M. Tousignant - Academia.edu (original) (raw)
Papers by M. Tousignant
International Journal of Telerehabilitation, 2009
The purpose of this study was to investigate the efficacy of in-home telerehabilitation as an alt... more The purpose of this study was to investigate the efficacy of in-home telerehabilitation as an alternative to conventional rehabilitation services following knee arthroplasty. Five community-living elders who had knee arthroplasty were recruited prior to discharge from an acute care hospital. A pre/post-test design without a control group was used for this pilot study. Telerehabilitation sessions (16) were conducted by two trained physiotherapists from a service center to the patient’s home using H264 videoconference CODECs (Tandberg 550 MXP) connected at 512 Kb\s. Disability (range of motion, balance and lower body strength) and function (locomotor performance in walking and functional autonomy) were measured in face-to-face evaluations prior to and at the end of the treatments by a neutral evaluator. The satisfaction of the health care professional and patient was measured by questionnaire. Results are as follows. One participant was lost during follow-up. Clinical outcomes improve...
![Research paper thumbnail of [Development of indicators to promote measures for the prevention and rehabilitation of functional decline in older people]](https://attachments.academia-assets.com/94465111/thumbnails/1.jpg)
](Revue d'épidémiologie et de santé publique, 2012
In Europe and Asia, long-term care funding is disability-based. This introduces a perverse effect... more In Europe and Asia, long-term care funding is disability-based. This introduces a perverse effect by inappropriately adding value to functional decline among beneficiaries. To support the efforts in prevention and rehabilitation made by personnel in long-term care services, indicators have to be developed to promote functional improvement of beneficiaries. As people receiving those services are already experiencing a functional decline process, it is essential to know the natural magnitude of functional decline in order to assess deviation from this expected decline. The objective of the study was to estimate the natural decrease of autonomy in beneficiaries of home care services and nursing homes. Two databases were used: for home-dwelling people, 1235 subjects over 75 years old who participated in the PRISMA study; for institutions, 1330 residents over 65 years old of a nursing home in Sherbrooke (QC, Canada). These subjects were assessed several times over many years with the Fun...
Disability and Rehabilitation, 2011
To assess some fall-related clinical variables (balance, gait, fear of falling, functional autono... more To assess some fall-related clinical variables (balance, gait, fear of falling, functional autonomy, self-actualization and self-efficacy) that might explain the fact that supervised Tai Chi has a better impact on preventing falls compared to a conventional physiotherapy program. Methods: The participants (152 older adults over 65 who were admitted to a geriatric day hospital program) were randomly assigned to either a supervised Tai Chi group or the usual physiotherapy. The presence of the clinical variables related to falls was evaluated before the intervention (T1), immediately after (T2), and 12 months after the end of the intervention (T3). Results: Both exercise programs significantly improved fall-related outcomes but only the Tai Chi intervention group decreased the incidence of falls. For both groups, most variables followed the same pattern, i.e. showed significant improvement with the intervention between T1 and T2, and followed by a statistically significant decrease at the T3 evaluation. However, self-efficacy was the only variable that improved solely with the Tai Chi intervention (p = 0.001). Conclusions: The impact of supervised Tai Chi on fall prevention can not be explained by a differential effect on balance, gait and fear of falling. It appeared to be related to an increase of general self-efficacy, a phenomenon which is not seen in the conventional physiotherapy program.
Lecture Notes in Computer Science, 2012
Demands for rehabilitation services, particularly in-home care and outpatient clinics, are increa... more Demands for rehabilitation services, particularly in-home care and outpatient clinics, are increasing and are difficult to meet. In-home telerehabilitation is growing as a complement or alternative to face-to-face therapy. The technological aspect of telerehabilitation is in constant evolution and is central to a high quality and efficient way for rehabilitation delivery. The aim of this presentation is to demonstrate technological innovations used "inhome" with the telerehabilitation platform over the years (generations 1 and 2 of the technological infrastructure). The improvements made from the first to the second generation partly implied the use of external sensors to allow a real time follow-up of clinical parameters. These changes have permitted research and new studies to target new populations for teletreatment.
