Faculté de médecine – Travaux et publications
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Item Accès libre Advancing stroke rehabilitation : the role of wearable technology according to research expertsCain, Amelia; Gunby, Tanisha; Winstein, Carolee; Demers, Marika; Université de Montréal. Faculté de médecine. École de réadaptation (Taylor and Francis, 2025-01-28)Background: Advancements in wearable technology have created new opportunities to monitor stroke survivors' behaviors in daily activities. Research insights are needed to guide its adoption in clinical practice, address current gaps, and shape the future of stroke rehabilitation. This project aims to: (1) Understand stroke rehabilitation researchers' perspectives on the opportunities, challenges, and clinical relevance of wearable technology for stroke rehabilitation, and (2) Identify necessary next steps to integrate wearable technology in research and clinical practice. Methods: Using a phenomenological qualitative design, two 90-minute focus groups were conducted with 12 rehabilitation researchers. The focus groups consisted of semi-structured, open-ended questions on functional movement behavior, motor performance and benefits and pitfalls of wearable technology. The transcribed focus groups were analyzed using inductive thematic analysis. Results: Three main themes were derived from the analysis: (1) Assessing activity performance is critical to inform interventions, (2) The demonstrated benefit is not commensurate with the added hassle, (3) Collaboration is needed between the industry, academia and end-users. Necessary future steps were recognized including the identification of intuitive and actionable metrics, and the integration of sensor-derived data with electronic health records and into clinical workflow to support self-management strategies. Conclusion: Wearable technology shows great potential to complement and support stroke rehabilitation. Many key barriers to clinical adoption remain which underscore the necessity to foster collaborations between industry, academia, and the participants we serve.Item Accès libre Interventions to promote bimanual activities and participation in daily life activities in children with cerebral palsy : a scoping reviewDavid, Anne Claire; Fournier-Poisson, Laura; Robert, Maxime T.; Demers, Marika; Université de Montréal. Faculté de médecine. École de réadaptation (Taylor and Francis, 2025-05-08)Aims: To identify rehabilitation interventions and outcome measures that target bimanual activities and autonomy in activities of daily living (ADLs) in children with cerebral palsy. Methods: This scoping review followed the Arksey and O'Malley framework. The literature search was conducted in five medical databases. Inclusion criteria were studies of children with cerebral palsy that delivered rehabilitation interventions targeting upper limb function and used valid outcome measures assessing bimanual activities or ADLs. The exclusion criteria were pharmacological or surgical interventions, reviews, expert opinions, protocols and qualitative studies. Two independent researchers screened titles/abstracts and full texts. Data related to the study participants, interventions, outcome measures and results were extracted. Results: Eighty-nine publications were included in this review. Out of the 17 interventions identified, the most frequent were constraint-induced movement therapy (n = 29), virtual reality (n = 22), hand-arm bimanual intensive training (n = 12), bimanual intensive training (n = 11) and action observation (n = 6). All five interventions showed significant improvements on bimanual function, whereas all but action observation showed improvements in autonomy in ADLs. We identified 15 outcome measures capturing bimanual activities and 6 capturing autonomy in ADLs. Conclusion: This scoping review provides essential information for the improvement of rehabilitation interventions for children with cerebral palsy.Item Accès libre Predicting mortality among critically ill patients with acute kidney injury treated with renal replacement therapy : development and validation of new prediction modelsLi, Daniel H.; Wald, Ron; Blum, Daniel; McArthur, Eric; James, Matthew T.; Burns, Karen E. A.; Friedrich, Jan O.; Adhikari, Neill K. J.; Nash, Danielle M.; Lebovic, Gerald; Harvey, Andrea K.; Dixon, Stephanie N.; Silver, Samuel A.; Bagshaw, Sean M.; Beaubien-Souligny, William; Université de Montréal. Faculté de médecine (Elsevier, 2019-12-18)Purpose Severe acute kidney injury (AKI) is associated with a significant risk of mortality and persistent renal replacement therapy (RRT) dependence. The objective of this study was to develop prediction models for mortality at 90-day and 1-year following RRT initiation in critically ill patients with AKI. Methods All patients who commenced RRT in the intensive care unit for AKI at a tertiary care hospital between 2007 and 2014 constituted the development cohort. We evaluated the external validity of our mortality models using data from the multicentre OPTIMAL-AKI study. Results The development cohort consisted of 594 patients, of whom 320(54%) died and 40 (15% of surviving patients) remained RRT-dependent at 90-day Eleven variables were included in the model to predict 90-day mortality (AUC:0.79, 95%CI:0.76–0.82). The performance of the 90-day mortality model declined upon validation in the OPTIMAL-AKI cohort (AUC:0.61, 95%CI:0.54–0.69) and showed modest calibration. Similar results were obtained for mortality model at 1-year. Conclusions Routinely collected variables at the time of RRT initiation have limited ability to predict mortality in critically ill patients with AKI who commence RRT.Item Accès libre Profiles of children’s social behaviors and peer victimization in early elementary school : sex differences and stability over timeChaput-Langlois, Sophie; Parent, Sophie; Castellanos-Ryan, Natalie; Tremblay, Richard Ernest; Seguin, Jean; Université de Montréal. Faculté de médecine. Département de psychiatrie et d'addictologie; Université de Montréal. Faculté des arts et des sciences. École de psychoéducation; Université de Montréal. Faculté des arts et des sciences. Département de psychologie (American Psychological Association, 2025)Research suggests that younger children engage in fewer peer victimization roles, compared to their older peers (e.g., aggressor, victim, defender). Still, the development of these roles throughout early elementary school remains unclear. Additionally, aggression and social behaviors evolve differently in boys and girls, yet sex differences in these roles are not well understood. This study examined children’s profiles of involvement in physical and relational aggression, prosocial behaviors, and peer victimization in kindergarten, first and second grade by using latent profile analyses and testing profile similarity across sex and school years. Then, it examined the stability of profile membership from kindergarten to second grade before testing how early socioeconomic status predicted profile membership. The sample included 1757 children of various sociodemographic backgrounds, mostly white, from a longitudinal birth study in Canada. Boys’ profiles aligned with a four-role typology that remained consistent from kindergarten to second grade: Prosocial, normative, moderately aggressive-victimized (AV), and highly AV profiles. In kindergarten, girls’ typology also included four profiles: Prosocial, normative, relationally aggressive, and AV. By first grade, a fifth profile emerged: Victimized girls. Profile membership for both boys and girls was generally very stable over time, and low socioeconomic status predicted higher odds of belonging to any AV profiles compared to prosocial ones. These findings underscore both developmental similarities and distinctions in boys’ and girls’ social behaviors and experiences in early elementary school and the precocity of stable membership in at-risk profiles. They highlight socioeconomic status as an early risk factor that could inform prevention research. This study suggests that there are distinct, relatively stable groups of boys and girls characterized by different configurations of social behaviors and peer victimization experiences, from kindergarten through second grade. Of particular concern is the stability across time of the classification into aggressive-victimized groups, suggesting a need to identify these children early for prevention purposes, before these social behaviors and experiences become crystallized. It also highlights sex differences, where only girls showed early emergence of a combination of prosocial and aggressive behaviors, and a pattern of victimization in the absence of aggressive behaviors.Item Accès libre Athletes’ lived experiences recovering from and returning to sport following a sport-related concussion : a meta-synthesis of qualitative studiesCadotte, Gabrielle; Duncan, Lindsay R.; Caron, Jeffrey; Université de Montréal. Faculté de médecine (Taylor and Francis, 2024-11-25)A small, but growing body of qualitative studies have explored athletes’ lived experiences with sport-related concussions (SRCs). For this meta-synthesis, we reviewed and synthesized qualitative, peer-reviewed studies on athletes’ lived experiences during recovery from and/or return to sport following SRC. Following PRISMA guidelines, we initially identified 5062 articles through PsycINFO, Embase, MedLine, SportDiscus, and Web of Science. After eliminating duplicates, screening titles, abstracts and full texts, 33 peer-reviewed articles matched our inclusion criteria. Subsequently, the authors appraised the quality of the included articles using the Critical Appraisal Skills Program. We followed guidelines for thematic synthesis, in which we initially developed 16 descriptive themes, each rooted in the original data extracted from the 33 articles. Subsequently, we developed four analytical themes that were informed by the descriptive themes and existing models and frameworks in the sport and exercise literature: (a) SRC characteristics: Identifying SRC features, (b) SRC consequences: Understanding the impact of the injury, (c) SRC outcomes: Discovering paths to recovery, and (d) Influential factors: Exploring the contextual factors affecting SRC consequences and outcomes. Our