Julie Keysor - Academia.edu (original) (raw)
Papers by Julie Keysor
Neuromodulation: Technology at the Neural Interface
Archives of Rehabilitation Research and Clinical Translation, 2022
Post COVID-19 condition is characterized by a myriad of persistent symptoms experienced up to 60 ... more Post COVID-19 condition is characterized by a myriad of persistent symptoms experienced up to 60 days after the acute infection, not just in those hospitalized, but also in patients with mild to moderate acute symptoms. The overwhelming evidence on a multisystem involvement in post COVID-19 condition compounded with its notable prevalence brings to attention the need for integrated delivery models for addressing healthcare needs of this population. The World Health Organization recently highlighted critical gaps in current healthcare delivery models to adequately provide the level of integrative care required to address the multisystem needs of this population and recommended development of new innovative models of delivery. This paper presents a novel approach to addressing these gaps from a rehabilitation perspective.
Physiotherapy Theory and Practice, 2022
BACKGROUND Chronic low back pain (cLBP) is a complex condition that is physically and psychologic... more BACKGROUND Chronic low back pain (cLBP) is a complex condition that is physically and psychologically debilitating, with vulnerable populations experiencing more severe outcomes. Physical therapy (PT) includes evidence-based treatments that can reduce disability, however the experience of PT can vary amongst different populations. Empirical evidence is largely based on majority samples that are predominantly white with high educational attainment. Little is known regarding how people from vulnerable groups (e.g. low income and racial minority) experience physical therapy treatment for low back pain. OBJECTIVE To describe the experience of physical therapy in a predominantly low-income and minority population with cLBP. METHODS This qualitative study was embedded within a randomized controlled trial for patients with cLBP in urban, underserved communities. We used a convenience sample to interview 12 participants from the 102 who participated in the PT arm of the trial and then performed thematic analysis to describe their experience. RESULTS Three major themes emerged: 1) Empowerment through education and exercise; 2) Interconnectedness to providers and other patients; and 3) Improvements in pain, body mechanics, and mood. Divergent cases were few however centered around a lack of improvement in pain or an absence of connection with the therapist. Within the first theme a prevailing sub-theme emerged that aligned with Bandura's theory of self-efficacy: 1) Mastery of experience; 2) Verbal persuasion; 3) Vicarious experience; and 4) Physiological state. CONCLUSIONS Our participants' insight highlighted the value of cognitive-emotional and interpersonal dimensions of PT. These may be particularly important components of PT in populations that have experienced systemic distrust in providers and disparities in services. Future work could use Bandura's model of self-efficacy to build a PT intervention comprised of fear-based movement exercises, interconnectedness, a strong therapeutic alliance, and mindfulness techniques.
Archives of Physical Medicine and Rehabilitation, 2021
Research Objectives To describe workplace barriers reported on the Work Experience Survey for Rhe... more Research Objectives To describe workplace barriers reported on the Work Experience Survey for Rheumatic Conditions (WES-RC), an intervention tool used in the recent Work It clinical trial. Design This is a descriptive study using data from the intervention arm of the Work It RCT, which examined an intervention delivered by occupational and physical therapists to people with arthritis. Setting General community. Participants Employed individuals with self-reported arthritis or rheumatological conditions, working at least part-time, and who lived/worked in Massachusetts. Interventions N/A. Main Outcome Measures Descriptive statistics of the WES-RC domains were computed including: include getting ready for work, workplace access, physical job demands, mental job demands, time/energy and emotional job demands, relationships with people at work, working conditions, and company policies, and job/career/home life. Results The mean age for the study sample (N=143) was 50.3. 73% female, 66% white, 68% single, and 59% had a college degree. Osteoarthritis was the most reported condition (43%). Doing stairs at home and lifting/carrying were the top barriers in getting ready to work reported by 44% and %43 of participants, respectively. Stairs and walking to work were the top barriers for workplace access, reported by 40%, and 28% of participants, respectively. Sitting for prolonged periods of time (physical job demands), reported by 55% of participants, remembering (mental job demands) reported by 30% of participants. Feeling self-conscious about a health condition was reported by 37% of participants. Cold temperature and air conditioning were the top barriers in working conditions/company policy reported by 43% of the participants. Getting household work and/ or shopping done, and consideration of what work options if needed or wanted to change jobs were the top barriers in job/career/home life, reported by 34% and 29% of the participants respectively. Conclusions The WES-RC identifies many problematic areas that fall within the expertise of occupational and physical therapy. With an RCT supporting the use of this tool, this could be useful to clinicians during practice to identify areas of need for patients. Author(s) Disclosures We have no disclosures to declare.
