bluuebunny/crossref_metadata_2025 huggingface dataset:
Prediction of height effect, plastic deformation and fracture energy for high-strength concrete by linear shear softening constitutive relation based on energy conservation method
Authors: Wang X. B.
Published: September 2008

Based on the energy conservation method, the slopes of post-peak stress–deformation curves undergoing class I behaviour and class II behaviour are presented for a high-strength concrete specimen subjected to shear failure in the form of shear band exhibiting linear strain softening beyond peak shear stress. The predicted height effect coincides well with the previous experiments. The transition occurs from class I behaviour to class II behaviour as specimen height increases. The slope of the relative stress–plastic deformation curve is derived. The horsetail-like profile of the measured curves for different heights cannot be explained if shear band inclination is only related to friction or/and dilation angles. The deduction that shear band inclination depends on specimen height is verified by previous experiments and numerical prediction using fast Lagrangian analysis of continua. If the dependence of strength and shear band inclination on geometrical size is neglected, then post-peak shear fracture energy is a material parameter. The linear regression on scattered experimental data shows that post-peak fracture energy is independent of specimen height, as is consistent with the present analysis regardless of the size effects of strength and shear band inclination. The size-dependent strength and shear band inclination as well as the sensitivity of shear band inclination and pattern to boundary condition and position of material imperfections are responsible for the scattered post-peak shear fracture energy.
Experimental study of the evolution of heat and moisture transfer parameters of a concrete slab
Authors: Khelidj A. , Bastian G. , Baroghel-Bouny V. , Villain G.
Published: September 2008

After casting, concrete slab upper surfaces are seldom protected. Therefore, depending on the distance to the surface, water distributes itself differently between hydration and drying. The effect of this is the appearance of gradients for the parameters characterising heat and moisture transfers within such porous media. In the present paper, after a possible modelling and a specific metrology of these transfers are evoked, the experiment conducted to reveal and examine the evolution of these gradients with time is discussed. Some divergences (already mentioned in the literature) appear as regards moisture diffusivity depending whether a static or a dynamic approach is chosen. Lastly, experimental results, in particular those concerning heat transfers, could contribute to the feeding of a data bank for the use of future modelling.
Toxicity of select organic acids to the slightly thermophilic acidophile Acidithiobacillus caldus
Authors: Aston John E. , Apel William A. , Lee Brady D. , Peyton Brent M.
Published: September 2008

Acidithiobacillus caldus is a thermophilic acidophile found in commercial biomining, acid mine drainage systems, and natural environments. Previous work has characterized A. caldus as a chemolithotrophic autotroph capable of utilizing reduced sulfur compounds under aerobic conditions. Organic acids are especially toxic to chemolithotrophs in low-pH environments, where they diffuse more readily into the cell and deprotonate within the cytoplasm. In the present study, the toxic effects of oxaloacetate, pyruvate, 2-ketoglutarate, acetate, malate, succinate, and fumarate on A. caldus strain BC13 were examined under batch conditions. All tested organic acids exhibited some inhibitory effect. Oxaloacetate was observed to inhibit growth completely at a concentration of 250 μM, whereas other organic acids were completely inhibitory at concentrations of between 1,000 and 5,000 μM. In these experiments, the measured concentrations of organic acids decreased with time, indicating uptake or assimilation by the cells. Phospholipid fatty acid analyses indicated an effect of organic acids on the cellular envelope. Notable differences included an increase in cyclic fatty acids in the presence of organic acids, indicating possible instability of the cellular envelope. This was supported by field emission scanning-electron micrographs showing blebbing and sluffing in cells grown in the presence of organic acids.
Modeling and Simulation of Noncatalytic Gas-Solid Reaction in a Moving Bed Reactor
Authors: Arabi Sasan , Hashemipour Rafsanjani Hassan
Published: September 2008

This work is a simulation of a countercurrent moving bed reactor in which a reduction of porous iron ore pellets to sponge iron is performed. Simultaneous mass and energy balances of the reactor will lead to a set of ordinary differential equations. The iron ore reduction kinetics was modeled with a three-stage shrinking core model. Solving the ODE system allows prediction of the concentration and temperature profiles of all species within the reactor.The model is validated with experimental data obtained during operation of the bench-scale and full-scale processes and allows optimization of the process. The model is used to explore the behavior of the reactor when residence time of pellets is changed in order to increase or decrease the solid conversion. Also, it is used to explore the performance of the reactor under different conditions.
Economic Realities Associated With Diabetes Care: Opportunities to Expand Delivery of Physical Therapist Services to a Vulnerable Population
Authors: Cohn Rhea
Published: September 2008

