Julia Bidonde | University of Saskatchewan (original) (raw)

Papers by Julia Bidonde

Flexibility exercise training for adults with fibromyalgia (review), 2019

Background Exercise training is commonly recommended for adults with fibromyalgia. We defined fle... more Background
Exercise training is commonly recommended for adults with fibromyalgia. We defined flexibility exercise training programs as those involving movements of a joint or a series of joints, through complete range of motion, thus targeting major muscle-tendon units. This review is one of a series of reviews updating the first review published in 2002.
Objectives
To evaluate the benefits and harms of flexibility exercise training in adults with fibromyalgia.
Search methods
We searched the Cochrane Library, MEDLINE, Embase, CINAHL (Cumulative Index to Nursing and Allied Health Literature), PEDro (Physiotherapy Evidence Database), Thesis and Dissertation Abstracts, AMED (Allied and Complementary Medicine Database), the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP), and ClinicalTrials.gov up to December
2017, unrestricted by language, and we reviewed the reference lists of retrieved trials to identify potentially relevant trials.
Selection criteria
We included randomized trials (RCTs) including adults diagnosed with fibromyalgia based on published criteria. Major outcomes were health-related quality of life (HRQoL), pain intensity, stiffness, fatigue, physical function, trial withdrawals, and adverse events.
Data collection and analysis
Two review authors independently selected articles for inclusion, extracted data, performed ’Risk of bias’ assessments, and assessed the certainty of the body of evidence for major outcomes using the GRADE approach. All discrepancies were rechecked, and consensus was achieved by discussion.
Main results
We included 12 RCTs (743 people). Among these RCTs, flexibility exercise training was compared to an untreated control group, landbased aerobic training, resistance training, or other interventions (i.e. Tai Chi, Pilates, aquatic biodanza, friction massage, medications). Studies were at risk of selection, performance, and detection bias (due to lack of adequate randomization and allocation concealment, lack of participant or personnel blinding, and lack of blinding for self-reported outcomes). With the exception of withdrawals and adverse events, major outcomes were self-reported and were expressed on a 0-to-100 scale (lower values are best, negative mean differences (MDs) indicate improvement). We prioritized the findings of flexibility exercise training compared to land-based aerobic training and present them fully here. Very low-certainty evidence showed that compared with land-based aerobic training, flexibility exercise training (five trials with 266 participants) provides no clinically important benefits with regard to HRQoL, pain intensity, fatigue, stiffness, and physical function. Low-certainty evidence showed no difference between these groups for withdrawals at completion of the intervention (8 to 20 weeks). Mean HRQoL assessed on the Fibromyalgia Impact Questionnaire (FIQ) Total scale (0 to 100, higher scores indicating worse HRQoL) was 46 mm and 42 mm in the flexibility and aerobic groups, respectively (2 studies, 193 participants); absolute change was 4% worse (6% better to 14% worse), and relative change was 7.5% worse (10.5% better to 25.5% worse) in the flexibility group. Mean pain was
57 mm and 52 mm in the flexibility and aerobic groups, respectively (5 studies, 266 participants); absolute change was 5% worse (1% better to 11% worse), and relative change was 6.7% worse (2% better to 15.4% worse). Mean fatigue was 67 mm and 71 mm in the aerobic and flexibility groups, respectively (2 studies, 75 participants); absolute change was 4% better (13% better to 5% worse), and
relative change was 6% better (19.4% better to 7.4% worse). Mean physical function was 23 points and 17 points in the flexibility and aerobic groups, respectively (1 study, 60 participants); absolute change was 6% worse (4% better to 16% worse), and relative change was 14% worse (9.1% better to 37.1% worse). We found very low-certainty evidence of an effect for stiffness. Mean stiffness was 49 mm to 79 mm in the flexibility and aerobic groups, respectively (1 study, 15 participants); absolute change was 30% better (8% better to 51% better), and relative change was 39% better (10% better to 68% better). We found no evidence of an effect in all-cause withdrawal between the flexibility and aerobic groups (5 studies, 301 participants). Absolute change was 1% fewer withdrawals in the flexibility group (8% fewer to 21% more), and relative change in the flexibility group compared to the aerobic training intervention group was 3% fewer (39% fewer to 55% more). It is uncertain whether flexibility leads to long-term effects (36 weeks after a 12-week intervention), as the evidence was of low certainty and was derived from a single trial. Very low-certainty evidence indicates uncertainty in the risk of adverse events for flexibility exercise training. One adverse effect was described among the 132 participants allocated to flexibility training. One participant had tendinitis of the Achilles tendon (McCain
1988), but it is unclear if the tendinitis was a pre-existing condition.
Authors’ conclusions
When compared with aerobic training, it is uncertain whether flexibility improves outcomes such as HRQoL, pain intensity, fatigue,
stiffness, and physical function, as the certainty of the evidence is very low. Flexibility exercise training may lead to little or no difference for all-cause withdrawals. It is also uncertain whether flexibility exercise training has long-term effects due to the very low certainty of the evidence. We downgraded the evidence owing to the small number of trials and participants across trials, as well as due to issues related to unclear and high risk of bias (selection,
performance, and detection biases). While flexibility exercise training appears to be well tolerated (similar withdrawal rates across groups), evidence on adverse events was scarce, therefore its safety is uncertain.

