Saturday, May 3 (2:00 pm – 2:40 pm)
Grouped Scientific Podium Posters Breakout Sessions (8 -min presentation + 2-min questions per session)
Group 1
The Treatment of Cervicogenic Headache with Transcranial Direct Current Stimulation and Exercise Therapy: A randomized control trial evaluating functional outcomes – Jobin Kaiden
Objective: The objectives were to evaluate functional outcomes of cervical motor control, strength and endurance following active transcranial direct current stimulation (tDCS) with exercise therapy (ET) compared to sham tDCS+ET in people with cervicogenic headache (CGH), Methods: Thirty-two participants with CGH participated in this sham-controlled, randomized, double-blinded pilot
trial and were randomized to active tDCS+ET or sham tDCS+ET. Participants completed 6-weeks of daily ET concurrently combined with 3 sessions per week of tDCS. Assessments included: numeric pain rating scale for neck pain, craniocervical flexion test (mmHg), cervical isometric strength (N), cervical flexor and extensor endurance (seconds), and range of motion (degrees) pre-treatment, post-treatment, 6-weeks and 12-weeks post treatment. Linear mixed effect models evaluated group-time interactions at each follow-up while accounting for exercise program adherence and sex.
Results: There were significant group-time interactions for the numeric pain rating scale focused on neck pain and for the craniocervical flexion test at post-treatment follow-ups. Furthermore, measures of endurance and strength improved significantly over time independently of group.
Conclusions: Active tDCS+ET demonstrated significant benefits in deep cervical flexor motor control compared to sham tDCS+ET that remained improved up to 12 weeks post-treatment. This suggests tDCS+ET may improve functional outcomes for people with CGH.
Kaiden Jobin completed both his Bachelor of Health Sciences and Master of Science degrees at the University of Calgary and is currently completing his Doctor of Medicine degree there as well. Kaiden’s research experience primarily lies in neuromodulation therapy with both his BHSc and MSc thesis’ being clinical studies evaluating the efficacy of two types of neuromodulation therapy in two different patient populations. His BHSc thesis evaluated the use of transcranial magnetic stimulation in a subset of patients with persistent post-concussion symptoms. Meanwhile his MSc thesis was a pilot study evaluating the use of transcranial direct current stimulation in patients with chronic cervicogenic headache. Outside of research, Kaiden is a part of several student interest groups at the University of Calgary in the Cumming School of Medicine. He is also a part of the Alberta Medical Association student advocacy committee as well as two subcommittees within the Canadian Federation of Medical Students. In his free time, Kaiden enjoys spending time in the mountains whether camping, skiing, or hiking.
The educational pathway to Advanced Practice for the physiotherapist: a systematic mixed studies review – Kaitlyn Maddigan
Advanced Practice Physiotherapy (APP) is a higher level of practice grounded in four pillars: clinical practice, leadership, education and research. A critical step toward successful integration and sustainability of APP in healthcare systems is understanding the educational pathway to APP. The objectives of this systematic mixed studies review were 1) to describe the post-licensure educational pathways that physiotherapists engage in to advance their level of practice 2) to evaluate the pillars of APP demonstrated by the physiotherapist after
traversing a post-licensure educational pathway. Reported in accordance with PRISMA, eight databases plus the grey literature were searched to yield 23,233 studies. Two independent reviewers determined eligibility, extracted data, assessed quality (QuADS) and determined the overall confidence in the cumulative evidence (GRADE-CERQual). Eighty-one studies were included in a data based convergent qualitative synthesis. Six distinct post-licensure educational pathways were described and evaluated: Master’s level education, residency and fellowship programs, accredited area of practice education, mentorship, multiple encounter courses and
single encounter courses. There is a high level of confidence (GRADE-CERQual) in the finding that Masters level education consistently resulted in all four pillars demonstrated by the physiotherapist. Masters level education is the optimal pathway to APP.
Kaitlyn Maddigan is a dedicated and accomplished physical therapist currently working at Fowler Kennedy Sport Medicine Clinic. She holds a Bachelor of Science (BSc) with honours specialization in Kinesiology, a Master of Physical Therapy, and a Master of Clinical Science in Advanced Health Care Practice. Kaitlyn has further distinguished herself in her field by obtaining the designation of a Registered International Sport Physical Therapist (RISPT) and becoming a fellow of the Canadian Academy of Manipulative Physical Therapists (FCAMPT). Kaitlyn is currently pursuing a PhD in Health and Rehabilitation Sciences at Western, focusing her research on investigating the educational pathway to Advanced Practice for Physical Therapists on an international scale. She also contributes to the academic community as an instructor at Western University, where she teaches in the Masters of Clinical Science program for Advanced Health Care Practice. In addition to her clinical and academic roles, Kaitlyn is a member of the integrated medical team for Hockey Canada’s National Women’s Team Programs.
