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Biomedical subjects

Dina Brooks

Publications and source records attributed to Dina Brooks.

At least 19 recordsLinked to original sources
PubMed2006

Do functional walk tests reflect cardiorespiratory fitness in sub-acute stroke?

BACKGROUND AND PURPOSE: The Six-Minute Walk Test (6MWT) has been employed as a measure of functional capacity, but its relationship to cardiorespiratory fitness in stroke is not well established. Gait speed measured over short distances is commonly used as an index of walking competency following stroke. We evaluated the relationship between the 6MWT, aerobic fitness (VO2peak) and walking competency in sub-acute stroke. METHODS: Thirty-six individuals (mean age +/- SD, 64.6 +/- 14.4 years; time post-stroke 16.2 +/- 13.3 days) were evaluated using the 6MWT (distance, speed, heart rate), a maximal exercise test (VO2peak, heart rate, exercise test duration), and walking competency using a five meter walk (speed, symmetry ratio). Correlation analyses were used to examine the relationships between these outcomes. RESULTS: There was a strong correlation between the 6MWT and five meter walk velocity for preferred (r = 0.79) and fast (r = 0.82) speed (p < 0.001). On average, the 6MWT speed was faster than the preferred gait speed (94.9 cm/s vs. 83.8 cm/s, p = 0.003), but slower than the fast-paced walk (115.1 cm/s, p < 0.001). There was significant though more moderate association between 6MWT distance and VO2peak (r = 0.56, p < 0.001) and exercise test duration (r = 0.60, p < 0.001). CONCLUSION: The speed selected during the 6MWT was strongly related to the velocities selected during the five meter walk distance (intermediate to the selected preferred and fast speeds). Although the 6MWT may be challenging to the cardiorespiratory system, it appears to be more strongly influenced by potential limits to walking speed rather than cardiorespiratory capacity. As a result, this test is not, by itself, an adequate measure of aerobic fitness early after stroke.

Journal Article↗
PubMed2006

Self-care approaches to managing chronic obstructive pulmonary disease: a provincial survey.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a common chronic respiratory condition associated with considerable personal and social burden yet little is known about how patients manage their condition. PURPOSE: The purpose of this study was to identify, from the perspective of individuals living with COPD, their management approaches. METHODS: A mailed survey was conducted with individuals living in Ontario with physician confirmed COPD who experienced daily respiratory symptoms. Potential participants were identified through existing databases. Questionnaire development was based on focus groups and pilot testing. RESULTS: Completed questionnaires were received from 353 of the 452 eligible participants, representing a 78% response rate. The mean age of responders was 68 +/- 12 years (sd) with 52% male, 85% ex-smokers, 52% with moderate COPD (self-report) and 52% treated by a family physician. Common strategies used by participants included inhaled bronchodilators (100%), annual influenza vaccination (90%), aerobic types of activity (75%), regular physician visits (72%), breathing exercises (69%) and inhaled steroids (67%). Forty-four percent of participants had scores indicative of depression. Participants (68%) reported using a shared decision-making model for management decisions and were satisfied with their interactions with the health care team (physician and non-physician). CONCLUSION: Most individuals with COPD use several strategies to manage their disease. Health care professionals have an important role in ensuring that evidence-based guidelines for COPD are translated to patients.

Activities of Daily Living↗
PubMed2006

Validity of 3 physical performance measures in inpatient geriatric rehabilitation.

OBJECTIVE: To evaluate the construct validity and the responsiveness of 3 measures of physical performance measures as outcome measures for frail older persons. DESIGN: Pre-post design with measures at admission and discharge. SETTING: Three inpatient geriatric rehabilitation programs. PARTICIPANTS: Fifty-two subjects (35 women, 17 men; age, 80+/-8y). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Physical performance measures were Timed Up & Go (TUG) test, two-minute walk test (2MWT), and functional reach. Functional status was measured with the FIM instrument and the Modified Barthel Index. RESULTS: The TUG and 2MWT scores differed significantly in groups of patients using different ambulatory aids (P=.006), whereas no such difference was observed for the functional reach (P=.40). The correlations between the TUG test and FIM and between the 2MWT and FIM were -.59 and .59 (P<.001), respectively, at admission, and -.42 and .47 (P< or =.04), respectively, at admission and discharge. The correlations between functional reach and the FIM were not significant (P> or =.09). Standardized response means were 1.1 for the TUG, 0.7 for the 2MWT, and 0.5 for functional reach. CONCLUSIONS: The TUG test and 2MWT are valid and responsive outcome measures in older persons participating in geriatric rehabilitation. Functional reach was a moderately responsive outcome measure but did not consistently reflect ambulatory or functional status.