findings offer a comprehensive description of qualitative evidence on athletes’ lived experiences with SRC, including gaps in knowledge and insights for future research in the field.Item Accès libre Leaving the mark : FMOs as an emerging class of cytokinetic regulatorsLacroix, Léa; Goupil, Eugénie; Smith, Matthew James; Labbé, Jean-Claude; Université de Montréal. Faculté de médecine. Département de pathologie et biologie cellulaire (Taylor and Francis, 2025-04-08)Posttranslational modification of proteins plays a fundamental role in cell biology. It provides cells a means to regulate the signaling, enzymatic or structural properties of proteins without continuous cycles of synthesis and degradation, offering multiple distinct functions to individual proteins in a rapid and reversible manner. Modifications can include phosphorylation, ubiquitination or methylation, which are widespread and simple to detect using current approaches. More challenging to identify, one modification of growing significance is the direct oxidation of cysteine and methionine side chains. Protein oxidation has long been known to occur spontaneously upon the accumulation of cellular reactive oxygen species (ROS), but new data are providing insight into the targeted oxidation of proteins by flavin-containing monooxygenases (FMOs). Here, we review how oxidation of cellular proteins can modulate their activity and consider potential roles for FMOs in the targeted modification of proteins shaping cell division, with a particular focus on two families of FMOs: MICAL and OSGIN.Item Accès libre Impact of expressive intentions on upper-body kinematics in two expert pianistsTurner, Craig; Mailly, Robin; Dal Maso, Fabien; Verdugo, Felipe; Université de Montréal. Faculté de médecine. École de kinésiologie et des sciences de l'activité physique (Frontiers Media, 2025-01-13)Introduction: Expression is a key aspect of music performance. Studies on pianists’ gestures and expression have mainly documented the impact of their expressive intentions on proximal segments and head linear kinematics. It remains unclear how pianists’ expressive intentions influence joint angular kinematics as well as exposure to risk factors of injury, such as poor overall posture and distal jerky movements, two kinematic factors linked to injury. The first objective of this exploratory case study was to analyze the influence of pianists’ expressive intentions on proximal and distal joint range of motion (ROM) across different musical contexts. The second objective was to evaluate the impact of expressive intentions on the posture of joints that are commonly injured in pianists, as well as distal joint angular jerk. Methods: Two expert pianists (P1 and P2) performed six musical excerpts (E1–E6) in two experimental conditions: normal condition (including expressive intentions) and the control condition (strictly playing the composer’s notations written in the score with no subjective interpretation). An inertial measurement unit system recorded upper body kinematics. Methods: Two expert pianists (P1 and P2) performed six musical excerpts (E1–E6) in two experimental conditions: normal condition (including expressive intentions) and the control condition (strictly playing the composer’s notations written in the score with no subjective interpretation). An inertial measurement unit system recorded upper body kinematics. Results and discussion: Both proximal and distal joint ROM increased when pianists incorporated expressive intentions. Participants exhibited more static, non-neutral wrist postures when incorporating expressive intentions (right and left wrist for P1 and P2, respectively), suggesting an increased risk of distal injury. On the contrary, the thorax exhibited more dynamic, neutral flexion postures, suggesting a reduced risk of proximal injury. These results suggest that expressive intentions may impact proximal and distal postures differently. Incorporating expressive intentions also led to jerkier, less smooth wrist movements in lyrical, non-virtuosic musical excerpts (E1–E4). However, in more virtuosic excerpts (E5–E6), there were generally no differences between conditions. Spatiotemporal constraints might explain these discrepancies between non-virtuosic and virtuosic musical excerpts. These results provide evidence of the impact of expressive intentions on the entire kinematic chain, while highlighting the implications of the subjective dimension of music expression in relation to exposure to risk factors of injury.Item Accès libre Chromatin dynamics and DNA replication roadblocksHammond-Martel, Ian; Verreault, Alain; Wurtele, Hugo; Université de Montréal. Faculté de médecine (Elsevier, 2021)A broad spectrum of spontaneous and genotoxin-induced DNA lesions impede replication fork progression. The DNA damage response that acts to promote completion of DNA replication is associated with dynamic changes in chromatin structure that include two distinct processes which operate genome-wide during S-phase. The first, often referred to as histone recycling or parental histone segregation, is characterized by the transfer of parental histones located