Cochrane Database of Systematic Reviews, 2019

What is fibromyalgia and what is mixed exercise? Fibromyalgia is a condition causing chronic pain... more What is fibromyalgia and what is mixed exercise?
Fibromyalgia is a condition causing chronic pain and soreness throughout the body. People with this condition often feel depressed,
tired, and stiff, and have difficulty sleeping. Mixed exercise is defined as regular sessions of two or more types of exercise including
aerobic (walking or cycling), strengthening (lifting weights or pulling against resistance bands), or flexibility (stretching) exercise.
Study characteristics
Reviewers searched for studies until December 2017, and found 29 studies (2088 people) conducted in 12 different countries. The
average age of study participants was 51 years, and 98% were female. The average exercise programme was 14 weeks long with three
sessions of 50 to 60 minutes per week. All exercise programmes were fully or partially supervised. Reviewers were most interested in
comparing mixed exercise groups to control groups (19 studies; 1065 people). People in control groups either received no treatment or
continued their usual care.
Key results - mixed exercise vs control
Each outcome below is measured on a scale that goes from 0 to 100, where lower scores are better.
Health-related quality of life (HRQL)
After 5 to 26 weeks, people who exercised were 7% better (3% better to 11% better) or improved by 7 points on a 100 point scale.
People who exercised rated their HRQL at 49 points.
People in the control group rated their HRQL at 56 points.
Pain
After 5 to 26 weeks, people who exercised had 5% less pain (1% better to 9% better) or improved by 5 points on a 100 point scale.
People who exercised rated their pain at 53 points.
People in the control group rated their pain at 58.6 points.
Tiredness
After 14 to 24 weeks, people who exercised were 13% less tired (8% better to 18% better) or improved by 13 points on a 100 point
scale
People who exercised rated their tiredness at 59 points.
People in the control group rated their tiredness at 72 points.
Stiffness
After 16 weeks, people who exercised were 7% less stiff (1% better 1 to 12% better) or improved by 7 points on a 100 point scale.
People who exercised rated their stiffness at 61 points.
People in the control group rated their stiffness at 68 points.
Ability to do daily activities (physical function)
After 8 to 24 weeks, people who exercised were 11% better (7% to 15%) or improved by 11 points on a 100 point scale.
People who exercised rated their physical function at 38 points.
People in the control group rated their physical function at 49 points.
Harms - Some participants experienced increased pain, soreness, or tiredness during or after exercise. Studies reported no injuries or
other harms. However, reporting of harms was missing or incomplete in many studies. We are uncertain whether risk is increased with
exercise.
Leaving the study early - 11% of control participants left the study early compared with 12% of exercisers.
Long-term effects - Analysis of long-term effects of HRQL showed maintenance of mixed exercise effects at 6 to 12 weeks and at 13 to
26 weeks but not at 27 to 52 weeks. Very low-quality evidence suggests that it is uncertain whether mixed exercises improve HRQL in
the long term. Withdrawals and adverse events were not measured.
Other - Reviewers found no evidence that the benefits and harms of mixed exercise were any different from education programmes,
cognitive-behavioural training, biofeedback, medication, or other types of exercise.
Conclusions and quality of evidence
Mixed exercise may improve HRQL and the ability to do daily activities, may decrease pain and tiredness, and may be acceptable to
individuals with fibromyalgia. Low-quality evidence suggests that mixed exercise may slightly improve stiffness. When compared to
other exercise or non-exercise interventions, we are uncertain about the effects of mixed exercise. Although mixed exercise appears to
be well tolerated (similar numbers of people leaving the study across groups), evidence on harms was scarce, so we are uncertain about
its safety. Reviewers considered the quality of evidence to be low to moderate because of small numbers of people in the studies, some
issues involving study design, and the low quality of results.

Background: Fibromyalgia is a chronic disorder characterized by widespread muscular tenderness, p... more Background: Fibromyalgia is a chronic disorder characterized by widespread muscular tenderness, pain, fatigue, and cognitive difficulties. Nonpharmacological treatment options, such as physical activity, are important for people with fibromyalgia. There are strong recommendations to support engagement in physical activity for symptom management among adults with fibromyalgia. Dance is a mode of physical activity that may allow individuals with fibromyalgia to improve their physical function, health, and well-being. Dance has the potential to promote improved pain processing while simultaneously providing the health and social benefits of engaging in physical activity that contributes to symptom management and overall function rehabilitation. However, we are unaware of current evidence on dance as a nonpharmacological/physical activity intervention for adults with fibromyalgia.

Background: The majority of a child's language development occurs in the first 5 years of life wh... more Background: The majority of a child's language development occurs in the first 5 years of life when brain development is most rapid. There are significant long-term benefits to supporting all children's language and literacy development such as maximizing their developmental potential (i.e., cognitive, linguistic, social-emotional), when children are experiencing a critical period of development (i.e., early childhood to 9 years of age). A variety of people play a significant role in supporting children's language development, including parents, guardians, family members, educators, and/or speech-language pathologists. Speech-language pathologists and educators are the professionals who predominantly support children's language development in order for them to become effective communicators and lay the foundation for later developing literacy skills (i.e., reading and writing skills). Therefore, these professionals need formal and informal assessments that provide them information on a child's understanding and/or use of the increasingly complex aspects of language in order to identify and support the receptive and expressive language learning needs of diverse children during their early learning experiences (i.e., aged 1.5 to 9 years). However, evidence on what methods and tools are being used is lacking. Methods: The authors will carry out a scoping review of the literature to identify studies and map the receptive and expressive English language assessment methods and tools that have been published and used since 1980. Arksey and O'Malley's (2005) six-stage approach to conducting a scoping review was drawn upon to design the protocol for this investigation: (1) identifying the research question; (2) identifying relevant studies; (3) study selection; (4) charting the data; (5) collating, summarizing, and reporting the results; and (6) consultation. Discussion: This information will help these professionals identify and select appropriate assessment methods or tools that can be used to support development and/or identify areas of delay or difficulty and plan, implement, and monitor the progress of interventions supporting the development of receptive and expressive language skills in individuals with diverse language needs (e.g., typically developing children, children with language delays and disorders, children learning English as a second or additional language, Indigenous children who may be speaking dialects of English). Researchers plan to evaluate the effectiveness of the assessment methods or tools identified in the scoping review as an extension of this study.