Each year, more Americans are newly diagnosed with type 2 diabetes mellitus. The costs for managing this disease are high, and the cascade of problems associated with poorly controlled diabetes is significant. At the same time, the number of uninsured or underinsured Americans is growing. This article describes current trends in health insurance availability and coverage for the growing number of people with diabetes and addresses the direct costs associated with treating this disease. The economic burden of health care for people with diabetes continues to escalate. Payers and employers are interested in decreasing their direct and indirect costs, improving profit margins, decreasing employee absenteeism, and increasing employee productivity. For physical therapists to recognize existing or new opportunities to participate in the management of this costly disease, it is critical that they understand how employees, payers, and employers are responding to the changing market forces affecting health insurance.
Diabetes-Related Microvascular and Macrovascular Diseases in the Physical Therapy Setting
Authors: Cade W Todd
Published: September 2008

Physical therapists commonly treat people with diabetes for a wide variety of diabetes-associated impairments, including those from diabetes-related vascular disease. Diabetes is associated with both microvascular and macrovascular diseases affecting several organs, including muscle, skin, heart, brain, and kidneys. A common etiology links the different types of diabetes-associated vascular disease. Common risk factors for vascular disease in people with diabetes, specifically type 2 diabetes, include hyperglycemia, insulin resistance, dyslipidemia, hypertension, tobacco use, and obesity. Mechanisms for vascular disease in diabetes include the pathologic effects of advanced glycation end product accumulation, impaired vasodilatory response attributable to nitric oxide inhibition, smooth muscle cell dysfunction, overproduction of endothelial growth factors, chronic inflammation, hemodynamic dysregulation, impaired fibrinolytic ability, and enhanced platelet aggregation. It is becoming increasingly important for physical therapists to be aware of diabetes-related vascular complications as more patients present with insulin resistance and diabetes. The opportunities for effective physical therapy interventions (such as exercise) are significant.
Plantar Stresses on the Neuropathic Foot During Barefoot Walking
Authors: Mueller Michael J , Zou Dequan , Bohnert Kathryn L , Tuttle Lori J , Sinacore David R
Published: September 2008

Background and Purpose

Patients with diabetes mellitus and peripheral neuropathy are at high risk for plantar skin breakdown due to unnoticed plantar stresses during walking. The purpose of this study was to determine differences in stress variables (peak plantar pressure, peak pressure gradient, peak maximal subsurface shear stress, and depth of peak maximal subsurface shear stress) between the forefoot (where most ulcers occur) and the rear foot in subjects with and without diabetes mellitus, peripheral neuropathy, and a plantar ulcer measured during barefoot walking.

Subjects

Twenty-four subjects participated: 12 with diabetes mellitus, peripheral neuropathy, and a plantar ulcer (DM+PN group) and 12 with no history of diabetes mellitus or peripheral neuropathy (control group). The subjects (11 men, 13 women) had a mean age (±SD) of 54±8 years.

Methods

Plantar pressures were measured during barefoot walking using a pressure platform. Stress variables were estimated at the forefoot and the rear foot for all subjects.

Results

All stress variables were higher (127%–871%) in the forefoot than in the rear foot, and the peak pressure gradient showed the greatest difference (538%–871%). All stress variables were higher in the forefoot in the DM+PN group compared with the control group (34%–85%), and the peak pressure gradient showed the greatest difference (85%). The depth (X̅±SD) of peak maximum subsurface shear stress in the forefoot in the DM+PN group was half that in the control group (3.8±2.0 versus 8.0±4.3 mm, respectively).

Discussion and Conclusions

These results indicate that stresses are relatively higher and located closer to the skin surface in locations where skin breakdown is most likely to occur. These stress variables may have additional value in predicting skin injury over the traditionally measured peak plantar pressure, but prospective studies using these variables to predict ulcer risk are needed to test this hypothesis.
Diabetes Mellitus and Gait Dysfunction: Possible Explanatory Factors
Authors: Brach Jennifer S , Talkowski Jaime B , Strotmeyer Elsa S , Newman Anne B
Published: September 2008

Background and Objective

Gait characteristics differ in individuals with diabetes compared with those without diabetes. Limited information regarding potential explanatory factors for this association exists. This study examined the association between diabetes and gait characteristics in older adults and explored potential explanatory factors.

Design

A cross-sectional, observational study design was used.

Methods

At the 1998–1999 clinic visit, 558 ambulatory older adults (mean age=79 years) from the Pittsburgh site of the Cardiovascular Health Study had an assessment of their gait characteristics, diabetes, health status, cognition, mood, lower-extremity circulation and sensation, vision, lower-extremity strength (force-producing capacity), physical activity, and body mass index (BMI). A series of linear regression models were developed to examine the association between diabetes and gait characteristics and to examine potential explanatory factors for the associations.

Results

Diabetes was related to gait speed (β=−.06 m/s); however, the association was partially explained by health status variables, cognition, mood, lower-extremity circulation and sensation, visual impairment, lower-extremity strength, physical activity, and BMI. Health status and lower-extremity strength each explained the greatest proportion of the association (β reduced 66% by each). Diabetes was related to step width (β=.02 m), and the association could not be explained by the examined factors.