ahead of replication forks onto nascent DNA. The second, known as de novo chromatin assembly, consists of the deposition of new histone molecules onto nascent DNA. Because these two processes occur at all replication forks, their potential to influence a multitude of DNA repair and DNA damage tolerance mechanisms is considerable. The purpose of this review is to provide a description of parental histone segregation and de novo chromatin assembly, and to illustrate how these processes influence cellular responses to DNA replication roadblocks.Item Accès libre p75NTR modulation prevents cellular, cortical activity and cognitive dysfunctions caused by perinatal hypoxiaChattopadhyaya, Bidisha; Lee, Karen K. Y .; Carreño-Muñoz, Maria Isabel; Paris-Rubianes, Andrea; Lavertu-Jolin, Marisol; Berryer, Martin; Longo, Frank M.; Di Cristo, Graziella; Université de Montréal. Faculté de médecine. Département de neurosciences (Oxford University Press, 2025-03-04)Children who experienced moderate perinatal hypoxia are at risk of developing long-lasting subtle cognitive and behavioural deficits, including learning disabilities and emotional problems. Understanding the underlying mechanisms is an essential step for designing targeted therapy. Fast-spiking, parvalbumin-positive (PV) GABAergic interneurons modulate the generation of gamma oscillations, which in turn regulate many cognitive functions including goal-directed attentional processing and cognitive flexibility. Due to their fast-firing rate, PV cell function requires high levels of energy, which may render them highly vulnerable to conditions of metabolic and oxidative stress caused by perinatal hypoxia. Here, we show that adult mice that experienced moderate perinatal hypoxia (MPH) have decreased cortical PV expression levels in addition to specific impairments in social behaviour, recognition memory and cognitive flexibility. We further found that the expression level of the neurotrophin receptor p75NTR, which limits PV cell maturation during the first postnatal weeks, is increased in MPH mice. Genetic deletion of p75NTR in GABAergic neurons expressing the transcription factor Nkx2.1, which include PV cells, protects mice from PV expression loss and the long-term cognitive effects of MPH. Finally, treatment with a p75NTR inhibitor starting after MPH and lasting for a week, prevented PV expression loss and the occurrence of cognitive and cortical activity deficits in adult mice. Altogether our data reveals p75NTR-mediated signaling, as a potential molecular target, for the treatment of the cognitive alterations caused by MPH.Item Accès libre Participation at home of adults with multiple disabilities and influencing factors from their parents' perspectiveCutnam, Gabrielle; Iavorova Kroumova, Elisa; Rochette, Annie; Université de Montréal. Faculté de médecine. École de réadaptation (Taylor and Francis, 2025-02-03)To understand participation at home of adults with multiple disabilities and the indicatorsof their engagement from the parents’ perspective as well as to explore the influencing environmentalfactors.Methods: A qualitative, descriptive design was used. Participants had to be the parent of an adultpresenting multiple disabilities aged between 21 and 65 with no degenerative diagnosis. Semi-structuredinterviews were conducted using an interview guide, anchored in the Human Development Model –Disability Creation Process and developed through an iterative process. Data were analyzed using a6-step qualitative analysis process.Results: The majority (5/8) of participating parents were aged between 56 and 61 years and were theparents of an adult with multiple disabilities aged between 21 and 41. Two themes for participationwere generated: communication to build relationships, and they are disabled, but not so much whereasfour themes relating to environmental factors were generated: context as a determinant of meaningfulactivity, the effects of the caregiver’s attitude on social participation, the importance of the relationship oftrust, and facilitating participation through adaptations.Conclusion: Non-verbal communication and context of realization of activities of adults with multipledisabilities should be considered as they contribute to making participation meaningful.Item Accès libre Perceived training needs of municipal stakeholders in Quebec (Canada) relating to universal design action plansRochette, Annie; Vermeulen, Perrine; Boucher, Normand; Roussel, Nathalie; Simard, Nathalie; Grondin-Gravel, Gabrielle; Morissette, A.; Lamontagne, Michel; Fougeyrollas, Patrick; Université de Montréal. Faculté de médecine. École de réadaptation (Taylor and Francis, 2025-02-21)Quebec (Canada) municipalities with ≥15 000 inhabitants are legally required to produce an annual action plan to reduce barriers encountered by person with disabilities. Actual tools for universal design are diverse and not harmonised between cities, leading to important training needs. We thus aimed to identify priority training needs among municipalities of all sizes. We use a two-phase sequential descriptive design starting with an online survey (Phase 1) anchored into dimensions of