European Journal of Physiotherapy, 2020
Journal of Geriatric Physical Therapy, 2016
Background/purpose: Evidence suggests that more than 30% of patients post-total knee replacement ... more Background/purpose: Evidence suggests that more than 30% of patients post-total knee replacement (TKR) are living with participation restrictions, yet little is known about their perceptions of and factors contributing to these restrictions. The purpose of this study was to identify emergent or recurring themes behind participation restrictions after TKR. Methods: Nineteen participants between 50 and 85 years old reporting participation restrictions 1 to 5 years post-TKR completed semistructured qualitative interviews about their participation experience after TKR. Participants provided background information in written questionnaires. Data collected from in-person interviews were analyzed qualitatively using a grounded theory approach. Results: Participants discussed 3 major themes with regard to participation post-TKR: (1) limiting activities requiring long-distance walking due to continued knee impairments, (2) avoiding activities with negative or unknown outcome expectancies, an...
The Journal of rheumatology, 2004
To prospectively analyze patient questionnaire scores concerning functional disability as well as... more To prospectively analyze patient questionnaire scores concerning functional disability as well as formal education level as potential predictors of premature mortality over 10 years in 1416 patients with rheumatoid arthritis (RA) from 15 private practice rheumatology settings in 11 diverse cities in the United States. At baseline in 1985 and periodically over 10 years, patients completed mailed self-report multidimensional health assessment questionnaires (MDHAQ) that included functional disability scores, formal education level, and other demographic and clinical data. Vital status was determined 10 years after baseline. Potential predictors of 10 year mortality were analyzed using descriptive statistics and Cox proportional hazards models. Vital status was accounted for in 1378 patients, 97.3% of the cohort. The standard mortality ratio was 1.6, similar to most reported series of patients with RA, as 401 patients died versus 251 expected over 10 years. Evidence of "dose-respo...
Work (Reading, Mass.), 2007
Low back pain is one of the most prevalent work related injuries in the physical therapy professi... more Low back pain is one of the most prevalent work related injuries in the physical therapy profession. New graduates and therapists working in rehabilitation and acute care hospitals are at the highest risk for developing low back pain [9]. Although physical therapists are trained in maintaining proper body mechanics and preventing work related injuries, between 30% and 63% of therapists will experience low back pain at some point in their careers [2,4,9]. The culture of physical therapy is one of the primary factors contributing to this problem, with many therapists reporting that their decision to use back pain preventive strategies depends on their colleagues' use of these strategies. The authors will use Green and Kreuter's PRECEDE-PROCEED model to identify behavioral, environmental, educational and ecological factors contributing to the problem; then will propose a health promotion intervention using the social action theory at the community level to decrease work-related...
PM&R, 2010
ObjectiveTo determine whether fat distribution in obese adults is significantly associated with d... more ObjectiveTo determine whether fat distribution in obese adults is significantly associated with decreased function and increased disability.DesignCross‐sectional epidemiologic analysis.SettingMulticenter, community‐based study.ParticipantsMulticenter Osteoarthritis Study participants included adults ages 50–79 years at high risk of developing or already possessing knee osteoarthritis. A total of 549 men and 892 women from the Multicenter Osteoarthritis Study who had a body mass index ≥30 kg/m2 and who underwent dual energy x‐ray absorptiometry (DEXA) scans were included in these analyses. Exclusion criteria included bilateral knee replacements, cancer, or other rheumatologic disease.MethodsBody fat distribution was determined using baseline DEXA scan data. A ratio of abdominal fat in grams compared with lower limb fat in grams (trunk:lower limb fat ratio) was calculated. Participants were divided into quartiles of trunk:lower limb fat ratio, with highest and lowest quartiles represe...
The Milbank Quarterly, 2002
Promoting the health and well‐being of all Americans—including those with disabilities—has emerge... more Promoting the health and well‐being of all Americans—including those with disabilities—has emerged as a national priority since the passage of the Americans with Disabilities Act (ADA) more than ten years ago. The ADA marked the first explicit national goal of achieving equal opportunity, independent living, and economic self‐sufficiency for individuals with disabilities (Americans with Disabilities Act 1989). Its passage marked a growing recognition of the needs of people with disabilities. Achieving the ADA's goals, however, requires more than simply satisfying its specific provisions; it requires the careful management of the health needs of persons with disability (Patrick 1997).People with disabilities represent an increasingly recognized target population whose health care needs can be addressed and, it is hoped, improved through health services research. Health services research aims to improve health and health care systems through research on the structure, processes, a...