Identifying competencies in advanced healthcare practice: an umbrella review – Emily Kenyon
Background: The four pillars of advanced healthcare practice (AHCP) are clinical practice, leadership and management, education, and research. It is unclear, however; how competencies of AHCP as defined by individual health professions relate to these pillars.
Objective: To identify existing competencies across AHCP literature and examine how they relate to the four pillars of a multi-professional AHCP framework.
Methods: An umbrella review was conducted in accordance with JBI methodology. The electronic search for published and grey literature was completed using CINAHL, Scopus, Medline (OVID), Embase (OVID), ERIC (OVID) and Google.
Results: Seventeen publications detailing 620 individual competencies were included. AHCP competencies were described across four professions and 22 countries, with many publications related to nursing and AHCP in the United Kingdom, Canada, and Australia.
Conclusion: Competencies of AHCP are generally consistent with the four pillars. However, the distribution of competencies is unequal across pillars, professions, and geographical regions, which may provide direction for further research.
Emily Kenyon graduated from the University of Alberta in 2011 with a Bachelor of Science in Kinesiology. After working as a Kinesiologist and Strength and Conditioning Coach, Emily returned to the University of Alberta and in 2015 completed a Master of Science in Physical Therapy. Following graduation, Emily went on to obtain additional certification in spinal manipulation, functional dry needling, and concussion management. She has completed a Master of Clinical Science in Advanced Healthcare Practice in the field of Comprehensive Musculoskeletal Physiotherapy at Western University in 2023.Emily joins the team at the Toronto Rock Sport Medicine & Wellness Center in Oakville after previously working alongside the Canadian Armed Forces as a Civilian Physiotherapist for eight years.
Group 2
The relationship between pupillary light reflex and clinical measures of nociplastic pain in chronic WAD. An observational study – Colin Wasylynuk
Background: People with chronic whiplash-associated disorders (WAD) may demonstrate features of nociplastic pain where one possible co-morbidities is increased light sensitivity. Light sensitivity can be measured via the Pupillary Light Reflex(PLR) and has not previously been evaluated in chronic WAD.
Purpose: To determine: (1) there is a significant difference in PLR measures between a healthy cohort(HC) and people with chronic WAD, and (2) if clinical measures of nociplastic pain are correlated to PLR measures in both HC and WAD cohorts.
Methods: In this observational, exploratory study, asymptomatic people(HC) and an age/sex-matched cohort with chronic WAD and nociplastic pain were recruited. Clinical measures of nociplastic pain were collected, including pain intensity, Central Sensitization Inventory, Pressure Pain Thresholds, Temporal Summation and Conditioned Pain Modulation. Measures of PLR were collected using a validated iPhone app in a standardized environment.
Conclusion(s): The between-group differences in PLR support other research in chronic WAD demonstrating autonomic nervous system dysfunction; with altered pupil constriction amplitude suggestive of changes in parasympathetic, and increased responsiveness of pupil re-dilatation suggestive of altered sympathetic nervous system function. There was no relationship between PLR and clinical measures of nociplastic pain. Other comorbidities are required to establish that chronic WAD is a probable nociplastic pain condition.
Colin Wasylynuk is a practicing clinical physiotherapist in Calgary, Canada and is looking forward to presenting the results of his Masters thesis he conducted through the University of British Columbia and successfully completed in 2023.
Association Between Symptoms and Health Outcomes in Chronic Whiplash Associated Disorders – Lisa Jasper (presented by Dr. Ashley Smith)
Purpose: This study explores how symptoms across different body systems relate to pain, disability, and quality of life in individuals with chronic whiplash-associated disorders (WAD).
Methods: A cross-sectional study was conducted at a multidisciplinary chronic pain center. Participants with a history of WAD completed questionnaires about symptoms and related health outcomes. Mediation analysis evaluated associations between symptoms and health outcomes, as well as the role of pain-related thoughts.