inclusive access followed by focus group discussions (Phase 2). Descriptive statistics and a semi-inductive content analysis for qualitative data were used. A total of n = 114 municipalities responded to Phase 1 including nearly half (37/78) of municipalities with a population ≥15 000 inhabitants. The top five priority needs were 1) Needs assessment, 2) General knowledge, 3) Practical and organisational knowledge, 4) Design/planning phase and 5) Know-how, attitudes, mentalities, culture of the municipalities. Participants (n = 10) to Phase 2 insisted on their needs for practical knowledge, including authentic, contextualised examples coming from other cities. No major differences in needs to prioritise emerged when contrasting larger and smaller size’s municipalities. Results highlighted a variety of training needs, including the importance of prioritising practical contextualised knowledge anchored in authentic experience.Item Accès libre Attenuating hyperammonemia preserves protein synthesis and muscle mass via restoration of perturbed metabolic pathways in bile duct-ligated ratsBosoi, Cristina R.; Kumar, Avinash; Oliveira, Mariana M.; Welch, Nicole; Clément, Marc-André; Tremblay, Mélanie; Ten-Have, Gabriella A. M.; Engelen, Marielle P. K. J.; Bémeur, Chantal; Deutz, Nicolaas E. P.; Dasarathy, Srinivasan; Rose, Christopher; Université de Montréal. Faculté de médecine. Département de médecine (Springer, 2025-01-23)Sarcopenia and hepatic encephalopathy (HE) are complications of chronic liver disease (CLD), which negatively impact clinical outcomes. Hyperammonemia is considered to be the central component in the pathogenesis of HE, however ammonia's toxic effects have also been shown to impinge on extracerebral organs including the muscle. Our aim was to investigate the effect of attenuating hyperammonemia with ornithine phenylacetate (OP) on muscle mass loss and associated molecular mechanisms in rats with CLD. Six-week bile duct-ligated (BDL) rats and Sham-operated controls were treated with OP (1 g/kg, oral) for 5 weeks. Body composition, assessed by EchoMRI, and muscle protein fractional synthesis rate were evaluated. Signalling mechanisms regulating protein homeostasis, ATP content and metabolic intermediates in the tricarboxylic acid cycle (TCA) in skeletal muscle were quantified. OP treatment attenuated hyperammonemia, prevented brain edema and improved locomotor activity in BDL rats. Increased muscle ammonia, reduction in lean body mass, decreased muscle protein synthesis rate and ATP content were restored in OP-treated versus saline-treated BDL rats. TCA cycle intermediary metabolite, α-ketoglutarate, alterations of molecular markers regulating protein homeostasis including mTOR signalling and autophagy, were also preserved in muscle of OP-treated BDL rats. OP attenuated hyperammonemia, preserved muscle protein synthesis and prevented muscle mass loss in a preclinical model of CLD through restoration of perturbed signalling responses and altered TCA intermediary metabolites. Ammonia-lowering strategies have the potential for rapid clinical translation for simultaneous neuroprotection and sarcopenia prevention in patients with CLD.Item Accès libre How have neck muscle vibration effects on visuospatial behavior and spatial neglect been explored? A scoping reviewDuclos, Noémie C.; Sorita, Eric; Poncet, Frédérique; Duclos, Cyril; Jamal, Karim; Université de Montréal. Faculté de médecine. École de réadaptation (Taylor and Francis, 2024-11-28)Introduction: Neck muscle vibration (NMV) has been proposed as a bottom-up intervention toenhance visuospatial exploration in post-stroke patients with unilateral spatial neglect (USN). Whilesome studies report enlarged visual exploration during NMV application, others find no significantimpact, highlighting inconsistencies in the literature. The diversity in NMV application methodsand the variation in visuospatial outcome measures may contribute to these conflicting findings.This study aimed to overview the methodological approaches used to investigate NMV’s effects onvisuospatial behavior in USN patients, focusing on aspects beyond sample size and study design.Methods: Among the seven databases, studies that applied NMV and assessed visual or perceptualoutcomes were included in the analysis. Two independent reviewers screened titles and abstractsto select the studies to analyze. Data about the publication, population, modalities of application,and outcomes were extracted and synthesized.Results: Twenty-five publications from 1988 to 2023 were included, involving a total of 512participants, of whom 114 (22.3%) had USN. The presence of USN was assessed based on paper-and-pencil tests. The frequency of NMV was set between 80 and 125 hz. In 22 studies, NMV wereapplied on the left side of the neck muscles. Six studies proposed multiple NMV sessions, lastingbetween 5 and 50 minutes/day, 3–5 times/week, for 2–4 weeks. One study included a follow-upperiod of up to 1.4 years. The tasks during NMV often involved indicating the subjective straightahead (SSA, n = 8), pointing out targets, or no specific activity (n = 7, each). The SSA and cancella-tion tests were the