Conclusions

Diabetes was associated with gait alterations in older adults. Slowed gait speed appears to be secondary to the peripheral effect of the disease on other body systems. The effect of diabetes on step width was not explained in the analyses and may be related to peripheral motor nerve function or central influences of the disease, which could not be assessed in this study.
Epidemiology of Diabetes and Diabetes-Related Complications
Authors: Deshpande Anjali D , Harris-Hayes Marcie , Schootman Mario
Published: September 2008

In 2005, it was estimated that more than 20 million people in the United States had diabetes. Approximately 30% of these people had undiagnosed cases. Increased risk for diabetes is primarily associated with age, ethnicity, family history of diabetes, smoking, obesity, and physical inactivity. Diabetes-related complications—including cardiovascular disease, kidney disease, neuropathy, blindness, and lower-extremity amputation—are a significant cause of increased morbidity and mortality among people with diabetes, and result in a heavy economic burden on the US health care system. With advances in treatment for diabetes and its associated complications, people with diabetes are living longer with their condition. This longer life span will contribute to further increases in the morbidity associated with diabetes, primarily in elderly people and in minority racial or ethnic groups. In 2050, the number of people in the United States with diagnosed diabetes is estimated to grow to 48.3 million. Results from randomized controlled trials provide evidence that intensive lifestyle interventions can prevent or delay the onset of diabetes in high-risk individuals. In addition, adequate and sustained control of blood sugar levels, blood pressure, and blood lipid levels can prevent or delay the onset of diabetes-related complications in people with diabetes. Effective interventions, at both the individual and population levels, are desperately needed to slow the diabetes epidemic and reduce diabetes-related complications in the United States. This report describes the current diabetes epidemic and the health and economic impact of diabetes complications on individuals and on the health care system. The report also provides suggestions by which the epidemic can be curbed.
Inflammatory Osteolysis in Diabetic Neuropathic (Charcot) Arthropathies of the Foot
Authors: Sinacore David R , Hastings Mary K , Bohnert Kathryn L , Fielder Faye A , Villareal Dennis T , Blair Vilray P , Johnson Jeffrey E
Published: September 2008

Objective

Osteolysis and low bone mineral density (BMD) are underappreciated consequences of several chronic diseases that may elevate the risk for fracture. The purpose of this study was to assess tarsal BMD associated with acute inflammation (ie, inflammatory osteolysis) in individuals with chronic diabetes mellitus (DM), peripheral neuropathy (PN), and recent-onset neuropathic (Charcot) arthropathy (NCA) of the foot.

Research Design and Methods

This was a case-control study of 32 people (11 men, 21 women) with DM, PN, and NCA of the foot or ankle. The subjects with DM, PN, and NCA were compared with 64 age-, sex-, and race-matched control subjects (24 men, 40 women) without DM, PN or NCA. Within the first 3 weeks of cast immobilization, BMD was estimated in both calcanei using quantitative ultrasonometry. Acute inflammation was confirmed by comparing skin temperature differences between the feet of the subjects with DM, PN, and NCA and the feet of the control subjects.

Results

Skin temperature differences averaged 6.7°F (SD=4.0°F) (involved foot minus noninvolved foot) in the feet of the subjects with DM, PN, and NCA compared with 0.0°F (SD=1.3°F) in the feet of the control subjects. Calcaneal BMD averaged 384 mg/cm2 (SD=110) in the involved feet and 467 mg/cm2 (SD=123) in the noninvolved feet of the subjects with DM, PN, and NCA and 545 mg/cm2 (SD=121) in combined right and left feet of the control subjects.

Conclusions

Inflammation in individuals with DM, PN, and NCA may contribute to or exacerbate a rapid loss of BMD. Inflammatory osteolysis may be a prominent factor responsible for both the spontaneous onset of neuropathic fracture and the insidious and progressive foot deformity that is the hallmark of the chronic Charcot foot.
Clinical Measures of Physical Fitness Predict Insulin Resistance in People at Risk for Diabetes
Authors: Chen Chiao-Nan , Chuang Lee-Ming , Wu Ying-Tai
Published: September 2008

Background and Purpose

Physical inactivity has been well documented as a risk factor for type 2 diabetes. Previous studies measured the level of physical activity either with questionnaires or with direct measurements of maximum oxygen uptake. However, questionnaires are patient-report measures, and methods for obtaining direct maximum oxygen uptake measurements often are not available clinically. The purpose of this study was to investigate whether clinical measurement of health-related physical fitness with a simple test battery can predict insulin resistance, a precursor of type 2 diabetes, in people at risk for diabetes.

Subjects and Methods

A total of 151 volunteers with at least one diabetes risk factor (overweight, hypertension, dyslipidemia, family history, impaired glucose tolerance, gestational diabetes, or delivering a baby weighing more than 4.0 kg) were recruited. Insulin resistance (as determined with the homeostasis model assessment of insulin resistance [HOMA-IR]), physical fitness (including body composition, as determined with the body mass index and waist circumference), muscle strength (handgrip strength [force-generating capacity]), muscle endurance (sit-up test), flexibility (sit-and-reach test), and cardiorespiratory endurance (step test) were measured, and a physical activity questionnaire was administered. Backward regression analysis was used to build the prediction models for insulin resistance from components of physical fitness and physical activity.

