Posters Presentation - CAMPT-NOD Orthosymposium

Posters Presentation (Grand Foyer)

Confirmed

A new clinical and research framework to understand diastasis rectus abdominis: Is it time to move beyond the inter-recti distance?

The inter-recti distance [IRD] is used in clinical practice/research as the primary indicator of severity and intervention outcome for diastasis rectus abdominis [DRA]. Consistently, studies note an increased IRD with contraction of transversus abdominis [TrA]. Some authors recommend avoidance of TrA training assuming that increased IRD is a negative outcome. Others recommend including TrA as part of a comprehensive training program and have a different interpretation when the IRD increases. Current evidence is confusing for clinical
practice. Recent scrutiny questions whether IRD is meaningful for DRA, and if reliance on this measure may have compromised progress.

Purpose/Method
This presentation of two studies aims to clarify the confusion and propose a new framework to interpret DRA severity and treatment outcome using the distortion index [DI]. The case series results of a program aimed to address control of the linea alba [LA] showed consistent improvement in DI with training over time. Similar to other studies, the IRD change was insignificant and variable.

Conclusion
Lee & Hodges propose that the DI provides clearer understanding of the behaviour of LA in DRA and how it changes over time with interventions that restore optimal strategies for the many functions of the abdominal wall.

Diane Lee is a UBC graduate in the field of rehabilitation medicine. She is a fellow of the Canadian Academy of Manipulative Therapy (1981), certified practitioner of intramuscular stimulation (Gunn IMS) and certified by the Canadian Physiotherapy Association as a
clinical specialist in Women’s Health. She was an instructor and chief examiner for CAMPT for over 20 years and in 2021 received the CPA Medal of Distinction and in 2023 the CPA Professional Contribution Award.

Diane is the owner, director, and a practicing physiotherapist at Diane Lee & Associates, a private multi-disciplinary physiotherapy clinic in South Surrey, BC, Canada.

She has been a keynote speaker at many conferences, has contributed chapters to several books and self-published the book The Abdominal Wall & Diastasis Rectus Abdominis (2nd edn) in 2023. Her book, The Pelvic Girdle, was first published by Churchill Livingstone in 1989, is now in its 4th edition (2011) and has been translated into multiple languages. The Thorax – An Integrated Approach was released in 2018 by Handspring Publishing. She holds the North American patent for two sacroiliac belts, The Com-Pressor, and The Baby Belly Pelvic Support. With respect to research, she continues to investigate the behaviour of the abdominal wall, in collaboration with Prof. Paul Hodges, in women with diastasis rectus abdominis.

Effectiveness and safety of manual therapy when compared with oral pain medications in patients with neck pain: a systematic review and meta-analysis – Joshua Makin and Taylor Laframboise

Background: This systematic review and meta-analysis seek to investigate the effectiveness and safety of manual therapy (MT) interventions compared to oral pain medication in the management of neck pain Methods: We searched from inception to March 2023, in Cochrane Central Register of Controller Trials (CENTRAL), MEDLINE, EMBASE, Allied and Complementary Medicine (AMED) and Cumulative Index to Nursing and Allied Health Literature (CINAHL; EBSCO) for randomized controlled trials that examined the effect of manual therapy interventions for neck pain when compared to medication in adults with self-reported neck pain, irrespective of radicular findings, specific cause, and associated cervicogenic headaches Results: Nine trials (779 participants) were included in the meta-analysis. We found low certainty of evidence that MT interventions may be more effective than oral pain medication in pain reduction in the short-term.
Conclusions: MT may be more effective for people with neck pain in both short and long-term with a better safety profile regarding adverse events when compared to patients receiving oral pain medications.

Joshua Makin completed his Master’s degree in physiotherapy in Ireland, and completed his Master’s in Clinical Science at Western University, which earned him his Manual and Manipulative Therapy (FCAMPT) designation. He is a full time clinician in Calgary Alberta.
Taylor Laframboise completed her Master’s of Science in Physiotherapy at Queen’s University and most recently, completed her Master’s of Clinical Science in Comprehensive Musculoskeletal Physiotherapy at Western University. She is a full time clinician in Guelph, Ontario.

Does therapeutic patient educational intervention improve outcomes in patients with neck pain compared to no treatment, or other treatment? A SR and Meta – Lisa Lewis

Background: Neck pain is the fourth leading cause of global disability relating to MSK conditions. Yet, despite its high economic burden, there is no definitive treatment for neck pain.