Activities of Daily Living↗
PubMed2006

Maximal exercise test results in subacute stroke.

OBJECTIVES: To establish the feasibility and reliability of graded maximal exercise testing, suitability of standard indexes of maximum oxygen consumption (Vo(2)max), and evidence of trial-to-trial practice effects in subacute stroke. DESIGN: Descriptive, cross-sectional study. SETTING: Rehabilitation hospital. PARTICIPANTS: Consecutive sample of 35 participants (mean age, 65.7+/-2.6 y; mean days poststroke, 17.6+/-2.2 d). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Graded maximal exercise test using semirecumbent cycle ergometry. A subset (n=20) performed repeated tests to determine test-retest reliability and presence of practice effects. RESULTS: Thirty-one (89%) participants completed the exercise test without symptomatic responses (mean peak level of oxygen consumed [Vo(2)peak], 10.7 mL.kg(-1).min(-1); peak work rate, 39 W). Twelve (34%), 15 (44%), and 3 (9%) participants achieved oxygen consumption per unit time (Vo(2)) plateau, respiratory exchange ratio, and heart rate criteria, respectively. Although test-retest correlations were high (intraclass correlation coefficient range, .67-.87), higher Vo(2)peak (1.0 mL.kg(-1).min(-1), P=.04) and work rate (7.3 W, P=.01) were observed with repeated testing, with no associated increase in reaching standard criteria for Vo(2)max. CONCLUSIONS: This work has important implications for developing guidelines for measuring aerobic capacity early after stroke. Although maximal exercise testing using semirecumbent cycle ergometry is feasible, standard Vo(2)max criteria are not consistently appropriate. At least 1 practice trial is recommended before the actual evaluation is performed.

Adult↗
PubMed2006

Referral to and discharge from cardiac rehabilitation: key informant views on continuity of care.

OBJECTIVES: To assess the system-level barriers and facilitators of continuity of care from acute care to cardiac rehabilitation (CR), and from CR discharge to follow-up with primary health care providers. METHOD: Semi-structured individual interviews with 24 key informants including CR staff, research scientists, policy makers, cardiologists and other doctors from a regional to international level were conducted regarding the processes of referral to and discharge from cardiac rehabilitation. Key informant interviews were audio taped, transcribed, and imported into QSR N6 software for Grounded analysis. RESULTS: Themes that emerged related to communication, referral and discharge processes, health care provider practices, inter- and intra-institutional relationships, and alternative models of delivery to improve continuity. CONCLUSIONS: Ramifications for enhancing referral of patients to beneficial CR services and follow-up by primary care providers to ensure maintenance of functional and health-related gains are discussed.

Communication↗
PubMed2006

Effect of rollator use on health-related quality of life in individuals with COPD.

OBJECTIVE: The purpose of this study was to evaluate the influence of rollator use on health-related quality of life in patients with COPD. DESIGN: Randomized controlled trial. METHODS: Thirty-one postrehabilitation patients with COPD were randomized to receive a rollator (n = 18) or usual care (n = 13) for 8 weeks and to record the frequency of rollator use. Outcome measures at baseline, 4 weeks, and 8 weeks included the Chronic Respiratory Questionnaire (CRQ) and the 6-min walk (6MW). RESULTS: During acute testing, subjects consistently walked further when assisted (baseline 6MW: 292 +/- 67 m vs 263 +/- 67 m; 8 weeks: 283 +/- 65 m vs 259 +/- 68 m [+/-SD]; p = 0.013). However, provision of a rollator at home was not associated with group differences in the CRQ (p > 0.08) or in the unassisted 6MW (p = 0.4) or the assisted 6MW (p = 0.5). Eight of 18 subjects assigned to the rollator group used the rollator less than three times per week. Regular users demonstrated a consistent improvement in mastery compared with infrequent users (4 weeks: 4.7 +/- 0.6 vs 5.2 +/- 0.8, respectively; 8 weeks: 5.3 +/- 0.8 vs 4.7 +/- 0.4; p = 0.014). CONCLUSIONS: Despite evidence of effectiveness during acute testing, this study did not demonstrate a rollator effect on quality of life or exercise capacity when the rollator was provided at home, for a longer period. Actual use of a rollator may be an important determinant of its effect. Therefore, when prescribing a rollator, health-care professionals should attempt to identify those most likely to use it.