Results

Body mass index, muscle strength, and cardiorespiratory fitness predicted HOMA-IR in men (adjusted R2=.264). In women, age, waist circumference, and cardiorespiratory fitness were the predictors of HOMA-IR (adjusted R2=.438).

Discussion and Conclusion

Clinical measures of physical fitness can predict insulin resistance in people at risk for diabetes. The findings support the validity of clinical measures of physical fitness for predicting insulin resistance in people at risk for diabetes.
Comparison of Combined Aerobic and High-Force Eccentric Resistance Exercise With Aerobic Exercise Only for People With Type 2 Diabetes Mellitus
Authors: Marcus Robin L , Smith Sheldon , Morrell Glen , Addison Odessa , Dibble Leland E , Wahoff-Stice Donna , LaStayo Paul C
Published: September 2008

Background and Purpose

The purpose of this study was to compare the outcomes between a diabetes exercise training program using combined aerobic and high-force eccentric resistance exercise and a program of aerobic exercise only.

Subjects and Methods

Fifteen participants with type 2 diabetes mellitus (T2DM) participated in a 16-week supervised exercise training program: 7 (mean age=50.7 years, SD=6.9) in a combined aerobic and eccentric resistance exercise program (AE/RE group) and 8 (mean age=58.5 years, SD=6.2) in a program of aerobic exercise only (AE group). Outcome measures included thigh lean tissue and intramuscular fat (IMF), glycosylated hemoglobin, body mass index (BMI), and 6-minute walk distance.

Results

Both groups experienced decreases in mean glycosylated hemoglobin after training (AE/RE group: −0.59% [95% confidence interval (CI)=−1.5 to 0.28]; AE group: −0.31% [95% CI=−0.60 to −0.03]), with no significant between-group differences. There was an interaction between group and time with respect to change in thigh lean tissue cross-sectional area, with the AE/RE group gaining more lean tissue (AE/RE group: 15.1 cm2 [95% CI=7.6 to 22.5]; AE group: −5.6 cm2 [95% CI=−10.4 to 0.76]). Both groups experienced decreases in mean thigh IMF cross-sectional area (AE/RE group: −1.2 cm2 [95% CI=−2.6 to 0.26]; AE group: −2.2 cm2 [95% CI=−3.5 to −0.84]) and increases in 6-minute walk distance (AE/RE group: 45.5 m [95% CI=7.5 to 83.6]; AE group: 29.9 m [95% CI=−7.7 to 67.5]) after training, with no between-group differences. There was an interaction between group and time with respect to change in BMI, with the AE/RE group experiencing a greater decrease in BMI.

Discussion and Conclusion

Significant improvements in long-term glycemic control, thigh composition, and physical performance were demonstrated in both groups after participating in a 16-week exercise program. Subjects in the AE/RE group demonstrated additional improvements in thigh lean tissue and BMI. Improvements in thigh lean tissue may be important in this population as a means to increase resting metabolic rate, protein reserve, exercise tolerance, and functional mobility.
A Conceptual Model of Firm Knowledge Base Dynamics in the Context of Mobility of Researchers
Authors: Slavcheva Kremena , De Castro Julio O. , Fosfuri Andrea
Published: September 2008

We examine how knowledge‐intensive firms modify their organizational knowledge bases in the context of mobility of researchers. Building on a dynamic capabilities perspective, we propose a conceptual model of firm knowledge base dynamics that clearly distinguishes between two mechanisms: (1) changes in a firm’s pool of researchers and (2) a firm’s ability to reconfigure knowledge. Our model posits that these two mechanisms interact to affect the type of variation in a firm’s knowledge base and elucidates how firms deploy knowledge from different domains.
High-temperature type IIa gratings in 12-ring photonic crystal fibre with germanosilicate core
Authors: Cook K. , Pohl A.A.P. , Canning J.
Published: September 2008

The inscription of efficient Bragg gratings (> 20 dB) in 12-ring photonic crystal fibre with a germanosilicate doped core without the need for hydrogen loading using 193 nm is demonstrated. We show the characteristic rollover from type I grating to type IIa – the first observation of a type IIa grating in structured optical fibre. The type IIa grating is shown to survive up to 700°C before any degradation in transmission or reflection takes place.
The Effect of Family Literacy Interventions on Children’s Acquisition of Reading From Kindergarten to Grade 3: A Meta-Analytic Review
Authors: Sénéchal Monique , Young Laura
Published: September 2008

This review focuses on intervention studies that tested whether parent–child reading activities would enhance children’s reading acquisition. The combined results for the 16 intervention studies, representing 1,340 families, were clear: Parent involvement has a positive effect on children’s reading acquisition. Further analyses revealed that interventions in which parents tutored their children using specific literacy activities produced larger effects than those in which parents listened to their children read books. The three studies in which parents read to their children did not result in significant reading gains. When deciding which type of intervention to implement, educators will have to weigh a variety of factors such as the differences in effectiveness across the different types of intervention, the amount of resources needed to implement the interventions, and the reading level of the children.
Assessing Improvement in Patients Who Report Small Limitations in Functional Status on Condition-Specific Measures
Authors: Stratford Paul W. , Spadoni Gregory F.
Published: September 2008

Purpose: Our purpose was to describe the challenges associated with detecting improvement of patients who present with small but important limitations in functional status. There are three components to this article: (1) introduction of the challenges, (2) presentation of proposed solutions, and (3) case illustrations.