Journal of back and musculoskeletal rehabilitation, 2002
The purpose was to estimate the criterion validity of the Back Range of Motion (BROM II) and Elec... more The purpose was to estimate the criterion validity of the Back Range of Motion (BROM II) and Electronic Digital Inclinometer (EDI-320) devices. METHODS. This study compared the range of motion measurements of low back pain (LBP) patients taken with the BROM II and EDI-320 with measurements using the double inclinometer (DI) method as the gold standard. Forty subjects with LBP volunteered for the study. The subjects were asked to do three forward flexion movements. A measurement was taken with each of the three different devices for each movement. The BROM II demonstrated good linear relationship (Pearson r = 0.78; 95% CI: 0.78-0.94) and the EDI-320 very good linear relationship (Pearson r = 0.88; 95% CI: 0.62-0.89) with the gold standard, the DI. The Pearson correlation value indicates good validity of the EDI-320 in our sample of LBP patients. Although a good correlation was established for the BROM II, the significant difference of the mean ROM reported for this instrument compare...
Work (Reading, Mass.), 2011
Identify barriers and facilitators related to the use of low-back pain guidelines as perceived by... more Identify barriers and facilitators related to the use of low-back pain guidelines as perceived by occupational therapists (OTs). A qualitative approach was used. Nine OTs with varied characteristics were randomly selected. Participants were asked to use the guidelines with at least two clients. Semi-structured interviews were done to identify barriers and facilitators related to use. Transcripts of the interviews were analyzed. Participants agreed with the guidelines, found them compatible with their current practice, and believed using them would help in preventing persistent disability. Some questioned if their work organization, based on group therapy, would limit their use of the guidelines. Because of the guidelines' biopsychosocial perspective, they anticipated problems regarding client expectations and collaboration with other health professionals. Participating OTs raised few barriers related to them. Barriers were mostly related to client expectations, work organization...
BMC geriatrics, Jan 13, 2007
Functional status or disability forms the core of most assessment instruments used to identify mi... more Functional status or disability forms the core of most assessment instruments used to identify mix and level of resources and services needed by older adults who possess common characteristics. The Functional Autonomy Measurement System (SMAF) is a 29-item scale measuring functional ability in five different areas. It has been recommended for use for home care, for allocation of chronic beds, for developing care plans in institutional settings and for epidemiological and evaluative studies. The SMAF can also be used with a case-mix classification system (Iso-SMAF) to allocate resources based on patients' functional autonomy characteristics. The objective of this project was to develop a software version of the SMAF to facilitate the evaluation of the functional status of older adults in health services research and to optimize the clinical decision-making process. The eSMAF was developed over an 24-month period using a modified waterfall software engineering process. Requirement...
Physical therapy, 2001
A structured and rigorous methodology was developed for the formulation of evidence-based clinica... more A structured and rigorous methodology was developed for the formulation of evidence-based clinical practice guidelines (EBCPGs), then was used to develop EBCPGs for selected rehabilitation interventions for the management of low back, neck, knee, and shoulder pain. Evidence from randomized controlled trials (RCTs) and observational studies was identified and synthesized using methods defined by the Cochrane Collaboration that minimize bias by using a systematic approach to literature search, study selection, data extraction, and data synthesis. Meta-analyses were conducted where possible. The strength of evidence was graded as level I for RCTs or level II for nonrandomized studies. An expert panel was formed by inviting stakeholder professional organizations to nominate a representative. This panel developed a set of criteria for grading the strength of both the evidence and the recommendation. The panel decided that evidence of clinically important benefit (defined as 15% greater r...