Methods: EMBASE, MEDLINE, Cochrane, and CINAHL, were systematically searched, from inception to October 2023 for RCTs and screened for inclusion criteria by two independent reviewers. Data were extracted, analyzed, and rated for internal validity and strength of the evidence. Meta-analysis estimated pooled pain values using a random effects model.
Results: Overall, 1761 participants from 21 studies were included in the systematic review and meta-analysis. In the short term (up to 12 weeks), no difference was found in pain intensity reduction by patient education alone when compared to other intervention without an education component.

Conclusion: Education combined with other interventions were found to have small, although not statistically significant, benefit in reducing neck pain than interventions without any patient education component. No difference was found between education alone and other intervention.

Lisa Lewis graduated from the University of Manitoba in 2017 earning her Master of Physical Therapy and in 2024 she completed her Masters of Clinical Science in Comprehensive Musculoskeletal Physiotherapy (MClSc-CMP) through Western University (FCAMPT designation). She is a full time clinician in Edmonton, Alberta.

The Effectiveness of Physiotherapy Interventions for Pregnancy-Related Lumbopelvic Pain: A Systematic Review and Meta-Analysis of Randomized Control Trials – Greg Spadoni

Background and Rationale: Lumbopelvic pain (LPP) is common during pregnancy. However, the current management of LPP in this population is based on outdated clinical practice guidelines (CPGs) from low-quality evidence.

Purpose/Research Objectives: This systematic review aimed to determine the effectiveness of physiotherapy interventions in pregnant women with LPP.

Methods: Data bases were searched for randomized controlled trials (RCTs) evaluating interventions within the scope of physiotherapy for pregnancy-related LPP.

Results: Thirty-one studies fulfilled the eligibility criteria. There was low certainty evidence that exercise is not better than standard care for pain or disability in the short term, however, there is moderate certainty that exercise was better than standard care for pain intensity at 6-12 weeks. Manual therapy techniques, as a standalone intervention, showed very-low certainty evidence of varied effects on pain and function outcomes.

Conclusion: Exercise interventions show low certainty evidence for improving pain intensity and function in pregnancy-related LPP over medium-term periods. Manual therapy techniques showed very-low certainty evidence. Previous research also found limited evidence for the recommendation of manual therapies to improve pain and function related to LPP in pregnancy.

Greg Spadoni is a full-time Associate Professor in the School of Rehabilitation Science (SRS), Physiotherapy, McMaster University, engaged in a teaching role. He is currently the Chair of the physiotherapy program’s Admissions Committee. In 2023 he was awarded the MERIT Faculty Fellowship at McMaster to support his education scholarship. Greg is a physiotherapist with expertise in musculoskeletal health and has attained the designation of Clinical Specialist Musculoskeletal from the Canadian Physiotherapy Association (CPA). This designation certifies physiotherapists who have focused their careers and demonstrated advanced clinical competence, leadership, continuing professional development and research in a specific area of practice. In 2021, his collective career accomplishments were acknowledged and highlighted as a recipient of the CPA’s Medal of Distinction, and in 2023 he was presented with the Lifetime Membership Award from the Canadian Academy of Manipulative Therapy.

How can we improve injury prevention program implementation in girls sport? A knowledge exchange event to share research and practical experience – Dr. Allison Ezzat

Purpose: There is a research gap that demands improved gender equity for girls/women in the prevention of sport-related injuries. Compared to boys, knee injuries (anterior cruciate ligament tears) occur at over twice the rate in girls. Neuromuscular injury prevention (IP) programs can prevent up to two-thirds of musculoskeletal injuries sustained by girls/women, yet they are rarely implemented/sustained in real-world settings.

Learning objectives:
1. Understand the evidence on IP program effectiveness/use in girls sports, as well as physiotherapists’ role in IP program implementation.
2. Be exposed to emerging research from semi-structured interviews with physiotherapist IP experts working in girls sports.
3. Share experiences/perspectives/ideas of working in or injury management with girls/women.

Approach: This poster will share current research on the effectiveness/use of IP programs in girls sports, including physiotherapists’ role. Preliminary emerging themes from the research teams’ ongoing project will be shared. The poster will include a QR code linked to questions for attendees to share their IP experience and insight.

Conclusion: This knowledge exchange will unite research evidence and clinical experience to contribute to developing innovative solutions for reducing injury in girls sport. It may also inspire physiotherapists to reflect on opportunities to engage in IP.