most frequent outcomes.Conclusions: NMV application modalities varied widely across studies, with only vibration fre-quency showing consistency. The tasks performed during NMV and the outcome measures werediverse and generally unrelated to activities of daily living. Therefore, NMV effects during moreecologically valid tasks should be explored.Item Accès libre Effect of a whole-group intervention on children’s participation in interactive book readingMcMahon-Morin, Paméla; Nasri, Bouchra; Verduyckt, Ingrid; Rezzonico, Stefano; Gingras, Marie-Pier; Université de Montréal. Faculté de médecine. École d'orthophonie et d'audiologie (Taylor and Francis, 2024-09-12)This study examined the effects of an SLP-delivered whole-class interactive book reading intervention and a professional development program on children’s self-initiated participation. Eleven kindergarten teachers and the children in their classes participated in this quasi-experimental study. They were filmed during book reading at pre- and post-intervention, and follow-up. Children’s types of spontaneous comments appeared to be more diverse after the intervention, and the types that increased or emerged were consistent with the language targets of the interactive book reading. Nonparametric statistical tests were conducted. Significant changes were found in the number of hands raised by children to make a spontaneous comment and in the number of spontaneous comments after the intervention and at follow-up. Results for child-initiated interaction sequences were mitigated. This study invites school-based SLPs to foster children’s self-initiated participation in their tier-1 intervention and to support teachers in using children’s spontaneous comments to further scaffold children’s learning.Item Accès libre Improving pelvic floor muscle training with AI : a novel quality assessment system for pelvic floor dysfunctionEl-Sayegh, Batoul; Dumoulin, Chantal; Leduc-Primeau, François; Sawan, Mohamad; Université de Montréal. Faculté de médecine. École de réadaptation (MDPI, 2024-10-29)The first line of treatment for urinary incontinence is pelvic floor muscle (PFM) training, aimed at reducing leakage episodes by strengthening these muscles. However, many women struggle with performing correct PFM contractions or have misconceptions about their contractions. To address this issue, we present a novel PFM contraction quality assessment system. This system combines a PFM contraction detector with a maximal PFM contraction performance classifier. The contraction detector first identifies whether or not a PFM contraction was performed. Then, the contraction classifier autonomously quantifies the quality of maximal PFM contractions across different features, which are also combined into an overall rating. Both algorithms are based on artificial intelligence (AI) methods. The detector relies on a convolutional neural network, while the contraction classifier uses a custom feature extractor followed by a random forest classifier to predict the strength rating based on the modified Oxford scale. The AI algorithms were trained and tested using datasets measured by vaginal dynamometry, combined in some cases with digital assessment results from expert physiotherapists. The contraction detector was trained on one dataset and then tested on two datasets measured with different dynamometers, achieving 97% accuracy on the first dataset and 100% accuracy on the second. For the contraction performance classifier, the results demonstrate that important clinical features can be extracted automatically with an acceptable error. Furthermore, the contraction classifier is able to predict the strength rating within a ±1 scale point with 97% accuracy. These results demonstrate the system’s potential to enhance PFM training and rehabilitation by enabling women to monitor and improve their PFM contractions autonomously.Item Accès libre Management of physical impairments, activity limitations and participation restrictions in survivors of childhood acute lymphoblastic leukemia: perspectives from physiotherapistsBrochu, Annie; Hébert, Luc J.; Fiscaletti, Melissa; Kairy, Dahlia; Université de Montréal. Faculté de médecine. École de réadaptation (Lippincott, 2024-10-04)Background: Survivors of childhood acute lymphoblastic leukemia (cALL) present a high risk of long-term neuromusculoskeletal (NMSK) sequelae. Clinical guidelines for specific management of these complications are still lacking. The aim of this study is to (1) describe current physiotherapy practice with cALL survivors at one of Canada’s specialized pediatric oncology centers, (2) explore perceived optimal management of long-term NMSK sequelae by physiotherapists, and (3) identify the barriers and facilitators for its in-clinic implementation. Methods: This qualitative descriptive study with a focus group using a semi-structured interview guide was conducted with physiotherapists (n = 6) from one of Canada’s specialized pediatric oncology centers. We performed a hybrid analysis including both a deductive and an inductive approach using the International Classification of Functioning, Disability, and Health and Consolidated