Journal of the American Geriatrics Society, 2005
Objectives: To examine whether common musculoskeletal disorders of feet are associated with pain ... more Objectives: To examine whether common musculoskeletal disorders of feet are associated with pain and foot‐related functional limitation.Design: A cross‐sectional study using stratified random sampling.Setting: A residential community.Participants: Ethnically diverse sample of elderly persons (n=784).Measurements: Foot disorders (hallux valgus/bunion, pes planus (flat foot), pes cavus (high arch), hammertoe, mallet toe, claw toe, overlapping toes, bunionette, and plantar fasciitis), foot pain, the foot health functional status (FHFS, range 0–100, 100=no problems) scale, and walk time score (range 0–4, 4=fastest).Results: Most commonly assessed musculoskeletal disorders, including hallux valgus and toe deformities, were not associated with pain or function limitation. Plantar fasciitis and, to a lesser extent, pes cavus were associated with worse FHFS scores; foot pain partially explained this association. Neither foot disorders nor foot pain were significantly associated with slower ...
Journal of Rehabilitation Medicine, 2005
The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 2009
The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 2001
Journal of Aging and Health, 2005
The objectives of this study are to examine whether specific foot disorders and ankle weakness an... more The objectives of this study are to examine whether specific foot disorders and ankle weakness and foot pain are related to functional limitations or disabilities in elders. Community-dwelling adults 65 and older were enrolled in a population-based, cross-sectional study of foot disorders and health outcomes. Demographics, health status, comorbidities, self-reported foot and knee pain, function and disability, and observed structural foot disorders, body mass index, and ankle muscle strength were assessed on 717 participants. The associations of foot disorders, foot pain, and ankle muscle weakness with function and disability were examined with regression analyses. Foot disorders were not associated with functional outcomes or disability. Ankle weakness was associated with performance-based function ( p = .005), self-report function ( p < .001), and disability ( p = .009). Foot pain was associated with self-report function ( p = .01) and disability ( p = .007). Foot pain and ankl...
Disease Management and Health Outcomes, 2001
Neuromodulation: Technology at the Neural Interface
Archives of Rehabilitation Research and Clinical Translation, 2022
Post COVID-19 condition is characterized by a myriad of persistent symptoms experienced up to 60 ... more Post COVID-19 condition is characterized by a myriad of persistent symptoms experienced up to 60 days after the acute infection, not just in those hospitalized, but also in patients with mild to moderate acute symptoms. The overwhelming evidence on a multisystem involvement in post COVID-19 condition compounded with its notable prevalence brings to attention the need for integrated delivery models for addressing healthcare needs of this population. The World Health Organization recently highlighted critical gaps in current healthcare delivery models to adequately provide the level of integrative care required to address the multisystem needs of this population and recommended development of new innovative models of delivery. This paper presents a novel approach to addressing these gaps from a rehabilitation perspective.
Physiotherapy Theory and Practice, 2022
BACKGROUND Chronic low back pain (cLBP) is a complex condition that is physically and psychologic... more BACKGROUND Chronic low back pain (cLBP) is a complex condition that is physically and psychologically debilitating, with vulnerable populations experiencing more severe outcomes. Physical therapy (PT) includes evidence-based treatments that can reduce disability, however the experience of PT can vary amongst different populations. Empirical evidence is largely based on majority samples that are predominantly white with high educational attainment. Little is known regarding how people from vulnerable groups (e.g. low income and racial minority) experience physical therapy treatment for low back pain. OBJECTIVE To describe the experience of physical therapy in a predominantly low-income and minority population with cLBP. METHODS This qualitative study was embedded within a randomized controlled trial for patients with cLBP in urban, underserved communities. We used a convenience sample to interview 12 participants from the 102 who participated in the PT arm of the trial and then performed thematic analysis to describe their experience. RESULTS Three major themes emerged: 1) Empowerment through education and exercise; 2) Interconnectedness to providers and other patients; and 3) Improvements in pain, body mechanics, and mood. Divergent cases were few however centered around a lack of improvement in pain or an absence of connection with the therapist. Within the first theme a prevailing sub-theme emerged that aligned with Bandura's theory of self-efficacy: 1) Mastery of experience; 2) Verbal persuasion; 3) Vicarious experience; and 4) Physiological state. CONCLUSIONS Our participants' insight highlighted the value of cognitive-emotional and interpersonal dimensions of PT. These may be particularly important components of PT in populations that have experienced systemic distrust in providers and disparities in services. Future work could use Bandura's model of self-efficacy to build a PT intervention comprised of fear-based movement exercises, interconnectedness, a strong therapeutic alliance, and mindfulness techniques.
