Carolina Moriello - Academia.edu (original) (raw)

Papers by Carolina Moriello

Research paper thumbnail of Pedometer-facilitated walking intervention shows promising effectiveness for reducing cancer fatigue: a pilot randomized trial

Clinical rehabilitation, 2014

Mechanisms for cancer related fatigue suggest that exercise but "not too much and not too li... more Mechanisms for cancer related fatigue suggest that exercise but "not too much and not too little" could be effective. This study aimed to investigate feasibility and estimate the potential effects of a walking exercise program in people with advanced cancer and fatigue. A pilot randomized trial. McGill University Health Centre (MUHC), Montreal, Canada. People with advanced cancer undergoing interdisciplinary assessment and rehabilitation with a fatigue level of 4 to 10 on a visual analogue scale. An 8-week fatigue-adapted, walking intervention, facilitated using a pedometer (STEPS), and offered at the same time as or after rehabilitation. Measures of fatigue, physical function and well-being were administered at entry, and 8, 16 and 24 weeks. Generalized estimating equations (GEE) estimated the odds of response for people receiving the STEPS program in comparison to the odds of response in the controls (odds ratio, OR). Twenty-six persons were randomized to three groups: d...

Research paper thumbnail of Getting on with the rest of your life following stroke: A randomized trial of a complex intervention aimed at enhancing life participation post stroke

Clinical rehabilitation, Jan 27, 2015

To enhance participation post stroke through a structured, community-based program. A controlled ... more To enhance participation post stroke through a structured, community-based program. A controlled trial with random allocation to immediate or four-month delayed entry. Eleven community sites in seven Canadian cities. Community dwelling persons within five years of stroke onset, cognitively intact, able to toilet independently. Evidence-based program delivered in three 12-week sessions including exercise and project-based activities, done as individuals and in groups. Hours spent per week in meaningful activities outside of the home and Reintegration to Normal Living Index; Stroke-Specific Geriatric Depression Scale, Apathy Scale, gait speed, EuroQuol EQ-5D, and Preference-Based Stroke Index. All measures were transformed to a scale from 0 to 100. Assessments prior to randomization, after the first session at three months, six months, 12 months, and 15 months. A total of 186 persons were randomized. The between-group analysis showed no disadvantage to waiting and so groups were combi...

Research paper thumbnail of Does aggressive hydration reverse the effects of pneumoperitoneum on renal perfusion?

Surgical Endoscopy, 2006

Background: Although pneumoperitoneum (PP) decreases renal blood flow, it remains unclear whether... more Background: Although pneumoperitoneum (PP) decreases renal blood flow, it remains unclear whether this impacts renal function. Our aim was to characterize the effects of PP on renal perfusion and function using two fluid strategies for intravenous fluid administration. Methods: Twelve 30-kg pigs were randomized into two groups: maintenance (3 cc/kg/h of normal saline (NS)) and bolus (15 cc/kg/h + 20 cc/kg NaCl bolus prior to induction of PP). Pigs were studied in a blinded fashion for 30 min prior, 60 min during, and 30 min after release of 15 mmHg CO 2 PP. Cardiac output (CO) and stroke volume (SV) were measured using an esophageal Doppler probe, renal cortical perfusion (RCP) was measured with a laser Doppler probe on the right kidney, and renal function was measured using the fractional excretion of sodium (FeNa) and urine output. Statistical analysis was performed with area-under-thecurve (AUC) analysis and analysis of variance Results: AUC analysis revealed moderate effect size for CO (0.416) and small effect size for SV (0.366) and RCP (0.363), with decreases seen in the control group but not the bolus group. During PP, urine output increased in the bolus group (p = 0.04) but not in the control group; there was no difference in FeNa in either group. Conclusion: Aggressive fluid hydration during CO 2 PP of 15 mmHg preserves CO, SV, and RCP while increasing urine output. No effect on renal function as measured by FeNa was observed in either group.

Research paper thumbnail of The extent to which common health-related quality of life indices capture constructs beyond symptoms and function

Quality of Life Research, 2011

Purpose This study proposes to identify for 5 widely used generic HRQL and QOL measures the exten... more Purpose This study proposes to identify for 5 widely used generic HRQL and QOL measures the extent to which function and global feelings of well-being are represented in their content. Methods The 5 indices were the EQ-5D, the HUI, the SF-36, SF-12, and the WHOQOL-Bref. A total of 15 raters with a variety of health and research backgrounds mapped the items. Raters independently identified all codes that could possibly map to the item and indicated the code that best reflected the underlying intent of the item, using the standardized mapping rules and methodology. A Delphi process aided consensus for each of the items. The consensus rounds involved reconsideration of item codes for which 70% of raters did not agree on the ''best'' code. These consensus rounds were terminated when item codes reached the threshold of 70% agreement or when it became evident from that consensus would not be reached. Results Function was a predominant construct for the 5 indices, with the proportion of items capturing function ranging from a low of 27% for the WHOQOL-Bref to a high of 92% for the SF-12. Less than 50% of items within the indices mapped to the granularity of function as described by the ICF. Conclusions This paper demonstrates an additional method to validate the content of health-related indices to supplement the qualitative methods of consulting with experts and patients.