Framework for Implementation Research. Results: Even though the participants were experts in managing NMSK sequelae in survivors of cALL, standardized management of these patients is lacking. Physiotherapists described their perceived optimal management of NMSK sequelae as systematic and interdisciplinary. Barriers (eg, relative priority and availability of resources) and facilitators (eg, relative benefit and commitment) for implementing this perceived optimal management were identified. Conclusion: Physiotherapy management could improve care and services offered to survivors of cALL. The identification of barriers and facilitators to best practice offers relevant potential solutions to explore in order to improve and optimize management of this patient group.Item Accès libre Physical impairments, activity limitations, and participation restrictions of childhood acute lymphoblastic leukemia survivors with and without hip osteonecrosis : a PETALE cohort studyBrochu, Annie; Kairy, Dahlia; Alos, Nathalie; Laverdière, Caroline; Sinnett, Daniel; Sultan, Serge; Curnier, Daniel; Miron, Marie-Claude; Ramy, El-Jalbout; Fiscalett, Melissa; Hébert, Luc J.; Université de Montréal. Faculté de médecine. École de réadaptation (Springer, 2024-04-02)Purpose Long-term musculoskeletal complications represent a growing burden for survivors of childhood acute lymphoblastic leukemia (cALL). This study aimed to describe physical impairments, activity limitations, and participation restrictions in a high-risk subgroup of cALL survivors of the PETALE cohort. Methods This cross-sectional study, using observational data from the PETALE cohort, included a subgroup of survivors who presented high-risk criteria for late effects. Outcomes measures consisted of hip magnetic resonance imaging, maximal isometric muscle strength (MIMS) or torque (MIMT), range of motion (ROM), Near Tandem Balance (NTB), 6-Minute Walk Test (6MWT), Five Time Sit-to-Stand Test (FTSST), and health-related quality of life. Descriptive statistics and regression analyses were performed. Results Survivors (n = 97, 24.2 ± 6.7 years old) showed limited grip strength, FTSST, and NTB performance compared to reference values (p < 0.001). Thirteen participants (14.6%, 18 hips) had hip osteonecrosis (ON) (53.8% male). Higher severity hip ON was found in female survivors (66.7% vs. 22.2%). Survivors with hip ON had reduced hip external rotation ROM compared to those without (p < 0.05). Relationships were found between MIMS and ROM outcomes (r = 0.32, p < 0.01) and with 6MWT (r = 0.39–0.41, p < 0.001). Our multiple linear regression model explained 27.6% of the variance of the 6MWT. Conclusions Survivors in our subgroup had clinically significant physical impairments and activity limitations, and those with hip ON showed worst hip impairment outcomes. Implications for Cancer Survivors These findings emphasize the importance of long-term follow-up including physical therapy assessment to help early identification and management of physical impairments and activity limitations in survivors of cALL.Item Accès libre Trajectories of opioid consumption as predictors of patient-reported outcomes among individuals attending multidisciplinary pain treatment clinicsAngarita-Fonseca, Adriana; Lacasse, Anaïs; Choinière, Manon; Kaboré, Jean-Luc; Sylvestre, Marie-Pierre; Tchouangue Dinkou, Gillis Delmas; Bruneau, Julie; Martel, Marc Olivier; Hovey, Richard; Motulsky, Aude; Rahme, Elham; Pagé, Gabrielle; Université de Montréal. Faculté de médecine. Département d'anesthésiologie et de médecine de la douleur (Wiley, 2023-10-06)Purpose This study aimed to identify opioid consumption trajectories among persons living with chronic pain (CP) and put them in relation to patient-reported outcomes 6 months after initiating multidisciplinary pain treatment. Methods This study used data from the Quebec Pain Registry (2008–2014) linked to longitudinal Quebec health insurance databases. We included adults diagnosed with CP and covered by the Quebec public prescription drug insurance plan. The daily cumulative opioid doses in the first 6 months after initiating multidisciplinary pain treatment were transformed into morphine milligram equivalents. An individual-centered approach involving principal factor and cluster analyses applied to longitudinal statistical indicators of opioid use was conducted to classify trajectories. Multivariate regression models were applied to evaluate the associations between trajectory group membership and outcomes at 6-month follow-up (pain intensity, pain interference, depression, and physical and mental health-related quality of life). Results We identified three trajectories of opioid consumption: “no or very low and stable” opioid consumption (n = 2067, 96.3%), “increasing” opioid consumption (n = 40, 1.9%), and “decreasing” opioid consumption (n = 39, 1.8%). Patients in the “no or very low and stable” trajectory were less likely to be current smokers, experience polypharmacy, use opioids or benzodiazepine preceding their first visit, or experience pain interference at treatment initiation. Patients in the “increasing” opioid consumption group had