Winnipeg, Man.; Brown University (Hayes), Providence, RI
| | - Suzanne M Cadarette
- McGill University (Morin), Montréal, Que.; University of Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patient partners (Funnell, McIntyre, Bartley, Thomas); University of Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Brock University (Ward, Gittings), St. Catharines, Ont.; McMaster University (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; University of Wisconsin (Binkley), Madison, Wisc.; Dalhousie University (Burrell), Halifax, NS; Menzies Medical Centre (Holmes), Morden, Man.; University of Calgary (Negm), Calgary, Alta.; University of British Columbia (Ashe), Vancouver, BC; University of Saskatchewan (Chilibeck), Saskatoon, Sask.; University of British Columbia (Ponzano), Kelowna, BC; University of Melbourne (Wark), Melbourne, Australia; University of Manitoba (Falk, Frame), Winnipeg, Man.; Brown University (Hayes), Providence, RI
| | - Angela M Cheung
- McGill University (Morin), Montréal, Que.; University of Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patient partners (Funnell, McIntyre, Bartley, Thomas); University of Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Brock University (Ward, Gittings), St. Catharines, Ont.; McMaster University (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; University of Wisconsin (Binkley), Madison, Wisc.; Dalhousie University (Burrell), Halifax, NS; Menzies Medical Centre (Holmes), Morden, Man.; University of Calgary (Negm), Calgary, Alta.; University of British Columbia (Ashe), Vancouver, BC; University of Saskatchewan (Chilibeck), Saskatoon, Sask.; University of British Columbia (Ponzano), Kelowna, BC; University of Melbourne (Wark), Melbourne, Australia; University of Manitoba (Falk, Frame), Winnipeg, Man.; Brown University (Hayes), Providence, RI
| | - Phil Chilibeck
- McGill University (Morin), Montréal, Que.; University of Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patient partners (Funnell, McIntyre, Bartley, Thomas); University of Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Brock University (Ward, Gittings), St. Catharines, Ont.; McMaster University (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; University of Wisconsin (Binkley), Madison, Wisc.; Dalhousie University (Burrell), Halifax, NS; Menzies Medical Centre (Holmes), Morden, Man.; University of Calgary (Negm), Calgary, Alta.; University of British Columbia (Ashe), Vancouver, BC; University of Saskatchewan (Chilibeck), Saskatoon, Sask.; University of British Columbia (Ponzano), Kelowna, BC; University of Melbourne (Wark), Melbourne, Australia; University of Manitoba (Falk, Frame), Winnipeg, Man.; Brown University (Hayes), Providence, RI
| | - Sheila Dunn
- McGill University (Morin), Montréal, Que.; University of Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patient partners (Funnell, McIntyre, Bartley, Thomas); University of Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Brock University (Ward, Gittings), St. Catharines, Ont.; McMaster University (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; University of Wisconsin (Binkley), Madison, Wisc.; Dalhousie University (Burrell), Halifax, NS; Menzies Medical Centre (Holmes), Morden, Man.; University of Calgary (Negm), Calgary, Alta.; University of British Columbia (Ashe), Vancouver, BC; University of Saskatchewan (Chilibeck), Saskatoon, Sask.; University of British Columbia (Ponzano), Kelowna, BC; University of Melbourne (Wark), Melbourne, Australia; University of Manitoba (Falk, Frame), Winnipeg, Man.; Brown University (Hayes), Providence, RI
| | - Jamie Falk
- McGill University (Morin), Montréal, Que.; University of Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patient partners (Funnell, McIntyre, Bartley, Thomas); University of Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Brock University (Ward, Gittings), St. Catharines, Ont.; McMaster University (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; University of Wisconsin (Binkley), Madison, Wisc.; Dalhousie University (Burrell), Halifax, NS; Menzies Medical Centre (Holmes), Morden, Man.; University of Calgary (Negm), Calgary, Alta.; University of British Columbia (Ashe), Vancouver, BC; University of Saskatchewan (Chilibeck), Saskatoon, Sask.; University of British Columbia (Ponzano), Kelowna, BC; University of Melbourne (Wark), Melbourne, Australia; University of Manitoba (Falk, Frame), Winnipeg, Man.; Brown University (Hayes), Providence, RI
| | - Heather Frame
- McGill University (Morin), Montréal, Que.; University of Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patient partners (Funnell, McIntyre, Bartley, Thomas); University of Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Brock University (Ward, Gittings), St. Catharines, Ont.; McMaster University (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; University of Wisconsin (Binkley), Madison, Wisc.; Dalhousie University (Burrell), Halifax, NS; Menzies Medical Centre (Holmes), Morden, Man.; University of Calgary (Negm), Calgary, Alta.; University of British Columbia (Ashe), Vancouver, BC; University of Saskatchewan (Chilibeck), Saskatoon, Sask.; University of British Columbia (Ponzano), Kelowna, BC; University of Melbourne (Wark), Melbourne, Australia; University of Manitoba (Falk, Frame), Winnipeg, Man.; Brown University (Hayes), Providence, RI
| | - William Gittings
- McGill University (Morin), Montréal, Que.; University of Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patient partners (Funnell, McIntyre, Bartley, Thomas); University of Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Brock University (Ward, Gittings), St. Catharines, Ont.; McMaster University (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; University of Wisconsin (Binkley), Madison, Wisc.; Dalhousie University (Burrell), Halifax, NS; Menzies Medical Centre (Holmes), Morden, Man.; University of Calgary (Negm), Calgary, Alta.; University of British Columbia (Ashe), Vancouver, BC; University of Saskatchewan (Chilibeck), Saskatoon, Sask.; University of British Columbia (Ponzano), Kelowna, BC; University of Melbourne (Wark), Melbourne, Australia; University of Manitoba (Falk, Frame), Winnipeg, Man.; Brown University (Hayes), Providence, RI
| | - Kaleen Hayes
- McGill University (Morin), Montréal, Que.; University of Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patient partners (Funnell, McIntyre, Bartley, Thomas); University of Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Brock University (Ward, Gittings), St. Catharines, Ont.; McMaster University (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; University of Wisconsin (Binkley), Madison, Wisc.; Dalhousie University (Burrell), Halifax, NS; Menzies Medical Centre (Holmes), Morden, Man.; University of Calgary (Negm), Calgary, Alta.; University of British Columbia (Ashe), Vancouver, BC; University of Saskatchewan (Chilibeck), Saskatoon, Sask.; University of British Columbia (Ponzano), Kelowna, BC; University of Melbourne (Wark), Melbourne, Australia; University of Manitoba (Falk, Frame), Winnipeg, Man.; Brown University (Hayes), Providence, RI
| | - Carol Holmes
- McGill University (Morin), Montréal, Que.; University of Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patient partners (Funnell, McIntyre, Bartley, Thomas); University of Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Brock University (Ward, Gittings), St. Catharines, Ont.; McMaster University (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; University of Wisconsin (Binkley), Madison, Wisc.; Dalhousie University (Burrell), Halifax, NS; Menzies Medical Centre (Holmes), Morden, Man.; University of Calgary (Negm), Calgary, Alta.; University of British Columbia (Ashe), Vancouver, BC; University of Saskatchewan (Chilibeck), Saskatoon, Sask.; University of British Columbia (Ponzano), Kelowna, BC; University of Melbourne (Wark), Melbourne, Australia; University of Manitoba (Falk, Frame), Winnipeg, Man.; Brown University (Hayes), Providence, RI
| | - George Ioannidis
- McGill University (Morin), Montréal, Que.; University of Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patient partners (Funnell, McIntyre, Bartley, Thomas); University of Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Brock University (Ward, Gittings), St. Catharines, Ont.; McMaster University (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; University of Wisconsin (Binkley), Madison, Wisc.; Dalhousie University (Burrell), Halifax, NS; Menzies Medical Centre (Holmes), Morden, Man.; University of Calgary (Negm), Calgary, Alta.; University of British Columbia (Ashe), Vancouver, BC; University of Saskatchewan (Chilibeck), Saskatoon, Sask.; University of British Columbia (Ponzano), Kelowna, BC; University of Melbourne (Wark), Melbourne, Australia; University of Manitoba (Falk, Frame), Winnipeg, Man.; Brown University (Hayes), Providence, RI
| | - Susan B Jaglal
- McGill University (Morin), Montréal, Que.; University of Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patient partners (Funnell, McIntyre, Bartley, Thomas); University of Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Brock University (Ward, Gittings), St. Catharines, Ont.; McMaster University (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; University of Wisconsin (Binkley), Madison, Wisc.; Dalhousie University (Burrell), Halifax, NS; Menzies Medical Centre (Holmes), Morden, Man.; University of Calgary (Negm), Calgary, Alta.; University of British Columbia (Ashe), Vancouver, BC; University of Saskatchewan (Chilibeck), Saskatoon, Sask.; University of British Columbia (Ponzano), Kelowna, BC; University of Melbourne (Wark), Melbourne, Australia; University of Manitoba (Falk, Frame), Winnipeg, Man.; Brown University (Hayes), Providence, RI
| | - Robert Josse
- McGill University (Morin), Montréal, Que.; University of Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patient partners (Funnell, McIntyre, Bartley, Thomas); University of Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Brock University (Ward, Gittings), St. Catharines, Ont.; McMaster University (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; University of Wisconsin (Binkley), Madison, Wisc.; Dalhousie University (Burrell), Halifax, NS; Menzies Medical Centre (Holmes), Morden, Man.; University of Calgary (Negm), Calgary, Alta.; University of British Columbia (Ashe), Vancouver, BC; University of Saskatchewan (Chilibeck), Saskatoon, Sask.; University of British Columbia (Ponzano), Kelowna, BC; University of Melbourne (Wark), Melbourne, Australia; University of Manitoba (Falk, Frame), Winnipeg, Man.; Brown University (Hayes), Providence, RI
| | - Aliya A Khan
- McGill University (Morin), Montréal, Que.; University of Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patient partners (Funnell, McIntyre, Bartley, Thomas); University of Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Brock University (Ward, Gittings), St. Catharines, Ont.; McMaster University (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; University of Wisconsin (Binkley), Madison, Wisc.; Dalhousie University (Burrell), Halifax, NS; Menzies Medical Centre (Holmes), Morden, Man.; University of Calgary (Negm), Calgary, Alta.; University of British Columbia (Ashe), Vancouver, BC; University of Saskatchewan (Chilibeck), Saskatoon, Sask.; University of British Columbia (Ponzano), Kelowna, BC; University of Melbourne (Wark), Melbourne, Australia; University of Manitoba (Falk, Frame), Winnipeg, Man.; Brown University (Hayes), Providence, RI