Archives of Physical Medicine and Rehabilitation, 2021
Research Objectives To describe workplace barriers reported on the Work Experience Survey for Rhe... more Research Objectives To describe workplace barriers reported on the Work Experience Survey for Rheumatic Conditions (WES-RC), an intervention tool used in the recent Work It clinical trial. Design This is a descriptive study using data from the intervention arm of the Work It RCT, which examined an intervention delivered by occupational and physical therapists to people with arthritis. Setting General community. Participants Employed individuals with self-reported arthritis or rheumatological conditions, working at least part-time, and who lived/worked in Massachusetts. Interventions N/A. Main Outcome Measures Descriptive statistics of the WES-RC domains were computed including: include getting ready for work, workplace access, physical job demands, mental job demands, time/energy and emotional job demands, relationships with people at work, working conditions, and company policies, and job/career/home life. Results The mean age for the study sample (N=143) was 50.3. 73% female, 66% white, 68% single, and 59% had a college degree. Osteoarthritis was the most reported condition (43%). Doing stairs at home and lifting/carrying were the top barriers in getting ready to work reported by 44% and %43 of participants, respectively. Stairs and walking to work were the top barriers for workplace access, reported by 40%, and 28% of participants, respectively. Sitting for prolonged periods of time (physical job demands), reported by 55% of participants, remembering (mental job demands) reported by 30% of participants. Feeling self-conscious about a health condition was reported by 37% of participants. Cold temperature and air conditioning were the top barriers in working conditions/company policy reported by 43% of the participants. Getting household work and/ or shopping done, and consideration of what work options if needed or wanted to change jobs were the top barriers in job/career/home life, reported by 34% and 29% of the participants respectively. Conclusions The WES-RC identifies many problematic areas that fall within the expertise of occupational and physical therapy. With an RCT supporting the use of this tool, this could be useful to clinicians during practice to identify areas of need for patients. Author(s) Disclosures We have no disclosures to declare.
European Journal of Physiotherapy, 2020
Journal of Geriatric Physical Therapy, 2016
Background/purpose: Evidence suggests that more than 30% of patients post-total knee replacement ... more Background/purpose: Evidence suggests that more than 30% of patients post-total knee replacement (TKR) are living with participation restrictions, yet little is known about their perceptions of and factors contributing to these restrictions. The purpose of this study was to identify emergent or recurring themes behind participation restrictions after TKR. Methods: Nineteen participants between 50 and 85 years old reporting participation restrictions 1 to 5 years post-TKR completed semistructured qualitative interviews about their participation experience after TKR. Participants provided background information in written questionnaires. Data collected from in-person interviews were analyzed qualitatively using a grounded theory approach. Results: Participants discussed 3 major themes with regard to participation post-TKR: (1) limiting activities requiring long-distance walking due to continued knee impairments, (2) avoiding activities with negative or unknown outcome expectancies, an...
The Journal of rheumatology, 2004
To prospectively analyze patient questionnaire scores concerning functional disability as well as... more To prospectively analyze patient questionnaire scores concerning functional disability as well as formal education level as potential predictors of premature mortality over 10 years in 1416 patients with rheumatoid arthritis (RA) from 15 private practice rheumatology settings in 11 diverse cities in the United States. At baseline in 1985 and periodically over 10 years, patients completed mailed self-report multidimensional health assessment questionnaires (MDHAQ) that included functional disability scores, formal education level, and other demographic and clinical data. Vital status was determined 10 years after baseline. Potential predictors of 10 year mortality were analyzed using descriptive statistics and Cox proportional hazards models. Vital status was accounted for in 1378 patients, 97.3% of the cohort. The standard mortality ratio was 1.6, similar to most reported series of patients with RA, as 401 patients died versus 251 expected over 10 years. Evidence of "dose-respo...