Background: Fibromyalgia is a chronic disorder characterized by widespread muscular tenderness, p... more Background: Fibromyalgia is a chronic disorder characterized by widespread muscular tenderness, pain, fatigue, and cognitive difficulties. Nonpharmacological treatment options, such as physical activity, are important for people with fibromyalgia. There are strong recommendations to support engagement in physical activity for symptom management among adults with fibromyalgia. Dance is a mode of physical activity that may allow individuals with fibromyalgia to improve their physical function, health, and well-being. Dance has the potential to promote improved pain processing while simultaneously providing the health and social benefits of engaging in physical activity that contributes to symptom management. However, we are unaware of current evidence on dance as a nonpharmacological/physical activity intervention for adults with fibromyalgia.

Objectives: The use of trial registry records and randomized controlled trial (RCT) study protoco... more Objectives: The use of trial registry records and randomized controlled trial (RCT) study protocols can assist systematic reviewers in evaluating and, possibly, minimizing publication and selective reporting biases. This study examined current guidance on the use of registry records and RCT study protocols from key systematic review organizations, institutes, and collaborations. Study Design and Setting: Handbooks, guidelines, and standard documents from key systematic review organizations and the EQUATOR network database were identified. Textual excerpts providing guidance on the use of trial registry records, RCT protocols, and ongoing/unpublished studies were extracted independently by two reviewers and coded into a systematic review framework. Results: Eleven documents published in English between 2009 and 2016 were included. Guidance for using RCT protocols and trial registry records was provided for 7 of 16 framework categories, and guidance for using unpublished and ongoing studies was available for 8 of 16 categories. Conclusion: This study identified gaps and ambiguities in language in guidance on the use of RCT protocols and trial registry records. To encourage and assist reviewers to use trial registry records and RCT study protocols in systematic reviews, current guidance should be expanded and clarified.

Purpose: To describe participants' attitudes, beliefs, and experiences with the use of two method... more Purpose: To describe participants' attitudes, beliefs, and experiences with the use of two methods of scoring the Multiple Mini-Interview (MMI) for admission to a Master of Physical Therapy program: a rank-based scoring system (RBS; used from 2007 to 2013) and a criterion-based scoring system (CBS; tested in 2014). The MMI uses short independent assessments to obtain an aggregate score of candidates' professionalism and interpersonal skills, based on behavioural questions within scenarios that assess one attribute at a time. Method: This qualitative descriptive inquiry sought to capture the experiences of 18 MMI interviewers primarily through semi-structured interviews. Interviews were transcribed verbatim, and the data were analyzed using thematic analysis. The results were validated by theoretical and investigator triangulation and member checking. Results: One major theme, scoring systems, and two sub-themes, CBS and RBS, emerged across all data. Participants unanimously agreed that CBS is a more fair and objective way to score candidates' interviews. Conclusions: CBS was well accepted by participants, and the majority preferred it over RBS. Participants felt that CBS presented a more accurate depiction of candidates. Objectif : Dé crire les attitudes, les croyances et les expé riences des participants face a ` l'utilisation de deux mé thodes d'attribution d'une note a ` la mini-entrevue multiple (MEM) pour l'admission a ` un programme de maıˆtrise en physiothé rapie: un systè me de classement selon la note reç ue (RBS, utilisé de 2007 a ` 2013) et un systè me de classement selon des critè res (CBS, testé en 2014). La MEM utilise de brè ves e ´ valuations indé pendantes pour produire, au sujet du professionnalisme et des techniques de relations interpersonnelles des candidats, une note agré gé e basé e sur des questions relatives au comportement dans les scé narios qui e ´ valuent une qualité a ` la fois. Mé thode : Cette recherche descriptive qualitative visait a ` saisir les expé riences de 18 intervieweurs MEM principalement grâ ce a ` des entrevues semi-structuré es. Les entrevues ont e ´ té transcrites textuellement et l'on a analysé les donné es en appliquant une analyse thé matique. Les ré sultats ont e ´ té validé s par triangulation entre la thé orie et les chercheurs et par une vé rification auprè s des membres. Ré sultats : Un thè me de premier plan, soit les systè mes de notation, et deux sous-thè mes, soit les systè mes RBS et CBS, ont e ´ mergé de toutes les donné es. Les participants ont convenu a ` l'unanimité que le classement selon des critè res constitue une fac¸on plus e ´ quitable et objective d'attribuer une note aux entrevues des candidats. Conclusion : Les participants ont bien accepté le classement basé sur des critè res qu'ils pré fé raient en majorité au classement selon la note reç ue. Les participants e ´ taient d'avis que le classement basé sur des critè res repré sentait plus fidè lement les candidats.