| | - Virginia McIntyre
- McGill University (Morin), Montréal, Que.; University of Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patient partners (Funnell, McIntyre, Bartley, Thomas); University of Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Brock University (Ward, Gittings), St. Catharines, Ont.; McMaster University (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; University of Wisconsin (Binkley), Madison, Wisc.; Dalhousie University (Burrell), Halifax, NS; Menzies Medical Centre (Holmes), Morden, Man.; University of Calgary (Negm), Calgary, Alta.; University of British Columbia (Ashe), Vancouver, BC; University of Saskatchewan (Chilibeck), Saskatoon, Sask.; University of British Columbia (Ponzano), Kelowna, BC; University of Melbourne (Wark), Melbourne, Australia; University of Manitoba (Falk, Frame), Winnipeg, Man.; Brown University (Hayes), Providence, RI
| | - Lynn Nash
- McGill University (Morin), Montréal, Que.; University of Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patient partners (Funnell, McIntyre, Bartley, Thomas); University of Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Brock University (Ward, Gittings), St. Catharines, Ont.; McMaster University (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; University of Wisconsin (Binkley), Madison, Wisc.; Dalhousie University (Burrell), Halifax, NS; Menzies Medical Centre (Holmes), Morden, Man.; University of Calgary (Negm), Calgary, Alta.; University of British Columbia (Ashe), Vancouver, BC; University of Saskatchewan (Chilibeck), Saskatoon, Sask.; University of British Columbia (Ponzano), Kelowna, BC; University of Melbourne (Wark), Melbourne, Australia; University of Manitoba (Falk, Frame), Winnipeg, Man.; Brown University (Hayes), Providence, RI
| | - Ahmed Negm
- McGill University (Morin), Montréal, Que.; University of Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patient partners (Funnell, McIntyre, Bartley, Thomas); University of Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Brock University (Ward, Gittings), St. Catharines, Ont.; McMaster University (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; University of Wisconsin (Binkley), Madison, Wisc.; Dalhousie University (Burrell), Halifax, NS; Menzies Medical Centre (Holmes), Morden, Man.; University of Calgary (Negm), Calgary, Alta.; University of British Columbia (Ashe), Vancouver, BC; University of Saskatchewan (Chilibeck), Saskatoon, Sask.; University of British Columbia (Ponzano), Kelowna, BC; University of Melbourne (Wark), Melbourne, Australia; University of Manitoba (Falk, Frame), Winnipeg, Man.; Brown University (Hayes), Providence, RI
| | - Alexandra Papaioannou
- McGill University (Morin), Montréal, Que.; University of Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patient partners (Funnell, McIntyre, Bartley, Thomas); University of Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Brock University (Ward, Gittings), St. Catharines, Ont.; McMaster University (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; University of Wisconsin (Binkley), Madison, Wisc.; Dalhousie University (Burrell), Halifax, NS; Menzies Medical Centre (Holmes), Morden, Man.; University of Calgary (Negm), Calgary, Alta.; University of British Columbia (Ashe), Vancouver, BC; University of Saskatchewan (Chilibeck), Saskatoon, Sask.; University of British Columbia (Ponzano), Kelowna, BC; University of Melbourne (Wark), Melbourne, Australia; University of Manitoba (Falk, Frame), Winnipeg, Man.; Brown University (Hayes), Providence, RI
| | - Matteo Ponzano
- McGill University (Morin), Montréal, Que.; University of Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patient partners (Funnell, McIntyre, Bartley, Thomas); University of Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Brock University (Ward, Gittings), St. Catharines, Ont.; McMaster University (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; University of Wisconsin (Binkley), Madison, Wisc.; Dalhousie University (Burrell), Halifax, NS; Menzies Medical Centre (Holmes), Morden, Man.; University of Calgary (Negm), Calgary, Alta.; University of British Columbia (Ashe), Vancouver, BC; University of Saskatchewan (Chilibeck), Saskatoon, Sask.; University of British Columbia (Ponzano), Kelowna, BC; University of Melbourne (Wark), Melbourne, Australia; University of Manitoba (Falk, Frame), Winnipeg, Man.; Brown University (Hayes), Providence, RI
| | - Isabel B Rodrigues
- McGill University (Morin), Montréal, Que.; University of Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patient partners (Funnell, McIntyre, Bartley, Thomas); University of Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Brock University (Ward, Gittings), St. Catharines, Ont.; McMaster University (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; University of Wisconsin (Binkley), Madison, Wisc.; Dalhousie University (Burrell), Halifax, NS; Menzies Medical Centre (Holmes), Morden, Man.; University of Calgary (Negm), Calgary, Alta.; University of British Columbia (Ashe), Vancouver, BC; University of Saskatchewan (Chilibeck), Saskatoon, Sask.; University of British Columbia (Ponzano), Kelowna, BC; University of Melbourne (Wark), Melbourne, Australia; University of Manitoba (Falk, Frame), Winnipeg, Man.; Brown University (Hayes), Providence, RI
| | - Lehana Thabane
- McGill University (Morin), Montréal, Que.; University of Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patient partners (Funnell, McIntyre, Bartley, Thomas); University of Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Brock University (Ward, Gittings), St. Catharines, Ont.; McMaster University (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; University of Wisconsin (Binkley), Madison, Wisc.; Dalhousie University (Burrell), Halifax, NS; Menzies Medical Centre (Holmes), Morden, Man.; University of Calgary (Negm), Calgary, Alta.; University of British Columbia (Ashe), Vancouver, BC; University of Saskatchewan (Chilibeck), Saskatoon, Sask.; University of British Columbia (Ponzano), Kelowna, BC; University of Melbourne (Wark), Melbourne, Australia; University of Manitoba (Falk, Frame), Winnipeg, Man.; Brown University (Hayes), Providence, RI
| | - Christine A Thomas
- McGill University (Morin), Montréal, Que.; University of Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patient partners (Funnell, McIntyre, Bartley, Thomas); University of Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Brock University (Ward, Gittings), St. Catharines, Ont.; McMaster University (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; University of Wisconsin (Binkley), Madison, Wisc.; Dalhousie University (Burrell), Halifax, NS; Menzies Medical Centre (Holmes), Morden, Man.; University of Calgary (Negm), Calgary, Alta.; University of British Columbia (Ashe), Vancouver, BC; University of Saskatchewan (Chilibeck), Saskatoon, Sask.; University of British Columbia (Ponzano), Kelowna, BC; University of Melbourne (Wark), Melbourne, Australia; University of Manitoba (Falk, Frame), Winnipeg, Man.; Brown University (Hayes), Providence, RI
| | - Lianne Tile
- McGill University (Morin), Montréal, Que.; University of Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patient partners (Funnell, McIntyre, Bartley, Thomas); University of Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Brock University (Ward, Gittings), St. Catharines, Ont.; McMaster University (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; University of Wisconsin (Binkley), Madison, Wisc.; Dalhousie University (Burrell), Halifax, NS; Menzies Medical Centre (Holmes), Morden, Man.; University of Calgary (Negm), Calgary, Alta.; University of British Columbia (Ashe), Vancouver, BC; University of Saskatchewan (Chilibeck), Saskatoon, Sask.; University of British Columbia (Ponzano), Kelowna, BC; University of Melbourne (Wark), Melbourne, Australia; University of Manitoba (Falk, Frame), Winnipeg, Man.; Brown University (Hayes), Providence, RI
| | - John D Wark
- McGill University (Morin), Montréal, Que.; University of Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patient partners (Funnell, McIntyre, Bartley, Thomas); University of Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Brock University (Ward, Gittings), St. Catharines, Ont.; McMaster University (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; University of Wisconsin (Binkley), Madison, Wisc.; Dalhousie University (Burrell), Halifax, NS; Menzies Medical Centre (Holmes), Morden, Man.; University of Calgary (Negm), Calgary, Alta.; University of British Columbia (Ashe), Vancouver, BC; University of Saskatchewan (Chilibeck), Saskatoon, Sask.; University of British Columbia (Ponzano), Kelowna, BC; University of Melbourne (Wark), Melbourne, Australia; University of Manitoba (Falk, Frame), Winnipeg, Man.; Brown University (Hayes), Providence, RI
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Tibert N, Ponzano M, Brien S, Funnell L, Gibbs JC, Jain R, Keller HH, Laprade J, Morin SN, Papaioannou A, Weston Z, Wideman TH, Giangregorio L. Non-pharmacological management of osteoporotic vertebral fractures: health-care professional perspectives and experiences. Disabil Rehabil 2023:1-8. [PMID: 37493172 DOI: 10.1080/09638288.2023.2239146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
PURPOSE To understand experiences and perceptions on non-pharmacological treatment of vertebral fractures and virtual-care from the perspective of care professionals' (HCPs). DESIGN AND SETTING We conducted semi-structured interviews with 13 HCPs within Canada (7 F, 6 M, aged 46 ± 12 years) and performed a thematic and content analysis from a post-positivism perspective. RESULTS Two themes were identified: acuity matters when selecting appropriate interventions; and roadblocks to receiving non-pharmacological interventions. We found that treatment options were dependent on the acuity/stability of fracture and were individualized accordingly. Pain medication was perceived as important, but non-pharmacological strategies were also considered helpful in supporting recovery. Participants discussed barriers related to the timely identification of fracture, referral to physiotherapy, and lack of knowledge among HCPs on how to manage osteoporosis and vertebral fractures. HCPs reported positive use of virtual-care, but had concerns related to patient access, cost, and comprehensive assessments. CONCLUSION HCPs used and perceived non-pharmacological interventions as helpful and selected specific treatments based on the recency of fracture and patient symptoms. HCPs' also believed that virtual-care that included an educational component, an assessment by a physiotherapist, and an exercise group was a feasible alternative, but concerns exist and may require further evaluation.Implications for RehabilitationNon-pharmacological strategies in combination with pain medication may be a more effective strategy to support recovery than pain medication alone but should be informed by fracture acuity and patient symptoms.To improve access to physiotherapy and other non-pharmacological treatment options during the acute or chronic management of vertebral fractures, it may be worthwhile to explore the effectiveness and feasibility of virtual-care.