significantly greater depression scores at 6-month compared to patients in the “no or very low and stable” trajectory group. Conclusion Opioid consumption trajectories do not seem to be important determinants of most PROs 6 months after initiating multidisciplinary pain treatment.Item Accès libre A prospective cohort study of acute pain and in-hospital opioid consumption after cardiac surgery : associations with psychological and medical factors and chronic postsurgical painPagé, Gabrielle; Ganty, Praveen; Wong, Dorothy; Rao, Vivek; Khan, James; Ladha, Karim S.; Hanlon, John; Miles, Sarah; Katznelson, Rita; Wijeysundera, Duminda; Katz, Joel; Clarke, Hance; Université de Montréal. Faculté de médecine. Département d'anesthésiologie et de médecine de la douleur (Lippincott, Williams & Wilkins, 2024-01-31)BACKGROUND: Understanding the association of acute pain intensity and opioid consumption after cardiac surgery with chronic postsurgical pain (CPSP) can facilitate implementation of personalized prevention measures to improve outcomes. The objectives were to (1) examine acute pain intensity and daily mg morphine equivalent dose (MME/day) trajectories after cardiac surgery, (2) identify factors associated with pain intensity and opioid consumption trajectories, and (3) assess whether pain intensity and opioid consumption trajectories are risk factors for CPSP. METHODS: Prospective observational cohort study design conducted between August 2012 and June 2020 with 1-year follow-up. A total of 1115 adults undergoing cardiac surgery were recruited from the preoperative clinic. Of the 959 participants included in the analyses, 573 completed the 1-year follow-up. Main outcomes were pain intensity scores and MME/day consumption over the first 6 postoperative days (PODs) analyzed using latent growth mixture modeling (GMM). Secondary outcome was 12-month CPSP status. RESULTS: Participants were mostly male (76%), with a mean age of 61 ± 13 years. Three distinct linear acute postoperative pain intensity trajectories were identified: “initially moderate pain intensity remaining moderate” (n = 62), “initially mild pain intensity remaining mild” (n = 221), and “initially moderate pain intensity decreasing to mild” (n = 251). Age, sex, emotional distress in response to bodily sensations, and sensitivity to pain traumatization were significantly associated with pain intensity trajectories. Three distinct opioid consumption trajectories were identified on the log MME/day: “initially high level of MME/day gradually decreasing” (n = 89), “initially low level of MME/day remaining low” (n = 108), and “initially moderate level of MME/day decreasing to low” (n = 329). Age and emotional distress in response to bodily sensations were associated with trajectory membership. Individuals in the “initially mild pain intensity remaining mild” trajectory were less likely than those in the “initially moderate pain intensity remaining moderate” trajectory to report CPSP (odds ratio [95% confidence interval, CI], 0.23 [0.06–0.88]). No significant associations were observed between opioid consumption trajectory membership and CPSP status (odds ratio [95% CI], 0.84 [0.28–2.54] and 0.95 [0.22–4.13]). CONCLUSIONS: Those with moderate pain intensity right after surgery are more likely to develop CPSP suggesting that those patients should be flagged early on in their postoperative recovery to attempt to alter their trajectory and prevent CPSP. Emotional distress in response to bodily sensations is the only consistent modifiable factor associated with both pain and opioid trajectories.Item Accès libre Virtual group psychotherapy for chronic pain : exploring the impact of the virtual medium on participants’ experiencesMoore, Emily; Paré, Catherine; Carde, Estelle; Pagé, Gabrielle; Université de Montréal. Faculté de médecine. Département d'anesthésiologie et de médecine de la douleur (Oxford University Press, 2023-09-21)Background Virtual psychotherapy for chronic pain (CP) has been shown to be feasible, efficacious, and acceptable; however, little is known about how virtual delivery of group psychotherapy affects participants’ experiences. This study aimed to explore the impact of a virtual medium during the coronavirus disease 2019 (COVID-19) pandemic on social interactions and therapeutic processes in the context of group psychotherapy for CP management. Methods This qualitative, interview-based study collected data on 18 individuals who participated in virtual group psychotherapy in a tertiary care pain management unit. Results Results of the thematic analysis showed 4 themes. First, the ability to participate and connect was modified by not meeting in person. Connections also occurred differently as the usual patterns of interactions changed. Participants described important shifts in how emotions are communicated and subsequent experience of empathy. Finally, the commonality of chronic pain experience was identified as a central driver of connection between participants. Conclusions Mixed impacts of the virtual medium on group psychotherapy dynamics and processes were found. Future research could explore ways to mitigate the negative impacts.