Summary of Key Points: Three factors contribute to the identified challenges: (1) little room is available on the scale to detect improvement, (2) regression towards the mean, and (3) the nonlinear properties of most self-report measures. Two strategies were identified to overcome these challenges: (1) to average the results of measurements performed on different occasions and (2) to apply a patient-specific measure. Examples of the successful application of these strategies are presented for two patients with low back pain.

Conclusions: Averaging measurements taken on different occasions and applying patient-specific measures represent effective strategies for detecting improvement in patients who present with small limitations in functional status.
Outcomes of Home-Based Rehabilitation Provided by Primary Therapists for Patients with Rheumatoid Arthritis: Pilot Study
Authors: Li Linda C. , Davis Aileen M. , Lineker Sydney , Coyte Peter C. , Bombardier Claire
Published: September 2008

Purpose: To evaluate the outcomes of patients with rheumatoid arthritis (RA) receiving treatment from a rheumatology-trained primary therapist and to assess the feasibility of the research protocol.

Method: The experimental (E) group received treatment from a primary therapist in addition to their overall medical care. The usual care (UC) group continued receiving usual medical care. The first 10 patients completed the Health Assessment Questionnaire, a pain visual analogue scale, and the Arthritis Community Research and Evaluation Unit RA Knowledge Questionnaire. Patients were classified as clinical responders if they showed 20% improvement in two-thirds of core measures between baseline and 6 months. Baseline assessment was performed immediately prior to randomization. All patients completed the EuroQol and a monthly health resource use questionnaire.

Results: A trend towards improvement was found in the E group (n = 11) in all clinical measures at discharge (approximately 6 weeks from baseline) and 6 months from baseline. In contrast, the UC group (n = 13) showed a slight deterioration in pain (at 6 weeks) and in disease-specific knowledge (at 6 months). Three of six patients in the E group and one of four patients in the UC group met the criteria of clinical responders.

Conclusions: The study suggests an improvement trend in patient outcomes after treatment from a primary therapist and that the study protocol is feasible for a full-scale clinical trial.
Prevalence of and Risk Factors Associated with Neck Problems in Undergraduate Physiotherapy Students
Authors: Bialocerkowski Andrea E. , Grimmer Karen A. , Nyland Leah J.
Published: September 2008

Purpose: To determine the point prevalence of and risk factors associated with neck problems in undergraduate physiotherapy students.

Method: In March 2001, all undergraduate students enrolled in the bachelor of physiotherapy program at the University of South Australia were invited to participate in this study. Students completed a reliable and valid questionnaire over four recall periods, eliciting information as to the prevalence of neck problems and possible risk factors (environmental factors and students' demographic characteristics).

Results: Two hundred fifty students (response rate = 72%) participated. The prevalence of neck problems was 61% over the lifetime, 55% over the previous year, 38% over the previous month, and 32% over the previous week. The point prevalence increased substantially between the first and second years and continued at this higher level during the fourth year. Second- and fourth-year students were approximately twice as likely to experience neck problems compared with first-year students. Being female and exposure to multiple occupational activities for long periods of time were significantly associated with neck problems. Study and stress were also contributing factors.

Conclusions: Students and lecturers should attend to the risk factors associated with developing neck problems in undergraduate physiotherapy students. Addressing these risk factors could possibly lead to a reduction in neck problems later in practice.
Exercise Training for Individuals with Coronary Artery Disease or Heart Failure
Authors: Mandic Sandra , Riess Kenneth , Haykowsky Mark J.
Published: September 2008

Purpose: Cardiovascular disease is the leading cause of mortality in Canada, resulting in impaired aerobic capacity (VO2peak) that leads to a reduced ability to perform activities of daily living. We examine the mechanisms responsible for the decline in VO2peak found in individuals with coronary artery disease (CAD) or heart failure (HF). In addition, the role that exercise rehabilitation plays in attenuating the decline in VO2peak and strength is reviewed. Finally, we provide an exercise program that can be used by physiotherapists to improve the overall physical fitness of patients with CAD or HF.

Summary of Key Points: Aerobic training and resistance training, as part of a comprehensive cardiac rehabilitation program, have been shown to improve VO2peak, muscle strength, and quality of life while reducing mortality in individuals with CAD or HF. Physiotherapists should incorporate these effective interventions in the rehabilitation of individuals with CAD or HF.

Recommendations: Individuals with CAD or HF should be encouraged to perform regular moderate-intensity aerobic and resistance training to improve their physical fitness and quality of life.
Investigating Care Provided by Physical Therapists Treating People with Rheumatoid Arthritis: Pilot Study
Authors: Lineker Sydney C. , Hurley Laurie , Wilkins Annette
Published: September 2008

Purpose: To describe the management of rheumatoid arthritis by physical therapists (PTs) in Ontario and to explore factors that influence the delivery of client-centred care.