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Affiliation(s)
- Nicholas Tibert
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Matteo Ponzano
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Sheila Brien
- Canadian Osteoporosis Patient Network, Osteoporosis Canada; Toronto, Canada
| | - Larry Funnell
- Canadian Osteoporosis Patient Network, Osteoporosis Canada; Toronto, Canada
| | | | - Ravi Jain
- Ontario Osteoporosis Strategy, Osteoporosis Canada, North York, Canada
| | - Heather H Keller
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada
- Schlegel-UW Research Institute for Aging, and Department of Kinesiology and Health Sciences, Waterloo, Canada
| | - Judi Laprade
- Department of Surgery, University of Toronto, Toronto, Canada
| | - Suzanne N Morin
- McGill University, Montréal, Canada
- Research Institute of McGill University Health Centre, Montréal, Canada
| | | | - Zach Weston
- Lazaridis School of Business & Economics, Wilfrid Laurier University, Waterloo, Canada
| | | | - Lora Giangregorio
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada
- Schlegel-UW Research Institute for Aging, and Department of Kinesiology and Health Sciences, Waterloo, Canada
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Tibert N, Ponzano M, Brien S, Funnell L, Gibbs JC, Jain R, Keller H, Laprade J, Morin SN, Papaioannou A, Weston Z, Wideman TH, Giangregorio L. Non-pharmacological management of osteoporotic vertebral fractures: Patient perspectives and experiences. Clin Rehabil 2023; 37:713-724. [PMID: 36510450 DOI: 10.1177/02692155221144370] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To understand perceptions on rehabilitation after vertebral fracture, non-pharmacological strategies, and virtual care from the perspective of individuals living with vertebral fractures. DESIGN AND SETTING We conducted semi-structured interviews online and performed a thematic and content analysis from a post-positivism perspective. PARTICIPANTS Ten individuals living with osteoporotic vertebral fractures (9F, 1 M, aged 71 ± 8 years). RESULTS Five themes emerged: pain is the defining limitation of vertebral fracture recovery; delayed diagnosis impacts recovery trajectory; living with fear; being dissatisfied with fracture management; and "getting back into the game of life" using non-pharmacological strategies. CONCLUSION Participants reported back pain and an inability to perform activities of daily living, affecting psychological and social well-being. Physiotherapy, education, and exercise were considered helpful and important to patients; however, issues with fracture identification and referral limited the use of these options. Participants believed that virtual rehabilitation was a feasible and effective alternative to in-person care, but perceived experience with technology, cost, and individualization of programs as barriers.
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Affiliation(s)
- Nicholas Tibert
- Department of Kinesiology and Health Sciences, 8430University of Waterloo, Waterloo, ON, Canada
| | - Matteo Ponzano
- Department of Kinesiology and Health Sciences, 8430University of Waterloo, Waterloo, ON, Canada
| | | | | | | | - Ravi Jain
- Ontario Osteoporosis Strategy, Osteoporosis Canada, Toronto, ON, Canada
| | - Heather Keller
- Department of Kinesiology and Health Sciences, 8430University of Waterloo, Waterloo, ON, Canada
- Schlegel-UW Research Institute for Aging, and Department of Kinesiology and Health Sciences, Waterloo, ON, Canada
| | | | - Suzanne N Morin
- 5620McGill University, Montréal, QC, Canada
- Research Institute of McGill University Health Centre, Montréal, QC, Canada
| | | | - Zach Weston
- 8431Wilfrid Laurier University, Waterloo, ON, Canada
| | | | - Lora Giangregorio
- Department of Kinesiology and Health Sciences, 8430University of Waterloo, Waterloo, ON, Canada
- Schlegel-UW Research Institute for Aging, and Department of Kinesiology and Health Sciences, Waterloo, ON, Canada
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Ponzano M, Tibert N, Brien S, Funnell L, Gibbs JC, Keller H, Laprade J, Morin SN, Papaioannou A, Weston Z, Wideman TH, Giangregorio LM. Publisher Correction: International consensus on the non-pharmacological and non-surgical management of osteoporotic vertebral fractures. Osteoporos Int 2023; 34:1139. [PMID: 37036475 DOI: 10.1007/s00198-023-06717-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Affiliation(s)
- Matteo Ponzano
- School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia, Okanagan Campus, 1238 Discovery Avenue, Kelowna, BC, V1V 1V9, Canada.
- International Collaboration On Repair Discoveries (ICORD), Blusson Spinal Cord Centre (BSCC), University of British Columbia, Vancouver, BC, Canada.
| | - N Tibert
- Department of Kinesiology and Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON, N2T0G6, Canada
| | - S Brien
- Canadian Osteoporosis Patient Network, Osteoporosis Canada, 201 - 250 Ferrand Dr, Toronto, ON, M3C 3G8, Canada
| | - L Funnell
- Canadian Osteoporosis Patient Network, Osteoporosis Canada, 201 - 250 Ferrand Dr, Toronto, ON, M3C 3G8, Canada
| | - J C Gibbs
- Department of Kinesiology and Physical Activity, McGill University, 845 Rue Sherbrooke O, Montréal, QC, H3A0G4, Canada
| | - H Keller
- Department of Kinesiology and Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON, N2T0G6, Canada
- Schlegel-UW Research Institute for Aging, Waterloo, ON, Canada
| | - J Laprade
- Department of Surgery, University of Toronto, 149 College Street, Toronto, ON, M5S, Canada
| | - S N Morin
- Department of Medicine, McGill University, 845 Rue Sherbrooke O, Montréal, QC, H3A0G4, Canada
| | - A Papaioannou
- Department of Medicine, McMaster University, 1280 Main St W, Hamilton, ON, L8S4L8, Canada
| | - Z Weston
- Canadian Society for Exercise Physiology (CSEP), Ottawa, Canada
- Wilfrid Laurier University, 75 University Ave W, Waterloo, ON, N2L3C5, Canada
| | - T H Wideman
- School of Physical & Occupational Therapy, McGill University, 845 Rue Sherbrooke O, Montréal, QC, H3A0G4, Canada
| | - L M Giangregorio
- Department of Kinesiology and Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON, N2T0G6, Canada
- Schlegel-UW Research Institute for Aging, Waterloo, ON, Canada
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Ponzano M, Wiest MJ, Coleman A, Newton E, Pakosh M, Patsakos EM, Magnuson DSK, Giangregorio LM, Craven BC. The use of alkaline phosphatase as a bone turnover marker after spinal cord injury: A scoping review of human and animal studies. J Spinal Cord Med 2023; 46:167-180. [PMID: 34935593 PMCID: PMC9987745 DOI: 10.1080/10790268.2021.1977905] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Serum alkaline phosphatase (ALP) is measured as an indicator of bone or liver disease. Bone-specific alkaline phosphatase (B-ALP) is an isoform of ALP found in the bone tissue which can predict fractures and heterotopic ossification. OBJECTIVE The aim of this scoping review was to explore the current use of ALP and B-ALP in studies using humans or animal models of SCI, and to identify ways to advance future research using ALP and B-ALP as a bone marker after SCI. RESULTS HUMAN STUDIES: 42 studies were included. The evidence regarding changes or differences in ALP levels in individuals with SCI compared to controls is conflicting. For example, a negative correlation between B-ALP and total femur BMD was observed in only one of three studies examining the association. B-ALP seemed to increase after administration of teriparatide, and to decrease after treatment with denosumab. The effects of exercise on ALP and B-ALP levels are heterogeneous and depend on the type of exercise performed. ANIMAL STUDIES: 11 studies were included. There is uncertainty regarding the response of ALP or B-ALP levels after SCI; levels increased after some interventions, including vibration protocols, curcumin supplementation, cycles in electromagnetic field or hyperbaric chamber. Calcitonin or bisphosphonate administration did not affect ALP levels. CONCLUSION Researchers are encouraged to measure the bone-specific isoform of ALP rather than total ALP in future studies in humans of animal models of SCI.
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Affiliation(s)
- Matteo Ponzano
- KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.,Department of Kinesiology, University of Waterloo, Waterloo, Canada
| | - Matheus J Wiest
- KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - André Coleman
- Department of Physiology and Pathophysiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Emily Newton
- KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Maureen Pakosh
- Library & Information Services, University Health Network, Toronto Rehabilitation Institute, Toronto, Canada
| | - Eleni M Patsakos
- KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.,Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - David S K Magnuson
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, USA
| | - Lora M Giangregorio
- KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.,Department of Kinesiology, University of Waterloo, Waterloo, Canada.,Schlegel-UW Research Institute for Aging, Waterloo, Canada
| | - B Catharine Craven
- KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.,Department of Kinesiology, University of Waterloo, Waterloo, Canada.,Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.,Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
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Peckett KH, Ponzano M, Steinke A, Giangregorio LM. Bracing and taping interventions for individuals with vertebral fragility fractures: a systematic review of randomized controlled trials with GRADE assessment. Arch Osteoporos 2023; 18:36. [PMID: 36840787 DOI: 10.1007/s11657-023-01224-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 02/10/2023] [Indexed: 02/26/2023]
Abstract
This systematic review analyzes the effects of bracing and taping after osteoporotic vertebral fractures. Spinal orthose may have positive effects on pain, but the evidence is of very low certainty. Clinical judgment is recommended when prescribing spinal orthoses. PURPOSE To examine the effects of bracing and taping interventions on pain, physical functioning, health-related quality of life, back extensor strength, kyphosis curvature, and adverse events in individuals with vertebral fragility fractures. METHODS Four databases were searched from inception up to January 2022. We included randomized controlled trials testing the effect of bracing or taping interventions compared with a non-intervention control in adults ≥ 45 years with vertebral fragility fractures. Narrative syntheses were presented for all the outcomes. We assessed the risk of bias using the Cochrane Risk of Bias Assessment Tool and the certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation. RESULTS Three studies were included. Soft bracing interventions exhibited inconsistent effects on pain. One study showed no difference between groups, and another study should a decrease in pain in the soft bracing group compared to the control group. Rigid bracing interventions did not have a significant change in pain between the control and intervention groups. One study demonstrated a decrease in pain at rest (VAS: - 10.8 ± 19.3) and during movement (VAS: - 20.9 ± 29.8) after a taping intervention. The other outcomes were not consistent across studies. CONCLUSIONS Spinal orthoses may improve pain in people with vertebral fractures; however, we cannot draw definitive conclusions on the efficacy or harms of bracing or taping due to the very low certainty evidence and the small number of studies. Effects on other outcomes are uncertain.