Results: Of 305 individuals in the database, 238 met the study criteria. The majority of participants reported symptoms affecting multiple body systems, especially neurological, gastrointestinal, and psychological systems. Many experienced moderate-to-severe pain, disability, and poor physical quality of life. A broader range of symptoms was linked to worse health outcomes. However, these effects were largely mediated by pain-related thoughts, except for eye symptoms, which were directly correlated with pain and disability.
Conclusions: This study highlights that chronic WAD is characterized by multiple symptoms across various body systems. Although a broader symptom profile is linked to poorer health outcomes, the effects are often mediated by pain-related thoughts. Notably, prior health conditions did not adversely impact outcomes, suggesting a need for targeted interventions focusing on cognitive aspects to enhance recovery in chronic WAD patients.
Dr. Ashley Smith has appointments with the Department of Clinical Neurosciences at the University of Calgary and McMaster University School of Rehabilitation Science. Ashley has over 50 peer-reviewed publications and book chapters, primarily investigating pain mechanisms, whiplash-associated disorders and orthobiologics. Ashley’s ongoing postdoctoral clinical research studies investigate how clinical manifestations of WAD can be modulated, both interventionally and via endogenous analgesia. He is also a member of the Cochrane Musculoskeletal group, investigating the role of spinal injections in people with chronic neck and low back pain. Ashley’s clinical responsibilities revolve around co-ordinating evidencebased inter- and multi-disciplinary care of people with chronic musculoskeletal pain as Director of Rehabilitation and Research at Vivo Cura Health. He is also a tireless patient advocate and volunteers with FAIR Alberta to advocate for the rights of Albertans injured in motor vehicle collisions and was honored to be the first non-lawyer to be recognized for community advocacy efforts on behalf of those people.
The Association Between Diagnostic Imaging, Medication Intake and Health Outcomes in Chronic Whiplash-Associated Disorders: An Observational Study – Dr. Ashley Smith
Research Purposes:
This cross-sectional study aimed to investigate the association between medication intake and diagnostic imaging (DI), and health outcomes including pain, disability, physical and mental health-related quality of life in people with chronic whiplash-associated disorders (WAD). We also aimed to evaluate whether medication intake and DI use differed based on specific presenting clinical manifestations (pain classification category (nociceptive, nociplastic or neuropathic), psychologic features, pain cognitions and sleep).
Methods:
Participants (n=270;64% female) were enrolled in the study if they were over 17 years old, did not sustain a concussion and were classified as WAD grades I, II or III. They completed questionnaires that evaluated various health domains (pain ntensity/interference; disability; physical and mental health quality of life; depression, anxiety and stress; posttraumatic stress; pain catastrophizing and sleep).
Results:
Different classes of medication intake, use of multiple medications, receiving Computed Tomography, Ultrasound or Magnetic Resonance Imaging scans and multiple DI utilization were associated with worse health outcomes (pain, disability and physical/mental health quality of life). Increased medication intake was also associated with increased DI utilization.
Conclusion:
In concert, these results suggest that increased healthcare resource utilization was associated with worse health outcomes – both physically and psychologically – in chronic WAD.
Dr. Ashley Smith has appointments with the Department of Clinical Neurosciences at the University of Calgary and McMaster University School of Rehabilitation Science. Ashley has over 50 peer-reviewed publications and book chapters, primarily investigating pain mechanisms, whiplash-associated disorders and orthobiologics. Ashley’s ongoing postdoctoral clinical research studies investigate how clinical manifestations of WAD can be modulated, both interventionally and via endogenous analgesia. He is also a member of the Cochrane Musculoskeletal group, investigating the role of spinal injections in people with chronic neck and low back pain. Ashley’s clinical responsibilities revolve around co-ordinating evidencebased inter- and multi-disciplinary care of people with chronic musculoskeletal pain as Director of Rehabilitation and Research at Vivo Cura Health. He is also a tireless patient advocate and volunteers with FAIR Alberta to advocate for the rights of Albertans injured in motor vehicle collisions and was honored to be the first non-lawyer to be recognized for community advocacy efforts on behalf of those people.
Group 3
Feasibility and acceptability of dry needling to treat provoked vestibulodynia – Dr. Melanie Roch
This study assessed the feasibility and acceptability of dry needling (DN) to treat provoked vestibulodynia (PVD). Forty-six women were randomly assigned to receive either real or sham DN for six weeks. Treatment sessions targeted the hip, lower back, abdominal and pelvic floor muscles. Feasibility outcomes included adherence (treatment sessions and evaluations), dropout rates, secondary effects and pain were monitored throughout the study. Acceptability was measured pre- and post-treatment.