Methods: PTs working in rheumatology asked consecutive, nonsurgical patients to complete standardized assessments at baseline and discharge. PT interventions were compared with those recommended by published clinical practice guidelines. After discharge, patients were mailed the WASCANA Client-Centred Care Survey (WCCS).

Results: Twenty-six PTs recruited 53 patients. The mean number of hours of treatment was 7.6 over a mean time frame of 68 days. The most frequent interventions were exercise (100%), education, and physical modalities (both 94.6%). There were important clinical improvements in several outcome measures (effect sizes > 0.3). The Numerical Pain Rating Scale and the Arthritis Impact Measurement Scales-2 (AIMS2) pain score improved the most, with effect sizes of > 0.6. Forty-five patients (80%) returned WCCS questionnaires. Mean scores were good (< 2) for five of the six WCCS domain scores and borderline (2.1) for one domain, community integration.

Conclusions: Patients reported improved outcomes, especially less pain, suggesting that a pain measure would be useful in evaluating PT interventions for persons with rheumatoid arthritis. In general, PTs provided evidence-based and client-centred care; however, there may be potential to improve care by helping patients more fully integrate into the community.
Aerobic Exercise for Individuals with Chronic Obstructive Pulmonary Disease
Authors: Gupta Renu , Brooks Dina
Published: September 2008

Purpose: Pulmonary rehabilitation has been found to consistently improve exercise capacity, quality of life, and symptoms in individuals with chronic obstructive pulmonary disease (COPD). Different types of exercise can be integrated into a pulmonary rehabilitation program. For the purposes of this article, we focus specifically on aerobic exercise, providing recommendations for optimal aerobic exercise prescription in individuals with COPD.

Summary of Key Points: Individuals with all degrees of severity of COPD can benefit from participation in an exercise-training program in inpatient, outpatient, or home-based settings. Aerobic exercise training using the large muscle groups of the lower extremities, via ground-based walking, a treadmill, a cycle ergometer, or a combination of all three modalities, is preferred. High-intensity training yields significant physiological improvements in aerobic fitness. However, in individuals with COPD, training intensity should be guided by patient tolerance and safety. Interval training is an alternate option for patients who cannot sustain continuous periods of high-intensity exercise. Individuals with COPD should aim to exercise at least three to five times per week, completing 20 to 30 minutes per session.

Conclusions: The clinical recommendations provided serve as a guide to help optimize aerobic fitness in individuals with COPD. As with all exercise prescriptions, clinicians should consider the individual needs and goals of the patient when designing an aerobic exercise program.
Evidence-Based Physiotherapy for Acute Low Back Pain: A Composite Clinical Algorithm Synthesized from Seven Recent Clinical Guidelines
Authors: Holohan Vanessa , Deenadayalan Yamini , Grimmer Karen
Published: September 2008

Purpose: To produce a composite evidence-based treatment algorithm for physiotherapy management of acute low back pain (LBP) using current, high-quality, English-language clinical guidelines.

Methods: A systematic literature review of library databases and Internet search engines was performed to identify full-text, Englishlanguage clinical guidelines on the physiotherapy treatment of acute LBP. Quality assessment of the guidelines was undertaken by two independent reviewers using the AGREE instrument. Guideline recommendations were synthesized into interventions that were supported by strong, moderate or weak evidence. A composite clinical algorithm for physiotherapy management of acute LBP was developed.

Results: Seven guidelines were included. Keeping active, written patient education, manipulation and referral to a spine specialist had strong supporting evidence for the management of acute non-radiating LBP. There were a large number of treatment options with moderate or inconclusive evidence. Bed rest and massage, as stand-alone treatments, had strong evidence of harm for patients with acute non-radiating LBP.

Conclusions: Based on current evidence, a composite algorithm was constructed to assist physiotherapists when making treatment decisions for acute LBP. A synthesis of current clinical guideline recommendations provides physiotherapists with readily interpretable guidance for the management of acute LBP and encourages the uptake of best-evidence treatment options.
The Consequences of Delisting Publicly Funded, Community-Based Physical Therapy Services in Ontario: A Health Policy Analysis
Authors: Gordon Melanie , Waines Barbara , Englehart Jennifer , Montgomery Susan , Devitt Rachel , Holyoke Paul , Cott Cheryl A. , Landry Michel D.
Published: September 2008

Purpose: Because publicly-funded, community-based physical therapy (PT) services through Ontario's network of Schedule 5 providers were partially delisted in April 2005, we examined the perceived consequences of this policy decision among different provider categories following partial delisting. Schedule 5 providers or clinics, renamed “Designated Physiotherapy Clinics” following partial delisting, are privately-owned and operated facilities that have agreements with Ontario's Ministry of Health and Long-Term Care to deliver publicly funded services for eligible clients.