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Affiliation(s)
- Kimberly H Peckett
- Department of Kinesiology and Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada
| | - Matteo Ponzano
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, Canada
| | - Alex Steinke
- Department of Kinesiology and Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada
| | - Lora M Giangregorio
- Department of Kinesiology and Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada.
- Schlegel-UW Research Institute for Aging, Waterloo, Canada.
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Ponzano M, Tibert N, Brien S, Funnell L, Gibbs JC, Keller H, Laprade J, Morin SN, Papaioannou A, Weston Z, Wideman TH, Giangregorio LM. International consensus on the non-pharmacological and non-surgical management of osteoporotic vertebral fractures. Osteoporos Int 2023; 34:1065-1074. [PMID: 36799981 DOI: 10.1007/s00198-023-06688-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 01/26/2023] [Indexed: 02/18/2023]
Abstract
UNLABELLED We identified a knowledge gap in the non-pharmacological and non-surgical management of osteoporotic vertebral fractures. MAIN RESULTS This international consensus process established multidisciplinary biopsychosocial recommendations on pain, nutrition, safe movement, and exercise for individuals with acute and chronic vertebral fractures. SIGNIFICANCE These recommendations will guide clinical practice and inform interventions for future research. PURPOSE To establish international consensus on recommendations for the non-pharmacological and non-surgical management of osteoporotic vertebral fractures. METHODS We adopted a five-step modified Delphi consensus process: (1) literature search and content analysis, (2) creation of the survey, (3) selection of the expert panel, (4) first round of the rating process, and (5) second round of the rating process. The first round included 49 statements and eight open-ended questions; the second round included 30 statements. Panelists were asked to rate their agreement with each of the statements using a 9-point scale, with the option to provide further comments. Consensus for each statement was determined by counting the number of panelists whose rating was outside the 3-point region containing the median. RESULTS We invited 76 people with degree in medicine, physiotherapy, kinesiology, and experience in the management of osteoporotic vertebral; 31 (41%) and 27 (36%) experts agreed to participate to the first and the second round, respectively. The mean percentage agreement after the first and second rounds was 76.6% ± 16.0% and 90.7% ± 6.5%, respectively. We established consensus on recommendations on pain, early satiety, weight loss, bracing, safe movement, and exercise for individuals with acute and chronic vertebral fractures. CONCLUSION Our international consensus provides multidisciplinary biopsychosocial recommendations to guide the management of osteoporotic vertebral fractures and inform interventions for future research.
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Affiliation(s)
- Matteo Ponzano
- School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia, Okanagan Campus, 1238 Discovery Avenue, Kelowna, BC, V1V 1V9, Canada.
- International Collaboration On Repair Discoveries (ICORD), Blusson Spinal Cord Centre (BSCC), University of British Columbia, Vancouver, BC, Canada.
| | - N Tibert
- Department of Kinesiology and Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON, N2T0G6, Canada
| | - S Brien
- Canadian Osteoporosis Patient Network, Osteoporosis Canada, 201 - 250 Ferrand Dr, Toronto, ON, M3C 3G8, Canada
| | - L Funnell
- Canadian Osteoporosis Patient Network, Osteoporosis Canada, 201 - 250 Ferrand Dr, Toronto, ON, M3C 3G8, Canada
| | - J C Gibbs
- Department of Kinesiology and Physical Activity, McGill University, 845 Rue Sherbrooke O, Montréal, QC, H3A0G4, Canada
| | - H Keller
- Department of Kinesiology and Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON, N2T0G6, Canada
- Schlegel-UW Research Institute for Aging, Waterloo, ON, Canada
| | - J Laprade
- Department of Surgery, University of Toronto, 149 College Street, Toronto, ON, M5S, Canada
| | - S N Morin
- Department of Medicine, McGill University, 845 Rue Sherbrooke O, Montréal, QC, H3A0G4, Canada
| | - A Papaioannou
- Department of Medicine, McMaster University, 1280 Main St W, Hamilton, ON, L8S4L8, Canada
| | - Z Weston
- Canadian Society for Exercise Physiology (CSEP), Ottawa, Canada
- Wilfrid Laurier University, 75 University Ave W, Waterloo, ON, N2L3C5, Canada
| | - T H Wideman
- School of Physical & Occupational Therapy, McGill University, 845 Rue Sherbrooke O, Montréal, QC, H3A0G4, Canada
| | - L M Giangregorio
- Department of Kinesiology and Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON, N2T0G6, Canada
- Schlegel-UW Research Institute for Aging, Waterloo, ON, Canada
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Giangregorio L, Tibert N, Ponzano M, Emond D, Thabane L, Burns C. Working with multidisciplinary or non-academic collaborators as mentors. Health Behavior Research 2022. [DOI: 10.4148/2572-1836.1149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Gandini A, Pastorino L, Ponzano M, Puglisi S, Borea R, Cremante M, Grassi M, Bruno W, Dalmasso B, Andreotti V, Vanni I, Allavena E, Catalano F, Martelli V, Pastorino A, Iaia M, Fornarini G, Sciallero M, Puccini A, Ghiorzo P. 1305P Landscape and clinical significance of germline pathogenic variants (PV) in pancreatic cancer (PC)-predisposing genes in PC patients. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Presseau J, Kasperavicius D, Rodrigues IB, Braimoh J, Chambers A, Etherington C, Giangregorio L, Gibbs JC, Giguere A, Graham ID, Hankivsky O, Hoens AM, Holroyd-Leduc J, Kelly C, Moore JE, Ponzano M, Sharma M, Sibley KM, Straus S. Selecting implementation models, theories, and frameworks in which to integrate intersectional approaches. BMC Med Res Methodol 2022; 22:212. [PMID: 35927615 PMCID: PMC9351159 DOI: 10.1186/s12874-022-01682-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 07/13/2022] [Indexed: 11/20/2022] Open
Abstract
Background Models, theories, and frameworks (MTFs) provide the foundation for a cumulative science of implementation, reflecting a shared, evolving understanding of various facets of implementation. One under-represented aspect in implementation MTFs is how intersecting social factors and systems of power and oppression can shape implementation. There is value in enhancing how MTFs in implementation research and practice account for these intersecting factors. Given the large number of MTFs, we sought to identify exemplar MTFs that represent key implementation phases within which to embed an intersectional perspective. Methods We used a five-step process to prioritize MTFs for enhancement with an intersectional lens. We mapped 160 MTFs to three previously prioritized phases of the Knowledge-to-Action (KTA) framework. Next, 17 implementation researchers/practitioners, MTF experts, and intersectionality experts agreed on criteria for prioritizing MTFs within each KTA phase. The experts used a modified Delphi process to agree on an exemplar MTF for each of the three prioritized KTA framework phases. Finally, we reached consensus on the final MTFs and contacted the original MTF developers to confirm MTF versions and explore additional insights. Results We agreed on three criteria when prioritizing MTFs: acceptability (mean = 3.20, SD = 0.75), applicability (mean = 3.82, SD = 0.72), and usability (median = 4.00, mean = 3.89, SD = 0.31) of the MTF. The top-rated MTFs were the Iowa Model of Evidence-Based Practice to Promote Quality Care for the ‘Identify the problem’ phase (mean = 4.57, SD = 2.31), the Consolidated Framework for Implementation Research for the ‘Assess barriers/facilitators to knowledge use’ phase (mean = 5.79, SD = 1.12), and the Behaviour Change Wheel for the ‘Select, tailor, implement interventions’ phase (mean = 6.36, SD = 1.08). Conclusions Our interdisciplinary team engaged in a rigorous process to reach consensus on MTFs reflecting specific phases of the implementation process and prioritized each to serve as an exemplar in which to embed intersectional approaches. The resulting MTFs correspond with specific phases of the KTA framework, which itself may be useful for those seeking particular MTFs for particular KTA phases. This approach also provides a template for how other implementation MTFs could be similarly considered in the future. Trial registration Open Science Framework Registration: osf.io/qgh64. Supplementary Information The online version contains supplementary material available at 10.1186/s12874-022-01682-x.
