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Marshall S.C.,The Ottawa Hospital | Marshall S.C.,The Ottawa Hospital Rehabilitation Center | Marshall S.C.,University of Ottawa | Marshall S.C.,Canadian Institutes of Health Research | And 2 more authors.
Traffic Injury Prevention | Year: 2011

Background: Numerous medical conditions can affect one's ability to operate a motor vehicle. The likelihood of having multiple medical conditions increases with advancing age; however, the interplay of the associated impairments has not been previously addressed in the literature. Objective: To identify the incremental risks for the effects of multiple chronic medical conditions on driving ability and crash risk. Methods: A comprehensive English-language literature search using the keywords driving, motor vehicle crashes, accidents, multiple medical conditions, and chronic medical conditions was completed. To be included, the article had to address the effects of the combination of multiple chronic medical conditions on driving and include a relevant outcome, such as crashes, driving violations, on-road driving assessment, driving simulator assessment, or driving cessation/avoidance patterns. Results: The overall trend was for increasing number of chronic medical conditions to be associated with higher crash risk and higher likelihood of driving cessation. Although there is some evidence that impaired functional abilities are associated with poorer driving outcome, most of the studies do not support this. No studies were identified that evaluated compensation techniques for drivers with multiple chronic medical conditions with the exception of driving avoidance or self-restriction. Conclusions: The evidence supports the view that drivers with more chronic medical conditions tend to cease driving or engage in driving avoidance. The myriad combinations of diseases and disease severity present a level of complexity that complicates making informed decisions about driving with multiple chronic medical conditions. © 2011 Taylor & Francis Group, LLC.

Wong K.,University of Ottawa | Sun F.,Boston University | Trudel G.,The Ottawa Hospital Rehabilitation Center | Sebastiani P.,Boston University | Laneuville O.,University of Ottawa
BMC Musculoskeletal Disorders | Year: 2015

Background: Contractures of the knee joint cause disability and handicap. Recovering range of motion is recognized by arthritic patients as their preference for improved health outcome secondary only to pain management. Clinical and experimental studies provide evidence that the posterior knee capsule prevents the knee from achieving full extension. This study was undertaken to investigate the dynamic changes of the joint capsule transcriptome during the progression of knee joint contractures induced by immobilization. We performed a microarray analysis of genes expressed in the posterior knee joint capsule following induction of a flexion contracture by rigidly immobilizing the rat knee joint over a time-course of 16 weeks. Fold changes of expression values were measured and co-expressed genes were identified by clustering based on time-series analysis. Genes associated with immobilization were further analyzed to reveal pathways and biological significance and validated by immunohistochemistry on sagittal sections of knee joints. Results: Changes in expression with a minimum of 1.5 fold changes were dominated by a decrease in expression for 7732 probe sets occurring at week 8 while the expression of 2251 probe sets increased. Clusters of genes with similar profiles of expression included a total of 162 genes displaying at least a 2 fold change compared to week 1. Functional analysis revealed ontology categories corresponding to triglyceride metabolism, extracellular matrix and muscle contraction. The altered expression of selected genes involved in the triglyceride biosynthesis pathway; AGPAT-9, and of the genes P4HB and HSP47, both involved in collagen synthesis, was confirmed by immunohistochemistry. Conclusions: Gene expression in the knee joint capsule was sensitive to joint immobility and provided insights into molecular mechanisms relevant to the pathophysiology of knee flexion contractures. Capsule responses to immobilization was dynamic and characterized by modulation of at least three reaction pathways; down regulation of triglyceride biosynthesis, alteration of extracellular matrix degradation and muscle contraction gene expression. The posterior knee capsule may deploy tissue-specific patterns of mRNA regulatory responses to immobilization. The identification of altered expression of genes and biochemical pathways in the joint capsule provides potential targets for the therapy of knee flexion contractures. © 2015 Wong et al.; licensee BioMed Central.