The purpose of this study was to investigate the satisfaction of patients and physiotherapists to... more The purpose of this study was to investigate the satisfaction of patients and physiotherapists toward technology used during in-home teletreatment following discharge from an acute care hospital after a stroke. The teletreatment that was delivered to the patients consisted of 45-minute sessions of exercises inspired from Tai Chi movements, twice a week, over a period of 8 weeks. The health care services satisfaction questionnaire was completed by the patients at the end of the intervention. The subjective appreciation of the technical quality of the physiotherapist using the technology during the telerehabilitation treatment was noted at the end of each treatment session. The analyses for this pilot study have thus been completed on a total of 6 patients and over 96 sessions by a physiotherapist. Satisfaction towards health care services provided was high for both patients (86%) and physiotherapists (90%). While patient satisfaction is very important in maintaining treatment compliance, the satisfaction of health care professionals must be high in order for new treatments to become mainstream in clinics. Our results show that in-home telerehabilitation seems to be a promising alternative to traditional face-to-face treatments.
expertise-sante.com
... Michel Tousignant, PhD, Réjean Hébert, M., MPhil Nicole Dubuc, PhD, Carole Coulombe, Danielle... more ... Michel Tousignant, PhD, Réjean Hébert, M., MPhil Nicole Dubuc, PhD, Carole Coulombe, Danielle Benoit, Guylaine Allard ... Il comporte 29 items mesurant les habiletés fonctionnelles de cinq domaines : les activités de la vie quotidienne (7 items), la mobilité (6 items), la ...
Trials, 2014
Background: The incidence of strokes in industrialized nations is on the rise, particularly in th... more Background: The incidence of strokes in industrialized nations is on the rise, particularly in the older population. In Canada, a minority of individuals who have had a stroke actually receive intensive rehabilitation because most stroke patients do not have access to services or because their motor recovery was judged adequate to return home. Thus, there is a considerable need to organize home-based rehabilitation services for everyone who has had a stroke. To meet this demand, telerehabilitation, particularly from a service center to the patient's home, is a promising alternative approach that can help improve access to rehabilitation services once patients are discharged home. Methods/Design: This non-inferiority study will include patients who have returned home post-stroke without requiring intensive rehabilitation. To be included in the study, participants will: 1) not be referred to an Intensive Functional Rehabilitation Unit, 2) have a Rankin score of 2 or 3, and 3) have a balance problem (Berg Balance Scale score between 46 and 54). Participants will be randomly assigned to either the teletreatment group or the home visits group. Except for the delivery mode, the intervention will be the same for both groups, that is, a personalized Tai Chi-based exercise program conducted by a trained physiotherapist (45-minute session twice a week for eight consecutive weeks). The main objective of this research is to test the non-inferiority of a Tai Chi-based exercise program provided via telerehabilitation compared to the same program provided in person at home in terms of effectiveness for retraining balance in individuals who have had a stroke but do not require intensive functional rehabilitation. The main outcome of this study is balance and mobility measured with the Community Balance and Mobility Scale. Secondary outcomes include physical and psychological capacities related to balance and mobility, participants' quality of life, satisfaction with services received, and cost-effectiveness associated with the provision of both types of services. Study/trial registration: ClinicalTrials.gov: NCT01848080
Telemedicine and e-Health, 2011
Objective: We measured the satisfaction of both patients and healthcare professionals with the te... more Objective: We measured the satisfaction of both patients and healthcare professionals with the technologies and services provided during in-home telerehabilitation as an alternative to conventional rehabilitation after discharge from total knee arthroplasty surgery. Methods: This study was embedded in a larger controlled trial where 48 community-living older adults who received total knee arthroplasty were recruited prior to discharge from acute care following surgery and randomly assigned to treatment arms (Tele and Comparison). The participants' satisfaction with the services was assessed at the end of the intervention for both groups using the Healthcare Satisfaction Questionnaire. For the Tele group, the patients' perception of in-home telehealth was assessed before treatment and after completion of teletreatments. The satisfaction of the healthcare professionals with the technology during the telerehabilitation services was noted at the end of each treatment session using a technical quality subjective appreciation questionnaire. Results: Both groups of patients (Tele and Comparison) were satisfied with the services received and no significant difference was observed between them. Moreover, the physiotherapists' satisfaction with regard to goal achievement, patient-therapist relationship, overall session satisfaction, and quality and performance of the technological platform was high. Conclusions: As patient satisfaction is important in maintaining motivation and treatment compliance and the satisfaction of healthcare professionals must be high in order for new treatments to become mainstream in clinics, the results show that in-home telerehabilitation seems to be a promising alternative to traditional face-to-face treatments.