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Affiliation(s)
- Justin Presseau
- Clinical Epidemiology, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada. .,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada. .,School of Psychology, University of Ottawa, Ottawa, Canada.
| | - Danielle Kasperavicius
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
| | | | - Jessica Braimoh
- Department of Social Science, York University, Toronto, ON, Canada
| | | | - Cole Etherington
- Clinical Epidemiology, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada.,Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Lora Giangregorio
- Department of Kinesiology and Health Sciences, and Schlegel Research Institute for Aging, University of Waterloo, Waterloo, ON, Canada
| | - Jenna C Gibbs
- Department of Kinesiology and Physical Education, McGill University, Montreal, QC, Canada
| | - Anik Giguere
- Department of Family Medicine and Emergency Medicine, Université Laval, Québec, QC, Canada
| | - Ian D Graham
- Clinical Epidemiology, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Olena Hankivsky
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Alison M Hoens
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Jayna Holroyd-Leduc
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Christine Kelly
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | | | - Matteo Ponzano
- Department of Kinesiology and Health Sciences, and Schlegel Research Institute for Aging, University of Waterloo, Waterloo, ON, Canada
| | - Malika Sharma
- Division of Infectious Diseases, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Kathryn M Sibley
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,George and Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, MB, Canada
| | - Sharon Straus
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
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Sibley KM, Kasperavicius D, Rodrigues IB, Giangregorio L, Gibbs JC, Graham ID, Hoens AM, Kelly C, Lalonde D, Moore JE, Ponzano M, Presseau J, Straus SE. Development and usability testing of tools to facilitate incorporating intersectionality in knowledge translation. BMC Health Serv Res 2022; 22:830. [PMID: 35761251 PMCID: PMC9238081 DOI: 10.1186/s12913-022-08181-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 06/07/2022] [Indexed: 11/17/2022] Open
Abstract
Background The field of knowledge translation (KT) has been criticized for neglecting contextual and social considerations that influence health equity. Intersectionality, a concept introduced by Black feminist scholars, emphasizes how human experience is shaped by combinations of social factors (e.g., ethnicity, gender) embedded in systemic power structures. Its use has the potential to advance equity considerations in KT. Our objective was to develop and conduct usability testing of tools to support integrating intersectionality in KT through three key phases of KT: identifying the gap; assessing barriers to knowledge use; and selecting, tailoring, and implementing interventions. Methods We used an integrated KT approach and assembled an interdisciplinary development committee who drafted tools. We used a mixed methods approach for usability testing with KT intervention developers that included semi-structured interviews and the System Usability Scale (SUS). We calculated an average SUS score for each tool. We coded interview data using the framework method focusing on actionable feedback. The development committee used the feedback to revise tools, which were formatted by a graphic designer. Results Nine people working in Canada joined the development committee. They drafted an intersectionality primer and one tool that included recommendations, activities, reflection prompts, and resources for each of the three implementation phases. Thirty-one KT intervention developers from three countries participated in usability testing. They suggested the tools to be shorter, contain more visualizations, and use less jargon. Average SUS scores of the draft tools ranged between 60 and 78/100. The development committee revised and shortened all tools, and added two, one-page summary documents. The final toolkit included six documents. Conclusions We developed and evaluated tools to help embed intersectionality considerations in KT. These tools go beyond recommending the use of intersectionality to providing practical guidance on how to do this. Future work should develop guidance for enhancing social justice in intersectionality-enhanced KT. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08181-1.
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Affiliation(s)
- Kathryn M Sibley
- Department of Community Health Sciences, University of Manitoba, 379 - 753 McDermot Avenue, Winnipeg, MB, R3E 0W3, Canada. .,George and Fay Yee Centre for Healthcare Innovation, 379- 753 McDermot Avenue, Winnipeg, MB, R3E 0W3, Canada.
| | - Danielle Kasperavicius
- Knowledge Translation Program, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | | | - Lora Giangregorio
- Department of Kinesiology and Health Sciences, and Schlegel-UW Research Institute for Aging, University of Waterloo, Waterloo, ON, Canada
| | - Jenna C Gibbs
- Department of Kinesiology and Physical Education, McGill University, Montreal, QC, Canada
| | - Ian D Graham
- Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Alison M Hoens
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Christine Kelly
- Department of Community Health Sciences, University of Manitoba, 379 - 753 McDermot Avenue, Winnipeg, MB, R3E 0W3, Canada
| | - Dianne Lalonde
- Learning Network, Centre for Research & Education on Violence Against Women & Children, Western University, London, ON, Canada
| | | | - Matteo Ponzano
- Department of Kinesiology and Health Sciences, and Schlegel-UW Research Institute for Aging, University of Waterloo, Waterloo, ON, Canada
| | - Justin Presseau
- Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.,School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Sharon E Straus
- Division of Infectious Diseases, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
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Giangregorio L, Ponzano M. Letter to the Editor on "Effects of Two Newly Developed Spinal Orthoses on Trunk Muscle Strength, Posture, and Quality-of-Life in Women With Postmenopausal Osteoporosis: A Randomized Trial". Am J Phys Med Rehabil 2022; 101:e81-e82. [PMID: 35034051 DOI: 10.1097/phm.0000000000001961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Manji R, Ponzano M, Ashe MC, Wark JD, Kendler D, Papaioannou A, Cheung AM, Adachi JD, Thabane L, Scherer SC, Ziebart C, Gibbs JC, Giangregorio LM. Exploring the Association between Pain and Fracture Characteristics in Women with Osteoporotic Vertebral Fractures. Physiother Can 2022. [DOI: 10.3138/ptc-2020-0067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose: The purpose of this study was to estimate the association between pain and the number, severity, and location of fractures in women with osteoporotic vertebral fractures. Method:We used an 11-point numeric pain rating scale to assess pain during movement in the preceding week and lateral spinal radiographs to confirm number, location, and severity of vertebral fractures. In model 1, we assessed the association between pain during movement and the number, severity, and location of fractures. We adjusted model 2 for pain medication use and age. Results: The mean age of participants was 76.4 (SD 6.9) years. We found no statistically significant associations between pain and fracture number (estimated β = 0.23, 95% CI: ‒0.27, 0.68), fracture severity (estimated β = ‒0.46, 95% CI: ‒1.38, 0.49), or fracture location at T4–T8 (estimated β = 0.06, 95% CI: ‒1.26, 1.34), T9–L1 (estimated β = 0.35, 95% CI: ‒1.17, 1.74), or L2–L4 (estimated β = 0.40, 95% CI: ‒1.01, 1.75). Age and pain medication use were not significantly associated with pain. Model 1 accounted for 4.7% and model 2 for 7.2% of the variance in self-reported pain. Conclusion: The number, location, and severity of fractures do not appear to be the primary explanation for pain in women with vertebral fractures. Clinicians must consider other factors contributing to pain.
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Affiliation(s)
- Rahim Manji
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Matteo Ponzano
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
- Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
| | - Maureen C. Ashe
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada
| | - John D. Wark
- Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
- Bone & Mineral Medicine and Department of Diabetes & Endocrinology, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - David Kendler
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alexandra Papaioannou
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Geriatric Education and Research in Aging Sciences Centre, Hamilton, Ontario, Canada
| | - Angela M. Cheung
- Department of Medicine and Joint Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Samuel C. Scherer
- Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Christina Ziebart
- School of Physical Therapy, Western University, London, Ontario, Canada
| | - Jenna C. Gibbs
- Department of Kinesiology and Physical Education, McGill University, Montreal, Quebec, Canada
| | - Lora M. Giangregorio
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
- Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
- Schlegel–UW Research Institute for Aging, University of Waterloo, Waterloo, Ontario, Canada
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Abstract
This is a review of evidence and practical tips on exercise for individuals with osteoporosis, including individuals with hip and vertebral fractures. Balance and functional training, with or without strength training, can prevent falls. Several types of exercise can improve outcomes that are important to patients, such as physical functioning or quality of life. Individuals with osteoporosis should prioritize balance, functional and resistance training ≥ twice weekly, where exercises, volume, intensity, and progression are aligned with the patient's goals and abilities. Patients who want to participate in other activities (e.g., walking, impact exercise, yoga, Pilates) can do them in addition to, but not instead of, balance and functional or strength training, if they can be done safely or modified. Avoid generic advice like "Don't bend or twist", which is difficult or impossible to operationalize, and may create fear and activity avoidance. Instead, be specific about the types of activities to avoid or modify, and provide tips on how to make daily activities safer, or signpost to resources from national osteoporosis societies. For example, not all bending or twisting is bad; it is activities that involve rapid, repetitive, sustained, weighted, or end range of motion twisting or flexion of the spine that may need to be modified, especially in individuals at high risk of fracture.
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Affiliation(s)
- L M Giangregorio
- Department of Kinesiology and Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, Ontario, N2K 2N1, Canada; Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada.
| | - Matteo Ponzano
- Department of Kinesiology and Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, Ontario, N2K 2N1, Canada
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Ponzano M, Tibert N, Bansal S, Katzman W, Giangregorio L. Publisher Correction: Exercise for improving age-related hyperkyphosis: a systematic review and meta-analysis with GRADE assessment. Arch Osteoporos 2021; 17:9. [PMID: 34964063 DOI: 10.1007/s11657-021-01040-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Matteo Ponzano
- Department of Kinesiology, University of Waterloo, Waterloo, Canada
| | - Nicholas Tibert
- Department of Kinesiology, University of Waterloo, Waterloo, Canada
| | - Symron Bansal
- Department of Kinesiology, University of Waterloo, Waterloo, Canada
| | - Wendy Katzman
- Department of Physical Therapy and Rehabilitation Science, University of California San Francisco, San Francisco, USA
| | - Lora Giangregorio
- Department of Kinesiology, University of Waterloo, Waterloo, Canada.
- Schlegel-UW Research Institute for Aging, Waterloo, Canada.
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Kim KV, Bartley J, Ashe MC, Bardai Z, Butt D, Chilibeck PD, Ponzano M, Rodrigues IB, Stapleton J, Thabane L, Wark JD, Giangregorio L. Effect of Yoga on Health-Related Outcomes in People at Risk of Fractures: A Systematic Review. Appl Physiol Nutr Metab 2021; 47:215-226. [PMID: 34914565 DOI: 10.1139/apnm-2021-0736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We summarized the effects of yoga on health-related outcomes and adverse events in men and postmenopausal women ≥50 years-old at increased risk of fracture, to inform the updated Osteoporosis Canada clinical practice guidelines. Six databases were searched for observational studies, randomized controlled trials and case series. Certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation handbook. Nine studies were included and reported using narrative syntheses due to the limited available evidence. Overall, the available evidence was of very low certainty. There was no effect of yoga on health-related quality of life in randomized trials. Effects on other health-related outcomes were mixed or not available in the literature. Five studies reported no adverse events directly related to the study intervention, and two studies did not report whether adverse events occurred. However, two case series reported vertebral fractures related to yoga participation, possibly due to excessive spinal flexion. Due to the limited and very low certainty evidence, guideline developers will need to draw indirect evidence from yoga studies among middle aged or older adults that are not at fracture risk. (PROSPERO: CRD42019124898) NOVELTY BULLETS: • Evidence in general was of very low certainty. • Yoga had no effect on health-related quality of life in randomized trials. Evidence was mixed or unavailable for other outcomes. • Case studies reported yoga poses involving spinal flexion coincided with incidents of vertebral compression fracture among older adults with increased fracture risk.