Real DN group attended 99% of the treatment sessions, compared to 91% in the sham group (p>.05). All the evaluations were completed in the real DN group, compared to 91% in the sham group (p>.05). For the main secondary effects, 95.7% of the participants in the real DN group experienced muscle aches vs 52.4% in the sham DN group (p<.001) and 34.8% autonomic reactions, which was not observed in the sham DN group (p<.001). All participants reported high levels of acceptability across all dimensions, with no significant difference between groups (p>.05). Additionally, the real DN group showed a significant decrease in pain intensity during intercourse compared to the sham group (mean difference between groups 2.4; 95%CI 1.4; 3.3; p<.001).
These findings support the feasibility and acceptability to use DN to treat PVD.
Dr. Mélanie Roch graduated from Laval University with a degree in Physiotherapy. She then earned her Fellow designation from the Canadian Academy of Manipulative Physiotherapy (FCAMPT) and has been teaching in the AIM program at AQPMA, the Québec branch of the NOD, since 2009. She is actively involved with the education committee as the incoming Credential Chair and has recently been designated as an examiner for the advanced exams in manual therapy. Most recently, Dr. Roch completed her PhD and has been appointed as a full-time professor at the Université de Sherbrooke in the School of Rehabilitation within the Physiotherapy program. Her research interests primarily focus on myofascial pain and trigger points, quantification and characterization of myofascial issues, and the effects of dry needling in physiotherapy. Her doctoral thesis examined the feasibility, acceptability, and effects of dry needling for chronic pelvic pain,
specifically addressing provoked vestibulodynia.
Effect of Dynamic Multi-Planar Neuromuscular Neck Training (TopSpin360) on Headache and Neck Pain Associated with Post-Concussion Syndrome: A Randomized Control Feasibility Study – Theo Versteegh
Post-concussion syndrome (PCS) occurs in up to 80% of mild traumatic brain injury (mTBI) cases, with headache and neck pain being prominent symptoms. This study evaluates the effect of dynamic multi-planar neuromuscular neck training using the TopSpin360 device on headache and neck pain in PCS patients. In this randomized control trial, 58 PCS patients (72 days post-injury on average) were assigned to standard care (CON) or standard care plus TopSpin360 (INT). INT participants trained with TopSpin360 twice weekly for 8 weeks. Headache Disability Index (HDI), Neck Disability Index (NDI), and SCAT5 symptom scores were assessed at baseline and after 8 weeks.
Results showed no adverse events, with the INT group completing an average of 94.6% of sessions and demonstrating statistically significant improvements across all measures. Large effect sizes were noted for SCAT5 and HDI changes, with medium effects for NDI. These findings support TopSpin360’s potential in reducing PCS-related headache and neck pain.
Theo Versteegh graduated with a Bachelor’s in Physiotherapy from Western University in 1998, where he also played the high-concussion risk sport of football for four years. Following graduation, he moved to Vancouver to work at the Allan McGavin Sports Medicine Clinic at UBC and completed his FCAMPT training, joining the International Federation of Manipulative Physiotherapists in 2002. His career has spanned multiple continents, including work at King Faisal Specialist Hospital in Saudi Arabia and private practice in London, England.
Returning to Canada, Theo pursued a Master’s in Physiotherapy, with his research examining the benefits of dynamic warmups for older golfers. After watching Syndey Crosby suffer a severe concussion in 2011, he began exploring solutions to improve neck stability and reduce concussion risk in athletes through neck training. This lead to the invention of the TopSpin360, a multi-planar neuromuscular training device designed to train neck strength dynamically across all planes of motion. In essence, applying musculoskeletal rehabilitation principles of tissue loading that we know work exceedingly well in the extremities and applying this to the spine. This approach uses self-generated centripetal force to create a dynamic training load that automatically and safely adjusts to the level of the individual. Driven by a commitment to evidence-based practice, Theo went on to complete a PhD focused on the role of this approach in concussion mitigation, with his findings supporting the innovative approach TopSpin360 offers. Today, he continues to conduct primary research in sports and rehabilitation with a focus on concussion prevention and injury recovery.