Research paper thumbnail of What does a structured review of the effectiveness of exercise interventions for persons with multiple sclerosis tell us about the challenges of designing trials?

Multiple Sclerosis Journal, 2009

Objective The goal of this review is to ascertain the extent to which the current body of researc... more Objective The goal of this review is to ascertain the extent to which the current body of research on the role of exercise in multiple sclerosis (MS) provides sufficiently strong evidence to guide regular exercise prescription. Methods We searched CINAHL, COCHRANE, EMBASE, and MEDLINE between 1950 and December 2007 with combinations of MeSH terms and keywords. We assessed the methodological quality of selected randomized controlled trials (RCTs) of exercise interventions using the Physiotherapy Evidence Database scale and evaluated the effects of the exercise interventions by calculating effect sizes (ES) for the target outcomes. Results Eleven RCTs met the criteria, all with acceptable methodological quality. The ES ranged from −0.36 to 3.50 on the target outcomes. Only one study had 95% confidence intervals clearly excluding a value of 0. Measures of body functions and structures and activities were the most common target outcomes of interventions. Conclusion Although there was some evidence to support positive effects of exercise on physical and psychosocial functioning and on quality of life, our review revealed insufficient research in this area, making it difficult to guide regular exercise prescription. Furthermore, it also emphasizes the methodological challenges in these RCTs leading us to believe that there is a great need for high quality RCTs in this area, contributing evidence for regular exercise and physical activity prescription for persons with MS. Multiple Sclerosis 2009; 15: 412-421.

Research paper thumbnail of Relationship between muscle strength and functional walking capacity among people with stroke

The Journal of Rehabilitation Research and Development, 2011

The purpose of t his study was to estimate, using the Position-Specific Global Index (PSGI) of Lo... more The purpose of t his study was to estimate, using the Position-Specific Global Index (PSGI) of Low er-Limb Muscle Strength, the extent to which muscle strength is independently associated with functional walking capacity. We performed an observational, cross-sectional study with 63 patients poststroke (onset between 3 and 12 months) at a major teaching hospital in an urban Canadian city. We assessed functional walking capacity with the six-minute walk test (6MWT) and muscle strength with handheld dynamometry. We established the relationship between the lower-limb muscles and fu nctional walking capacity with the PSGI. The PSGI explained 70% (p < 0.001) of the variability in the 6MWT, whereas the index of alternate against-gravity muscle strength explained 39% and the hip flexors in a supine position explained 51%.

Research paper thumbnail of A randomized trial of two home-based exercise programmes to improve functional walking post-stroke

Clinical Rehabilitation, 2013

To estimate the relative effectiveness in improving walking ability and other mobility and health... more To estimate the relative effectiveness in improving walking ability and other mobility and health outcomes post-stroke of two home-based exercise programmes - stationary cycling and an exercise and walking programme. An observer-blinded, randomized, pragmatic, trial with repeated measures. Hospital centers in two Canadian cities. People within 12 months of acute stroke who were able to walk &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;10 meters independently and healthy enough to engage in exercise. Two dose-equivalent interventions, one involving stationary cycling and the other disability-targeted interventions were tested. Both protocols required daily moderate intensity exercise at home building up to 30 minutes per day. One group exercised on a stationary bicycle, the second group carried out mobility exercises and brisk walking. The primary outcome was walking capacity as measured by the six-minute walk test (6MWT). Secondary outcomes were physical function, role participation, health-related quality of life exercise adherence, and adverse events. The study failed to meet recruitment targets: 87 participants (cycle group, n = 43; exercise group, n = 44) participated. No significant effects of group or time were revealed for the 6MWT, which was approximately 320 m at randomization. A significant effect for role participation was found in favor of the exercise group (global odds ratio (OR) for cycling vs. exercise was 0.51; 95% confidence interval (CI), 0.27-0.95). Change in the 6MWT between highest and lowest adherence categories was statistically significant (p = 0.022). Both programmes were equally effective in maintaining walking capacity after discharge from stroke rehabilitation; or were equally ineffective in improving walking capacity. Clinical Trials Gov number: NCT00786045.