Aged↗
PubMed2005

Reliability and validity of the AGREE instrument used by physical therapists in assessment of clinical practice guidelines.

BACKGROUND: The AGREE instrument has been validated for evaluating Clinical Practice Guidelines (CPG) pertaining to medical care. This study evaluated the reliability and validity of physical therapists using the AGREE to assess quality of CPGs relevant to physical therapy practice. METHODS: A total of 69 physical therapists participated and were classified as generalists, specialist or researchers. Pairs of appraisers within each category evaluated independently, a set of 6 CPG selected at random from a pool of 55 CPGs. RESULTS: Reliability between pairs of appraisers indicated low to high reliability depending on the domain and number of appraisers (0.17-0.81 for single appraiser; 0.30-0.96 when score averaged across a pair of appraisers). The highest reliability was achieved for Rigour of Development, which exceeded ICC> 0.79, if scores from pairs of appraisers were pooled. Adding more than 3 appraisers did not consistently improve reliability. Appraiser type did not determine reliability scores. End-users, including study participants and a separate sample of 102 physical therapy students, found the AGREE useful to guide critical appraisal. The construct validity of the AGREE was supported in that expected differences on Rigour of Development domains were observed between expert panels versus those with no/uncertain expertise (differences of 10-21% p = 0.09-0.001). Factor analysis with varimax rotation, produced a 4-factor solution that was similar, although not in exact agreement with the AGREE Domains. Validity was also supported by the correlation observed (Kendall-tao = 0.69) between Overall Assessment and the Rigour of Development domain. CONCLUSION: These findings suggest that the AGREE instrument is reliable and valid when used by physiotherapists to assess the quality of CPG pertaining to physical therapy health services.

Cardiology↗
PubMed2005

Illness perceptions among cardiac patients: relation to depressive symptomatology and sex.

OBJECTIVE: This study examined cardiovascular disease (CVD) illness perceptions and how they relate to depressive symptomatology among women and men. METHODS: Acute coronary syndrome (ACS) patients at two hospitals were approached, and 661 consented to participate (504 men, 157 women; 75% response rate). Participants completed a survey including the Hospital Anxiety and Depression Scale (HADS) and Illness Perception Questionnaire (IPQ). RESULTS: Women perceived a significantly more chronic course (P<.001) and more cyclical episodes (P<.05) than men did, while men perceived greater personal control (P<.001) and treatability (P<.05) than women did. Participants perceived diet, heredity, and stress as the greatest CVD causes. For women (F=5.49, P<.001), greater depressive symptomatology was significantly related to younger age (P<.05), lower activity status (P<.001), and perceiving a chronic time course (P<.01). For men (F=7.68, P<.001), greater depressive symptomatology was significantly related to being non-white (P<.05), lower activity status (P<.001), less exercise behavior (P=.01), and three illness perceptions, namely, perceiving a chronic course (P<.05), greater consequences (P<.001), and lower treatability (P<.05). CONCLUSION: Women, compared with men, are more likely to attribute CVD to causes beyond their control and to perceive CVD as a chronic, untreatable condition. Illness perceptions were related to depressive symptomatology, which suggests that interventions to reframe these perceptions may be warranted to improve emotional health in the context of CVD.

Acute Disease↗
PubMed2005

Inspiratory muscle training in adults with chronic obstructive pulmonary disease: a systematic review.