Quantitative Sensory Testing of Nervous System Dysfunction and Sensitisation in Chronic Subacromial Shoulder Pain – Lyndal Solomons
Purpose
Subacromial pain syndrome (SAPS) accounts for 85% of shoulder complaints. The pain-production mechanisms of this disorder are only partially understood, which hampers intervention strategies.
Methods
This cross-sectional study conducted static and dynamic quantitative sensory testing and pain mapping of a SAPS population (n=21) compared with age- and sex-matched controls (n=21).
Results
The estimated mean difference of pressure pain threshold: at deltoid in SAPS compared to controls was -92.4 kPa (95% confidence interval (CI): -260.1, 75.3; p=.274), adjusted for covariates; at infraspinatus (locally) was – 203 kPa (95% CI: -383, -22.7, p=.028), and at tibialis anterior (remotely), was -196 kPa (95% CI: -376, -15.4, p=.034). There was no statistically or practically significant difference between groups for heat or mechanical pain thresholds, conditioned pain modulation or temporal summation. 19 of the 21 SAPS participants demonstrated related pain beyond the subacromial area.
Conclusion
People with SAPS demonstrate reduced pressure pain thresholds in local tissues, tissues with the same segmental nerve supply and remote tissues. They also demonstrate spreading sensitisation. They do not demonstrate reduced mechanical or heat pain thresholds, augmented temporal summation or impaired CPM. Further research is needed to elucidate the relative contributions of central and peripheral sensitisation to this sensory profile.
Lyndal Solomons graduated from the University of Sydney with a Bachelor of Applied Science in 
Physiotherapy and from the University of Western Australia with a Master of Manual Therapy. Lyndal has also completed a PhD in Rehabilitation Sciences at the University of British Columbia. Her research focusses on the neurophysiological characteristics of chronic pain and its management with Gunn IMS. She works clinically as a physiotherapist at UBC Sport and Exercise Medicine Clinic in Vancouver. She currently also serves as Chair of the Acupuncture and Dry Needling Division of the Canadian Physiotherapy Association.
Group 4
Information needs for people with neck pain seeking physiotherapy neck manipulation or mobilization: An Exploratory Study – Anita Gross
Objective: To explore the foundational needs for a decision aid on receiving physiotherapy cervical manipulation and mobilization from a broad age spectrum.
Method: A survey targeting adults, child/infant-parent dyads, and adult-caretaker dyads in Canada and the USA aimed to capture knowledge, attitudes, treatment expectations (10 items from the Treatment Expectation Questionnaire, decision conflict (Decisional Conflict Scale (DCS)) and participant demographics.
Results: Forty-eight of 146 participants (mean age 48) fully completed the survey. Respondents were acquainted with mobilization (86%) and manipulation (82%). Mobilization (67%) was preferred and perceived positively over manipulation (7%). Manipulation was perceived as risky; stroke (manipulation 52%/mobilization 25%) was identified as the top risk/adverse effect, followed by soreness, pain, headache, stiffness, tenderness, dizziness, and fatigue (manipulation 41%/mobilization 57%). Treatment expectations were met and there was a low DCS subscales and total scores. There was a very low response rate from older adults and parent dyads.
Conclusion: Adults with neck pain receiving physiotherapy cervical manipulation/mobilization knew the benefits, risks, and major/ minor adverse events; treatment expectations were positive with low decisional conflict. Future mixed methods research is needed like an inter-professional child/infant-parent dyad structured interview to gain insight and guide clinicians in counseling patients to facilitate shared decision-making.
Anita
Gross is an Associate Clinical Professor at McMaster University in the School of Rehabilitation Sciences leading their advanced orthopedic musculoskeletal-manipulative physical therapy (OMPT) program. She is a lecturer in the Master’s of Clinical Science program in Manipulative Therapy at Western University and the Canadian Physiotherapy Association AIM program. She is the chair of the IFOMPT/IOPTP Taskforce on Pediatric Manipulation informing PT policy with systematic reviews and evidence gap maps. She is a linician scientist and educator. She has over 140 peer reviewed publications, has been principal/co-investigator on 30 grants and has been an invited speaker at 20 international
conferences. She coordinates the Cervical Overview Group, an International Network that conducts and maintains Cochrane systematic reviews on neck pain and participates in randomized clinical trials on back pain (Welback). She works in private practice OMPT and is a Fellow of the Canadian Academy of Manipulative Physiotherapy (FCAMPT).