Methods: A health policy research approach used semi-structured telephone interviews with 33 physical therapists from Schedule 5 clinics, home care settings, hospitals, and private clinics within the Greater Toronto Area and across Ontario.

Results: Schedule 5 providers perceived an immediate decrease in demand, whereas PT providers from other categories reported no change at the time of interview. Conversely, all providers forecasted decreased access for ineligible clients but a potential for improved access and reduced wait times among those who remained eligible. In the final analysis, PT informants in all categories agreed that partial delisting was an improved policy decision compared with full delisting, as proposed initially.

Conclusions: Perceived consequences appeared to depend on provider type. However, informants from all provider categories cautioned that this policy decision would have a significant impact on the health status of some Ontarians. Further research is warranted to explore the long-term effects of this policy decision.
Use of Electrophysical Agents: Findings and Implications of a Survey of Practice in Metro Toronto
Authors: Nussbaum Ethne L. , Burke Sarah , Johnstone Leslie , Lahiffe Geraldine , Robitaille Eric , Yoshida Karen
Published: September 2008

Purposes: (1) To determine the availability, use and factors associated with the use of electrophysical agents (EPAs) in the management of patients with musculoskeletal impairments in physical therapy (PT) outpatient clinics in Metro Toronto and (2) to determine sources of EPA information used by physical therapists (PTs) and their perceived need for continuing EPA education.

Method: Information was collected by a questionnaire distributed to all eligible PTs in the defined area. Data included the characteristics of PTs and clinics, availability and use of EPAs by PTs, treatments received by patients, sources and influence of EPA information, use of support personnel and PTs' past education and future needs.

Results: The response rate was 54.1 per cent. The results were analyzed for 125 eligible PTs. On a typical day, treatment excluded EPAs for 29 per cent of patients. Treatment included one, two and three or more EPAs for 36, 26, and 9 per cent of patients, respectively. On average, PTs used EPAs for more than half of their patients: the most significant factors associated with EPA use were type of patient funding and number of patients treated per hour. Place of entry-level education and years since graduation were associated with the sources and perceived importance of EPA information that PTs used. More than half of the respondents indicated an interest in continuing EPA education.

Conclusions: EPAs are commonly included in PT management of persons with musculoskeletal impairments. Entry-level and continuing education should promote use of EPAs based on scientific evidence.
Examining the Pain Stages of Change Questionnaire in Chronic Pain
Authors: Williams Renee M. , Hapidou Eleni G. , Lin Chia-Yu A. , Abbasi Hira
Published: September 2008

Purpose: This study examined the relationships of a readiness to adopt a self-management approach to chronic pain, measured by the Pain Stages of Change Questionnaire (PSOCQ), with other pain-related scales in patients attending a chronic pain management program and determined if these measures changed from admission to discharge. The PSOCQ consists of four stages: Pre-contemplation, Contemplation, Action and Maintenance.

Method: A convenience sample of 140 patients (mean age = 43.8 years; SD = 8.3 years) with chronic pain completed the PSOCQ, the Pain Disability Index (PDI), the Pain Intensity Scale (PIS), the Center for Epidemiologic Studies-Depression Scale (CES-D) and the Multidimensional Health Locus of Control Scale (MHLC) at admission and discharge. The MHLC consists of three subscales: Internal, Chance and Powerful Others.

Results: At discharge, Pearson correlation coefficients demonstrated that Pre-contemplation was positively associated with the PDI, the PIS and the CES-D and negatively associated with Internal MHLC, whereas Action and Maintenance showed the opposite findings. There were significant improvements in all measures, except the MHLC, over the four-week program.

Conclusions: These findings provide support for the use of the PSOCQ in assessing patients' readiness to adopt a self-management approach to pain and in monitoring their progress in rehabilitation.
Efficacy of Mobilization with Movement for Patients with Limited Dorsiflexion after Ankle Sprain: A Crossover Trial
Authors: Reid Andrea , Birmingham Trevor B. , Alcock Greg
Published: September 2008

Purpose: Although a primary goal of many manual therapy techniques is to improve joint range of motion (ROM), efficacy studies evaluating the effect of treatment on ROM are limited. The purpose of this study was to evaluate the effect of a talocrural joint mobilization-with-movement (MWM) technique on dorsiflexion ROM in participants demonstrating decreased range following lateral ankle sprain.

Method: Twenty-three participants who had sustained unilateral ankle sprains within the past two years and exhibited a restriction in weight-bearing dorsiflexion participated in the study. We used a crossover design with random assignment to either a sham mobilization or an MWM technique. One week later, participants returned and received the alternate technique. Dorsiflexion was assessed using a weight-bearing lunge test.

Results: The change in dorsiflexion following the MWM technique (0.63 6 0.89 cm) was significantly greater (p 5 0.02) than the change following the sham technique (0.18 6 0.35 cm).