Background: Violence against children is an important public health concern. Millions of children... more Background: Violence against children is an important public health concern. Millions of children across the world experience violence. There is strong evidence linking early life violence to psychological problems (e.g. depression, anxiety) and behavioural problems (e.g. suicide attempts, self‐harm, poor employment prospects). If effective interventions can be identified, these will help children to stay healthy, enable them to live an active and productive life, contribute to society, and enjoy life.
Objective: The aim of this overview of reviews was to investigate the effect of interventions for children who have been exposed to violence in close relationships.
Method: We conducted an overview of reviews in accordance with the Knowledge Centre’s handbook. We searched eleven databases up to September 2015, unrestricted by language,
to identify potentially relevant systematic reviews.
Two review authors independently selected systematic reviews for inclusion. They extracted
data, and assessed the quality of the body of evidence for the major outcomes (i.e. post‐traumatic stress disorder, mental health, adverse events, cognition, quality of life, caretaker and child relationship, and placement) using the GRADE approach (Grading of Recommendations Assessment, Development and Evaluation).
Results: We included five moderate to high quality systematic reviews published between 2008 and 2013. The reviews included interventions targeting children from 0 to 18 years; one review included children from 0 to 14 years. We classified the interventions into psychotherapy and treatment foster care. The comparator intervention was either another
active intervention or treatment as usual.Psychotherapy interventions
Six psychotherapeutic interventions were included: child‐parent psychotherapy, cognitive behavioural therapy, group psychotherapy for sexually abuse girls, play therapy, psychodynamic therapy, and trauma focused cognitive behavioural therapy.
The outcomes evaluated by these interventions were post‐traumatic stress disorder (PTSD), adverse events, and the relationship between the caretaker and the child (i.e. attachment). The pooled results in one review, which concerned the effect of trauma focused cognitive behavioural therapy (TF‐CBT), indicate the intervention may slightly
improve symptoms of PTSD (3 trials, n=389; standardized mean difference (SMD) 0.40, 95%CI 0.20 lower to 0.60 lower) at 12 weeks post intervention. However, the remaining evidence suggests it is uncertain whether these interventions decrease symptoms or improve the relationship between the caretaker and the child because the certainty
of the evidence is very low. Treatment Foster Care interventions
Eleven treatment foster care interventions were included: attachment and biobehavioural catch up, Enhanced Foster Care, Fostering Healthy Futures, Fostering Individualized Assistance Programme, Incredible Years, Keeping Foster and Kinship Parents Trained and Supported, Middle School Success, Multidimensional Treatment Foster Care, Nurse Home Visitation, Parent Child Interaction Therapy, and Treatment Foster
Care. The outcomes evaluated by these interventions were adverse events, cognition, mental health, quality of life, caretaker and child relationship (e.g. attachment) and placement (e.g. permanency). The results of these interventions suggest it is uncertain if they improve/decrease outcomes because the certainty of the evidence is very low.
Discussion
We included five moderate to high quality systematic reviews, which in total included 37 primary studies. They concerned the effect of interventions for children exposed to violence. The results from these reviews suggest that branded TF‐CBT may slightly decrease PTSD symptoms. Despite ongoing research in the area, there is uncertain evidence about the effect of other psychotherapeutic (e.g. CBT, psychodynamic, and play therapy) and treatment foster care interventions (e.g. Middle School Success, Enhanced Foster Care) for children exposed to violence. Only three reviews reported on adverse
events. Unfortunately, there is little knowledge about effective interventions for children who have experienced violence.

Archives of Physical Medicine and Rehabilitation, 2015

To describe walking measurement in children with spina bifida and to identify patterns in the use... more To describe walking measurement in children with spina bifida and to identify patterns in the use of walking measures in this population. Seven medical databases-Medline, PubMed, Embase, Scopus, Web of Science, CINAHL, and AMED-were searched from the earliest known record until March 11, 2014. Search terms encompassed 3 themes: (1) children; (2) spina bifida; and (3) walking. Articles were included if participants were children with spina bifida aged 1 to 17 years and if walking was measured. Articles were excluded if the assessment was restricted to kinematic, kinetic, or electromyographic analysis of walking. A total of 1751 abstracts were screened by 2 authors independently, and 109 articles were included in this review. Data were extracted using standardized forms. Extracted data included study and participant characteristics and details about the walking measures used, including psychometric properties. Two authors evaluated the methodological quality of articles using a previously published framework that considers sampling method, study design, and psychometric properties of the measures used. Nineteen walking measures were identified. Ordinal-level rating scales (eg, Hoffer Functional Ambulation Scale) were most commonly used (57% of articles), followed by ratio-level, spatiotemporal measures, such as walking speed (18% of articles). Walking was measured for various reasons relevant to multiple health care disciplines. A machine learning analysis was used to identify patterns in the use of walking measures. The learned classifier predicted whether a spatiotemporal measure was used with 77.1% accuracy. A trend to use spatiotemporal measures in older children and those with lumbar and sacral spinal lesions was identified. Most articles were prospective studies that used samples of convenience and unblinded assessors. Few articles evaluated or considered the psychometric properties of the walking measures used. Despite a demonstrated need to measure walking in children with spina bifida, few valid, reliable, and responsive measures have been established for this population.

Journal of Applied Sport Psychology, 2009

By means of a phenomenological case study, the meaning of a group fitness program to older women ... more By means of a phenomenological case study, the meaning of a group fitness program to older women who lived alone was described. Nine women, aged 67 to 83 years old (mean age 75) who were enrolled in a group fitness program shared their motivation to attend, the social and health benefits they received, and the significance of connecting weekly with women their own age. The analysis of in-depth semi-structured interviews and artifact documentation resulted in three themes (a) trading roles, (b) a happier me, and (c) it's our program. As single women the participants recognized that engaging in a fitness program provided a social context in which to expand networks that dwindled due to changes in family responsibilities. They also took great pride in taking responsibility for their own wellness through exercise. The meanings of the experiences were interpreted with the support of Weiss' (1973) theoretical framework on social support.

Physical Therapy Reviews, May 15, 2015

Physical Therapy Reviews, 2015

Physiotherapy Theory and Practice, 2008

Current Pain and Headache Reports, 2011

Fibromyalgia syndrome, a chronic condition typically characterized by widespread pain, nonrestora... more Fibromyalgia syndrome, a chronic condition typically characterized by widespread pain, nonrestorative sleep, fatigue, cognitive dysfunction, and other somatic symptoms, negatively impacts physical and emotional function and reduces quality of life. Exercise is commonly recommended in the management of people with fibromyalgia, and interest in examining exercise benefits for those with the syndrome has grown substantially over the past 25 years. Research supports aerobic and strength training to improve physical fitness and function, reduce fibromyalgia symptoms, and improve quality of life. However, other forms of exercise (e.g., tai chi, yoga, Nordic walking, vibration techniques) and lifestyle physical activity also have been investigated to determine their effects. This paper highlights findings from recent randomized controlled trials and reviews of exercise for people with fibromyalgia, and includes information regarding factors that influence response and adherence to exercise to assist clinicians with exercise and physical activity prescription decision-making to optimize health and well-being.