The purpose of this study was to conduct a systematic review to determine the effect of inspiratory muscle training (IMT) on inspiratory muscle strength and endurance, exercise capacity, dyspnea and quality of life for adults with chronic obstructive pulmonary disease (COPD). A systematic review of the literature was conducted according the Cochrane Collaboration protocol using Medline and CINAHL. Nineteen of 274 extracted articles met the inclusion criteria and addressed comparisons of interest which included: IMT versus sham; IMT versus no intervention; low- versus high-intensity IMT; and two different modes of IMT. Thirteen meta-analyses were reported. Results indicate that targeted resistive or threshold IMT was associated with significant improvements in some outcomes of inspiratory muscle strength (PI(max) (cm H2O)) and endurance (Inspiratory Threshold Loading (kPa)), exercise capacity (Borg Scale for Respiratory Effort (modified Borg scale), Work Rate maximum (Watts)), and dyspnea (Transition Dyspnea Index), whereas IMT without a target or not using threshold training did not show improvement in these variables. There was no conclusive evidence regarding quality of life measures. IMT is effective for adults with COPD when using threshold or targeted devices that control or provide a target for training intensity.

Adolescent↗
PubMed2005

Inspiratory muscle training compared with other rehabilitation interventions in adults with chronic obstructive pulmonary disease: a systematic literature review and meta-analysis.

The purpose of this systematic review was to determine the effect of inspiratory muscle training (IMT) (alone or combined with exercise and/or pulmonary rehabilitation) compared to other rehabilitation interventions such as: exercise, education, other breathing techniques or exercise and/or pulmonary rehabilitation among adults with chronic obstructive pulmonary disease (COPD). A systematic review of the literature on IMT and COPD was conducted according to the Cochrane Collaboration protocol. Inclusion criteria for the review included randomized controlled trials, published in English, comparing IMT or combined IMT and exercise/pulmonary rehabilitation with other rehabilitation interventions such as general exercise, education, other breathing techniques or exercise/pulmonary rehabilitation among adults with COPD. 274 articles were retrieved, and 16 met the inclusion criteria. Seven meta-analyses were performed that compared targeted or threshold IMT to exercise (n = 3) or to education (n = 4). Results showed significant improvements in inspiratory muscle strength and endurance, and in the dyspnea scale on a quality of life measure, for participants in the IMT versus education group. In other instances where meta-analyses could not be performed, a qualitative review was performed. IMT results in improved inspiratory muscle strength and endurance compared to education. Further trials are required to investigate the effect of IMT (or combined IMT) compared to other rehabilitation inventions for outcomes such as dyspnea, exercise tolerance, and quality of life.

Adult↗
PubMed2005

Is inspiratory muscle training effective for individuals with cervical spinal cord injury? A qualitative systematic review.

OBJECTIVE: To perform a systematic review to determine the effect of inspiratory muscle training (IMT) in adults with cervical spinal cord injury (CSCI). DESIGN: A systematic search of the literature on IMT and CSCI according to the Cochrane Collaboration protocol was performed. We searched electronic databases up to August 2003 including MEDLINE and CINAHL, searched reference lists from pertinent articles and books, made personal contact with authors, and hand searched targeted journals to identify potential studies for inclusion. STUDY SELECTION: Inclusion criteria for the review included randomized controlled trials published in English comparing IMT with another comparison group among adults with CSCI. DATA EXTRACTION: Two reviewers abstracted relevant data from included studies. Methodological quality of the studies was assessed using criteria developed by Jadad et al. We also assessed whether the comparison groups were similar at baseline and whether an intention-to-treat analysis was performed. RESULTS: Forty articles were retrieved and three met the inclusion criteria. All studies used inspiratory resistance muscle trainers for at least 15 min, twice daily, five to seven days per week for six to eight weeks. Meta-analysis could not be performed due to differences in study design and outcomes. Only one study reported a positive effect of IMTcompared to control for measures of dyspnoea and pulmonary function. CONCLUSION: Literature on the effect of IMT among adults with CSCI is scarce and an overall effect could not be confirmed.

Breathing Exercises↗
PubMed2005

Increasing patient-initiation of cardiac rehabilitation referral in female percutaneous coronary intervention patients.