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Affiliation(s)
- Kawon V Kim
- University of Waterloo, 8430, Department of Kinesiology and Health Sciences, Waterloo, Canada;
| | - Joan Bartley
- Osteoporosis Canada, 388825, Canadian Osteoporosis Patient Network, Toronto, Ontario, Canada;
| | - Maureen C Ashe
- University of British Columbia, Vancouver, British Columbia, Canada;
| | - Zahra Bardai
- McMaster University, 3710, Department of Medicine, Hamilton, Ontario, Canada;
| | - Debra Butt
- University of Toronto, 7938, Department of Family and Community Medicine, Toronto, Ontario, Canada;
| | | | - Matteo Ponzano
- University of Waterloo, Kinesiology and Health Sciences, Waterloo, Ontario, Canada;
| | | | - Jackie Stapleton
- University of Waterloo, 8430, University of Waterloo Library, Waterloo, Ontario, Canada;
| | - Lehana Thabane
- McMaster University, 3710, Department of Health Research Methods, Evidence and Impact, Hamilton, Ontario, Canada;
| | - John D Wark
- The University of Melbourne, 2281, Medicine, Dentistry, and Health Sciences, Melbourne, Victoria, Australia;
| | - Lora Giangregorio
- University of Waterloo, 8430, Department of Kinesiology and Health Sciences, Waterloo, Canada, N2L 3G1.,Schlegel Research Institute for Aging, Waterloo, Canada, N2J 0E2;
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Ponzano M, Tibert N, Bansal S, Katzman W, Giangregorio L. Exercise for improving age-related hyperkyphosis: a systematic review and meta-analysis with GRADE assessment. Arch Osteoporos 2021; 16:140. [PMID: 34546447 DOI: 10.1007/s11657-021-00998-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 08/22/2021] [Indexed: 02/03/2023]
Abstract
UNLABELLED We reviewed exercise trials in men and women ≥ 45 years with hyperkyphosis at the baseline and performed meta-analyses for kyphosis and health-related outcomes. PURPOSE To determine the effects of exercise interventions on kyphosis angle, back extensor muscle strength or endurance, physical functioning, quality of life, pain, falls, and adverse events in adults 45 years or older with hyperkyphosis. METHODS Multiple databases were searched to May 2020. Randomized controlled trials (RCTs), non-RCT, and pre-post intervention studies that had at least one group with a mean kyphosis angle of at least 40° at the baseline were included. RESULTS Twenty-four studies were included. Exercise or physical therapy improved kyphosis outcomes (SMD - 0.31; 95% confidence intervals [CI] - 0.46, - 0.16; moderate certainty evidence), back extensor muscle strength (MD 10.51 N; 95% CI 6.65, 14.38; very low certainty evidence), and endurance (MD 9.76 s; 95% CI 6.40, 13.13; low certainty evidence). Meta-analyses showed improvements in health-related quality of life (HRQoL) (SMD 0.21; 95% CI 0.06, 0.37; moderate certainty of evidence), general pain (MD - 0.26; 95% CI - 0.39, - 0.13; low certainty of evidence), and performance on the timed up and go (TUG) test (MD - 0.28 s; 95% CI - 0.48, - 0.08; very low certainty of evidence). The effects on the rate of falls (incidence rate ratio [IRR] 1.15; 95% CI 0.64, 2.05; low certainty evidence) or minor adverse events (IRR 1.29; 95% CI 0.95, 1.74; low certainty evidence) are uncertain. No serious adverse events were reported in the included studies. CONCLUSIONS Interventions targeting hyperkyphosis may improve kyphosis outcomes in adults with hyperkyphosis.
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Affiliation(s)
- Matteo Ponzano
- Department of Kinesiology, University of Waterloo, Waterloo, Canada
| | - Nicholas Tibert
- Department of Kinesiology, University of Waterloo, Waterloo, Canada
| | - Symron Bansal
- Department of Kinesiology, University of Waterloo, Waterloo, Canada
| | - Wendy Katzman
- Department of Physical Therapy and Rehabilitation Science, University of California San Francisco, San Francisco, USA
| | - Lora Giangregorio
- Department of Kinesiology, University of Waterloo, Waterloo, Canada. .,Schlegel-UW Research Institute for Aging, Waterloo, Canada.
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Rodrigues IB, Ponzano M, Hosseini Z, Thabane L, Chilibeck PD, Butt DA, Ashe MC, Stapleton J, Wark J, Giangregorio LM. The Effect of Impact Exercise (Alone or Multicomponent Intervention) on Health-Related Outcomes in Individuals at Risk of Fractures: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Sports Med 2021; 51:1273-1292. [PMID: 33914282 DOI: 10.1007/s40279-021-01432-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Exercise is commonly recommended to prevent and manage osteoporosis. High magnitude strains at rapid rate and short bouts should theoretically elicit an osteogenic response; however, the effects of different levels of impact exercises on several outcomes in people at risk of fracture are still unknown. OBJECTIVE To report the effect of impact exercise on falls, fractures, adverse events, mortality, bone mineral density (BMD), physical functioning, and health-related quality of life (QoL). METHODS We included randomized controlled trials testing the effect of impact exercise compared with a non-exercise control on outcomes in adults ≥ 50 years with low BMD or fragility fractures. Two reviewers selected studies and extracted data. Where possible, we pooled outcomes using mean difference (MD) with a fixed-effects model and 95% confidence interval (CI). We reported risk of bias using Cochrane and certainty of evidence using GRADE. RESULTS We included 29 trials; 19 studies evaluated impact exercise alone, and the remaining trials combined impact with resistance or balance training. Impact exercise alone or combined with resistance training improved Timed Up-and-Go values (MD - 0.95 s, 95% CI - 1.09 to - 0.81, low certainty evidence) and lumbar spine (MD 0.04 g/cm2, 95% CI 0.02-0.06, low certainty evidence) and femoral neck BMD (MD 0.04 g/cm2, 95% CI 0.02-0.07, low certainty evidence). Impact exercise did not improve health-related QoL assessed with QUALEFFO-41 (MD 0.06, 95% CI - 2.18 to 2.30, moderate certainty evidence). The effects of impact exercise on falls, fractures, and mortality are uncertain due to insufficient data. Many trials had a high risk of bias for two or more items. CONCLUSIONS There is low certainty evidence that impact exercise may improve physical function and BMD in people at risk of fracture. The effect of impact exercises on falls, fractures, and mortality remains unclear. Our findings should be interpreted with caution due to risk of bias and small sample sizes. TRIAL REGISTRATION Registered in Prospero (CRD42018115579) on January 30, 2019.
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Affiliation(s)
- Isabel B Rodrigues
- Department of Kinesiology, University of Waterloo, Waterloo, ON, N2L 3G1, Canada
| | - Matteo Ponzano
- Department of Kinesiology, University of Waterloo, Waterloo, ON, N2L 3G1, Canada
| | - Zeinab Hosseini
- College of Kinesiology, University of Saskatchewan, Saskatoon, SK, S7N 5B2, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Philip D Chilibeck
- College of Kinesiology, University of Saskatchewan, Saskatoon, SK, S7N 5B2, Canada
| | - Debra A Butt
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, M5G 1V7, Canada
| | - Maureen C Ashe
- Department of Family Practice, University of British Columbia, Vancouver, BC, V6T 1Z3, Canada
| | - Jackie Stapleton
- University of Waterloo Library, University of Waterloo, Waterloo, ON, N2L 3G1, Canada
| | - John Wark
- Department of Medicine, Bone and Mineral Medicine, Department of Diabetes and Endocrinology, University of Melbourne, Royal Melbourne Hospital, Victoria, 3050, Australia
| | - Lora M Giangregorio
- Department of Kinesiology, University of Waterloo, Waterloo, ON, N2L 3G1, Canada.
- Schlegel-University of Waterloo, Research Institute for Aging, Waterloo, ON, N2J 0E2, Canada.
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Ponzano M, Rodrigues IB, Hosseini Z, Ashe MC, Butt DA, Chilibeck PD, Stapleton J, Thabane L, Wark JD, Giangregorio LM. Progressive Resistance Training for Improving Health-Related Outcomes in People at Risk of Fracture: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Phys Ther 2021; 101:6048920. [PMID: 33367736 DOI: 10.1093/ptj/pzaa221] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 11/23/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Osteoporosis clinical practice guidelines recommend exercise to prevent fractures, but the efficacy of exercise depends on the exercise types, population studied, or outcomes of interest. The purpose of this systematic review was to assess the effects of progressive resistance training (PRT) on health-related outcomes in people at risk of fracture. METHODS Multiple databases were searched in October 2019. Eligible articles were randomized controlled trials of PRT interventions in men and women ≥50 years with low bone mineral density (BMD) or fracture history. Descriptive information and mean difference (MD) and SD were directly extracted for included trials. A total of 53 studies were included. RESULTS The effects of PRT on the total number of falls (incidence rate ratio [IRR] = 1.05; 95% CI = 0.91 - 1.21; 7 studies) and on the risk of falling (risk ratio [RR] = 1.23; 95% CI = 1.00 - 1.51; 5 studies) are uncertain. PRT improved performance on the Timed "Up and Go" test (MD = -0.89 seconds; 95% CI = -1.01 to -0.78; 13 studies) and health-related quality of life (standardized MD = 0.32; 95% CI = 0.22-0.42; 20 studies). PRT may increase femoral neck (MD = 0.02 g/cm2; 95% CI = 0.01-0.03; 521 participants, 5 studies) but not lumbar spine BMD (MD = 0.02 g/cm2; 95% CI = -0.01-0.05; 4 studies), whereas the effects on total hip BMD are uncertain (MD = 0.00 g/cm2; 95% CI = 0.00-0.01; 435 participants, 4 studies). PRT reduced pain (standardized MD = -0.26; 95% CI = -0.37 to -0.16; 17 studies). Sensitivity analyses, including PRT-only studies, confirmed these findings. CONCLUSION Individuals at risk of fractures should be encouraged to perform PRT, as it may improve femoral neck BMD, health-related quality of life, and physical functioning. PRT also reduced pain; however, whether PRT increases or decreases the risk of falls, the number of people experiencing a fall, or the risk of fall-related injuries is uncertain. IMPACT Individuals at risk of fractures should be encouraged to perform PRT, as it may have positive effects on femoral neck BMD, health-related quality of life, physical functioning, and pain, and adverse events are rare. LAY SUMMARY Exercise is recommended for people at risk of osteoporotic fractures. Our study showed that progressive resistance training improves physical functioning, quality of life, and reduces pain. The effects of progressive resistance training on the risk of falling are unclear. Adverse events are rare, and often minor (eg, soreness, pain, musculoskeletal injury). Considering the benefits and safety, people at risk of fractures should engage in progressive resistance training interventions.