Conclusions: These findings suggest that a talocurual MWM improves ankle dorsiflexion immediately following treatment. Future research evaluating the effectiveness of multiple treatments on functional outcomes is warranted.
Barriers to Rehabilitation in Primary Health Care in Ontario: Funding and Wait Times for Physical Therapy Services
Authors: Cott Cheryl A. , Devitt Rachel M.A. , Falter Laura-Beth , Soever Leslie J. , Passalent Laura A.
Published: September 2008

Purpose: The purpose of this study was to examine barriers to accessing physical therapy (PT) services in Ontario primary health care with respect to funding sources and wait times.

Methods: A stratified random sample of 1100 registered Ontario PTs and 3000 Ontario family physicians were surveyed by mail in 2004. Relationships were examined between PT wait times, funding source, geographical region and caseload composition.

Results: Physicians identified the cost of private rehabilitation and long wait times as the most common barriers to referring patients to rehabilitation. Wait times for PT were longer in publicly funded settings than in privately funded practice settings (p, 0.001) and in the North (p, 0.001) and East (p 5 0.010) regions of Ontario compared with the most urban region of Ontario. Patients with chronic musculoskeletal conditions, cardiopulmonary conditions and general debility were at least three times more likely to receive PT services at publicly funded than privately funded practice settings. Furthermore, patients with acute musculoskeletal conditions were less likely to receive PT services in publicly funded practice settings (odds ratio 5 0.11, 95% confidence interval 5 0.05-0.23).

Conclusions: Current Ontario health-care structures may affect access to PT services for vulnerable populations such as those with chronic conditions, those lacking private health insurance and those living in less urban regions of Ontario.
Communicating with Your Clients: Are You as “Culturally Sensitive” as You Think?
Authors: Capell Jen
Published: September 2008

Purpose: As immigration and globalization diversify our populations, physiotherapists and other health care professionals are increasingly exposed to cultural diversity in their client or patient caseloads. Despite a strong desire to effectively care for these clients, most physiotherapists have little instruction regarding theoretical and practical factors that influence intercultural communication. This article provides a clinically relevant introduction to the theoretical background and pertinent factors critical to successful communication with culturally dissimilar clients.

Summary of Key Points: Hofstede and Hall, seminal researchers on cultural interactions and intercultural communication, provided cultural models that enable clinicians to make insightful observations regarding cultural behaviour without having an in-depth understanding of specific cultures. In addition to introducing these cultural theories, this article describes salient factors that influence the quality of intercultural communication. These factors include communication filters and predictors and transmission of health information to clients, either face to face, through an interpreter, or through media such as the Internet. Finally, the influence of clientcentred care on interactions with clients from certain minority groups is discussed.

Conclusions: Practical knowledge and understanding of cultural variations that produce communication differences are essential for effective communication with clients. This increased awareness may improve health care outcomes for minority populations.
The Canadian Thoracic Society Recommendations for Management of Chronic Obstructive Pulmonary Disease: Implications for Physiotherapists
Authors: Reid W. Darlene , Kelm Cheryle , Hopkins-Rosseel Diana , Brooks Dina
Published: September 2008

Purpose: The purposes of this article are (1) to list key messages from the 2003 chronic obstructive pulmonary disease (COPD) guidelines of the Canadian Thoracic Society (CTS) and associated implications and responsibilities for physiotherapists and (2) to compare these guidelines with other published reports or statements describing pulmonary rehabilitation.

Summary of Key Points: The main responsibilities that physiotherapists should assume to optimize prevention of COPD and management of persons with COPD are to (1) recommend and support smoking cessation for all patients who are smokers; (2) prescribe exercise programmes for patients with COPD; (3) ensure that people with COPD resume activity after an acute exacerbation; (4) refer patients to physicians for appropriate evaluation and care if not yet diagnosed with COPD or if the management of the patient's symptoms is not optimal or consistent with the COPD guidelines developed by the CTS; (5) facilitate adherence to pharmacotherapy; (6) participate actively in ongoing evaluation and education about all aspects of care for patients with COPD and their caregivers; and (7) support patients with COPD and their caregivers with end-of-life issues.

Conclusions: Physiotherapists, as direct access practitioners or members of a multidisciplinary team, should play a major role in the health care of persons with COPD, a serious health condition that affects 4% of adult Canadians.
Weighing the Evidence: Clinical Decision Making in Neurological Physical Therapy
Authors: McGlynn Mandy , Cott Cheryl A.
Published: September 2008

Purpose: The purpose of this study was to explore (1) the processes that neurological physical therapists go through in making dayto-day clinical decisions and (2) the sources of information or evidence that therapists use in their day-to-day practice.

Method: A qualitative, grounded theory method was used consisting of semistructured, face-to-face in-depth interviews with 12 neurological physical therapists practising in a variety of settings in the Greater Toronto Area. Data were analyzed using a constant comparative approach.

Results: Therapists weigh a variety of informal and formal sources of evidence as they go about their day-to-day practice. Our results fall into three main categories: (1) sources of evidence weighed, (2) when and why therapists weigh the evidence, and (3) factors that influence the process of weighing the evidence.

Conclusions: The results of this study indicate that implementing evidence-based practice will be a challenge to the physical therapy profession unless we broaden our definition of evidence to include informal sources of evidence that are highly valued by clinicians.