Current Rheumatology Reviews, 2014

Flexibility exercise training for adults with fibromyalgia (review), 2019

Background Exercise training is commonly recommended for adults with fibromyalgia. We defined fle... more Background
Exercise training is commonly recommended for adults with fibromyalgia. We defined flexibility exercise training programs as those involving movements of a joint or a series of joints, through complete range of motion, thus targeting major muscle-tendon units. This review is one of a series of reviews updating the first review published in 2002.
Objectives
To evaluate the benefits and harms of flexibility exercise training in adults with fibromyalgia.
Search methods
We searched the Cochrane Library, MEDLINE, Embase, CINAHL (Cumulative Index to Nursing and Allied Health Literature), PEDro (Physiotherapy Evidence Database), Thesis and Dissertation Abstracts, AMED (Allied and Complementary Medicine Database), the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP), and ClinicalTrials.gov up to December
2017, unrestricted by language, and we reviewed the reference lists of retrieved trials to identify potentially relevant trials.
Selection criteria
We included randomized trials (RCTs) including adults diagnosed with fibromyalgia based on published criteria. Major outcomes were health-related quality of life (HRQoL), pain intensity, stiffness, fatigue, physical function, trial withdrawals, and adverse events.
Data collection and analysis
Two review authors independently selected articles for inclusion, extracted data, performed ’Risk of bias’ assessments, and assessed the certainty of the body of evidence for major outcomes using the GRADE approach. All discrepancies were rechecked, and consensus was achieved by discussion.
Main results
We included 12 RCTs (743 people). Among these RCTs, flexibility exercise training was compared to an untreated control group, landbased aerobic training, resistance training, or other interventions (i.e. Tai Chi, Pilates, aquatic biodanza, friction massage, medications). Studies were at risk of selection, performance, and detection bias (due to lack of adequate randomization and allocation concealment, lack of participant or personnel blinding, and lack of blinding for self-reported outcomes). With the exception of withdrawals and adverse events, major outcomes were self-reported and were expressed on a 0-to-100 scale (lower values are best, negative mean differences (MDs) indicate improvement). We prioritized the findings of flexibility exercise training compared to land-based aerobic training and present them fully here. Very low-certainty evidence showed that compared with land-based aerobic training, flexibility exercise training (five trials with 266 participants) provides no clinically important benefits with regard to HRQoL, pain intensity, fatigue, stiffness, and physical function. Low-certainty evidence showed no difference between these groups for withdrawals at completion of the intervention (8 to 20 weeks). Mean HRQoL assessed on the Fibromyalgia Impact Questionnaire (FIQ) Total scale (0 to 100, higher scores indicating worse HRQoL) was 46 mm and 42 mm in the flexibility and aerobic groups, respectively (2 studies, 193 participants); absolute change was 4% worse (6% better to 14% worse), and relative change was 7.5% worse (10.5% better to 25.5% worse) in the flexibility group. Mean pain was
57 mm and 52 mm in the flexibility and aerobic groups, respectively (5 studies, 266 participants); absolute change was 5% worse (1% better to 11% worse), and relative change was 6.7% worse (2% better to 15.4% worse). Mean fatigue was 67 mm and 71 mm in the aerobic and flexibility groups, respectively (2 studies, 75 participants); absolute change was 4% better (13% better to 5% worse), and
relative change was 6% better (19.4% better to 7.4% worse). Mean physical function was 23 points and 17 points in the flexibility and aerobic groups, respectively (1 study, 60 participants); absolute change was 6% worse (4% better to 16% worse), and relative change was 14% worse (9.1% better to 37.1% worse). We found very low-certainty evidence of an effect for stiffness. Mean stiffness was 49 mm to 79 mm in the flexibility and aerobic groups, respectively (1 study, 15 participants); absolute change was 30% better (8% better to 51% better), and relative change was 39% better (10% better to 68% better). We found no evidence of an effect in all-cause withdrawal between the flexibility and aerobic groups (5 studies, 301 participants). Absolute change was 1% fewer withdrawals in the flexibility group (8% fewer to 21% more), and relative change in the flexibility group compared to the aerobic training intervention group was 3% fewer (39% fewer to 55% more). It is uncertain whether flexibility leads to long-term effects (36 weeks after a 12-week intervention), as the evidence was of low certainty and was derived from a single trial. Very low-certainty evidence indicates uncertainty in the risk of adverse events for flexibility exercise training. One adverse effect was described among the 132 participants allocated to flexibility training. One participant had tendinitis of the Achilles tendon (McCain
1988), but it is unclear if the tendinitis was a pre-existing condition.
Authors’ conclusions
When compared with aerobic training, it is uncertain whether flexibility improves outcomes such as HRQoL, pain intensity, fatigue,
stiffness, and physical function, as the certainty of the evidence is very low. Flexibility exercise training may lead to little or no difference for all-cause withdrawals. It is also uncertain whether flexibility exercise training has long-term effects due to the very low certainty of the evidence. We downgraded the evidence owing to the small number of trials and participants across trials, as well as due to issues related to unclear and high risk of bias (selection,
performance, and detection biases). While flexibility exercise training appears to be well tolerated (similar withdrawal rates across groups), evidence on adverse events was scarce, therefore its safety is uncertain.