Physiotherapy Research International, 1997
Background and Purpose A new parallelogram goniometer was designed by the Rehabilitation Centre o... more Background and Purpose A new parallelogram goniometer was designed by the Rehabilitation Centre of the Royal Ottawa Health Care Group in 1983. The advantage of using such a goniometer is that the clinician is not required to estimate the joint axis of rotation when taking a measurement. The parallelogram goniometer has obtained a good intratester and intertester reliability when measuring active range of motion of hip abduction on eight individuals with hip pathologies. However, the validity of the parallelogram goniometer has not been examined. The purposes of this study were to examine the intratester and intertester reliability and the criterion validity of the parallelogram and universal goniometers for active knee flexion on healthy individuals. Subjects: Sixty healthy university students (44 females and 16 males; mean age of 20.6 yrs.) participated to this study. Methods Measurements with the universal and parallelogram goniometers were taken in two different positions, the smaller and larger angles of active knee flexion. All measurements were taken by two trained testers. A radiograph was taken in both positions to serve as the 'gold standard'. The sequence of the measurements and radiographs were randomly selected. The intra and intertester reliability of both goniometers were established by calculating the intraclass correlation coefficients (ICCs) using the repeated-measures ANOVA. The criterion validity was examined by calculating Pearson product-moment correlation coefficients (r) between each goniometric and radiologic measurements. A 0.05 level of significance was chosen for each statistical test. Results Intratester reliability ranged from good to excellent for the small angles (ICC=0.85 and 0.87) and the large angles (ICC=0.91 and 0.96) when using the parallelogram goniometer. Intertester reliability was fair for the small angles of flexion (ICC=0.43 to 0.52) and good to excellent for the large angles of flexion (ICC=0.82 to 0.88). The parallelogram goniometer was found to have
Manual Therapy, 2001
This study examined the intratester and intertester reliability of the electronic digital goniome... more This study examined the intratester and intertester reliability of the electronic digital goniometer EDI-320 for the measurement of active neck flexion and extension in healthy subjects. In the context of evidence-based practice, the EDI-320 instrument has the potential to improve patient assessment, provide a clearer picture of patient progress, and confirm the effectiveness of physiotherapy interventions. However, the psychometric properties of the EDI-320 have not yet been documented for cervical spine range of motion. Forty-four individuals with no known history of cervical disorder within the three months prior to the testing, voluntarily consented to participate in this study. Repeated measurements with the EDI-320 were taken by two trained testers (TH1 and TH2) and data were recorded by two separate observers. Subjects performed a standardized warm-up. Testers were required to repeat palpation of bony landmarks prior to each trial. Measurements were taken at the end-range of active cervical flexion and extension for each subject. Both testers measured each subject twice. The intraclass correlation coefficients (ICC) were derived from one-way ANOVA for intratester reliability and a two-way ANOVA for intertester reliability. Paired t -tests were then applied to verify for systematic error. Moderate intratester reliability was found for both testers for flexion (TH1: ICC=0.77; 95% CI: 0.62-0.87; TH2: ICC=0.77; 95% CI: 0.58-0.87). As for extension, high intratester reliability was found for TH1 (ICC=0.79; 95% CI: 0.65-0.88) and moderate for TH2: (ICC=0.83; 95% CI: 0.63-0.92). Intertester reliability results showed a moderate reliability for both flexion and extension (ICC=0.66; 95% CI: 0.24-0.84) on the first trial. On the second trial, reliability was moderate for flexion (ICC=0.73; 95% CI: 0.53-0.85) and high for extension (ICC=0.80; 95% CI: 0.64-0.89). The t -test analysis revealed the inclusion of systematic error by Tester 2 for intratester reliability. This error was also found for all but one of the intertester reliability calculations. This study has shown that the EDI-320 is a moderately reliable instrument for quantifying cervical flexion and extension range of motion. The presence of systematic error in the study highlights the importance of following standardized procedures and suggests that the EDI-320 could be more reliable than reported in this study. Further psychometric studies investigating the validity of the EDI and reliability with subjects affected by cervical pathology is warranted.