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Affiliation(s)
| | | | | | - Maureen C Ashe
- The University of British Columbia, Vancouver, Canada.,Centre for Hip Health and Mobility, Vancouver, Canada
| | - Debra A Butt
- University of Toronto, Toronto, Canada.,Scarborough Health Network, Scarborough, Canada
| | | | | | - Lehana Thabane
- McMaster University, Hamilton, Canada.,St Joseph's Healthcare Hamilton, Hamilton, Canada
| | - John D Wark
- University of Melbourne, Melbourne, Australia.,Royal Melbourne Hospital, Parkville, Australia
| | - Lora M Giangregorio
- University of Waterloo, Waterloo, Canada.,Schlegel-UW Research Institute for Aging, Waterloo, Canada
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El-Kotob R, Ponzano M, Chaput JP, Janssen I, Kho ME, Poitras VJ, Ross R, Ross-White A, Saunders TJ, Giangregorio LM. Resistance training and health in adults: an overview of systematic reviews. Appl Physiol Nutr Metab 2020; 45:S165-S179. [DOI: 10.1139/apnm-2020-0245] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The objective of this overview of systematic reviews was to determine the benefits and harms of resistance training (RT) on health outcomes in adults aged 18 years or older, compared with not participating in RT. Four electronic databases were searched in February 2019 for systematic reviews published in the past 10 years. Eligibility criteria were determined a priori for population (community dwelling adults), intervention (exclusively RT), comparator (no RT or different doses of RT), and health outcomes (critical: mortality, physical functioning, health-related quality of life, and adverse events; important: cardiovascular disease, type 2 diabetes mellitus, mental health, brain health, cognitive function, cancer, fall-related injuries or falls, and bone health). We selected 1 review per outcome and we used the GRADE process to assess the strength of evidence. We screened 2089 records and 375 full-text articles independently, in duplicate. Eleven systematic reviews were included, representing 364 primary studies and 382 627 unique participants. RT was associated with a reduction in all-cause mortality and cardiovascular disease incidence, and an improvement in physical functioning. Effects on health-related quality of life or cognitive function were less certain. Adverse events were not consistently monitored or reported in RT studies, but serious adverse events were not common. Systematic reviews for the remaining important health outcomes could not be identified. Overall, RT training improved health outcomes in adults and the benefits outweighed the harms. (PROSPERO registration no.: CRD42019121641.) Novelty This overview was required to inform whether there was new evidence to support changes to the recommended guidelines for resistance training.
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Affiliation(s)
- Rasha El-Kotob
- Department of Kinesiology, University of Waterloo, Waterloo, ON N2L 3G1, Canada
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, ON M4G 3V9, Canada
| | - Matteo Ponzano
- Department of Kinesiology, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - Jean-Philippe Chaput
- Healthy Active Living and Obesity Research Group, Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada
| | - Ian Janssen
- School of Kinesiology and Health Studies, Queen’s University, Kingston, ON K7L 3N6, Canada
| | - Michelle E. Kho
- School of Rehabilitation Sciences, McMaster University, Hamilton, ON L8S 1C7, Canada
| | | | - Robert Ross
- School of Kinesiology and Health Studies, Queen’s University, Kingston, ON K7L 3N6, Canada
| | - Amanda Ross-White
- Queen’s University Library, Queen’s University, Kingston, ON K7L 3N6, Canada
| | - Travis J. Saunders
- Department of Applied Human Sciences, University of Prince Edward Island, Charlottetown, PE C1A 4P3, Canada
| | - Lora M. Giangregorio
- Department of Kinesiology, University of Waterloo, Waterloo, ON N2L 3G1, Canada
- Schlegel-University of Waterloo Research Institute for Aging, University of Waterloo, ON N2J 0E2, Canada
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Etherington N, Rodrigues IB, Giangregorio L, Graham ID, Hoens AM, Kasperavicius D, Kelly C, Moore JE, Ponzano M, Presseau J, Sibley KM, Straus S. Applying an intersectionality lens to the theoretical domains framework: a tool for thinking about how intersecting social identities and structures of power influence behaviour. BMC Med Res Methodol 2020; 20:169. [PMID: 32590940 PMCID: PMC7318508 DOI: 10.1186/s12874-020-01056-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 06/18/2020] [Indexed: 01/13/2023] Open
Abstract
Background A key component of the implementation process is identifying potential barriers and facilitators that need to be addressed. The Theoretical Domains Framework (TDF) is one of the most commonly used frameworks for this purpose. When applying the TDF, it is critical to understand the context in which behaviours occur. Intersectionality, which accounts for the interface between social identity factors (e.g. age, gender) and structures of power (e.g. ageism, sexism), offers a novel approach to understanding how context shapes individual decision-making and behaviour. We aimed to develop a tool to be used alongside applications of the TDF to incorporate an intersectionality lens when identifying implementation barriers and enablers. Methods An interdisciplinary Framework Committee (n = 17) prioritized the TDF as one of three models, theories, and frameworks (MTFs) to enhance with an intersectional lens through a modified Delphi approach. In collaboration with the wider Framework Committee, a subgroup considered all 14 TDF domains and iteratively developed recommendations for incorporating intersectionality considerations within the TDF and its domains. An iterative approach aimed at building consensus was used to finalize recommendations. Results Consensus on how to apply an intersectionality lens to the TDF was achieved after 12 rounds of revision. Two overarching considerations for using the intersectionality alongside the TDF were developed by the group as well as two to four prompts for each TDF domain to guide interview topic guides. Considerations and prompts were designed to assist users to reflect on how individual identities and structures of power may play a role in barriers and facilitators to behaviour change and subsequent intervention implementation. Conclusions Through an expert-consensus approach, we developed a tool for applying an intersectionality lens alongside the TDF. Considering the role of intersecting social factors when identifying barriers and facilitators to implementing research evidence may result in more targeted and effective interventions that better reflect the realities of those involved.
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Affiliation(s)
- Nicole Etherington
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Rm L1287, Ottawa, ON, K1H 8L6, Canada.
| | | | - Lora Giangregorio
- Department of Kinesiology, University of Waterloo, Waterloo, Canada.,Schlegel-UW Research Institute for Aging and KITE Toronto Rehab-University Health Network, Toronto, Canada
| | - Ian D Graham
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Rm L1287, Ottawa, ON, K1H 8L6, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Alison M Hoens
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada.,Centre of Health Evaluation and Outcome Sciences, University of British Columbia, Vancouver, Canada.,Arthritis Research Canada, Richmond, Canada
| | | | - Christine Kelly
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | | | - Matteo Ponzano
- Department of Kinesiology, University of Waterloo, Waterloo, Canada
| | - Justin Presseau
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Rm L1287, Ottawa, ON, K1H 8L6, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Kathryn M Sibley
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada.,Centre for Healthcare Innovation, Winnipeg, Manitoba, Canada
| | - Sharon Straus
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, Canada
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Abstract
CLINICAL RELEVANCE There is strong evidence from meta-analyses that exercise as a single intervention can reduce the number and risk of falls in community-dwelling older adults, yet not all types of exercise are equal. OBSERVATIONS Programs that include 3 h a week of exercise and provide a high challenge to balance can reduce falls by almost 40%. Reactive and volitional stepping interventions have also been shown to reduce falls by about 50%. Evidence is less clear regarding the efficacy of exercise in individuals who have experienced a stroke, who live in long-term care, who have been recently discharged from the hospital, or who have visual impairments, but there is some evidence that multifactorial programs may be useful. CONCLUSION Depending on the population, exercise as a single or as part of a multifactorial intervention may be beneficial in reducing falls.
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Affiliation(s)
- I B Rodrigues
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada.