Substantial health risks continue following coronary revascularization, and cardiac rehabilitation (CR) plays a large role in enhancing prognosis. However, fewer women than men are referred to and participate in CR. This study prospectively evaluates a psycho-educational intervention designed to increase patient-initiation of CR referral discussion with their physician, It was hypothesized that an educational brochure along with a motivational interview would facilitate the discussion of CR between physicians and female patients, ultimately resulting in increased referral of women to CR when compared to a control group. Eighty female percutaneous coronary intervention patients were recruited from two acute care sites in Toronto, Ontario. Eight weeks later, a second research assistant blind to condition telephoned participants to assess aftercare and CR referral processes. Results showed that patients in the experimental group more often discussed CR with a health care provider (chi2(1)=5.99, p=.01), and there was a trend toward increased referral when compared to control patients (chi2(1)=2.83, p=.09). Gaps in secondary prevention are noted, and areas for improved referral of women patients to CR are discussed.

Aged↗
PubMed2004

The two-minute walk test as a measure of functional capacity in cardiac surgery patients.

OBJECTIVE: To examine construct validity and sensitivity of the two-minute walk test (2MWT) in cardiac surgery patients. DESIGN: Measurements were made in patients preoperatively, during the postoperative in-hospital stay, and 6 to 8 weeks after discharge from hospital. SETTING: Ambulatory and hospitalized care. PARTICIPANTS: Patients (N=122; mean age +/- standard deviation, 63+/-9 y) undergoing coronary artery bypass grafting. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The 2MWT, New York Heart Association (NYHA) functional classification for cardiac disease, the Nottingham Extended Activities of Daily Living scale, and the Medical Outcomes Survey 36-Item Short-Form Health Questionnaire (SF-36). RESULTS: Distance walked in 2 minutes decreased significantly postoperatively (from 138+/-26 m to 84+/-33 m, P<.001), but increased again at follow-up (151+/-31 m, P<.0001). Distance walked on the 2MWT correlated significantly to SF-36 (physical function subscale) preoperatively (r=.44) and at follow-up (r=.48) (P<.001). There was a significant difference in distance walked between those with NYHA class I and II compared with those classified as III or IV (P=.04). However, there was no significant difference in distance walked in 2 minutes between those who developed cardiac or pulmonary complications postoperatively (P> or =0.2). CONCLUSIONS: The 2MWT was sensitive to change after cardiac surgery and showed moderate correlation with measures of physical functioning in this population. However, the 2MWT could not identify those who developed complications in the postoperative period.

Activities of Daily Living↗
PubMed2004

The development of a helpline for chronic obstructive pulmonary disease (COPD).

BACKGROUND: The goal of the helpline is to assist individuals with chronic obstructive pulmonary disease (COPD) better manage their disease through improved understanding of COPD, its symptoms and treatment. OBJECTIVES: The purpose of this project was to develop and validate a protocol for a COPD helpline. METHODS: Ten key informants with expertise in helpline development or COPD were interviewed. Fifty individuals with COPD participated in content validation of the protocol. RESULTS: An initial protocol for the helpline aimed to provide: (1) information and education regarding COPD and its management via the telephone and with written materials; (2) guidance regarding course of management; (3) resource links to other support services and programs locally, provincially, and/or nationally; and (4) caring support and reassurance to those with COPD and their families. The majority of the calls from individuals with COPD sought medical information (74%) and required 36.6 +/- 14.5 min (range: 15-85) to complete. Many different topics were discussed, with medication and exercise being the most common. The availability of the call center was identified as one means of replacing information sought from other health care providers, mainly physicians and pulmonary rehabilitation staff. CONCLUSION: A protocol of a helpline for COPD has been developed based on the literature, theoretical knowledge, and input from key informants and individuals with COPD.

Aged↗
PubMed2004

Self-care issues from the perspective of individuals with chronic obstructive pulmonary disease.

This study explored factors that influence self-care from the perspective of individuals with Chronic Obstructive Pulmonary Disease (COPD). Seven focus groups were held with individuals who had physician diagnosed COPD and experienced daily symptoms that limited activities. Forty-two subjects participated in the study. All sessions were audiotaped, transcribed and coded independently. The main theme identified was surviving COPD: the context for living and the two sub-themes identified were adjusting physically and emotionally to COPD. Participants discussed their self-care practices within the context of the purpose and meaning of life. Although participants experienced major physical limitations, the issues highlighted were those of individuals striving to survive with COPD and to hold on to some quality of life through adjusting physically and emotionally. Individuals with COPD have developed strategies to adapt to the disease, compensate for limitations, and integrate self-care activities for managing COPD into their daily routine. Health professionals should use approaches that support the whole needs of the individual to achieve the best quality of life for individuals with COPD and their families.