Journal of Stroke and Cerebrovascular Diseases, 1997
The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 2010
International Journal of Telerehabilitation, 2009
The purpose of this study was to investigate the efficacy of in-home telerehabilitation as an alt... more The purpose of this study was to investigate the efficacy of in-home telerehabilitation as an alternative to conventional rehabilitation services following knee arthroplasty. Five community-living elders who had knee arthroplasty were recruited prior to discharge from an acute care hospital. A pre/post-test design without a control group was used for this pilot study. Telerehabilitation sessions (16) were conducted by two trained physiotherapists from a service center to the patient’s home using H264 videoconference CODECs (Tandberg 550 MXP) connected at 512 Kb\s. Disability (range of motion, balance and lower body strength) and function (locomotor performance in walking and functional autonomy) were measured in face-to-face evaluations prior to and at the end of the treatments by a neutral evaluator. The satisfaction of the health care professional and patient was measured by questionnaire. Results are as follows. One participant was lost during follow-up. Clinical outcomes improve...
Revue d'épidémiologie et de santé publique, 2012
In Europe and Asia, long-term care funding is disability-based. This introduces a perverse effect... more In Europe and Asia, long-term care funding is disability-based. This introduces a perverse effect by inappropriately adding value to functional decline among beneficiaries. To support the efforts in prevention and rehabilitation made by personnel in long-term care services, indicators have to be developed to promote functional improvement of beneficiaries. As people receiving those services are already experiencing a functional decline process, it is essential to know the natural magnitude of functional decline in order to assess deviation from this expected decline. The objective of the study was to estimate the natural decrease of autonomy in beneficiaries of home care services and nursing homes. Two databases were used: for home-dwelling people, 1235 subjects over 75 years old who participated in the PRISMA study; for institutions, 1330 residents over 65 years old of a nursing home in Sherbrooke (QC, Canada). These subjects were assessed several times over many years with the Fun...
Disability and Rehabilitation, 2011
To assess some fall-related clinical variables (balance, gait, fear of falling, functional autono... more To assess some fall-related clinical variables (balance, gait, fear of falling, functional autonomy, self-actualization and self-efficacy) that might explain the fact that supervised Tai Chi has a better impact on preventing falls compared to a conventional physiotherapy program. Methods: The participants (152 older adults over 65 who were admitted to a geriatric day hospital program) were randomly assigned to either a supervised Tai Chi group or the usual physiotherapy. The presence of the clinical variables related to falls was evaluated before the intervention (T1), immediately after (T2), and 12 months after the end of the intervention (T3). Results: Both exercise programs significantly improved fall-related outcomes but only the Tai Chi intervention group decreased the incidence of falls. For both groups, most variables followed the same pattern, i.e. showed significant improvement with the intervention between T1 and T2, and followed by a statistically significant decrease at the T3 evaluation. However, self-efficacy was the only variable that improved solely with the Tai Chi intervention (p = 0.001). Conclusions: The impact of supervised Tai Chi on fall prevention can not be explained by a differential effect on balance, gait and fear of falling. It appeared to be related to an increase of general self-efficacy, a phenomenon which is not seen in the conventional physiotherapy program.
Lecture Notes in Computer Science, 2012
Demands for rehabilitation services, particularly in-home care and outpatient clinics, are increa... more Demands for rehabilitation services, particularly in-home care and outpatient clinics, are increasing and are difficult to meet. In-home telerehabilitation is growing as a complement or alternative to face-to-face therapy. The technological aspect of telerehabilitation is in constant evolution and is central to a high quality and efficient way for rehabilitation delivery. The aim of this presentation is to demonstrate technological innovations used "inhome" with the telerehabilitation platform over the years (generations 1 and 2 of the technological infrastructure). The improvements made from the first to the second generation partly implied the use of external sensors to allow a real time follow-up of clinical parameters. These changes have permitted research and new studies to target new populations for teletreatment.