Research paper thumbnail of Validating the Six-Minute Walk Test as a Measure of Recovery After Elective Colon Resection Surgery

Archives of Physical Medicine and Rehabilitation, 2008

Moriello C, Mayo NE, Feldman L, Carli F. Validating the six-minute walk test as a measure of reco... more Moriello C, Mayo NE, Feldman L, Carli F. Validating the six-minute walk test as a measure of recovery after elective colon resection surgery. Arch Phys Med Rehabil 2008;89:1083-9.

Research paper thumbnail of Mapping the Stroke Impact Scale (SIS-16) to the International Classification of Functioning, Disability and Health

Journal of Rehabilitation Medicine, 2008

Objective: To demonstrate how the International Classification of Functioning, Disability and Hea... more Objective: To demonstrate how the International Classification of Functioning, Disability and Health (ICF) can be used to create coded functional status indicators specific for stroke from a simple stroke-specific functional index, the Stroke Impact Scale-16 (SIS-16). Subjects: Nineteen professionals for the mapping portion and 8 persons with stroke for the cognitive debriefing portion. Methods: Participants were asked to identify appropriate codes for the corresponding items of the SIS-16 following a structured protocol for mapping measures to the ICF. A Delphi technique was used in order to reach consensus for as many items as possible. In addition, cognitive debriefing was conducted with persons with stroke. Results: A total of 13 items had Functional Status Indicators endorsed (8 items at the 4 digit level and 5 items at the 3 digit level). There were 3 items that did not reach consensus. The cognitive debriefing sessions demonstrated the differences in interpretation from the persons with stroke and the intentions by the developers. Conclusion: This study has shown how the ICF can capture most items from functional status measures, such as the SIS-16. Furthermore, the items can be used to map onto a standard coding framework, illustrating the potential for increased use of Functional Status Indicators.

Research paper thumbnail of Development of a Position-Specific Index of Muscle Strength to be Used in Stroke Evaluation

Archives of Physical Medicine and Rehabilitation, 2006

Moriello C, Mayo NE. Development of a position-specific index of muscle strength to be used in st... more Moriello C, Mayo NE. Development of a position-specific index of muscle strength to be used in stroke evaluation. Arch Phys Med Rehabil 2006;87:1490-5.

Research paper thumbnail of Pedometer-facilitated walking intervention shows promising effectiveness for reducing cancer fatigue: a pilot randomized trial

Clinical rehabilitation, 2014

Mechanisms for cancer related fatigue suggest that exercise but "not too much and not too li... more Mechanisms for cancer related fatigue suggest that exercise but "not too much and not too little" could be effective. This study aimed to investigate feasibility and estimate the potential effects of a walking exercise program in people with advanced cancer and fatigue. A pilot randomized trial. McGill University Health Centre (MUHC), Montreal, Canada. People with advanced cancer undergoing interdisciplinary assessment and rehabilitation with a fatigue level of 4 to 10 on a visual analogue scale. An 8-week fatigue-adapted, walking intervention, facilitated using a pedometer (STEPS), and offered at the same time as or after rehabilitation. Measures of fatigue, physical function and well-being were administered at entry, and 8, 16 and 24 weeks. Generalized estimating equations (GEE) estimated the odds of response for people receiving the STEPS program in comparison to the odds of response in the controls (odds ratio, OR). Twenty-six persons were randomized to three groups: d...

Research paper thumbnail of Getting on with the rest of your life following stroke: A randomized trial of a complex intervention aimed at enhancing life participation post stroke

Clinical rehabilitation, Jan 27, 2015

To enhance participation post stroke through a structured, community-based program. A controlled ... more To enhance participation post stroke through a structured, community-based program. A controlled trial with random allocation to immediate or four-month delayed entry. Eleven community sites in seven Canadian cities. Community dwelling persons within five years of stroke onset, cognitively intact, able to toilet independently. Evidence-based program delivered in three 12-week sessions including exercise and project-based activities, done as individuals and in groups. Hours spent per week in meaningful activities outside of the home and Reintegration to Normal Living Index; Stroke-Specific Geriatric Depression Scale, Apathy Scale, gait speed, EuroQuol EQ-5D, and Preference-Based Stroke Index. All measures were transformed to a scale from 0 to 100. Assessments prior to randomization, after the first session at three months, six months, 12 months, and 15 months. A total of 186 persons were randomized. The between-group analysis showed no disadvantage to waiting and so groups were combi...

Research paper thumbnail of Does aggressive hydration reverse the effects of pneumoperitoneum on renal perfusion?