Dr. Allison Ezzat is a physiotherapist and implementation scientist at the BC Injury Research and Prevention Unit, BC Children’s Hospital Research Institute, and a Clinical Assistant Professor in the Department of Physical Therapy, University of British Columbia (UBC). Her research applies implementation science methodologies to advance the primary prevention of knee injuries in adolescents in real-world settings. She has a focus on reducing gender disparity for girls/women in injury risk and decreasing the long-term injury burden (e.g., knee osteoarthritis). She is a Fellow in the Canadian Academy of Manual and Musculoskeletal Physical Therapists (FCAMPT) and has practiced clinically throughout her academic training specializing in management of knee injuries across the lifespan.

Angle-specific analysis of isokinetic knee muscle strength at six months following anterior cruciate ligament reconstruction
– Don Ogborn
Co-authors: Elias Mondor; Dr. Greg Stranges; Dr. Jarret Woodmass; Dr. Robert Longstaffe; Dr. Devin Lemmex; Dr. Sheila McRae; Dr. Jeff Leiter; Dr. Peter MacDonald

Quadriceps strength deficits are common following anterior cruciate ligament reconstruction (ACLr). Strength analyses have traditionally relied on analysis of peak isokinetic torque alone, without consideration of the full torque-joint angle relationship. Statistical parametric mapping (SPM) allows the full torque-joint angle relationship to be considered. There are no studies to date using SPM to directly compare joint-angle torque curves for patients that have had a hamstring (STG), quadriceps tendon (QT), or bone-patellar tendon-bone (BPTB) graft.

The purpose of this study was to compare angle-specific isokinetic knee flexor and extensor torque at six months following primary ACLr in patients with BPTB, QT, or STG autografts. Five repetitions of concentric isokinetic knee flexion and extension at 90°/s were sampled at 100 Hz (Biodex System 4). Completed repetitions were analyzed with one-dimensional SPM (Matlab R2024a) using ANOVA (graft type) and t-tests (between-limb comparisons). SPM revealed impairments in knee flexor and extensor strength occurring primarily in the mid-range of knee flexion at six months following ACLr, that are consistent with the type of graft harvested (knee extensor versus flexor).

Dan Ogborn PT MSc(PT) PhD is a Senior Research Associate and Physiotherapist at the Pan Am Clinic Foundation, the Director of the Resident Research Program in Orthopedic Surgery and an Adjunct, Assistant Professor in Surgery and the Faculty of Kinesiology and Recreation Management at the University of Manitoba in Winnipeg, Manitoba, Canada. His research program and clinical practice focus on return to sport assessment and performance enhancement for patients following orthopedic surgery and injury.

Comparing Nordic Hamstring Curls and Isokinetic Dynamometry for the evaluation of knee flexor strength after hamstring harvest for ACL reconstruction
– Dan Ogborn
Co-authors: Rebecca Franklin; Dr. Greg Stranges; Dr. Jarret Woodmass; Dr. Robert Longstaffe; Dr. Devin Lemmex; Dr. Sheila McRae; Dr. Jeff Leiter; Dr. Peter MacDonald

Persistent deficits in knee flexor muscular strength have been observed following harvest of the semitendinosus and gracilis tendons (STG) for graft creation during anterior cruciate ligament reconstruction (ACLr). These deficits may be larger when assessed with the Nordic Hamstring Curl (NHC) as opposed to standard isokinetic dynamometry. 182 patients with STG (n=58), bone-patellar tendon-bone (BPTB, n=54) and quadriceps tendon (QT, n=70) grafts were assessed approximately 12 months after primary ACLr. Five repetitions of concentric isokinetic knee flexion were completed in the seated and supine positions at 90°/s. Three eccentric NHC repetitions were completed thereafter. Affected limb isokinetic relative torque was reduced in seated and supine regardless of graft (p=0.01). Deficits in affected limb relative force during the NHC were greatest in STG (mean difference -0.87 n/kg (95%CI -1.2 – -0.5 n/kg), p = 0.03). Consequently, the lowest LSI values were found for STG during the NHC (73.68% LSI (95%CI 69.85 – 77.51% LSI)) compared to supine (86.08% LSI (95%CI 82.47 – 89.70 % LSI), p<0.001) and seated concentric isokinetic knee flexion (86.47% LSI (95%CI 82.88-90.06% LSI), p<0.001). Deficits in knee flexor strength are largest in those with STG versus other graft types for primary ACLr when assessed with the NHC.