Journal of back and musculoskeletal rehabilitation, 2002
The purpose was to estimate the criterion validity of the Back Range of Motion (BROM II) and Elec... more The purpose was to estimate the criterion validity of the Back Range of Motion (BROM II) and Electronic Digital Inclinometer (EDI-320) devices. METHODS. This study compared the range of motion measurements of low back pain (LBP) patients taken with the BROM II and EDI-320 with measurements using the double inclinometer (DI) method as the gold standard. Forty subjects with LBP volunteered for the study. The subjects were asked to do three forward flexion movements. A measurement was taken with each of the three different devices for each movement. The BROM II demonstrated good linear relationship (Pearson r = 0.78; 95% CI: 0.78-0.94) and the EDI-320 very good linear relationship (Pearson r = 0.88; 95% CI: 0.62-0.89) with the gold standard, the DI. The Pearson correlation value indicates good validity of the EDI-320 in our sample of LBP patients. Although a good correlation was established for the BROM II, the significant difference of the mean ROM reported for this instrument compare...
Work (Reading, Mass.), 2011
Identify barriers and facilitators related to the use of low-back pain guidelines as perceived by... more Identify barriers and facilitators related to the use of low-back pain guidelines as perceived by occupational therapists (OTs). A qualitative approach was used. Nine OTs with varied characteristics were randomly selected. Participants were asked to use the guidelines with at least two clients. Semi-structured interviews were done to identify barriers and facilitators related to use. Transcripts of the interviews were analyzed. Participants agreed with the guidelines, found them compatible with their current practice, and believed using them would help in preventing persistent disability. Some questioned if their work organization, based on group therapy, would limit their use of the guidelines. Because of the guidelines' biopsychosocial perspective, they anticipated problems regarding client expectations and collaboration with other health professionals. Participating OTs raised few barriers related to them. Barriers were mostly related to client expectations, work organization...
BMC geriatrics, Jan 13, 2007
Functional status or disability forms the core of most assessment instruments used to identify mi... more Functional status or disability forms the core of most assessment instruments used to identify mix and level of resources and services needed by older adults who possess common characteristics. The Functional Autonomy Measurement System (SMAF) is a 29-item scale measuring functional ability in five different areas. It has been recommended for use for home care, for allocation of chronic beds, for developing care plans in institutional settings and for epidemiological and evaluative studies. The SMAF can also be used with a case-mix classification system (Iso-SMAF) to allocate resources based on patients' functional autonomy characteristics. The objective of this project was to develop a software version of the SMAF to facilitate the evaluation of the functional status of older adults in health services research and to optimize the clinical decision-making process. The eSMAF was developed over an 24-month period using a modified waterfall software engineering process. Requirement...
Physical therapy, 2001
A structured and rigorous methodology was developed for the formulation of evidence-based clinica... more A structured and rigorous methodology was developed for the formulation of evidence-based clinical practice guidelines (EBCPGs), then was used to develop EBCPGs for selected rehabilitation interventions for the management of low back, neck, knee, and shoulder pain. Evidence from randomized controlled trials (RCTs) and observational studies was identified and synthesized using methods defined by the Cochrane Collaboration that minimize bias by using a systematic approach to literature search, study selection, data extraction, and data synthesis. Meta-analyses were conducted where possible. The strength of evidence was graded as level I for RCTs or level II for nonrandomized studies. An expert panel was formed by inviting stakeholder professional organizations to nominate a representative. This panel developed a set of criteria for grading the strength of both the evidence and the recommendation. The panel decided that evidence of clinically important benefit (defined as 15% greater r...
The purpose of this study was to investigate the satisfaction of patients and physiotherapists to... more The purpose of this study was to investigate the satisfaction of patients and physiotherapists toward technology used during in-home teletreatment following discharge from an acute care hospital after a stroke. The teletreatment that was delivered to the patients consisted of 45-minute sessions of exercises inspired from Tai Chi movements, twice a week, over a period of 8 weeks. The health care services satisfaction questionnaire was completed by the patients at the end of the intervention. The subjective appreciation of the technical quality of the physiotherapist using the technology during the telerehabilitation treatment was noted at the end of each treatment session. The analyses for this pilot study have thus been completed on a total of 6 patients and over 96 sessions by a physiotherapist. Satisfaction towards health care services provided was high for both patients (86%) and physiotherapists (90%). While patient satisfaction is very important in maintaining treatment compliance, the satisfaction of health care professionals must be high in order for new treatments to become mainstream in clinics. Our results show that in-home telerehabilitation seems to be a promising alternative to traditional face-to-face treatments.