Activities of Daily Living↗
PubMed2003

Comparison between an indoor and an outdoor 6-minute walk test among individuals with chronic obstructive pulmonary disease.

OBJECTIVES: To investigate the feasibility of an outdoor 6-minute walk test (6MWT) as a measure of functional status among individuals with chronic obstructive pulmonary disease (COPD), and to examine the relationship between performance on an indoor and an outdoor 6MWT. DESIGN: An experimental, repeated-measures crossover design. Subjects were studied on 2 separate days in the same week. Two 6MWTs-one indoors and the other outdoors-were performed on each study day, with a rest in between. The test order was randomly selected on the first day and reversed on the second day. Outdoor tests were performed on days of moderate weather conditions (mean temperature +/- standard deviation, 21 degrees +/-3 degrees C; mean wind speed, 15+/-7km/h; no precipitation) and on a flat surface (sidewalk). SETTING: Outpatient rehabilitation program in Ontario. PARTICIPANTS: Eighteen subjects with COPD (10 men, 8 women; age, 70+/-8y), 5 using supplemental oxygen at rest (forced expiratory volume in 1s, 1.0+/-0.3L; 42%+/-8% of predicted). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Distance walked in 6 minutes (in meters), duration of rest (in seconds), and change in rate of perceived dyspnea. RESULTS: There was no significant effect of setting (indoors vs outdoors) on distance walked (394+/-86m vs 398+/-84m, P=0.4), duration of rest (13+/-28s vs 9+/-20s, P=0.4), or change in rate of perceived dyspnea (2.3+/-1.7 vs 2.3+/-2.0, P=0.8). Testing day had no significant effect on walk test performance (all P>0.1). CONCLUSIONS: The results indicate that the 6MWT performed outdoors within reasonable climatic parameters may be reflective of 6MWT performance indoors.

Aged↗
PubMed2002

Reliability of the two-minute walk test in individuals with transtibial amputation.

OBJECTIVE: To determine inter- and intrarater reliability of the two-minute walk test (2MWT) in individuals with transtibial amputation. DESIGN: Prospective; test-retest method by a pair of trained physical therapists. SETTING: Two regional amputee rehabilitation centers in Canada. PARTICIPANTS: Thirty-three subjects (23 men, 10 women; mean age +/- standard error, 63.6+/-2.0y) with transtibial amputation; 6 in outpatient rehabilitation, 27 in inpatient rehabilitation. The most common primary diagnoses were peripheral vascular disease (n=15) and diabetes (n=11). INTERVENTIONS: Each subject performed a total of four 2MWTs, 1 test for each rater, on 2 consecutive days at approximately the same time of day. Subjects were given at least a 20-minute rest between tests. The order of raters was randomized on the first day and reversed for the next day. The walk tests were performed in the same enclosed corridors with the same starting point for all tests. The subjects were familiar with the test or were given 1 or more practice tests at least 1 day before testing. Subjects were allowed to walk with a mobility aid of their choice. Raters used a digital stopwatch to time the tests and a calibrated wheel with a counter to measure the distance walked in meters. The raters were blinded to each other's scores. MAIN OUTCOME MEASURE: Distance walked in 2 minutes (in meters). RESULTS: Within-rater reliability was high (intraclass correlation coefficient [ICC],.90-.96). Between rater reliability was also high (ICC.98-.99). Analysis of variance (ANOVA) showed a significant effect for day of test (P<.001) in the inpatient group but no effect for therapist (P=.098) or for interaction of day and therapist (P=.710). Similarly, in the outpatient group, ANOVA showed a significant effect for day (P=.013) but no effect for therapist (P=.259) or interaction of day and therapist (P=.923). CONCLUSION: Although the 2MWT showed evidence of inter- and intrarater reliability in individuals with unilateral below-knee amputation, the distance walked in 2 minutes continued to improve over time. This improvement was not solely the result of a training and learning effect.

Activities of Daily Living↗