Cochrane Database of Systematic Reviews, 2019

What is fibromyalgia and what is mixed exercise? Fibromyalgia is a condition causing chronic pain... more What is fibromyalgia and what is mixed exercise?
Fibromyalgia is a condition causing chronic pain and soreness throughout the body. People with this condition often feel depressed,
tired, and stiff, and have difficulty sleeping. Mixed exercise is defined as regular sessions of two or more types of exercise including
aerobic (walking or cycling), strengthening (lifting weights or pulling against resistance bands), or flexibility (stretching) exercise.
Study characteristics
Reviewers searched for studies until December 2017, and found 29 studies (2088 people) conducted in 12 different countries. The
average age of study participants was 51 years, and 98% were female. The average exercise programme was 14 weeks long with three
sessions of 50 to 60 minutes per week. All exercise programmes were fully or partially supervised. Reviewers were most interested in
comparing mixed exercise groups to control groups (19 studies; 1065 people). People in control groups either received no treatment or
continued their usual care.
Key results - mixed exercise vs control
Each outcome below is measured on a scale that goes from 0 to 100, where lower scores are better.
Health-related quality of life (HRQL)
After 5 to 26 weeks, people who exercised were 7% better (3% better to 11% better) or improved by 7 points on a 100 point scale.
People who exercised rated their HRQL at 49 points.
People in the control group rated their HRQL at 56 points.
Pain
After 5 to 26 weeks, people who exercised had 5% less pain (1% better to 9% better) or improved by 5 points on a 100 point scale.
People who exercised rated their pain at 53 points.
People in the control group rated their pain at 58.6 points.
Tiredness
After 14 to 24 weeks, people who exercised were 13% less tired (8% better to 18% better) or improved by 13 points on a 100 point
scale
People who exercised rated their tiredness at 59 points.
People in the control group rated their tiredness at 72 points.
Stiffness
After 16 weeks, people who exercised were 7% less stiff (1% better 1 to 12% better) or improved by 7 points on a 100 point scale.
People who exercised rated their stiffness at 61 points.
People in the control group rated their stiffness at 68 points.
Ability to do daily activities (physical function)
After 8 to 24 weeks, people who exercised were 11% better (7% to 15%) or improved by 11 points on a 100 point scale.
People who exercised rated their physical function at 38 points.
People in the control group rated their physical function at 49 points.
Harms - Some participants experienced increased pain, soreness, or tiredness during or after exercise. Studies reported no injuries or
other harms. However, reporting of harms was missing or incomplete in many studies. We are uncertain whether risk is increased with
exercise.
Leaving the study early - 11% of control participants left the study early compared with 12% of exercisers.
Long-term effects - Analysis of long-term effects of HRQL showed maintenance of mixed exercise effects at 6 to 12 weeks and at 13 to
26 weeks but not at 27 to 52 weeks. Very low-quality evidence suggests that it is uncertain whether mixed exercises improve HRQL in
the long term. Withdrawals and adverse events were not measured.
Other - Reviewers found no evidence that the benefits and harms of mixed exercise were any different from education programmes,
cognitive-behavioural training, biofeedback, medication, or other types of exercise.
Conclusions and quality of evidence
Mixed exercise may improve HRQL and the ability to do daily activities, may decrease pain and tiredness, and may be acceptable to
individuals with fibromyalgia. Low-quality evidence suggests that mixed exercise may slightly improve stiffness. When compared to
other exercise or non-exercise interventions, we are uncertain about the effects of mixed exercise. Although mixed exercise appears to
be well tolerated (similar numbers of people leaving the study across groups), evidence on harms was scarce, so we are uncertain about
its safety. Reviewers considered the quality of evidence to be low to moderate because of small numbers of people in the studies, some
issues involving study design, and the low quality of results.

Background: Fibromyalgia is a chronic disorder characterized by widespread muscular tenderness, p... more Background: Fibromyalgia is a chronic disorder characterized by widespread muscular tenderness, pain, fatigue, and cognitive difficulties. Nonpharmacological treatment options, such as physical activity, are important for people with fibromyalgia. There are strong recommendations to support engagement in physical activity for symptom management among adults with fibromyalgia. Dance is a mode of physical activity that may allow individuals with fibromyalgia to improve their physical function, health, and well-being. Dance has the potential to promote improved pain processing while simultaneously providing the health and social benefits of engaging in physical activity that contributes to symptom management and overall function rehabilitation. However, we are unaware of current evidence on dance as a nonpharmacological/physical activity intervention for adults with fibromyalgia.

Background: The majority of a child's language development occurs in the first 5 years of life wh... more Background: The majority of a child's language development occurs in the first 5 years of life when brain development is most rapid. There are significant long-term benefits to supporting all children's language and literacy development such as maximizing their developmental potential (i.e., cognitive, linguistic, social-emotional), when children are experiencing a critical period of development (i.e., early childhood to 9 years of age). A variety of people play a significant role in supporting children's language development, including parents, guardians, family members, educators, and/or speech-language pathologists. Speech-language pathologists and educators are the professionals who predominantly support children's language development in order for them to become effective communicators and lay the foundation for later developing literacy skills (i.e., reading and writing skills). Therefore, these professionals need formal and informal assessments that provide them information on a child's understanding and/or use of the increasingly complex aspects of language in order to identify and support the receptive and expressive language learning needs of diverse children during their early learning experiences (i.e., aged 1.5 to 9 years). However, evidence on what methods and tools are being used is lacking. Methods: The authors will carry out a scoping review of the literature to identify studies and map the receptive and expressive English language assessment methods and tools that have been published and used since 1980. Arksey and O'Malley's (2005) six-stage approach to conducting a scoping review was drawn upon to design the protocol for this investigation: (1) identifying the research question; (2) identifying relevant studies; (3) study selection; (4) charting the data; (5) collating, summarizing, and reporting the results; and (6) consultation. Discussion: This information will help these professionals identify and select appropriate assessment methods or tools that can be used to support development and/or identify areas of delay or difficulty and plan, implement, and monitor the progress of interventions supporting the development of receptive and expressive language skills in individuals with diverse language needs (e.g., typically developing children, children with language delays and disorders, children learning English as a second or additional language, Indigenous children who may be speaking dialects of English). Researchers plan to evaluate the effectiveness of the assessment methods or tools identified in the scoping review as an extension of this study.