expertise-sante.com
... Michel Tousignant, PhD, Réjean Hébert, M., MPhil Nicole Dubuc, PhD, Carole Coulombe, Danielle... more ... Michel Tousignant, PhD, Réjean Hébert, M., MPhil Nicole Dubuc, PhD, Carole Coulombe, Danielle Benoit, Guylaine Allard ... Il comporte 29 items mesurant les habiletés fonctionnelles de cinq domaines : les activités de la vie quotidienne (7 items), la mobilité (6 items), la ...
Trials, 2014
Background: The incidence of strokes in industrialized nations is on the rise, particularly in th... more Background: The incidence of strokes in industrialized nations is on the rise, particularly in the older population. In Canada, a minority of individuals who have had a stroke actually receive intensive rehabilitation because most stroke patients do not have access to services or because their motor recovery was judged adequate to return home. Thus, there is a considerable need to organize home-based rehabilitation services for everyone who has had a stroke. To meet this demand, telerehabilitation, particularly from a service center to the patient's home, is a promising alternative approach that can help improve access to rehabilitation services once patients are discharged home. Methods/Design: This non-inferiority study will include patients who have returned home post-stroke without requiring intensive rehabilitation. To be included in the study, participants will: 1) not be referred to an Intensive Functional Rehabilitation Unit, 2) have a Rankin score of 2 or 3, and 3) have a balance problem (Berg Balance Scale score between 46 and 54). Participants will be randomly assigned to either the teletreatment group or the home visits group. Except for the delivery mode, the intervention will be the same for both groups, that is, a personalized Tai Chi-based exercise program conducted by a trained physiotherapist (45-minute session twice a week for eight consecutive weeks). The main objective of this research is to test the non-inferiority of a Tai Chi-based exercise program provided via telerehabilitation compared to the same program provided in person at home in terms of effectiveness for retraining balance in individuals who have had a stroke but do not require intensive functional rehabilitation. The main outcome of this study is balance and mobility measured with the Community Balance and Mobility Scale. Secondary outcomes include physical and psychological capacities related to balance and mobility, participants' quality of life, satisfaction with services received, and cost-effectiveness associated with the provision of both types of services. Study/trial registration: ClinicalTrials.gov: NCT01848080
Telemedicine and e-Health, 2011
Objective: We measured the satisfaction of both patients and healthcare professionals with the te... more Objective: We measured the satisfaction of both patients and healthcare professionals with the technologies and services provided during in-home telerehabilitation as an alternative to conventional rehabilitation after discharge from total knee arthroplasty surgery. Methods: This study was embedded in a larger controlled trial where 48 community-living older adults who received total knee arthroplasty were recruited prior to discharge from acute care following surgery and randomly assigned to treatment arms (Tele and Comparison). The participants' satisfaction with the services was assessed at the end of the intervention for both groups using the Healthcare Satisfaction Questionnaire. For the Tele group, the patients' perception of in-home telehealth was assessed before treatment and after completion of teletreatments. The satisfaction of the healthcare professionals with the technology during the telerehabilitation services was noted at the end of each treatment session using a technical quality subjective appreciation questionnaire. Results: Both groups of patients (Tele and Comparison) were satisfied with the services received and no significant difference was observed between them. Moreover, the physiotherapists' satisfaction with regard to goal achievement, patient-therapist relationship, overall session satisfaction, and quality and performance of the technological platform was high. Conclusions: As patient satisfaction is important in maintaining motivation and treatment compliance and the satisfaction of healthcare professionals must be high in order for new treatments to become mainstream in clinics, the results show that in-home telerehabilitation seems to be a promising alternative to traditional face-to-face treatments.