Work (Reading, Mass.), 2007
Low back pain is one of the most prevalent work related injuries in the physical therapy professi... more Low back pain is one of the most prevalent work related injuries in the physical therapy profession. New graduates and therapists working in rehabilitation and acute care hospitals are at the highest risk for developing low back pain [9]. Although physical therapists are trained in maintaining proper body mechanics and preventing work related injuries, between 30% and 63% of therapists will experience low back pain at some point in their careers [2,4,9]. The culture of physical therapy is one of the primary factors contributing to this problem, with many therapists reporting that their decision to use back pain preventive strategies depends on their colleagues' use of these strategies. The authors will use Green and Kreuter's PRECEDE-PROCEED model to identify behavioral, environmental, educational and ecological factors contributing to the problem; then will propose a health promotion intervention using the social action theory at the community level to decrease work-related...
PM&R, 2010
ObjectiveTo determine whether fat distribution in obese adults is significantly associated with d... more ObjectiveTo determine whether fat distribution in obese adults is significantly associated with decreased function and increased disability.DesignCross‐sectional epidemiologic analysis.SettingMulticenter, community‐based study.ParticipantsMulticenter Osteoarthritis Study participants included adults ages 50–79 years at high risk of developing or already possessing knee osteoarthritis. A total of 549 men and 892 women from the Multicenter Osteoarthritis Study who had a body mass index ≥30 kg/m2 and who underwent dual energy x‐ray absorptiometry (DEXA) scans were included in these analyses. Exclusion criteria included bilateral knee replacements, cancer, or other rheumatologic disease.MethodsBody fat distribution was determined using baseline DEXA scan data. A ratio of abdominal fat in grams compared with lower limb fat in grams (trunk:lower limb fat ratio) was calculated. Participants were divided into quartiles of trunk:lower limb fat ratio, with highest and lowest quartiles represe...
The Milbank Quarterly, 2002
Promoting the health and well‐being of all Americans—including those with disabilities—has emerge... more Promoting the health and well‐being of all Americans—including those with disabilities—has emerged as a national priority since the passage of the Americans with Disabilities Act (ADA) more than ten years ago. The ADA marked the first explicit national goal of achieving equal opportunity, independent living, and economic self‐sufficiency for individuals with disabilities (Americans with Disabilities Act 1989). Its passage marked a growing recognition of the needs of people with disabilities. Achieving the ADA's goals, however, requires more than simply satisfying its specific provisions; it requires the careful management of the health needs of persons with disability (Patrick 1997).People with disabilities represent an increasingly recognized target population whose health care needs can be addressed and, it is hoped, improved through health services research. Health services research aims to improve health and health care systems through research on the structure, processes, a...
Journal of the American Geriatrics Society, 2005
Objectives: To examine whether common musculoskeletal disorders of feet are associated with pain ... more Objectives: To examine whether common musculoskeletal disorders of feet are associated with pain and foot‐related functional limitation.Design: A cross‐sectional study using stratified random sampling.Setting: A residential community.Participants: Ethnically diverse sample of elderly persons (n=784).Measurements: Foot disorders (hallux valgus/bunion, pes planus (flat foot), pes cavus (high arch), hammertoe, mallet toe, claw toe, overlapping toes, bunionette, and plantar fasciitis), foot pain, the foot health functional status (FHFS, range 0–100, 100=no problems) scale, and walk time score (range 0–4, 4=fastest).Results: Most commonly assessed musculoskeletal disorders, including hallux valgus and toe deformities, were not associated with pain or function limitation. Plantar fasciitis and, to a lesser extent, pes cavus were associated with worse FHFS scores; foot pain partially explained this association. Neither foot disorders nor foot pain were significantly associated with slower ...
Journal of Rehabilitation Medicine, 2005
The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 2009
The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 2001
Journal of Aging and Health, 2005
The objectives of this study are to examine whether specific foot disorders and ankle weakness an... more The objectives of this study are to examine whether specific foot disorders and ankle weakness and foot pain are related to functional limitations or disabilities in elders. Community-dwelling adults 65 and older were enrolled in a population-based, cross-sectional study of foot disorders and health outcomes. Demographics, health status, comorbidities, self-reported foot and knee pain, function and disability, and observed structural foot disorders, body mass index, and ankle muscle strength were assessed on 717 participants. The associations of foot disorders, foot pain, and ankle muscle weakness with function and disability were examined with regression analyses. Foot disorders were not associated with functional outcomes or disability. Ankle weakness was associated with performance-based function ( p = .005), self-report function ( p < .001), and disability ( p = .009). Foot pain was associated with self-report function ( p = .01) and disability ( p = .007). Foot pain and ankl...
Disease Management and Health Outcomes, 2001