Surgical Endoscopy, 2006

Background: Although pneumoperitoneum (PP) decreases renal blood flow, it remains unclear whether... more Background: Although pneumoperitoneum (PP) decreases renal blood flow, it remains unclear whether this impacts renal function. Our aim was to characterize the effects of PP on renal perfusion and function using two fluid strategies for intravenous fluid administration. Methods: Twelve 30-kg pigs were randomized into two groups: maintenance (3 cc/kg/h of normal saline (NS)) and bolus (15 cc/kg/h + 20 cc/kg NaCl bolus prior to induction of PP). Pigs were studied in a blinded fashion for 30 min prior, 60 min during, and 30 min after release of 15 mmHg CO 2 PP. Cardiac output (CO) and stroke volume (SV) were measured using an esophageal Doppler probe, renal cortical perfusion (RCP) was measured with a laser Doppler probe on the right kidney, and renal function was measured using the fractional excretion of sodium (FeNa) and urine output. Statistical analysis was performed with area-under-thecurve (AUC) analysis and analysis of variance Results: AUC analysis revealed moderate effect size for CO (0.416) and small effect size for SV (0.366) and RCP (0.363), with decreases seen in the control group but not the bolus group. During PP, urine output increased in the bolus group (p = 0.04) but not in the control group; there was no difference in FeNa in either group. Conclusion: Aggressive fluid hydration during CO 2 PP of 15 mmHg preserves CO, SV, and RCP while increasing urine output. No effect on renal function as measured by FeNa was observed in either group.

Research paper thumbnail of The extent to which common health-related quality of life indices capture constructs beyond symptoms and function

Quality of Life Research, 2011

Purpose This study proposes to identify for 5 widely used generic HRQL and QOL measures the exten... more Purpose This study proposes to identify for 5 widely used generic HRQL and QOL measures the extent to which function and global feelings of well-being are represented in their content. Methods The 5 indices were the EQ-5D, the HUI, the SF-36, SF-12, and the WHOQOL-Bref. A total of 15 raters with a variety of health and research backgrounds mapped the items. Raters independently identified all codes that could possibly map to the item and indicated the code that best reflected the underlying intent of the item, using the standardized mapping rules and methodology. A Delphi process aided consensus for each of the items. The consensus rounds involved reconsideration of item codes for which 70% of raters did not agree on the ''best'' code. These consensus rounds were terminated when item codes reached the threshold of 70% agreement or when it became evident from that consensus would not be reached. Results Function was a predominant construct for the 5 indices, with the proportion of items capturing function ranging from a low of 27% for the WHOQOL-Bref to a high of 92% for the SF-12. Less than 50% of items within the indices mapped to the granularity of function as described by the ICF. Conclusions This paper demonstrates an additional method to validate the content of health-related indices to supplement the qualitative methods of consulting with experts and patients.

Research paper thumbnail of What does a structured review of the effectiveness of exercise interventions for persons with multiple sclerosis tell us about the challenges of designing trials?

Multiple Sclerosis Journal, 2009

Objective The goal of this review is to ascertain the extent to which the current body of researc... more Objective The goal of this review is to ascertain the extent to which the current body of research on the role of exercise in multiple sclerosis (MS) provides sufficiently strong evidence to guide regular exercise prescription. Methods We searched CINAHL, COCHRANE, EMBASE, and MEDLINE between 1950 and December 2007 with combinations of MeSH terms and keywords. We assessed the methodological quality of selected randomized controlled trials (RCTs) of exercise interventions using the Physiotherapy Evidence Database scale and evaluated the effects of the exercise interventions by calculating effect sizes (ES) for the target outcomes. Results Eleven RCTs met the criteria, all with acceptable methodological quality. The ES ranged from −0.36 to 3.50 on the target outcomes. Only one study had 95% confidence intervals clearly excluding a value of 0. Measures of body functions and structures and activities were the most common target outcomes of interventions. Conclusion Although there was some evidence to support positive effects of exercise on physical and psychosocial functioning and on quality of life, our review revealed insufficient research in this area, making it difficult to guide regular exercise prescription. Furthermore, it also emphasizes the methodological challenges in these RCTs leading us to believe that there is a great need for high quality RCTs in this area, contributing evidence for regular exercise and physical activity prescription for persons with MS. Multiple Sclerosis 2009; 15: 412-421.