Background: Fibromyalgia is a chronic disorder characterized by widespread muscular tenderness, p... more Background: Fibromyalgia is a chronic disorder characterized by widespread muscular tenderness, pain, fatigue, and cognitive difficulties. Nonpharmacological treatment options, such as physical activity, are important for people with fibromyalgia. There are strong recommendations to support engagement in physical activity for symptom management among adults with fibromyalgia. Dance is a mode of physical activity that may allow individuals with fibromyalgia to improve their physical function, health, and well-being. Dance has the potential to promote improved pain processing while simultaneously providing the health and social benefits of engaging in physical activity that contributes to symptom management. However, we are unaware of current evidence on dance as a nonpharmacological/physical activity intervention for adults with fibromyalgia.

Objectives: The use of trial registry records and randomized controlled trial (RCT) study protoco... more Objectives: The use of trial registry records and randomized controlled trial (RCT) study protocols can assist systematic reviewers in evaluating and, possibly, minimizing publication and selective reporting biases. This study examined current guidance on the use of registry records and RCT study protocols from key systematic review organizations, institutes, and collaborations. Study Design and Setting: Handbooks, guidelines, and standard documents from key systematic review organizations and the EQUATOR network database were identified. Textual excerpts providing guidance on the use of trial registry records, RCT protocols, and ongoing/unpublished studies were extracted independently by two reviewers and coded into a systematic review framework. Results: Eleven documents published in English between 2009 and 2016 were included. Guidance for using RCT protocols and trial registry records was provided for 7 of 16 framework categories, and guidance for using unpublished and ongoing studies was available for 8 of 16 categories. Conclusion: This study identified gaps and ambiguities in language in guidance on the use of RCT protocols and trial registry records. To encourage and assist reviewers to use trial registry records and RCT study protocols in systematic reviews, current guidance should be expanded and clarified.

Purpose: To describe participants' attitudes, beliefs, and experiences with the use of two method... more Purpose: To describe participants' attitudes, beliefs, and experiences with the use of two methods of scoring the Multiple Mini-Interview (MMI) for admission to a Master of Physical Therapy program: a rank-based scoring system (RBS; used from 2007 to 2013) and a criterion-based scoring system (CBS; tested in 2014). The MMI uses short independent assessments to obtain an aggregate score of candidates' professionalism and interpersonal skills, based on behavioural questions within scenarios that assess one attribute at a time. Method: This qualitative descriptive inquiry sought to capture the experiences of 18 MMI interviewers primarily through semi-structured interviews. Interviews were transcribed verbatim, and the data were analyzed using thematic analysis. The results were validated by theoretical and investigator triangulation and member checking. Results: One major theme, scoring systems, and two sub-themes, CBS and RBS, emerged across all data. Participants unanimously agreed that CBS is a more fair and objective way to score candidates' interviews. Conclusions: CBS was well accepted by participants, and the majority preferred it over RBS. Participants felt that CBS presented a more accurate depiction of candidates. Objectif : Dé crire les attitudes, les croyances et les expé riences des participants face a ` l'utilisation de deux mé thodes d'attribution d'une note a ` la mini-entrevue multiple (MEM) pour l'admission a ` un programme de maıˆtrise en physiothé rapie: un systè me de classement selon la note reç ue (RBS, utilisé de 2007 a ` 2013) et un systè me de classement selon des critè res (CBS, testé en 2014). La MEM utilise de brè ves e ´ valuations indé pendantes pour produire, au sujet du professionnalisme et des techniques de relations interpersonnelles des candidats, une note agré gé e basé e sur des questions relatives au comportement dans les scé narios qui e ´ valuent une qualité a ` la fois. Mé thode : Cette recherche descriptive qualitative visait a ` saisir les expé riences de 18 intervieweurs MEM principalement grâ ce a ` des entrevues semi-structuré es. Les entrevues ont e ´ té transcrites textuellement et l'on a analysé les donné es en appliquant une analyse thé matique. Les ré sultats ont e ´ té validé s par triangulation entre la thé orie et les chercheurs et par une vé rification auprè s des membres. Ré sultats : Un thè me de premier plan, soit les systè mes de notation, et deux sous-thè mes, soit les systè mes RBS et CBS, ont e ´ mergé de toutes les donné es. Les participants ont convenu a ` l'unanimité que le classement selon des critè res constitue une fac¸on plus e ´ quitable et objective d'attribuer une note aux entrevues des candidats. Conclusion : Les participants ont bien accepté le classement basé sur des critè res qu'ils pré fé raient en majorité au classement selon la note reç ue. Les participants e ´ taient d'avis que le classement basé sur des critè res repré sentait plus fidè lement les candidats.