McWilliams L.A.,Acadia University | Dick B.D.,University of Alberta | Bailey K.,Acadia University | Verrier M.J.,University of Alberta | Kowal J.,The Ottawa Hospital Rehabilitation Center
Health Psychology | Year: 2012

Objective: The Pain Response Preference Questionnaire (PRPQ) assesses preferences regarding pain-related social support. The initial factor analytic study of the PRPQ conducted with a nonclinical sample identified scales labeled Solicitude, Management, Suppression, and Encouragement. The first aim of the current study was to evaluate whether these scales would be appropriate for use with chronic pain patients. The construct validity of the emerging scales and their relations to pain-related disability were also investigated. Methods: A large sample of chronic pain patients (N = 300) completed the PRPQ along with self-reports of personality constructs, coping styles, pain severity, and disability. Results: Factor analysis supported a three-factor solution. Two factors were similar to those obtained in its initial evaluation, and were given the identical labels of Solicitude and Suppression. The remaining factor was labeled Activity Direction and was comprised primarily of items that were part of the earlier Management and Encouragement scales. Internally consistent PRPQ scales based on these factors were created. Correlation analyses involving the personality and coping measures provided support for the construct validity of these PRPQ scales. Supportive of their clinical utility, multiple regression analyses indicated that, after adjusting for pain severity, the PRPQ scales accounted for significant variance in disability ratings. Conclusions: Additional factor analytic research aimed at identifying the most appropriate set of PRPQ scales is warranted. The present findings indicate that the PRPQ scales used in the current study have strong psychometric properties and hold promise as research and clinical tools. © 2012 American Psychological Association.

Wilson K.G.,The Ottawa Hospital Rehabilitation Center | Kowal J.,The Ottawa Hospital Rehabilitation Center | Henderson P.R.,The Ottawa Hospital Rehabilitation Center | McWilliams L.A.,University of Saskatchewan | Peloquin K.,University of Montreal
Rehabilitation Psychology | Year: 2013

Objective: Chronic pain is a known risk factor for suicide. To date, however, few studies of people with chronic pain have tested specific predictions about suicidal ideation that are derived from theory. The interpersonal theory of suicide proposes that the psychological constructs of thwarted belongingness and perceived burdensomeness are unique and independent precursors to suicidal ideation. We tested this hypothesis in a clinical sample of patients with chronic pain. Method: A total of 303 patients of a chronic pain rehabilitation program completed measures of pain severity, duration, and disability; cognitive-affective measures of depression and catastrophizing; and interpersonal measures of relationship distress and self-perceived burden to others. The latter measures were included as indices of the belongingness and burdensomeness constructs. Participants also rated two items pertaining to suicidal ideation. Results: In a multiple regression analysis, both distress in interpersonal relations (β = 0.12, p < .037) and self-perceived burden to others (β = 0.25, p < .001) were significant predictors of suicidal ideation, even after adjusting statistically for demographic characteristics, pain severity and duration, functional limitations, catastrophizing, and depression. Conclusions: These findings suggest that the interpersonal theory is relevant to understanding elevated rates of suicidal ideation among people with chronic pain, and may have broader applicability to other populations with chronic illness or disability. © 2013 American Psychological Association.

Srour N.,Ottawa Hospital Research Institute | LeBlanc C.,The Ottawa Hospital Rehabilitation Center | King J.,University of Ottawa | McKim D.A.,Ottawa Hospital Research Institute | And 2 more authors.
PLoS ONE | Year: 2013

Introduction: Pulmonary function abnormalities have been described in multiple sclerosis including reductions in forced vital capacity (FVC) and cough but the time course of this impairment is unknown. Peak cough flow (PCF) is an important parameter for patients with respiratory muscle weakness and a reduced PCF has a direct impact on airway clearance and may therefore increase the risk of respiratory tract infections. Lung volume recruitment is a technique that improves PCF by inflating the lungs to their maximal insufflation capacity. Objectives: Our goals were to describe the rate of decline of pulmonary function and PCF in patients with multiple sclerosis and describe the use of lung volume recruitment in this population. Methods: We reviewed all patients with multiple sclerosis referred to a respiratory neuromuscular rehabilitation clinic from February 1999 until December 2010. Lung volume recruitment was attempted in patients with FVC <80% predicted. Regular twice daily lung volume recruitment was prescribed if it resulted in a significant improvement in the laboratory. Results: There were 79 patients included, 35 of whom were seen more than once. A baseline FVC <80% predicted was present in 82% of patients and 80% of patients had a PCF insufficient for airway clearance. There was a significant decline in FVC (122.6 mL/y, 95% CI 54.9-190.3) and PCF (192 mL/s/y, 95% 72-311) over a median follow-up time of 13.4 months. Lung volume recruitment was associated with a slower decline in FVC (p<0.0001) and PCF (p = 0.042). Conclusion: Pulmonary function and cough decline significantly over time in selected patients with multiple sclerosis and lung volume recruitment is associated with a slower rate of decline in lung function and peak cough flow. Given design limitations, additional studies are needed to assess the role of lung volume recruitment in patients with multiple sclerosis. © 2013 Srour et al.

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