Research paper thumbnail of Relationship between muscle strength and functional walking capacity among people with stroke

The Journal of Rehabilitation Research and Development, 2011

The purpose of t his study was to estimate, using the Position-Specific Global Index (PSGI) of Lo... more The purpose of t his study was to estimate, using the Position-Specific Global Index (PSGI) of Low er-Limb Muscle Strength, the extent to which muscle strength is independently associated with functional walking capacity. We performed an observational, cross-sectional study with 63 patients poststroke (onset between 3 and 12 months) at a major teaching hospital in an urban Canadian city. We assessed functional walking capacity with the six-minute walk test (6MWT) and muscle strength with handheld dynamometry. We established the relationship between the lower-limb muscles and fu nctional walking capacity with the PSGI. The PSGI explained 70% (p < 0.001) of the variability in the 6MWT, whereas the index of alternate against-gravity muscle strength explained 39% and the hip flexors in a supine position explained 51%.

Research paper thumbnail of A randomized trial of two home-based exercise programmes to improve functional walking post-stroke

Clinical Rehabilitation, 2013

To estimate the relative effectiveness in improving walking ability and other mobility and health... more To estimate the relative effectiveness in improving walking ability and other mobility and health outcomes post-stroke of two home-based exercise programmes - stationary cycling and an exercise and walking programme. An observer-blinded, randomized, pragmatic, trial with repeated measures. Hospital centers in two Canadian cities. People within 12 months of acute stroke who were able to walk &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;10 meters independently and healthy enough to engage in exercise. Two dose-equivalent interventions, one involving stationary cycling and the other disability-targeted interventions were tested. Both protocols required daily moderate intensity exercise at home building up to 30 minutes per day. One group exercised on a stationary bicycle, the second group carried out mobility exercises and brisk walking. The primary outcome was walking capacity as measured by the six-minute walk test (6MWT). Secondary outcomes were physical function, role participation, health-related quality of life exercise adherence, and adverse events. The study failed to meet recruitment targets: 87 participants (cycle group, n = 43; exercise group, n = 44) participated. No significant effects of group or time were revealed for the 6MWT, which was approximately 320 m at randomization. A significant effect for role participation was found in favor of the exercise group (global odds ratio (OR) for cycling vs. exercise was 0.51; 95% confidence interval (CI), 0.27-0.95). Change in the 6MWT between highest and lowest adherence categories was statistically significant (p = 0.022). Both programmes were equally effective in maintaining walking capacity after discharge from stroke rehabilitation; or were equally ineffective in improving walking capacity. Clinical Trials Gov number: NCT00786045.

Research paper thumbnail of Validating the Six-Minute Walk Test as a Measure of Recovery After Elective Colon Resection Surgery

Archives of Physical Medicine and Rehabilitation, 2008

Moriello C, Mayo NE, Feldman L, Carli F. Validating the six-minute walk test as a measure of reco... more Moriello C, Mayo NE, Feldman L, Carli F. Validating the six-minute walk test as a measure of recovery after elective colon resection surgery. Arch Phys Med Rehabil 2008;89:1083-9.

Research paper thumbnail of Mapping the Stroke Impact Scale (SIS-16) to the International Classification of Functioning, Disability and Health

Journal of Rehabilitation Medicine, 2008

Objective: To demonstrate how the International Classification of Functioning, Disability and Hea... more Objective: To demonstrate how the International Classification of Functioning, Disability and Health (ICF) can be used to create coded functional status indicators specific for stroke from a simple stroke-specific functional index, the Stroke Impact Scale-16 (SIS-16). Subjects: Nineteen professionals for the mapping portion and 8 persons with stroke for the cognitive debriefing portion. Methods: Participants were asked to identify appropriate codes for the corresponding items of the SIS-16 following a structured protocol for mapping measures to the ICF. A Delphi technique was used in order to reach consensus for as many items as possible. In addition, cognitive debriefing was conducted with persons with stroke. Results: A total of 13 items had Functional Status Indicators endorsed (8 items at the 4 digit level and 5 items at the 3 digit level). There were 3 items that did not reach consensus. The cognitive debriefing sessions demonstrated the differences in interpretation from the persons with stroke and the intentions by the developers. Conclusion: This study has shown how the ICF can capture most items from functional status measures, such as the SIS-16. Furthermore, the items can be used to map onto a standard coding framework, illustrating the potential for increased use of Functional Status Indicators.

Research paper thumbnail of Development of a Position-Specific Index of Muscle Strength to be Used in Stroke Evaluation

Archives of Physical Medicine and Rehabilitation, 2006

Moriello C, Mayo NE. Development of a position-specific index of muscle strength to be used in st... more Moriello C, Mayo NE. Development of a position-specific index of muscle strength to be used in stroke evaluation. Arch Phys Med Rehabil 2006;87:1490-5.