Background: Violence against children is an important public health concern. Millions of children... more Background: Violence against children is an important public health concern. Millions of children across the world experience violence. There is strong evidence linking early life violence to psychological problems (e.g. depression, anxiety) and behavioural problems (e.g. suicide attempts, self‐harm, poor employment prospects). If effective interventions can be identified, these will help children to stay healthy, enable them to live an active and productive life, contribute to society, and enjoy life.
Objective: The aim of this overview of reviews was to investigate the effect of interventions for children who have been exposed to violence in close relationships.
Method: We conducted an overview of reviews in accordance with the Knowledge Centre’s handbook. We searched eleven databases up to September 2015, unrestricted by language,
to identify potentially relevant systematic reviews.
Two review authors independently selected systematic reviews for inclusion. They extracted
data, and assessed the quality of the body of evidence for the major outcomes (i.e. post‐traumatic stress disorder, mental health, adverse events, cognition, quality of life, caretaker and child relationship, and placement) using the GRADE approach (Grading of Recommendations Assessment, Development and Evaluation).
Results: We included five moderate to high quality systematic reviews published between 2008 and 2013. The reviews included interventions targeting children from 0 to 18 years; one review included children from 0 to 14 years. We classified the interventions into psychotherapy and treatment foster care. The comparator intervention was either another
active intervention or treatment as usual.Psychotherapy interventions
Six psychotherapeutic interventions were included: child‐parent psychotherapy, cognitive behavioural therapy, group psychotherapy for sexually abuse girls, play therapy, psychodynamic therapy, and trauma focused cognitive behavioural therapy.
The outcomes evaluated by these interventions were post‐traumatic stress disorder (PTSD), adverse events, and the relationship between the caretaker and the child (i.e. attachment). The pooled results in one review, which concerned the effect of trauma focused cognitive behavioural therapy (TF‐CBT), indicate the intervention may slightly
improve symptoms of PTSD (3 trials, n=389; standardized mean difference (SMD) 0.40, 95%CI 0.20 lower to 0.60 lower) at 12 weeks post intervention. However, the remaining evidence suggests it is uncertain whether these interventions decrease symptoms or improve the relationship between the caretaker and the child because the certainty
of the evidence is very low. Treatment Foster Care interventions
Eleven treatment foster care interventions were included: attachment and biobehavioural catch up, Enhanced Foster Care, Fostering Healthy Futures, Fostering Individualized Assistance Programme, Incredible Years, Keeping Foster and Kinship Parents Trained and Supported, Middle School Success, Multidimensional Treatment Foster Care, Nurse Home Visitation, Parent Child Interaction Therapy, and Treatment Foster
Care. The outcomes evaluated by these interventions were adverse events, cognition, mental health, quality of life, caretaker and child relationship (e.g. attachment) and placement (e.g. permanency). The results of these interventions suggest it is uncertain if they improve/decrease outcomes because the certainty of the evidence is very low.
Discussion
We included five moderate to high quality systematic reviews, which in total included 37 primary studies. They concerned the effect of interventions for children exposed to violence. The results from these reviews suggest that branded TF‐CBT may slightly decrease PTSD symptoms. Despite ongoing research in the area, there is uncertain evidence about the effect of other psychotherapeutic (e.g. CBT, psychodynamic, and play therapy) and treatment foster care interventions (e.g. Middle School Success, Enhanced Foster Care) for children exposed to violence. Only three reviews reported on adverse
events. Unfortunately, there is little knowledge about effective interventions for children who have experienced violence.

Archives of Physical Medicine and Rehabilitation, 2015

To describe walking measurement in children with spina bifida and to identify patterns in the use... more To describe walking measurement in children with spina bifida and to identify patterns in the use of walking measures in this population. Seven medical databases-Medline, PubMed, Embase, Scopus, Web of Science, CINAHL, and AMED-were searched from the earliest known record until March 11, 2014. Search terms encompassed 3 themes: (1) children; (2) spina bifida; and (3) walking. Articles were included if participants were children with spina bifida aged 1 to 17 years and if walking was measured. Articles were excluded if the assessment was restricted to kinematic, kinetic, or electromyographic analysis of walking. A total of 1751 abstracts were screened by 2 authors independently, and 109 articles were included in this review. Data were extracted using standardized forms. Extracted data included study and participant characteristics and details about the walking measures used, including psychometric properties. Two authors evaluated the methodological quality of articles using a previously published framework that considers sampling method, study design, and psychometric properties of the measures used. Nineteen walking measures were identified. Ordinal-level rating scales (eg, Hoffer Functional Ambulation Scale) were most commonly used (57% of articles), followed by ratio-level, spatiotemporal measures, such as walking speed (18% of articles). Walking was measured for various reasons relevant to multiple health care disciplines. A machine learning analysis was used to identify patterns in the use of walking measures. The learned classifier predicted whether a spatiotemporal measure was used with 77.1% accuracy. A trend to use spatiotemporal measures in older children and those with lumbar and sacral spinal lesions was identified. Most articles were prospective studies that used samples of convenience and unblinded assessors. Few articles evaluated or considered the psychometric properties of the walking measures used. Despite a demonstrated need to measure walking in children with spina bifida, few valid, reliable, and responsive measures have been established for this population.

Journal of Applied Sport Psychology, 2009

By means of a phenomenological case study, the meaning of a group fitness program to older women ... more By means of a phenomenological case study, the meaning of a group fitness program to older women who lived alone was described. Nine women, aged 67 to 83 years old (mean age 75) who were enrolled in a group fitness program shared their motivation to attend, the social and health benefits they received, and the significance of connecting weekly with women their own age. The analysis of in-depth semi-structured interviews and artifact documentation resulted in three themes (a) trading roles, (b) a happier me, and (c) it's our program. As single women the participants recognized that engaging in a fitness program provided a social context in which to expand networks that dwindled due to changes in family responsibilities. They also took great pride in taking responsibility for their own wellness through exercise. The meanings of the experiences were interpreted with the support of Weiss' (1973) theoretical framework on social support.

Physical Therapy Reviews, May 15, 2015

Physical Therapy Reviews, 2015

Physiotherapy Theory and Practice, 2008

Current Pain and Headache Reports, 2011

Fibromyalgia syndrome, a chronic condition typically characterized by widespread pain, nonrestora... more Fibromyalgia syndrome, a chronic condition typically characterized by widespread pain, nonrestorative sleep, fatigue, cognitive dysfunction, and other somatic symptoms, negatively impacts physical and emotional function and reduces quality of life. Exercise is commonly recommended in the management of people with fibromyalgia, and interest in examining exercise benefits for those with the syndrome has grown substantially over the past 25 years. Research supports aerobic and strength training to improve physical fitness and function, reduce fibromyalgia symptoms, and improve quality of life. However, other forms of exercise (e.g., tai chi, yoga, Nordic walking, vibration techniques) and lifestyle physical activity also have been investigated to determine their effects. This paper highlights findings from recent randomized controlled trials and reviews of exercise for people with fibromyalgia, and includes information regarding factors that influence response and adherence to exercise to assist clinicians with exercise and physical activity prescription decision-making to optimize health and well-being.

Current Rheumatology Reviews, 2014