Physiotherapy Research International, 1997
Background and Purpose A new parallelogram goniometer was designed by the Rehabilitation Centre o... more Background and Purpose A new parallelogram goniometer was designed by the Rehabilitation Centre of the Royal Ottawa Health Care Group in 1983. The advantage of using such a goniometer is that the clinician is not required to estimate the joint axis of rotation when taking a measurement. The parallelogram goniometer has obtained a good intratester and intertester reliability when measuring active range of motion of hip abduction on eight individuals with hip pathologies. However, the validity of the parallelogram goniometer has not been examined. The purposes of this study were to examine the intratester and intertester reliability and the criterion validity of the parallelogram and universal goniometers for active knee flexion on healthy individuals. Subjects: Sixty healthy university students (44 females and 16 males; mean age of 20.6 yrs.) participated to this study. Methods Measurements with the universal and parallelogram goniometers were taken in two different positions, the smaller and larger angles of active knee flexion. All measurements were taken by two trained testers. A radiograph was taken in both positions to serve as the 'gold standard'. The sequence of the measurements and radiographs were randomly selected. The intra and intertester reliability of both goniometers were established by calculating the intraclass correlation coefficients (ICCs) using the repeated-measures ANOVA. The criterion validity was examined by calculating Pearson product-moment correlation coefficients (r) between each goniometric and radiologic measurements. A 0.05 level of significance was chosen for each statistical test. Results Intratester reliability ranged from good to excellent for the small angles (ICC=0.85 and 0.87) and the large angles (ICC=0.91 and 0.96) when using the parallelogram goniometer. Intertester reliability was fair for the small angles of flexion (ICC=0.43 to 0.52) and good to excellent for the large angles of flexion (ICC=0.82 to 0.88). The parallelogram goniometer was found to have
Manual Therapy, 2001
This study examined the intratester and intertester reliability of the electronic digital goniome... more This study examined the intratester and intertester reliability of the electronic digital goniometer EDI-320 for the measurement of active neck flexion and extension in healthy subjects. In the context of evidence-based practice, the EDI-320 instrument has the potential to improve patient assessment, provide a clearer picture of patient progress, and confirm the effectiveness of physiotherapy interventions. However, the psychometric properties of the EDI-320 have not yet been documented for cervical spine range of motion. Forty-four individuals with no known history of cervical disorder within the three months prior to the testing, voluntarily consented to participate in this study. Repeated measurements with the EDI-320 were taken by two trained testers (TH1 and TH2) and data were recorded by two separate observers. Subjects performed a standardized warm-up. Testers were required to repeat palpation of bony landmarks prior to each trial. Measurements were taken at the end-range of active cervical flexion and extension for each subject. Both testers measured each subject twice. The intraclass correlation coefficients (ICC) were derived from one-way ANOVA for intratester reliability and a two-way ANOVA for intertester reliability. Paired t -tests were then applied to verify for systematic error. Moderate intratester reliability was found for both testers for flexion (TH1: ICC=0.77; 95% CI: 0.62-0.87; TH2: ICC=0.77; 95% CI: 0.58-0.87). As for extension, high intratester reliability was found for TH1 (ICC=0.79; 95% CI: 0.65-0.88) and moderate for TH2: (ICC=0.83; 95% CI: 0.63-0.92). Intertester reliability results showed a moderate reliability for both flexion and extension (ICC=0.66; 95% CI: 0.24-0.84) on the first trial. On the second trial, reliability was moderate for flexion (ICC=0.73; 95% CI: 0.53-0.85) and high for extension (ICC=0.80; 95% CI: 0.64-0.89). The t -test analysis revealed the inclusion of systematic error by Tester 2 for intratester reliability. This error was also found for all but one of the intertester reliability calculations. This study has shown that the EDI-320 is a moderately reliable instrument for quantifying cervical flexion and extension range of motion. The presence of systematic error in the study highlights the importance of following standardized procedures and suggests that the EDI-320 could be more reliable than reported in this study. Further psychometric studies investigating the validity of the EDI and reliability with subjects affected by cervical pathology is warranted.
Journal of Stroke and Cerebrovascular Diseases, 1997
The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 2010