| | - M Ponzano
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
| | - L M Giangregorio
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
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Gibbs JC, MacIntyre NJ, Ponzano M, Templeton JA, Thabane L, Papaioannou A, Giangregorio LM. Exercise for improving outcomes after osteoporotic vertebral fracture. Cochrane Database Syst Rev 2019; 7:CD008618. [PMID: 31273764 PMCID: PMC6609547 DOI: 10.1002/14651858.cd008618.pub3] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Vertebral fractures are associated with increased morbidity (e.g. pain, reduced quality of life) and mortality. Therapeutic exercise is a non-pharmacological conservative treatment that is often recommended for patients with vertebral fractures to reduce pain and restore functional movement. This is an update of a Cochrane Review first published in 2013. OBJECTIVES To assess the effects (benefits and harms) of exercise intervention of four weeks or greater (alone or as part of a physical therapy intervention) versus non-exercise/non-active physical therapy intervention, no intervention or placebo among adults with a history of vertebral fractures on incident fragility fractures of the hip, vertebra or other sites. Our secondary objectives were to evaluate the effects of exercise on the following outcomes: falls, pain, physical performance, health-related quality of life (disease-specific and generic), and adverse events. SEARCH METHODS We searched the following databases until November 2017: the Cochrane Library (Issue 11 of 12), MEDLINE (from 2005), Embase (from 1988), CINAHL (Cumulative Index to Nursing and Allied Health Literature, from 1982), AMED (from 1985), and PEDro (Physiotherapy Evidence Database, from 1929). Ongoing/recently completed trials were identified by searching the World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov. Conference proceedings were searched via ISI and SCOPUS, and targeted searches of proceedings of the American Congress of Rehabilitation Medicine and American Society for Bone and Mineral Research. Search terms or MeSH headings included terms such as vertebral fracture AND exercise OR physical therapy. For this update, the search results were limited from 2011 onward. SELECTION CRITERIA We included all randomized controlled trials and quasi-randomized trials comparing exercise or active physical therapy interventions with placebo/non-exercise/non-active physical therapy interventions or no intervention implemented in individuals with a history of vertebral fracture. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials and extracted data using a pre-tested data extraction form. Disagreements were resolved by consensus, or third-party adjudication. We used Cochrane's tool for assessing risk of bias to evaluate each study. Studies were grouped according to duration of follow-up (i.e. a) 4-12 weeks; b) 16-24 weeks; c) 52 weeks); a study could be represented in more than one group depending on the number of follow-up assessments. For dichotomous data, we reported risk ratios (RR) and corresponding 95% confidence intervals (95% CI). For continuous data, we reported mean differences (MD) of the change from baseline and 95% CI. Data were pooled for Timed Up and Go test, self-reported physical function measured by the QUALEFFO-41 physical function subscale score (scale of zero to 100; lower scores indicate better self-reported physical function), and disease-specific quality of life measured by the QUALEFFO-41 total score (scale of zero to 100; lower scores indicate better quality of life) at 12 weeks using a fixed-effect model. MAIN RESULTS Nine trials (n = 749, 68 male participants; two new trials in this review update) were included. Substantial variability across the trials prevented any meaningful pooling of data for most outcomes. Risk of bias across all studies was variable; low risk across most domains in four studies, and unclear/high risk in most domains for five studies. Performance bias and blinding of subjective outcome assessment were almost all high risk of bias.One trial reported no between-group difference in favor of the effect of exercise on incident fragility fractures after 52 weeks (RR 0.54, 95% CI 0.17 to 1.71; very low-quality evidence with control: 184 per 1000 and exercise: 100 per 1000, 95% CI 31 to 315; absolute difference: 8%, 95% CI 2 to 30). One trial reported no between-group difference in favor of the effect of exercise on incident falls after 52 weeks (RR 1.06, 95% CI 0.53 to 2.10; very low-quality evidence with control: 262 per 1000 and exercise: 277 per 1000; 95% CI 139 to 550; absolute difference: 2%, 95% CI -12 to 29). These findings should be interpreted with caution because of the very serious risk of bias in these studies and the small sample sizes resulting in imprecise estimates.We are uncertain that exercise could improve pain, self-reported physical function, and disease-specific quality of life, because certain studies showed no evidence of clinically important differences for these outcomes. Pooled analyses revealed a small between-group difference in favor of exercise for Timed Up and Go (MD -1.13 seconds, 95% CI -1.85 to -0.42; studies = 2), which did not change following a sensitivity analysis (MD -1.09 seconds, 95% CI -1.78 to -0.40; studies = 3; moderate-quality evidence). Exercise improved QUALEFFO-41 physical function score (MD -2.84 points, 95% CI -5.57 to -0.11; studies = 2; very low-quality evidence) and QUALEFFO-41 total score (MD -3.24 points, 95% CI -6.05 to -0.43; studies = 2; very low-quality evidence), yet it is unlikely that we observed any clinically important differences. Three trials reported four adverse events related to the exercise intervention (costal cartilage fracture, rib fracture, knee pain, irritation to tape, very low-quality evidence). AUTHORS' CONCLUSIONS In conclusion, we do not have sufficient evidence to determine the effects of exercise on incident fractures, falls or adverse events. Our updated review found moderate-quality evidence that exercise probably improves physical performance, specifically Timed Up and Go test, in individuals with vertebral fracture (downgraded due to study limitations). However, a one-second improvement in Timed Up and Go is not a clinically important improvement. Although individual trials did report benefits for some pain and disease-specific quality of life outcomes, the findings do not represent clinically meaningful improvements and should be interpreted with caution given the very low-quality evidence due to inconsistent findings, study limitations and imprecise estimates. The small number of trials and variability across trials limited our ability to pool outcomes or make conclusions. Evidence regarding the effects of exercise after vertebral fracture in men is scarce. A high-quality randomized trial is needed to inform safety and effectiveness of exercise to lower incidence of fracture and falls and to improve patient-centered outcomes (pain, function) for individuals with vertebral fractures (minimal sample size required is approximately 2500 untreated participants or 4400 participants if taking anti-osteoporosis therapy).
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Affiliation(s)
- Jenna C Gibbs
- McGill UniversityDepartment of Kinesiology and Physical Education475 Pine Avenue WCurrie Gym Office A208MontrealQuebecCanadaH2W 1S4
| | - Norma J MacIntyre
- McMaster UniversitySchool of Rehabilitation Science1400 Main Street WestRoom 403HamiltonONCanadaL8S 4L8
| | - Matteo Ponzano
- University of WaterlooDepartment of Kinesiology200 University Ave WWaterlooONCanadaN2L 3G1
| | - Jeffrey Alan Templeton
- University of WaterlooDepartment of Kinesiology200 University Ave WWaterlooONCanadaN2L 3G1
| | - Lehana Thabane
- McMaster UniversityDepartment of Clinical Epidemiology and Biostatistics50 Charlton Ave ERoom H325, St. Joseph's HealthcareHamiltonONCanadaL8N 4A6
| | - Alexandra Papaioannou
- McMaster UniversityDepartment of MedicineHamilton Health SciencesP.O. Box 2000, Chedoke Wilcox, 2nd FloorHamiltonONCanadaL8N 3Z5
| | - Lora M Giangregorio
- University of WaterlooDepartment of Kinesiology200 University Ave WWaterlooONCanadaN2L 3G1
- Schlegel‐UW Research Institute for AgingWaterlooONCanada
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Ponzano M, Gollin M. Effects of hard versus clay courts on athletic performance under conditions of fatigue in competitive tennis. MED SPORT 2018. [DOI: 10.23736/s0025-7826.17.02997-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Ponzano M, Gollin M. Effects of hard courts and clay courts on sprinting performance after a wheelchair tennis match: an acute study. MED SPORT 2018. [DOI: 10.23736/s0025-7826.17.03088-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Affiliation(s)
- Matteo Ponzano
- Faculty of Applied Health Sciences, Department of Kinesiology, University of Waterloo, Waterloo, Canada
- Adapted Training and Performance Research Group, SUISM, University of Turin, Turin, Italy
| | - Massimiliano Gollin
- Adapted Training and Performance Research Group, SUISM, University of Turin, Turin, Italy
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
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Affiliation(s)
- Matteo Ponzano
- Adapted Training and Performance Research Group, SUISM, University of Turin, Torino, Italy
| | - Massimiliano Gollin
- Adapted Training and Performance Research Group, SUISM, University of Turin, Torino, Italy
- Department of di Clinical and Biological Sciences, University of Turin, Torino, Italy
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Abstract
The effect of dopaminergic-related and stimulatory drugs have been studied in chronic hebephrenic schizophrenics untreated with neuroleptic drugs. 6 patients received therapy of 2 g L-dopa + 200 mg carbodopa per day orally for 30 days, then placebo for 30 days. Following that 3 of the same patients received therapy of 2 g L-dopa + 200 mg carbodopa + 300 mg imipramine orally for 30 days, then placebo for 30 days. Following that the same 3 patients received 1 mg apomorphine s.c. for 15 days, then placebo for 15 days, then 1 mg apomorphine s.c. + 2 g L-dopa + 200 mg carbodopa per os daily for 15 days, then placebo for 15 days. The patients were examined psychologically by the Wittenborn Rating Scale, the Weigl Object-Sorting Test, and tests for verbal learning and verbal association, before and after each therapeutic trial. Levels of FSH, LH, testosterone and GH were assayed radioimmunologically before, in the middle of and after each course of therapy. 2 patients showed improvement in the affective-behavioural symptomatology during therapy, while the other 4, who had a more severe degree of mental deterioration and destruction, were unchanged. FSH and LH levels, very low under basal conditions, did not change under therapy. Testosterone was very low before therapy and increased in only 1 subject. Normal basal GH levels increased during therapy in some of the patients, but not constantly. The results obtained are discussed in relation to the catecholamine hypotheses of schizophrenia.
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Cazzullo CL, Fornari MG, Maffei C, Penati G, Ponzano M, Resele L, Scarone S. Sleep, psychophysiological functioning and learning processes in schizophrenia. Act Nerv Super (Praha) 1977; 19 Suppl 2:409-17. [PMID: 233188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Sleep research has underlined how sleep is a specific functional moment inserted in the more complex system of circadian psychobiological rhythms. Many experimental data have evidenced that in particular REM sleep is involved in information processing and cognitive processes. The authors examine correlations between daytime cognitive performances and sleep patterns in a group of 11 schizophrenic patients, and in a control group made of 11 non-schizophrenic (borderline, depressed, character disorders) patients. Results show that there exists a relationship between REM sleep and cognitive activities, beyond nosographic partitions. They on the other side suggest caution in using sleep as a means of discrimination between schizophrenic and non-schizophrenic patients.
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Penati G, Maffei C, Fornari MG, Ponzano M, Resele LF, Scarone S. Neurophysiological aspects and learning processes in schizophrenic patients. Act Nerv Super (Praha) 1977; 19 Suppl 2:418-25. [PMID: 551685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Two groups of schizophrenic patients (acute and chronic subjects) were observed in order to study possible differences in neuropsychological performances and their relationship with symptomatology. 16 acute and 16 chronic patients, aged 18 to 35 years were tested with a battery of neuropsychological tests (Word Association Test, Serial Verbal Learning, Weigl's test, Simple Reaction Times, Choice Continuous Reaction Time). Clinical profiles were evaluated by means of MMPI and WAIS (Wechsler Adult Intelligence Scale). Findings concerning cognitive processes show no significant differences between the two groups. Results suggest a correlation between clinical profiles and performances in acute patients, whereas in chronic subjects this correlation seems markedly reduced. Finally, chronicity (i.e. the length of illness) does not seem so be an important factor in determining consistent defects in neuropsychological performances.
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